Obstetric Care Research Articles

Artificial Intelligence in Predicting the Mode of Delivery: A Systematic Review.

The integration of artificial intelligence (AI) into obstetric care offers significant potential to enhance clinical decision-making and optimize maternal and neonatal outcomes. Traditional prediction methods for mode of delivery often rely on subjective clinical judgment and limited statistical models, which may not fully capture complex patient data. This systematic review aims to evaluate the current state of research on AI applications in predicting the mode of delivery, comparing the performance of AI models with traditional methods, and identifying gaps for future research. A comprehensive literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus databases, covering publications from January 2010 to July 2024. Inclusion criteria were studies employing AI techniques to predict the mode of delivery, published in peer-reviewed journals, and involving human subjects. Studies were assessed for quality using the Prediction Model Risk of Bias Assessment Tool (PROBAST), and data were synthesized narratively due to heterogeneity. In total, 18 studies met the inclusion criteria, employing various AI models such as logistic regression, random forest, gradient boosting, and neural networks. Sample sizes ranged from 40 to 94,480 participants across diverse geographic settings. AI models demonstrated high accuracy rates, often exceeding 90%, and strong predictive metrics (area under the curve (AUC) values from 0.745 to 0.932). Key predictors included maternal age, gravidity, parity, gestational age, labor induction type, and fetal weight. Notable models like the Adana Systemand Categorical Boosting (CatBoost, Yandex LLC, Moscow, Russia) highlighted the effectiveness of AI in enhancing prediction accuracy and supporting clinical decisions. AI models significantly outperform traditional statistical methods in predicting the mode of delivery, providing a robust tool for obstetric care. Future research should focus on standardizing data collection, improving model interpretability, addressing ethical concerns, and ensuring fairness in AI predictions to enhance clinical trust and application.

Mobil Monitoring Doppler Ultrasound (MoMDUS) study: protocol for a prospective, observational study investigating the use of artificial intelligence and low-cost Doppler ultrasound for the automated quantification of hypertension, pre-eclampsia and fetal growth restriction in rural Guatemala

IntroductionUndetected high-risk conditions in pregnancy are a leading cause of perinatal mortality in low-income and middle-income countries. A key contributor to adverse perinatal outcomes in these settings is limited access...

The Impact of Obesity on Childbirth Expectations.

Positive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well-being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs. Using an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one-way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors. In total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P =.008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P <.001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.95; P =.027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11-6.32; P <.001 and aOR, 4.77; 95% CI, 3.37-6.74; P<.001, respectively). Women living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well-being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.

The Didactic Spiral in the Organization of Continuous Training in Neonatal Resuscitation

The dynamic educational process is a didactic spiral in the organization of continuous training in neonatal resuscitation, it is a "living", developing system of training medical specialists in obstetric care with the progress of competencies from the basic level to the highest professionalism and skill, from technical skills to supra—professional competencies.

Outcomes of infants with birthweights less than 501 g compared to infants weighing 501-750 g at a center utilizing first intention high frequency jet ventilation.

Data on clinical outcomes of infants with birthweights less than 501 g (ELBW<501) are limited. To evaluate management strategies and clinical outcomes of ELBW<501infants compared to infants weighing 501-750 g (ELBW501-750). A retrospective study of all ELBW<501 and ELBW501-750 infants born between 2012 and 2022 at a center utilizing first intention high frequency jet ventilation was performed. Patient characteristics, clinical and outcome data were compared between the two groups. A total of 358 infants (92 ELBW<501 infants and 266 ELBW501-750) were included. The survival rate for the ELBW<501 group was 60.9% compared to 86.5% for ELBW501-750. ELBW<501 infants required more frequent use of 2.0 mm endotracheal tubes, required higher FiO2 and longer duration of mechanical ventilation. Compared to ELBW501-750 group, the ELBW<501 group were more likely to be SGA (68.2% vs. 16.5%) and more premature (23.2 vs. 24.3 weeks) with lower survival, longer length of stay, higher incidence of ROP and lower weight at discharge but comparable rates of IVH, grade 3 BPD, discharged on supplemental oxygen, and tracheostomy. ELBW<501 infants are at risk for significant morbidity and mortality. However, with specialized obstetric and neonatal care, survival rates of 60% are possible with respiratory outcomes comparable to ELBW501-750 infants. However, the increased risk of severe ROP for ELBW<501 requiring either surgical or medical intervention is concerning and warrants optimal surveillance.

Possibilities of Simulation Training in Improving Obstetric Care Using the Perm Region as an Example

In the context of solving the problem of reducing cases of critical obstetric conditions and maternal mortality, employees of the Perm State Medical University, on behalf of the Minister of Health of the Perm Territory, developed a comprehensive training program for employees of medical organizations of the obstetric and gynecological profile and chief physicians of the Perm Territory. Over the course of the year, work was carried out to organize on-site training and training for heads of specialized departments.

Evaluating the implementation fidelity of basic emergency obstetrics and neonatal care services in Beyeda District, Northwest Ethiopia: a case study evaluation.

Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia. A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants' interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity. The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants' engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers' respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services. The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.

Efektivitas Rebus Daun Sirih Merah dan Konsumsi Telur Ayam Rebus terhadap Luka Perineum pada Ibu Postpartum di PMB S Kabupaten Pandeglang Tahun 2024

Poor care of perineal wounds can cause infection which will slow down the healing process of perineal wounds. Efforts to prevent perineal wound infections can be provided with pharmacological therapy and non-pharmacological therapy. To provide midwifery care and determine the effectiveness of boiling red betel leaves and consuming boiled chicken eggs on perineal wounds in postpartum mothers. The research used is descriptive qualitative research. The target of the activity was 2 postpartum mothers who had perineal wounds who were given intervention 1 by giving boiled red betel leaves, and intervention 2 by giving boiled chicken eggs for 5 days. From the research results, it was found that postpartum mothers who experienced perineal wounds before and after being given intervention experienced accelerated healing of perineal wounds on the 4th day. There is an effect of boiled red betel leaves and boiled chicken eggs on accelerating the healing of perineal wounds in postpartum mothers. For postpartum mothers, consume boiled chicken eggs and red betel leaves to speed up the healing of perineal wounds.

Maternal sepsis: Clinical pearls for diagnosis and management

Sepsis is a leading cause of maternal morbidity and mortality worldwide. Early recognition and treatment improve outcomes. Multiple sepsis diagnostic screening tools are available and may be used in clinical practice; however, early thorough bedside evaluation of the patient is fundamental. Obstetricians should be able to recognize sepsis and promptly initiate potentially life-saving treatments, such as fluid resuscitation, vasopressors, broad-spectrum antibiotics, and early source control. It is recommended that obstetrical care, including delivery timing, not be altered solely due to the diagnosis of sepsis.

No More ‘Us’ and ‘Them’

Teamwork is a crucial part of providing effective, safe maternity care. However, in contemporary UK practice, it seems it is not always effectively achieved. Most midwives will recognise the idea of trying to protect women and birthing people from their care becoming over-medicalised. Midwives protect and promote the physiology of pregnancy, birth and the postnatal period; that is our job. However it is also our job to ‘work cooperatively… respect(ing) the skills, expertise and contributions of your colleagues, referring matters to them when appropriate… to preserve the safety of those receiving care’.3 The failings described in the 2022 Kirkup report into maternity services in East Kent demand that we take effective teamwork seriously. We cannot afford to think in terms of ‘us’ and ‘them’, particularly regarding midwifery versus obstetric care.

Update on the Obstetric Anesthesia Practice in Flanders/Belgium: A 10-year follow-up survey and review

Background: With 75% of women receiving neuraxial anesthesia for labor and cesarean section (CS) in Flanders, Belgium, obstetric anesthesia is an essential part of perinatal care. Despite advancements in obstetric anesthesia and guidelines being updated regularly, past surveys have shown great variability among hospitals. Objective: This investigation aims to observe current obstetric anesthesia practices, compare them with previous surveys, and assess adherence to guidelines among anesthesiologists. Methods: An online questionnaire-based survey, approved by the KU Leuven Ethics Committee, was conducted focusing on three main topics: analgesia during labor, anesthesia for CS, and postoperative analgesia after CS. The survey, consisting of 127 questions, was distributed via email to the heads of anesthesia departments in 57 Flemish hospitals providing obstetric anesthesia care. Responses were anonymously analyzed. Results: For labor analgesia initiation, a conventional epidural with administration of ropivacaine 0.2% (+- sufentanil) remains the most widespread used technique, although Combined-Spinal Epidural (CSE) has gained significant popularity. Patient-controlled epidural analgesia (PCEA) in combination with continuous epidural infusion (CEI) is the preferred maintenance method, however programmed-intermittent bolus (PIEB) has found its way into standard practice. CSs are mostly done by performing CSE or single shot spinal, using hyperbaric bupivacaine 0.5% with sufentanil. Spinal-induced hypotension is treated with a combination of left lateral tilt, fluid administration and vasopressor administration, usually as a bolus. Post-CS pain is mainly treated by a combination of oral/ parenteral analgesics and neuraxial analgesia (PCEA +- CEI), with only a minority choosing regional techniques such as wound infiltration, transverse abdominal plane blocks, quadratus lumborum blocks, etc. Conclusion: Compared to previous surveys, the Flemish anesthesiologists adhere well to the latest guidelines and gold standards in obstetric anesthesia, consistently modernizing their practices. Nevertheless, with the continual introduction of novel techniques and methods, it is imperative for practitioners to maintain efforts in pursuing ongoing innovation.

O59 - Measuring maternal satisfaction with continuity models of midwifery care

O59 - Measuring maternal satisfaction with continuity models of midwifery care

O67 - Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care

O67 - Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care

A Professional Development Program in Management of Midwifery Emergencies for Midwifery Graduates.

Midwifery emergencies can be managed by providing effective and quality care through a skilled workforce. Improving the quality of midwifery care requires the professional development of midwives, especially those who are novice, to maintain their capabilities and enhance their performance. This study was designed to develop a professional development program in the management of midwifery emergencies for midwifery graduates. This mixed-method study was conducted in two phases. In the first phase, a qualitative study was conducted to investigate the program needs, facilitators, and barriers to the management of midwifery emergencies in midwifery graduates. Further, the initial version of the program was developed based on the results of the qualitative study and literature review. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used to develop a professional development program for the management of midwifery emergencies. The developed program was then evaluated and approved by a panel of experts. In the second phase, the developed professional development program is implemented, and its impacts are evaluated. Finally, the final professional development program in the management of midwifery emergencies for midwifery graduates is provided. In total, 2,360 primary codes were extracted and merged into 210 codes. After extracting the sub-categories and categories, a review of the texts was conducted, and the final program was developed. Using a professional development program for newly graduated midwives is an effort to improve the health of mothers and infants who receive these services.

O63 - Using women’s experiences of positive support from maternity clinicians to inform the future of midwifery care

O63 - Using women’s experiences of positive support from maternity clinicians to inform the future of midwifery care

Disparities in obstetric sepsis and strategies to prevent them

Severe morbidity and mortality associated with sepsis in obstetric care occur even among those presumed to be at low risk, are highly preventable and deserve critical public health prioritization. Continued research is warranted that focuses on the development and performance assessment of screening tools, standardizing diagnostic criteria, and understanding how to implement and sustain quality improvement practices to support timely recognition and treatment, as well as equitable healthcare practices to improve maternal outcomes across diverse populations

Hypertensive Disorders of Pregnancy in Saudi Arabia: Evaluating Maternal and Neonatal Risks, Outcomes, and Aspirin Prophylaxis: A Review Article.

Hypertensive disorders during pregnancy, including pre-eclampsia and eclampsia, pose significant risks to both maternal and neonatal health. This review article evaluates the prevalence, maternal and neonatal outcomes, and the efficacy of aspirin prophylaxis in managing these conditions in Saudi Arabia. Utilizing data from multiple retrospective studies and recent guidelines, we highlight the regional variations in the outcomes of hypertensive disorders of pregnancy. Severe complications such as Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome occurred in 6.6% of cases, while eclampsia was reported in 6.7% of cases. Cesarean sections were notably high, with rates reaching up to 79% among affected pregnancies. Maternal risk factors identified include chronic hypertension (prevalence 17%), diabetes (ranging from 10.4% to 26.3%), and advanced maternal age. Neonatal complications often involve preterm birth, reported in 26.5% to 26.7% of cases, intrauterine growth restriction (ranging from 15.7% to 25%), and increased NICU admissions, reported in 2.4% of cases. No data were found in the included studies to evaluate the prophylactic use of low-dose aspirin in reducing the incidence of pre-eclampsia or improving fetomaternal outcomes. Despite the effectiveness of aspirin, awareness and implementation of prophylaxis guidelines remain suboptimal among healthcare providers in Saudi Arabia. A national survey revealed that only a fraction of obstetrical care providers were fully knowledgeable about aspirin prophylaxis guidelines. This review underscores the necessity for enhanced educational programs and standardized guidelines to improve maternal and neonatal outcomes in hypertensive pregnancies within the region.

O71 - AMGP: Providing Continuity of Care for Western Australia’s Most Disadvantaged Women and Families, While Meeting their Complex Obstetric Care Needs

O71 - AMGP: Providing Continuity of Care for Western Australia’s Most Disadvantaged Women and Families, While Meeting their Complex Obstetric Care Needs

Sepsis in obstetric care for the emergency clinician: A review

Sepsis remains a leading cause of mortality among pregnant and recently pregnant patients, rendering it a subject of vital importance to emergency clinicians in the US. However, death by sepsis has been found to be largely preventable with prompt and appropriate intervention. This narrative review provides a summary of the physiologic, epidemiologic, and systemic factors specific to obstetric sepsis that contribute to delays in diagnosis and treatment. Additionally, it provides a framework for emergency department providers to approach infection identification, antimicrobial selection, and appropriate resuscitation prior to disposition.

Outcome Evaluation of an Integrated, Combined-care Perinatal Addiction Medicine- Primary Care Obstetrics Model for Urban, Inner-city Pregnant Patients With Severe Substance Use Disorders

ABSTRACT Objective: Programs for pregnant individuals with severe substance use disorders that combine addiction, obstetrical, and psychosocial care contribute to better neonatal and maternal outcomes. This research aims to describe patient demographics, retention in care, and maternal and neonatal outcomes associated with an integrated perinatal addiction program. Methods: Retrospective chart review of patients who received care in the Substance Use in Pregnancy (SUP) program at St Michael’s Hospital, Toronto, ON, Canada, between July 1, 2013, and December 31, 2019. Demographic information, as well as outcome measures, were collected for each mother-infant dyad. Descriptive statistics were used to describe study participants and maternal and neonatal outcomes. Results: A total of 121 pregnancies were included in the study. Most of the cohort was unemployed, single, and with unstable housing. Pregnant patients attended, on average, 10 prenatal visits (SD=7.8), and 77% of the cohort had a visit after delivery. Ninety-seven percent of the pregnant individuals completed prenatal screening. Sixty-one percent of infants required admission to the neonatal intensive care unit with an average length of stay of 14 days (SD=14.9). Nicotine (71%) and cannabis (50%) were the most used drugs at program enrolment, followed by opioids (41%), cocaine (34%) and alcohol (32%). The proportion of pregnant patients using substances was lower at delivery, compared with the first visit, except for fentanyl users. Conclusions: The SUP program yields positive maternal and neonatal outcomes associated with high rates of prenatal appointment attendance. Participation in this integrated, combined care program is associated with sustained retention in care for a highly marginalized patient population. Objectif: Les programmes destinés aux personnes enceintes souffrant de troubles sévères liés à l’utilisation de substances psychoactives qui combinent les soins en toxicomanie, obstétricaux et psychosociaux contribuent à de meilleurs résultats néonataux et maternels. Cette recherche vise à décrire les caractéristiques démographiques des patients la rétention dans les soins et les résultats maternels et néonataux associés à un programme intégré en toxicomanie périnatale. Méthodes: Examen rétrospectif des dossiers des patientes ayant reçu des soins dans le cadre du programme Substance Use in Pregnancy (SUP) à l’hôpital St Michael, Toronto, ON, Canada entre le 1er juillet 2013 et le 31 décembre 2019. Des données démographiques ainsi que des mesures de résultats ont été collectées pour chaque dyade mère-enfant. Des statistiques descriptives ont été utilisées pour décrire les participants à l'étude et les résultats maternels et néonataux. Résultats: Au total, 121 grossesses ont été incluses dans l'étude. La plupart des membres de la cohorte étaient sans emploi, célibataires et avaient un logement instable. Les patientes enceintes ont assisté en moyenne à 10 visites prénatales (écart-type=7,8) et 77% de la cohorte ont eu une visite après l’accouchement. 97% des femmes enceintes ont effectué un dépistage prénatal. 61% des nourrissons ont dû être admis dans une unité de soins intensifs néonataux, avec une durée moyenne de séjour de 14 jours (écart-type=14,9). La nicotine (71%) et le cannabis (50%) étaient les drogues les plus consommées au moment de l’inscription au programme, suivies des opioïdes (41%), de la cocaïne (34%) et de l’alcool (32%). La proportion de patientes enceintes consommant des substances était plus faible à l’accouchement qu'à la première visite, sauf pour les consommatrices de fentanyl. Conclusions: Le programme SUP produit des résultats maternels et néonataux positifs associés à des taux élevés d’assiduité aux rendez-vous prénataux. La participation à ce programme de soins intégrés et combinés est associée à une rétention durable des soins pour une population de patients très marginalisés.