Rate Of Vaginal Birth Research Articles

The effects of dance on maternal childbirth: a systematic review and meta-analysis

BackgroundPrevious guidelines have clearly stated that dance is safe and beneficial during pregnancy and for childbirth. However, due to the small sample size of individual studies and different interventions, there were inconsistencies about the effect of dance on maternal childbirth.MethodsWe included studies evaluating the effect of dance on women in labor. Risk of bias was assessed using the revised Risk of bias assessment tool for randomized controlled trials (RCTs). Data analyses was performed using Review Manager Software version 5.4.ResultsA total of 12 RCTs comprising 1,486 pregnant women were included in the analysis. We found that the rate of natural childbirth and satisfaction with delivery were higher in the dance group than in the control group.The pain at 30 min and at 60 min after the intervention were lower in the dance group than in the control group. Meanwhile, the duration of the first stage, the second stage and the total labor duration was shorter in the dance group than in the control group.However, there were no statistically significant differences in the pain at 90 min after intervention, the duration of the third stage, and the rate of the normal 1-minute Apgar scores > 7 points between the two groups.ConclusionsDance during labor could reduce labor pain to an extent, shorten the duration of labor, promote natural childbirth, and improve satisfaction with labor, with no adverse effects on neonatal outcomes.Trial registrationThe protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001.

Benefits of yoga in pregnancy: a randomised controlled clinical trial.

Modern obstetrics confronts a rise in caesarean sections (CS). Prevention of unnecessary primary CS is a global priority. Women face intense psychological and physiological challenges during childbirth. Fear and anxiety during labour reduce women's self-confidence and empowerment. Yoga is a body-mind practice that lowers maternal fear and anxiety and helps relax pelvic floor muscles during labour. The study examined whether yoga practice in pregnancy influences CS rate in primiparous singleton pregnant women, labour pain intensity and epidural analgesia requests at delivery ward admission. We conducted a single-blind, randomised, controlled clinical trial comparing yoga to standard obstetric care in pregnancy. A total of 214 participants were randomised, 106 in yoga and 108 in controls. Weekly 90-min yoga classes were led by a certified yoga teacher's supervision. Every pregnant woman in the interventional group completed 12 yoga sessions. Yoga group had a lower total CS due to less frequent In-labour CS (p=0.004) and a higher rate of spontaneous vaginal birth (p=0.009). They experienced less pain intensity during labour (p<0.001), and there was no difference in epidural analgesia requests. Engaging in yoga during pregnancy reduces the rate of In-labour CS, decreases discomfort and encourages spontaneous vaginal birth in primiparous singleton pregnant women.

The Need for a Public Health Approach to Childbirth Rate: A Critical Study from Japan

The Article Abstract is not available.

Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner.

Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner. This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. 31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician's care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35-42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section-especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative.

Transdermal contraception and quality of life

Analysis of the current demographic situation in Ukraine in recent years indicates the presence of a deep demographic crisis on the background of social and economic problems and the military-political situation. In such conditions, one of the aspects of the country’s effective demographic policy should be the improvement of women’s reproductive health which depends on the abortion rate.In Ukraine the frequency of abortions has decreased significantly in recent years and today it is 4.6 per 1,000 women of fertile age, while the rate of childbirth exceeds the rate of abortions. Such outcome is the result of the effective use of modern family planning methods, including hormonal contraception. The patch which contains norelgestromin and ethinyl estradiol is the only contraceptive in Europe with transdermal hormone administration. With its use it is possible to ensure a constant level of ethinyl estradiol and norelgestromin in a woman’s blood without peaks and troughs by passing the digestive tract.The objective: to compare the impact on the quality of life of women, as well as the effectiveness, safety and convenience of using a patch containing norelgestromin and ethinylestradiol with a combined oral contraceptive in women of reproductive age.Materials and methods. 266 women of reproductive age who needed reliable contraception and used various modern hormonal methods of contraception were followed up through 2022.The women were divided into the following clinical groups: I group (main group; n=133) – healthy women of fertile age who used a transdermal hormonal system containing norelgestromin 6.0 mg, ethinyl estradiol 0.60 mg for the contraception; II group (comparison group; n=133) – healthy women of fertile age who used a combined oral contraceptive (ethinyl estradiol 0.02 mg and drospirenone 3 mg in a 24+4 regimen) for the contraception.Evaluation of efficiency, safety, convenience was carried out according to the Perl index, data from the FSFI questionnaire (Female sexual function index), the SF-36 quality of life scale.Results. The results demonstrated that hormonal patch, which contains norelgestromin and ethinyl estradiol, is a highly effective contraceptive drug and does not affect the parameters of hormonal and non-hormonal homeostasis, and is well tolerated by women.During the study the use of transdermal contraception in women of reproductive age prevented unplanned pregnancy in 100 % of cases. Evaluating the convenience of the contraceptive method on a five-point scale, women who used the hormonal patch have estimated the convenience with an average score of 4.98±0.02 points; in the group of women who used combined oral contraceptives, the result of convenience was significantly lower: the average score was 4.3±0.03 points (p&lt;0.05).The transdermal form of the contraceptive avoids the effect of “first passage” through the liver, as a result, women who used transdermal contraception had 3.5 times less complications of the digestive tract.Conclusions. Hormonal patch containing norelgestromin and ethinylestradiol is a modern, easy-to-use and reliable method of hormonal contraception for women of reproductive age. It allows you to avoid the effect of “first passage” through the liver, complications of the digestive tract and thrombosis.The constant level of ethinyl estradiol and norelgestromin in a woman’s blood, which this patch provides, makes it possible to improve the psycho-emotional state, increase libido and positively affects the quality of life of women of reproductive age.

A Prospective Evaluation of Health Literacy Levels of Pregnant Women in Antenatal Classes: Impact on Delivery Outcomes in Nulliparous and Multiparous Women.

Backgrounds/Objectives: Modern technology and educational activities, such as antenatal classes (ACs), increase patient informedness in medicine and improve collaboration between physicians and patients. The present study aimed to evaluate and compare the impact of maternal health literacy (HL) on delivery outcomes between nulliparous and multiparous women who attended antenatal classes. Methods: This prospective study recruited 281 pregnant women who regularly attended ACs, but only 188 who gave birth at our academic tertiary hospital were included in the final analysis. Socio-demographic characteristics, peripartum data (cervical dilatation at the time of admission to the hospital, duration of labor, and mode of delivery), and obstetric interventions (cesarean section (C/S) rate and rate of instrumental vaginal birth and episiotomy) were recorded, and the level of HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HL levels did not significantly affect peripartum and postpartum outcomes. Results: The study results showed that HL levels did not impact labor duration and newborn Apgar scores (p > 0.05). Patient education levels and employment status affected the peripartum duration of labor (p = 0.048 and p = 0.001, respectively). There were no differences in the HL total score and subscale scores (p > 0.05) between nulliparous and multiparous patients, and the rate of primary C/S was similar in both groups. Conclusions: HL levels did not impact delivery (peripartum) outcomes in pregnant women who attended antenatal classes. However, the primary C/S rate was similar between the nulliparous and multiparous groups, which may indicate that antenatal education services can correct the negative impact of low HL levels on the primary C/S rate.

How does place impact intrapartum practice for midwives and obstetricians?

BackgroundRising rates of labour and birth interventions are causing concern, having the potential to cause harm if used inappropriately. International evidence demonstrates that place itself influences birth outcomes, but evidence is limited as to how. In New Zealand there are differences in the rates of spontaneous vaginal births by place, along with differences when benchmarking uncomplicated primiparae birthing in hospital maternity facilities throughout the country. AimTo develop understanding of how place influenced midwives’ and obstetricians’ practice in relation to supporting physiological birth. MethodFor this Hermeneutic Phenomenological study participants were purposively selected and consisted of nine midwives (employed and self-employed) and three obstetricians, all practising in midwifery led units or hospital maternity facilities. Data was collected using semi-structured interviews. The method of analysis involved writing and rewriting to surface interpretive insights, drawing on philosophical notions from Heidegger and Gadamer. FindingsThe findings revealed that place influences what practitioners are attuned to, what is easier for them to achieve, and their ability to provide woman-centred care. Competing tensions and pressures within place can blur the perceived relationship between normality and risk, influencing what is considered to be safe. SummaryPlace is not neutral; it influences how midwives and obstetricians practise and shapes how they support physiological labour and birth. The findings of this research contribute to a deeper understanding of the barriers and enablers to supporting physiological birth within place.

A double-blind, randomized, placebo-controlled trial of melatonin as an adjuvant agent for induction of labor: TheMILO trial.

Melatonin has been suggested to have a biological role in the onset and progress of labor. We tested the hypothesis that the addition of melatonin during an induction of labor will reduce the need for a cesarean birth. This trial underwent protocol amendments that are detailed in the main text of the article. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12616000311459). At a multi-center health service including secondary and tertiary obstetric hospitals, we performed a randomized, double-blind, placebo-controlled trial in women with a singleton cephalic pregnancy, free of significant maternal or perinatal complications who were undergoing induction of labor (with or without cervical ripening). Women were randomized to 10 mg melatonin vs placebo, with cervical ripening as required, and then 6-h during their induction of labor to a maximum of four doses or until birth. The primary outcome was cesarean birth. Secondary outcomes included labor, maternal, and neonatal outcomes. Data were analyzed using intention to treat. Sub-group analyses based on mode of ripening and parity were also performed. Between 2019 and 2021 we randomized 189 women (103 to melatonin and 86 to placebo). The study was prematurely terminated due to logistical complications resulting from the COVID-19 pandemic. Cesarean rates were 28/103 (27.2%) in the melatonin group vs 20/84 (23.3%) in the placebo group (RR 1.17 95% CI 0.71-1.92). There were no significant differences in rate of cesarean birth between the melatonin and placebo groups for failure to progress (13.4% and 9.3%, respectively, RR 1.46; 95% CI 0.64-3.32) or suspected fetal distress (10.7% and 10.5%, respectively, RR 1.02; 95% CI 0.44-2.34). The melatonin group had significantly lower rates of spontaneous vaginal birth within 24 h (35.0% vs. 50.0%; RR 0.70 95% CI 0.50-0.98). The rates of secondary outcomes such as total length of labor, rate of postpartum hemorrhage, and instrumental birth were comparable. Babies born in the melatonin group were more likely to need admission to the special care nursery, namely for hypoglycemic monitoring (18.5% vs. 8.1% RR 2.26; 95% CI 1.00-5.10). In women undergoing induction of labor, melatonin does not reduce the cesarean section rate. Melatonin use intrapartum may also be associated with neonatal hypoglycemia.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Predicting Whelping Day with Early Pregnancy Ultrasonography and Induction of Parturition using Mifepristone on the Expected Delivery Date in Bitches

Background: Inducing whelping in canines is becoming an accepted practice in obstetrical management to ensure safe pregnancy outcomes, although pinpointing the exact day for induction poses challenges. The precise timing of delivery is vital for foetal survival, as the placenta¢s nutrient supply cannot sustain the foetus beyond the expected delivery date (EDD). Additionally, completing the full gestation term is crucial for comprehensive organ development, especially for the maturation of the lungs. Methods: The present retrospective observational study was aimed to evaluate the accuracy of whelping day prediction by early pregnancy ultrasonography and to propose a viable whelping induction protocol with mifepristone on the EDD to improve the overall reproductive efficiency in canines. Result: Among 115 pregnancies in Group I, 69.57 % whelped exactly on the predicted day (±0), 93.04% whelped within ±1 day and 100% within ±2 days. In Group II, among 124 pregnancies 69.35% whelped on or before the EDD. Of the 38 bitches that did not whelp by the evening of EDD and which were given two doses of mifepristone, 73.68% whelped within 24 h. An additional 4 of the remaining 10 bitches whelped within 36 hours, resulting in an overall whelping induction response of 84.21 % and a cumulative vaginal birth rate of 95.16%. Six bitches (4.84%) required a caesarean section (CS) 36 h post-induction. The percentages of normal whelping, dystocia and CS varied significantly across Groups I, II and III, with Group II showing a significant reduction in dystocia and caesareans, supporting the hypothesis of inducing whelping with mifepristone on the prediction day to have more vaginal births. The percentage of animals that had CS in Groups I, II and III were 14.78, 4.84 and 56.67, respectively. The perinatal mortality rates were 14.83%, 10.47% and 25.15% in Groups I, II and III, respectively, with Group II showing significantly better puppy survivability.

Marital status after colorectal surgery in familial adenomatous polyposis: a nationwide multicenter study in Japan.

Patients with familial adenomatous polyposis (FAP) experience psychological and social challenges concerning future events such as marriage and childbirth alongside the medical risks of colorectal cancer (CRC) and FAP-related disease. We retrospectively investigated the rate of marriage and childbirth postoperatively in Japanese patients with FAP. We included 161 patients who had colorectal surgery and reported marital status from a national survey of 35 Japanese institutions. Participants were classified according to marital status: married before colectomy (80 patients), married after colectomy (13 patients), and unmarried (68 patients). The marriage rate for all 161 patients (57.8%, standardized ratio 0.95, 95% confidence interval [CI] 0.76-1.14) was comparable to that in the general Japanese population (57.1%). The marriage rate among the 81 patients who were unmarried before colectomy was low (16.0%); however, the standardized marital ratio (0.75, 95% CI 0.34-1.15) was not significantly lower than that of the general population. In multivariable logistic regression, younger age (born after 1980, odds ratio [OR] 0.12, p < 0.001) and genetic testing (OR 4.06, p = 0.001) were associated with postoperative marriage. Seventy-one percent of patients with FAP who married after colectomy became pregnant and achieved delivery. The marriage rate of patients with FAP was comparable to that of the general population whereas the rate after colectomy was low among patients with FAP. However, in patients with FAP, colorectal surgery itself may not lead to negative consequences in terms of fecundity.

Antenatal education incorporating complementary medicine techniques for labour and birth to reduce the rates of epidural in primiparous women: A randomised control trial

ProblemGlobally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions. BackgroundThere are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women. AimTo reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour. MethodsLow to moderate risk primiparous women were randomised at 24–36 weeks’ gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280 FindingsIn total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001). DiscussionHigher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth. ConclusionsReplicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.

Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study.

Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression. Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery. In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.

Vaginal dinoprostone vs Foley catheter for induction of labor at term with an unfavorable cervix: an open-label randomized controlled trial

BackgroundInduction of labor (IOL) with mechanical methods or pharmacological agents is used in about 20% to 30% of all pregnant women. We specialized in comparing the effectiveness and safety of dinoprostone vs transcervical Foley catheter for IOL in term pregnant women with an unfavorable cervix with adequate samples. ObjectiveTo compare the effectiveness and safety of dinoprostone vs transcervical Foley catheter for IOL in term pregnant women with an unfavorable cervix. Study DesignThis is a parallel, open-label randomized controlled trial in two maternal centers in Shanghai, China between October 2019 and July 2022. Women with a singleton pregnancy in cephalic presentation at term and an unfavorable cervix (Bishop score <6) scheduled for IOL were eligible. A total of 1860 women were randomly allocated to cervical ripening with either a dinoprostone vaginal insert (10 mg) or a 60 cc Foley catheter for up to 24 hours. The primary outcomes were vaginal delivery rate and time to vaginal delivery. Secondary outcomes included time to delivery and maternal and neonatal morbidity. Analysis was done from an intention-to-treat perspective. The trial was registered with the China trial registry (CTR2000038435). ResultsThe vaginal birth rates were 72.8% (677/930) vs 69.9% (650/930) in vaginal dinoprostone and Foley catheter, respectively (aRR 1.04, 95% confidence interval [CI] 0.98-1.10, risk difference: 0.03). Time to vaginal delivery was not significantly different between the two groups (sub-distribution hazard ratio 1.11, 95% CI 0.99-1.24). Vaginal dinoprostone was more likely complicated with hyperstimulation with fetal heart rate changes (5.8% vs 2.8%, aRR 2.09, 95% CI 1.32-3.31) and placenta abruption (0.9% vs 0.1%, aRR: 8.04, 95% CI 1.01-64.15), while Foley catheter was more likely complicated with suspected intrapartum infection (5.1% vs 8.2%, aRR: 0.62, 95% CI 0.44-0.88) and postpartum infection (1.4% vs 3.7%, aRR: 0.38, 95% CI 0.20-0.72). The composite of poor neonatal outcomes was not significantly different between the two groups (4.5% vs 3.8%, aRR 1.21, 95% CI 0.78-1.88), while more neonatal asphyxia occurred in the dinoprostone group (1.2% vs 0.2%, aRR 5.39, 95% CI 1.22-23.92). In a subgroup analysis, vaginal dinoprostone decreased vaginal birth rate slightly in multiparous women (90.6% vs 97.0%, aRR 0.93, 95% CI 0.88-0.99). ConclusionsIn term pregnant women with an unfavorable cervix, IOL with vaginal dinoprostone or Foley catheter has similar effectiveness. Foley catheter leads to better safety for neonates, while it may result in a higher risk of maternal infection. Furthermore, Foley catheter should be preferred in multiparous women.

The effect of pregnancy pilates-assisted childbirth preparation training on urinary incontinence and birth outcomes: a randomized-controlled study

PurposeTo examine the effect of pregnancy pilates-assisted birth preparation training on urinary incontinence (UI) including stress urinary incontinence (SUI) and urge urinary incontinence (UUI) during pregnancy, and the postpartum period and birth outcomes.MethodIn this single-center, single-blind, randomized, controlled study, 126 participants who have 28–30 weeks of gestation and nulliparous were randomly assigned to receive either the (n = 63) or control group (n = 63). The study was carried out between March and August 2022. Pregnancy pilates intervention was applied twice in a week, a total of 8 weeks to pilates group. The control group was given routine obstetric and pregnancy care. A personal data form and the Michigan Incontinence Severity Index Form (M-ISI) were used as data collection tools.ResultsThe mean weight gains of the experimental group during pregnancy were significantly lower than the control group. The experimental group had almost twice the rate of vaginal birth than those of the control group. The duration of labor mean score of experimental group was 5 h and 43 min less than the duration of labor of the control group (p < 0.001). After intervention, and postpartum period, the SUI and UUI severity of the experimental group was significantly lower than those of the control group (p < 0.001).ConclusionPilates-assisted childbirth preparation training reduced the severity of UI including SUI and UUI symptoms during pregnancy and the early postpartum. In addition, pilates-assisted childbirth preparation training contributes to decrease in weight gain during pregnancy, the increase in the vaginal birth rate, and the shortening of the duration of labor.Trial registrationNCT06185439

Maternal Morbidity following Trial of Labor after Cesarean in Women Experiencing Antepartum Fetal Death

This study aims to investigate whether trial of labor after cesarean delivery (TOLAC) in women with antepartum fetal death, is associated with an elevated risk of maternal morbidity. A retrospective multicenter. TOLAC of singleton pregnancies following a single low-segment incision were included. Maternal adverse outcomes were compared between women with antepartum fetal death and women with a viable fetus. Controls were matched with cases in a 1:4 ratio based on their previous vaginal births and induction of labor rates. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 181 women experienced antepartum fetal death and were matched with 724 women with viable fetuses. Univariate analysis revealed that women with antepartum fetal death had significantly lower rates of TOLAC failure (4.4% vs. 25.1%, p < 0.01), but similar rates of composite adverse maternal outcomes (6.1% vs. 8.0%, p = 0.38) and uterine rupture (0.6% vs. 0.3%, p = 0.56). Multivariable analyses controlling for confounders showed that an antepartum fetal death vs. live birth isn't associated with the composite adverse maternal outcomes (aOR 0.96, 95% CI 0.21–4.44, p = 0.95). TOLAC in women with antepartum fetal death is not associated with an increased risk of adverse maternal outcomes while showing high rates of successful vaginal birth after cesarean (VBAC).

Patterns of peasant way of life in Tobolsk province in the second half of the XIXth century (on the materials of N.N. Mataev’s personal archive)

The goal of the research is to analyze the specifics of the everyday life of old-timer peasants of Tobolsk province on the basis of information collected during ethnographic fieldwork in the Tyumen region. On the basis of the involved narrative sources, such as personal diaries, memoirs, biographies and retelling of ancestral memories of the hereditary peasant N.N. Mataev, marital behavior, child-parent relations, interaction between family members in and out of the home lifehave been studied, the level of child mortality and birth rate have been analyzed, and the cultural specifics of everyday life of several generations of one family have been revealed. The collected records in the form of interviews, diaries and memoirs refer to the end of the 19th century and the beginning of the 20th century, i.e. to the period of active changes and transformations in the way of life of the peasant village in Russia, which determines the relevance of the research, because a thorough study of the identity of the Siberian sub-ethnos allows us to find differences in the consequences of these transformations and understand the history of Western Siberia. The principle of historicism and the civilizational approach applied allow us to observe the stages of development of new forms of family structure and the transformation of peasant life as a result of modernization. The studied ethnographic materials allow to present more fully the picture of peasant everyday life and to draw conclusions about the specific features of the life cycle of the traditional patriarchal peasant family and the community of old residents of Tobolsk province.

Rate, Precautions, and Outcome of Vaginal Birth after Caesarean Section in Beni-Suef Governorate

Rate, Precautions, and Outcome of Vaginal Birth after Caesarean Section in Beni-Suef Governorate

ASSESSMENT OF HEALTH-RELEVANT QUALITY OF LIFE IN THE CONTEXT OF THE MEDICAL AND SOCIAL PROFILE OF WOMEN WITH COMPLICATED PREGNANCIES

In modern Russia, there is a decline in the birth rate, a decline in women's reproductive health, and a high rate of complicated pregnancy and childbirth. The causes of unfavorable course and outcome of pregnancy are multifactorial. The contribution of medical factors to the course of the gestational process and the condition of the newborn is often not determinant in the course and outcome of pregnancy. One of the factors influencing the course of pregnancy is health-relevant quality of life. The aim of the study was to analyze the influence of certain characteristics of the medical and social profile on the health-relevant quality of life of pregnant women with complicated pregnancy. Materials and Methods. 153 pregnant women with complicated pregnancy were included in the study. Cohort one-stage sociological study of quality of life was realized by questionnaire survey method. The study of health-relevant quality of life of pregnant women with complicated pregnancy was conducted using the WHOQOL-100 questionnaire (WHO QOL-100). Results. When assessing the quality of life of pregnant women, there is a decrease in the average values of quality of life indicators in the spheres and subspheres of the questionnaire, determined by the somatic condition of respondents. A statistically significant dependence of the decrease in the mean values of the quality of life indicators of respondents in the age group of 30-39 years compared to respondents aged 20-29 years has been established. The evidence of the influence of the level of education on the quality of life of women with pathologic course of pregnancy is presented. In a comparative analysis of the quality of life of respondents whose professional activity is not associated with physical exertion and respondents who perform physical labor of varying degrees of severity, the greatest decrease in the average quality of life indicators is noted in the group of respondents engaged in heavy physical labor. There are higher quality of life indicators of respondents who are officially married. Conclusions. The conducted study provides evidence of somatic and social determinacy of health-relevant quality of life in pregnant women with complicated pregnancy. The established limitations of the quality of life allow objectifying personalized medical and social assistance to pregnant women, aimed at improving their quality of life and pregnancy outcome.

Passive second stage of labor: Does a fourth hour increase maternal morbidity in nulliparous patients at term with epidural?

ObjectivesProlonging the passive second stage of labor could increase vaginal birth rate, but the data concerning maternal and fetal morbidity are contradictory. The French guidelines did not specify a maximum duration of the passive second stage. Our objective was to assess if allowing a 4th hour after full dilatation before pushing increased maternal morbidity, compared to 3 h after full dilatation. Study designThis single-center, retrospective, observational cohort study took place from January 1–December 31, 2020, in a tertiary maternity unit. All consecutive term nulliparous women who delivered under epidural anesthesia and without pathological fetal heart rate and reaching a second-stage passive phase of labor lasting at least 3 h were included. We compared 2 groups according to the duration of the passive second stage: “3-hour group” and “4-hour group”. In the "3-hour group," featuring a second-stage passive phase of up to 3 h, pushing is initiated for favorable conditions, while a cesarean section is performed if conditions are deemed unfavorable. In the "4-hour group", obstetric conditions not justifying immediate pushing after three hours, and the obstetric team believed that an additional hour of expectant management could lead to a successful vaginal delivery. The principal endpoint was a composite criterion of maternal morbidity including obstetric anal sphincter injuries, postpartum hemorrhage, transfusion and intrauterine infection. ResultsWe included 111 patients in the “4-hour group” and 349 in the “3-hour group”. Composite maternal morbidity did not increase in the “4-hour group” compared to the “3-hour group” (21 (18.9 %) versus 61 (17.5 %); p = 0.73). Neonatal morbidity was similar between the two groups. In the “4-hour group, 91 (82 %) patients had vaginal deliveries”, 62 (55,9 %) by spontaneous vaginal delivery and 29 (26,1 %) with instrumental assistance. ConclusionFor selected patients, waiting for 4 h at full dilation can be beneficial due to the high rate of vaginal delivery and low incidence of maternal and fetal complications.