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Abstract Background Cleansing of the vulva and perineum is recommended during preparation for vaginal delivery, and special attention is paid to cleansing before episiotomy because episiotomy is known to increase the risk of perineal wound infection and/or dehiscence. However, the optimal method of perineal cleansing has not been established, including the choice of antiseptic agent. To address this issue, we designed a randomized controlled trial to examine whether skin preparation with chlorhexidine-alcohol is superior to povidone-iodine for the prevention of perineal wound infection after vaginal delivery. Methods In this multicenter randomized controlled trial, term pregnant women who plan to deliver vaginally after episiotomy will be enrolled. The participants will be randomly assigned to use antiseptic agents for perineal cleansing (povidone-iodine or chlorhexidine-alcohol). The primary outcome is superficial or deep perineal wound infection within 30 days after vaginal delivery. The secondary outcomes are the length of hospital stay, physician office visits, or hospital readmission for infection-related complications, endometritis, skin irritations, and allergic reactions. Discussion This study will be the first randomized controlled trial aiming to determine the optimal antiseptic agent for the prevention of perineal wound infections after vaginal delivery. Trial registration ClinicalTrials.gov NCT05122169. First submitted date on 8 November 2021. First posted date on 16 November 2021

Objective: Whilst many studies have explored the mechanisms of stress urinary incontinence (SUI) following various modes of delivery, few have examined outcomes of postpartum SUI in women who experienced new-onset SUI during their pregnancy. Our primary objective was to investigate the risk factors for persistent postpartum SUI in women with new-onset SUI during pregnancy at 1-year follow-up following vaginal delivery. Materials and methods: 303 women with new-onset SUI during pregnancy who underwent vaginal delivery in a university hospital between 2014 and 2015 were included. In-person interviews were conducted for all participants on the second postpartum day, followed by phone interviews at 12 months postpartum, with completion of structured questionnaires, including Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7). Demographic, obstetrics and questionnaire scores were analyzed and compared between the group of women who experienced persistent postpartum SUI and the group who did not. Results: At 12 months postpartum, 16.5% (n = 50) of women had persistent postpartum SUI, with 83.5% (n = 253) experiencing resolution of SUI symptoms. Maternal age ≥35 years (aOR = 2.62; 95% CI, 1.40–4.87, P = 0.002), gestational age at birth ≥40 weeks (aOR = 2.21; 95% CI, 1.12–4.37, P = 0.022), and severe perineal lacerations (aOR = 2.32; 95% CI, 1.27–4.45, P = 0.013) were independent risk factors for persistent postpartum SUI for women following vaginal delivery at 1-year follow-up. Conclusion: The prevalence of persistent postpartum SUI at 1-year following vaginal delivery is 16.5%, with advanced maternal age, gestational age at birth ≥40 weeks and severe perineal lacerations being independent risk factors.

Abstract Background Stress urinary incontinence (SUI) is a common public health issue that negatively impacts the quality of life for women worldwide, of which early detection and rehabilitation are consequently pivotal. The aim of this study is to establish a simple nomogram for identifying women at risk of postpartum SUI. Methods A retrospective study was conducted in a tertiary specialized hospital in Shanghai, China. The study included only women with singleton, full-term, and vaginal deliveries. 2,441 women who delivered from July 2019 to November 2019 were included in the training cohort, and 610 women who delivered from January 2022 to February 2022 were included in the validation cohort. SUI was determined by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Univariate and multifactorial logistical regression were used to identify independent risk factors for postpartum SUI and further construct the nomogram accordingly. Based on concordance statistics (C-statistics), calibration curves, and decision curve analyses, we evaluated the performance of the nomogram in the training cohort and the validation cohort. In addition, the model was validated internally in the training cohort through cross-validation. Results There were no significant statistically differences in important baseline data such as age, pre-pregnancy BMI, and parity between the training and validation cohorts. SUI was observed in 431 (17.6%) and 125 (20.5%) women in the training and validation cohorts, respectively. According to the regression analysis, age, parity, second stage of labor, infant weight, and forceps delivery were included in the nomogram. The nomogram had a C-statistic of 0.80 (95% confidence interval [CI] 0.74–0.85) for predicting SUI. C-statistics were stable in both internally cross-validated training cohort (mean 0.81) and validation cohort (0.83 [95% CI 0.79–0.87]). The nomogram’s calibration curve was near the ideal diagonal line. Additionally, the model exhibited a positive net benefit from the decision curve analysis. Conclusion We have created a nomogram that can be utilized to quantify the risk of postpartum SUI for women with vaginal delivery. The model might contribute to predicting early postpartum SUI, thereby facilitating the management of SUI.

Background and aims: The women’s experience of the delivery process has significant consequences. The quality of these experiences affects the health of the mother and child, their emotional connection, the mother’s sexual activity, and her desire to have another child in the future. The present study investigated the women’s experience of the delivery process, the care provided in the unit, and their satisfaction with the delivery environment. Methods: This cross-sectional study was conducted on 250 women referred to the labor delivery and recovery room (LDR) unit of Amir al-Momenin hospital (AS) in Zabol city, Iran, in 2022. Data collection tools included the personal characteristics questionnaire, the Childbirth Experience Questionnaire (CEQ), the questionnaire on satisfaction with the delivery environment, and the questionnaire on care provided in the unit. Data analysis was done by SPSS software version 23 using descriptive statistics (absolute and relative frequency, mean and standard deviation) and inferential tests (Pearson correlation test, independent t-test, one-way ANOVA). Results: This study showed that the mean score of childbirth experience was 65.09±4.71. Also, a statistically significant relationship was found between satisfaction with the delivery environment, the care provided in the unit, and the childbirth experience (P value

Background: Activation of the complement system may play a role in the pathophysiology of human labor. Yet no unanimous conclusion has been drawn. Objective: To compare the differences in maternal complement components C3 and C4 serum levels in cesarean section and the vaginal delivery at term and in the postpartum hemorrhage. Methods: One hundred and sixty six women delivered at term were enrolled in this study. Maternal blood samples were obtained from 47 cases of elective cesarean section and 119 cases of the vaginal delivery. Serum complement levels were measured subsequently by immuno-scatter turbidimetry. Results: The maternal complement levels declined significantly during delivery by both the cesarean section and the vaginal delivery (p＜0.01) in comparison with the baseline. A much larger drop of C3 serum level was found in the postpartum hemorrhage and in the vaginal delivery, and the incidence of the postpartum hemorrhage has a positive correlation with the complement decline rate. Conclusion: The complement system may be involved in the delivery process and represents a predictive value in postpartum hemorrhage.

Objective: To examine patient characteristics among those who selected the long-acting reversible contraception (LARC) and surgical sterilization methods at vaginal delivery. Design: Retrospective cohort study. Setting: The National Inpatient Sample. Patient(s): A total of 8,013,785 vaginal deliveries from October 2016 to December 2019. Intervention(s): Exposure assignment per LARC (subdermal contraceptive implant [implants] or intrauterine device [IUD]) or surgical sterilization (bilateral salpingectomy [BS] or bilateral tubal ligation [BTL]) type. Main Outcome Measure(s): Utilization trends of LARC or surgical sterilization, assessed with linear segmented regression with log-transformation, and differences in patient characteristics per the exposure strata (implants vs. IUD in the LARC group and BS or BTL in the surgical sterilization group), assessed using the multivariate binary logistic regression model. Result(s): In a comparison between LARC and surgical sterilization, surgical sterilization use decreased from 1.90% to 1.55% (18.4% relative decrease), whereas LARC use increased from 0.35% to 1.02% (191% relative increase). In the LARC group, implant use (from 0.12% to 0.50%) increased more compared with IUD use (from 0.22% to 0.52%): relative increase, 317% vs. 136%. In the surgical sterilization group, BTL use decreased from 0.66% to 0.18% (72.7% relative decrease), whereas BS use was statistically unchanged (from 1.24% to 1.37%). In a multivariate analysis, recent year remained an independent characteristic for implant use in the LARC group and BS use in the surgical sterilization group. Moreover, in both LARC and surgical sterilization strata, procedure choices significantly differed on the basis of patient, pregnancy, hospital, and delivery factors. Conclusion(s): Immediate postpartum contraception choice has evolved in recent years in the United States with an increasing demand for the LARC methods with implants at the time of vaginal delivery.

Objective To assess the feasibility of vaginal delivery after HIFU.Methods A total of 37 women who met the trial of labor after HIFU (TOLAH) inclusion criteria and 368 women who met the trial of labor after cesarean delivery (TOLAC) inclusion criteria gave birth at Shanghai First Maternity and Infant Hospital between 14th June 2018 and 24th September 2021. The delivery outcomes of the two groups were compared. Multivariable logistic regression analysis was used to estimate the adjusted risk of postpartum hemorrhage (PPH).Results In the Qualified Candidates for TOLAH group, vaginal delivery is substantially less common (p = 0.000). The prevalence of PPH in the Qualified Candidates for TOLAH group is lower than in the Candidates for TOLAC group (8.82% vs 10.51%, p = 0.534; 0% vs 2.51%, p = 0.418). Hemoglobin drop in the Qualified Candidates for TOLAH group is also lower (7.03 ± 7.39vs 12.11 ± 12.62, p = 0.001). The rate of using more than two types of uterotonic medications to promote contraction is significantly lower in the Qualified Candidates for TOLAH group (54.05% vs 69.84%, p = 0.04), and the percentage of abnormal uterine contraction is lower in the Qualified Candidates for TOLAH group (35.14% vs 49.18%, p = 0.072). PPH is strongly predicted by abnormal uterine contraction (aOR: 17.177, 95% CI:5.046 ∼ 58.472, p = 0.000), but not by HIFU (aOR:1.105; 95% CI:0.240 ∼ 5.087, p = 0.898). No uterine rupture occurred in the cases after HIFU.Conclusions No uterine rupture occurred in our study group after HIFU. HIFU is not a risk for PPH. It is promising for those after HIFU to choose vaginal delivery.

Background & aim: The rate of unnecessary caesarean section are exceptionally high in some countries, including Iran. Though women may choose their mode of delivery, negative feelings of regret and hopelessness can occur in relation to decision-making following birth. Thus, this study aimed to compare regret and hopelessness in primiparous women following both vaginal and cesarean birth.Methods: Overall, 300 participants were included in this descriptive comparative study. Participants were included following vaginal birth (n=100), birth via emergency cesarean section (n=100) and birth via elective cesarean section (n=100) between June and October 2019. Participants were recruited from comprehensive health centers in Zabol, southeast of Iran. Data collection tools included the demographic characteristics questionnaire, Decision Regret Scale, and Beck Hopelessness Scale which were completed eight weeks after childbirth. To analyze data independent-sample T test and one-way ANOVA were used.Results: Mean and standard deviation for scores in relation to regret eight weeks following vaginal birth and elective cesarean section were 29.70 ± 25.97, 43.20 ± 15.88, respectively. There was a statistically significant difference between the mean score of regret in the vaginal birth and elective cesarean section (P < 0.001). There was no statistically significant difference in terms of hopelessness among three groups of vaginal birth, birth via emergency cesarean section, and birth via elective cesarean section.Conclusion: The higher scores in relation to regret in women who birthed via elective cesarean section in this study suggest that strategies are required to reduce rates of unnecessary cesarean sections.

Abstract Background Episiotomy is a surgical solution to relieve perineal stress, resulting in an easily repairable incision, in comparison to the risks of serious vaginal trauma during delivery. The midwife typically adopts such a clinical decision, on experience and subjective judgment. However, the association between perineal stress and episiotomy is poorly characterized. Our aim was to identify a threshold value for perineal stress leading to episiotomy, which eventually may be employed as a clinical tool for assessing whether an episiotomy is required or not. Methods In total, 245 nulliparous women were investigated for perineal stress during non-instrumental vaginal delivery in Ningbo Women & Children’s Hospital. During the second stage of labor, a flexible membrane stress sensor was placed between the fetal head and perineal wall above the anal fissure. Once the entire fetal head pressed against the sensor, real-time perineal stress was measured, and the peak value was recorded. Cases were divided into non-episiotomy group (n = 173) and episiotomy group (n = 72). The correlations between perineal stress and episiotomy was assessed through logistic regression with adjustment for maternal age, estimated birthweight, duration of second stage of labor, maternal body mass index, and presence of analgesia. Midwives were blinded to all stress measurement values. The predictive value of perineal stress on performing episiotomy was evaluated, together with the ideal cut-off perineal stress value for performing episiotomy. A ROC analysis was also performed. Results The episiotomy group had significantly higher levels of perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 N versus 118.37 ± 19.21 N, p

Background: management of persistent occiput posterior position has always been controversial. Manual rotation by a delivery operator can reduce instrumental delivery and cesarean section. Aim: This study aims to determine the knowledge and experience of midwives and gynecologists about manual rotation of persistent occiput posterior position. Methods: This descriptive cross-sectional study was performed in 2022. The questionnaire link was sent to 300 participating midwives and gynecologists via WhatsApp Messenger. Two hundred sixty-two participants completed the questionnaire. Data analysis was performed using SPSS22 statistical software and descriptive statistics. Results: 189 people (73.3%) had limited information about this technique, and 240 (93%) had never performed it. If this technique is recognized as a safe intervention and is included in the national protocol, 239 people (92.6%) want to learn, and 212 (82.2%) are willing to do it. Conclusion: According to the results, the knowledge and skills of midwives and gynecologists need to be trained and improved for manual rotation of persistent occiput posterior position. [ABSTRACT FROM AUTHOR]

Estrogens locally delivered to the vagina by tablets, capsules, rings, pessaries, and creams are the most common and highly recommended platforms to treat the genitourinary syndrome of menopause (GSM). Estradiol, an essential estrogen, is routinely administered alone, or in combination with progestins, to effectively alleviate the symptoms associated with moderate to severe menopause when non-pharmacological interventions are not indicated. Since the risk and side effects of estradiol use depends on the administered amount and duration of use, the lowest effective dose of estradiol is recommended when long-term treatment is required. Although there is a wealth of data and literature comparing vaginally administered estrogen-containing products, there is a lack of information revealing the effect of the delivery system used and formulation constituent's attributes on the efficacy, safety, and patient acceptability of these dosage forms. This review therefore aims to classify and compare various designs of commercially available and non-commercial vaginal 17β-estradiol formulations and analyze their performance in terms of systemic absorption, efficacy, safety, and patient satisfaction and acceptance. The vaginal estrogenic platforms included in this review are the currently marketed and investigational 17β-estradiol tablets, softgel capsules, creams, and rings for the treatment of GSM, based on their different design specifications, estradiol loads, and materials used in their preparation. Additionally, the mechanisms of the effects of estradiol on GSM have been discussed, as well as their potential impact on treatment efficacy and patient compliance. [Display omitted] • Locally delivered estrogen to the vagina has been successfully achieved using tablets, capsules, rings, pessaries, and creams to treat the genitourinary syndrome of menopause (GSM). • Though many studies have focused on these estrogen-containing products, comparative efficacy, safety, and patient acceptability data is still lacking. • This review therefore classifies and compares the various platforms for the treatment of GSM, focusing on their performance in terms of systemic absorption, efficacy, safety, and patient satisfaction and acceptance. • The factors to be considered when designing an estrogen-containing product for GSM has also been provided, in addition to the future perspectives for research in this field. [ABSTRACT FROM AUTHOR]

Objective: To create a reference curve for postvoid residual volume (PVRV) in asymptomatic postpartum women who are at low risk of developing postpartum urinary retention (PUR), a well‐known complication in the immediate postpartum period. Methods: This is a prospective observational study measuring PVRV after uncomplicated vaginal delivery. PVRV was assessed by transabdominal ultrasound using a portable ultrasound scanner within the first 26 h after delivery (PVRV 1) and on the day of discharge (day 2 or 3 postpartum) (PVRV 2). A PVRV of 150 mL or more was defined as the cut‐off value for covert PUR. Results: The prevalence of covert PUR was 7.1%. Primiparity, duration of second stage, and obstetric injury were correlated with higher PVRV 1. The median PVRV 1 was 21 mL and PVRV 2 was 11 mL. The subgroup of nulliparous women had a significantly higher PVRV 1 compared with multiparous women. At discharge, the majority (99.1%) of women had a PVRV of less than 150 mL. Conclusion: Asymptomatic women were at low risk of developing PUR. However, women with a prolonged second stage may benefit from a routine postpartum assessment. Our results allow for a better understanding of PVRV in the early postpartum period. Synopsis: Postpartum urinary retention is a rare finding in asymptomatic women following an uncomplicated vaginal delivery. Assessment of postvoid residual volumes facilitates diagnosis and early intervention. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of efficacy for cervical ripening among the Bishop score criteria in nulliparous women at term. Method: Prospective observational study of nulliparous women with singleton term fetuses in vertex presentation, intact membranes, and an unfavorable cervix (Bishop score < 6) who underwent cervical ripening with a cervical‐ripening balloon (CRB; n = 47) or dinoprostone vaginal insert (PG; n = 28). The authors analyzed Bishop score criteria (dilatation, effacement, fetal station, consistency, position) before and after device removal. Primary outcome was favorable cervix (Bishop score ≥ 6) after device removal. Secondary outcomes were vaginal delivery, modification of Bishop score criteria, and perinatal morbidity. Results: Rates of favorable cervix after cervical ripening were similar between groups (66.7% with CRB vs. 59.3% with PG; P = 0.526). Vaginal delivery (76.6% vs. 78.6%; P = 0.843) and perinatal morbidity did not differ between groups. CRB appeared to be more effective than PG in increasing consistency (+0.7 ± 0.2 vs. +0.3 ± 0.2; P = 0.001) and dilatation of the cervix (+1.3 ± 0.3 vs. +0.9 ± 0.3; P = 0.005). No Bishop score criterion was found as a significant predictor for vaginal delivery. Conclusion: CRB seems to be more effective than PG in increasing the consistency and dilatation of the cervix. Efficacy of CRB and PG for vaginal delivery was similar. Synopsis: Cervical‐ripening balloon appears to be more effective than dinoprostone vaginal insert in increasing consistency and dilatation of the cervix in nulliparous women at term. [ABSTRACT FROM AUTHOR]

Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 Primigravida patients+21 Multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (5 days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length =30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was =30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (Correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (Correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery. [ABSTRACT FROM AUTHOR]

Background: A clavicle fracture is one of the most common birth injuries. The objective of this study was to examine whether the decreased incidence of birth‐related clavicle fractures in Finland is because of temporal changes in their predisposing factors. Methods: For this nationwide population‐based study, we used the Finnish Medical Birth Register and the Care Register for Health Care databases. The study population included all singleton, live‐born newborn born spontaneously or by vacuum‐assisted delivery, in cephalic presentation ≥37+0 weeks of gestation. The incidences of clavicle fractures, pregnancy characteristics, and risk assessments for fracture were calculated and compared between two time periods: 2004–2010 and 2011–2017. Results: A total of 629 457 newborn were born vaginally between 2004 and 2017. The clavicle fracture incidence decreased from 17.6/1000 to 6.2/1000 live births. Shoulder dystocia, diabetes, and birthweight ≥4000 g were the strongest predisposing factors. The incidence of birthweight ≥4000 g decreased, meanwhile type 1 diabetes and shoulder dystocia remained stable and gestational diabetes, type 2 diabetes, and maternal obesity increased in the later study period. The incidence of clavicle fractures without known predisposing factors declined. Simultaneously, the cesarean birth rate remained stable (13.2%–13.1%), although the rate of vacuum‐assisted deliveries increased (8.5%–9.5%). Discussion: The incidence of clavicle fractures decreased, even though the incidence of most risk factors remained stable or increased, and the cesarean birth rate remained stable. This decline may be related to the reduction of fracture incidence among deliveries without known risk factors, and the decrease in birthweight ≥4000 g. [ABSTRACT FROM AUTHOR]

Background: A majority of pregnant women experience sleep disruption during pregnancy, especially in the third trimester. Lack of sleep is associated with preterm birth, prolonged labor and higher cesarean section rate. Six or less hours of night sleep in the last month of pregnancy is associated with a higher rate of caesarean births. Eye-masks and earplugs compared to headband improve night sleep by 30 or more minutes. We sought to evaluate eye-mask and earplugs compared to sham/placebo headbands on spontaneous vaginal delivery. Methods: This randomized trial was conducted from December 2019-June 2020. 234 nulliparas, 34–36 weeks' gestation with self-reported night sleep < 6 h were randomized to eye-mask and earplugs or sham/placebo headband (both characterized as sleep aids) to be worn each night to delivery. After two weeks, interim outcome data of the average night sleep duration and the trial sleep related questionnaire was answered through the telephone. Results: Spontaneous vaginal delivery rates were 60/117(51.3%) vs. 52/117(44.4%) RR 1.15 95% CI 0.88–1.51 P = 0.30 for eye-mask and earplugs or headband respectively. At 2-weeks into the intervention period, the eye-mask and earplugs arm reported longer night sleep duration 7.0 ± 1.2 vs. 6.6 ± 1.5 h P = 0.04, expressed increased satisfaction with the allocated aid 7[6.0–8.0] vs. 6[5.0–7.5] P < 0.001, agreed they slept better 87/117(74.4%) vs. 48/117(41.0%) RR 1.81 95% CI 1.42–2.30 NNTb 4 (2.2–4.7) P < 0.001 and higher compliance median[interquartile range] 5[3–7] vs. 4[ 2–5] times per week of sleep aid use P = 0.002. Conclusion: Eye-mask and earplugs use at home in late third trimester do not increase the spontaneous vaginal delivery rate even though self-reported night sleep duration, sleep quality, satisfaction and compliance with allocated sleep aid were significantly better than for sham/placebo headband. Trial registration This trial was registered with ISRCTN on June 11, 2019 with trial identification number: ISRCTN99834087. [ABSTRACT FROM AUTHOR]

Background: Vaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education. Methods: This quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant. Results: The mean score of midwives' skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p <.001). Conclusion: The results of the present study indicated that the simulation situation for critical skills, such as vaginal birth skills, was significantly more effective than workplace-based learning situations. [ABSTRACT FROM AUTHOR]

The development of polymeric carriers based on partially deacetylated chitin nanowhiskers (CNWs) and anionic sulfated polysaccharides is an attractive strategy for improved vaginal delivery with modified drug release profiles. This study focuses on the development of metronidazole (MET)-containing cryogels based on carrageenan (CRG) and CNWs. The desired cryogels were obtained by electrostatic interactions between the amino groups of CNWs and the sulfate groups of CRG and by the formation of additional hydrogen bonds, as well as by entanglement of carrageenan macrochains. It was shown that the introduction of 5% CNWs significantly increased the strength of the initial hydrogel and ensured the formation of a homogeneous cryogel structure, resulting in sustained MET release within 24 h. At the same time, when the CNW content was increased to 10%, the system collapsed with the formation of discrete cryogels, demonstrating MET release within 12 h. The mechanism of prolonged drug release was mediated by polymer swelling and chain relaxation in the polymer matrix and correlated well with the Korsmeyer–Peppas and Peppas–Sahlin models. In vitro tests showed that the developed cryogels had a prolonged (24 h) antiprotozoal effect against Trichomonas, including MET-resistant strains. Thus, the new cryogels with MET may be promising dosage forms for the treatment of vaginal infections. [ABSTRACT FROM AUTHOR]

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]

During the first year of life, development and balance of newborn gut microbiota are strongly influenced by external factors such as delivery mode, breastfeeding, duration of pregnancy, mother diet and lifestyle, siblings and pets, environment, and antibiotics administration. Gut microbiota colonization starts with facultative anaerobes and continues with the establishment of anaerobic genera of which Bifidobacteria are the gold standard of a healthy gut neonatal microbiota. Scientific literature traditionally describes the fetus as sterile in the womb and identifies the membranes rupture as the beginning of microbial colonization. Vaginal delivery is an important source for the onset of infant colonization which will then continue with the transfer of a new selection of intestinal bacteria with breastfeeding. During cesarean delivery a direct contact of the mouth of newborn with the vaginal and intestinal microbiota is absent, and environmental bacteria play an important role for infants intestinal colonization. Nature has ensured that newborns receive other specific maternal bacteria, through a subsequent method of transfer: breastfeeding. We present a brief and comprehensive state-of-the-art in order to encourage natural childbirth and breastfeeding whenever possible and discuss innovative directions for develop new ad hoc personalized treatments in order to restore physiological microbiota. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hypertensive disorders of pregnancy includes Gestational Hypertension, Preeclampsia and Eclampsia, Chronic Hypertension and Preeclampsia superimposed in Chronic Hypertension. These condition complicates around 5 to 10 percent of pregnancies and have significant contributions on maternal and fetal adverse outcome. This study was done to find out the maternal and fetal outcome in cases of Preeclampsia and Eclampsia. MATERIAL AND METHODS: It was a hospital based cross sectional observational study done in department of Obstetrics and Gynecology of Universal College of Medical Sciences from August 2021 to March 2022. Maternal and fetal outcome in Preeclampsia and eclampsia were studied in 116 cases. RESULTS: Incidence of diseases was 5.94%, preeclampsia 33 (28.4%), eclampsia 23 (19.8%) and severe preeclampsia 60 (57.7%). Adverse maternal outcome were HELLP (Hemolysis, Elevated liver enzyme and Low platelets counts) syndrome 15 (12.93%), Abruption placenta 7 (6.03%), need of blood transfusion 20 (17.24%), Pulmonary Oedema 3 (2.58%), Post-Partum Hemorrhage 3 (2.58%) and one case had maternal death. Total 121 babies were born, 42 (34.71%) admitted in NICU, 10 (8.26%) were intra uterine fetal death (IUFD), 3 (2.48%) were neonatal death (NND), 10 (8.26%) refused treatment and leave against medical advice. Common fetal morbidities were intra uterine growth restriction (IUGR) 29 (23.76%), preterm Low birth weight 22 (18.18%), anomalous baby 3 (2.48%) and congenital pneumonia 1 (0.83%). CONCLUSION: Proper Antenatal care and screening, timely referral and prompt management favoured the outcome in positive way. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study is aimed to introduce a new technique used in controlling the postpartum bleeding during normal vaginal delivery. METHODS: This study was conducted on 150 pregnant women aged 18 years or more who were eligible for normal vaginal delivery. After placental delivery, Mostafa Maged maneuver was applied. The amount of blood loss was estimated by counting the number of pads immediately before applying the maneuver compared to the number of pads immediately after applying the maneuver to determine the effectiveness of the Mostafa Maged maneuver. RESULTS: The study revealed that 15.3% of the study group had atony, and 23.3% were complicated with postpartum hemorrhage. In terms of blood loss, the average number of pads used before Mostafa Maged compression was (2.8) pads, with a range of 1 to 6 pads. The mean blood loss volume was (353.3±158.5) ml ranging between 125 and 750 ml. we should consider that Mostafa Maged maneuver is immediately applied after placental delivery. That is why small amount of 125 ml of blood loss in few patients is estimated, which decreased to (0.54±0.14) pads ranging between 0.5 and 1 pad with a mean (65.2±17.7) ml blood loss ranging between 60 and 125 ml after applying Mostafa Maged maneuver during normal vaginal delivery. There was a statistical decrease in the number of pads and volume of blood loss after Mostafa Maged maneuver. CONCLUSION: Mostafa Maged maneuver was found to be effective in stopping and preventing postpartum bleeding during vaginal delivery as this maneuver is used as a prophylaxis against post-partum hemorrhage in patients with risk factors of postpartum hemorrhage. It is also used to control post-partum hemorrhage during vaginal delivery. It has been proven to be tolerable, easy to learn and easy to perform. [ABSTRACT FROM AUTHOR]

Changes between pre- and postpartum hemoglobin might be useful for optimizing the postpartum diagnosis of postpartum hemorrhage (PPH), defined as a blood loss exceeding 500 mL. This study's principal objective was to estimate the mean change in hemoglobin (between pre/post-delivery hemoglobin) among women with vaginal deliveries and PPH. The secondary objectives were to analyze: hemoglobin changes according to blood volume loss, the appropriateness of standard thresholds for assessing hemoglobin loss, and the intrinsic and extrinsic performances of these threshold values for identifying PPH. French maternity units (n = 182) participated in the prospective HERA cohort study. Women with a vaginal delivery at or after a gestation of 22 weeks with a PPH (n = 2964) were eligible. The principal outcome was hemoglobin loss in g/L. The mean hemoglobin change was 30 ± 14 g/L among women with a PPH. Overall, hemoglobin decreased by at least 10% in 90.4% of women with PPH. Decreases ≥ 20 g/L and ≥40 g/L were found, respectively, in 73.9% and 23.7% of cases. Sensitivity and specificity values for identifying PPH were always <65%, the positive predictive values were between 35% and 94%, and the negative predictive values were between 14% and 84%. Hemoglobin decrease from before to after delivery should not be used as a PPH diagnostic screening test for PPH diagnosis for all vaginal deliveries. [ABSTRACT FROM AUTHOR]

Objective: To develop a comprehensive machine learning (ML) model predicting unplanned cesarean delivery (uCD) among singleton pregnancies based on features available at admission to labor. Methods: A retrospective cohort study from a tertiary medical center. Women with singleton vertex pregnancy of 34 weeks or more admitted for vaginal delivery between March 2011 and May 2019 were included. The cohort was divided into training (80%) and validation (20%) data sets. A separate cohort between June 2019 and April 2021 served as a test data set. Features selection was performed using a Random Forest ML algorithm. Results: The study population included 73 667 women, of which 4125 (6.33%) underwent uCD. The final model consisted of 13 features, based on prediction importance. The XGBoost model performed best with areas under the curve for the training, validation, and test data sets of 0.874, 0.839, and 0.840, respectively. The model showed a 65% positive predictive value for uCD among women in the 100th centile group, and a 99% or more negative predictive value in the less than 50th centile group. Positive and negative predictive values remained high among subgroups with high pretest probability of uCD. Conclusion: An ML model for the prediction of uCD provides clinically useful risk stratification that remains accurate across gestational weeks 34–42 and among clinical risk groups. The model may be clinically useful for physicians and women admitted for labor. Synopsis: A machine learning model predicts unplanned cesarean delivery and can inform women's individualized decision making. [ABSTRACT FROM AUTHOR]

Problem: Previous studies document an association between mode of delivery (MOD) and allergic conditions in children. Immunoglobulin (Ig) concentrations at birth may play a role. The goal of this study is to assess the impact of MOD on Ig concentrations at delivery from newborn dried blood spots (DBS). Method of study: The Upstate KIDS Study (2008–2010) is a prospective cohort of mother‐child pairs recruited from New York State, excluding New York City. Ig subtypes IgA, IgE, IgG1, IgG2, IgG3, IgG4, and IgM were measured in residual NDBS from the Newborn Screening Program (N = 3274 infants). MOD was categorized as vaginal delivery (VD), emergency cesarean delivery (ECD) or planned cesarean delivery (PCD). Associations between MOD and Ig levels were assessed using ANOVA and multiple regression, with models adjusted for gestational age, birth weight, maternal race, plurality, and smoking status. Results: IgA, and the IgG subtypes IgG3 and IgG4 were found to be significantly lower in PCD neonates relative to VD neonates in adjusted regression models: 3.57 mg/ml, (95% CI: 3.51, 3.63) compared to 3.64 mg/ml (95% CI: 3.59, 3.69); 8.95 ng/ml (95% CI: 8.88,9.03) compared to 9.03 ng/ml (95% CI: 8.98, 9.08) and 8.05 ng/ml (95% CI: 7.91, 8.20) compared to 8.22 ng/ml (95% CI: 7.91,8.20), respectively. Conclusions: MOD may thus be related to neonatal immune profile. Results were found to be robust to sensitivity testing based on maternal complications and indication for CD. Clinical implications are unclear given the small levels of association found in newborns, but the result suggests greater susceptibility to infection, and further study is warranted. [ABSTRACT FROM AUTHOR]

Documentation of fetal to neonatal heart rate (HR) transition is limited. The aim of the current study was to describe HR changes from one hour before to one hour after normal vaginal deliveries. We conducted a prospective observational cohort study in Tanzania from 1 October 2020 to 30 August 2021, including normal vaginal deliveries with normal neonatal outcomes. HR was continuously recorded from one hour before to one hour after delivery, using the Moyo fetal HR meter, NeoBeat newborn HR meter, and the Liveborn Application for data storage. The median, 25th, and 75th HR percentiles were constructed. Overall, 305 deliveries were included. Median (interquartile range; IQR) gestational age was 39 (38–40) weeks and birthweight was 3200 (3000–3500) grams. HR decreased slightly during the last 60 min before delivery from 136 (123,145) to 132 (112,143) beats/minute. After delivery, HR increased within one minute to 168 (143,183) beats/min, before decreasing to around 136 (127,149) beats/min at 60 min after delivery. The drop in HR in the last hour of delivery reflects strong contractions and pushing. The rapid increase in initial neonatal HR reflects an effort to establish spontaneous breathing. [ABSTRACT FROM AUTHOR]

Introduction: Practice of starting and sustaining breastfeeding is affected by many conditions, mode of delivery is one of the major factor influencing it. Purpose of the study was to see if the mode of delivery affects the subsequent lactation in early postpartum period and to raise awareness among the community about the importance of mode of delivery in early initiation of breast feeding. Materials and Methods: Present study was a hospital based observational, comparative prospective study. A sample size of 120 subjects in each group (caesarean delivery CD Group and vaginal delivery VD group) was required. Serum prolactin and LATCH score both at 1st hour and 24th hour were compared in both groups. Results: Mean LATCH score at 1st hour and 24th hour of CD Group was 5.44 ± 0.68 and 7.12 ± 0.95, respectively. The mean LATCH score at 1st hour and 24th hour of VD Group was 7.12 ± 0.94 and 8.1 ± 1, respectively. Mean serum prolactin level at 1st hour and 24th hour of CD Group was 259.68 ± 33.99 and 309.99 ± 42.27, respectively. Mean serum prolactin level at 1st hour and 24th hour of VD Group was 304.91 ± 42.07 and 333.34 ± 42.65, respectively. The mothers delivered by caesarean had main problem with latch (L) and hold (H) of the baby as compared to mothers delivered vaginally. Conclusion: Mode of delivery has a direct impact on early initiation of breast feeding. Caesarean delivery is a cause for delay in initiation of breastfeeding. [ABSTRACT FROM AUTHOR]

Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2–5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2–5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2–5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions. [ABSTRACT FROM AUTHOR]

Background: The growing rate of caesarean section is a major concern for quality of maternal life and public health. Concerns about such increases prompted the WHO to recommend Robson ten group classification system for assessing the Caesarean Section rate. The present study's aim was to assess the caesarean rate using Robson's ten group classification system and highlighted the reliable information system, in turn, helps to construct interventions to reduce avoidable caesareans. Methods: This crosssectional study was carried out on 5796 women who delivered from 25th November 2021 to 24th November 2022 in Jinnah Post Graduate medical Centre Karachi. Data was collected from the women admitted for delivery using Robson's Pro forma. Relative size and caesarean rate of each group and overall caesarean section rate was calculated. Results: Of the total 5796 deliveries, 2141 (36.9%) were caesarean deliveries and 3655 (63.1%) had normal deliveries. Out of Robson's ten groups system, Group 10 had a higher contribution of 705 (12.2%) to the overall caesarean rate followed by group 5 had 627 (10.8%). The contributing prevalence of Group 1, 2, 3, 4, 6, 7, 8 and 9 were 122 (2.1%), 317 (5.5%), 50 (0.87%), 167 (2.9%), 42 (0.72%), 35 (0.6%), 49 (0.85%) and 27 (0.46%) respectively. Conclusion: Our study concluded that Group 10 and 5 were the most responsible for the whole Caesarean Section rate. In all contributing groups, there is a need to identify the indications and to sub classify these groups further so that preventable caesarean sections can be avoided by reducing these factors. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of immediate skin-to-skin contact (SSC) between mothers and their newborns on episiotomy pain. Material and Methods: This randomized controlled trial enrolled 60 participants who underwent vaginal delivery. The participants were divided into two groups: an immediate SSC group and a no SSC group (n=30 for each group). SSC was initiated within 10 minutes after birth with a contact duration of at least 30 minutes. Episiotomy pain severity was evaluated using a visual analog scale (VAS) at one hour after birth in both groups. The pain scores were analyzed using the Mann-Whitney U test and the optimum contact time for reducing episiotomy wound pain was evaluated by a receiver operating characteristic (ROC) curve. Results: The median VAS of episiotomy pain at one hour after delivery in the SSC group was statistically significantly lower than the no SSC group (1.9 (0.8-3.1) vs. 3.4 (2-5.2) cm, p-value

BACKGROUND: In worldwide literature, it has been found that cesarean deliveries represent higher costs and are associated with maternal morbidity and other complications. OBJECTIVE: This study aimed to estimate the cost-effectiveness of elective cesarean delivery compared with spontaneous vaginal delivery in short-term maternal outcomes for low-risk obstetrical population in Colombia. STUDY DESIGN: A cost-effectiveness study using a healthcare-system perspective was performed in 2019 in Colombia. The reference population were women with full-term and low-risk pregnancy, either by spontaneous vaginal delivery or elective cesarean delivery under medical or nonmedical indications. An analytical decision model (decision tree) was designed for maternal outcomes. The time horizon was 42 days postpartum, and the health effects were measured by Quality Adjusted Life Years. A review of the literature and a validation process by a national expert committee were conducted to determine the maternal outcomes and estimate their probabilities. Costs were estimated with a top-down analysis, an incremental cost-effectiveness ratio was calculated, and finally, a sensitivity analysis was performed. RESULTS: Within a 42-day time horizon, it was found that spontaneous vaginal delivery is the less-expensive and more-effective mode of delivery, it showed a reduction in costs (324 USD) and a gain in Quality Adjusted Life Years (0.03) compared with elective cesarean delivery. Our analysis suggests that spontaneous vaginal delivery is the dominant alternative compared with elective cesarean delivery. CONCLUSION: Spontaneous vaginal delivery showed to be the cost-effective mode of delivery for low-risk obstetrical population in Columbia. These results are useful not only for obstetricians but for decision makers, who should encourage nationwide health policies in favor of spontaneous vaginal delivery.

BACKGROUND: Cesarean delivery is a major source of maternal morbidity, and repeat cesarean delivery accounts for 40% of cesarean delivery, but recent data on the trial of labor after cesarean and vaginal birth after cesarean are limited. OBJECTIVE: This study aimed to report the national rates of trial of labor after cesarean and vaginal birth after cesarean by number of previous cesarean deliveries and examine the effect of demographic and clinical characteristics on these rates. STUDY DESIGN: This was a population-based cohort study using the US natality data files. The study sample was restricted to 4,135,247 nonanomalous singleton, cephalic deliveries between 37 and 42 weeks of gestation, with a history of previous cesarean delivery and delivered in a hospital between 2010 and 2019. Deliveries were grouped by number of previous cesarean deliveries (1, 2, or ≥3). The trial of labor after cesarean (deliveries with labor among deliveries with previous cesarean delivery) and vaginal birth after cesarean (vaginal deliveries among trial of labor after cesarean) rates were computed for each year. The rates were further subgrouped by history of previous vaginal delivery. Year of delivery, number of previous cesarean deliveries, history of previous cesarean delivery, age, race and ethnicity, maternal education, obesity, diabetes mellitus, hypertension, inadequate prenatal care, Medicaid payer, and gestational age were examined concerning the trial of labor after cesarean and vaginal birth after cesarean using multiple logistic regression. SAS software (version 9.4) was used for all analyses. RESULTS: The trial of labor after cesarean rates increased from 14.4% in 2010 to 19.6% in 2019 (P

BACKGROUND: Inpatient postpartum recovery trajectories following cesarean delivery and spontaneous vaginal delivery are underexplored. OBJECTIVE: This study primarily aimed to compare recovery following cesarean delivery and spontaneous vaginal delivery in the first postpartum week, and secondarily to evaluate psychometrically the Japanese version of the Obstetric Quality of Recovery-10 scoring tool. STUDY DESIGN: Following institutional review board approval, the EQ-5D-3L (EuroQoL 5-Dimension 3-Level) questionnaire and a Japanese version of the Obstetric Quality of Recovery-10 measure were used to evaluate inpatient postpartum recovery in uncomplicated nulliparous parturients delivering via scheduled cesarean delivery or spontaneous vaginal delivery. RESULTS: A total of 48 and 50 women who delivered via cesarean delivery and spontaneous vaginal delivery, respectively, were recruited. Women delivering via scheduled cesarean delivery experienced significantly worse quality of recovery on days 1 and 2 compared with those who had spontaneous vaginal delivery. Quality of recovery significantly improved daily, plateauing at days 4 and 3 for cesarean delivery and spontaneous vaginal delivery groups, respectively. Compared with cesarean delivery, spontaneous vaginal delivery was associated with prolonged time to analgesia requirement, decreased opioid consumption, reduced antiemetic requirement, and reduced times to liquid/solid intake, ambulation, and discharge. Obstetric Quality of Recovery-10-Japanese is a valid (correlates with the EQ-5D-3L including a global health visual analog scale, gestational age, blood loss, opioid consumption, time until first analgesic request, liquid/solid intake, ambulation, catheter removal, and discharge), reliable (Cronbach alpha=0.88; Spearman–Brown reliability estimate=0.94; and intraclass correlation coefficient=0.89), and clinically feasible (98% 24-hour response rate) measure. CONCLUSION: Inpatient postpartum recovery is significantly better in the first 2 postpartum days following spontaneous vaginal delivery compared with scheduled cesarean delivery. Inpatient recovery is largely achieved within 4 and 3 days following scheduled cesarean delivery and spontaneous vaginal delivery, respectively. Obstetric Quality of Recovery-10-Japanese is a valid, reliable, and feasible measure of inpatient postpartum recovery.

Human papillomavirus (HPV) can be vertically transmitted. Our objective was to measure the association between the mode of delivery and the detection of HPV in infants. We used data collected from pregnant women during the HERITAGE study. Self-collected vaginal samples from the first and third trimester were obtained for HPV testing. Specimens from oral, pharyngeal, conjunctival and anogenital mucosa were collected from infants 36–48 h after delivery and at 3 months of age. All samples were tested for HPV DNA by the Linear Array assay. Adjusted odd ratios (aOR) and 95% confidence interval (CI) were estimated using multivariate logistic regressions. From the 282 women revealed to be HPV-positive in both the first and third trimesters, 25 infants were born HPV-positive. The overall probability of transmission was 8.9% (25/282); 3.7% (3/81) in participants with a caesarean section and 10.9% (22/201) for those who delivered vaginally. Vaginal delivery increased the risk of HPV in infants compared to caesarean (aOR: 3.63, 95%CI: 1.03–12.82). Infants born after a caesarean with ruptured membranes were not at increased risk of HPV compared to infants born after an elective caesarean section with intact membranes (aOR: 1.31, 95%CI: 0.10–17.76). Our results support the hypothesis that transmission occurs mostly during the passage in the vaginal canal.

Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast ® and Vicryl Rapide ® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast ® (n=47) or Vicryl Rapide ® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (pversus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast ® and Vicryl Rapide ® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast ® suture is clinically equivalent to Vicryl Rapide ® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020

Background. According to various researchers, obstetric perineal injury is the most commOn complication in childbirth, the frequency of which can vary from 13 to 85%. Currently, vaginal delivery and birth trauma are recognized as the leading risk factors for the development of pelvic, urodynamic and sexual dysfunctions. Urinary and fecal incontinence, pelvic organ prolapse, sexual health disorders, chronic pelvic pain and the presence of cosmetic defects in the perineum are the reasons for a significant decrease in the quality of life of women after delivery. Recently, there has been a tendency to "rejuvenate" dysfunctions of the ligamentous apparatus and muscles of the pelvic floor, which support the pelvic organs in a normal position in women after the first birth. In the absence of timely diagnosis and treatment, anatomical changes and clinical symptoms will rapidly progress, forming persistent dysfunctions of the pelvic organs. Aim. To evaluate pelvic and urodynamic dysfunctions in women after per vias naturales delivery with concomitant perineal trauma. Materials and methods. A prospective cohort comparative study was conducted, which included 55 women of reproductive age after delivery per vias naturales of the fetus in cephalic presentation. The main group consisted of 30 women who had a perineal injury during childbirth, the control group included 25 women with uncomplicated straining period. All patients 34 months after delivery underwent a gynecological examination with perineometry, ultrasound examination of the pelvic organs, as well as a comprehensive urodynamic study. Results. Women with a perineal injury during childbirth were significantly more likely to complain of frequent urination and urinary incontinence during physical exertion than women in the control group 70.0% versus 40.0% and 76.7% versus 40.0% of cases respectively (p0.05). According to the ultrasound data, the patients of the main group had a significantly more pronounced deviation of the angle and the angle during straining in comparison with the control group 4.672.6 versus 2.651.1 and 11.937.1 versus 7.104.7 respectively (p0.05). Statistically significant differences were also obtained when measuring the strength of the pelvic floor muscles in patients with perineal injury in comparison with the control group 68.175.8 mmHg versus 76.805.3 mmHg (p0.05). According to urofluometry, the patients of the main group showed a statistically significant decrease in the rate of average and maximum urine flow than in the women of the control group 11.693.8 ml/sec versus 17.902.1 ml/sec and 20.617.0 ml/s versus 25.223.1 ml/s respectively (p0.05). Conclusion. The results obtained indicate the occurrence of urodynamic and pelvic disorders in women during the first 4 months after childbirth, complicated by perineal trauma. In women who have experienced birth trauma, such pelvic and urodynamic dysfunctions as hypermobility of the urethrovesical segment in 86% of cases, a decrease in the strength of the pelvic floor muscles in 54% of cases, and a decrease in the average urine flow rate in 25% of cases were revealed. These disorders can be diagnosed using available non-invasive instrumental examination methods, such as ultrasound, perineometry and uroflowmetry. Thus, there is a need for early detection of pelvic floor dysfunctions for the purpose of subsequent treatment after childbirth, which in turn will help prevent the progression of genital prolapse and urinary incontinence, prevent their severe forms, reduce the need for surgical interventions and preserve the quality of life of women.

Objective To evaluate the effects of different delivery modes on diastasis recti abdominis （DRA） in 6-8 weeks postpartum period. Methods Clinical data of 1354 singleton deliveries who had regular prenatal examination and delivery were collected. According to delivery times and delivery modes, 775 primiparous women [including 546 vaginal delivery （A1 group） and 229 caesarean section （B1 group）] and 579 multipara women [including 357 second vaginal delivery （A2 group） and 222 second caesarean section （B2 group）] were followed-up. The inter-rectus distance was examined by high-frequency ultrasound at three locations on the linea alba （3 cm above the umbilicus, umbilicus, 3 cm below the umbilicus） in 6-8 weeks postpartum. The effects of two delivery modes on DRA in postpartum period were evaluated. Results DRA mainly occurred at umbilicus, followed by at the 3 cm above the umbilicus and 3 cm below the umbilicus. The incidence of DRA in the caesarean section groups was higher than that of the vaginal delivery groups among primiparous or multipara women （92.1% vs. 77.6% and 95.5% vs. 90.8%, both P < 0.05）. The inter-rectus distance at three locations in the caesarean section groups was longer than that in the vaginal delivery groups among primiparous or multipara women （B1 group vs. A1 group and B2 group vs. A2 group, all P < 0.001）. The inter-rectum distance at three locations in B2 group was longer than that in B1 group （all P < 0.001）. Conclusion Caesarean section elevates the incidence of DRA and increases the inter-rectus distance in early postpartum period.

Background: Pregnant women who request a caesarean section in the absence of obstetric indication are increasing in number. Objectives: The objective of this study is to analyse the responsible factor for maternal requests for a planned or elective caesarean section in western Rajasthan. Methods: A descriptive cross-sectional qualitative study was conducted with semi-structured proforma, in-depth interviews with women delivered by caesarean section. A total number of 100 patients who underwent caesarean section were taken, and 100 patients of vaginal delivery were included in the study for demographic comparison. Data were analysed with statistical software. Results: In our study, out of 100 patients who underwent caesarean delivery, 38% patients had a history of previous caesarean section, 18 % choose caesarean section due to past traumatic or negative experiences, 14 % due to safety issues of the child, 13 % choose caesarean section due to fear and pain of labour, 9 % due to religious belief, 5% due to family advice and peer pressor and 3% wanted a simultaneous tubectomy. Conclusion: Previous caesarean section with the refusal of vaginal birth after a caesarean section was the most common cause of elective caesarean section. There are various rationales and life experiences behind a maternal request for a caesarean section needing carefully targeted attention and health care. A previous traumatic birth experience and pain also prompted a caesarean to avoid a repetition of the trauma.

ObjectiveTo assess the risk factors of puerperal genital hematomas in women after vaginal delivery. Methods Clinical data of 34 945 cases of vaginal delivery were reviewed retrospectively. According to the incidence of puerperal genital hematomas, 112 women presenting with puerperal genital hematomas were divided into the genital hematomas group, and 260 randomly selected from 34 833 normal women were assigned into the control group. Clinical data of 372 cases were collected and compared between two groups. The risk factors of puerperal genital hematomas were assessed by logistic regression analysis. Results The total incidence of puerperal genital hematomas was 0.32% （112/34 945） in this study. No statistical significance was observed in the gravidity, first stage of labor time, second stage of labor time, the number of precipitate labor, neonatal birth weight and the number of macrosomia between two groups （all P > 0.05）. However, the proportion of nulliparity, episiotomy, perineal laceration, vaginal laceration, and instrumental delivery in the genital hematomas group was significantly higher compared with that in the control group （all P < 0.05）. Multivariate logistic regression analysis showed that nulliparity （OR=1.663, 95%CI 1.003-2.757） and vaginal laceration （OR=3.698, 95%CI 1.962-6.970） were risk factors of puerperal genital hematomas （both P < 0.05）. Conclusions Nulliparity, episiotomy, perineal laceration, vaginal laceration, and instrumental delivery are associated with a higher rate of puerperal genital hematomas. Clinicians should pay extensive attention to nulliparity and vaginal laceration, deliver effective interventions and improve clinical prognosis of pregnant women after vaginal delivery.

Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast® and Vicryl Rapide® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast® (n=47) or Vicryl Rapide® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p

Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 Primigravida patients+21 Multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (5 days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length ≤30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was ≤30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (Correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (Correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery.

Introduction and hypothesisAnal incontinence (AI) is a prevalent postpartum disorder. This study aims to investigate and quantify the risk factors for AI in the Chinese population during the first year following vaginal delivery.MethodsThe case control study was conducted at Peking University Third Hospital, including all women who delivered vaginally between January 1, 2014, and June 30, 2018. Participants were followed up by telephone interviews 1 year after delivery. AI was defined as the involuntary loss of flatus or feces using a retrospective Jorge and Wexner score above 0. Clinical data were retrieved from the medical record system. Univariate and multivariate analyses were applied to identify potential risk factors accounting for AI. Based on the logistic regression model, a nomogram was constructed to predict the probability of AI postpartum. Restricted cubic spline was utilized to explore potential non-linear relationships between birth weight and AI postpartum.ResultsAmong the 140 AI and 421 none AI cases, we observed antepartum factors like every 100 g of birth weight gain (OR 1.39, 95% CI 1.30–1.49), while intrapartum factors like forceps-assisted vaginal delivery (OR 7.11, 95% CI 2.60–19.45), midline episiotomy (OR 13.11, 95% CI 1.71–100.89), second-degree perineal tear (OR 6.51, 95% CI 1.16–36.68), and third to fourth-degree perineal tear were independent risk factors for postpartum AI. Significantly, infant weighing over 3,400 g at birth increased the risk of AI postpartum. Based on logistic regression model, we constructed a nomogram to estimate the risk of AI 1 year after vaginal delivery.ConclusionOur findings indicated that during the first year following vaginal delivery, infant with birth weight of 3,400 g or more, forceps-assisted vaginal delivery, midline episiotomy, and second to fourth-degree perineal tear increased the risk of AI. As a result, it is essential to limit the routine use of forceps and midline episiotomy and to monitor fetal weight during prenatal care.

According to the World Health Organization (WHO), the rates of caesarean section delivery, which is the most common surgical procedure in gynecology and obstetrics, are increasing globally and amount to 21%. In Poland percentage of caesarean sections (CS) is one of the highest in Europe and amount to 42.2%. The reason for this is the extension of medical indications, but also an increase in the number of CS at the request of pregnant women. Although CS can be a lifesaving procedure, it can also cause many health complications for both - the woman and the child. Numerous studies indicate that caesarean delivery is associated with childhood asthma. Several hypotheses of the pathogenesis of this relationship have been presented. One of them, which is based on the hygiene hypothesis indicates that mode of delivery can cause different bacteria colonization in infants. Lack of contact of fetus with the mother’s vaginal flora during CS labor may cause improper immune system maturation. Another hypothesis is that reduced exposure to stress hormones and mechanical forces during CS labor can indicate infant respiratory complications such as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN). It is suggested that these abnormalities have an impact on asthma development in later life. On the other hand, there are studies which do not confirm that mode of delivery has an influence on the induction of asthma. Due to the significant heterogeneity of studies and unclear risk factors and pathomechanism of the childhood asthma it is impossible to strong confirm the association between caesarean section and asthma developing.

Aim: We investigated cervical parameters predictive of vaginal delivery in elective labor induction among women at 40–41 gestational weeks. Methods: This Japanese prospective single‐center cohort study was conducted between July 2019 and June 2020. We enrolled women with an uncomplicated singleton pregnancy who underwent labor induction at 40–41 gestational weeks. We analyzed background characteristics and cervical parameters, including Bishop score, cervical length, posterior cervical angle, and changes in cervical parameters before and after cervical dilatation. The endpoint was the rate of vaginal delivery. Results: Of 142 eligible participants, all 24 multiparous women underwent vaginal delivery. Among the nulliparous women (n = 118), the following categories showed significantly higher rates of vaginal delivery: Bishop scores of ≥6 before and after dilatation, compared with Bishop score <6 (adjusted prevalence ratio (aPR) [95% confidence interval (CI)]; 1.58 [1.17–2.13] and 1.56 [1.13–2.14], respectively) and cervical length of <10 and 10–20 mm before dilation, compared with cervical length of >30 mm (aPR [95% CI]; 1.47 [1.00–2.15] and 2.13 [1.42–3.18], respectively). The posterior cervical angle and other background characteristics showed no significant associations. Furthermore, women with cervical lengths of ≥20 mm before and <20 mm after dilatation showed a higher rate of vaginal delivery, compared to cervical length of ≥20 mm even after dilatation (aPR [95% CI]; 1.95 [1.19–3.20]). Conclusions: High Bishop score, short cervical length, and changes in cervical length with dilatation are potential independent predictors of vaginal delivery following elective labor induction in nulliparous women at 40–41 gestational weeks. [ABSTRACT FROM AUTHOR]

Aim: Cesarean section rates have increased, and although various measures such as antenatal education programs have been introduced to correct this, these could not be performed face-to-face due to the COVID-19 pandemic and were largely carried out online. The aim of this study was to find out what effect traditional education during pregnancy and its online replacement have on the rate of cesarean births and how the pregnancy turns out in unusual situations. Materials and Methods: The research was designed as a retrospective cross-sectional study. Fifty women undergoing childbirth in our hospital who received online antenatal education (Group 1), 101 women who received classic education (Group 2), and 77 women receiving no education (Group 3) took part in the study. Patient data were retrieved from the hospital information system and patient records. Results: This study involved 228 pregnant women. Fifty pregnant women (22%) receiving antenatal online education were assigned to Group 1, 101 women (44%) receiving classic face-to-face education to Group 2, and 77 women (34%) receiving no education to Group 3. Forty percent of Group 1, given online education, and 62.4% of Group 2, given classic education, were able to give birth via the normal vaginal route, and the difference was statistically significant (0.001). Cesarean delivery rates were significantly higher in Group 1 (60%) than in Group 2 (37.6%) (0.001). Statistically similar results were determined in all three groups in terms of birth weight, birth length, and low birth weight. No significant difference was also observed between the three groups in terms of premature birth (37 weeks) (p=0.67). Conclusion: Online antenatal education does not reduce cesarean delivery rates compared to classic education. However, neonatal outcomes are similar. [ABSTRACT FROM AUTHOR]

The main objective of this study was to evaluate the association between maternal and fetal anthropometric characteristics and third- and fourth-degree perineal tears. This retrospective cohort study considered all consecutive pregnancies from 2011 to 2017 at a single Institution. The inclusion criteria were: singletons who delivered vaginally during the study period, the presence of information on maternal pre-pregnancy weight, maternal height, and weight of the newborn. The feto-maternal body-mass index (BMI) was calculated as neonatal weight in kg on maternal height in squared meters (kg/m2). In total, 5397 singleton-term pregnancies were included; the prevalence of third-fourth-degree perineal tears was 0.47%. The most predictive factors were: nulliparity, feto-maternal BMI, neonatal weight, gestational age at delivery, and neonatal head circumference. After adjustment in multivariate analysis, the only independent predictors were nulliparity and fetomaternal BMI. The AUC of the final multivariate model was 73.54% (95% CI 65.65–81.42). Furthermore, feto-maternal BMI and gestational age had a significant direct correlation. Nulliparity and feto-maternal BMI are the two best predictors for third and fourth-degree perineal tears in our setting. Confirming this association in future research and integrating it into a decision algorithm on delivery timing could reduce obstetric damage to the anal sphincter. [ABSTRACT FROM AUTHOR]

Background: Cleansing of the vulva and perineum is recommended during preparation for vaginal delivery, and special attention is paid to cleansing before episiotomy because episiotomy is known to increase the risk of perineal wound infection and/or dehiscence. However, the optimal method of perineal cleansing has not been established, including the choice of antiseptic agent. To address this issue, we designed a randomized controlled trial to examine whether skin preparation with chlorhexidine-alcohol is superior to povidone-iodine for the prevention of perineal wound infection after vaginal delivery. Methods: In this multicenter randomized controlled trial, term pregnant women who plan to deliver vaginally after episiotomy will be enrolled. The participants will be randomly assigned to use antiseptic agents for perineal cleansing (povidone-iodine or chlorhexidine-alcohol). The primary outcome is superficial or deep perineal wound infection within 30 days after vaginal delivery. The secondary outcomes are the length of hospital stay, physician office visits, or hospital readmission for infection-related complications, endometritis, skin irritations, and allergic reactions. Discussion: This study will be the first randomized controlled trial aiming to determine the optimal antiseptic agent for the prevention of perineal wound infections after vaginal delivery. Trial registration: ClinicalTrials.gov NCT05122169. First submitted date on 8 November 2021. First posted date on 16 November 2021 [ABSTRACT FROM AUTHOR]

Objective: Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and review the reported obstetrical complications and outcomes after vaginal delivery for these women. Data sources: A systematic search was performed from inception up to 25 July 2022 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking. Study eligibility criteria/appraisal: All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening, data extraction and risk of bias assessment was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed. Results: Only five of the 2377 articles screened were eligible for inclusion with a total of 13 attempted vaginal deliveries in eight women. In three patients complications were reported: failed vaginal delivery requiring urgent cesarean section in two patients, and vaginal tearing in one patient. Conclusion: High quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem. Trial registration: CRD42020201390. Date: 28–07-2020s. [ABSTRACT FROM AUTHOR]