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Objective: The aim of the present open label randomized controlled trial was to compare the rate of cesarean section (CS) after elective induction with that of expectant management in low‐risk nulliparous women at 39 weeks. Methods: This randomized controlled trial from a tertiary maternity care center enrolled low risk nulliparous pregnant women at 38–38+4 weeks between April 1, 2019 and December 31, 2021. Participants were randomized into either the elective induction group (e‐IOL) or the expectant management (EM) group though computer generated block randomization. The primary outcome was cesarean rate and the secondary outcome include adverse maternal and perinatal outcome between e‐IOL and EM groups. We performed intention to treat analysis. Results: A total of 360 women were enrolled into the present study. Analysis was performed for 179 women in the e‐IOL group and 180 women in the EM group. The baseline demographic characteristics including Bishop score were comparable between the groups. The CS rate in both groups was 17.3% (31/179) and 25% (45/180), which is comparable (P = 0.08). There was one intrapartum stillbirth in the e‐IOL group, and two babies succumbed in the neonatal period in the EM group. The maternal and perinatal outcomes between the groups were not found to be significantly different. Conclusion: Elective induction of low‐risk nulliparous women at 39 weeks was not associated with increased cesarean section rate. The maternal and perinatal outcomes were comparable. Large, multicentric real time randomized controlled trials are needed to understand the benefit of elective induction in low‐risk nulliparous women. This should include centers with large volume of deliveries especially from emerging countries also. Synopsis: Elective induction at 39 weeks is not associated with increased cesarean sections. However, routine elective induction cannot be generalized to all low‐risk women. [ABSTRACT FROM AUTHOR]

Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery. Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity. This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at

Objective: To determine the prevalence and secular trends of obstetric anal sphincter injuries (OASIS) in vacuum and forceps deliveries in Norway, both with and without episiotomy. Design: Population‐based real‐world data collected during 2001–2018. Setting: Medical Birth Registry Norway. Population or Sample: Nulliparous women with singleton foetuses in a cephalic presentation delivered by either vacuum or forceps (n = 70 783). Methods: Logistic regression analyses were applied to the OASIS prevalence in six 3‐year time periods. Both crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined. Main Outcome Measures: OASIS prevalence. Results: The OASIS prevalence in vacuum and forceps deliveries decreased from 14.8% during 2001–2003 to 5.2% during 2016–2018. The overall reduction between the first and last 3‐year time period was 61% (aOR = 0.39, 95% CIs = 0.35–0.43). The only exception to this decreasing trend in OASIS was found in forceps deliveries performed without an episiotomy. The OASIS prevalence was approximately twofold higher in forceps compared to vacuum deliveries (aOR = 1.92, 95% CIs = 1.79–2.05). Performing either a mediolateral or lateral episiotomy was associated with a 45% decrease in the prevalence of OASIS relative to no episiotomy (aOR = 0.55, 95% CIs = 0.52–0.58). Conclusions: Opting for vacuum rather than forceps delivery in conjunction with a mediolateral or lateral episiotomy could significantly lower the OASIS prevalence in nulliparous women. [ABSTRACT FROM AUTHOR]

Introduction: A common gynaecological problem among women that leads to a negative impact on quality of life and causes distress is the involuntary loss of urine which is addressed as urinary incontinence (UI). Females involved in playing various types of sports perform high-intensity activities which can serve as risk factors for UI and pelvic organ prolapse. According to the available literature, there is a scarcity of information regarding data on the prevalence of UI in Indian female athletes. Therefore, the purpose of the present study was to evaluate the prevalence of UI in nulliparous Indian sportswomen. Methodology: For a duration of 6 months, a cross-sectional study was carried out in various sports centres across the states of Telangana, Maharashtra, Gujarat, and Delhi. A total of 560 nulliparous Indian female sportswomen were involved based on the selection criteria. The various sports involved were malkhamb, kabaddi, kushti, weightlifting, gymnastics, basketball, badminton, and athletics. All the participants were provided with a questionnaire for female UI diagnosis (QUID), which was the primary outcome measure Results: Out of 560 women enrolled in the study, the highest prevalence was found for stress urinary incontinence (SUI), consisting of 126 (22.5%) women, followed by mixed urinary incontinence (MUI), involving 49 (8.8%) women, and urge urinary incontinence (UUI), including 47 (8.4%) women. Additionally, the prevalence of UI was highest in obese and overweight Indian sportswomen. Moreover, the highest prevalence of SUI among women was for weightlifting, whereas for UUI and MUI, malkhamb and kushti sports were the most prevalent, respectively. Conclusion: The present study concluded that the highest prevalence among nulliparous Indian sportswomen was for SUI, followed by MUI and UUI. Additionally, weightlifting sport showed the highest prevalence for SUI, followed by malkhamb for UUI and kushti for MUI. The prevalence of UI in Indian sportswomen is important as it imparts knowledge and awareness among women and benefits professionals in designing appropriate preventive and rehabilitative protocols for curtailing such problems in the near future.

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. The initial ovulatory response during synchronization programs is often low in dairy heifers, largely due to follicular dynamics and hormonal dynamics. Specifically, the progesterone (P4) concentration at the time of the first GnRH treatment in a breeding program can influence the LH response, often resulting in a suboptimal ovulatory response. The objective of this study was to determine the effect of the highest label dose 200 μg (100 μg vs. 200 μg) of GnRH (50 μg of gonadorelin hydrochloride per mL; Factrel, Zoetis Inc. Madison, NJ) at the first GnRH of a 6-d CO-Synch plus P4 device program on ovulatory response and pregnancy per AI (P/AI) in first service in Holstein heifers. A total of 1,308 Holstein heifers were randomly allocated at the beginning of a 6-d CO-Synch program at day 0 to receive either i.m. treatment of 100 μg (2CC, n = 655) or 200 μg (4CC, n = 653) of GnRH. Also, at d 0, heifers received an intravaginal insert with 1.38 g of P4 (Eazi-Breed CIDR Cattle Insert, Zoetis Inc.). On day 6, the insert was removed, and i.m. treatment of 25 mg of PGF 2α (12.5 mg of dinoprost tromethamine/mL; Lutalyse HighCon Injection, Zoetis Inc.) was administered. On d 7, a second i.m. treatment of 25 mg of PGF 2α was given, followed on d 9 by concurrent i.m. treatment of 100 μg of GnRH, and timed AI. A subset of 396 heifers had their ovaries scanned to evaluate ovulatory response, and blood samples were collected to measure the serum concentration of P4 at d 0 and d 6 of the study. The P4 concentrations at d 0 were categorized as low (≤3 ng/mL) or high (>3 ng/mL). The ovulatory response was greater for heifers receiving 4CC than 2CC at d 0 (54.7% vs. 42.8%). The ovulatory response was greater for low P4 than high P4 at d 0 (54.3% vs. 37.8%). However, we did not observe an interaction between treatment and P4 concentrations (low P4 2CC = 48.6% vs. high P4 2CC = 30.0%; low P4 4CC = 60.0% vs. high P4 4CC = 45.5%). The receiver operating characteristic curve analysis indicated that P4 concentrations at d 0 treatment could predict the ovulatory response, although the area under the curve was only 0.6. As expected, heifers that ovulated had increased P/AI (no = 55.6% vs. yes = 67.7%); however, we found no effect of treatment on P/AI (2CC = 63.3% vs. 4CC = 59.6%), and no interactions between treatment and ovulation and treatment and P4 (high vs. low) for pregnancy outcomes. In summary, P4 concentration and increasing the dose of GnRH at d 0 positively affected ovulatory response in Holstein heifers. However, there was no interaction between treatment and P4 on ovulation and no subsequent impact of GnRH dose on P/AI. [ABSTRACT FROM AUTHOR]

Objective: Vacuum-assisted vaginal deliveries are gradually decreasing due to the fear of complications. This study aimed to compare maternal and neonatal outcomes of vacuum-assisted vaginal deliveries with spontaneous deliveries. Methods: All nulliparous women who underwent vacuum-assisted deliveries between October 1, 2018, and October 1, 2022, were included in our study, forming the case group. The control group comprised nulliparous women who experienced spontaneous vaginal delivery. We compared the demographic, maternal, and neonatal outcomes of the pregnant women included in both groups. Results: Caput succedaneum was more prevalent in the vacuum-assisted vaginal delivery group (p < 0.001), with lower mean 1st and 5th minute APGAR scores compared to the spontaneous vaginal delivery group (p < 0.001, p = 0.002, respectively). No significant differences were observed between the two groups concerning cephalohematoma (p = 0.269), clavicle fracture (p = 0.308), respiratory failure (p = 0.117), jaundice (p = 0.089), and sepsis (p = 0.772). In terms of maternal complications, there were no significant differences between the groups in terms of grade 2/3 perineal tears (p = 0.082, p = 0.159, respectively), uterine atony (p = 0.308), cervical laceration (p = 0.158), and hysterectomy (p = 0.32) Conclusion: These findings provide valuable insights for clinicians, suggesting that the use of vacuum assistance might be considered as an alternative before opting for cesarean delivery, especially when necessary indications arise during the second stage of labor. [ABSTRACT FROM AUTHOR]

BackgroundBirth weights have continued to decline in Japan in recent years. However, secular trend changes such as the birth weight relative to the week of gestation remain to be explored. This study aimed to determine the trends over time in mean birth weight and small for gestational age (SGA) rate for each gestational week.MethodsWe used a large dataset of 27,015,792 births obtained from birth certificates between 1997 and 2021. Births from 22 to 41 weeks of gestation were evaluated in six groups (22–24, 25–27, 28–31, 32–33, 34–36, and 37–41 weeks of gestational age). For each group, secular trend changes in the z-scores calculated from standard birth weight values were assessed. Time trends in the proportion of SGA and mean birth weight z-scores were evaluated using the Cochran–Armitage trend test and linear regression analysis. Binomial logistic regression was performed to ascertain the effects of gestational age, sex, primiparity, number of births, and maternal age on the likelihood of SGA.ResultsThe mean birth weight of preterm infants continued to decrease, and the z-score for mean birth weight decreased linearly, falling to −0.7 at 25–27 weeks of gestation from 1997–2001 (first period) to 2017–2021 (final period). Maternal age continued to increase from the first period to the last period for all weeks of gestation. There was a linear increase in the SGA rate in preterm infants born at

Abstract Background Pregnancy and childbirth have been connected to modified risk of a wide variety of conditions in later life, including neurodegenerative disorders and cancers. The presence, extent, and direction of the effect that childbearing status has on decreasing or increasing the risk of these conditions differs depending on the disease. The mechanisms by which pregnancy and childbirth modify the risk of diseases are still unknown. DNA methylation (DNAm) alterations that occur during pregnancy and persist after childbirth may help us understand this phenomenon. Results Blood DNAm was available from 89 women (28 parous; 61 nulliparous) at ages 18 and 26 years in the Isle of Wight birth cohort; no significant differences in the population characteristics were present between the analyzed population and the full cohort. We performed an epigenome-wide association study on 389,355 CpGs and identified 184 CpGs to be significantly differentially methylated between parous and nulliparous women after adjusting for confounders and multiple testing. Of these CpGs, 105 had regression coefficients in the same direction in an independent Mexico City based ELEMENT cohort, of which 13 were significant (replication P

A 24-year-old nulliparous unmarried woman presented to the Gynaecological Department with complaints of abdominal pain for two years that has worsened over the past two days. The pain was dull aching with no aggravating or relieving factors. It was continuous in nature and was associated with a few episodes of vomiting. There was no history of fever or other constitutional symptoms. Vital signs were normal. The patient had primary amenorrhoea and cyclical abdominal pain, for which she was examined and diagnosed with vaginal atresia. Following this, she underwent neovaginoplasty 10 years ago, using the McIndoe vaginoplasty technique. However, the patient failed to undergo periodic vaginal dilatation.

Background: Evidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results. Objectives: To evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women. Search Strategy: We searched six databases for relevant studies through a search strategy containing the relevant keywords "IV hydration", "IV fluids", and "labor" from the inception of these databases to May 1, 2023, without any applied restrictions. Selection Criteria: Search results were imported to Covidence for screening of eligible articles for this review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only. Data Collection and Analysis: Data regarding the characteristics of included studies, participant's baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta‐analysis models using RevMan 5.4. Main results: Pooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56–0.88, P = 0.002), the first stage of labor duration (MD –46.97, 95% CI –81.79 to −12.14, P = 0.008), the second stage of labor duration (MD –2.69, 95% CI –4.34 to −1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58–0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02–1.12, P = 0.009) was higher with a 250 mL/h infusion rate. Conclusion: IV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second‐stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed. Synopsis: IV fluids at 250 mL/h reduce cesarean section rates and significantly affect the labor outcomes as compared with 125 mL/h. [ABSTRACT FROM AUTHOR]

Background: The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). Methods: We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior–posterior, y: superior–inferior, z: left–right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. Results: Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of <8 mm. Angles to the xz-plane range between −15.4° (right PRM) and 40.7° (left PAM). The PRM is the largest pelvic muscle in static MRI. The ICC indicated moderate-to-good agreement between raters. Conclusions: The accurate morphometry of the LAM and its subdivisions, along with reliable inter-rater agreement, was demonstrated, enhancing the understanding of normal pelvic anatomy in young nulliparous women. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and childbirth have been connected to modified risk of a wide variety of conditions in later life, including neurodegenerative disorders and cancers. The presence, extent, and direction of the effect that childbearing status has on decreasing or increasing the risk of these conditions differs depending on the disease. The mechanisms by which pregnancy and childbirth modify the risk of diseases are still unknown. DNA methylation (DNAm) alterations that occur during pregnancy and persist after childbirth may help us understand this phenomenon. Results: Blood DNAm was available from 89 women (28 parous; 61 nulliparous) at ages 18 and 26 years in the Isle of Wight birth cohort; no significant differences in the population characteristics were present between the analyzed population and the full cohort. We performed an epigenome-wide association study on 389,355 CpGs and identified 184 CpGs to be significantly differentially methylated between parous and nulliparous women after adjusting for confounders and multiple testing. Of these CpGs, 105 had regression coefficients in the same direction in an independent Mexico City based ELEMENT cohort, of which 13 were significant (replication P < 0.05). These 13 CpGs were associated with 16 unique genes. DNAm levels tracked with gene expression in 3 of the replicated genes, one of which (TM2D3) was differentially expressed in parous vs nulliparous women. Gene disease association analysis identified a network of parous-associated diseases. Conclusions: Our results suggest that pregnancy and childbirth lead to DNAm changes in parous women and these changes persist at least 6 months and up to 8 years postpartum. Parous-related CpG sites may play a role in how childbearing status modifies risk of later life diseases in women. Further studies are needed to explore the linkage and mechanism. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). Methods: This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. Results: From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). Conclusion: Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate expectant compared to immediate return to hospital upon outpatient Foley catheter expulsion predicated on maternal satisfaction and amniotomy‐titrated oxytocin infusion to delivery interval. Methods: This randomized trial was conducted in a tertiary university hospital in Malaysia from September 2020 to February 2022. A total of 330 nulliparous women at term with unripe cervices (Bishop score ≤5), singleton viable fetus in cephalic presentation, reassuring preinduction fetal heart rate tracing and intact membranes who underwent planned outpatient Foley catheter induction of labor (IOL) were included. Women were randomized to expectant or immediate return to hospital if the Foley was spontaneously expelled at home before their scheduled hospital admission the following day. Primary outcomes were amniotomy‐titrated oxytocin infusion to delivery interval and maternal satisfaction on the induction process (assessed by 0–10 visual numerical rating scale [VNRS]). Results: Amniotomy‐titrated oxytocin infusion to delivery interval was 8.7 ± 4.1 versus 8.9 ± 3.9 h, P = 0.605 (mean difference − 0.228 95% CI: −1.1 to +0.6 h) and maternal satisfaction VNRS score was median (interquartile range) 8 (7–9) versus 8 (7–9), P = 0.782. Early return to hospital rates were 37/165 (22.4%) versus 72/165 (43.6%), RR 0.51 (95% CI: 0.37–0.72), P ≤ 0.001, Cesarean delivery rates were 80/165 (48.5%) versus 80/165 (48.5%), RR 1.00 (95% CI: 0.80–1.25), P = 1.00 and duration of hospital stay was 54.4 ± 22.9 versus 56.7 ± 22.8 h, P = 0.364 for the expectant versus immediate return groups respectively. Conclusion: In outpatient Foley catheter IOL, expectant compared to immediate return to hospital following Foley dislodgement results in similarly high maternal satisfaction. The amniotomy‐titrated oxytocin to delivery duration is non‐inferior with expectant management. Synopsis: Expectant or immediate return to hospital after Foley expulsion in nulliparas outpatient labor induction shows good acceptability and comparable outcomes. [ABSTRACT FROM AUTHOR]

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: β = 0.178, p <.01 vs MP: β = 0.164, p <.01) and a perceived lack of instrumental support from friends (NP: β = -0.154, p <.01 vs MP: β = −0.154, p <.01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (β = 0.096, p <.05), job change (β = 0.127, p <.01), financial problems (β = 0.145, p <.01) and lack of instrumental support from partner (β = −0187, p <.01). For multiparous women, moving (β = 0.080, p <.05) and lack of instrumental support from family (β = −0.151, p <.01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify the factors influencing preeclampsia (PE) development in nulliparous Japanese women and to develop a PE prediction model using second trimester sonographic and clinical data readily available to obstetricians. Methods: This historical cohort study examined the obstetric records of nulliparous women who delivered at Yamanashi Prefectural Central Hospital from January 2019 to May 2023. A model was constructed to predict the PE development rate, with a focus on 796 nulliparous women. The assessed outcome was PE, excluding superimposed PE. Data on maternal age, assisted reproductive technology, mean arterial pressure, uterine artery notching, and umbilical artery resistance index were extracted. Multivariable logistic regression analysis was conducted on these five factors. Results: The incidence of PE was 4.3% (34/796). Multivariable analysis indicated significant odds ratios for the association of PE with mean arterial pressure (adjusted odds ratio: 1.06, 95% confidence interval: 1.03–1.10) and uterine artery notching (adjusted odds ratio: 6.28, 95% confidence interval: 2.82–14.0) in nulliparous women. The PE prediction formula was established as follows: Probability of PE development (%) = (odds/1 + odds) × 100, odds = ex and x = −11.3 + 0.039 × maternal age (years) + 0.91 × assisted reproductive technology + 0.061 × mean arterial pressure (mmHg) + 1.84 × uterine artery notching + 1.84 × umbilical artery resistance index. The sensitivity and specificity of this model were 58.8% and 84.5%, respectively (area under the curve: 0.79). Conclusions: This study is the first to provide a prediction formula targeting the Japanese population. Our specialized model for nulliparous women could guide obstetricians to educate women regarding the precise prospect of PE development. [ABSTRACT FROM AUTHOR]

BackgroundThe most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users.MethodsThis 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment.FindingsBetween June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A). Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78·7% [95% CI: 72·9-84·5%] vs. 70·2% [95% CI: 59·7-80·7], p = 0·014), lower rates of removal for bleeding and/or pain (8·1% vs. 16·2%, p = 0·003) and lower IUD expulsion rates (4·8% vs. 8·9%, p = 0·023), respectively.InterpretationThe NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy.FundingBill & Melinda Gates Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Mona Lisa, N.V. (Belgium).

Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%−99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue. [ABSTRACT FROM AUTHOR]

• We found an association between physical activity and soluble fms-like tyrosine kinase 1 (sFlt-1). • Physical activity is associated with lower first trimester levels of sFlt-1. • Physical activity may be a risk modifier of preeclampsia. Physical activity during pregnancy has long been investigated for its role in preeclampsia prevention. The mechanism of this relationship is unknown, although some studies suggest physical activity may affect placental analytes throughout pregnancy. The objective of this study was to determine the effect of physical activity on preeclampsia-associated placental analytes using a prospective cohort of pregnant nulliparous patients. This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. Frequency and duration of up to three leisure activities was reported in the first and second trimesters and was analyzed, with participants either meeting or not meeting the recommended exercise of 150 min per week. Levels of the following placental analytes, placental growth factor, soluble endoglin, and soluble fms-like tyrosine kinase-1 (sFLT1), were analyzed stratified by the physical activity level. A total of 1,956 participants were included in the analysis. The level of sFLT1 in the first trimester was lower in the group that had ≥ 150 min per week of physical activity, compared to the group that had < 150 min (846.3 [821.6, 871,8] versus 893.0 [864.5,922.5], p = 0.017). There were no significant sFLT1 changes in the second trimester based on physical activity. After controlling for maternal demographic and clinical factors, sFLT1 levels in the second trimester were significantly lower (p = 0.049) in participants that had ≥ 150 min of physical activity per week. Our findings of decreased sFLT1 levels suggest this could be the mechanism explaining the association between PA in pregnancy and lower risk of preeclampsia. [ABSTRACT FROM AUTHOR]

For maximum productivity in a dairy farm, the earliest and the most accurate detection of pregnancy is essential. The aim of this study was to determine the efficacy of expression patterns of miR‐26a, and serum Preimplantation Factor (PIF) levels for pregnancy diagnosis during the early pregnancy in nulliparous and multiparous cows. A total of 60 cows (30 nulliparous and 30 multiparous Holstein cows) were enrolled in the study. Blood samples were collected for miR‐26a on days 8 and 16 (D8 and D16), and for the PIF on days 10 and 20 (D10 and D20) following insemination (D0). Pregnancies were determined by ultrasonography on the 28th day after insemination. Expression levels of miR‐26a determined by qPCR. PIF levels were assessed by using commercial ELISA kits. All data were analyzed by using the MIXED procedure of SPSS. The expression levels of miR‐26a were 6.64 folds higher on D16 in pregnant compared to non‐pregnant multiparous cows (p <.05). On D8 and D16, miR‐26a expression levels were found higher 13 folds in pregnant compared to non‐pregnant nulliparous cows (p <.05). Additionally, miR‐26a expressions were higher 5.42 folds (p <.05) on D8, 7.19 folds higher (p <.01) on D16 in pregnant nulliparous and multiparous cows, and were 6.30 folds higher (p <.001) on D8 and D16 according to non‐pregnant animals. PIF levels were greater in pregnant animals (p <.05). Analyzing miR‐26a on D8 might be considered as sufficient in nulliparous cows. Pregnancy detection in multiparous cows can be made on the 16th day with this method. Furthermore, PIF evaluations may be sufficient on D10 in multiparous cows. Besides, PIF levels and miR‐26a expression levels might be used safely in field conditions and clinical applications. [ABSTRACT FROM AUTHOR]

Due to limited research on the effectiveness and safety of intravenous (IV) fluids administered during labor, there are no guidelines available. Thus, this meta-analysis aims to evaluate efficacy of IV Ringer's lactate during labor as compared to usual care. Six databases were searched for the randomized controlled trials (RCTs) comparing the effects of IV Ringer's lactate at 125 mL/h or 250 mL/hr during labor in nulliparous women at term as compared to usual care, and the search results were imported to Covidence for screening of the articles. All the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% CI in the meta-analysis models using RevMan 5.4. Pooled data from 7 RCTs with 967 nulliparous women showed that the active stage of labor duration (MD −32.16 with 95% CI [40.43 to −23.90], p < 0.00001), need of oxytocin augmentation (RR 0.72 with 95% CI [0.54 to 0.96], p = 0.03) and incidence of prolonged labor (RR 0.57 with 95% CI [0.34 to 0.95], p = 0.03) was significantly lower with IV Ringer's lactate. However, the total duration of labor (p = 0.23), duration of second stage of labor (p = 0.31) and cesarean section rate (p = 0.070) did not differ between the two groups. The test for subgroup analysis based on infusion rate was significant (p = 0.01) for the active stage of labor. IV Ringer's lactate reduced the duration of active labor, the need for oxytocin augmentation and the prolonged labor incidence. However, it did not differ in effect on immediate neonatal health but was found to have more potential for reducing maternal vomiting as compared to usual care with unrestricted oral intake. Further research is needed to explore its effects in the larger and more diverse populations and with different IV fluids for evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Background/Aims: Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women. Methods: In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed. Results: A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women. Conclusions: To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged labor increases adverse maternal and neonatal outcomes. Very few interventions are known to shorten labor duration. The present study was performed with aim to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion on the duration of the active phase of labor in nulliparous women. Methods: In this double-blind randomized clinical trial (blinding of patients and data analyst), which was performed in 2020-2021, 60 nulliparous women in the active phase of labor who had referred to the teaching hospitals of Mashhad University of Medical Sciences were randomized by block randomization method and allocated to two groups of receiving normal saline at a rate of 150cc per hour and dextrose at 5% saline at the same rate. The primary outcome was evaluating the duration of the active phase of the labor. Secondary outcomes included the duration of second phase of labor and the rate of cesarean section, maternal and neonatal outcomes. Data analysis was performed using SPSS statistical software (version 25) and Chi-square tests and Fisher's exact test. P 0.05). Conclusion: It seems that the use of dextrose-containing solutions in nulliparous women during labor shortens the duration of labor compared to normal saline.

Objectives: Postpartum hemorrhage (PPH) is a common cause of maternal death worldwide, but data on PPH incidence and influencing factors for nulliparous and multiparous women is scarce. So, the study aimed to assess the differences in PPH incidence and influencing factors between nulliparous and multiparous women. Methods: A multicenter retrospective cohort study was conducted among women who gave birth at ≥ 28 weeks of gestation in Hunan Province, China, from January 2017 to December 2018. Logistic regression assessed PPH-influencing factors, and the receiver operating characteristic curve (ROC curve) assessed the predictive performance of identified factors. Results: A total of 144,845 postpartum women were included in the study. The incidence of PPH (blood loss ≥ 500 ml) was 2.1 % and 1.7 % for nulliparous and multiparous women, respectively. Among the nulliparous and multiparous women, similar influencing factors of PPH included erythrocyte suspension transfusion before childbirth, anemia, soft-birth canal avulsion, Cesarean-section, placenta abruption, and general anesthesia administration before birth. Thrombophlebitis was associated [aOR 18.46(1.67–20.31)] with PPH among only the nulliparous women, while instrument-assisted birth [aOR 1.95(1.16–3.28)] and gestational hypertension [aOR 1.57(1.13–2.19)] were associated with PPH among only the multiparous women. The areas under the ROC-curve for the overall-cohort, nulliparous, and multiparous groups were [0.829(0.821–0.838)], [0.828(0.815–0.840)] and [0.833(0.822–0.844)], respectively. Conclusion: PPH incidence is higher among nulliparous women than among multiparous women, but influencing factors vary relatively by parity. The study findings provide new insights into the use of different approaches to PPH prevention for nulliparous and multiparous women in clinical practice.

IntroductionPelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15–49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages.MethodsThe study included 22 asymptomatic Nepali women aged 18–30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase.ResultsResults indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p = 0.03, d = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted.ConclusionThese findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women.

Introduction: The increasing Cesarean Section (CS) rates may be attributed to women's increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women. Methods: A cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants' demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables. Results: The results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p < 0.05). Moreover, the participants who had increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, fear from not being involved in decision-making, and overall FOC had a higher probability of choosing CS as the preferred delivery mode compared to the participants who had lower fear (p < 0.05). Discussion: Having high FOC increases the CS preference among nulliparous women. Increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, and fear from not being involved in decision-making seem to be significant dimensions of childbirth fear associated with CS preference among nulliparous women. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of low‐dose aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. Design: Non‐prespecified secondary analysis of a randomised masked trial of LDA. Setting: The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR) clusters, a prospective, population‐based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Pakistan, India (two sites‐Belagavi and Nagpur) and Guatemala. Population: Nulliparous singleton pregnancies between 6+0 weeks and 13+6 weeks in six low‐middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial. Methods: We compared the incidence of HDP at delivery at three gestational age periods (<28, <34 and <37 weeks) between women who were randomised to aspirin or placebo. Women were included if they were randomised and had an outcome at or beyond 20 weeks (Modified Intent to Treat). Main Outcome Measures: Our primary outcome was pregnancies with HDP associated with preterm delivery (HDP@delivery) before <28, <34 and <37 weeks. Secondary outcomes included small for gestational age (SGA) <10th percentile, <5th percentile, and perinatal mortality. Results: Among the 11 976 pregnancies, LDA did not significantly lower HDP@delivery <28 weeks (relative risk [RR] 0.18, 95% confidence interval [CI] 0.02–1.52); however, it did lower HDP@delivery <34 weeks (RR 0.37, 95% CI 0.17–0.81) and HDP@delivery <37 weeks (RR 0.66, 95% CI 0.49–0.90). The overall rate of HDP did not differ between the two groups (RR 1.08, 95% CI 0.94–1.25). Among those pregnancies who had HDP, SGA <10th percentile was reduced (RR 0.81, 95% CI 0.67–0.99), though SGA <5th percentile was not (RR 0.84, 95% CI 0.64–1.09). Similarly, perinatal mortality among pregnancies with HDP occurred less frequently (RR 0.55, 95% CI 0.33–0.92) in those receiving LDA. Pregnancies randomised to LDA delivered later with HDP compared with those receiving placebo (median gestational age 38.5 weeks vs. 37.9 weeks; p = 0.022). Conclusions: In this secondary analysis of a study of low‐risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks but not in the overall rate of HDP. These results suggest that LDA works in part by delaying HDP. [ABSTRACT FROM AUTHOR]

Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal–neonatal outcomes between the two groups. Methods: This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. Results: The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal–neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Conclusions: Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Reprodução Animal is the property of Revista Brasileira de Reproducao Animal 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 Revista Brasileira de Reprodução Animal is the property of Revista Brasileira de Reproducao Animal 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.)

Aim: To explore the association between induction of labour at full‐term gestations in low‐risk nulliparous women and childhood school outcomes. Methods: A retrospective whole‐of‐population cohort study linking perinatal data to educational test scores at grades 3, 5 and 7 in Victoria, Australia. Low‐risk nulliparous women with singleton pregnancies induced at 39 and 40 weeks without a medical indication were compared to those expectantly managed from that week of gestation. Multivariable logistic regressions were used as well as generalised estimating equations on longitudinal data. Results: At 39 weeks, there were 3687 and 103 164 infants in the induction and expectant arms, respectively. At 40 weeks' gestation, there were 7914 and 70 280 infants, respectively. Infants born to nulliparous women induced at 39 weeks' gestation had significantly poorer educational outcomes at grade 3 (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.13–1.70) but not grades 5 (aOR = 1.05, 95% CI: 0.84–1.33) and 7 (aOR = 1.07, 95% CI: 0.81–1.40) compared to those expectantly managed. Infants born to nulliparous women induced at 40 weeks had comparable educational outcomes at grade 3 (aOR = 1.06, 95% CI: 0.90–1.25) but poorer educational outcomes at grades 5 (aOR = 1.23, 95% CI: 1.05–1.43) and 7 (aOR = 1.23, 95% CI: 1.03–1.47) compared to those expectantly managed. Conclusions: There were inconsistent associations between elective induction of labour at full‐term gestations in low‐risk nulliparous women and impaired childhood school outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The goal of modern obstetrics is to enhance feto-maternal health. In certain cases, interventions are required to safeguard it. The most frequent interventional procedure is currently induction of labour. This study was conducted to assess feto-maternal outcome in induced women in comparison to spontaneous labour in nullipara. Methodology: This was a prospective study conducted among 55 nulliparous pregnant women at or beyond 37 weeks of gestation who were in need of induction. Progress of labour was monitored with modified WHO partograph. All consecutive patients who entered into spontaneous labour (n=55) were also included. Results: Mean cervical dilatation in 'spontaneous labour' group was 4.48 (± 0.65) cm and in 'induction labour' group was 4.4 (± 0.62) cm. In 'spontaneous labour' group, 36.4% required augmentation whereas in 'induction labour' group 67.3% required. In former, 81.8% had normal vaginal deliveries, whereas 63.6% in the later group. Mean duration of first stage of labour in 'spontaneous labour' group was 11.42 (± 2.32) hours and in 'induction labour' group was 10.36 (± 2.78) hrs. The rate of maternal complication was significantly more in 'induction labour' group compared to 'spontaneous labour' group. There was no significant difference in neonatal outcome in new-born in both the study groups. Conclusion: Induction of labour is associated with higher rate of LSCS. Duration of first stage of labour is significantly shorter in induced women, however duration of second and third stage of labour was almost similar to spontaneous labour. Induction of labour is a safe procedure. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 24-year-old woman who presented with abdominal pain and was diagnosed with giant haematometrocolpos, a condition characterized by the distension of the uterine cavity and vagina with blood due to anatomical mechanical obstruction. The patient had previously undergone neovaginoplasty but failed to undergo periodic vaginal dilatation. Ultrasound and MRI confirmed the diagnosis, and the patient underwent drainage and subsequent vaginal reconstruction. The case highlights the importance of periodic vaginal dilatation in patients who have undergone vaginoplasty. [Extracted from the article]

Background: Hypertensive disorders of pregnancy (HDP) remain a primary contributor for maternal and perinatal death and results in long-term health risks for both the mother and child. Heterogeneous studies have evaluated the possible benefit of low dose aspirin (50 to 150 mg per day) in pregnancy to minimize the risk of HDP. Objective: To assess the impact of low-dose Aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. Methodology: This was a non-prespecified secondary analysis of a randomized masked trial of Low-dose Aspirin (LDA). Nulliparous singleton pregnancies between 6 weeks and 0 days and 13 weeks 6 days in 6 low- middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial were included. The incidence of HDP at delivery at three gestational age periods (< 37 weeks) between women who were randomized to Aspirin or Placebo. Women were included if they were randomized and had an outcome at or beyond 20 weeks (Modified Intent to Treat). Results: Amongst the 11,976 pregnancies, LDA did not significantly lower HDP at delivery. Conclusion: In low-risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks. LDA works in part by delaying HDP.

Background: The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). Methods: We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior–posterior, y: superior–inferior, z: left–right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. Results: Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of

BACKGROUND: Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery. OBJECTIVE: Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity. STUDY DESIGN: This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at

IntroductionThe increasing Cesarean Section (CS) rates may be attributed to women’s increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women.MethodsA cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants’ demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables.ResultsThe results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p

Introduction: The goal of modern obstetrics is to enhance feto-maternal health. In certain cases, interventions are required to safe-guard it. The most frequent interventional procedure is currently in-duction of labour. This study was conducted to assess feto-maternal outcome in induced women in comparison to spontaneous labour in nullipara. Methodology: This was a prospective study conducted among 55 nulliparous pregnant women at or beyond 37 weeks of gestation who were in need of induction. Progress of labour was monitored with modified WHO partograph. All consecutive patients who entered into spontaneous labour (n=55) were also included. Results: Mean cervical dilatation in ‘spontaneous labour’ group was 4.48 (± 0.65) cm and in ‘induction labour’ group was 4.4 (± 0.62) cm. In ‘spontaneous labour’ group, 36.4% required augmentation whereas in ‘induction labour’ group 67.3% required. In former, 81.8% had normal vaginal deliveries, whereas 63.6% in the later group. Mean du-ration of first stage of labour in ‘spontaneous labour’ group was 11.42 (± 2.32) hours and in ‘induction labour’ group was 10.36 (± 2.78) hrs. The rate of maternal complication was significantly more in ‘in-duction labour’ group compared to ‘spontaneous labour’ group. There was no significant difference in neonatal outcome in new-born in both the study groups. Conclusion: Induction of labour is associated with higher rate of LSCS. Duration of first stage of labour is significantly shorter in in-duced women, however duration of second and third stage of labour was almost similar to spontaneous labour. Induction of labour is a safe procedure.

Background: The combination of ropivacaine and dexmedetomidine has been used as an epidural analgesic for inducing labor. However, there is limited data regarding the administration of epidural analgesia for labor maintenance, hence, this study aimed to determine the optimum concentration through dose-response curves of ropivacaine plus dexmedetomidine, which could be used along with the Programmed Intermittent Epidural Bolus (PIEB) technique. Methods: One hundred parturients were randomized into 4 groups who were administered four different doses of ropivacaine (dexmedetomidine at 0.4 μgmL-1): 0.04%, 0.06%, 0.08%, and 0.1%. The primary outcome that was determined included the proportion of patients experiencing breakthrough pain during their 1st stage of labor. Breakthrough pain was described as a visual analog scale [VAS] score of >30 mm, requiring supplemental epidural analgesia after the administration of at least one patient-controlled bolus. The effective concentration of analgesia that was used for labor maintenance in 50% (EC50) and 90% (EC90) of patients were calculated with the help of probit regression. Secondary outcomes included epidural block characteristics, side effects, neonatal outcomes, and patient satisfaction. Results: The results indicated that the proportion of patients without breakthrough pain was 45% (10/22), 55% (12/22), 67% (16/24), and 87% (20/23) for 0.04%, 0.06%, 0.08%, and 0.10% doses of the analgesic that were administered, respectively. The EC50 value was 0.051% (95% confidence interval [CI], 0.011%-0.065%) while the EC90 value was recorded to be 0.117% (95% CI, 0.094%-0.212%). Side effects were similar among groups. Conclusion: A ropivacaine dose of 0.117% can be used as epidural analgesia for maintaining the 1st stage of labor when it was combined with dexmedetomidine (0.4 μgmL-1) and the PIEB technique. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between episiotomy and severe obstetric anal sphincter injury (OASIS) in nulliparous women at term according to the use of an instrument for delivery with control confounding by indication. Methods: This was an observational retrospective cohort study including 12 346 women from 2004 to 2020. All nulliparous women with a cephalic singleton pregnancy were included. The primary outcome was the occurrence of OASIS. Association between episiotomy and OASIS was assessed by multivariate logistic regression with adjustment for confounding factors and stratification on the use of an instrument at delivery. Propensity score matching was used to account for indication bias. Results: Among 12 346 women included, 7803 (63.2%) had an episiotomy and 4543 (36.8%) did not have an episiotomy; the rate of OASIS was similar in both groups (0.7%). After stratification on use of instrument, an association between episiotomy and OASIS was shown in the case of instrumental delivery (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26–0.80) but not if the delivery was spontaneous (OR 0.76, 95% CI 0.29–1.98). The result was similar after matching on propensity score (in the case of operative vaginal delivery: OR 0.20, 95% CI 0.10–0.75). Conclusion: Episiotomy seems to be a protective factor for OASIS in nulliparous woman at term only in the case of operative vaginal delivery. Synopsis: Episiotomy seems to be a protective factor for OASIS in nulliparous woman at term only in the case of operative vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: To characterize the length of the second stage of labor among women completing a first vaginal birth after a cesarean (VBAC), according to the stage of labor during primary cesarean delivery (CD). Methods: A retrospective cohort study of VBACs between 2011 and 2020. Study groups were divided as follows: CD not in labor, CD in the first stage of labor, and CD in the second stage of labor. The primary outcome was the length of the second stage. Results: A total of 1310 VBACs were included. The timing of the primary CD was not associated with the duration of the second stage. The median second stage of duration of VBACs with previous first stage CD versus previous CD not in labor was 81 versus 106 min, respectively (P = 0.050). In multivariable linear regression, maternal age, birth weight, and epidural were independently associated with second‐stage length. Maternal and neonatal outcomes did not differ between study groups and were not affected by the second‐stage length. Conclusion: When stratified according to the labor stage of the primary CD, second‐stage duration among women completing VBACs was not associated with labor stage at the primary CD. Extremes of the second‐stage duration were not associated with increased morbidity. Synopsis: The length of the second stage of labor among women completing vaginal birth after a cesarean is not associated with labor stage of the primary cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate maternal and neonatal outcomes by method of cervical ripening for labor induction among low-risk nulliparous individuals. Study Design This is a secondary analysis of a multicenter randomized trial of labor induction at 39 weeks versus expectant management in low-risk nulliparous participants. Participants undergoing cervical ripening for labor induction in either group were included. Participants were excluded for preripening membrane rupture, abruption, chorioamnionitis, fetal demise, or cervical dilation ≥3.5 cm. Cervical ripening was defined by the initial method used: prostaglandin only (PGE; referent), Foley with concurrent prostaglandin (Foley-PGE), Foley only (Foley), and Foley with concurrent oxytocin (Foley-oxytocin). Coprimary outcomes were adverse maternal and neonatal composites. Secondary outcomes included cesarean delivery and length of labor and delivery (L&D) stay. Multivariable analysis was used to adjust for patient characteristics. Results Of 6,106 participants included in the trial, 2,376 (38.9%) met criteria for this analysis. Of these, 1,247 (52.4%) had cervical ripening with PGE, 290 (12.2%) had Foley-PGE, 385 (16.2%) had Foley, and 454 (19.1%) had Foley-oxytocin. The maternal composite outcome was similar among participants who received Foley-PGE (24.1%, adjusted relative risk [aRR] = 1.21, 95% confidence interval [CI]: 0.96–1.52), Foley (21.3%, aRR = 1.16, 95% CI: 0.92–1.45), or Foley-oxytocin (19.4%, aRR = 1.04, 95% CI: 0.83–1.29), compared with PGE (19.7%). The neonatal composite outcome was less frequent in participants who received the Foley-PGE (2.4%, aRR = 0.35, 95% CI: 0.16–0.75) or Foley (3.6%, aRR = 0.51, 95% CI: 0.29–0.89) but did not reach statistical significance for participants who received Foley-oxytocin (4.6%, aRR = 0.63, 95% CI: 0.40–1.01) compared with PGE only (6.8%). Participants who received Foley-PGE or Foley-oxytocin had a shorter L&D stay (adjusted mean difference = −1.97 hours, 95% CI: −3.45 to −0.49 and −5.92 hours, 95% CI: −7.07 to −4.77, respectively), compared with PGE. Conclusion In term low-risk nulliparous participants, Foley alone or concurrent with PGE is associated with a lower risk of adverse neonatal outcomes than with PGE alone. Length of L&D stay was the shortest with concurrent Foley-oxytocin. Key Points Adverse maternal outcomes are similar among different methods of cervical ripening in low-risk women. Adverse neonatal outcomes are less frequent with use of Foley alone or in combination with PGE. The use of Foley alone, or in combination with other agents, appears to be beneficial. [ABSTRACT FROM AUTHOR]

Aim and background: This research aims to investigate the impact of core stability exercises on lumbar lordosis angle, pain, functional disability, and quality of life in nulliparous women. Material and Methods: The study design was semi-experimental. The research sample consisted of 32 nulliparous women who were randomly divided into two groups: a core stability exercise group (n=16) and a control group. Prior to the intervention, pain, lumbar lordosis angle, functional disability, and quality of life were measured using the Quebec back pain questionnaire, flexible ruler, Oswestry functional disability questionnaire, and SF36 health questionnaire, respectively. The core stability exercise group then underwent 8 weeks of training, with three sessions per week lasting 45-60 minutes per session. After completing the intervention, all measurements were repeated in the post-test phase. Two-way analysis of variance was used for inter-group and intra-group comparisons. Results: The results showed that pain, quality of life, and functional disability significantly improved in the core stability exercise group after 8 weeks (P≤0.05). However, there was no significant change in the lumbar lordosis angle in either the control or exercise group (P≥0.05). Conclusion: Core stability exercises, by enhancing lumbo-pelvic-hip stability, can alleviate back pain, improve functional capacity, and enhance quality of life. However, it is advisable to incorporate these exercises along with other corrective exercises to address lumbar lordosis complications in pregnant women. [ABSTRACT FROM AUTHOR]

Background: When the advantages of delivery for the mother or the foetus outweigh the hazards of continuing the pregnancy, labour should be induced. Objective: The purpose of the study was to examine the effectiveness of foetal fibronectin (fFN) and transvaginal cervix ultrasonography in predicting successful labour induction for unfavourable cervixes (Bishop score 5 or below). Subjects and Methods: In the Maternity Centre, Faculty of Medicine, Ain Shams University, a prospective study was carried out. Patients in this study were selected from those attending in Obstetrics Outpatient Department who were nullipara pregnant women. 40 women were assessed for study eligibility and fulfilled all inclusion criteria. Results: Mode of delivery had a significant correlation with Bishop score, while there was no discernible correlation between delivery method and transvaginal ultrasound. The bishop score was significantly correlated with fFN, all the cases with bishop 3 were negative fFN. The OSS showed insignificant relation with fFN. Also, there was no significant difference between negative and positive fFN regarding cervix (CX) length. The sensitivity of CX in prediction of successful labor induction occurring within 24 hours at cut off value of 3.11 was 50.0% and the specificity was 53.2%, and the accuracy was 51.1%. The Bishop score at cut off value of 4.0, the sensitivity was 60%, specificity was 64.5% and the accuracy was 62%. The sensitivity of fetal fibronectin in prediction of successful labor induction occurring within 24 hours at cutoff value 1.56 was 85%, the specificity was 80% and the accuracy was 82.6%. Conclusion: Although transvaginal cervical length measurement provides an objective way to evaluate the cervix when the Bishop score is equivocal, it may not be able to predict failed inductions with enough accuracy but it can help identify women who are at risk for caesarean delivery. fFN showed a highly significant sensitivity, specificity and accuracy to predict the successful induction of labor. [ABSTRACT FROM AUTHOR]

Background: The impact of foetal head station at the onset of 2nd stage of labor on the duration of 2nd stage duration is still controversial in spite of multiple studies conducted on evaluation of foetal head station early in labor, but still much less data on the impact of foetal head descend in the 2nd stage. Objective: The study aimed to evaluate the correlation between foetal head station diagnosed at the start of second stage of labour and fetomaternal delivery outcomes. Subjects and methods: This study was carried out on 100 female participants were in spontaneous labor at 37-42 weeks in emergency room (ER) at Obstetrics and Gynecology Department at Menoufia University Hospitals after obtaining their consent from January 2022 till December 2022. Upon the diagnosis of the second stage of labour, women were divided into three groups according to the foetal head station: above (S<0), at the level of (S=0), and below (S>0). The length of the second stage and the risk of operational delivery were examined and stratified by parity between the groups. All subjects had routine testing (CBC, Coagulation profile, Kidney function tests, Liver function tests), and all females underwent obstetric ultrasounds. Results: 46% of the 100 individuals who matched the inclusion criteria were nulliparous, whereas 54% were multiparous. 10.9%, 34.8%, and 54.3% of the nulliparous women had foetal head S<0, S=0, and S>0 following second stage diagnosis. 20.4%, 37%, and 42.6% of the multiparous women were identified as having foetal head S<0, S=0, and S>0, respectively. The length of the second stage was independently and strongly correlated with foetal head station at the time of second stage diagnosis (P<0.001). Conclusion: The length of the second stage is strongly and independently correlated with the foetal head station at the first diagnosis of the second stage. Between three groups of multiparous, there was a statistically significant difference in the necessity for the Kristeller manoeuvre, with multiparous females with S0 needing fundal pressure more often. [ABSTRACT FROM AUTHOR]

Background: It is important to be concerned about anxiety during pregnancy since it will influence the fetus's growth. Extreme levels of stress, sadness, or anxiety during pregnancy increase the risk of an adverse pregnancy outcome. Objectives: To Evaluate the Nulliparous pregnant women childbirth anxiety. To find out the association between pregnant women’s anxiety with some demographical and gestational age. Methodology: A descriptive design used a non-probability (purposive sample) of (200) nulliparous pregnant women to collect the data through a self-reported questionnaire. The questionnaire comprised of (14) items of pregnancy related anxiety. The study was conducted from February to July 2023. Results: Regarding age about half (50%) of pregnant women at age (20-29) years (27%) are graduated from preparatory school. More than two-thirds (67%) in the second trimester. The majority of them have planned pregnancy (81.5%). Most of them have mild anxiety (57%), and the leftover (43%) have severe anxiety. There are no significant association between pregnant women’s childbirth anxiety with age, education, or gestational age. Conclusion: This study concluded that more than half of pregnant women have mild anxiety, and more than two thirds have severe anxiety. Recommendations: Pregnant women need prenatal education and support regarding childbirth anxiety during routine prenatal visits. [ABSTRACT FROM AUTHOR]

Abstract Background The use of cervical strain elastography for nulliparous women during late-term pregnancy remains unclear. This study assesses the predictive value of late-term cervical strain elastography for successful induction of labor (IOL) in nulliparous women. Methods This single-centered, prospective study included 86 patients undergoing IOL between January 2020 and March 2022. Univariate and multivariate analyses were conducted to identify predictive factors for successful IOL. The predictive values were assessed using the area under receiver operating characteristic (ROC) curves. Results IOL was successful in 58 patients. The hardness ratio and cervical length were significantly associated with successful late-term IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone. Conclusions The hardness ratio and cervical length assessed by cervical strain elastography during late-term pregnancy are predictors of the success of IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.

Introduction: One of the medical interventions in childbirth is episiotomy which is used to widen the pelvic outlet. Plantago is one of the oldest medicinal plants that have wound healing properties due to its flavonoids and phenolic compounds. The present study was performed aimed to determine the effect of plantago cream on intensity of pain and episiotomy wound healing in nulliparous women.Methods: This triple-blind clinical trial study was performed in 2019 on 107 nulliparous women who had referred to Valiasr Hospital in Birjand for natural childbirth. The participants were randomly divided into two groups of placebo and drug. After delivery, mothers used 2-3 cm of prescribed cream on the sutures for 10 days and twice a day. The wound healing rate was evaluated on the third, seventh and tenth days after delivery using the Reda tool. Data were analyzed using SPSS 21 software and Chi-square and Mann-Whitney tests. P< 0.05 was considered statistically significant.Results: The mean of Reda score in the drug group was 3.433 ± 0.635 on the third day, and 0.773 ± 0.422 on the seventh day, but in the placebo group, it was 5.611 ± 0.492, 2.185 0 0.478, respectively. The two groups had significant difference on the third and seventh days in terms of wound healing (p

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85–1.05]; P =.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01–1.18]; P =.024). We did not observe any differences in adverse maternal or neonatal outcomes. Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery—a secondary outcome—was increased in the intervention group. The intervention appears to be safe. [ABSTRACT FROM AUTHOR]

Purpose: To determine the validity of intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. Methods: Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3 h ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descent, measured by AOP change/h (calculated from serial measurements), was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. Results: Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153° ± 19 vs. 133° ± 17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127° was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1° ± 11.4° vs. 6.2° ± 6.3°, p < 0.001). Conclusion: Ultrasound-assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting the mode and interval time to delivery in real-life clinical practice. [ABSTRACT FROM AUTHOR]