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• This is the first study attempting to provide scientific evidence on the various maneuvers for the insertion of the blades in rotational forceps. • The best results were obtained with the direct maneuver. • Inserting the posterior blade first was the maneuver with the worst results. The Kielland's forceps is the most used forceps for assisting rotational operative births. There are various maneuvers described for blade insertion. Among these, the most used ones are the direct, first posterior, and wandering maneuver. The objective of this study was to compare these three maneuvers using a simulator. In this experimental study, 144 rotational forceps-assisted births were conducted using a simulation model, with 72 starting in a right occiput-transverse position and 72 in a left occiput-transverse position. Each of the three maneuvers (direct, first posterior, or wandering) for blade insertion was performed 48 times by a total of 6 operators, comprising 3 obstetricians with over 10 years of experience and 3 trainees. The assessment of forceps application included evaluating the placement of the blades in terms of asymmetry and the distance from the lock to the posterior fontanelle. Additionally, the study evaluated the number of reinsertions and relocations required, the perceived difficulty of the procedure, and the operator's level of experience. There were no statistically significant differences in terms of asymmetry with the three maneuvers. Regarding the distance from the lock to the posterior fontanelle, the best results were obtained with the direct maneuver. There were no differences in the number of reinsertions, relocations, and the perceived difficulty by the operators among the three maneuvers. Experienced obstetricians had better outcomes in terms of the need for reinsertions. The direct maneuver offer advantages in the insertion of blades for rotational forceps. [ABSTRACT FROM AUTHOR]

Aim: To analyze temporal trends and regional variations in operative vaginal delivery (OVD) in Japan. Methods: Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan from 2014 to 2021, we identified the numbers of vacuum and forceps deliveries. We analyzed annual totals and proportions of OVDs and calculated the mean age of women undergoing these deliveries. We also predicted trends in OVD for the next 20 years and compared geographical differences in the proportions of forceps deliveries among OVDs. Results: During the observation period, out of 7 368 814 total births, 8.4% were through OVD, including 7.6% by vacuum and 0.8% by forceps. Both delivery methods showed an increasing trend from 2014 to 2021: vacuum deliveries rose from 7.0% to 8.7%, and forceps deliveries increased from 0.6% to 1.0%. Notably, the proportion of forceps deliveries in OVD increased from 8.1% to 10.5%. The mean age was higher for forceps deliveries than vacuum deliveries. According to our predictions, vacuum deliveries may continue to increase, but forceps deliveries may stabilize. The proportion of forceps deliveries among OVDs ranged from 0% to 38% across Japanese prefectures. Conclusions: This study shows an increase in the use of OVD in Japan from 2014 to 2021. There are large regional differences in the choice between vacuum and forceps deliveries. These findings can help us understand the practice of OVD in Japan. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. Method: During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety‐six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. Results: The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). Conclusion: It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants. [ABSTRACT FROM AUTHOR]

• Manual rotation is the preferred method to rotate the fetal head in the UK. • There is no clear evidence to guide practices of rotational vaginal birth. • UK Obstetricians would support an RCT of manual versus instrumental rotation. • This RCT would ascertain which rotational method has the lowest chance of OASI. Malposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland's) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland's rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals. [ABSTRACT FROM AUTHOR]

Objective: Obstetric forceps play an important role in safe childbirth, yet there is a lack of distinction between various forceps types in clinical practice. This study aimed to evaluate and compare perineal pressure and forces on the baby during nonrotational forceps‐assisted births using Simpson‐Braun forceps, Kielland forceps, and Thierry spatulas on a simulation model. Methods: This experimental study involved six obstetricians conducting 108 forceps‐assisted births on a simulation model. Instruments were assessed for their impact on perineal pressure, traction force, and operator‐assessed difficulty. Results: Thierry's spatulas exerted the lowest force on the baby, while Kielland forceps exhibited the lowest perineal pressure, though not statistically significant. An experienced obstetrician demonstrated less perineal pressure with Simpson forceps. Notably, no significant differences in difficulty were observed between instruments. Conclusion: This study highlights distinctions in forceps performance, with Thierry spatulas applying the least force on the fetal head, while an experienced obstetrician fared better with Simpson forceps in terms of perineal pressure. Kielland forceps remain a viable alternative for nonrotational forceps births, showing comparable outcomes. Synopsis: Thierry spatulas are gentlest on the fetal head, Simpson forceps are favored by experienced obstetricians for perineal pressure, and Kielland forceps offer an alternative with similar outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the ease of removal of malpositioned intrauterine devices (IUDs) based on a retrospective cohort study involving 436 cases. It highlights that a significant majority of these IUDs can be removed successfully in the office setting using ring forceps, with 82 percent being extracted on the first attempt, emphasizing the practicality of managing malpositioned IUDs without the need for special equipment or specialist referrals.

Simple Summary: Atresia Ani (AA) is a rare congenital anomaly affecting rectal and anal development in companion animals, with its occurrence in cats being poorly documented. This study investigated Type IV Atresia Ani (which includes a recto-vaginal fistula) in female cats, focusing on surgical intervention as the primary treatment. Over 2 years, nine female cats with Type IV Atresia Ani were analyzed for age, body condition, and fistula length. Statistical analysis revealed that a body condition score of 3, an age range of 3 to 4 weeks, and a fistula length of 1 to 2 mm influenced fecal incontinence and anal stenosis development during the perioperative period. Incidence of this condition was 4.7% among the 192 cats evaluated. Cats with a body condition score of 3, an age of 3 to 4 weeks, and a fistula size of 1 to 2 mm showed better surgical outcomes. This study is the first to report the disease incidence in cats undergoing surgery, according to the authors' knowledge. Atresia Ani (AA) is a rare congenital anomaly in companion animals affecting rectal and anal development. Its incidence in cats remains unreported. This retrospective study aimed to characterize age, body condition, fistula size, and perioperative outcomes in Type IV Atresia Ani (with recto-vaginal fistula) in female cats. Surgical intervention is the primary treatment. Conducted over 2 years, the study included nine female cats diagnosed with Type IV Atresia Ani and recto-vaginal fistula undergoing surgery. Statistical analysis used the R program (version 4.2.1) with Rstudio®® extension. Significant results were observed at a 95% confidence interval and p < 0.05. The condition had an incidence of 4.7% among the 192 cats evaluated over a 2-year period. The findings suggest that a body condition score of 3, an age of 3 to 4 weeks, and a fistula length of 1 to 2 mm correlated with better surgical outcomes, reducing the likelihood of fecal incontinence and anal stenosis development, and enhancing defecation awareness during the perioperative period. This study is the first to report the disease incidence in cats undergoing surgery, according to the authors' knowledge. [ABSTRACT FROM AUTHOR]

To investigate neonatal injuries, morbidities and risk factors related to vaginal deliveries. This retrospective, descriptive study identified 3500 patients who underwent vaginal delivery between 2020 and 2022. Demographic data, neonatal injuries, complications arising from vaginal delivery and pertinent risk factors were documented. Neonatal injuries and morbidities were prevalent in cases of assisted vacuum delivery, gestational diabetes mellitus class A2 (GDMA2) and pre-eclampsia with severe features. Caput succedaneum and petechiae were observed in 291/3500 cases (8.31%) and 108/3500 cases (3.09%), respectively. Caput succedaneum was associated with multiparity (adjusted odds ratio [AOR] 0.36, 95% confidence interval [CI] 0.22–0.57, P < 0.001) and assisted vacuum delivery (AOR 5.18, 95% CI 2.60–10.3, P < 0.001). Cephalohaematoma was linked to GDMA2 (AOR 11.3, 95% CI 2.96–43.2, P < 0.001) and assisted vacuum delivery (AOR 16.5, 95% CI 6.71–40.5, P < 0.001). Scalp lacerations correlated with assisted vacuum and forceps deliveries (AOR 6.94, 95% CI 1.85–26.1, P < 0.004; and AOR 10.5, 95% CI 1.08–102.2, P < 0.042, respectively). Neonatal morbidities were associated with preterm delivery (AOR 3.49, 95% CI 1.39–8.72, P = 0.008), night-time delivery (AOR 1.32, 95% CI 1.07–1.63, P = 0.009) and low birth weight (AOR 7.52, 95% CI 3.79–14.9, P < 0.001). Neonatal injuries and morbidities were common in assisted vacuum delivery, maternal GDMA2, pre-eclampsia with severe features, preterm delivery and low birth weight. Cephalohaematoma and scalp lacerations were prevalent in assisted vaginal deliveries. Most morbidities occurred at night. Clinical trial registration: Thai Clinical Trials Registry 20220126004. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements. [ABSTRACT FROM AUTHOR]

Background: The maternal continuum of care (CoC) is a cost-effective approach to mitigate preventable maternal and neonatal deaths. Women in developing countries, including Tanzania, face an increased vulnerability to significant dropout rates from maternal CoC, and addressing dropout from the continuum remains a persistent public health challenge. Method: This study used the 2022 Tanzania Demographic and Health Survey (TDHS). A total weighted sample of 5,172 women who gave birth in the past 5 years and had first antenatal care (ANC) were included in this study. Multilevel binary logistic regression analyses were used to examine factors associated with dropout from the 3 components of maternal CoC (i.e., ANC, institutional delivery, and postnatal care (PNC)). Results: The vast majority, 83.86% (95% confidence interval (CI): 82.83%, 84.83%), of women reported dropout from the maternal CoC. The odds of dropout from the CoC was 36% (AOR = 0.64, (95% CI: 0.41, 0.98)) lower among married women compared to their divorced counterparts. Women who belonged to the richer wealth index reported a 39% (AOR = 0.61, (95% CI: 0.39, 0.95)) reduction in the odds of dropout, while those belonged to the richest wealth index demonstrated a 49% (AOR = 0.51, (95% CI: 0.31, 0.82)) reduction. The odds of dropout from CoC was 37% (AOR = 0.63, (95% CI: 0.45,0.87)) lower among women who reported the use of internet in the past 12 months compared to those who had no prior exposure to the internet. Geographical location emerged as a significant factor, with women residing in the Northern region and Southern Highland Zone, respectively, experiencing a 44% (AOR = 0.56, 95% CI: 0.35–0.89) and 58% (AOR = 0.42, 95% CI: 0.26–0.68) lower odds of dropout compared to their counterparts in the central zone. Conclusion: The dropout rate from the maternity CoC in Tanzania was high. The findings contribute to our understanding of the complex dynamics surrounding maternity care continuity and underscore the need for targeted interventions, considering factors such as marital status, socioeconomic status, internet usage, and geographical location. [ABSTRACT FROM AUTHOR]

This article is a systematic review and meta-analysis that examines the use of routine ultrasound in improving instrument placement during operative vaginal delivery. The study found that while ultrasound improved the accuracy of diagnosing fetal head position, it did not significantly affect instrument placement or other procedural outcomes. The authors suggest that further research and specific training may be needed to fully understand the benefits and limitations of ultrasound in this context. [Extracted from the article]

The article offers information on the challenges of determining truth, especially in medical and legal contexts like allegations of child endangerment or abusive head trauma (AHT). Topics include a case study involving a mother admitted to a New Zealand hospital in labor, which resulted in a complex delivery and subsequent allegations of AHT. The case highlights the complexities of medical decision-making and the importance of probability analysis in differential diagnosis.

Neonatal clinical sepsis is recognized as a significant health problem, This study sought to identify a predictive model of risk factors for clinical neonatal sepsis. A retrospective study was conducted from 1 October 2018 to 31 March 2023 in a large tertiary hospital in China. Neonates were divided into patients and controls based on the occurrence of neonatal sepsis. A multivariable model was used to determine risk factors and construct models.The utilization and assessment of model presentation were conducted using Norman charts and web calculators, with a focus on model differentiation, calibration, and clinical applicability (DCA). Furthermore, the hospital's data from 1 April 2023 to 1 January 2024 was utilized for internal validation. In the modelling dataset, a total of 339 pairs of mothers and their newborns were included in the study and divided into two groups: patients (n = 84, 24.78%) and controls (n = 255, 75.22%). Logistic regression analysis was performed to examine the relationship between various factors and outcome. The results showed that maternal age < 26 years (odds ratio [OR] = 2.16, 95% confidence interval [CI] 1.06–4.42, p = 0.034), maternal gestational diabetes (OR = 2.17, 95% CI 1.11–4.27, p = 0.024), forceps assisted delivery (OR = 3.76, 95% CI 1.72–5.21, p = 0.032), umbilical cord winding (OR = 1.75, 95% CI 1.32–2.67, p = 0.041) and male neonatal sex (OR = 1.59, 95% CI 1.00–2.62, p = 0.050) were identified as independent factors influencing the outcome of neonatal clinical sepsis. A main effects model was developed incorporating these five significant factors, resulting in an area under the curve (AUC) value of 0.713 (95% CI 0.635–0.773) for predicting the occurrence of neonatal clinical sepsis. In the internal validation cohort, the AUC value of the model was 0.711, with a 95% CI of 0.592–0.808. A main effects model incorporating the five significant factors was constructed to help healthcare professionals make informed decisions and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Operative vaginal delivery (OVD) refers to the use of forceps or a vacuum during vaginal delivery, a fundamental component of emergency obstetric and newborn care. But, worldwide, there is a declining trend in the instrumental delivery and increase in cesarean delivery. Objective: This study aims to assess the current trends, risks, and complications associated with OVD at Dubai Hospital, United Arab Emirates (UAE). Study design: Retrospective observational study of all women who delivered by OVD over a 5-year period from 2018 to 2022. We collected data on maternal demographics, maternal, and neonatal outcomes and total deliveries. Results: During the study period, 2.8% of women had successful operative vaginal deliveries. Our incidence remained the same during the study period. We had a total of 273 instrumental deliveries during the study period; out of this, 54.6% were delivered by metal cup, 42% by Kiwi, and 3.3% by forceps. We also noticed the preference of Kiwi over the years as compared with metal vacuum. The most common indication for OVD was fetal distress, accounting for 85.7% of cases. We also noticed a significant increase in OVD for patients on epidural analgesia (14.7% in 2018 vs 43.6% in 2022). Among the patients who underwent instrumental deliveries, 13 cases (4.8% of the total) were identified with 3rd-degree perineal tears. Multiple vaginal lacerations and cervical tears were observed in 25% of the cases. Major perineal tears, the need for suturing in operation theater, and the need for blood transfusion were seen more in women delivered by metal cups as compared with Kiwi and forceps, but not statistically significant. About 13% babies developed neonatal jaundice, and 18.3% babies needed admission to the neonatal intensive care unit (NICU). Shoulder dystocia is more common in babies delivered by metal cups (4.6%). Conclusion: Operative vaginal delivery remains a crucial component of obstetric care, with stable incidence. We observed a shifting preference toward the Kiwi vacuum extractor over metal cups while fetal distress remained the primary indication. [ABSTRACT FROM AUTHOR]

Female surgeons have ergonomic issues with commercialized instruments tailored for male surgeons. The purpose of this study was to identify satisfaction levels and ergonomic problems of female surgeons while using laparoscopic forceps with ring-handles and suggest improvement measures. A questionnaire was sent to 19,405 members of the Japanese Society of Gastroenterological Surgery via email between 1 August 2022 and 30 September 2022. It included demographic information and specific questions regarding the use of laparoscopic forceps with ring- handles (ergonomic evaluation, influence of the negative aspects of laparoscopic forceps during surgery, physical discomfort in the hands and fingers, degree of satisfaction, and handle size). Valid responses were received from 1,030 respondents (131 female and 899 male surgeons). The ergonomics of the laparoscopic forceps with ring-handles were rated lower by female surgeons in all ten categories (all p value < 0.05). They also reported a negative impact on surgical manipulation and discomfort to their hands and fingers. Female surgeons had a wide variety of ergonomic problems when using laparoscopic forceps with ring-handles, and showed lower levels of satisfaction. Developing a different model tailored to female surgeons with smaller hands and a weaker grip could be a viable solution. [ABSTRACT FROM AUTHOR]

There are different kinds of benign and malignant lesions in the oral cavity. Clinically, definite diagnosis can be confirmed only by doing adequate surgical biopsy and subsequent histopathological examination. Inadequate biopsy technique, unsuitable selection of the location for biopsy, inappropriate tissue handling and record of patients' information may lead to artifacts and misdiagnosis by the oral pathologists. Soft tissue stabilization is a challenge during oral surgery procedures. It needs the cooperation of operator, assistants, and patients to overcome the difficulty and ensure the successful outcome. In this article, we reviewed the procedures for clinical surgical biopsy, and raised three current tissue stabilization methods including fingers and gauze stabilization, stabilization with chalazion forceps and adapted instruments, and stabilization with retraction sutures. Moreover, some limitations were also presented. Clinician should examine the clinical characteristics of the oral lesion, the surrounding anatomical structures, and their own clinical experience and preference to select the appropriate tool. More understanding of these biopsy and tissue stabilization methods can effectively improve the biopsy procedures and obtain adequate tissues for histopathological examination and subsequent issue of an accurate pathological report. [ABSTRACT FROM AUTHOR]

Aim: To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. Methods: We conducted a population‐based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). Results: A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80–3.16) and forceps (RR 3.35, 95% CI 3.07–3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1–26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72–32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8–36.4) and skull fractures (RR 2.04, 95% CI 1.86–2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. Conclusions: Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery. Methods: We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered. Results: The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01–2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30–20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09–6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01–1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23–7.43; P = 0.016). Conclusions: The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%). Clinical trial registration: Thai Clinical Trials Registry: 20220126004. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care. Methods: We conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care. Results: The incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56–0.94), nulliparity (aOR = 1.96; 95% CI 1.66–2.30), previous PPH (aOR = 2.67; 95% CI 1.67–4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25–4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10–1.69), instrumental birth (aOR = 2.69; 95% CI 1.53–4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93–7.88), perineal trauma (aOR = 4.67; 95% CI 3.16–6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42–2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78–3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care. Conclusions: The risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs. [ABSTRACT FROM AUTHOR]

Assisted vaginal birth (AVB) is the vaginal birth of a baby performed with the help of a medical device. In the United Kingdom, 10–15% of birthing people will have an AVB for maternal and/or fetal indications. Devices for AVB most commonly include forceps and vacuum, with differing risks and benefits. However, complications can include maternal and fetal morbidity. The decision-making in AVB is complex and multi-factorial to ensure a safe AVB is achieved. Technical and non-technical skills including: communication, situational awareness and human factors, are crucial for holistic care. Safety considerations comprised of a thorough assessment, intrapartum care and postnatal aspects of management. Training needs to cover all aspects of a competent AVB, including understanding the different devices and evaluating which to use in varied clinical settings. With rising rates of second-stage caesarean AVB continues to be an essential skill in obstetric care. [ABSTRACT FROM AUTHOR]

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This commentary discusses an article on the effect of an intrapartum pelvic dilator device on levator ani muscle avulsion during primiparous vaginal delivery. The pilot results show that the device may be effective in preventing this type of injury, which can have long-term consequences. However, there are some concerns raised, such as the requirement of epidural analgesia for device use and the high rate of obstetric anal sphincter injury in the study group. The author suggests further research and education on preventive strategies for these types of injuries. [Extracted from the article]

Background: There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. Objectives: To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non‐rotational forceps delivery (NRFD) or a second‐stage caesarean section (CS), from a systematic review and meta‐analysis of the literature. Search Strategy: Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Selection Criteria: Case series, prospective or retrospective cohort studies and population‐based studies. Data Collection and Analysis: A meta‐analysis using a random‐effects model was used to derive weighted pooled estimates of maternal and neonatal complications. Main Results: Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non‐rotational forceps (RR 0.79, 95% CI 0.65–0.95) and second‐stage CS (RR 0.45, 95% CI 0.36–0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR 1.79, 95% CI 1.08–2.98), but rates of neonatal birth trauma were lower (RR 0.49, 95% CI 0.26–0.91). There were no differences seen in the rates of 5‐min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second‐stage CS (RR 0.47, 95% CI 0.23–0.97). Conclusions: Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour. Linked article: This article is commented on by Parris and Siassakos, pp. 865 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17413. [ABSTRACT FROM AUTHOR]

Purpose: To assess study design and a range of anatomical and functional changes after internal limiting membrane (ILM) peeling using forceps developed for atraumatic ILM pick-up compared to standard forceps. Methods: We conducted a masked proof-of concept randomised controlled trial (RCT) on 65 patients who underwent ILM peeling for idiopathic full-thickness macular hole (FTMH) using etched-tip forceps (etched-tip group, 33 eyes) compared to standard ILM forceps (smooth-tip group, 32 eyes). Patients were assessed preoperatively, 3 weeks, 3 and 6 months postoperatively. Results: The primary closure rate was 95.4%. There was no statistically significant difference between the groups in terms of final visual acuity (66.9 vs 70.9 ETDRS letters, p = 0.13), difference of visual field mean deviation (1.32 vs 1.14 decibels), and number of eyes with pick-up-related retinal haemorrhages (16% vs 16%, p = 0.96), swelling of arcuate nerve fibre layer lesions (63% vs 55%, p = 0.54), number of dissociated optic nerve fibre layer lesions (31.4 vs 41.0, p = 0.16), nor inner retina defects (37% vs 22%, p = 0.17). Similar changes in inner retinal volumes were detected in all 9 sectors of an ETDRS grid except for a trend (p = 0.06) towards a lower reduction in the inferior inner sector in the etched-tip group. Conclusions: The study was successfully completed with masking maintained and a low risk of bias. Multiple endpoints relating to ILM peeling were assessed, and estimates were provided that can be used for future studies. Although the study was not powered to assess any specific endpoint, the anatomical and functional outcomes assessed did not significantly differ. [ABSTRACT FROM AUTHOR]

Risks of failed vacuum or forceps delivery attempts increased with older age, higher body mass index, and birth weights more than 4,000 g and decreased with physician experience. OBJECTIVE: To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births. METHODS: This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders. RESULTS: Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93–0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64–0.91). CONCLUSION: In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills. [ABSTRACT FROM AUTHOR]

Forceps corneal injuries during infant delivery cause Descemet membrane (DM) breaks, that cause corneal astigmatism and corneal endothelial decompensation. The aim of this study is to characterise corneal higher-order aberrations (HOAs) and corneal topographic patterns in corneal endothelial decompensation due to obstetric forceps injury. This retrospective study included 23 eyes of 21 patients (54.0 ± 9.0 years old) with forceps corneal injury, and 18 healthy controls. HOAs and coma aberrations were significantly larger in forceps injury (1.05 [0.76–1.98] μm, and 0.83 [0.58–1.69], respectively) than in healthy controls (0.10 [0.08–0.11], and 0.06 [0.05–0.07], respectively, both P < 0.0001). Patient visual acuity was positively correlated with coma aberration (rs = 0.482, P = 0.023). The most common topographic patterns were those of protrusion and regular astigmatism (both, six eyes, 26.1%), followed by asymmetric (five eyes, 21.7%), and flattening (four eyes, 17.4%). These results indicate that increased corneal HOAs are associated with decreased visual acuity in corneal endothelial decompensation with DM breaks and corneal topography exhibits various patterns in forceps injury. [ABSTRACT FROM AUTHOR]

Placenta previa occur when the placenta is situated completely or its part into the lower uterine segment. Placenta previa can give rise to bleeding either during pregnancy, during labour or following delivery. Transvaginal sonography is most accurate method to diagnose placenta previa. Due to the fact that since one part of the placenta is partially detached, while the other part of placenta has grown into the uterus, postpartum haemorrhage with lethal outcome may occur, unless the mother is hospitalized. Such complications can be prevented by legal abortions. Placenta previa prevents a safe vaginal delivery and requires the delivery of the neonate to be via caesarean delivery. [ABSTRACT FROM AUTHOR]

Background: Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium‐stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth. Methods: We conducted a nationwide cross‐sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments. Results: There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and/or lack of adherence to these guidelines. Conclusions: To reduce unwarranted variation in local protocols, evidence‐based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence‐based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care. [ABSTRACT FROM AUTHOR]

Background: This study investigated the impact and short-term surgical outcomes of two different main energy devices for robotic gastrectomy for gastric cancer. The outcomes of robotic gastrectomy with ultrasonic shears and those of robotic gastrectomy with conventional forceps were compared.Methods: We retrospectively evaluated 171 patients who underwent robotic distal gastrectomy or total gastrectomy for gastric cancer. We classified patients into the ultrasonic shears (US) and Maryland bipolar (MB) forceps groups according to the main energy device used for robotic gastrectomy.Results: We extracted 58 patients from the US group and 58 patients from the MB forceps groups using propensity score matching. The total console time (310 min [interquartile range (IQR), 253-369 min] and 332 min, [IQR, 294-429 min]; p = 0.022) and the console time to gastrectomy (222 min [IQR, 177-266 min] and 247 min [IQR, 208-321 min]; p = 0.004) were significantly shorter in the US group than in the MB forceps group. Less blood loss occurred in the US group than in the MB forceps group (20 mL [IQR, 10-40 mL] and 30 mL [IQR, 16-80 mL]; p = 0.014). The postoperative complication rate and postoperative hospital stay length were similar between groups. A multivariate multiple linear regression analysis demonstrated that the use of an ultrasonically activated device was one an independent factor that reduced the operative time of robotic gastrectomy.Conclusion: Using ultrasonic shears as the main energy device may contribute to better surgical outcomes after robotic gastrectomy for gastric cancer. [ABSTRACT FROM AUTHOR]

Objective: Instruments used in assisted vaginal birth have seen little innovation for decades. Due to the risk of trauma and technical difficulty incurred during forceps delivery, instrumental deliveries are on a decline, and the global rate of primary cesarean birth is rising. The novel Paily Obstetric Forceps (POF) features a compact, lighter design with thinner blades, designed to increase operator comfort and minimize maternal and neonatal injuries. We aim to determine the feasibility and safety of POF in achieving vaginal birth compared to a ventouse device with a 50 mm silastic cup.Study Design: We conducted a single-blinded, parallel arm, randomized clinical trial of the novel POF vs a ventouse device, in patients undergoing indicated assisted vaginal birth, at a tertiary care obstetric unit. We randomized 100 patients to be allocated on a 1:1 ratio to both intervention arms. Primary outcome was the proportion of successful instrumental deliveries. Secondary outcomes were the number of pulls required during traction and any maternal or neonatal adverse events.Results: The POF was significantly more successful in achieving vaginal birth than the ventouse device (n = 50/50, 100 % vs n = 42/50, 84 %, p = 0.006). Operators reported requiring significantly fewer pulls during POF traction than ventouse. POF demonstrated a higher risk for maternal trauma (RR = 3.2, 95 % CI = 1.5 to 6.9, NNH = 2.7) but a lower risk for neonatal injury (RR = 0.6, 95 % CI = 0.3 to 1, NNH = 5.7). Maternal and neonatal recovery durations were comparable. There were no incidences of maternal or neonatal mortality.Conclusion: The POF can be used in indicated assisted vaginal birth with superior success rates and better neonatal outcomes than ventouse. Other obstetric forceps must be standardized to conduct larger superiority trials of forceps designs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to create a simulation model in shoulder dystocia, breech delivery, and vacuum forceps applications, and to show the effect of education on the knowledge-skill level of the individuals involved. STUDY DESIGN: This prospective cohort research was conducted among assistant doctors and midwives. The course was held in the simulation center by creating 4 different scenarios. The steps of each maneuver were determined separately. Performance was evaluated on a five-point Likert-type scale between 1-5 points before and after training. A higher score was considered higher proficiency in the subject. RESULTS: Of the participants in the study, 51.4% (n=19) of 37 were doctors. The post-training scores obtained from each step of the shoulder dystocia maneuvers, breech birth maneuver, forceps application, and vacuum application were statistically significantly higher than the pre-training scores (p<0.001). The change in the post-training skill scores of the physicians was significantly higher than that of the midwives (p<0.001). Post-training, 67.9% of the participants thought that the simulation training was a great help in transforming their theoretical knowledge into practice. CONCLUSION: Breech delivery, shoulder dystocia, forceps, and vacuum applications are difficult subjects to education in obstetrics. In these pieces of training, simulation should be used as a training method in obstetric education and integrated into the curriculum. We believe that giving and disseminating an effective and accessible simulation protocol to healthcare professionals can reduce birth complications. [ABSTRACT FROM AUTHOR]

Purpose: Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods: A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results: Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/ stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion: In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy. [ABSTRACT FROM AUTHOR]

This study used machine learning and a national prospective cohort registry database to analyze the major risk factors of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants, including environmental factors. The data consisted of 10,353 VLBW infants from the Korean Neonatal Network database from January 2013 to December 2017. The dependent variable was NEC. Seventy-four predictors, including ambient temperature and particulate matter, were included. An artificial neural network, decision tree, logistic regression, naïve Bayes, random forest, and support vector machine were used to evaluate the major predictors of NEC. Among the six prediction models, logistic regression and random forest had the best performance (accuracy: 0.93 and 0.93, area under the receiver-operating-characteristic curve: 0.73 and 0.72, respectively). According to random forest variable importance, major predictors of NEC were birth weight, birth weight Z-score, maternal age, gestational age, average birth year temperature, birth year, minimum birth year temperature, maximum birth year temperature, sepsis, and male sex. To the best of our knowledge, the performance of random forest in this study was among the highest in this line of research. NEC is strongly associated with ambient birth year temperature, as well as maternal and neonatal predictors. [ABSTRACT FROM AUTHOR]

Background & Aims: The most suitable procedure for resecting small-sized gastric neoplasms remains unclear. Endoscopic mucosal resection leads to non-curative resection owing to slippage of the snare, and technically difficult endoscopic submucosal dissection (ESD) is instrumentally uneconomical. A novel, cost-effective, multifunctional snare called SOUTEN is available as a hybrid ESD (h-ESD) device developed for facilitating ESD. This study aimed to assess the acceptability of h-ESD using the SOUTEN for resecting small-sized gastric neoplasms. Methods: This was a prospective observational study conducted at our single institution between March 2019 and March 2021. Fifty-seven consecutive patients who underwent h-ESD using SOUTEN for small-sized gastric neoplasms ≤15 mm involving adenoma and tubular-type mucosal carcinoma without ulceration were enrolled. The primary outcome was curative resection rate for h-ESD. Secondary outcomes were the rates of conversion to ESD, rate of total (h-ESD + ESD) curative resection, procedure time, rates of intra-and postoperative complications, and presence of additional knives excluding hemostatic forceps. Results: The curative resection rate of h-ESD was 89.5% (51/57). The total (h-ESD + ESD) curative resection rate was 94.7% (54/57). The mean procedure time was 21.2 (±16.5) minutes. One case of delayed bleeding occurred. Additional knives were applied in two cases. Conclusions: The cost-efficient h-ESD using SOUTEN can be an acceptable procedure for resecting smallsized gastric neoplasms. [ABSTRACT FROM AUTHOR]

Summary: Background: Women with inflammatory bowel diseases (IBD) often receive biologics to maintain remission during pregnancy. Aims: To assess maternal and neonatal outcomes in patients with IBD treated with ustekinumab (UST) during pregnancy Methods: In a multicentre, prospective cohort study, we recruited women with IBD treated with UST during pregnancy between 2019 and 2021. Outcomes were compared among patients treated with UST, anti‐tumour necrosis factor α, (anti‐TNF) and non‐UST, non‐anti‐TNF therapies. UST‐treated patients were matched 1:2 to controls according to age, body mass index and parity. Newborns were followed up to 12 months. Results: We recruited 129 pregnant patients: UST 27; anti‐TNF 52; non‐UST, non‐anti‐TNF 50 (thiopurine or mesalazine 30, no therapy 20); Crohn's disease 25 (96.9%). Overall, pregnancy, neonatal and newborn outcomes were satisfactory, with no significant differences among patients treated with UST, anti‐TNF and non‐UST non‐anti‐TNF agents for obstetrical maternal complications [UST 3 (11.5%), anti TNF 12 (23.1%), non UST, non‐anti‐TNF 4 (8.2%), p = 0.095], pre‐term delivery [1 (4.3%), 9 (18.4%), 4 (5.7%), p = 0.133], low birth weight [1 (4.2%), 5 (10.2%), 4 (8.3%), p = 0.679], or first year newborn hospitalisation [2 (9.1%), 4 (8.2%), 3 (6.1%), p = 0.885]. Conclusion: Pregnant patients with IBD treated with UST demonstrated favourable pregnancy and neonatal outcomes that were comparable with those in patients treated with anti‐TNF or other therapy. Data are reassuring for patients with IBD and their physicians when considering UST during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Studies on medication safety in pregnancy are increasingly focusing on child neurodevelopmental outcomes. Establishing neurodevelopmental safety is complex due to the range of neurodevelopmental outcomes and the length of follow-up needed for accurate assessment. The aim of this study was to provide an inventory of European data sources for use in pharmacoepidemiologic studies investigating neurodevelopment following maternal medication exposure. Method: The EUROmediSAFE inventory of data sources in Europe for evaluating perinatal and long-term childhood risks associated with in-utero exposure to medication was updated by contacting colleagues across 31 European countries, literature review and internet searches. Included data sources must record at least one neurodevelopmental outcome and maternal medication use in pregnancy must be available, either in the data source itself or through linkage with another data source. Information on the domain of neurodevelopment, measure/scale used and the approach to measurement were recorded for each data source. Results: Ninety data sources were identified across 14 countries. The majority (63.3%) were created for health surveillance and research with the remaining serving administrative purposes (21.1% healthcare databases,15.6% other administrative databases). Five domains of neurodevelopment were identified—infant development (36 data sources,13 countries), child behaviour (27 data sources, 10 countries), cognition (29 data sources, 12 countries), educational achievement (20 data sources, 7 countries), and diagnostic codes for neurodevelopmental disorders (42 data sources, 11 countries). Thirty-nine data sources, in 12 countries, had information on more than one domain of neurodevelopment. Conclusion: This inventory is invaluable to future studies planning to investigate the neurodevelopmental impact of medication exposures during pregnancy. Caution must be used when combining varied approaches to neurodevelopment outcome measurement, the age of children in the data source, and the sensitivity and specificity of the outcome measure selected should be borne in mind. [ABSTRACT FROM AUTHOR]

Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India. [ABSTRACT FROM AUTHOR]

Objectives: To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Material and methods: Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Statistics Department (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results: Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions: The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: A fetal catheterization is an efficient tool allowing longitudinal in vivo studies on hormonal and metabolic changes, including fetal blood gases and acid-base changes. These surgical techniques made it possible to take blood samples daily under aseptic conditions to determine arterial and/or venous blood samples for acid-base variables (like pH, blood gas tensions: partial pressure of carbon dioxide and partial pressure of oxygen, oxygen saturation, bicarbonate concentration, total carbon dioxide, and base excess). All these examinations may contribute to a better understanding of the physiological changes that occur during calving, which may help reach a significant reduction in losses caused by perinatal mortality, which is still high today. The objective of the present study was to evaluate the changes in maternal and fetal arterial acid-base variables withdrawn from catheterized dams and fetuses during the last days before and during calving. The average gestation length in nine cows with chronically catheterized fetuses was 285 ± 10 (SD) days. The arterial acid-base variables of a catheterized dam and fetus were very stable during late gestation. Four newborn calves showed small differences between prenatal and postnatal pH values (−0.035). At the same time, pCO2 values started to increase significantly (p = 0.02), indicating a shift towards physiological respiratory acidosis during calving. The partial pressure of oxygen and oxygen saturation values showed some non-significant improvements immediately after birth, while the other acid-base parameters did not differ. The remaining five newborn calves showed a significant decrease in arterial blood pH (p < 0.01) and BE (p = 0.01), while pCO2 tended to be higher (p = 0.06), indicating a shift towards physiological respiratory and metabolic acidosis, while the other acid-base parameters hardly differed. It is essential to mention that physiological (n = 2) and mild metabolic acidosis (n = 2) developed gradually in four newborn calves during the second stage of calving, lasting about ≤ 2 h. In contrast, in the remaining newborn calf the physiological metabolic acidosis developed during the last 3 min of birth because immediately before birth, the BE value was 0.4 mmol/L. After birth, it was −5.4 mmol/L. The results indicate that the acid-base variables may start to move gradually in the direction of expressed respiratory and metabolic acidosis only after appearing the amniotic sac and fetal feet in the vulva during the second stage of labor; therefore, it is essential to complete obstetrical assistance in time. [ABSTRACT FROM AUTHOR]

There is accumulating evidence on the perinatal aspects of COVID-19, but available data are still insufficient. The reports on perinatal aspects of COVID-19 have been published on a small group of patients. Vertical transmission has been noted. The SARS-CoV-2 genome can be detected in umbilical cord blood and at-term placenta, and the infants demonstrate elevated SARS-CoV-2-specific IgG and IgM antibody levels. In this work, the analysis of clinical characteristics of RT-PCR SARS-CoV-2-positive pregnant women and their infants, along with the placental pathology correlation results, including villous trophoblast immunoexpression status for SARS-CoV-2 antibody, is presented. RT-PCR SARS-CoV-2 amniotic fluid testing was performed. Neonatal surveillance of infection status comprised RT-PCR testing of a nasopharyngeal swab and the measuring of levels of anti-SARS-CoV-2 in blood serum. In the initial study group were 161 pregnant women with positive test results. From that group, women who delivered during the hospital stay were selected for further analysis. Clinical data, laboratory results, placental histomorphology results, and neonatal outcomes were compared in women with immunohistochemistry (IHC)-con SARS-CoV-2-positive and IHC SARS-CoV-2-negative placentas (26 cases). A positive placental immunoprofile was noted in 8% of cases (n = 2), whereas 92% of cases were negative (n = 24). Women with placental infection proven by IHC had significantly different pathological findings from those without. One infected neonate was noted (n = 1; 4%). Infection was confirmed in perinatal autopsy, as there was the intrauterine fetal demise. The potential course of the infection with the risk of vertical transmission and implications for fetal–neonatal condition is critical for proper clinical management, which will involve comprehensive, multidisciplinary perinatal care for SARS-CoV-2-positive patients. [ABSTRACT FROM AUTHOR]

Purpose: Urinary incontinence has the potential to reduce participation in sport and exercise and diminish athletic performance. The purpose of this study was to explore the association between obstetric history and urinary incontinence in a cohort of resistance-trained women. Patients and Methods: This international, cross-sectional survey was completed by 1252 women competing in either powerlifting, weightlifting or CrossFit. The Incontinence Severity Index determined the severity of urinary incontinence. Results: Almost 43% of the participants experienced urinary incontinence in the threemonths prior to the study. The prevalence of urinary incontinence in this cohort according to mode of birth were: caesarean 42.6%, unassisted vaginal 59.3%, vacuum extraction 58.8%, forceps 60.3%, vaginal and caesarean births 66.2%, forceps and vacuum extraction 73.1%. The prevalence of urinary incontinence in the subgroup of women who had undergone urogenital surgery was 63.6%. Kendall's tau-b indicated that the correlation between ISI score and the number of births was strong and positive (τ = 0.25, p < 0.001). Conclusion: Our results suggest that both the number of births and mode of birth influenced the likelihood of urinary incontinence in resistance-trained women. Women who had experienced only caesarean births had the lowest likelihood of urinary incontinence, while women who had experienced both vaginal and caesarean births had the most severe and second highest likelihood of urinary incontinence. Women who had undergone urogenital surgery continued to experience a high likelihood of urinary incontinence. [ABSTRACT FROM AUTHOR]

Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital. [ABSTRACT FROM AUTHOR]

Objective. To explore the effect of exercise during pregnancy on the maternal and neonatal health outcomes. Methods. Eligible papers were systematically retrieved from PubMed, Embase, OVID, and ScienceDirect. Two researchers independently extracted the primary endpoints from the included literature. Random-effect model or fixed-effect model were utilized to generate and compute relative risk and mean difference, as appropriate. Publication bias was quantified and assessed using the funnel plot with Egger's test. Results. This study included 13 literatures with a total of 3047 pregnant women with gestational weeks more than 10 weeks. The incidence of vaginal delivery was significantly higher in the intervention group than that in the control group (28.7% vs 23.3%, P < 0.001). The differences of duration of the first stage and second stage of labor between the interventional group and control group were both statistically insignificant (mean difference: 27.92, 95% CI: − 70.60, 14.7, P = 0.20 ; mean difference: 0.63, 95% CI: − 4.47, 5.74, P = 0.81). In addition, there were no significant differences with regard to gestational age at delivery (mean difference = − 0.23 , 95% CI: − 1.29, 0.83, P = 0.67), Apgar score (mean difference = 0.06 , 95% CI: − 0.13, 0.26, P = 0.53), and birth weight (mean difference = − 23.78 , 95% CI: − 60.66, 13.11, P = 0.21) between the 2 groups. Women in the intervention group were more likely to experience vaginal delivery than the control group (RR = 1.27 , 95% CI: 1.04, 1.55, P = 0.01). Conclusions. Physical exercise during pregnancy could improve the incidence of natural labor. [ABSTRACT FROM AUTHOR]

Simple Summary: To improve the lives of chimpanzees living in managed care, it is important to understand why their lives have ended. Previous efforts to document the causes of death for chimpanzees living in research facilities have been useful; however, interpretations need to consider the relatively small number of facilities assessed, the recency of those evaluations, and the possibility that mortality rates were affected by experimental interventions at these sites. Here, the causes of death of 224 chimpanzees at 42 accredited zoos over a 25-year period were analyzed. Most of the chimpanzees over 1 month of age died from causes associated with degenerative diseases (50%), infection (26%), and trauma (15%). Causes of fatal trauma ranged from aggression from conspecifics, the outcomes of exhibit escapes, or accidental drowning. The number of accidental deaths has decreased in the past decade, likely as a result of advances in exhibit design and management. Cardiopulmonary problems have long been known to be prevalent within the chimpanzee population, and they remain a major contributor to death for both sexes in this population. Understanding these findings provides an opportunity to improve the care and management of captive chimpanzees. Understanding causes of death allows adjustment of health management strategies for animals in managed care. From 224 documented chimpanzee deaths occurring from 1995 to 2019 in 42 accredited U.S. zoos, post-mortem records and necropsy reports were analyzed for the primary cause of death, which were available for 214 individuals. In total, 37 cases of stillbirth and neonatal deaths were assessed (16.5%); however, the focus was otherwise placed on the remaining 177 cases in which the death occurred in individuals aged greater than 1 month. There were no sex-related differences in etiology; however, age variation in the cause of death was statistically significant (p < 0.001). Elderly (35 years and older) chimpanzees tended to die of intrinsic, often degenerative, etiologies, whereas infants, juveniles, and adolescents (less than 15 years) were more likely to be involved in fatal trauma. Overall, there were 27 deaths (15.3% of all post-neonatal deaths) related to trauma and 13 of these were directly or indirectly related to conspecific aggression. Understanding causes of mortality and the interrelation with management can benefit managed populations of chimpanzees. [ABSTRACT FROM AUTHOR]

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Purpose: The present study aims to evaluate the safety and efficacy of advanced inferior vena cava filter (IVCF) retrieval using laser assistance compared with forceps via systematic review and quantitative aggregation of available data. Methods: Pubmed and Embase were queried from establishment to September 2021. Original studies with a sample size ≥ 5 that reported at least one primary outcome of patients who underwent laser- or forceps-assisted IVCF retrieval were included. Primary outcomes included technical success and complication rates. Baseline characteristics were extracted: age, sex, presence of filter thrombus, strut penetration, previous retrieval attempt, filter dwell time, fluoroscopy time, and filter type. Complications were categorized by type and severity. Categorical data was pooled and evaluated with chi-square or Fisher exact tests. Results: From the 16 included studies, a total of 673 and 368 patients underwent laser- and forceps-assisted IVCF retrieval, respectively. Successful retrieval was achieved in 98.1 and 93.7% patients from the laser and forceps groups, respectively (p < 0.001). Major complication rates (1.6 vs 2.1%, p = 0.629) and risk of injury to cava or adjacent organs (1.0 vs 1.4%, p = 0.534) were similar between the two groups. A higher proportion of filters from the laser arm were closed-cell design (75.4 vs 68.1%, p = 0.020). Conclusion: Based on limited available evidence, forceps- and laser-assisted complex IVCF retrievals were equally safe. The use of laser sheath is associated with a higher retrieval rate than forceps alone, though the baseline characteristics of two cohorts were not controlled. Future large-scale case-controlled comparative studies with longer clinical follow-up are warranted. [ABSTRACT FROM AUTHOR]