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Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress. [ABSTRACT FROM AUTHOR]

The International Journal of Gynecology & Obstetrics has announced the winner of the John J. Sciarra IJGO Prize Paper Award for 2023. The winning paper, titled "Efficacy of combination of transcervical Foley catheter and sublingual misoprostol versus sublingual misoprostol for labor induction in pre‐eclampsia at 28–34 weeks," compares different methods of labor induction for women with pre-eclampsia. The study found that the combination approach achieved higher rates of vaginal birth within 24 hours compared to using misoprostol alone, with similar neonatal outcomes. This research highlights the importance of finding effective labor induction methods to reduce maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. The article also mentions other papers that received honorable mentions for their contributions to clinical research in the field of gynecology and obstetrics. The IJGO Prize Paper Award aims to encourage investigators from low- and middle-income countries to submit their best clinical research articles for publication. [Extracted from the article]

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

Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations. [ABSTRACT FROM AUTHOR]

The article offers several papers related to study of different diseases. Analysis on postoperative urinary incontinence after total abdominal hysterectomy or supracervical hysterectomy showed no statistical difference in the risk of developing stress or urge urinary incontinence in women who underwent supracervical hysterectom. The study of factors associated with worsening and improving urinary incontinence across the menopausal transition concludes that in midlife incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. The study of racial disparity in the success and complications of vaginal birth after cesarean delivery conludes that African American women are less to experience a uterine rapture.

Background: The Internet is a widely utilized platform for accessing health-related information and pregnant women are no different in this regard. The aim of the present study was to review and describe the use of the internet as a source of information during pregnancy. Methods: This systematic review was conducted by searching electronic databases such as PubMed until May 2023. The author also conducted general Internet searches using combinations of the search terms in the Google search engine. The search terms were as follows: pregnancy, "pregnancy period", "pregnant women", internet, network, information, "information sources", "information resources", "information tools", and "information providers". The search was limited to English language papers without limitations regarding publishing dates. Quantitative studies were sought, that reported original research and described Internet use by pregnant women and women within one year postpartum. Results: Fifteen articles met the inclusion criteria and were included in the review. This systematic review found that women used the Internet as a source of information during pregnancy. The most often mentioned topics of interest were fetal development, stages of delivery and nutrition. Women generally find health information on the internet as reliable and useful. Some papers included in this review found that higher education is associated with increased Internet use and the pregnant women with a university degree used the Internet more than women with less than a high school education, and that nulliparous women were more likely to seek information than multiparous women. Conclusions: Most of the pregnant women did not discuss the information they have retrieved from the Internet with their health providers. Consequently, healthcare providers should be prepared to support women in effectively navigating online resources, as well as interpreting and integrating the retrieved knowledge. [ABSTRACT FROM AUTHOR]

Shoulder dystocia is a well-known and feared complication in obstetrics that can have serious consequences for both the fetus and the birthing parent. Obstetricians and midwives are aware of the risk and have various procedures to intervene in such cases. Four papers in the journal Acta Obstetricia et Gynecologica Scandinavica provide insights into managing and counseling on shoulder dystocia. These papers discuss the use of obstetric maneuvers, team performance in real-life situations, recurrence rates, and the choice of delivery method in subsequent pregnancies. The findings highlight the need for improved training, counseling, and shared decision-making between patients and doctors. [Extracted from the article]

Aim: This study aimed to identify the effects of a web‐based birth preparation programme based on the Health Belief Model and supported by motivational interviews on fear of childbirth, self‐efficacy and the labour process in primigravida women. Methods: The study was conducted in a single‐blind, randomized controlled design with 73 pregnant women. The Birth Health Belief Scale, the Wijma Delivery Expectation/Experience Questionnaire A‐B, the Childbirth Self‐efficacy Scale and the Labour Process Assessment forms were used to collect data. Five sessions of motivational interviews were held with the pregnant women in the experimental group, while those in the control group were administered placebo education. Results: Fear of birth was lower, and the birth self‐efficacy total score was higher in the experimental group. None of the groups indicated significant differences in terms of their mode of delivery. Conclusion: Health Belief Model‐based web‐based birth preparation programme and motivational interviews were found to reduce the fear of birth, increase self‐efficacy and positively affect the birth process in primigravida women. Summary statement: What is already known about this topic? Caesarean delivery is an important health problem that is common all over the world.Fear of childbirth and low self‐efficacy are two important reasons for the increase in the frequency of caesarean section rates.Nurses can make important contributions to the prevention of optional caesarean birth by providing women with health education.What this paper adds? The web‐based birth preparation programme based on the Health Belief Model and motivational interview decreased fear of birth and improved attitudes and behaviours towards vaginal delivery by increasing health beliefs and birth self‐efficacy.The implications of this paper: This study brings a new perspective, indicating that a birth preparation programme based on the Health Belief Model and supported by motivational interviews with primigravida women is an effective method of preventing elective caesarean delivery.It is recommended that nurses use web‐based training tools and conduct cognitive behavioural strategies in antenatal classes. [ABSTRACT FROM AUTHOR]

Aim: To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn. Methods: This systematic review and meta‐analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included. Results: The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta‐analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need. Conclusion: This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process. Summary statement: What is already known about this topic? Hydrotherapy is a non‐pharmacological technique used in labour.Studies showed that hydrotherapy applied in the first stage of labour is an effective technique for lessening the intensity of labour pain, reducing the need for assisted vaginal childbirth and augmentation and lowering episiotomy rates. What this paper adds This study summarizes the evidence that hydrotherapy is effective in increasing vaginal birth rates and comfort, reducing pain during labour and assisted vaginal birth rates.This review revealed that hydrotherapy does not impact the duration of the first and second stages of labour, perineal trauma or episiotomy, the use of pain relief, labour augmentation, intrapartum/postpartum haemorrhage and neonatal outcomes. The implications of this paper: Increasing availability for reliable evidence about the effectiveness of hydrotherapy for reducing pain in the first stage of labour and rates of assisted vaginal birth, increasing vaginal birth rates, comfort and satisfaction is likely to be beneficial both in theory and practice for all stakeholders, including pregnant women, midwives, nurses and obstetricians. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth. Methods: In this cross‐sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B. Results: The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow‐ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow‐up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth. Conclusions: The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth. Summary statement: What is already known about this topic? Fear of childbirth (FOC) is a problem experienced by most women.Sociodemographic characteristics and past experiences can increase FOC.Birth interventions are common as the majority of births in Turkey take place in health institutions. What does this paper add? Women who have vaginal births appear to have severe and clinical levels of fear of childbirth. Multiparity, mobilization, high birth satisfaction and positive approaches by health care providers are strong predictors of reduced FOC.Enema, amniotomy and fundal pressure application, high‐intensity labour pain and a long duration of labour are strong predictors of increased FOC. The implications of this study: Many current routine interventions during childbirth should be avoided.The reduction of interventions in vaginal birth and support from health professionals during labour can be effective in reducing fear of childbirth and negative consequences related to FOC, as well as helping to achieve non‐invasive vaginal deliveries.It is recommended that hospitals be organized in line with the criteria of mother‐friendly hospitals, health professionals be trained and the environments in which women give birth be improved. [ABSTRACT FROM AUTHOR]

Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. Methods: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. Results: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. Conclusion: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals. Plain English Summary: Introduction: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project – PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. Method: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. Results: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. Conclusion: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals. [ABSTRACT FROM AUTHOR]

Perinatal cohort studies with a prospective longitudinal design are critical for determining the effects of early-life exposures on offspring's health outcomes. The Sri Lanka Mother and Newborn Growth cohort study aims to investigate the impact of maternal nutritional and psychosocial factors on newborns' birth weight in the Sri Lankan context. This paper presents the methodology of participant recruitment, follow-ups, an overview of measurements, and planned data analyses. This study included a nationally representative sample of Sri Lankan pregnant women recruited in their first trimester of pregnancy. Follow-up assessments were conducted once during the second and third trimesters of pregnancy and after the baby's birth, prospectively tracking the women's dietary intake, mental health, hemoglobin concentrations, and gestational weight gain data. Once the participants delivered their babies, the data on gestational age, sex of the newborn, birth weight, length and occipitofrontal circumference at birth, and mode of delivery were collected. Between August 2022 and August 2023, we recruited 2000 first-trimester pregnant women to the cohort and continued to follow up with them until the baby's birth. The response rates were 90.4%, 81.4%, and 75.2% in the first, second, and third follow-ups. We plan to analyze the data in July 2024. We expect this study to provide valuable insights into various early-life exposures affecting neonatal birth weight. The study's findings will serve as a valuable information resource for a broader scientific community, enabling the development of effective policies to prevent low-birth-weight deliveries in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. Methods: PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case–control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. Results: Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. Conclusion: Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD. [ABSTRACT FROM AUTHOR]

The number of obstetric departments in German hospitals has declined in the last decades. In particular, rural hospitals are challenged to sustain their delivery services. In this paper, we analyse the role of variation and overheads of obstetric departments from the perspective of current and future German hospital financing. For this purpose, we develop a Monte Carlo simulation model that analyses the workload of the labour room and the obstetric ward. The results show that a hospital with less than 640 deliveries per year cannot break even. In order to offer services 24 h per day, 365 days per year, five nurses, five midwives, and five gynaecologists are needed. This results in high fixed costs. At the same time, the variation coefficient of the labour room and the obstetric ward declines with an increasing number of deliveries. Consequently, small hospitals have a higher risk of over- and under-utilization in the course of the year. This paper acknowledges that economics is not the only decision dimension. The quality of the institution and the transport to the hospital have to be considered, as well as the population's wish for nearby services. However, the simulations clearly demonstrate that unless the hospital financing system is changed fundamentally, the decline in the number of hospitals offering delivery services will continue. [ABSTRACT FROM AUTHOR]

Aims: To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives. Design: A systematic integrated mixed methods review was conducted. Data sources: MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches. Review methods: Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes. Results: Thirty seven articles (29 studies) were included—quantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It's your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia. Conclusion: The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the "swing" within these factors directly affected whether birthing pool use was facilitated or inhibited. Plain English Summary: During childbirth, most women wish to use a pain management technique; some prefer to use medications and others prefer non-medication methods. Another option is to use a birthing pool, larger than a typical bath, that encourages buoyancy and the freedom to move. The warm water can also offer comfort, relaxation and pain relief. Extensive studies have demonstrated birthing pool use during childbirth is safe for mothers and babies. It is associated with reduced medical interventions (e.g. speeding up labour and cuts to the perineum), improved outcomes (e.g. satisfaction, less pain or excessive bleeding after birth). Given these positive outcomes, we wanted to explore any barriers or facilitators for birthing women and people accessing birthing pools so we could help improve access for those wishing to use one. We gathered and assessed the literature to explore these aspects. We included quantitative and qualitative studies exploring the perspectives of different maternity professionals and those of organisations. We reviewed 37 studies from 12 countries (from 2004 to 2020). We found that birthing pool use was a viable option when all maternity professional groups and their organisational guidelines or policies valued and supported its use. Conversely, in other organisations, multiple barriers prevented the use of birthing pools as an equally viable option to medication pain relief options. These barriers were influenced by the beliefs of different maternity professional groups, organisational guidelines or policies (where some were highly restrictive) whether midwives were supported to offer care in birthing pools or whether the midwives had the confidence to do so. [ABSTRACT FROM AUTHOR]

Background: The birth experience plays a pivotal role in the mother´s mental well-being and has a crucial effect on the mother-child bond. Unanticipated medical interventions, including fundal pressure, episiotomy, assisted vaginal delivery (AVD), or unplanned cesarean section (CS) during labor, may adversely affect the birth experience. The objective of this study is to identify factors contributing to the diminished evaluation of the birth experience after assessing the prevalence of unplanned obstetrical interventions in Germany. Methods: For this cross-sectional analysis, 4000 mothers whose children were born 8 or 12 months before were asked about their birth experience via a paper-based questionnaire. Overall 1102 mothers participated in the study, representing a response rate of 27.6%. The revised Childbirth Experience Questionnaire (CEQ2) was used to measure the childbirth experience. In addition to descriptive and bivariate analyses using the Wilcoxon rank-sum test and Kruskal-Wallis-test, we calculated multivariate linear regression models for each dimension of the CEQ2. Results: In general, the participants evaluated their childbirth experience favorably, assigning an average rating of 3.09 on a scale ranging from 1 to 4. Women who experienced fundal pressure, an AVD, or an unplanned CS rated their birth experience significantly worse compared to women who gave birth without interventions. Unplanned CSs received the lowest ratings for "personal capability" and "perceived safety," and an AVD resulted in lower scores for "professional support" and "participation." However, the interventions we studied did not account for much of the variation in how the childbirth experience plays out for different individuals. Conclusion: Obstetric interventions have a significant effect on different dimensions of the birth experience. If a high level of birth satisfaction is to be achieved, it is important to know which dimension of satisfaction is affected by the intervention so that explicit measures, like fostering communication, participation or safety can be taken to promote improvement. German Clinical Trial Register: DRKS00029214, retrospectively registered (Registration Date 22.06.2023). [ABSTRACT FROM AUTHOR]

Asthma is, worldwide, the most frequent non-communicable disease affecting both children and adults, with high morbidity and relatively low mortality, compared to other chronic diseases. In recent decades, the prevalence of asthma has increased in the pediatric population, and, in general, the risk of developing asthma and asthma-like symptoms is higher in children during the first years of life. The "gut–lung axis" concept explains how the gut microbiota influences lung immune function, acting both directly, by stimulating the innate immune system, and indirectly, through the metabolites it generates. Thus, the process of intestinal microbial colonization of the newborn is crucial for his/her future health, and the alterations that might generate dysbiosis during the first 100 days of life are most influential in promoting hypersensitivity diseases. That is why this period is termed the "critical window". This paper reviews the published evidence on the numerous factors that can act by modifying the profile of the intestinal microbiota of the infant, thereby promoting or inhibiting the risk of asthma later in life. The following factors are specifically addressed in depth here: diet during pregnancy, maternal adherence to a Mediterranean diet, mode of delivery, exposure to antibiotics, and type of infant feeding during the first three months of life. [ABSTRACT FROM AUTHOR]

Objective: The Moon has a noticeable influence on the Earth due to its gravity, the most visible manifestation of which are tides. We aimed to see if the Moon's daily cycle, like the Sun's, affects the prevalence and incidence of childbirth. Methods: In this retrospective cohort study, we examined all deliveries at the Academic Hospital of Udine between 2001 and 2019. All consecutive singleton pregnancies with spontaneous labor and vaginal delivery were included. Results: During the period, 13,349 singleton pregnancies with spontaneous labor and vaginal delivery were delivered in 6939 days. A significantly higher prevalence of deliveries was found with the Moon above the horizon (50.63% vs. 49.37%, p < 0.05). Moreover, during the day, there was a significantly higher prevalence of deliveries than during nighttime (53.74% vs. 45.79%, p < 0.05). Combining the Moon and Sun altitude, the majority of deliveries were registered when both were above the horizon (27.39% vs. 26.13%, 23.25%, or 23.24%, p < 0.05). These findings were confirmed in multivariate analysis after adjusting for parity, gestational age, or season. We found no correlation between birth and the Moon phase. Conclusions: Our data support the interaction of the Moon and the Sun in determining the time of birth. More research is needed to understand these phenomena and improve our understanding of labor initiation mechanisms. Highlights- What this paper adds: A significantly higher prevalence of deliveries was found with the Moon above the horizon; Combining the Moon and Sun, the majority of deliveries were registered when both were above the horizon; During the summer, we found an increase in the delivery rate. [ABSTRACT FROM AUTHOR]

Objective: An innovative approach by two Queensland health services was taken to establish a shared maternity services' research agenda by partnering with consumers and clinicians. The objective was to set the top five research priorities to ensure that the future direction of maternity research was relevant to end-user and organisational needs. Methods: A modified James Lind Alliance (JLA) methodology was applied between August 2022 and February 2023 across two south-east Queensland Health Services which included five participating maternity units and involved partnership with consumers, healthcare professionals and clinician researchers. The reporting guideline for priority setting of health research (REPRISE) was followed. Results: There were 192 respondents to the initial harvesting survey, generating 461 research suggestions. These were aggregated into 122 unique questions and further summarised into a list of 44 research questions. The 157 eligible interim prioritisation survey respondents short-listed 27 questions ready for ranking at a final consensus workshop. The top five question themes were: (1) maternity care experience, engagement and outcomes of priority populations; (2) increasing spontaneous vaginal birth; (3) experiences and perceptions of woman/person-centred care; (4) best practice care during the 'fourth' trimester; and (5) antibiotic use during labour and birth. Conclusion: Applying an adapted JLA framework can successfully shape and establish a research agenda within Australian health services, through partnership with consumers and practicing clinicians. This is a transparent process that strengthens the legitimacy and credibility of research agendas, and it can form a replicable framework for other settings. What is known about the topic? Establishment of research agendas often neglects the participation of research end-users, consumers and practising clinicians, consequently limiting relevance and translation. What does this paper add? Prioritised specific maternity research questions were jointly generated by consumers and front-line clinicians to highlight areas of focus for research funding and support. What are the implications for practitioners? By partnering with consumers and practising clinicians health service research priorities can be established to optimise patient outcomes and ensure future research is both translational and relevant. [ABSTRACT FROM AUTHOR]

Despite increasing advocacy of shared decision-making (SDM) approaches to maternal healthcare and the significance of including patient preferences in choosing the childbirth method, quantitative research to help the patients to make informed decisions is still lacking. This paper proposes a multi-attribute decision framework to guide the patients toward the best childbirth method considering their preferences, risk attitudes, pregnancy complications, and uncertainties during the delivery process. Valuations of health condition, intrapartum pain, duration of the process, recovery time, and feeling of empowerment constitute the attribute set of our model. Four major pregnancy complications - malpresentation, anemia, eclampsia, and gestational diabetes have been considered to assess the patients' pregnancy complication state. A deidentified dataset from the maternal delivery unit of the Dhaka Medical College (DMC) Hospital in Bangladesh, which was screened and validated by doctors from three different hospitals, was utilized to present a case study. For mothers with no complications, vaginal delivery (VG) is preferred regardless of the risk attitude. For mothers with single difficulty, as risk attitude changes from risk-averse to risk-seeking, the optimal strategy shifts from cesarean to VG. Cesarean delivery is preferred regardless of the risk attitude for mothers with more than one complication. Sensitivity analyses reveal that valuations of health conditions and intrapartum pain are the most sensitive attributes. The decisions obtained from the model are found consistent with the decision taken at DMC 85.25% times. This paper presents new insights to foster SDM and improve the childbirth experience. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Childbirth remains an important risk factor for the development of pelvic floor disorders, regardless of the mode of delivery. To accurately assess these symptoms, accurate, woman-centric assessments are needed. Online versions of these assessments may be especially useful in the COVID-19 era. Women may potentially answer questions differently in an online format, and this study aimed to validate an online version of the paper-based self-administered Australian Pelvic Floor Questionnaire (APFQ). Methods: The questionnaire was completed antenatally and at 3 months postpartum by 647 and 481 women respectively. Test– validity was assessed in subgroups of 61 and 57 women in each period, using intraclass correlation coefficients and Cohen's kappa. Sensitivity to change was assessed by comparing responses during pregnancy to those at 3 months postpartum. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed by comparing women with and without subjective bothersomeness. Results: Intraclass correlation coefficients were above 0.9 for all domains and the overall questionnaire. Cohen's kappa for individual questions ranged from 0.71–1.00 across the antenatal and postnatal questionnaires. Cronbach's alpha was acceptable for all domains except the prolapse domain. The APFQ was sensitive to changes occurring between antenatal recruitment and 3 months postpartum. Effect sizes ranged from 0.83–7.99. Conclusions: This online version of the APFQ is valid for assessing pelvic floor disorders in an Irish obstetric population. The APFQ is reproducible and responsive to change occurring with childbirth, and can be used to research longitudinal changes in pelvic floor disorders. As an online tool, this questionnaire may be useful in increasing response rates to clinical research. [ABSTRACT FROM AUTHOR]

There is evidence that caesarean section delivery can impact on neonatal weight loss and weight gain patterns in the first 5 days of life. We conducted an integrative systematic review to examine the association of mode of delivery on early neonatal weight loss. Pubmed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Excerpta Medica dataBASE, and Medical Literature Analysis and Retrieval System Online were searched for relevant papers published before June 2019. Reference lists from the relevant papers were then backwards and forwards searched. As neonatal weight loss was reported in different formats, a meta‐analysis could not be carried out. Most studies did not distinguish between elective and emergency caesarean sections or instrumental and nonassisted vaginal deliveries. Seven papers were included. All papers except one found that caesarean section was associated with higher weight loss in the early days of life. Two papers presented data from studies on babies followed up to 1 month. One study found that on day 25, babies born by caesarean section had significantly higher weight gain than those born vaginally, while another found that by day 28, babies born vaginally gained more weight per day (11.9 g/kg/day) than those born by caesarean section (10.9 g/kg/day; p =.02). Overall, infants born by caesarean section lost more weight than those born vaginally, but due to the small number of studies included, more are needed to look at this difference and why it may occur. This discrepancy in weight between the two groups may be corrected over time, but future studies will need larger sample sizes and longer follow‐up periods to examine this. [ABSTRACT FROM AUTHOR]

Background: The purpose of this descriptive and comparative study conducted at the Nene Hatun Maternity Hospital was to determine the fatigue levels of postpartum women who had vaginal birth and caesaren section, after 24 hours of childbirth. Methods: Visual Analogue Scale for Fatigue “VAS-F” was used to determine the fatigue levels of postpartum women. Results: It was determined that half of the postpartum women in both groups had a moderate-level fatigue. Mean score of the postpartum women with vaginal birth for fatigue was 59.5±25.2 and mean score of those, who gave caesaren section, for the fatigue was 71.2±22.8. Conclusion: According to the birth methods, the fatigue levels of the postpartum women who had vaginal birth were lower compared to those giving caesaren section, their energies were higher than the postpartum women who gave caesaren section. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) affects approximately 5–20% of pregnant women and is associated with adverse pregnancy outcomes. This review aimed to assess whether the oral microbiota of infants and their mothers with GDM had a different composition from that found in unaffected women and offspring. PubMed, Embase, Scopus, and Google Scholar were searched in December 2023 after protocol registration in the International Prospective Register of Systematic Reviews (CRD42023406505). Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Overall, 1113 articles were identified; after evaluating the full texts, 12 papers were included in the qualitative analysis. In six studies of the eight included, significant differences in microbiota between M-GDM and M-nGDM were found. In four studies, a depletion of Firmicutes and an enrichment of Proteobacteria was found in the microbiota of infants. Since all included studies were judged to have high risk of bias, a quantitative synthesis of the results was not carried out. In conclusion, although the oral microbiota of infants from mothers with GDM could be different from that of infants from mothers without GDM, there is insufficient evidence to clarify this aspect so far. [ABSTRACT FROM AUTHOR]

Copyright of Memoria y Civilizacion is the property of Servicio de Publicaciones de la Universidad de Navarra, S.A. 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 two-hit model has been proposed to explain the effects of diabetes on mothers who are already in a putative subclinical damaged state and then undergo neuronal damage during the delivery process. However, the anatomical and pathophysiological mechanisms are not well understood. Our overarching hypothesis in this review paper is that pregnant women who are diabetic have a damaged peripheral nervous system, constituting the "first hit" hypothesis. The delivery process itself—the "second hit"—can produce neurological damage to the mother. Women with diabetes mellitus (DM) are at risk for neurological damage during both hits, but the cumulative effects of both "hits" pose a greater risk of neurological damage and pathophysiological changes during delivery. In our analysis, we introduce the different steps of our concept paper. Subsequently, we describe each of the topics. First, we outline the mechanisms by which diabetes acts as a detrimental variable in neuropathy by focusing on the most common form of diabetic neuropathy, diabetic distal symmetrical polyneuropathy, also known as distal sensorimotor neuropathy. The possible role of macrosomia in causing diabetic neuropathy and obstetric neurological injury is discussed. Second, we describe how vaginal delivery can cause various obstetrical neurological syndromes and pathophysiological changes. Third, we highlight the risk of obstetric neuropathy and discuss anatomical sites at which lesions may occur, including lesions during delivery. Fourth, we characterize the pathophysiological pathways involved in the causation of diabetic neuropathy. Finally, we highlight diabetic damage to sensory vs. motor nerves, including how hyperglycemia causes different types of damage depending on the location of nerve cell bodies. [ABSTRACT FROM AUTHOR]

Objective: To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018. Methods: A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time. Results: There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively. Conclusions: There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia. What is known about the topic? Public maternity care costs vary in Australia dependent upon place of birth, even after adjusting for clinical and demographic factors. What does this paper add? This paper compares the change in costs for mother and baby from birth through to 12 months for births across Queensland over time. Costs for maternity care have increased over time and higher-cost treatment does not necessarily result in better health outcomes. What are the implications for practitioners? Reporting of cost alongside clinical outcomes should be included in performance monitoring of public hospital maternity care. [ABSTRACT FROM AUTHOR]

Background: Normal physiologic birth has been shown to result in optimal maternal–infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. Objective: In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. Methods: Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home‐based, community‐based, and hospital‐based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. Results: Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self‐confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person‐centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision‐making. The midwife–client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. Conclusions: This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth. [ABSTRACT FROM AUTHOR]

In the therapy of placenta-originated diseases during pregnancy, the main challenges are fetal exposure to drugs, which can pass through the placenta and cause safety concerns for fetal development. The design of placenta-resident drug delivery system is an advantageous method to minimize fetal exposure as well as reduce adverse maternal off-target effects. By utilizing the placenta as a biological barrier, the placenta-resident nanodrugs could be trapped in the local placenta to concentrate on the treatment of this abnormal originated tissue. Therefore, the success of such systems largely depends on the placental retention capacity. This paper expounds on the transport mechanism of nanodrugs in the placenta, analyzes the factors that affect the placental retention of nanodrugs, and summarizes the advantages and concerns of current nanoplatforms in the treatment of placenta-originated diseases. In general, this review aims to provide a theoretical basis for the construction of placenta-resident drug delivery systems, which will potentially enable safe and efficient clinical treatment for placenta-originated diseases in the future. [ABSTRACT FROM AUTHOR]

The article titled "How Adequate is Your Delivery Platform?" emphasizes the importance of a strong project delivery platform for successful project management. It discusses the components of a project delivery platform, including processes, skills, tools, and organizational structures. The article provides real-world examples to illustrate the impact of a well-balanced project delivery platform on project success. It highlights the negative consequences of poor project delivery and recommends a holistic approach that prioritizes both technical and human aspects of the platform. The article emphasizes the need for clear strategies and teamwork in project delivery. [Extracted from the article]

Background. Research has shown that pressure in the vaginal birth process aids the infant's neurophysiological adaption to extrauterine life, including their ability to regulate their responses to diverse sensory stimuli. As pressure is absent in elective caesarean section births, we hypothesised that these children may be at higher risk for developing sensory hyperreactivity (SHR), a sensory modulation difficulty which negatively impacts on the child's engagement in their occupations. This paper reports on a study which investigated associations between birth method and SHR. Method. In this cross-sectional study, 91 children aged three and four years from various language, cultural, and socioeconomic groups were recruited and categorised based on birth method (caesarean section or vaginal birth). Caregivers of each child completed the Short Sensory Profile-2 and a demographic questionnaire. The prevalence of SHR between the birth method groups was compared. Results. The prevalence of SHR was greater in the vaginal birth group (29%) than the caesarean section group (9%). Mothers in the vaginal birth group were younger (p ≤ 0.001), of lower-income level (p = 0.003), and more likely to be single (p = 0.037). During data collection with the vaginal birth group, comprehensibility of certain items in the Short Sensory Profile-2 proved challenging for many caregivers. Conclusion. The statistically significant higher prevalence of SHR in the vaginal birth group supported a null hypothesis. However, the results are questioned due to the challenges related to data collection. Given this, the study supports the need for further investigation of how sociocultural and socioeconomic factors influence the assessment of SHR in the South African context. [ABSTRACT FROM AUTHOR]

In this paper, we consider a multi-server queue with a finite buffer. Request arrivals are defined by the Markov arrival process. Service is provided to groups of requests. The minimal and maximal group sizes are fixed. The service time of a group has a phase-type distribution with an irreducible representation depending on the size of the group. The requests are impatient. The patience time for an arbitrary request has an exponential distribution. After this time expires, the request is lost if all servers are busy or, if some server is idle, with a certain probability, all requests staying in the buffer start their service even if their number is below the required minimum. The behavior of the system is described by a multi-dimensional continuous-time Markov chain that does not belong to the class of level-independent quasi-birth-and-death processes. The algorithm for the computation of the stationary distribution of this chain is presented, and expressions for the computation of the queuing system's performance characteristics are derived. The description of a delivery system operation in terms of the analyzed queuing model is given, and the problem of the optimization of its operation is numerically solved. Multi-server queues with a phase-type distribution for the group service time that are dependent on the size of the group, the account of request impatience, and the correlated arrival process have not previously been analyzed in the existing literature. However, they represent a precise model of many real-world objects, including delivery systems. [ABSTRACT FROM AUTHOR]

Post-partum haemorrhage (PPH) refers to excessive bleeding after delivery following either a vaginal delivery or a caesarean section. There have been many types of research conducted on issues related to PPH but very few literature on the systematic review related to PPH using qualitative methods. In this study, a review was conducted to determine the best available evidence to explore and determine women’s experiences of care following PPH. A total of eight papers were finally selected for review. Four criteria were selected for the review selection. First, the papers were published after 2011, second, the topic must be on the experience of PPH, third, the research design must be qualitative and lastly, the data collection method was a semi-structured interview method. In order to ensure a stringent, transparent review process, the Joanna Briggs Institute, JBI 2011 guidelines have been applied for this purpose. During data extraction, aggregation, and interpretation of the findings, five themes were identified in response to the review objectives. They are; implications of information deprivation across the care pathway; concerns about the baby and early mothering; professional collaboration and adequacy of care; fear of unknown outcomes and perceptions of coming close to death; and sensitivity to social isolation and perceived professional neglect. The review found that women’s needs should be given adequate attention during PPH care including unhindered information flow and the ability to be in close contact with the babies and husbands. It is hoped that the evidence obtained from this review could subsequently be utilised to inform the design and development of support interventions in future practice and potentially contribute to the existing knowledge and enhance evidence-based decision-making in practice and policy. This review also develops knowledge and understanding of women’s experience of care in relation to PPH. [ABSTRACT FROM AUTHOR]

Vaginal childbirth is the final phase of pregnancy when one or more fetuses pass through the birth canal from the uterus, and it is a biomechanical process. The uterine active contraction, causing the pushing force on the fetus, plays a vital role in regulating the fetus delivery process. In this project, the active contraction behaviors of muscle tissue were first modeled and investigated. After that, a finite element method (FEM) model to simulate the uterine cyclic active contraction and delivery of a fetus was developed in LS-DYNA. The active contraction was driven through contractile fibers modeled as one-dimensional truss elements, with the Hill material model governing their response. Fibers were assembled in the longitudinal, circumferential, and normal (transverse) directions to correspond to tissue microstructure, and they were divided into seven regions to represent the strong anisotropy of the fiber distribution and activity within the uterus. The passive portion of the uterine tissue was modeled with a Neo Hookean hyperelastic material model. Three active contraction cycles were modeled. The cyclic uterine active contraction behaviors were analyzed. Finally, the fetus delivery through the uterus was simulated. The model of the uterine active contraction presented in this paper modeled the contractile fibers in three-dimensions, considered the anisotropy of the fiber distribution, provided the uterine cyclic active contraction and propagation of the contraction waves, performed a large deformation, and caused the pushing effect on the fetus. This model will be combined with a model of pelvic structures so that a complete system simulating the second stage of the delivery process of a fetus can be established. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusions Anaesthetists of all grades who work on a labour ward are likely to be involved in the insertion or management of an intrathecal catheter after inadvertent dural puncture at some point in their careers. Although the use of intrathecal catheters after inadvertent dural puncture in labour has increased in popularity over recent decades, robust evidence on best practice has been lacking.The Obstetric Anaesthetists' Association set up an expert working party to review the literature. A modified Delphi approach was used to produce statements and recommendations on insertion and management of intrathecal catheters for labour and operative delivery following inadvertent dural puncture during attempted labour epidural insertion. Statements and recommendations were graded according to the US Preventive Services Task Force grading methodology.A total of 296 articles were identified in the initial literature search. Further screening identified 111 full text papers of relevance. A structured narrative review was produced which covered insertion of an intrathecal catheter; initial dosing; maintenance of labour analgesia; topping‐up for operative delivery; safety features; complications; and recommended follow‐up. The working party agreed on 17 statements and 26 recommendations. These were generally assigned a low or moderate level of certainty. The safety of mother and baby were a key priority in producing these guidelines.With careful management, intrathecal catheters can provide excellent labour analgesia and may also be topped‐up to provide anaesthesia for caesarean or operative vaginal delivery. The use of intrathecal catheters, however, also carries the risk of significant drug errors which may result in high‐ or total‐spinal anaesthesia, or even cardiorespiratory arrest. It is vital that all labour wards have clear guidelines on the use of these catheters, and that staff are educated as to their potential complications. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy are a group of pregnancy-related diseases characterized by the coexistence of pregnancy and elevated blood pressure, which seriously endanger the health of mothers and infants, and are one of the main causes of maternal and perinatal deaths. The purpose of this paper is to investigate the clinical analysis of vitamin E and astragalus in the adjuvant treatment of hypertensive disorders in pregnancy and to describe the learning model. This paper puts forward the problem of clinical treatment, which is established on the basis of adjuvant therapy, then narrates around the clinical characteristics of gestational hypertension, and designs and analyzes the experimental design and analysis of adjuvant therapy with vitamin E and astragalus. The experimental results showed that the delivery methods of the three groups of patients were compared P < 0.05. Compared with the traditional Chinese medicine control group and the vitamin E control group, there were more vaginal births in the experimental group, 36 patients in total. It shows that astragalus and vitamin E can alleviate the disease in different aspects and can effectively intervene in gestational hypertension. [ABSTRACT FROM AUTHOR]

Internationally, politicians and practitioners have focused strongly on humanization of births, to enable fewer medicalized birth care procedures. In this paper, we explore policy efforts to support better births in order to comprehend developments in maternity care in Denmark and France, two countries previously identified as having different birth cultures. Our analysis has been fueled by the question of how birth policies have developed in both countries in an era in which medicalization of birth has been problematized internationally. Using discourse analysis, we examine the political constructions of specific problems in central policy documents. The analysis shows which problematizations around maternity care are discursively constructed, what solutions are discursively presented and on what assumptions the problematizations are based. The article supports the conclusion of other scholars that a pervading risk discourse on birth and birthing bodies constitutes how maternity care can be experienced and practiced. [ABSTRACT FROM AUTHOR]

Methods for neonates’ delivery have evolved over the course of the years, to match the existing evidence, the access to care and the personal preferences of clinicians and prospective mothers. While clinical evidence points towards recommendations to reduce the rates of deliveries using surgical procedures (i.e., Caesarean delivery or c-section) in favour of natural deliveries and its variations; the evidence suggest that trends points in the other direction. This paper explores the trends within European Union counties, the changes over time and explore potential explanations for the dichotomy between recommendations and actual practices. [ABSTRACT FROM AUTHOR]

Maternal microbiota forms the first infant gut microbial inoculum, and perinatal factors (diet and use of antibiotics during pregnancy) and/or neonatal factors, like intra partum antibiotics, gestational age and mode of delivery, may influence microbial colonization. After birth, when the principal colonization occurs, the microbial diversity increases and converges toward a stable adult-like microbiota by the end of the first 3-5 years of life. However, during the early life, gut microbiota can be disrupted by other postnatal factors like mode of infant feeding, antibiotic usage, and various environmental factors generating a state of dysbiosis. Gut dysbiosis have been reported to increase the risk of necrotizing enterocolitis and some chronic diseases later in life, such as obesity, diabetes, cancer, allergies, and asthma. Therefore, understanding the impact of a correct maternal-to-infant microbial transfer and a good infant early colonization and maturation throughout life would reduce the risk of disease in early and late life. This paper reviews the published evidence on early-life gut microbiota development, as well as the different factors influencing its evolution before, at, and after birth, focusing on diet and nutrition during pregnancy and in the first months of life. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this paper is to evaluate national trends, socioeconomic risk factors, and maternal and obstetric outcomes for patients with and without opioid use disorder (OUD) at delivery hospitalization. Methods: This is a retrospective cohort using the National Inpatient Sample 2012–2016 of 3,554,477 deliveries to analyze trends in OUD in patients at delivery hospitalization. We conducted univariable and multivariable logistic regression to compare clinical, demographic, hospital, and geographic associations for patients with OUD during delivery hospitalization. Results: The incidence of OUD at delivery hospitalization increased from 4.48 per 1000 deliveries in 2012 to 7.67 in 2016. The highest rate of OUD was in the Northeast and the lowest in the West (9.29 vs. 4.13 per 1000, respectively, p <.001). After adjusting for confounders, history of concurrent cocaine use (adjusted odds ratio [aOR] = 5.95, 95% confidence interval [CI]: 5.38–6.59), sedative use (aOR = 17.28, 95% CI: 14.71–20.31), and amphetamine use (aOR = 4.05, 95% CI: 3.71–4.43), were strongly associated with OUD. Additionally, hepatitis C infection, (aOR = 21.98, 95% CI: 20.89–23.11), white race (aOR = 3.12, 95% CI: 3.00–3.24), and public insurance (aOR = 3.92, 95% CI: 3.77–4.08) were also associated with OUD. Discussion and Conclusion: The continued increase in rates of OUD at delivery hospitalization and its association with adverse perinatal outcomes highlights the need for universal screening and resource allocation for programs directed toward pregnant people. Scientific Significance: Our study builds upon the prior literature that reports trends in OUD at delivery hospitalization from 1998 to 2011 as well as presents a more in‐depth look at risk factors and adverse pregnancy outcomes than previously reported. [ABSTRACT FROM AUTHOR]

Background: WHO recommends attending minimum four ANC consultations during pregnancy to ensure early detection of complications. The objective of this study was to quantify ANC attendance and factors associated with it. Methods: Participants were randomly selected using the WHO Cluster survey methodology in Southern and Central Somalia. A paper-print questionnaire was used to collect all data. Outcomes of interest were: access to at least one ANC consultation, completion of at least four ANC consultations, initiation of breastfeeding and place of delivery, while exposures included factors related to the latest pregnancy and demographic characteristics. Associations were assessed through logistic regression. Results: Seven hundred ninety-two women answered the questionnaire; 85% attended at least one and 23% at least four ANC consultations, 95% started breastfeeding and 51% had an institutional delivery. Encouragement to attend ANC increased the odds of attending at least one consultation (aOR = 8.22, 95%CI 4.36–15.49), while negative attitude of husband or family decreased the odds (aOR = 0.33, 95%CI 0.16–0.69). Knowing there is a midwife increased the odds of at least four visits (aOR = 1.87, 95%CI 1.03–3.41). Attending at least four consultations increased the odds of delivering in a health structure (aOR = 1.50, 95%CI 1.01–2.24), and attending at least one consultation was associated with higher odds of initiating breastfeeding (aOR = 2.69, 95%CI 1.07–6.74). Conclusions: Family has a strong influence in women's ANC attendance, which increases the likelihood of institutional delivery and initiating breastfeeding. Women and families need to have access to information about benefits and availability of services; potential solutions can include health education and outreach interventions. [ABSTRACT FROM AUTHOR]

Purpose: India has shown good progress in maternal health outcome indicators. However, an area for improvement is to ensure all deliveries take place in institutions under the supervision of skilled birth attendants. This paper attempts to identify the factors that affect institutional deliveries using nationally representative National Family Health Survey (NFHS) data. Further, the authors investigate the factors contributing to the wealth-based inequality in institutional deliveries. Design/methodology/approach: To address the first aspect of identifying the factors associated with undergoing an institutional delivery, the authors have used logistic and multinominal logistic models. The explanatory variables are broadly socio-economic indicators of the mother and a few other household characteristics. Further, the concentration index and regression-based decomposition were used to carry out an inequality analysis in the institutional deliveries across different wealth groups. Findings: The authors found that women belonging to poor households, backward social groups and rural areas have significantly fewer odds of undergoing an institutional delivery. Age and education level of the mother, number of antenatal visits during pregnancy and place of residence (urban/rural) have contributed to the inequality in institutional deliveries in 2005–2006. However, the inequality due to these factors went down drastically in 2015–2016. Originality/value: To the best of the authors' knowledge, this study is a distinct attempt to use pooled data of the NFHS-3 [2005–2006] and NFHS-4 [2015–2016] in identifying factors contributing to a woman undergoing an institutional-based delivery. The study also decomposes the wealth-based inequality in the factors contributing to having an institutional delivery and analyses the contributions to inequality across the two time periods. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. 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.)

Introduction: Anesthesiologists play an important role in the management of labor and delivery during acute malaria infection. The peripartum anesthesia considerations for such cases remain unclear. Findings: Important peripartum considerations include the severity of thrombocytopenia and coagulopathy, hemodynamic status and cardiac disease, and the likelihood of central nervous system (CNS) involvement. Several antimalarial drugs may interact with perioperative medications, causing hypoglycemia, methemoglobinemia, or QT prolongation. Labor should usually not be induced. Patient volume status should be optimized pre-induction, but fluids should be administered with caution given the risk of cerebral edema. In case of CNS involvement intracranial pressure should be maintained. Case reports describe the successful use of neuraxial anesthesia but this approach requires further confirmation of safety. Despite the risks accompanying airway management in pregnancy, in some cases, general anesthesia was preferred due to the chance of CNS infection and disease complications. Tight postoperative assessments of neurological and bleeding status are indicated regardless of the mode of delivery. Conclusions: Despite the prevalence of malaria, the perioperative risk and preferred mode of anesthesia for pregnant patients with acute malaria remain under-researched and outcome data are limited. [ABSTRACT FROM AUTHOR]

Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs), including amide-type LAs, ester-type LAs, and other potential ion-channel blockers, are emerging as drugs for POP management because of their effectiveness and affordability. However, LAs typically exhibit short durations of action and prolonging the duration by increasing their dosage or concentration may increase the risk of motor block or systemic local anesthetic toxicity. In addition, techniques using LAs, such as intrathecal infusion, require professional operation and are prone to catheter displacement, dislodgement, infection, and nerve damage. With the development of materials science and nanotechnology, various LAs delivery systems have been developed to compensate for these disadvantages. Numerous delivery systems have been designed to continuously release a safe dose in a single administration to ensure minimal systemic toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia according to changes in the external trigger conditions, achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this review, we summarize POP pathways, animal models and methods for POP testing, and highlight LAs delivery systems for POP management. Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs) are emerging as drugs for POP management because of their effectiveness and affordability. However, they exhibit short durations and toxicity. Various LAs delivery systems have been developed to compensate for these disadvantages. They have been designed to continuously release a safe dose in a single administration to ensure minimal toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia to achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this paper, we summarize POP pathways, animal models, and methods for POP testing and highlight LAs delivery systems for POP management. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric risk profiles, cause of death, and mode of delivery. Methods: Utilizing a retrospective observational design, 4,561 maternal deaths in Mexico from 2010–2014 were analyzed. Data were sourced from the Deliberate Search and Reclassification of Maternal Deaths database, alongside other national databases. An algorithm was developed to extract the Robson Ten Group Classification System from clinical summaries text, facilitating a nuanced analysis of C-section rates. Information on the reasons for the performance of a C-section was also obtained. Logistic regression and multinomial logistic regression models were used to estimate the relation between obstetric risk factors, mode of delivery and causes of maternal death, adjusting for covariates. Results: Among maternal deaths in Mexico from 2010–2014, 47.1% underwent a C-section, with a significant history of previous C-sections observed in 31.4% of these cases, compared to 17.4% for vaginal deliveries (p<0.001). Early prenatal care in the first trimester was more common in C-section cases (46.8%) than in vaginal deliveries (38.3%, p<0.001). A stark contrast was noted in the place of death, with 82.4% of post-C-section deaths occurring in public institutions versus 69.1% following vaginal births. According to Robson's classification, the highest C-section rates were in Group 4 (67.2%, p<0.001) and Group 8 (66.9%, p<0.001). Logistic regression analysis revealed no significant difference in the odds of receiving a C-section in private versus other settings after adjusting for Robson criteria (OR: 1.21; 95% CI: 0.92, 1.60). A prior C-section significantly increased the likelihood of another (OR: 2.38; CI 95%: 2.01, 2.81). The analysis also indicated C-sections were significantly tied to deaths from hypertensive disorders (RRR = 1.25, 95% CI [1.12, 1.40]). In terms of indications, 6.3% of C-sections were performed under inadequate indications, while the indication was not identifiable in 33.1% of all C-sections. Conclusions: This study highlights a significant overuse of C-sections among maternal deaths in Mexico (2010–2014), revealed through the Robson classification and ana analysis of the reported indications for the procedure. It underscores the need for revising clinical decision-making to promote evidence-based guidelines and favor vaginal deliveries when possible. High C-section rates, especially noted disparities between private and public sectors, suggest economic and non-clinical factors may be at play. The importance of accurate data systems and further research with control groups to understand C-section practices' impact on maternal health is emphasized. [ABSTRACT FROM AUTHOR]

Background: Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology. Methods: A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care. Discussion: This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia. Trial registration: This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022]. [ABSTRACT FROM AUTHOR]

Clinical equipment is essential in a labour unit to assess, monitor, diagnose, and prevent complications during labour. The availability of good working equipment in the labour unit is needed to enhance optimal intrapartum monitoring and delivery for pregnant women. Thus, this paper employed a cross-sectional descriptive design using a quantitative research approach to ascertain how equipment impedes optimal intrapartum monitoring and delivery for pregnant women. A total of 59 midwives were recruited to participate in the study. Data collected using an electronic structured questionnaire were analysed with descriptive statistics using Statistical Package for Social Sciences (SPSS) version 25.0. The study reported that most midwives (68%) in labour units experienced barriers to using equipment when administering care to pregnant women. The barriers were perpetuated by various factors, such as bed capacity, in meeting patient demands, including examination lights, overhead radiant warmers, and examination weighing scales for newborns. Incorporating mandatory computerized maintenance management software is recommended to improve the quality of maternity equipment. In addition, there is a need for regular equipment inspections and maintenance by skilled technicians in selected hospitals of Limpopo Province, South Africa. [ABSTRACT FROM AUTHOR]

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