Search

This article describes the methods used to build a large-scale database of more than 250,000 electronic fetal monitoring (EFM) records linked to a comprehensive set of clinical information about the infant, the mother, the pregnancy, labor, and outcome. The database can be used to investigate how birth outcome is related to clinical and EFM features. The main steps involved in building the database were: (1) Acquiring the raw EFM recording and clinical records for each birth. (2) Assigning each birth to an objectively defined outcome class that included normal, acidosis, and hypoxic-ischemic encephalopathy. (3) Removing all personal health information from the EFM recordings and clinical records. (4) Preprocessing the deidentified EFM records to eliminate duplicates, reformat the signals, combine signals from different sensors, and bridge gaps to generate signals in a format that can be readily analyzed. (5) Post-processing the repaired EFM recordings to extract key features of the fetal heart rate, uterine activity, and their relations. (6) Populating a database that links the clinical information, EFM records, and EFM features to support easy querying and retrieval. •A multi-step process is required to build a comprehensive database linking electronic temporal fetal monitoring signals to a comprehensive set of clinical information about the infant, the mother, the pregnancy, labor, and outcome.•The current database documents more than 250,000 births including almost 4,000 acidosis and 400 HIE cases. This represents more than 80% of the births that occurred in 15 Northern California Kaiser Permanente Hospitals between 2011-2019. This is a valuable resource for studying the factors predictive of outcome.•The signal processing code and schemas for the database are freely available. The database will not be permitted to leave Kaiser firewalls, but a process is in place to allow interested investigators to access it.

Maternal mortality rates within the United States have reached an all-time high.  Annually, nearly seven hundred women die from pregnancy-related complications, a number of which were highly preventable.  When taking a closer look at these statistics, these deaths disproportionately affect Native American and African American women, making them two to three times more likely to suffer from poorer pregnancy outcomes.  This paper examines the variety of factors that contribute to such a disproportionate maternal mortality rate, including geographic differences, racial and economic inequalities, and the accessibility of healthcare.  Despite attempts to fix these issues, systemic and intrinsic issues persist, and individuals continue to suffer.  This paper highlights the need to address maternal mortality disparities that affect marginalized groups, improved accessibility to healthcare for all, and overall policy reform in order to solve this issue indefinitely.

Objective Cerebral oximetry using near-infrared spectroscopy (NIRS) is a noninvasive optical technology widely used in neonatology. The present study aimed to define reference ranges for cerebral tissue oxygen saturation (crSO 2) with a new four-wavelength NIRS device, Masimo O3 oximeter, during immediate transition after birth and compare values with those obtained previously with NIRO 200NX ®. Study Design This was a prospective observational study using Masimo O3 device to measure crSO 2 and regional cerebral fractional tissue oxygen extraction (cFTOE) in healthy term newborns delivered by primary cesarean section, during the 15 minutes after cord clamping. The neonates who required any medical support were excluded. The NIRS sensor was placed on the right forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry. Previous studies which established centiles for crSO 2 with NIRO 200NX were used for comparison. Results A total of 44 newborns were included. The median crSO 2 and cFTOE (interquartile range) at 2, 5, and 7 minutes was 54% (49–54), 71% (64–86), and 79% (73–84) and 0,25 (0,18–0,33), 0,19 (0,15–0,23), and 0,16 (0,12–0,21), respectively, with no further changes afterwards. The crSO 2 measurements were significantly higher with Masimo O3 compared with NIRO-200NX. Conclusion The present observational study presented reference ranges for crSO 2 and cFTOE measured with Masimo O3 oximeter during the immediate neonatal transition. Values obtained with O3 were higher than those obtained with other oximeters. For this reason, crSO 2 is device-specific so there must be known reference values for each oximeter to define therapeutic interventions based on crSO 2 and assess cerebral oxygenation in clinical studies. Key Points Masimo O3 uses four wavelengths to measure regional oxygen saturation value. O3 values of crSO 2 and cFTOE differ with other neonatal oximeters at birth. Knowledge of reference range of O3 at birth is essential to guide resuscitation. [ABSTRACT FROM AUTHOR]

Objective Gastroschisis is the most common congenital abdominal wall defect, with an increasing incidence. It results in extrusion of abdominal contents with associated delayed intestinal motility. Abnormal heart rate characteristics (HRCs) such as decreased variability occur due to the inflammatory response to sepsis in preterm infants. This study aimed to test the hypothesis that infants with gastroschisis have decreased heart rate variability (HRV) after birth and that this physiomarker may predict outcomes. Study Design We analyzed heart rate data from and clinical variables for all infants admitted with gastroschisis from 2009 to 2020. Results Forty-seven infants were admitted during the study period and had available data. Complex gastroschisis infants had reduced HRV after birth. For those with sepsis and necrotizing enterocolitis, abnormal HRCs occurred early in the course of illness. Conclusion Decreased HRV was associated with complex gastroschisis. Infants in this group experienced complications that prolonged time to full enteral feeding and time on total parenteral nutrition. Key Points Infants with gastroschisis can be classified into two subcategories, simple and complex disease. Those with complex disease often require prolonged stays in the neonatal intensive care unit and costly hospitalizations. We hypothesized that infants with complex gastroschisis are more likely to have abnormal HRC due to intestinal inflammation. In this study, we identified associations between abnormal HRV, heart rate characteristicHRC, and the development of gastroschisis complications. Additionally, we described differences in clinical characteristics between infants with complex versus simple gastroschisis. [ABSTRACT FROM AUTHOR]

Labor is a complex, subjective experience, and all factors that influence pain should be considered to ensure a comprehensive evaluation. This study aimed to determine whether gender roles were predictive of labor pain. The study has a descriptive and cross-sectional design. It was carried out in a delivery room of a city hospital in Turkey between September 2019 and September 2020. The study sample consisted of 231 primiparous women presenting for labor and delivery. Data were gathered with a descriptive characteristics form, Visual Analogue Scale and The Bem Sex-Role Inventory. Descriptive statistics and simple regression analysis were employed to analyze the obtained data. Regression analysis demonstrated that gender roles were predictive of labor pain in the latent, active, and transitional stages, but not in the second stage. Gender roles were most responsible for labor pain in the latent phase. Results of the study revealed that gender roles may be useful variables to predict women's labor pain, and contributed to the relevant literature. Nurses and midwives offering care for labor pain should consider gender roles as a factor affecting labor pain. It is also necessary to individualize the supporting care given during labor. [ABSTRACT FROM AUTHOR]

Macro-level crises affect individual lives and behaviors. One of COVID-19's many effects was to disrupt the way people imagined their own and their children's' futures or imagined reproductive futures. Using 65 interviews collected between March and July 2020 with mothers who experienced pregnancy, childbirth, and the postpartum period at the onset of COVID-19 in the US, this study examines two elements of reproduction and futurity; first, how the pandemic exacerbated health, economic, racial, and global emergency stressors to create unique reproductive experiences and nuanced imagined reproductive futures. Second, I use Lee Edelman's concept of reproductive futurism amidst COVID-19 to inquire whether reproduction maintains a compulsory sense of optimism amidst periods of social disruption. I find that despite the various stressors and in addition to the shared disruption of the pandemic, there remains a widespread maternal optimism about reproduction across birthing people with different intersectional social identities. Diverse imaginations of futurity are likely to impact reproductive practices and the meaning-making associated with them; in this research, I use maternal subjectivities to illustrate how narratives and experiences of reproduction are contextual, and offer a distinct avenue toward theoretical analyses of futurity. [ABSTRACT FROM AUTHOR]

• Recent evidence suggests that pregnancy accelerates biologic aging. • Little is known about how mode of delivery affects markers of biologic aging. • Leukocyte telomere length, a marker of biologic aging, was shorter after cesarean. • Telomere shortening persisted at an average of 6 weeks postpartum. • Other differences in multiomics by mode of delivery were not appreciated. Recent studies have suggested that pregnancy accelerates biologic aging, yet little is known about how biomarkers of aging are affected by events during the peripartum period. Given that immune shifts are known to occur following surgery, we explored the relation between mode of delivery and postpartum maternal leukocyte telomere length (LTL), a marker of biologic aging. Postpartum maternal blood samples were obtained from a prospective cohort of term, singleton livebirths without hypertensive disorders or peripartum infections between 2012 and 2018. The primary outcome was postpartum LTLs from one blood sample drawn between postpartum week 1 and up to 6 months postpartum, measured from thawed frozen peripheral blood mononuclear cells using quantitative PCR in basepairs (bp). Multivariable linear regression models compared LTLs between vaginal versus cesarean births, adjusting for age, body mass index, and nulliparity as potential confounders. Analyses were conducted in two mutually exclusive groups: those with LTL measured postpartum week 1 and those measured up to 6 months postpartum. Secondarily, we compared multiomics by mode of delivery using machine-learning methods to evaluate whether other biologic changes occurred following cesarean. These included transcriptomics, metabolomics, microbiomics, immunomics, and proteomics (serum and plasma). Of 67 included people, 50 (74.6 %) had vaginal and 17 (25.4 %) had cesarean births. LTLs were significantly shorter after cesarean in postpartum week 1 (5755.2 bp cesarean versus 6267.8 bp vaginal, p = 0.01) as well as in the later draws (5586.6 versus 5945.6 bp, p = 0.04). After adjusting for confounders, these differences persisted in both week 1 (adjusted beta −496.1, 95 % confidence interval [CI] −891.1, −101.1, p = 0.01) and beyond (adjusted beta −396.8; 95 % CI −727.2, −66.4. p = 0.02). Among the 15 participants who also had complete postpartum multiomics data available, there were predictive signatures of vaginal versus cesarean births in transcriptomics (cell-free [cf]RNA), metabolomics, microbiomics, and proteomics that did not persist after false discovery correction. Maternal LTLs in postpartum week 1 were nearly 500 bp shorter following cesarean. This difference persisted several weeks postpartum, even though other markers of inflammation had normalized. Mode of delivery should be considered in any analyses of postpartum LTLs and further investigation into this phenomenon is warranted. [ABSTRACT FROM AUTHOR]

Background: In India, current maternal mortality ratio is 97/100,000 livebirths, and still more efforts are needed to achieve Sustainable Development Goal 3, target 1 of 70/100,000 livebirths. Women die because of complications during and following pregnancy and childbirth. Skilled care during and immediately after delivery has been identified as one of the key strategies in reducing maternal mortality. Birth preparedness and complication readiness (BPCR) has been implemented as a comprehensive strategy to fill this gap. BPCR is one of the key interventions to reduce the maternal mortality. Materials and Methods: This was a community-based before and after interventional study (quasi-experimental study) and was conducted in two randomly selected primary health centers of South West district of Delhi. Results: A total of 152 community health workers (CHWs) took part in the study. About one fourth (22.03%) had knowledge regarding water breakage without labor, which increased to 85.53% after training and was statistically significant (P < 0.0001). Mean knowledge score preintervention was 4.35 (1.82), whereas the postintervention mean knowledge score was 8.98 (0.99) and was statistically significant (P < 0.0001) Conclusion: Though awareness of CHWs on some aspects of the BPCR components was good before the training program, marked improvement was seen in most of the domains after the training session. [ABSTRACT FROM AUTHOR]

Objective: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. Study Design: We used semi‐structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. Results: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital‐directed maternity care, to a trend that favors planned cesarean birth, driven by generation‐specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. Conclusions: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues. [ABSTRACT FROM AUTHOR]

Background: To prevent the spread of SARS‐CoV‐2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. Methods: An online survey (the Swedish Pregnancy Panel) including free‐text comments was conducted before and during the first wave of the COVID‐19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. Results: The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (−0.94 OLS, 95% CI = −1.17 to −0.72). The drop was largest for partners of first‐time mothers (−1.40 OLS, 95% CI = −1.69 to −1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. Conclusions: The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first‐time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences. [ABSTRACT FROM AUTHOR]

Background: The amount of tissue trauma within second‐degree perineal tears varies widely. Therefore, subcategorization of second‐degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second‐degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second‐degree tear subcategories. Methods: This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second‐degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second‐degree tear subcategories were analyzed using a multinominal regression model. Results: Perineal tears occurred as follows: first‐degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third‐ or fourth‐degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. Conclusion: The occurrence of second‐degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second‐degree tear in a more severe subcategory. [ABSTRACT FROM AUTHOR]

The surge in cesarean section (CS) deliveries in China over the past several decades has led to significant international discussion, yet critical social science inquiry remains limited. Drawing on insights from sociological and anthropological studies of childbirth, this article moves away from the premise that having a CS is a matter of individual choice. Instead, we treat childbirth as ground zero of a set of complex negotiations between multiple actors, and we show how the biopolitical and politico-economic reconfiguration of the process of childbirth governance from the 1990s onwards has contributed to a dramatic increase in cesarean deliveries. Combining ethnographic materials from China's rural and urban areas with an analysis of documents and quantitative data, we argue that the surge in CS rates in post-1990s China is part of a larger globalized process of the technocratic medicalization of birth, which has had a profound impact on the normative procedures and conditions shaping the process of childbirth, including the methods and forms of knowledge guiding childbirth management. This has contributed to the increasing normalization of a highly medicalized and interventionist model of childbirth, which has in turn facilitated the routinization of cesarean procedures. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. Design: Monocentric prospective cohort study. Setting: University Hospitals Leuven. Population: Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow‐up until 1 year postpartum. Methods: Standardised questionnaires reporting on PFD and BID at 12–14 and 28–32 weeks of gestation, and again at 6–8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed‐model analysis. A minimum of 174 women with complete follow‐up were required. Main Outcome Measures: The questionnaires used were the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ‐UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC‐SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ‐IR) and the Body Image Disturbance Questionnaire (BIDQ). Results: Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28–32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28–32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28–32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ‐UI SF score (β = 0.016, range 0.007–0.024), the PAC‐SYM score (β = 0.006, range 0.002–0.011) and the POPDI score (β = 0.009, range 0.005–0.012), but not with the SMIS score (β = 0.015, range −0.001 to 0.031) or the PISQ‐IR score, in sexually active women. Conclusions: Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID. [ABSTRACT FROM AUTHOR]

Conditions such as violence, drug abuse, sexual satisfaction, anxiety, depression, and disability interfere with a healthy pregnancy and can also account for maternal morbidity. The instrument WOICE was built by WHO to measure it. We applied WOICE in a prospective cohort of 125 pregnant women, using a before-after approach, during the third trimester of pregnancy, and after 42 until 90 days of childbirth. 60% had anxiety during pregnancy, decreasing to 48.8% after delivery (p = 0.07), and depression scores decreased from 7.56 to 5.80 (p = 0.014). Disability affected 62.4% and 56, respectively. 9.6% used drugs during pregnancy, reducing to 4.0% after delivery (RR 0.69, IC 0.49 − 0.69). [ABSTRACT FROM AUTHOR]

In this article, I propose a method to estimate the counterfactual distribution of an outcome variable when the treatment is endogenous, continuous, and its effect is heterogeneous. The types of counterfactuals considered are those in which the change in treatment intensity can be correlated with the individual effects or when some of the structural functions are changed by some other group's counterparts. I characterize the outcome and the treatment with a triangular system of equations in which the unobservables are related by a copula that captures the endogeneity of the treatment, which is nonparametrically identified by inverting the quantile processes that determine the outcome and the treatment. Both processes are estimated using existing quantile regression methods, and I propose a parametric and a nonparametric estimator of the copula. To illustrate these methods, I estimate several counterfactual distributions of the birth weight of children, had their mothers smoked differently during pregnancy. [ABSTRACT FROM AUTHOR]

Because the overwhelming majority of births in the United States (U.S.) occur in hospitals and other medical settings rather than at home, the only births many U.S. women see before giving birth themselves are those shown in media, such as films and television series. Using thematic analysis of 111 media pieces consisting of fictional films and television show episodes that feature childbirth and were released in the U.S. from 1988 to 2023, we investigate what these depictions communicate about women during childbirth and whether these portrayals have changed over time. Overall, we find that the depictions in these movies and television show episodes rely on institutionalized medicine, emotionally intense labor and deliveries, objectification of women, and gendered behaviors during childbirth. These depictions have changed little over the time period we examined and convey the strong preservation of the gender structure. [ABSTRACT FROM AUTHOR]

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

Introduction: There is no guideline or clinical consensus concerning the mid‐urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. Methods: We performed a systematic review and meta‐analysis, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. Results: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%−26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%−8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73−1.40; p = 0.96 and I2—test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91−2.30; p = 0.12 and I2—test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77‐2.01; p = 0.37 and I2—test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76−3.42; p = 0.22 and I2—test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. Conclusion: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Investigations into teacher dissatisfaction often limit concerns to the school setting; however, this ethnographic study investigated how Cuban women's employment as primary school teachers forced them to make strategic negotiations related to childbirth and eldercare. Interviews and participant observation conducted with five Black primary teachers revealed tensions between economic production and biological reproduction. Attention to teachers' lives outside of the classroom and the complications they experience are useful for Cuba and other counties experiencing shortages. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility of acquiring adequate transperineal ultrasound (TPUS) volumes of the anal sphincter (AS) immediately after vaginal birth, the reproducibility of its measurements, and detecting defects therein. Methods: Secondary analysis of TPUS volumes of the AS, acquired immediately after vaginal birth with a transversely oriented convex probe. Two independent experts ranked off‐line image quality as "inadequate," "adequate," or "ideal" using the Point‐of‐Care Ultrasound Image Quality scale. On "adequate" and "ideal" quality volumes, the length of the external AS at 6 and 12 o'clock, and the volume of the external and internal AS were measured. Additionally, volumes were screened for AS defects on tomographic ultrasound imaging. Subsequently, we rated the intra‐ and interrater agreement on those findings. Results: Of 183 volumes, 162 were considered "adequate" or of "ideal" quality (88.5%). Reasons for "inadequacy" were shadow artifacts (16/21), poor resolution (3/21), incomplete acquisition (1/21), or aberrant AS morphology (1/21). The intrarater reliability of two‐dimensional (2D) and three‐dimensional (3D) measurements was excellent, whereas interrater reliability was fair to good for 2D measurements and good for 3D measurements. In those tomographic ultrasound imaging (TUI) sequences including AS defects, the intra‐ and interrater reliability of the defect measurement were excellent [intraclass correlation coefficient (ICC) = 0.92 (0.80–0.94)] and moderate [ICC = 0.72 (0.63–0.79)]. In this cohort, there were only few (4/48; 8.3%) AS defects. However, grading them was poorly reproducible between experts. Conclusion: TPUS of the AS immediately after vaginal birth yields adequate image quality and allows for reproducible measurements. In the few patients with AS defects, there was good agreement on the presence, but it was poor for the extent of defects. [ABSTRACT FROM AUTHOR]

Objective: This comprehensive review aimed to assess perineal management strategies during labor and their effectiveness in preventing perineal tears while enhancing maternal well-being. Methods: A three-part review was conducted, covering labor pain causes and management, perineal tears and episiotomy, and preventive strategies with a focus on warm compresses. Existing literature and studies were synthesized to offer a holistic perspective on perineal management. Results: Understanding Labor Pain: Labor pain arises from uterine contractions, perineal and cervical stretching, and pelvic pressure. Management options, including pharmacological and nonpharmacological techniques, such as massage, hydrotherapy, and acupuncture, effectively alleviate pain. Perineal Tears and Episiotomy: Perineal tears, including Obstetric Anal Sphincter Injuries (OASIS), are frequently linked to instrumental delivery, prolonged labor, and fetal positioning. Episiotomy, while at times necessary, carries specific indications and potential complications. Preventive Strategies with Warm Compresses: Studies consistently demonstrate the effectiveness of warm compresses applied during the second stage of labor in reducing perineal tears and enhancing perineal integrity, thereby decreasing the need for sutures. Conclusion: Effective perineal management during labor is essential to ensure maternal well-being and reduce the risk of perineal trauma. Nonpharmacological pain management techniques provide viable options, while perineal tears and episiotomy complications emphasize the importance of preventive strategies. Warm compresses, thoughtfully applied during labor, consistently contribute to maintaining perineal integrity. Nurses play a pivotal role in implementing these strategies, offering holistic care, and ensuring safe and satisfying childbirth experiences. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes.This was an observational study using data from a cross‐sectional population‐based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928). We estimated the FGM/C prevalence using (i) the diagnosed cases and (ii) the indirect prevalence estimated by UNICEF in each source country. We compared population characteristics and perinatal outcomes between women diagnosed with FGM/C and two groups: (i) women originating in source countries and diagnosed as without FGM/C and (ii) all women without diagnosis of FGM/C whatever the country of birth.Diagnosed prevalence of FGM/C was 95% (95% CI: 0.78–1.14] and the indirect computed estimation prevalence was estimated at 1.53% (95% CI: 1.31–1.77) in 113 and 183 women, respectively. Labor and delivery outcomes were globally similar in women with FGM/C and the other two groups. Only episiotomy was more frequently performed in women with FGM/C than in the other two groups.In receiving countries, obstetric outcomes of women with FGM/C can be similar to those of other women, which does not preclude need of further research and training to provide the most appropriate care, including enhanced attention to diagnosis. [ABSTRACT FROM AUTHOR]

Background: Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. Methods: We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. Results: We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021. Conclusions: Routine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards. [ABSTRACT FROM AUTHOR]

Background Aim Methods Analysis Findings Conclusions Although prenatal care providers aim to prepare women for first childbirth, little research has explored retrospectively what birthing people would like to have known before first childbirth.To describe women's reports of what they would like to have known before first childbirth but feel they were not told.This is a secondary analysis of the First Baby Study, a large prospective cohort study conducted in Pennsylvania, USA. Telephone interviews were conducted with 3006 women 1 month after their first childbirth. Women were first asked: “Was there anything that you would have liked to have known before your delivery that you were not told?”. If “yes” they were asked a second question: “Please tell me what you would have liked to have known before your delivery”.A convergent mixed‐methods analysis including descriptive analytics to compare characteristics of women by answers to the first question, and qualitative content analysis of women's open‐ended answers to the second question.A total of 441 women (14.7%) reported there was something they would like to have known before their first childbirth. Women described that communication with care providers was their main concern. They would have liked a better understanding of their options before birth, more agency in decision‐making, and more information about the topics of their body, their birth, their baby, and what to expect beyond birth.Results highlight important topics for childbirth education, and the impact of gaps in shared decision‐making, patient–provider communication, and supportive care practices for first childbirth, especially where women have identified vulnerabilities. [ABSTRACT FROM AUTHOR]

Since 2016, China has progressively relaxed family planning policies to stimulate birth rates. This paper examines the behavioral health repercussions of China's 2016 universal two-child policy (UTCP) by analyzing sleep pattern data from China Family Panel Studies. Napping is a composite indicator that denotes health outcomes, job quality, and personal well-being. It reveals work conditions and environments to some extent. UTCP may lead to heightened social expectations regarding pregnancy likelihood, and changes in social expectations within the workplace may make work environments less equitable and more stressful for females. Leveraging a difference-in-difference model, this paper explores how napping behaviors among the working-age cohort have responded to the policy shifts. Our analysis reveals a gender discrepancy in response to the policy, specifically, females exhibit a discernible reduction in the likelihood of napping, as well as in the duration of both daytime naps and daily sleep. Conversely, such effects are not significant among males. These results suggest policy consequences extend beyond individuals directly impacted by childbirth or contemplating parenthood. Hence, while promoting fertility is still the government's goal, policymakers are encouraged to consider the broader challenges the female population faces from social and workplace environment factors. [ABSTRACT FROM AUTHOR]

This article discusses the lack of representation of pregnant individuals in clinical trials and drug development, resulting in a lack of safety and efficacy data for this population. It emphasizes the potential of model-informed drug development (MIDD) tools and the importance of collaboration between pharmaceutical companies and regulatory agencies. The article explores various MIDD methods, such as PBPK modeling, toxicology modeling, and QSP, and their applications in addressing the challenges faced in drug development for pregnant individuals. It also mentions the use of real-world data and machine learning to study the effects of drugs during pregnancy. The article calls for inclusivity in clinical trials and drug development for pregnant individuals and highlights the need for postmarketing studies to gather essential information on the safety of medicines used during pregnancy. It also suggests the use of machine learning and real-world data to identify potentially unsafe drugs for the fetus. Overall, the article emphasizes the need to bridge the knowledge gap and improve access to safe and effective therapies for pregnant individuals. [Extracted from the article]

Background Methods Results Conclusion The COVID‐19 pandemic added new challenges and stressors to the childbirth period, potentially increasing the risk of traumatic childbirth experiences. There is little known about posttraumatic growth (PTG) in a childbearing population. This study describes PTG in women after traumatic childbirth during the COVID‐19 pandemic and its association with sociodemographic, birth‐related characteristics, traumatic childbirth events, perceived stress, and core beliefs, as well as explores what factors predict PTG.A cross‐sectional study was conducted with 202 women who self‐identified as having experienced traumatic childbirth. Measures included sociodemographic and birth‐related characteristics, traumatic childbirth events, self‐reported stress during childbirth, the PTG Inventory, and the Core Beliefs Inventory (CBI).Perceived stress at the time of birth was very high in 70% of the respondents. CBI showed moderate disruption of core beliefs. 41.6% of mothers indicated substantial PTG. Education and type of birth were related to perceived stress levels; higher disruption of core beliefs was observed in individuals who experienced perineal trauma and lack of partners' presence during childbirth, and higher disruption of core beliefs was positively associated with PTG. Predictive models showed that perceived stress had a minimal effect, while the disruption of core beliefs showed a significant positive association with PTG.Traumatic childbirth experiences during the COVID‐19 pandemic were positively related to PTG. Health professionals should create an environment where women can explore their feelings and emotions. Changes in current practices are also necessary as cesareans have been shown to be highly associated with high levels of perceived stress. [ABSTRACT FROM AUTHOR]

Background: National level Sex Ratio at Birth (SRB) is normal in Bangladesh despite its patriarchal social structures, strong son preference, and low fertility level, widely recognized as preconditions for Gender-Biased Sex Selection (GBSS). To better understand this anomaly, we examine the trend in SRB in a sub-district in Bangladesh and assess the impact of the introduction of fetal sex-detection technology and the history of induced abortion on child sex using longitudinal data. Methods: We have used secondary data collected routinely by icddr, b's Matlab Health and Demographic Surveillance System (HDSS) between 1982 and 2018. All births occurring during this period (N = 206,390) were included in the analyses. We calculated the SRB and used multivariate logistic regression analyses to assess the likelihood of birth of a male child before and after the introduction of ultrasonogram in Matlab. Results: Overall, SRB was within the natural limit (106) during 1982–2018 in Matlab. SRB among women with a history of induced abortion was 109.3 before the introduction of ultrasonography in 2001 and 113.5 – after 2001. Women's history of induced abortion prior to introduction of ultrasonogram (1982–2000) increased the likelihood of birth of a male child 1.06 times (AOR 1.06; 95% CI- 1.01–1.11). In the period after, however, this likelihood was 1.08 (AOR 1.08; 95% CI- 1.02–1.15). Conclusions: In a context with normal SRB, it was found to be skewed among women who had induced abortion. SRB was relatively more skewed among such women after the advent of ultrasonogram compared to a period without ultrasonogram. Moreover, induced abortion after introduction of fetal sex determination technology increased the likelihood of birth of a male child. These findings suggest the plausibility of GBSS in a sub-group. Further research is needed, particularly in regions with skewed SRB to examine whether GBSS is indeed a threat to Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Many young couples are planning to share paid work, childcare, and housework equally between each other. But implementing such a 50/50-split-model is difficult and parents often return to traditional gender role distributions after the birth of a child. This return has potential negative effects on mental health, physical health, and relationship satisfaction. Therefore, this study aims to find practicable strategies on a behavioral-level which new parents can apply in their daily routine to successfully implement the 50/50-split-model if they wish to do so. Methods: This qualitative study, DREAMTALK, is part of the multi-method, prospective Dresden Study on Parenting, Work, and Mental Health (DREAM). For DREAMTALK, N = 25 parents implementing a 50/50-split-model were selected based on quantitative data regarding time use, which participants had provided in questionnaires. In DREAMTALK, problem-centered interviews were conducted with the selected sample at 17 months postpartum. Those were analyzed via qualitative content analysis, which is systematic, rule-guided, and based on the criteria of validity and reliability. Results: The qualitative content analysis revealed a catalog of 38 practicable strategies to manage daily routine, which can help parents to successfully implement a 50/50-split-model. Individual participants used 23 success strategies on average. Examples include having a regular coordination appointment with the other parent, planning foresightedly, flexibility, reducing cleaning, optimization of routes, or moderate split-shift parenting. Some of these strategies seem opposing, e.g., planning foresightedly, and at the same time, meeting unpredicted changes with flexibility. Those seemingly opposing strategies were well balanced by the participants, which was an additional strategy. Conclusions: Parents can use the success strategies relatively independently of external circumstances. This behavioral perspective extends prior theories, which have focused on explaining unequal gender role distributions with external circumstances. A behavioral perspective can be a gateway to assist more parents to pioneer in implementing the 50/50-split-model, which might in turn lead to a healthier and more satisfied public population. [ABSTRACT FROM AUTHOR]

Introduction: When medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria. Methods: We disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria's overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis. Results: CS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of 0.7%, 1.5% and 0.4% for the overall, urban and rural areas, respectively. Mothers with higher education demonstrated a greater CS prevalence of 14.0% overall, 15.3% in urban and 9.7% in rural residences. Frequent internet use increased CS prevalence nationally (14.3%) and in urban (15.1%) and rural (10.1%) residences. The southern regions showed higher CS prevalence, with the South-West leading overall (7.0%) and in rural areas (3.3%), and the South-South highest in urban areas (8.5%). Across all residences, rich wealth index, maternal age ≥ 35, lower birth order, and ≥ eight antenatal (ANC) contacts increased the odds of a CS. In rural Nigeria, husbands' education, spouses' joint healthcare decisions, birth size, and unplanned pregnancy increased CS odds. In urban Nigeria, multiple births, Christianity, frequent internet use, and ease of getting permission to visit healthcare facilities were associated with higher likelihood of CS. Conclusion: CS utilisation remains low in Nigeria and varies across rural-urban, regional, and socioeconomic divides. Targeted interventions are imperative for uneducated and socioeconomically disadvantaged mothers across all regions, as well as for mothers in urban areas who adhere to Islam, traditional, or 'other' religions. Comprehensive intervention measures should prioritise educational opportunities and resources, especially for rural areas, awareness campaigns on the benefits of medically indicated CS, and engagement with community and religious leaders to promote acceptance using culturally and religiously sensitive approaches. Other practical strategies include promoting optimal ANC contacts, expanding internet access and digital literacy, especially for rural women (e.g., through community Wi-Fi programs), improving healthcare infrastructure and accessibility in regions with low CS prevalence, particularly in the North-West, and implementing socioeconomic empowerment programs, especially for women in rural areas. [ABSTRACT FROM AUTHOR]

Background: There has been an increase in the number of nurses returning to work after childbirth (NRWCs) in Chinese hospital. Social support is important for NRWCs. Objective: To develop and validate a perceived social support scale for NRWCs in China. Method: The original items were based on a literature review, the social support theory, and semi-structured interviews. The Delphi technique was used to adjust further and screen the scale entries to form an initial draft of the scale. From February to October 2023, we recruited 627 NRWCs from hospitals in 12 provinces of China. The psychometric attributes of the scale were examined by construct validity, content validity, test–retest reliability, and internal consistency reliability. The STROBE checklist was used to guide the submission. Results: 4 dimensions and 22 items compose the initial scale. Exploratory factor analysis verified a four-factor scale structure. The confirmatory factor analysis results showed that the four-factor structure model fitted well. The resulting scale contains 4 dimensions with 18 items. The item-level content validity index ranged from 0.83 to 1.00. The Cronbach's alpha coefficient of four dimensions and total scale were respectively 0.957, 0.899, 0.870, 0.945, 0.967. The reliability of the scale over time was further verified, with a coefficient of 0.809 for the overall scale and a range from 0.682 to 0.718 for each domain. Conclusion: The perceived social support scale for NRWCs is a reliable and valid instrument. The application of the perceived social support scale for NRWCs would improve the assessment of social support among NRWCs. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Implications for the Profession and/or Patient Care What Problem Did the Study Address? What Were the Main Findings? Where and on Whom Will the Research have an Impact? Reporting Method Patient or Public Contribution To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth.Qualitative study based on Gadamer's hermeneutic phenomenology.This study was conducted with midwives (n = 18) at the birth unit of a third‐level public hospital in Jaén (Spain) in 2023. Personal semi‐structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming.Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided.Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them.The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system.The midwives´ experiences in cases which end with the delivery of a stillborn.Each action of the midwife is as important as the availability of resources to offer the most appropriate care.In each woman who receives the care of a midwife who attends the birth of a stillborn.COREQ checklist.No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience. [ABSTRACT FROM AUTHOR]

The Russian invasion of Ukraine in February 2022 resulted in a massive exodus of Ukrainians to Europe but also the emigration of Russian citizens. While attention has primarily been on the flow of Russian migrants to neighbouring countries, intercontinental migrations to regions like South America have been overlooked. This paper sheds light on the growing trend of Russians settling in Brazil. Drawing on a comprehensive dataset of migration statistics and qualitative data from empirical fieldwork conducted between 2019 and 2023 in three Brazilian cities, our analysis reveals that new Russian migrants to Brazil are primarily young, highly skilled and resourceful individuals. Unlike in other regions, family migration with young children is common among recent Russian migrants to Brazil. We show that strategic births ‐ using the birth of children to gain  residency and citizenship ‐has become the primary migration channel, forming a new migration system characterised by intensive circulation and turnover between Russia and Brazil. Moreover, while Russian emigration is driven by political reasons, the incorporation of migrants into Brazilian cities is influenced by the relatively privileged economic and legal status of these families. The paper contributes to a deeper understanding of complex migration patterns in the “Global South” by illuminating a geographically unconventional flow. [ABSTRACT FROM AUTHOR]

Background: Rates of non-communicable diseases are disproportionately high among Native Hawaiian (NH) people, and the proportion of NH infants being fed human milk (HM) is the lowest among all ethnicities within the state of Hawaiʻi. The aim of this study was to explore biological, socio-economic, and psychosocial determinants of the initiation and duration of human milk feeding (HMF) among a study of NH mothers and infants. Methods: A sample of 85 NH mother-infant dyads who were participating in a larger prospective study were involved in this research. Recruitment for the parent was delayed due to the COVID-19 pandemic. Recruitment started in November 2020 and continued until April 2022. Questionnaires were distributed at birth, two-months, four-months, and six-months postpartum. Questionnaires addressed topics relating to maternal and infant characteristics and infant feeding practices. Descriptive statistics, comparative analysis, and multivariate logistic regression tests were conducted. Results: The majority of participating mothers were aged between 31 and 35 years, had some college education or more, were employed, and multiparous. The majority of infants were receiving HM at each timepoint (94% at birth, 78% at two-months postpartum, and 76% at four and six-months postpartum). Factors found to be significantly associated with HMF initiation and duration were prenatal intention to HMF, maternal educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) recipiency. A prenatal intention to HMF was found to be a strong predictor of HMF at birth (aOR = 64.18, 95% CI 2.94, 1400.28) and at two-months postpartum (aOR = 231.55, 95% CI 2.18, 2418.3). Participants not involved with WIC were more likely to be HMF at four-months postpartum (aOR = 6.83, 95% CI 1.01, 46.23). Conclusion: This research supports existing evidence that prenatal intention to HMF and higher maternal educational attainment are positive predictors of HMF. WIC participation and being a SNAP recipient were found to be negatively associated with HMF which suggests a need for more culturally tailored support. Further research is required to reduce the gap in knowledge related to the determinants of HMF in NH. [ABSTRACT FROM AUTHOR]

Aim: To develop evidence‐based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. Population: Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. Setting: Health facilities in low‐ and middle‐income countries. Search Strategy: We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. Case scenarios: Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. Conclusions: We have developed three clinical algorithms to support evidence‐based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth. Evidence‐based clinical algorithms may help support respectful, high quality intrapartum care. [Correction added on 23 August 2024, after first online publication: The Abstract has been updated to structure layout in this version.] [ABSTRACT FROM AUTHOR]

Aim: To describe standardised iterative methods used by a multidisciplinary group to develop evidence‐based clinical intrapartum care algorithms for the management of uneventful and complicated labours. Population: Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility. Setting: Health facilities in low‐ and middle‐income countries. Search strategy: Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google. Case scenarios: Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes. Conclusions: Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence‐based, up to date, paper‐based or digital reminders and decision‐support tools. The algorithms need to be field tested and may need to be adapted to specific contexts. Evidence‐based intrapartum care clinical algorithms for a safe and positive childbirth experience. Evidence‐based intrapartum care clinical algorithms for a safe and positive childbirth experience. [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing enterocolitis (NEC) is a severe gastrointestinal problem that predominantly affects premature babies. The aim of this retrospective study was to evaluate patients who underwent surgical treatment for NEC and newborns who initially recovered with medical treatment but later developed a stricture and required surgery. Materials and Methods: We analyzed patients diagnosed with NEC between January 2009 and December 2021. Our study included patients who developed strictures after initially receiving medical treatment for NEC and subsequently underwent surgery. Demographic findings, mother's age, gestational weeks, birth weight, type of birth, postnatal age at NEC diagnosis, pH, first C-reactive protein (CRP) after onset of symptoms, leukocytes, hemoglobin and thrombocytes at the onset of NEC, echocardiography results, age at surgery, blood values before surgery, surgery technique, and outcomes were retrospectively analyzed. Results: Out of 40 patients who underwent primary surgery for NEC during the newborn period, 6 patients underwent surgery after initially receiving medical treatment. The female-to-male ratio was 15/31, and the median gestational age was 29 weeks. The median mother's age was 30 years, and the median birth weight was 1097g. The median postnatal age at NEC onset was 6 days (range 2-39). Echocardiography was performed in 43 patients, with 6 showing normal results and 28 having congenital cardiac anomalies. The median surgery day for patients who underwent primary surgery for NEC was 19 days (range 2-90). Ileostomy was performed in 26 patients, colostomy in 8 patients, and ileostomy plus colostomy in 1 patient. Surgery was conducted in 6 out of 392 patients who developed post- NEC strictures after initial medical treatment. Comparison between post-NEC stricture patients and those who underwent surgery for NEC revealed significant differences only in the age at surgery (p=0.024). Conclusion: Patients who clinically experience NEC should be considered for the development of strictures, especially in cases of prolonged feeding intolerance, distention, gastric residual, and rectal bleeding. Therefore, close follow-up and multidisciplinary approaches are crucial, and contrast barium radiography should be the initial diagnostic step. [ABSTRACT FROM AUTHOR]

Background and Objectives: To evaluate the severity of haemolytic disease of the foetus and newborn (HDFN) in subsequent pregnancies with RhD immunization and to identify predictive factors for severe disease. Materials and Methods: Nationwide prospective cohort study, including all pregnant women with RhD antibodies. All women with at least two pregnancies with RhD antibodies and RhD‐positive foetuses were selected. The main outcome measure was the severity of HDFN in the first and subsequent pregnancy at risk. A subgroup analysis was performed for the group of women where RhD antibodies developed after giving birth to an RhD‐positive child and thus after receiving anti‐D at least twice (group A) or during the first pregnancy at risk for immunization (group B). Results: Sixty‐two RhD immunized women with a total of 150 RhD‐positive children were included. The severity of HDFN increased for the whole group significantly in the subsequent pregnancy (p < 0.001), although it remained equal or even decreased in 44% of women. When antibodies were already detected at first trimester screening in the first immunized pregnancy, after giving birth to an RhD‐positive child (group A), severe HDFN in the next pregnancy was uncommon (22%). Especially when no therapy or only non‐intensive phototherapy was indicated during the first immunized pregnancy (6%) or if the antibody‐dependent cell‐mediated cytotoxicity result remained <10%. Contrarily, women with a negative first trimester screening and RhD antibodies detected later during the first pregnancy of an RhD‐positive child (group B), often before they had ever received anti‐D prophylaxis, were most prone for severe disease in a subsequent pregnancy (48%). Conclusion: RhD‐mediated HDFN in a subsequent pregnancy is generally more severe than in the first pregnancy at risk and can be estimated using moment of antibody detection and severity in the first immunized pregnancy. Women developing antibodies in their first pregnancy of an RhD‐positive child are at highest risk of severe disease in the next pregnancy. [ABSTRACT FROM AUTHOR]

Previous research indicates the presence of deeply ingrained gender biases within the health system, resulting in instances of mistreatment and violence against women and sexual dissidents. This study aimed to explore the stories of people assigned female at birth about their experiences of gynecological violence in Chile. Twenty-one women were recruited as participants, and semistructured interviews were conducted. Thematic analysis of the transcribed dialogs was performed, and four themes were developed: legitimization of violence, objectivation and loss of autonomy, transgression of intimacy and fear of abuse, and consequences of violence over time. This article sheds light on the impact and aftermath of gynecological violence among those seeking gynecological services, highlighting the convergence of cultural, institutional, and interpersonal factors that perpetuate this issue. [ABSTRACT FROM AUTHOR]

Human infants are helpless for a protracted period after birth. This has been attributed to maternal constraints causing an early birth while the brain is still immature. However, anatomical studies have shown that relative to other species, human newborn brains are not particularly immature. Consistent with this, neuroimaging studies have shown that the structure and function of many cognitive systems is surprisingly mature in humans at birth. Why else might humans have a protracted helpless period? In machine learning, learning good representations of the environment through self-supervised learning in large deep neural networks yields enormously powerful 'foundation models', which allow better generalisation to new problems and have a higher final performance. We propose that in the helpless period, human infants are learning a foundation model that underpins their later cognition. Humans have a protracted postnatal helplessness period, typically attributed to human-specific maternal constraints causing an early birth when the brain is highly immature. By aligning neurodevelopmental events across species, however, it has been found that humans are not born with especially immature brains compared with animal species with a shorter helpless period. Consistent with this, the rapidly growing field of infant neuroimaging has found that brain connectivity and functional activation at birth share many similarities with the mature brain. Inspired by machine learning, where deep neural networks also benefit from a 'helpless period' of pre-training, we propose that human infants are learning a foundation model: a set of fundamental representations that underpin later cognition with high performance and rapid generalisation. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death.A cross‐sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility.Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. “Intrauterine hypoxia and asphyxia” (ICD‐10 P20) and “unspecific causes of death” (ICD‐10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases.The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed. [ABSTRACT FROM AUTHOR]

Oral language is the primary means through which a child controls, describes, organises, and evaluates their life experiences and their ability to use oral language which effectively impacts their future literacy development. Currently, the world is awash with dynamic change and constant disruption. These include natural disasters such as the ongoing Australian floods and bush fires, droughts, the global COVID-19 pandemic, the pervasive use of digital technologies, continuing global unrest, and impacts on economic and social adversity. Many of these disruptions are having a negative impact on the development of children's oral language and ongoing communication capacities. This is interesting given the prioritisation in many western nations, including Australia, of learning to read and write over learning to talk and communicate. This paper serves as an example of what makes good classroom literacy research. It outlines the elements of robust research including a research proposal structure. In this instance, our research investigates educator perceptions of children's developing oral language and communication skills and practices in birth to 8-year-old education contexts within the current backdrop of extreme disruption. The paper includes a literature review, our proposed research methodology which includes interviews from participants in birth to 8-year-old education settings, in both national and global contexts sourced via snowball sampling. The data analysis uses Fairclough's Critical Discourse Analysis (CDA) of the contextualised interview responses from educators within a socio-cultural global malaise of disruption and power. We outline future plans and funding sources, including publications and potential school resources in the spirit of collegial cooperation to support excellence in literacy classroom research. [ABSTRACT FROM AUTHOR]

Prior research has established that parents who are in a relationship, yet unmarried at the time of their child's birth, are at an increased risk of relationship instability. However, the processes that may lead to the dissolution of these unmarried parents' couple relationships are less clear. Guided by the vulnerability–stress–adaptation model, the present study examined data from a sample of 1,575 mother and father dyads who participated in the Future of Families and Child Wellbeing Study over a 9-year period. A mixed effects Cox regression model was used to investigate how unmarried parents' reports of enduring vulnerability (depressive symptoms) over time influenced the onset of relationship dissolution between the time their focal child was 1- and 9-years old. Further, the potential mediating effect of mothers' and fathers' reports of stressful events (parenting stress) and adaptive processes (couple relationship interactions and coparenting behaviors) on the association between depressive symptoms and relationship dissolution by the 9-year follow-up were also examined. Results indicated that mothers' and fathers' reports of experiencing depressive symptoms over time were associated with relationship dissolution. Further, perceptions of couple interactions emerged as a significant mediator at the 3- (mothers) and 5- (mothers and fathers) year follow-up. Coparenting behaviors were a significant mediator for mothers and fathers at the 3- and 5-year follow-up. These results highlight how experiencing depressive symptoms over time, as well as perceptions of couple interactions and coparenting behaviors throughout the early years of parenting, are salient factors in the instability of unmarried parents' relationships. [ABSTRACT FROM AUTHOR]

Objectives: Previous research shows that sacroiliac (SI) joint fusion is age and sex dependent. Older individuals—specifically starting in the fifth or sixth decade of life—are more likely to develop SI fusion. Females have a lower frequency of SI joint fusion than males, perhaps due to pregnancy or parturition. This study examines the relationship between SI joint fusion with both sex and parity status in females. The issue is whether the prevalence of SI fusion in nulliparous females is more similar to that of males or parous females. Materials and Methods: The sample consists of 46 nulliparous females, 119 parous females, and 158 males from the William M. Bass Donated Skeletal Collection. Ages of the individuals ranged from 50 to 89 years. Sex, age, and parity status were self‐reported. Results: The frequency of SI joint fusion is significantly different among males (13.29%), nulliparous females (6.52%), and parous females (0.84%). Pairwise comparison of the three groups for SI joint fusion shows that parous females and males are significantly different, but nulliparous females are nonsignificantly different from parous females and males. Discussion: Parity status does not appear to be a factor in the sexually dimorphic nature of SI joint fusion in this sample. Rather, biomechanical and hormonal factors may have a greater contribution to higher rates of SI joint fusion in males than females. Research Highlights: Parous females have a lower prevalence of SI joint fusion compared with males of the same age categories.Parity status and SI joint fusion were not statistically significant, suggesting that the constraints of childbirth may not contribute to lower rates of SI joint fusion in females than males. [ABSTRACT FROM AUTHOR]

Objective: Data and guidelines are lacking, so implantable cardioverter–defibrillators (ICDs) are often deactivated during labour to prevent inappropriate shocks. This study aimed to ascertain the safety of an activated ICD during labour. Design: An observational study was performed. Setting: Dutch hospitals. Population or Sample: A total of 41 childbirths were included of 26 patients who gave birth between February 2009 and November 2018 after receiving an ICD in our tertiary hospital. Five of these childbirths were attended by the research team between December 2018 and August 2020, during which the ICD remained active. Methods: Groups were made based on ICD status during labour. Patients who gave birth with an activated ICD at least once were stratified to the activated ICD group. Patients' files were checked and patients received a questionnaire about childbirth perceptions and treatment preferences. The differences in ordinal data resulting from the questionnaire were calculated using a chi‐square or Fisher's exact test. Main outcome measures: Primary outcome was inappropriate ICD therapy and occurrence of ventricular arrhythmias requiring treatment. Results: During the 41 childbirths, no inappropriate shocks or ventricular arrhythmias occurred during labour. All patients in the activated ICD group (n = 13) preferred this setting, while 8 of the 13 patients in the deactivated ICD group preferred activation (p = 0.002). Reasons included avoiding hemodynamic monitoring, magnet placement, or labour induction to facilitate technician availability. Conclusions: This study shows no evidence that labour and birth in women with an activated ICD are unsafe, as there were no ventricular arrhythmias or inappropriate therapy. In addition, most patients prefer an activated ICD during labour. [ABSTRACT FROM AUTHOR]

The development of artificial womb technology (AWT) is continuing to proceed and raises important ethical and theological questions for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been minimal Christian engagement with this topic. There are broadly two primary uses of artificial womb technology: first, ectogestation, which is a form of enhanced neonatal care, where only some of the gestation period takes place in an artificial womb, and second, ectogenesis, where the entire period of gestation occurs in an artificial womb. It is plausible that some form of ectogestation in the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans remains far more speculative. Ectogestation is likely to significantly reduce maternal and neonatal morbidity and mortality, and so there is a strong prima facie case for supporting its development. Ectogenesis, however, may bring several challenges, including the further commodification of children, and the potential pathologizing of pregnancy and childbirth. Its long-term effects on those created through this process are also unknown. If it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of seemingly unproblematic ectogestation is likely to normalize the use of artificial gestation, and, in time, pave the way for ectogenesis. [ABSTRACT FROM AUTHOR]

This is a qualitative study that explores the perspectives and experiences of a group of Mexican women who experienced institutionalized childbirth care in the first and second waves of the COVID-19 pandemic. Through a semi-structured script, nine women who experienced childbirth care were interviewed between March and October 2020 in public and private hospitals in the city of San Luis Potosí, Mexico. Under the Grounded Theory analysis proposal, it was identified that the health strategies implemented during the pandemic brought with them a setback in the guarantee of humanized childbirth. Women described themselves as distrustful of the protocols that personnel followed to attend to their births in public sector hospitals and very confident in those implemented in the private sector. The intervention of cesarean sections without a clear justification emerged as a constant, as did early dyad separation. Healthcare personnel’s and institutions’ willingness and conviction to guarantee, protect and defend the right of women to experience childbirth free of violence remain fragile. Resistance persists to rethink childbirth care from a non-biomedicalizing paradigm. [ABSTRACT FROM AUTHOR]

Introduction: This scoping review aims to comprehensively explore the existing research on the changes in pelvic floor function that occur throughout the childbirth pathway (antenatal, intrapartum, and postnatal period). Furthermore, it seeks to identify new opportunities and directions for future research in this field. In particular, this review focuses on investigating pelvic floor muscle strength and tone in women during the childbirth pathway. Methods: The following databases were investigated from their inception: PubMed, OVID, Medline, ScienceDirect, The Cochrane Central Library, Scopus, Web of Science, PEDro, Scholar Google, Embase, and CINHAIL. Literature research was carried out from March to October 2022. Records identified through database searching were imported to Covidence. According to Arksey and O'Malley's five-stage scoping review framework, researchers screen titles and abstracts for eligibility and exclude records that do not meet the inclusion criteria. Results: A total of 40 studies were included in the data extraction phase. These articles underwent a review, with a specific emphasis on examining the tone, strength, and distensibility of the pelvic floor throughout the childbirth pathway. Among the selected studies, 22 investigated pelvic floor strength, 7 the distensibility, and 3 articles the tone. Conclusions: This review identified both areas of agreement and disagreement across all three themes examined, with a particular emphasis on labor and the postpartum period. Notably, the review unveiled a significant scarcity of data concerning the tone of pelvic floor muscles throughout the childbirth pathway. Further studies to investigate the relationship between midwifery care and pelvic floor outcomes are required to improve clinical practice. [ABSTRACT FROM AUTHOR]