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The purpose of this study was to investigate the impact of vaginal delivery on adverse pregnancy outcomes after cesarean section for the cicatricial uterus. Eighty patients with scarred uterus after cesarean section admitted to our hospital from October 2019 to May 2021 were selected for the study. Among them, 44 cases were eligible for vaginal delivery. Thirty-eight cases of cesarean delivery were selected as the control group and 42 cases of vaginal delivery were selected as the observation group according to the mode of delivery. Baseline data, 24-h blood loss, length of hospital stay, hospital costs, 5-minute Apger score, and adverse pregnancy outcomes were compared between the two groups. When comparing the age, gestational age, number of pregnancies, and duration of cesarean delivery between the two groups (t = 1.333, 0.989, 0.597, 0.752, P > 0.05), the scar thickness in the observation group was higher than that in the control group. The 24-h postpartum bleeding and hospitalization cost was lower in the observation group than in the control group, the hospitalization time was shorter than in the control group, and the 5-minute Apger score was higher than in the control group (t = 21.744, 15.029, 11.524, 7.342, P < 0.05). The incidence of maternal and neonatal complications was compared between the two groups (23.68% vs 7.14%, 7.89% vs 0.00%, correction 2 = 1.083, 1.605, P > 0.05). The incidence of adverse pregnancy outcomes was 7.14% in the observation group, which was significantly lower than the 31.57% in the control group. The difference was statistically significant (correction 2 = 4.060, P < 0.05). [ABSTRACT FROM AUTHOR]

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information. [ABSTRACT FROM AUTHOR]

Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%). Obstetrical anal sphincter injury is a significant risk factor for the development of anal incontinence, with approximately 10% of women developing symptoms within a year following vaginal birth. Obstetrical anal sphincter injuries have significant medicolegal implications and contribute greatly to healthcare costs. For example, in 2013 and 2014, the economic burden of obstetrical anal sphincter injuries in the United Kingdom ranged between £3.7 million (with assisted vaginal birth) and £9.8 million (with spontaneous vaginal birth). In the United States, complications associated with trauma to the perineum incurred costs of approximately $83 million between 2007 and 2011. It is therefore crucial to focus on improvements in clinical care to reduce this risk and minimize the development of perineal trauma, particularly obstetrical anal sphincter injuries. Identification of risk factors allows modification of obstetrical practice with the aim of reducing the rate of perineal trauma and its attendant associated morbidity. Risk factors associated with second-degree perineal trauma include increased fetal birthweight, operative vaginal birth, prolonged second stage of labor, maternal birth position, and advanced maternal age. With obstetrical anal sphincter injury, risk factors include induction of labor, augmentation of labor, epidural, increased fetal birthweight, fetal malposition (occiput posterior), midline episiotomy, operative vaginal birth, Asian ethnicity, and primiparity. Obstetrical practice can be modified both antenatally and intrapartum. The evidence suggests that in the antenatal period, perineal massage can be commenced in the third trimester of pregnancy to increase muscle elasticity and allow stretching of the perineum during birth, thereby reducing the risk of tearing or need for episiotomy. With regard to the intrapartum period, there is a growing body of evidence from the United Kingdom, Norway, and Denmark suggesting that the implementation of quality improvement initiatives including the training of clinicians in manual perineal protection and mediolateral episiotomy can reduce the incidence of obstetrical anal sphincter injury. With episiotomy, the International Federation of Gynecology and Obstetrics recommends restrictive rather than routine use of episiotomy. This is particularly the case with unassisted vaginal births. However, there is a role for episiotomy, specifically mediolateral or lateral, with assisted vaginal births. This is specifically the case with nulliparous vacuum and forceps births, given that the use of mediolateral or lateral episiotomy has been shown to significantly reduce the incidence of obstetrical anal sphincter injury in these groups by 43% and 68%, respectively. However, the complications associated with episiotomy including perineal pain, dyspareunia, and sexual dysfunction should be acknowledged. Despite considerable research, interventions for reducing the risk of perineal trauma remain a subject of controversy. In this review article, we present the available data on the prevention of perineal trauma by describing the risk factors associated with perineal trauma and interventions that can be implemented to prevent perineal trauma, in particular obstetrical anal sphincter injury. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Thiols are organic compounds containing sulfhydryl groups that exert antioxidant effects via dynamic thiol-disulfide homeostasis. The shift towards disulfide indicates the presence of an oxidative environment. Different modes of delivery can affect thiol-disul- fide homeostasis. Accordingly, we planned this research to evaluate the effects of the mode of delivery on thiol-disulfide homeostasis in both maternal serum and fetal cord blood samples. PATIENTS AND METHODS: We conducted a prospective case-control study involving two groups: vaginal delivery (n=50) and elective cesarean section (CS) (n=45). The vaginal delivery group exclusively comprised uncomplicated term deliveries, while the CS group included pregnant individuals with scheduled cesarean deliveries due to the absence of spontaneous labor onset. Maternal serum and fetal cord blood samples were collected, and thiol-disulfide exchanges were analyzed using an automated method capable of measuring both aspects of the thiol-disulfide balance. RESULTS: The levels of native thiol (-SH) and total thiol in both maternal serum and fetal cord blood samples were significantly higher in the vaginal delivery group than those in the CS group. An important discovery of our study was that fetal cord disulfide (-SS) level, which may reflect oxidative stress, was higher in newborns born via vaginal delivery when examined alone. However, in both maternal and fetal cord blood, the combined ratios, SS/SH ratio (%), SS/Total thiol ratio (%), and SH/Total thiol ratio (%) were observed to be similar between the groups in both maternal and fetal cord blood. It was observed that as the mother's weight gained during pregnancy increased, SS/SH and SS/total thiol increased (positive correlation), while SH/total thiol decreased (negative correlation). CONCLUSIONS: Our results showed that the dynamic thiol-disulfide homeostasis was greatly influenced by the way of delivery and supported the idea that vaginally-delivered infants may have more oxidative stress. [ABSTRACT FROM AUTHOR]

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]

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.)

OBJECTIVE: This study aimed to analyze the maternal and fetal outcomes of pregnant women with pre-eclampsia (PE), complicated with fetal growth restriction (FGR), and establish a prediction model of vaginal delivery to guide the selection of the delivery mode. PATIENTS AND METHODS: The study included 208 pregnant women with PE complicated with FGR. Of them, 49 patients were in the vaginal delivery group, and 159 patients were in the cesarean section group. The relevant maternal and fetal outcomes were analyzed. Patients were randomly divided into the training sample group and the test group with a ratio of 2:1. The three-layer neural network was used to select 24 maternal and infant outcome factors as the input nodes of the neural network to build a vaginal delivery prediction model. RESULTS: Results showed that the gestational age, the highest systolic and diastolic blood pressure, body weight, body length, and placental weight of the newborns in the vaginal delivery group were significantly higher than those in the cesarean section group. Incidence of preterm birth, amniotic fluid grade III, oligohydramnios, and severe small-for-gestational-age (sSGA) neonates were significantly lower in the vaginal delivery group compared to the cesarean section group (p < 0.05). A three-layer neural network delivery prediction model was constructed, and the accuracy rate of fitting with test samples was 91.80%. CONCLUSIONS: There is no significant difference in the incidence of maternal and fetal complications in PE complicated with FGR in different delivery methods. The three-layer neural network prediction model has good prediction ability for vaginal delivery of PE complicated with FGR and may be applied in clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine 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.)

Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural. A recent meta-analysis showed that the use of the birthing ball in labor significantly reduces maternal pain in labor by 1.7 points on a standard visual analog scale of 1 to 10 (mean difference, −1.70 points; 95% confidence interval, −2.20 to −1.20). The use of the birthing ball does not significantly affect the mode of delivery or the rate of other obstetrical complications. This suggests that its use is safe and can offer subjective improvement in maternal pain experienced during labor. The peanut ball is a peanut-shaped plastic ball placed between the knees of a person laboring in the lateral recumbent position, a position common in those laboring with an epidural. Traditionally, its use has been thought to allow for bent-knee positioning that can mimic a squatting position and facilitate frequent and optimal position changes during labor. Data regarding the effects of the peanut ball are mixed. A recent systematic review and meta-analysis found that the use of the peanut ball compared with no peanut ball is associated with a significantly decreased first stage of labor (mean difference, −87.42 minutes; 95% confidence interval, −94.49 to −80.34) and an 11% higher relative risk of vaginal delivery (relative risk, 1.11; 95% confidence interval, 1.02–1.22; n=669). The use of the peanut ball is not associated with increased incidences of obstetrical complications. As such, it is reasonable to offer to individuals in labor. There has been no reported risk of the use of either the birthing ball or the peanut ball. As such, both interventions can be offered to individuals in labor as an adjunct to labor management techniques based on moderate quality evidence. [ABSTRACT FROM AUTHOR]

Childbirth is a challenging event that can lead to long-term consequences such as prolapse or incontinence. While computational models are widely used to mimic vaginal delivery, their integration into clinical practice is hindered by time constraints. The primary goal of this study is to introduce an artificial intelligence pipeline that leverages patient-specific surrogate modeling to predict pelvic floor injuries during vaginal delivery. A finite element-based machine learning approach was implemented to generate a dataset with information from finite element simulations. Thousands of childbirth simulations were conducted, varying the dimensions of the pelvic floor muscles and the mechanical properties used for their characterization. Additionally, a mesh morphing algorithm was developed to obtain patient-specific models. Machine learning models, specifically tree-based algorithms such as Random Forest (RF) and Extreme Gradient Boosting, as well as Artificial Neural Networks, were trained to predict the nodal coordinates of nodes within the pelvic floor, aiming to predict the muscle stretch during a critical interval. The results indicate that the RF model performs best, with a mean absolute error (MAE) of 0.086 mm and a mean absolute percentage error of 0.38%. Overall, more than 80% of the nodes have an error smaller than 0.1 mm. The MAE for the calculated stretch is equal to 0.0011. The implemented pipeline allows loading the trained model and making predictions in less than 11 s. This work demonstrates the feasibility of implementing a machine learning framework in clinical practice to predict potential maternal injuries and assist in medical-decision making. [Display omitted] • Finite element-based machine learning approach to predict childbirth injuries. • Mesh-morphing algorithm to obtain patient-specific models of the pelvic floor. • Random forest model yields lowest mean absolute error for stretch prediction. • Real-time biomechanical analysis achievable and suitable for clinical applications. • Use of artificial intelligence tools contributes to reducing maternal morbidity. [ABSTRACT FROM AUTHOR]

Introduction and Objective. Childbirth is one of the most important events in a woman's life and is influenced by many factors. The aim of the research was to analyze the impact of the place of residence of women giving birth and the time of day on the course of natural birth. Materials and method. The study was conducted using the method of analysis of retrospective electronic documentation of patients who gave natural vaginal birth in the St. Zofia hospital in Warsaw, Poland. The analysis covered the period from 1 January 2015-31 December 2020; from 40,007 cases, 20,980 were qualified for final analysis. Analysis of the documentation allowed to obtain the following data: socio-demographic, lifestyle, obstetrics, course of delivery and the condition of the newborn. Analysis of the relationship between qualitative variables was performed using the Chi-square test, while the Mann-Whitney U test was used to compare two quantitative variables. Results. Women giving vaginal delivery from rural areas were younger (30.9 vs. 31.3), had primary education (2.4% vs. 1.7%) and secondary education (16.2% vs. 10.1%), were in a relationship (86.1% vs. 81.6%) and more often had a higher BMI at birth (27.8 vs. 27.0), compared to the patients living in cities (p<0.05). In addition, between 07:00-18:59., induction of labour (20.7% vs. 19.1%), epidural anesthesia (35.4% vs. 34.0%) and episiotomy were performed more often (29.1% vs. 27.8%) (p<0.05). Conclusions. Differences were shown in the course of vaginal delivery in relation to the place of residence of the women, and the time of day of the delivery. These factors should be considered in the planning of perinatal care. At the same time, it is necessary to conduct further research on the analyzed aspect in order to ensure the highest quality care. [ABSTRACT FROM AUTHOR]

Background: Breech is a common fetal presentation in preterm pregnancies. This study aimed to investigate the effect of acupressure at the BL67 point on the spontaneous rotation of fetus with breech presentation.Methods: An unblind, two-armed randomized controlled trial was carried out from September 2017 to April 2020. Research participants were 138 pregnant women at 32 to 35 weeks of gestational age that had fetal breech presentation confirmed by ultrasound. They were randomly assigned into intervention and control groups (n=69 in each group). The intervention group received acupressure at the BL67 point on both feet for 10 minutes daily and for two consecutive weeks. The control group received routine care. Demographic and midwifery data questionnaires were used for data collection.Results: The spontaneous rotation of fetus with breech presentation into cephalic was observed in the majority of participants in the intervention group (82.6%) compared to the control group (17.4%) (p<0.001). Statistically significant differences in the fetal presentation at delivery was observed between the groups (84.1% cephalic vs. 18.8% breech, p<0.001). Regarding the type of delivery, cesarean section was reported mostly (85.5%) in the control group compared to the intervention group (21.7%) (p<0.001). However, the first- and fifth-minute Apgar scores of newborns had no statistically significant differences between the groups (p=0.773).Conclusion: It is suggested to incorporate acupressure at the BL67 point into the care process for pregnant women to help with the reduction of the rate of cesarean section and avoid its related complications. [ABSTRACT FROM AUTHOR]

Fearing for possible consequences to the retina of women with pseudoxanthoma elasticum, vaginal delivery is sometimes discouraged. In our case series of 14 patients with pseudoxanthoma elasticum, we could not detect any (sub)retinal hemorrhages or progression of angioid streaks after childbirth. Vaginal delivery seems safe for the retina of patients with pseudoxanthoma elasticum if no active choroidal neovascularization is present. Background/Purpose: To investigate the effect of a vaginal delivery (VD) on retinal pathology in patients with pseudoxanthoma elasticum. Methods: Retrospective case series. All 14 consecutive women with pseudoxanthoma elasticum who visited the ophthalmology department during pregnancy and after delivery between 2010 and 2018 were included. Prepartum and postpartum imaging consisted of color imaging, near-infrared imaging, and optical coherence tomography and was assessed on occurrence of (sub)retinal hemorrhages and change in angioid streaks. Results: Fourteen patients (15 deliveries) were included, of whom 11 patients (79%) had a VD and three patients (21%) a secondary caesarian section. Data of three patients with VD (four deliveries) could not be assessed for (sub)retinal hemorrhage within 10 weeks postpartum. The median age at delivery was 31 years (IQR 29–37). One patient with VD (9%) had a choroidal neovascularization and was treated with anti-VEGF injections before assisted delivery. All patients had angioid streaks in the central 5,500 µ m of the posterior pole of both eyes. After delivery, no patient in the VD or caesarian section group presented with progression of angioid streaks or (sub)retinal hemorrhage. Conclusion: Pushing during the expulsion phase of VD seems safe in pseudoxanthoma elasticum patients without active choroidal neovascularization, and the presence of angioid streaks alone should not be an indication for elective caesarian section. [ABSTRACT FROM AUTHOR]

Postnatal thyroid hormone changes enable the neonate to be adapted for postnatal life. Several factors can affect this adaption. In this review, we summarized the studies that reported the association among the delivery factors and neonatal thyroid hormones and thyroid stimulating hormone. A comprehensive literature search was performed in PubMed, Web of Science, and Scopus up to March 2020, to identify the studies investigating the relationship between delivery factors, especially the mode of delivery and labor pain, and neonatal thyroid hormones and TSH. Finally, in this review study, of 157 articles obtained in the initial search, 25 eligible studies were reviewed. Various maternal, fetal/neonatal, and obstetric factors affected neonatal TSH and thyroid hormones. Among various influencing factors, mode of delivery, labor pains, and duration of labor have a strong relationship with neonatal thyroid hormones and need to be considered for interpretation of neonatal thyroid status. The majority of the studies revealed that vaginal deliveries (instrumental or natural) lead to higher levels of cord TSH compared to elective cesarean section. This can be explained by the increased secretion of catecholamine during labor. It has been suggested that blood TSH and thyroid hormone levels are affected by perinatal stress events such as maternal anxiety, labor pains, fetal distress, and other stimulants of the catecholamine response. These changes may act as the trigger to increase thyroid hormone levels for adapting of neonates in the first hours after birth. This assumption needs to be re-evaluated by performing comprehensive and well-designed studies. [ABSTRACT FROM AUTHOR]

Preterm infants face a high risk of various complications, and their gut microbiota plays a pivotal role in health. Delivery modes have been reported to affect the development of gut microbiota in term infants, but its impact on preterm infants remains unclear. Here, we collected fecal samples from 30 preterm infants at five-time points within the first four weeks of life. Employing 16 S rRNA sequencing, principal coordinates analysis, the analysis of similarities, and the Wilcoxon rank-sum test, we examined the top dominant phyla and genera, the temporal changes in specific taxa abundance, and their relationship with delivery modes, such as Escherichia-Shigella and Enterococcus based on vaginal delivery and Pluralibacter related to cesarean section. Moreover, we identified particular bacteria, such as Taonella , Patulibacter , and others, whose proportions fluctuated among preterm infants born via different delivery modes at varying time points, as well as the microbiota types and functions. These results indicated the influence of delivery mode on the composition and function of the preterm infant gut microbiota. Importantly, these effects are time-dependent during the early stages of life. These insights shed light on the pivotal role of delivery mode in shaping the gut microbiota of preterm infants and have significant clinical implications for their care and management. [ABSTRACT FROM AUTHOR]

There is limited data regarding the safety of vaginal delivery in women infected with COVID-19. Our goal was to assess the safety of vaginal delivery in women infected with COVID-19 and the risk of neonatal infection. This was a single medical center cohort study. Data were collected about the outcome of twenty-one women with laboratory-confirmed COVID-19 infection who delivered between March 23, 2020, and May 8, 2020. Twenty-one gravidas were diagnosed with COVID-19 infection. None required admission to the intensive care unit (ICU) and there were no fatalities. Seventeen delivered vaginally and four by caesareans. Apgar scores of all neonates were 9 at 1 min and 10 at 5 min. One neonate was diagnosed with COVID-19 infection 24 h after birth. Vaginal delivery in women infected with COVID-19 is not associated with a significant risk of neonatal infection. [ABSTRACT FROM AUTHOR]

Background: Repeated digital vaginal examination during labor may be uncomfortable for women and increases the risk of ascending infection. Transperineal ultrasound can assess fetal head descent, position, and cervical dilatation without these side effects. This study was conducted to evaluate the accuracy of transperineal ultrasound in monitoring labor progress. Results: The study included 40 primigravida women in labor. Fair correlation was found between the assessment of fetal head station by vaginal examination (VE) and fetal head perineal distance (HPD) by transperineal ultrasound (TPUS) (Kendall’s tau-b (τ) = − 0.299, 95% CI = − 0.479 to − 0.0863, p value =.0063) (Spearman rho = −.3844, p value =.0143; r2 = 0.1478). Strong correlation was found between the cervical dilatation assessed by VE and by TPUS (Pearson’s r =.8601, 95% CI = 0.7493 to 0.9240, p value <.0001, r2 = 0.7396). There is moderate agreement between VE and TPUS as regards the assessment of head position on the face-clock [weighted kappa (κ) =.557, 95% CI =.362 to.753]. Conclusion: Transperineal ultrasound can be used as an alternative to repeated digital examination for assessment of labor progress. [ABSTRACT FROM AUTHOR]

Background: Lower limb neurologic deficit after vaginal delivery remains poorly understood. The objective of this study was to describe the incidence, characteristics and prognosis associated with nerve injury occurring to women during vaginal delivery.Methods: A single-center observational study of women who complained about a lower limb neurologic deficit that appeared immediately after vaginal delivery. The follow-up period was up to four years.Results: Among the 10 569 women with a singleton vaginal delivery during the 30-month study period, 31 (0.3%) reported a neurologic deficit. Most women were nulliparous (71%) and the mean duration of the second stage of labor was 94 min [range 13-224 min]. In two-thirds of cases, delivery required instrumental assistance. Most neurologic deficits were sensory (67.7%) and primarily involved femoral nerve territory (83.9%). Most women recovered within six weeks (69.2%). In one case (a sensory deficit of the entire right leg), recovery only occurred after 3.5 years.Conclusion: Neurologic deficit was identified in 0.3% of our vaginal delivery population. Recovery from neurologic deficit may take many weeks and may occasionally be disabling. [ABSTRACT FROM AUTHOR]

Purpose: Hyaluronidase (HAase) has many uses in medicine, and reports suggest that it affects perineal tissue during fetal passage through the vaginal canal. However, its potential use for preventing perineal trauma has yet to be determined. This study sought to evaluate the efficacy and safety of perineal HAase injections in reducing perineal trauma during vaginal delivery. Materials and Methods: A multi-center, double-blind, placebo-controlled, randomized study was conducted from January 2016 to March 2017. Nulliparous women who planned to undergo vaginal delivery were recruited, and the enrolled women were randomly assigned to the HAase injection group (HAase injection, 5000 IU, n=75) or the control group (normal saline injection, n=73). The degree of perineal laceration, rate of episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal delivery were compared between the two groups. Results: A total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed between the HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24 hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). The overall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar between the two groups. Conclusion: HAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events. [ABSTRACT FROM AUTHOR]

Very little is known about the prevalence and risk factors of postpartum depression among women with vaginal births without major pregnancy complications. This study aimed to assess the prevalence of postpartum depression and identify its characteristics 2 months after singleton vaginal delivery at or near term. This was an ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery randomized controlled trial, which was conducted in 15 French hospitals in 2015–2016 and enrolled women with singleton vaginal deliveries after 35 weeks of gestation. After randomization, the characteristics of labor, delivery, and the immediate postpartum experience, including the experience of childbirth, were prospectively collected. Medical records provided women's other characteristics, particularly any psychiatric history. Of note, 2 months after childbirth, provisional postpartum depression diagnosis was defined as a score of ≥13 on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Associations between potential risk factors and postpartum depression were analyzed by multivariate logistic regression. Moreover, an Edinburgh Postnatal Depression Scale cutoff value of ≥11 was selected to perform a sensitivity analysis. The questionnaire was returned by 2811 of 3891 women (72.2% response rate). The prevalence rates of the provisional diagnosis were 9.9% (95% confidence interval, 8.6%–11.3%) defined by an Edinburgh Postnatal Depression Scale score of ≥13 and 15.5% (95% confidence interval, 14.0%–17.1%) with a cutoff value of ≥11. The characteristics associated with higher risks of postpartum depression in multivariate analysis were mostly related to prepregnancy characteristics, specifically age of <25 years (adjusted odds ratio, 1.8; 95% confidence interval, 1.1–2.9) and advanced age (adjusted odds ratio, 1.8; 95% confidence interval, 1.2–2.6), migration from North Africa (adjusted odds ratio, 2.9; 95% confidence interval, 1.9–4.4), previous abortion (adjusted odds ratio, 1.4; 95% confidence interval, 1.0–2.0), and psychiatric history (adjusted odds ratio, 2.9; 95% confidence interval, 1.8–4.8). Some characteristics of labor and delivery, such as induced labor (adjusted odds ratio, 1.5; 95% confidence interval, 1.1–2.0) and operative vaginal delivery (adjusted odds ratio, 1.4; 95% confidence interval, 1.0–2.0), seemed to be associated with postpartum depression. In addition, bad memories of childbirth in the immediate postpartum were strongly associated with postpartum depression symptoms at 2 months after giving birth (adjusted odds ratio, 2.4; 95% confidence interval, 1.3–4.2). Approximately 10% of women with vaginal deliveries have postpartum depression symptoms, assessed by a score of ≥13 on the depression scale that was used at 2 months. Prepregnancy vulnerability factors; obstetrical characteristics, such as induced labor and operative vaginal delivery; and bad memories of childbirth 2 days after delivery were the main factors associated with this provisional diagnosis. A screening approach that targets risk factors may help to identify women at risk of postpartum depression who could benefit from early intervention. [ABSTRACT FROM AUTHOR]

Episiotomy is a procedure during vaginal delivery to facilitate a safer delivery. However, it can also have complications including hemorrhage, perineal tears, infections, and vaginal hematoma which should be managed and monitored carefully. A 27-year-old woman with term pregnancy, had a normal vaginal delivery at 39 weeks of gestation, and a large episiotomy was performed due to the estimated neonate weight to prevent shoulder dystocia. She was complicated with a huge pelvic hematoma that was expanded to prerenal space. This complication was managed by conservative therapy, including antibiotic therapy, intensive observation of the patient's situation, and follow-up with a CT scan after consulting with a radiologist. The huge hematoma was reduced. Noninvasive management and close monitoring for pelvic hematoma due to episiotomy in a low-risk patient are successful; however, consulting with radiologists and experts and a multidisciplinary approach should be considered. • Episiotomy is a controversial issue among clinicians, and it can cause some complications, including hematoma • Huge hematoma due to episiotomy should be considered as a diagnosis even for patients without any medical or surgical history. • Conservative management for hematoma due to episiotomy in a patient without any risk factor is practical; however, it is important to consult with other experts and other therapies should be considered, [ABSTRACT FROM AUTHOR]

[Display omitted] Preterm labor is a growing health problem that causes newborn death, and safe and effective therapy is significantly needed. Arabin pessaries and progesterone are preventive and therapeutic approaches that can be applied to managing the short cervix; hence, reducing the risk of preterm labor. The main goal of current work is to fabricate a novel nanofiber formulation based on polycaprolactone (PCL) and loaded with progesterone to coat for Arabin pessaries to be used as dual preventive and therapeutic approaches for local vaginal delivery. Several important criteria were considered in this study to assess the prepared nanofibers (i.e.; nanofiber diameter, progesterone loading efficiency, progesterone release profiles and in vitro cytotoxicity assessment). The results showed a dimeter of 397 ± 88 nm, drug loading of 142 ± 3 µg/mg and encapsulation efficiency of 99 ± 2 % for the progesterone-loaded nanofibers. Approximately, 17 % of progesterone was released from the nanofibers after 90 days. The in vitro assessment showed that the application of progesterone is safe upon 24 and 48-hours incubation on HFF-1 cell line at concentrations ≤ 32 µg/mL and within 72-hours at a dose of ≤ 8 µg/mL. To conclude, the data recommended that progesterone-loaded nanofibers can coat the Arabin pessaries with the potential of being a safe and effective dual preventive and therapeutic tool for preterm labor. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School 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 Eastern Mediterranean Health Journal is the property of World Health Organization 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.)

HBV mother to child transmission (MTCT) can be prevented by passive and active immunoprophylaxis. In this study, we aim to assess whether vaginal delivery is safe for HBV MTCT after immunoprophylaxis. PubMed and Web of Science were systematically searched. We compared the MTCT incidence of infants at 6 months or older between vaginal delivery and caesarean section. Serological HBV positive incidences for newborns at birth were also compared. Eighteen studies with 11,446 mother-child pairs were included in the meta-analysis. The average incidence of serological HBV positive for newborns at birth was 7.2% in the cesarean section group, and 16.6% in the vaginal delivery group. The summary odds ratio (OR) was 0.499 (95% CI 0.364–0.684; Z = 4.33, P < 0.00001) between two groups. However, the average incidences of MTCT were 3.3% and 4.1% for the cesarean section group and the vaginal delivery group, respectively. The summary OR compared between two groups was 0.790 (95% CI 0.614 to 1.016; Z = 1.83, P = 0.067). The funnel plot, Begg's Test (z = −0.55, P = 0.583) and Egger's test (t = −0.29, P = 0.777) suggested there was no publication bias among the included studies. Sensitive analyze showed the ORs were 0.764 (95% CI 0.490 to 1.192; Z = 1.19, P = 0.236), and 0.386 (95% CI 0.132 to 1.125; Z = 1.74, P = 0.0081), respectively. The vaginal delivery did not increase the HBV MTCT incidence after immunoprophylaxis at 6 months old or more. The existing evidence does not support the conclusion that caesarean section can prevent MTCT in HBsAg-positive mother after immunoprophylaxis. However, this conclusion should be cautious in the HBV mother with high viral load. [ABSTRACT FROM AUTHOR]

Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79–1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P =.06). The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the contribution of the duration of skin-to-skin contact (SSC) on blood glucose levels at 2 hours after birth in healthy full-term infants. This observational study was done at one of the baby-friendly hospitals located in Aichi, Japan in 2009. Sixty newborn infants who were born vaginally from uncomplicated pregnancies were participated. All infants were held SSC within 5 minutes. All data regarding neonatal information, blood glucose levels at 2 hours of age, and maternal information were obtained from their medical history. Multiple linear regression analysis was performed to identify the independent contribution of the duration of SSC. The mean duration of SSC was 59.6 ± 13.6 minutes (range: 11.0-97.0 minutes) and the infant blood glucose level was 53.1 ± 9.5 (range: 30.0-80.0 mg/dL) mg/dL. The duration of SSC (β [95% confidence interval] = .282 [range: 0.037-0.357], standardized β = .282, P < .017) was significantly and positively associated with infant blood glucose levels independent of gestational age, birth weight, sex, length of second-stage labor, and mode of delivery. Thus, the longer early SSC was associated with higher blood glucose level at 2 hours of age in healthy full- term infants. [ABSTRACT FROM AUTHOR]

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem 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 Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine 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 Archivos Venezolanos de Puericultura y Pediatría is the property of Sociedad Venezolana de Puericultura y Pediatria 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.)

The article explores the experiences of South African multiparous labouring women on their use of the birthing ball during the first stage of labour. The authors used a qualitative research approach using unstructured audiotaped interviews as the data collection method and data were collected over a period of one calendar month. The sample for the study were women who were six hours to six weeks post-delivery, had at least one child already, used the birthing ball, were on no medication, and had delivered a live infant. The sample consisted of twelve purposively selected participants, two of whom were used for the pilot study. The data analysis method was Data Analysis Spiral. The authors made use of an independent coder to assist with coding the data and three major themes were identified. The results revealed that the labouring women experienced the birthing ball as a useful labour tool, as shortening the labour process and as empowering them during labour. [ABSTRACT FROM AUTHOR]

Because cesarean section delivery has significantly increased in recent decades, it raises questions about the differences between the mode of delivery -- vaginal delivery versus unplanned and planned cesarean section delivery -- and its influence on parental behavior and infant well-being. Many prenatal researchers and infant therapists consider cesarean section to be traumatic, physically and psychologically, for both the mother and the newborn, with implications for the individual's life as an infant, as a child, and as an adult. This paper focuses on the deprivation in duration and continuity and the all-or-nothing quality of the physical and psychological stimulation associated with cesarean section delivery and the possible influence of this procedure over a person's life span. The theoretical basis for this discussion is Bion's "caesura" model drawing on a statement by Freud, "Continuity exists between life prior to birth and following birth even though there is an impressive 'caesura' between them." Freud developed the idea of a connection between postnatal thought, emotional life and prenatal experience. The birth process and the caesura itself are the most dramatic and sharp separations in human life. [ABSTRACT FROM AUTHOR]

Background To determine the frequency of postpartum stress urinary incontinence (SUI) in women undergoing vaginal delivery or elective cesarean section and to investigate the sociodemographic determinants of SUI in a sample of Iranian patients. Methods This prospective cohort study was performed during a 1-year period from 2014 to 2015 including 286 healthy nulliparous women in the third trimester of pregnancy without prepregnancy urinary incontinence. Participants were categorized based on the mode of delivery, i.e., vaginal delivery ( n = 148) and elective cesarean section ( n = 138). SUI was evaluated in all the participants before delivery and at 1 month, 6 months, and 12 months after delivery using a previously validated Persian questionnaire. The frequency of postpartum SUI was recorded in both study groups and was compared between them. We also determined the sociodemographic determinants of SUI. Results Baseline characteristics were comparable. The frequency of postpartum SUI was significantly higher in vaginal delivery than in cesarean section after a 1-month ( p < 0.001), 6-month ( p < 0.001), and 12-month ( p < 0.001) period. Age was found to be associated with increased frequency of postpartum SUI in both vaginal delivery ( p = 0.021, r = 0.286) and cesarean section groups ( p = 0.043, r = 0.125). SUI was associated with tool-assisted vaginal delivery ( p < 0.001) and episiotomy ( p < 0.001). The birth weight was positively correlated with increased frequency of postpartum SUI in both vaginal delivery ( p = 0.011, r = 0.546) and cesarean section ( p = 0.034, r = 0.311). Patients with SUI had a significantly higher body mass index than the normal individuals ( p = 0.038). SUI was associated with lower income ( p = 0.028) and lower neighborhood residence ( p = 0.033). Conclusion Vaginal delivery is associated with a twofold increased risk of postpartum SUI in primipara women compared with elective cesarean section. Age and birth weight are the main risk factors of postpartum SUI in both modes of delivery. Tool-assisted delivery and episiotomy were determined as the risk factors of postpartum SUI in vaginal delivery. [ABSTRACT FROM AUTHOR]

Summary “RESEAU MATER” is useful to monitor nosocomial infections in maternity and contributes to the decreasing trend of it, since its implementation. Specifically, this network demonstrates its efficiency in the control of endometritis following vaginal deliveries, but not in the control of urinary tract infections. The aim of this study is to determine whether the difference between the control of endometritis and of urinary tract infection could be explained by an unsuitable regression model or by an unsuitable care policy concerning urinary cares. This study includes (1) the analysis of historic data of the network and (2) the description of French guidelines for maternity cares and available evaluations, concerning endometritis and urinary tract infection prevention. Univariate and multivariate odds ratios (ORs) were calculated for the total study period of 1999–2013, for these infections and their risk factors. The endometritis frequency is decreasing, in association with no significant evolution of associated risk factors, but urinary tract infection frequency is constant, in association with a increasing trend of its risk factors such as intermittent catheterization and epidural analgesia. In French guidelines, all preventive measures against endometritis are clearly broadcasted by all field operators, and repeated audits have reinforced the control of their application. But preventive measures against urinary tract infection seem to be broadcasted exclusively in the circle of infection prevention agencies and not in the obstetrics societies or in the Health Ministry communication. Urinary tract infection prevention requires a clearer public and professional policy in favor of a more efficient urinary cares, with a specific target to maternity. [ABSTRACT FROM AUTHOR]

Background: There are few studies on maternal haemodynamic changes during labour. None have used continuous cardiac output monitoring during all labour stages. In this observational study, we monitored haemodynamic variables continuously during the entire course of labour in healthy parturients.Methods: Continuous haemodynamic monitoring with the LiDCOplus technique was performed in 20 healthy parturients during spontaneous labour, vaginal delivery and for 15minutes postpartum. Cardiac output, stroke volume, heart rate, systemic vascular resistance, and systolic arterial pressure were measured longitudinally at baseline (periods between/without contractions) and during contractions in early and late stage 1, stage 2, during delivery, and postpartum, and were analysed with marginal linear models.Results: Twenty parturients were included. In early stage 1, baseline cardiac output was 6.3L/min (95% CI 5.7 to 6.9). Baseline values were similar across both labour stages and postpartum for all haemodynamic variables. During stage 2 contractions, cardiac output decreased by 32%, stroke volume decreased by 44%, heart rate increased by 52%, systemic vascular resistance increased by 88%, and systolic arterial pressure increased by 36% compared to baseline. During stage 1 contractions, haemodynamic changes were less profound and less uniform than during stage 2.Conclusion: Progression of labour had no major effect on haemodynamic baseline values. Haemodynamic stress during contractions was substantial in both labour stages, yet most pronounced during the second stage of labour. The absence of an increase in stroke volume and cardiac output postpartum questions the common belief in an immediate rise in cardiac output after delivery due to autotransfusion from the contracted uterus. [ABSTRACT FROM AUTHOR]

Objective: The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery. Materials and Methods: A retrospective study was conducted at Dr. Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5 min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions. Results: A total of 205 (3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52 cases) vaginal and 74% (153 cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1 min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476-16.870], P = 0.0001) and 5 min (OR 95% CI =7.727 [1.416-42.175], P = 0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18-6.26, P = 0.0001). Conclusions: There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs. [ABSTRACT FROM AUTHOR]

Bioadhesive films using tamarind seed polysaccharide were prepared for the treatment of candida vaginitis using nystatin as the model drug. Films were prepared by solvent casting method. A 32 factorial design was employed to study the effect of independent variables (polymer and plasticizer concentration) on a range of dependent variables namely mechanical, swelling, interfacial, and bioadhesive properties through response surface methodological approach, using Design Expert® software. Formulation composition that provided the most desired and optimized results was selected using desirability approach. Nystatin was solubilized using Tween 60 and was incorporated into the selected film. Drug solubilization and dispersion were confirmed by scanning electron microscopy and differential scanning calorimetry. The optimized film released 73.92± 2.54% of nystatin at the end of 8 h in simulated vaginal fluid and the release data showed best fit to Korsmeyer-Peppas model with R2 of 0.9990 and the release mechanism to be super case-II. The optimized film also showed appropriate anti candida activity through appearance of zone of inhibition during antifungal activity testing study. [ABSTRACT FROM AUTHOR]

The long-term effects of vaginal delivery, parity, and pregnancy on the pelvic floor remain uncertain and controversial issues. In comparison with studies using self-reported symptoms, surgical register data may offer a more valid means for evaluating the relative influence of these risk factors. This study used data from 3 high-quality nationwide registers, namely the Swedish National Quality Register of Gynecological Surgery, the Swedish Medical Birth Register, and the Total Population Register, to evaluate the contribution of vaginal and cesarean delivery, parity, and factors not related to childbirth to the long-term risk for reconstructive urogenital surgery. This was a register-based linkage study among women aged ≥45 years who underwent urinary incontinence or prolapse surgery from 2010 to 2017. This surgical cohort was divided into nulliparous women, women with ≥1 cesarean deliveries only, those with ≥1 vaginal deliveries, and according to the number of births. A corresponding reference group was constructed based on women born in 1960 from the Total Population Register (n=2,309,765). The Swedish Medical Birth Register was used to determine the rate of women with cesarean and vaginal delivery and their respective parity. Absolute and relative risk were presented per 1000 women with 95% confidence intervals. Pairwise differences were analyzed with Fisher exact tests and the Mann-Whitney U test for dichotomous and continuous variables. The trend between ≥3 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics. A total of 39,617 women underwent prolapse surgery and 20,488 underwent incontinence surgery. Among women with prolapse surgery, 97.8% had ≥1 vaginal delivery, 0.4% had ≥1 cesarean delivery only, and 1.9% were nullipara. Corresponding figures for those with incontinence surgery were 93.1%, 2.6%, and 4.3%, respectively. Women with vaginal deliveries were overrepresented in the prolapse surgery (relative risk, 1.23; 95% confidence interval, 1.22–1.24; P <.001) and incontinence surgery groups (relative risk, 1.17; 95% confidence interval, 1.15–1.19; P <.001). Nulliparous and cesarean delivered women were underrepresented in the prolapse surgery (relative risk, 0.14; 95% confidence interval, 0.13–0.15 and relative risk 0.055; 95% confidence interval, 0.046–0.065; all P <.001) and incontinence surgery groups (relative risk, 0.31; 95% confidence interval, 0.29–0.33 and relative risk, 0.40; 95% confidence interval, 0.36–0.43). The absolute risk for prolapse surgery was lowest after cesarean delivery (0.09 per 1000 women; 95% confidence interval, 0.08–0.11) and differed by a factor of 23 (absolute risk, 2.11 per 1000 women; 95% confidence interval, 2.09–2.13) from that after vaginal birth. The absolute risk for prolapse and incontinence surgery increased consistently with parity after vaginal births. This trend was not observed after cesarean delivery, which is on par with that of nulliparous women. The first vaginal birth contributed the highest increase in the absolute risk for pelvic organ prolapse surgery (6-fold) and stress urinary incontinence surgery (3-fold). The second vaginal birth contributed the lowest increase in the absolute risk for pelvic organ prolapse surgery (∼1/3 of the first vaginal birth) and for stress urinary incontinence surgery (∼1/10 of the first vaginal birth). Surgery for urinary incontinence and prolapse was almost exclusively related to vaginal parity. The risk for prolapse surgery increased consistently with parity after vaginal births but not after cesarean delivery, whereas the risk associated with cesarean delivery was on par with that of nulliparous women. Thus, cesarean delivery seems to offer protection from the need for pelvic organ prolapse and stress urinary incontinence surgery later in life. [ABSTRACT FROM AUTHOR]

Background: Despite the strong association between vaginal childbirth and pelvic floor dysfunction, genetic factors, pregnancy, advancing age, and lifestyle also play a role. The pelvic floor undergoes substantial changes during pregnancy, which may contribute to pelvic floor dysfunction. Conversely, these changes may be favorable for vaginal delivery. However, there is a lack of studies assessing pelvic floor symptoms over time according to delivery mode and including predelivery assessment.Objective: This study aimed to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy up to 8 years after the first delivery, stratified by delivery mode.Study Design: This was a longitudinal observational cohort study. A total of 300 nulliparous women were recruited during their first pregnancy. Pelvic floor symptoms were assessed at 21 and 37 weeks of gestation, and at 6 weeks, 6 months, 12 months, and 8 years after first delivery using the International Consultation on Incontinence Questionnaire modules: the urinary incontinence sum score, the weighted vaginal symptom sum score, the vaginal-associated quality of life score, the bowel control sum score, and the bowel-associated quality of life sum score. Delivery mode at first delivery defined delivery groups as: normal vaginal, operative vaginal, and cesarean delivery. A linear mixed-model analysis was used to assess symptom scores over time and differences in symptom scores between the delivery groups.Results: Of the 300 women included in the study, 193 attended the 8-year follow-up. Pelvic floor symptoms differed between women who had vaginal delivery and those who had cesarean delivery. The symptom scores showed a nonlinear statistically significant trend. In women who delivered vaginally, there was an increase of urinary incontinence and vaginal symptom scores already during pregnancy. In women who later delivered by cesarean, there was a decrease of symptom scores during pregnancy, and overall lower symptom scores relative to women who had vaginal delivery at 12 months after the first delivery. Pelvic floor symptom scores increased from 12 months to 8 years after the first delivery and exceeded pregnancy levels in all delivery groups; however, overall symptom scores were low. Differences between delivery groups were not statistically significant.Conclusion: Pelvic floor symptoms differed between women who had vaginal delivery and those who had cesarean delivery from the first pregnancy up to 8 years after the first delivery. These differences were already recognizable before the first delivery. [ABSTRACT FROM AUTHOR]

Introduction and objectives. The aim of this study is to highlight predictors or predisposing factors of stress urinary incontinence (SUI) in order to help clinicians during their treatment decisions and establish a preventive strategy to decrease the incontinence rate among women. Materials and methods. We performed a retrospective study over a period of 3 years (January 2012-December 2014) in Mure? County Hospital, Clinic of Urology. We examined 113 women with urinary incontinence and we established the following diagnosis: stress urinary incontinence in 68 cases (60%), urge urinary incontinence in 26 cases (23%) and mixed urinary incontinence in 19 cases (17%). The selection criteria for this study were female patients diagnosed with stress urinary incontinence having indication of surgical treatment (transobturator tape-TOT). We included in this study 24 patients admitted in the hospital. Results. Regarding the distribution of the patients depending on age group we observed that SUI was predominant in the 60-69 years age group (12 cases), followed by 70-79 years (6 cases), 50-59 years (4 cases) and 40-49years (2 cases). The mean age was 64,25+/-8,25 (standard deviation) years old with extremities between 41 to 46 years old. For the statistical analysis we applied Fisher's test, Chi-square test and unpaired test and we compared the group having SIU with a group of 47 patients without the disease. We analyzed the data and we observed that increased age, pregnancies, vaginal delivery, menopause, body mass index (BMI), diabetes and hysterectomy represents risk factors for SUI and that there is a significant relation between SUI and those factors, p<0,05. Statisticaly, we found no relation between caesarian, urinary tract infections, genital prolapse, neurological diseases and SUI, p was insignificant. Conclusions. Stress urinary incontinence is frequent in middle age women. Multiple predictors like age, pregnancy, vaginal delivery, menopause, high body mass index, hysterectomy had been found to be associated with SUI. Recognizing these predisposing factors, we can develop in time prevention techniques which can reduce the development and progression of symptomatology in SUI. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine the preferences of nulliparous women and their partners in giving birth and the reasons for these preferences. Methods The sample in this cross-sectional study consisted of 162 pregnant women in the last trimester of pregnancy and their partners. Data collection was accomplished using a questionnaire. Results It was found that most women (90.8%) and their partners (92%) preferred a vaginal birth. The couples' birth preferences were generally similar to one another. The main reasons for the choice of a vaginal birth were that it was natural and healthier for the mother and child and that recovery and discharge from the hospital were quicker. The main reasons for the choice of cesarean section were fear of childbirth and not putting the baby at risk. Conclusions Antenatal education may help to reduce the number of elective cesarean sections by changing the negative perceptions of vaginal birth and reducing the fear of childbirth. [ABSTRACT FROM AUTHOR]

Background Moyamoya disease more commonly occurs in young people and women, so patients with this disease may experience pregnancy and delivery. Cesarean section (CS) is often chosen as the mode of delivery for these patients in Japan. No appropriate mode of delivery has yet been established for pregnant women with moyamoya disease in terms of stroke prevention. We have used vaginal delivery under epidural analgesia (EA) in such patients unless CS has been indicated for the maternal or fetal reasons. This study retrospectively analyzed our patients with moyamoya disease who gave birth to confirm the safety of vaginal delivery under EA. Methods Twelve consecutive patients diagnosed with moyamoya disease had 14 deliveries at our hospital between September 2004 and January 2013. The incidences of intrapartum stroke were compared between cases of vaginal delivery under EA and CS cases. Results Ten vaginal deliveries under EA and 4 elective CSs were performed. No intrapartum stroke was observed during either vaginal delivery under EA or CS. Among the patients who underwent vaginal delivery under EA, 1 parturient who experienced 2 deliveries suffered transient ischemic attack during both postpartum periods. All 14 infants were healthy without sequelae. Conclusions Vaginal delivery under EA is an option for patients with moyamoya disease, provided that close cooperation with neurosurgeons, obstetricians, and anesthesiologists is assured. [ABSTRACT FROM AUTHOR]

Background: Peripartum quantitative blood loss (QBL) measurement is recommended over visual estimation. However, QBL measurement after vaginal delivery has been inadequately evaluated. The primary aim of this study was to determine the characteristics of QBL measurements from a large, multicenter cohort of patients having vaginal deliveries. We also determined the incidence of postpartum hemorrhage (PPH) and the relationship between gravimetric QBL from weighed sponges vs. volumetric QBL from liquid drape or suction cannister contents.Methods: Data were collected from 41 institutions in the United States of America that use an automated QBL device after vaginal delivery as part of routine care. The QBL device tracks cumulative blood loss based on gravimetry and volumetric V-drape assessment, automatically subtracting the dry weights of all blood-containing sponges, towels, pads and other supplies as well as the amniotic fluid volume.Results: Between January 2017 and April 2020, 104 079 QBL values were obtained from patients having vaginal deliveries. Total median [IQR] QBL was 171 [61-362] mL. The PPH incidence, stratified by QBL, was 15.2% (>500 mL), 3.4% (>1000 mL), and 1.0% (>1500 mL). The contribution of QBL from V-drapes was 60.6±26.3% of total QBL.Conclusion: Results from this large set of QBL measurements and the PPH incidence provide normative "real-world" clinical care values that can be expected as hospitals transition from estimated blood loss to QBL to assess the blood loss at vaginal delivery. [ABSTRACT FROM AUTHOR]

Background: During the second stage of labor, the maternal pelvic floor muscles undergo repetitive stretch loading as uterine contractions and strenuous maternal pushes combined to expel the fetus, and it is not uncommon that these muscles sustain a partial or complete rupture. It has recently been demonstrated that soft tissues, including the anterior cruciate ligament and connective tissue in sheep pelvic floor muscle, can accumulate damage under repetitive physiological (submaximal) loads. It is well known to material scientists that this damage accumulation can not only decrease tissue resistance to stretch but also result in a partial or complete structural failure. Thus, we wondered whether certain maternal pushing patterns (in terms of frequency and duration of each push) could increase the risk of excessive damage accumulation in the pelvic floor tissue, thereby inadvertently contributing to the development of pelvic floor muscle injury.Objective: This study aimed to determine which labor management practices (spontaneous vs directed pushing) are less prone to accumulate damage in the pelvic floor muscles during the second stage of labor and find the optimum approach in terms of minimizing the risk of pelvic floor muscle injury.Study Design: We developed a biomechanical model for the expulsive phase of the second stage of labor that includes the ability to measure the damage accumulation because of repetitive physiological submaximal loads. We performed 4 simulations of the second stage of labor, reflecting a directed pushing technique and 3 alternatives for spontaneous pushing.Results: The finite element model predicted that the origin of the pubovisceral muscle accumulates the most damage and so it is the most likely place for a tear to develop. This result was independent of the pushing pattern. Performing 3 maternal pushes per contraction, with each push lasting 5 seconds, caused less damage and seemed the best approach. The directed pushing technique (3 pushes per contraction, with each push lasting 10 seconds) did not reduce the duration of the second stage of labor and caused higher damage accumulation.Conclusion: The frequency and duration of the maternal pushes influenced the damage accumulation in the passive tissues of the pelvic floor muscles, indicating that it can influence the prevalence of pelvic floor muscle injuries. Our results suggested that the maternal pushes should not last longer than 5 seconds and that the duration of active pushing is a better measurement than the total duration of the second stage of labor. Hopefully, this research will help to shed new light on the best practices needed to improve the experience of labor for women. [ABSTRACT FROM AUTHOR]

During a normal vaginal delivery, the muscle cells propagate electrical signals throughout the uterine wall, resulting in uterine contractions. However, uncoordinated uterine activity may disturb the uterine contractions pattern and negatively impact fetal and maternal health. Some of the abnormalities identified by the specialists are excessively short resting intervals and tachysystole. This work aims to investigate the influence of abnormal uterine activity in terms of maximum principal stress distribution and collagen fibers stretch in the uterine tissue during vaginal delivery with (i) excessively short resting intervals without changing the contraction time, and (ii) tachysystole (contraction and reduced resting times). These patterns are compared with a normal uterine contraction pattern. To achieve our aims, a biomechanical model was developed, including finite element models of the uterus and the fetus, and an electro-chemo-mechanical constitutive model. Generally, the excessively short resting intervals exhibit higher average maximum principal stresses during the contraction and resting stages, lower average fibers stretch values in the longitudinal direction and higher stretch in the circumferential direction. On the other hand, the tachysystole exhibit generally lower stress values during the uterine contraction and higher stress values during the resting stages, higher stretch in the longitudinal direction, and lower stretch in the circumferential direction. [ABSTRACT FROM AUTHOR]

Background It is unclear whether antenatal fibrinogen concentrations are associated with postpartum haemorrhage. Methods This retrospective study included 871 women with a singleton pregnancy but no known risk factors for postpartum haemorrhage, in whom fibrinogen concentration was measured within the 21 days before delivery. Correlation between antenatal fibrinogen concentrations and estimated blood loss was analysed. We tested the hypothesis that the risk of postpartum haemorrhage was higher in women with antenatal fibrinogen concentrations of <3.3 g/L. Postpartum haemorrhage was defined as an estimated blood loss ⩾700 mL following vaginal delivery and ⩾1000 mL following caesarean delivery. Results In women delivering vaginally ( n = 337), estimated blood loss tended to increase with decreasing antenatal fibrinogen concentration ( R = −0.107, P = 0.05), median fibrinogen concentration was significantly lower in 69 women with postpartum haemorrhage than in 268 women without postpartum haemorrhage (3.93 vs. 4.18 g/L, P = 0.025), and postpartum haemorrhage occurred significantly more often in women with fibrinogen concentrations <3.3 g/L than in those with concentrations ⩾3.3 g/L (38% [11/29] vs. 19% [58/308], P = 0.018). In women undergoing caesarean delivery ( n = 534), median fibrinogen concentration did not differ between those who experienced postpartum haemorrhage ( n = 128) and those who did not ( n = 406) (4.18 g/L vs. 4.07 g/L, P = 0.43). Antenatal fibrinogen concentrations of <3.3 g/L were not associated with higher rates of postpartum haemorrhage (26% [11/43] vs. 24% [117/491], P = 0.80). Conclusions Antenatal fibrinogen concentration <3.3 g/L may be a risk factor for postpartum haemorrhage among women following vaginal delivery. [ABSTRACT FROM AUTHOR]

Purpose To epidemiologically investigate the relationship between a heavy for gestational age infant (HGA) and postpartum hemorrhage (PPH) resulting mainly from uterine atony. Methods This retrospective observational study included Japanese women at a single tertiary obstetric hospital in Tokyo metropolitan area. The inclusion criteria were as follows: 1) vaginal delivery between 2007 and 2010, 2) single delivery at term, 3) primipara, and 4) maternal age of ≥20 years. HGA is defined as an infant with a birth weight greater than the 90th percentile of the new intrauterine growth curves in Japan. The primary outcomes were PPH (blood loss, ≥500 ml) and severe PPH (SPPH; blood loss, ≥1,000 ml). Multiple logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) of PPH and SPPH in association with HGA. Results Of the 2,340 women studied, PPH and SPPH were found to occur in 593 (25.3%) and 63 (2.7%) women, respectively. The results of the multivariate analyses indicated that HGA was significantly associated with PPH (adjusted OR 2.34, 95% CI 1.71-3.19) and SPPH (adjusted OR 2.43, 95% CI 1.21-4.86). Conclusion HGA was considered an independent risk factor for PPH that results mainly from uterine atony. Thus, physicians and midwives could identify women at risk for PPH from uterine atony before delivery. [ABSTRACT FROM AUTHOR]

Physicians sometimes worry that women who have not given birth will have more difficulty with an intrauterine device, experiencing a higher expulsion rate. But the results of a recent study show that the opposite is true. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss vs. actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status.Methods: For this observational cohort study, photographs were taken of 18 blood loss scenarios for vaginal delivery and cesarean delivery, and six photographs were duplicated and annotated with maternal vital signs. Scenarios were categorized into 50% (500 mL), 100% (1000 mL) and 200% (2000 mL) of the defined blood loss volume for postpartum hemorrhage and the photographs were shown to participants to visually estimate blood loss volumes.Results: The mean ± standard deviation estimates of actual 500 mL, 1000 mL and 2000 mL blood loss volumes were 1208 ± 438 mL, 1676 ± 630 mL and 2637 ± 1123 mL, respectively (P <0.001 among groups). The difference was significantly greater in vaginal delivery than cesarean delivery scenarios (1064 ± 849 mL vs. 284 ± 456 mL; P <0.001). Estimated blood loss volume was not influenced by blood loss distribution/location, or by provider group or experience. The cardiovascular status of the patient impacted estimations only if tachycardia and hypotension were present.Conclusions: Most providers significantly overestimated blood loss volumes (by nearly 700 mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training. [ABSTRACT FROM AUTHOR]