Labor progression is traditionally considered linear; however, recent evidence highlights natural variations, including pauses or plateaus in contraction intensity or cervical dilation. Recognizing these variations is crucial, as a lack of clear distinction between physiological and pathological plateaus often leads to unnecessary interventions with potential short- and long-term consequences. This scoping review aims to map and summarize the characteristics, differences and management strategies of physiological and pathological labor plateaus in low-risk women. This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR). Eligibility criteria included studies on physiological term pregnancies detailing labor plateau characteristics or management strategies. We searched five databases (MEDLINE, CINAHL, Embase, Scopus, CENTRAL), relevant gray literature, and reference lists of included studies, without restrictions on time, geography, or setting. Two reviewers independently screened abstracts and full-text articles for inclusion. Data were synthesized narratively and summarized in tables. We included 35 studies. Definitions of labor plateaus varied widely. Factors contributing to labor plateaus were categorized into modifiable and non-modifiable factors. Management strategies ranged from non-invasive approaches such as emotional support and hydration to invasive interventions like amniotomy and oxytocin administration. Current literature does not clearly distinguish between physiological and pathological labor plateaus. Standardized definitions and management protocols are needed to improve clinical outcomes. Recognizing the potential for physiological progression during plateaus may help balance timely interventions with the benefits of supporting natural labor processes.

There is a paucity of uterine oxytocin receptors during preterm gestation. Whether this affects the requirement of oxytocin dose for uterine contraction in patients with preterm gestation is not researched. We compared effective dose in 90% of target population (ED90) of oxytocin infusion for satisfactory uterine tone during cesarean delivery in patients with preterm and term pregnancy. This biased coin sequential allocation, dose finding study, with triple blinding to dose allocation included nonlaboring women >18 years posted for cesarean delivery under spinal block, into either term or preterm group (n = 30 each; completed or <37-week gestation, respectively). Oxytocin infusion was initiated at 13 IU·h-1 in the first patient in both groups. Dose in subsequent cases was determined by response to oxytocin in previous patient of a particular group (dosing interval = 2 IU·h-1). Uterine tone was assessed using the one-finger palpation method by the surgeon. Myometrial oxytocin receptor expression was also evaluated on tissue obtained during surgery, using immunohistochemistry (IHC). The ED90 of oxytocin infusion to prevent intraoperative uterine atony was 1.5 times greater in the preterm group (25.7 IU·h-1 [95% confidence interval {CI}, 16.4-35.1]) as compared to the term group (16.2 IU·h-1 [95% CI, 14.8-17.7]). Intraoperative oxytocin amount was significantly greater (14.3 [11.7-17.5] vs 12.8 [10.4-14.7] IU; P = .048), and the need of additional uterotonic was clinically higher (16% vs 10%; effect size = 0.5 [95% CI, 0.1-2.5]; P = .448) for the preterm group. IHC showed increased oxytocin receptor expression for term versus preterm group (P = .040). Incidence of oxytocin-associated hypotension was greater for preterm group (50% vs 13%; P = .002). During cesarean delivery, oxytocin requirement is almost 1.5 times greater for preterm as compared to term pregnancy. This was supported by decreased expression of the myometrial oxytocin receptor upon IHC.

Data are conflicting regarding whether pregnancy influences disease progression in women with autosomal dominant polycystic kidney disease (ADPKD). This study examined whether pregnancy or number of pregnancies were associated with kidney disease progression in women with ADPKD. Women with early- (Study A) and late-stage (Study B) ADPKD from the Halt the Progression of Polycystic Kidney Disease (HALT-PKD) trials were included to examine the association between self-reported number of pregnancies (categorical predictor: no pregnancy vs. 1-2 pregnancies and ≥3 pregnancies), annual slope of estimated glomerular filtration rate (eGFR), annual percent change in total kidney volume (%ΔTKV) and a composite outcome (kidney failure, 50% decline in eGFR, or death) using multivariable linear regression and Cox proportional hazard models. Additionally, women who became pregnant, had full-term pregnancies, and available data during study participation (n=13) were propensity matched (1:4) to women who were not pregnant during study participation, and a mixed model was applied to determine the association of pregnancy with eGFR slope and %ΔTKV. Across all analyses, 455 women with a median age of 45 (IQR: 38-50) years and eGFR of 69+25 ml/min/1.73m2 at baseline were included. 199 women had 1-2 pregnancies and 165 women had ≥3 pregnancies. There was no association of 1-2 pregnancies or ≥3 pregnancies (vs. no pregnancies) with eGFR slope (Beta-estimate [95% Confidence interval]; 1-2 pregnancies: 0.22 [-0.44,0.89]; ≥3 pregnancies: -0.46 [-1.16, 0.25]), %ΔTKV (Beta-estimate [95% CI]; 1-2 pregnancies: 0.92 [-0.34, 2.17]; ≥3 pregnancies: 0.69 [-0.67, 2.04]), or time to composite outcome (Hazard ratio [95% CI]; 1-2 pregnancies: 1.04 [0.56, 1.93]; ≥3 pregnancies: 1.48 [0.78, 2.77]) in adjusted models. Moreover, there was no difference in annual eGFR slope (Beta-estimate:-0.14 [95% CI: -2.72, 2.44]) and %ΔTKV (Beta-estimate:0.04 [95% CI: -3.74, 3.82]) in women who became pregnant during HALT matched to women who did not became pregnant during HALT. Pregnancy was not associated with ADPKD progression among women with early and late-stage ADPKD enrolled in the HALT-PKD trials.

Unstable fetal lie, characterized by frequent changes in fetal presentation during late pregnancy, poses challenges in pregnancy management and delivery planning. We aimed to examine the obstetrical and neonatal outcomes associated with term pregnancies complicated by an unstable fetal lie. This retrospective cohort study included data recorded during 2012-2022 of women with term singleton pregnancies with an unstable fetal lie who attempted vaginal delivery after stabilizing to vertex. We compared their obstetrical and neonatal outcomes in a 1:2 ratio to those of women without a history of unstable fetal lie who had a singleton fetus in vertex presentation at delivery. Of 67,360 deliveries, 174 (0.25%) were with an unstable fetal lie. For women who attempted vaginal delivery (n = 116, 66.7%) compared to women with spontaneous vertex presentation who delivered vaginally (n = 232), the intrapartum cesarean delivery (CD) rate was higher (31.0% vs. 10.3%, p < 0.001). Also higher were the CD rates attributed to fetal distress (12.9% vs. 6.0%, p = 0.038) and labor dystocia (11.2% vs. 4.7%, p = 0.041), and the nuchal cord incidence rate (17.2% vs. 5.6%, p < 0.001). Multivariate logistic regression identified unstable fetal lie as an independent risk factor for emergent CD (OR 4.1, 95% CI 2.1-8.2, p < 0.001). Birth trauma, cord prolapse, and perinatal death were not reported. Vaginal delivery attempts in women with an unstable fetal lie did not show similar progression of labor and obstetrical outcomes as spontaneous vertex presentation. This emphasizes the need for tailored management.

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are related neurovascular conditions, with pregnancy as a shared risk factor. In this study, we aimed to describe shared and distinctive risk factors and outcomes in patients with pregnancy-associated PRES and/or RCVS. In this retrospective, nationwide, population-based cohort study, the national healthcare registers were utilized to identify women with PRES and/or RCVS during pregnancy or puerperium during 1987-2016. Subsequent pregnancies, vascular events, and deaths until 2022 were identified. Medical records were reviewed to classify cerebrovascular events and collect clinical details. In total, 27 patients had pregnancy-associated PRES and/or RCVS (18 PRES; 5 PRES + RCVS; 4 RCVS) during 1987-2016, resulting in an incidence of 1.52 per 100,000 (95% Cl 1.02-2.18) deliveries. All patients with PRES ± RCVS had preeclampsia with severe features during late pregnancy or early puerperium. In contrast, isolated RCVS showed a weaker association to preeclampsia and occurred in late puerperium, with a median puerperal day of 26 (IQR 11-45). Altogether, 40.7% of all patients had a stroke, 90.9% of which were hemorrhagic. Preeclampsia was diagnosed in 90.9% of stroke patients. Maternal mortality was 3.7%, whereas perinatal mortality was 7.4%. At 3 months, 92.3% had a good recovery (mRS 0-2). During follow-up, stroke recurrence was 3.7% and 33.3% had subsequent uneventful, full-term pregnancies. Pregnancy-associated PRES and RCVS are potentially life-threatening, rare conditions that can result in hemorrhagic stroke. PRES ± RCVS is strongly associated with preeclampsia with severe features, whereas puerperal RCVS seems to be a separate, later-occurring condition.

The objective of the study was to develop a predictive model for spontaneous onset of labor between 39 and 41 weeks' gestation using clinical, ultrasound and biochemical features. We conducted a multicenter, prospective, observational study in two university hospitals in Switzerland. Women with singleton pregnancies in cephalic presentation and intact membranes who opted for expectant management until late term were eligible for the study. Predictors collected at 39 weeks included maternal characteristics, cervical ultrasound measurements and biochemical markers. Competing risks survival regression models were developed, and predictive performance was assessed using time-dependent, receiver operating characteristic curves, calibration plots, and the Brier score. The main outcome measure was spontaneous onset of labor or prelabor rupture of membranes occurring before 41 weeks' gestation. A total of 429 women were recruited. Main outcome occurred in 72.0% of participants. Fourteen percent of women underwent labor induction at or beyond 41 weeks and another 14.0% required earlier induction for medical reasons. The final predictive model included maternal age, body mass index, prior vaginal delivery, cervical length, and a positive fetal fibronectin test. The model showed an area under the curve of 0.71-0.72 and good calibration. Using a dual cutoff approach to predict spontaneous labor or prelabor rupture of membranes within 7 days, participants were classified into three groups: 12.5% in a low-probability group (predicted probability ≤14.9%), 74.7% in an intermediate group (14.9%-56.8%), and 12.8% in a high-probability group (>56.8%). The model provides individualized probability estimates for spontaneous labor onset and may support shared decision-making in term pregnancies. Predictive accuracy was moderate, but good calibration suggested clinical utility.

To improve exclusive breastfeeding, we must resolve challenges for mothers and babies. This study aims to determine the maternal factors contributing to failure of exclusive breastfeeding. This cross-sectional study was conducted in all infants who had attended the healthcare centers for their first 6‑month vaccinations from 2019 to 2021 in Babol, Iran. Maternal factors were collected using achecklist, including demographic, social, and midwifery information. Failure of exclusive breastfeeding was defined as using anything other than breast milk, such as pacifiers, bottles, sugar water, or complementary feeding for infants during the first 6months of life. Binary logistic analysis examined the influence of predictor variables on exclusive breastfeeding. The significance level was set at P < 0.05. Out of the 1400 infants, at the end of the study, 413 (29.5%) were exclusively breastfed. Multivariate regression showed education level (odds ratio [OR]: 1.42, P = 0.003) and urban residence (OR: 1.89, P < 0.001) to be associated with increased discontinuation, while term pregnancy (OR: 0.47, P = 0.008) served as apreventive factor. Breastfeeding education (OR: 6.7, P = 0.067) and breast problems (OR: 6.4, P = 0.082) had asixfold effect on the decrease and increase of discontinuation of exclusive breastfeeding, respectively, although this relationship was not statistically significant. This study showed that preterm delivery, higher education, and living in an urban area can increase the probability of failure of exclusive breastfeeding. These findings provide valuable insights for healthcare professionals and policymakers promoting and supporting exclusive breastfeeding.

Background/Objectives: Preterm birth (PTB) is a major public health concern worldwide, which may lead to detrimental maternal and neonatal outcomes. Maternal nutritional status, gestational weight gain (GWG), and lifestyle factors are potentially modifiable determinants of adverse pregnancy outcomes. This study examined the association between PTB and maternal GWG and assessed whether maternal dietary habits and lifestyle factors were related to GWG in women delivering preterm versus at term. Methods: A retrospective case–control study was conducted at a tertiary center in Hungary (MANOR Study, 2019). The case group included n = 100 women with PTB, while n = 200 matched term deliveries served as controls (1:2 ratio). Data were collected using a self-administered questionnaire and medical records. Pre-pregnancy body mass index (BMI) was categorized using standard definitions, while GWG was classified as inadequate, recommended, or excessive according to the US 2009 Institute of Medicine guidelines. A 7-item dietary index score was calculated based on gestational dietary habits. Results: Pre-pregnancy BMI distribution did not considerably differ between groups (p > 0.05); over one-third of women in both groups were overweight or had obesity (38.7% vs. 36.7%). Previous PTB (p < 0.001) and gestational hypertension (GHT) (p = 0.003) were more common among current PTB cases, while smoking, alcohol consumption, and gestational diabetes mellitus (GDM) showed negligible differences (p > 0.05)—28.0% of cases, and 34.5% of controls were classified as having healthy dietary habits, based on the dietary index score calculated. Inadequate GWG was more prevalent among PTB cases (49.0% vs. 26.8%), whereas excessive GWG was less frequent among cases (21.9% vs. 38.4%). Being within the recommended GWG range and the manifestation of gestational hypertension were associated with lower (aOR: 0.39; 95% CI: 0.18–0.87; p = 0.020) and higher (aOR: 3.43; 95% CI: 1.44–8.19; p = 0.005) odds of PTB, respectively. Conclusions: Inadequate GWG was more common in PTB, while excessive GWG was more frequent in term pregnancies. Fast-food consumption was associated with excessive GWG among term births. Optimizing GWG and improving maternal diet quality should be included as key, cross-cutting interventions targeting the improvement of antenatal care.

To investigate the impact of a previous cesarean section on maternal and perinatal outcomes in term pregnancies undergoing labor induction. In this retrospective cohort study, women with singleton, low-risk term pregnancies and labor induction were compared according to the presence or absence of a previous cesarean delivery. The primary outcome was a composite of adverse maternal and perinatal events. Secondary outcomes included cesarean section rate, mode of vaginal delivery, and specific maternal or neonatal complications. The rate of composite adverse outcomes was comparable between groups (21.9% vs. 23.7%, p = 0.4826). However, placental abruption (1.3% vs. 0.3%, p = 0.0251), suspected triple I (1.9% vs. 0.4%, p = 0.0040), and shoulder dystocia (2.3% vs. 0.8%, p = 0.0265) occurred more frequently in women with a previous cesarean section. Abnormal cardiotocography (27.1% vs. 20.4%, p = 0.0058), operative vaginal delivery (17.8% vs. 11.9%, p = 0.0052), umbilical artery pH < 7.10 (4.9% vs. 2.8%, p = 0.0381), and the need for fetal blood sampling (8.7% vs. 5.0%, p = 0.0055) were also more common in this group. There was no difference in neonatal unit transfer (10.0% vs. 11.5%, p = 0.4328) or low Apgar scores (< 5 at 5min: 0.3% vs. 0.4%, p = 1.0000). Cesarean section rates were similar (14.8% vs. 14.9%, p = 0.9692). In multivariable analysis, absence of prior vaginal delivery (OR = 3.460, p < 0.0001), higher maternal BMI (OR = 1.038, p < 0.0001), and older maternal age (OR = 1.033, p = 0.0002) were independently associated with adverse outcomes, whereas previous cesarean section was not. Labor induction in women with a prior cesarean section was not associated with increased risk for composite adverse maternal or perinatal outcomes. Nonetheless, TOLAC should be conducted in settings with immediate access to obstetric and neonatal intervention.

Association of umbilical cord blood phthalate levels with neonatal growth parameters in term pregnancies.

Mild fundal pressure (MFP) and vacuum extraction (VE) are interventions used during the second stage of labor when clinical intervention is required. While VE is well established with standardized training and predictable risks, MFP remains controversial with limited comparative data. This study aimed to compare maternal and neonatal outcomes of MFP versus VE in women requiring intervention during the second stage of labor. This is a retrospective cohort study of women with singleton term pregnancies requiring intervention during the second stage of labor at a tertiary medical center (January 2022-June 2025). Both interventions were appropriate for the same indications; the choice was at physician discretion. The primary outcome was a composite maternal outcome comprising obstetric anal sphincter injury or postpartum hemorrhage. The secondary outcome was a composite neonatal outcome including Apgar score <7 at 5 min, umbilical cord pH <7.1, birth trauma, or neonatal intensive care unit admission. Of 2389 women, 641 (26.8%) underwent VE and 1748 (73.2%) received MFP. The composite maternal outcome occurred in 13.7% of VE versus 8.7% of MFP (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.79). The composite neonatal outcome occurred in 10.5% of VE versus 5.2% of MFP (OR 0.47, 95% CI 0.34-0.65), driven by higher birth trauma following VE (4.2% vs. 0.7%). After adjustment, MFP was associated with lower odds of composite maternal outcome (adjusted OR [aOR] 0.56, 95% CI 0.35-0.91) and composite neonatal outcome (aOR 0.57, 95% CI 0.32-0.99). Mild fundal pressure was associated with lower odds of composite maternal and neonatal adverse outcomes compared with VE.

The association between inflammatory bowel disease (IBD) without active perineal disease and the risk of perineal trauma during vaginal birth remains unclear. Thus, we aimed to determine whether IBD without active perianal disease is independently associated with perineal trauma. A retrospective cohort study including all primiparous women with singleton, cephalic, term pregnancies who delivered vaginally at a tertiary medical center between 2012 and 2023. Women with IBD without active perianal disease were compared with women without IBD. Women with active perianal disease were excluded according to institutional guidelines. The primary outcomes included overall perineal injury, defined as any spontaneous perineal tear, labial laceration, obstetric anal sphincter injury (OASI), and episiotomy. Multivariable logistic regression was performed to assess the association between inflammatory bowel disease and perineal trauma, adjusting for potential confounders. Among 45,250 primiparous women, 244 women (0.5%) had IBD. Overall perineal injury rates were similar between the IBD and control groups (84.0% vs. 85.4%; P = .553). OASI was comparable (0.4% vs. 0.9%; P = .728), and episiotomy rates did not differ significantly. In multivariable analysis, IBD was not associated with perineal trauma (aOR 0.82; 95% CI 0.56-1.19, P = .288). Independent predictors included vacuum-assisted delivery, higher birthweight, occiput posterior presentation, prolonged second stage, and epidural analgesia. Subgroup analysis showed no differences between ulcerative colitis and Crohn's disease. IBD without active perianal disease does not increase the risk of perineal injury in primiparous women undergoing term vaginal delivery. Vaginal birth is an appropriate mode of delivery in this population.

To develop antenatal prediction models for shoulder dystocia and birth trauma using routinely collected maternal and sonographic variables. Retrospective cohort study. Single tertiary referral centre in the UK. All singleton term liveborn pregnancies delivered between January 2016 and November 2024 with a third-trimester ultrasound performed at or beyond 36 weeks' gestation. Multivariable logistic regression was used to develop antenatal prediction models for shoulder dystocia and birth trauma, incorporating maternal characteristics and fetal biometry including abdominal circumference (AC; centile or mm) and estimated fetal weight (EFW; grams or centile). Model performance was assessed using tests for multicollinearity, discrimination (area under the ROC curve, AUC) and calibration. Shoulder dystocia and birth trauma, the latter defined as a composite of shoulder dystocia, postpartum haemorrhage requiring blood transfusion, caesarean delivery at full dilatation, or hypoxic-ischaemic encephalopathy (HIE ≥ 1). A total of 24 334 singleton term pregnancies were included; 432 (1.8%) were complicated by shoulder dystocia and 1210 (5.0%) by birth trauma. The model including maternal characteristics and AC centile demonstrated the best discrimination. For shoulder dystocia, the apparent AUC was 0.706 (95% CI 0.682-0.730); the optimism-corrected AUC after bootstrap validation was 0.699. For birth trauma, the apparent AUC was 0.669 (95% CI 0.654-0.685); the optimism-corrected AUC was 0.665. At a 10% false-positive rate, sensitivity was 31.5% for shoulder dystocia and 22.8% for birth trauma, compared with 20.4% and 14.0%, respectively, using EFW ≥ 90th centile. Antenatal models combining fetal AC centile with maternal risk factors outperform EFW-based thresholds currently used in clinical practice. Although discrimination was modest, the model may be useful for antenatal risk stratification and counselling, rather than as a stand-alone clinical test. Such models may help identify pregnancies at increased risk of delivery-related complications associated with fetal overgrowth and inform future studies evaluating targeted interventions.

Background: Accurate antenatal estimation of fetal weight is critical for intrapartum decision-making and optimisation of maternal and neonatal outcomes. Both clinical and ultrasonographic methods are routinely employed in term pregnancies; however, their comparative accuracy and the influence of maternal determinants remain variable across populations. This study aimed to compare the accuracy of clinical and ultrasonographic fetal weight estimation with actual birth weight and to identify maternal factors associated with estimation errors. Methods: This prospective comparative observational study was conducted at a tertiary care center over six months and included 100 term pregnant women with singleton, cephalic presentations. Clinical fetal weight estimation was performed using Johnson's formula based on symphysio-fundal height and fetal head station. Ultrasonographic estimation was derived from standard biometric parameters using Hadlock regression models (Hadlock-IV for primary analysis). Actual birth weight measured within 30 minutes of delivery served as the reference standard. Accuracy was defined as estimation within ±10% of actual birth weight. Associations between estimation accuracy and maternal factors were assessed using univariate and multivariate logistic regression analysis. Results: The mean actual birth weight was 3140 ± 405 g. Clinical estimation yielded a mean weight of 3045 ± 410 g, demonstrating a statistically significant underestimation of 95 g (p = 0.041). Ultrasonographic estimation showed a mean weight of 3118 ± 395 g, with a non-significant mean difference of −22 g (p = 0.318). Accuracy within ±10% of actual birth weight was 90% for clinical estimation and 94% for ultrasonography. On multivariate analysis, maternal BMI ≥25 kg/m² (AOR 2.41; 95% CI 1.01–5.74; p = 0.048) and gestational diabetes mellitus (AOR 3.02; 95% CI 1.12–8.14; p = 0.029) were independently associated with inaccurate clinical fetal weight estimation. Conclusion: Ultrasonographic fetal weight estimation demonstrates superior agreement with actual birth weight compared to clinical estimation in term pregnancies. Although clinical methods show acceptable overall accuracy, maternal obesity and gestational diabetes mellitus significantly reduce their reliability. Targeted ultrasonographic assessment in high-risk maternal subgroups may enhance intrapartum decision-making and perinatal preparedness.

To assess maternal infection following prelabor rupture of membranes (PROM) at term in a setting where active management is recommended, and to identify associated risk factors. A retrospective cohort study was conducted including pregnant women admitted to a Portuguese tertiary care center where immediate induction of labor is recommended following term PROM. Women with singleton term pregnancies complicated by PROM, who delivered between January 2020 and July 2023, were included. The primary outcome was intrauterine maternal infection, defined as clinical chorioamnionitis and/or endometritis. A comparative analysis was conducted between groups, based on latency to delivery (≤12 h vs. >12 h). A multivariable logistic regression model was used to evaluate the influence of confounding factors on the association between latency and the primary outcome. A total of 759 patients with singleton term pregnancies complicated by PROM were included, corresponding to a prevalence of 9.7%. Chorioamnionitis and/or endometritis occurred in 40 patients (5.3%), with significantly different rates between the up to 12 h and the more than 12 h latency groups (0.9% vs. 7.3%, P < 0.001). Latency of more than 12 h was independently associated with maternal infection (odds ratio 9.0; 95% confidence interval 2.1-39.2). Group B streptococcus colonization status was not associated with increased maternal infection risk. Neonatal outcomes were similar between groups. This study demonstrates the increased risk of maternal infection when latency exceeds 12 h following term PROM, supporting the rationale for active management strategies and highlighting the need to evaluate additional prophylactic measures.

Perineal trauma during vaginal delivery may result in long-term morbidity. We aimed to test the hypothesis that intrapartum administration of papaverine is associated with a lower incidence of obstetric anal sphincter injuries (OASIS) among primiparous patients. This retrospective cohort study included primiparous patients with singleton term (> 37weeks) pregnancies who delivered vaginally at Galilee Medical Center, Nahariya, Israel, between March 2020 and June 2024. Patients who received intrapartum 80mg intramuscular papaverine were compared with those who did not. The primary outcome was the incidence of OASIS, defined as third- (3A, 3B, 3C) and fourth-degree perineal tears. Secondary outcomes included the incidence of first- and second-degree perineal tears and episiotomy. Multivariable logistic regression identified independent predictors of OASIS. Among 4939 patients, 1082 (21.9%) received papaverine. Baseline demographics of the two groups were comparable; however, patients who received papaverine had a higher BMI and a higher rate of labor induction. The incidence of OASIS was significantly lower in the papaverine group (0.5% vs 1.3%; adjusted absolute risk difference [aRD] -0.7%, 95% CI -1.2 to -0.1; p = 0.016). First- and second-degree perineal tears were less frequent in univariate analysis (35.2% vs 39.2%, p = 0.019); however, after multivariable adjustment, this association was attenuated and no longer statistically significant (aRD -1.3%, 95% CI -4.1 to 1.5; p = 0.37).Episiotomy rates of the two groups were comparable. In this study, primiparous patients who received intrapartum papaverine experienced a lower incidence of OASIS than those who did not receive papaverine. Further prospective, protocolized studies are needed to confirm these findings.

The aim of the present study was to determine whether advanced maternal age is associated with increased risk of perineal injury and obstetric anal sphincter injury (OASI) among primiparous women. This was a retrospective cohort study of primiparous women aged 20-50 years with singleton term pregnancies in cephalic presentation who delivered vaginally at a single tertiary center between 2012 and 2024. Women were stratified into three groups: 20-30 (reference), 30-40, and 40-50 years. The primary outcome was overall perineal injury, defined as spontaneous perineal laceration, labial tear, episiotomy, or OASI. The secondary outcome was OASI, analyzed separately. Multivariable logistic regression assessed the association between maternal age and each outcome. Among 45 021 primiparous women, 18 230 (40.5%) were aged 20-30 years, 25 520 (56.7%) aged 30-40 years, and 1271 (2.8%) aged 40-50 years. Overall perineal injury rates were similar across groups (86.0%, 85.0%, and 85.3%), and the only significant pairwise difference was between women aged 20-30 and 30-40 years (P = 0.008). OASI rates were consistently low (0.8%, 0.9%, and 0.7%; P = 0.589). In multivariable analysis, women aged 30-40 years had lower odds of overall perineal injury compared with the reference group (adjusted odds ratio [aOR] 0.89; 95% confidence interval [CI]: 0.84-0.95; P < 0.001), whereas women aged 40-50 years showed no significant difference (aOR 0.92; 95% CI: 0.76-1.11; P = 0.371). In the model for the secondary outcome, maternal age was not associated with OASI. Advanced maternal age is not an independent predictor of perineal injury or OASI. Clinical counseling should emphasize modifiable risk factors rather than maternal age.

Spontaneous labor onset peaks during the late evening and early morning hours, indicating a circadian influence on parturition. However, the effect of the time of day of labor induction on labor duration and obstetrical outcomes remains unexplored. We hypothesize that the time of day of labor induction affects induction of labor duration and the risk of cesarean delivery. This study aimed to determine whether the time of day of labor induction impacts induction of labor duration and delivery outcomes in term pregnancies, and whether maternal characteristics such as body mass index and parity modulate this effect. This retrospective cohort study analyzed 3363 term pregnant participants who underwent induction at a single US hospital between 2019 and 2022. Time of induction was defined as the time of administration of the first cervical ripening agent or synthetic oxytocin (ie, Pitocin). Induction of labor duration was calculated as the time from induction to delivery. Multivariable analyses, survival models, and circadian rhythm analyses were performed to evaluate associations between time of day of labor induction, induction of labor duration, cesarean delivery, and neonatal outcomes. Induction of labor duration followed a significant circadian rhythm (P<.05, Lomb-Scargle), with a gradual lengthening in duration when induction was initiated later in the day, peaking at 11:00 ᴘᴍ (average duration of 21.0 vs 14.8 hours at 5:00 ᴀᴍ; P<.01, Kruskal-Wallis test). Participants induced during the early morning had up to 6 hours shorter labor compared with those induced in the late evening (P<.01). The optimal time of day for initiating labor induction was influenced by body mass index and parity, with significant differences in delivery probability by time of day of labor induction among nulliparous obese (P<.05, 2-way analysis of variance), and parous obese participants (P<.05). Time of induction was associated with reduced cesarean delivery rates and did not impact rates of neonatal intensive care unit admission or adverse neonatal outcomes. The time of day when labor induction was initiated influenced induction of labor duration, with the shortest duration observed when induction occurred during early morning hours. No increase in adverse maternal or fetal outcomes was identified after accounting for the time of day of labor induction. The optimal time of day for inducing labor is influenced by body mass index and parity and should be considered when performing this common obstetrical intervention.

One dose, big impact: Revisiting carbetocin in high-risk polyhydramnios deliveries.

Moderate and high levels of anticardiolipin antibodies (aCL) are associated with pregnancy-related complications, thrombosis, and other cardiovascular diseases. However, the clinical impact of isolated low IgM aCL levels on pregnancy outcomes has not yet been demonstrated in large-scale analyses. This study aimed to evaluate whether isolated low aCL levels induce epigenetic changes at early stages of gestation in otherwise normally ongoing pregnancies. The expression of 29 microRNAs linked to adverse obstetric outcomes and cardiovascular risk was assessed in 40 singleton normal term pregnancies with isolated low IgM aCL levels (IgM aCL <40 MPL units, IgG aCL negative) and 75 gestational-age-matched aCL-negative controls, using reverse transcription real-time polymerase chain reaction. Two microRNAs (miR-100-5p and miR-199a-5p) were upregulated, and seven (miR-130b-3p, miR-133a-3p, miR-145-5p, miR-155-5p, miR-210-3p, miR-342-3p, and miR-574-3p) were downregulated in normal term pregnancies with isolated low IgM aCL levels. After adjusting for maternal age, pre-pregnancy BMI, smoking, autoimmune disease, inherited thrombophilia, history of precancerosis, and ART conception, dysregulation of miR-133a-3p, miR-145-5p, and miR-574-3p remained statistically significant. Logistic regression (enter and backward methods) achieved very good performance in differentiating between cases and controls (areas under curve 0.917 and 0.908, respectively; 77.50% sensitivities at 10% false-positive rate; 86.96% accuracies). Using the multilayer perceptron, a type of artificial neural network, multiple models based on nine microRNAs were constructed. Some of them had better overall performance than the logistic regression approach. Isolated low IgM aCL positivity can adversely modify the epigenetic profile, which under additional unfavorable conditions may lead to pregnancy complications and increased cardiovascular risk. Some women have certain antibodies in their blood called aCL (anticardiolipin antibodies). These antibodies can sometimes be linked to pregnancy complications or a higher risk of heart disease. This study explored whether low levels of one type of these antibodies (called IgM aCL) early in pregnancy might still affect the body in ways that might matter later. We compared pregnant women with low levels of these antibodies to those without the antibodies and examined microRNAs - tiny molecules that help control cell activity - in their blood. Even low antibody levels were linked to small changes in microRNAs during the first trimester. Some of these changes resembled patterns seen in pregnancies that later develop complications or in people with increased cardiovascular risk. These findings do not mean that low antibody levels always cause problems. Instead, they suggest that such antibodies may slightly increase vulnerability, especially when combined with other risk factors.