Third Stage Of Labor Research Articles

Expression of Concern: Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage.

Expression of Concern: Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage.

The effect of pre-partum shearing of Corriedale ewes on placental and lamb development and neonatal behaviour.

To evaluate the effects of early and late pre-partum shearing of Corriedale ewes carrying single fetuses on placental and lamb development and neonatal lamb behaviour. At 70 days of gestation, 37 multiparous Corriedale ewes with known gestation dates were randomly allocated into three groups: S70 (n = 12) and S110 (n = 12), shorn at Day 70 and 110 of gestation, and US (n = 13), that were not shorn pre-partum. Gestation length, lambing duration, placental expulsion time, placental weight, number and weight of cotyledons, and placental efficiency (lamb weight/placental weight) were determined. At birth, body temperature, weight, morphometric measurements, ponderal index (lamb weight/lamb crown-rump length) and behaviour were recorded, with weight remeasured 72 hours later. Four male lambs per group were slaughtered immediately after parturition, and organ weight and perirenal brown fat weight and energy content recorded. Pre-partum shearing, regardless of timing, increased total dried placental weight per ewe. Pre-partum shearing at Day 70 of gestation increased the number and mean weight of the > 2 to ≤ 3-cm cotyledons, while pre-partum shearing at Day 110 of gestation increased only the weight of these cotyledons. At birth and at 72 hours, lambs from ewes shorn either at 70 days of gestation (birth: 5.5 (95% CI = 4.6-6.4) kg, p = 0.001; 72 hours: 6.4 (95% CI = 6.1-6.8) kg, p = 0.002) or at 110 days of gestation (birth: 5.4 (95% CI = 4.4-6.4) kg, p = 0.001; 72 hours: 6.5 (95% CI = 5.9-7.1) kg, p = 0.001) were heavier than lambs from unshorn ewes (birth: 4.0 (95% CI = 3.3-4.8) kg; 72 hours: 4.8 (95% CI = 3.5-6.1) kg). Lambs born to S70 and S110 ewes suckled sooner (31.5 (95% CI = 14.5-48.5) minutes, p = 0.001; and 39.3 (95% CI = 23.7-55.0) minutes, p = 0.001 respectively), than lambs born to the US group (70.3 (95% CI = 38.6-102.1) minutes). There was no evidence for an effect of pre-partum shearing on gestation length, parturition length, time of placental expulsion, placental efficiency, weight and energy of perirenal brown fat, and lamb temperature at birth. Shearing ewes pre-partum may lead to placental changes affecting lamb development and behaviour and associated with higher survival. The findings suggest pre-partum shearing may improve lamb survival, farm profitability and sustainability.

Mechanism of collagen type IV regulation by focal adhesion kinase during retained fetal membranes in dairy cows

Retained fetal membranes (RFM) is an important reproductive disease in dairy cows, caused by maternal and fetal placental tissue adhesion. The main collagen in maternal and fetal placenta tissues is collagen type IV (COL-IV) and its breakdown is the key to placental expulsion. Focal adhesion kinase (FAK) has been shown to regulate the hydrolysis of Col-IV by affecting the activity of MMP-2 and MMP-9 activity, but the regulation of the mechanisms involved in placenta expulsion in dairy cows after postpartum are still unclear. The aim of this study was to investigate the pathogenic mechanism of RFM by studying the relationship between the FAK signaling pathway and COL-IV regulation. Maternal placental tissues were collected from six healthy and six cows with RFM of similar age, parity, body condition and milk yield at 12 h postpartum. In vitro experiments were performed on bovine endometrial epithelial cells from three groups including a FAK inhibitor group, a FAK activator group and a control group without FAK inhibitor and activator. The abundance of molecules involved in the FAK signaling pathway and COL-IV was detected by immunohistochemistry, quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. The immunohistochemical results showed that the key molecules of FAK signaling pathway FAK, Src, MMP-2 and MMP-9 and Col-IV were expressed in placental tissues. The expression level of FAK, Src, MMP-2, and MMP-9 were significantly down-regulated (P < 0.05) and the abundances of COL-IV were significantly up-regulated (P < 0.05) in maternal placental tissues of RFM cows compared with healthy cows. In the FAK inhibitor treatment group, the relative expression levels of FAK and other related proteins were significantly down-regulated (P < 0.05) and the relative expression levels of COL-IV were significantly up-regulated (P < 0.05) with the results of the FAK activation group the opposite. These results indicated that FAK in maternal endometrial epithelial cells could regulate the hydrolysis process of Col-IV through the expression of key factors of signaling pathways and promote collagen hydrolysis, which in turn facilitated the process of postpartum placenta expulsion in dairy cows.

Analysis of clinical application effects of Esketamine combining Sufentanil in labor analgesia and their impacts on postpartum depression.

To evaluate the clinical effects of Esketamine combining Sufentanil in labor analgesia and their impacts on postpartum depression. This was a retrospective study. One hundred and fifty primiparae with spontaneous labor were selected at SSL Central Hospital of Dongguan City from July 10, 2021 to May 10, 2022 as the research objects and randomly divided into two groups (each n=75). While the control group underwent epidural infusion of Sufentanil for analgesia, the study group was administered Esketamine combining Sufentanil. Compared analgesic effects, time of birth course, adverse reactions, pain intensity, scores assigned to depression and anxiety before analgesia and after delivery were made for pregnant women in both groups. The response rates of the study and control groups reached 100% and 93%, respectively, with statistically significant differences (p=0.02). The time of the first, second, and third stages of labor in the study group were all significantly lower than that of the control group; showing statistical significance (p=0.00). Regarding adverse reactions showed no statistically significant differences (p=0.44). Moreover, the study group showed noticeably lower pain intensity than those of the control group during delivery, 20 minutes and one hour after delivery; and their differences were statistically significant (p=0.00). After delivery, both the SAS and SDS of the study group were respectively lower than those of the control group, with statistically significant differences as well (p=0.00). Applying Esketamine combining Sufentanil in epidural painless delivery produces rather favorable analgesic effects, shortens the time of the birth process, and improves postpartum anxiety and depression without leading to more adverse reactions.

Effect of omicron infection on maternal and neonatal delivery outcomes: A retrospective cohort study

BackgroundPeople are very concerned about the adverse effects of Omicron infection on delivery modes, duration of labor, and the postpartum status of pregnant women and neonates. Methods382 pregnant women (Omicron group: 136 cases; non-Omicron group: 246 cases) giving birth in our hospital were collected, demographic characteristics, vaccination, clinical manifestation and medication, delivery outcomes of pregnant women and neonates were recorded. Delivery outcomes were compared between the Omicron and non-Omicron groups, acute infection and non-acute infection groups to explore the relationship between adverse delivery outcomes and Omicron infection. ResultsPregnant women in the Omicron group had a longer hospitalization time (6.3 ± 3.6 days vs.5.5 ± 2.3 days), more 2-hour postpartum hemorrhage (291.7 ± 104.9 mL vs.262.7 ± 91.2 mL) and higher neonatal-pediatric transfer rate (20.6 % vs. 2.8 %), which might be associated with fetal distress, prenatal fever and pneumonia/respiratory distress. Neonates transferred to pediatrics due to jaundice were unique in the Omicron group. Fever-pregnant women have a more prolonged second stage of labor and hospital stay while coughing or expectoration ones have a shorter third stage of labor. Delivery outcomes did not differ whether the infected pregnant women were in the acute phase and whether to use antipyretics. ConclusionOmicron infection can increase the 2-hour postpartum hemorrhage volume and the neonatal-pediatric transfer rate. The symptoms can affect the duration of labor and hospital stay. However, whether the infected pregnant women are in the acute phase or use antipyretics do not affect the delivery outcome.

Maternal Complications After Laser Surgery for Twin-to-Twin Transfusion Syndrome, a Cohort Study.

To assess maternal complications after fetoscopic laser surgery (FLS) for the twin-to-twin transfusion syndrome (TTTS). All consecutive cases treated with FLS for TTTS between 2008 and 2021 at the Leiden University Medical Center (LUMC) were included. We allocated complications in three timeframes: "Admission for laser surgery," "pregnancy after laser," and "delivery and third stage of labor." Maternal complications were graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and for intra-abdominal hemorrhage, the Common Terminology Criteria for Adverse Events (CTCAE). In the study period, 637 mothers were treated for TTTS with FLS. There were 1559 occurrences of maternal complications. The rate of severe maternal complications (grade 3 or 4) was 8.0%. Severe complications consisted of six cases of severe intra-abdominal hemorrhage, nine cases of severe hemorrhage in pregnancy, one with severe chorioamnionitis, 10 with severe preeclampsia/HELLP syndrome, and 25 with a severe postpartum hemorrhage. Even though it is the gold standard for treating TTTS, FLS comes at a risk to the mother which should not be neglected. And even though not all complications have serious consequences to the mother, the severe maternal complication rate of 8.0% should be added to the inherent risks for the fetus, and should be discussed with patients eligible for surgery in order to make an informed decision on treatment options.

Asuhan Kebidanan Komprehensif pada NY “S” Di Bidan Praktek Swasta Bunda Kota Bukittinggi Tahun 2024

Comprehensive Care is continuous care from pregnancy to Family Planning (FP). Comprehensive care aims to provide quality services and prevent maternal and child mortality. The purpose of this case study is to provide comprehensive care to mothers from pregnancy, childbirth, postpartum, and newborn care using the documentation of the Seven Steps of Varney and SOAP. This assessment was conducted from January to April 2024 through data collection methods, interviews, and observations. Pregnancy care included three visits with the first day of the last menstrual period on July 12, 2023, and the expected delivery date on April 19, 2024. During the first, second, and third visits, the general condition of the mother was found to be good. Labor care was provided on April 24, 2024, at 11:30 AM when the mother came to the Midwife's Independent Practice, accompanied by her husband, complaining of abdominal pain since 08:00 AM and discharge mixed with blood. An internal examination revealed 4 cm dilation. At 4:00 PM, labor management was carried out. The delivery process was normal with the 60 Steps of Active Management of the Third Stage of Labor (AMTSL), the baby was born normal, male, weighing 2500 grams, with a length of 47 cm, and immediate newborn care was performed. Postpartum and newborn care proceeded smoothly without complications for both mother and baby.

Women and medicinal plants: a systematic review in the field of ethnobotany

This study delves into the intricate relationship between women and medicinal plants, underscoring their historical and cultural roles mainly in 11 different countries. By specifically examining the impact of social impositions on gender in healthcare and the use of medicinal plants, the research critiques the perspectives that have marginalized both women and nature. To address these issues, ethnobotanical studies should promote research that encompasses the gender. Conducting a systematic review on Women and Medicinal Plants, the research explores key aspects in ethnobotanical studies: botanical knowledge, transmission of knowledge, medicinal plants used in women’s reproductive health, access to healthcare, and the primary knowledge holders. The bibliographic survey, utilizing the Capes database, reveals 205 plant species with 32 medicinal uses for women's health. Rute chalepensis L. (rue) was mentioned four times for abortion, labor contraction, facilitating childbirth, and placental expulsion. In relation to women’s reproductive health, different plants have been used by women and traditional practitioners worldwide. The use of medicinal plants can be associated with social vulnerability in marginalized communities by society which do not have easy access to public health, so they rely on alternative methods such as homemade remedies. Although knowledge about medicinal plants is an intellectual task developed by women, in some societies, such as capitalist societies, gender roles will evolve into specific knowledge, such as the task of family health care. The triple workload is not beneficial to women. Traditional knowledge, when allied with sustainability, can promote gender equality by transmitting intergenerational botanical knowledge without gender distinction and by reclaiming cultivation practices beneficial to the environment, biodiversity, and human health. The study invites ethnobotanical researchers to investigate gender dynamics within their studies. The results of this work can contribute to future research on women and medicinal plants.

An Evidence-Based Approach to Vaginal Birth

This is a review of evidence-based management of vaginal birth, which is critical to optimizing the outcomes of birthing people and neonates. The current literature supports the use of immediate pushing in the second stage of labor, neuraxial anesthesia administration for vaginal birth for adequate pain control, use of warm compresses in labor to prevent obstetric lacerations, delayed cord clamping for term and preterm neonates, the utility of umbilical cord milking in neonates who require immediate resuscitation, and active management of the third stage of labor with oxytocin administration. In addition, the routine use of episiotomy is shown to increase morbidity without clear evidence of benefit in the setting of spontaneous vaginal delivery or operative vaginal delivery.

Spontaneous vaginal birth after multiple previous caesarean sections: A case report and literature review

Background: Vaginal birth after caesarean section (VBAC) is increasingly recognized as a safe and effective option for women with a history of Caesarean deliveries. However, limited attention has been given to feasibility and safety of VBAC after multiple caesarean sections. Case presentation: A 36-year-old woman with a history of four previous Caesarean sections presented in our centre in third stage of labour. Despite counseling for elective Caesarean section, she had a spontaneous vaginal delivery of a live 2.6 kg female neonate in a vehicle en route to the hospital. On arrival, she was stable but had lost about 500ml of blood. Immediate interventions included active management of third stage of labour and assessment for perineal injuries, with subsequent monitoring and blood transfusion. She had a normal postpartum recovery, was discharged after four days, and had a reassuring 6-week post-natal visit, with a referral to family planning. Conclusion: This case underscores the potential success and safety of vaginal birth after multiple (three or more) Caesarean sections, challenging the notion that a history of repeated C-sections precludes this option. Vaginal birth after CS (VBAC), initially restricted to one previous CS, is now considered in selected cases with two prior abdominal deliveries. However, the acceptance of VBAC after three or more CS remains limited despite available evidences indicating comparable success rates and maternal risks for VBAC after multiple CS when compared to VBAC after one prior CS or elective repeat CS.

Effects of Warm Compresses on the Perineal Area During the Active Phase of Labor: A Quasi-Experimental Study.

Background A perineal tear refers to any injury to the female genitalia during labor, which can occur spontaneously or with the use of instruments. An episiotomy, a surgical procedure, is sometimes performed to enlarge the vaginal orifice to facilitate delivery. Ineffective management of labor pain can result in negative physiological and psychosocial outcomes. Objective This study aims to investigate the effect of warm compresses on the perineal area during active labor. Methods This quasi-experimental study utilized a convenience sample, dividing 80 mothers into intervention and control groups. Participants were randomly assigned to groups after meeting the inclusion criteria and signing consent forms. The inclusion criteria encompassed pregnant women aged 18 years or older with a healthy singleton pregnancy, a cephalic presentation, and a gestational age of 37 weeks or more. The women were in the active phase of the first stage of labor (6-7 cm cervical dilation). In Part I, a data collection tool was developed to gather sociodemographic data, obstetrical history, and initial assessment information. Part II assessed perineal pain using the Visual Analogue Scale. Part III collected data on the perineal status post-delivery, and Part IV gathered information about the newborns. The research was conducted in the labor unit at East Jeddah Hospital, with data collection occurring from November 2022 to February 2023. Results The results of this study revealed that the mean second-stage labor pain score was 9.73 for the control group and 8.68 for the intervention group. In the third stage of labor, the mean pain score was 4.52 for the control group and 2.75 for the intervention group. During the fourth stage of labor, the mean pain score for the control group was 2.90, compared to 1.50 for the intervention group. In terms of perineal outcomes, 17 participants (42.5%) in the intervention group had an intact perineum, compared to 11 participants (27.5%) in the control group. However, there was no significant difference in the episiotomy rate between the two groups. Conclusions The findings of this study indicate that applying a warm compress to the perineal area during active labor can enhance perineal intactness and significantly reduce perineal pain. Future research could explore the challenges nurses encounter when applying warm compresses to the perineum during labor.

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied. This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery. In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor. Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40-0.90) in group A and 0.60 g% (interquartile range, 0.40-0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group. The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery. El resumen está disponible en Español al final del artículo.

Placental cord drainage impact on third stage of labor: a randomized controlled trial

BackgroundThe third stage of labor is a pivotal phase in obstetric care. Management may be physiological or active. Although the use of prophylactic placental cord drainage has been assessed in prior data, there is still no clear-cut evidence supporting its effectiveness in improving key obstetric outcomes. ObjectiveThe aim of the study was to investigate the impact of placental cord drainage during the third stage of labor on the amount of maternal bleeding, duration of the third stage, and incidence of postpartum hemorrhage. Study DesignA randomized controlled trial was conducted at a high-volume tertiary obstetric center between May 2021 and December 2022. A total of 212 pregnant women with a singleton uncomplicated pregnancy were randomly assigned to undergo placental cord drainage or standard care without drainage. The randomization was manual, using premarked cards drawn by the participants. The power calculation determined a sample size of 92 participants per group to achieve 80% power at a 5% significance level, aiming to detect 20% difference in bleeding amount between the groups. In practice, we included more than 100 women in each group. The primary outcome was the amount of bleeding during the third stage of labor, while secondary outcomes included the duration of the third stage and incidence of postpartum hemorrhage. After delivery, all participants received 10 units of oxytocin via intravenous drip, and delayed cord clamping was performed. In the study group, the maternal umbilical cord was then unclamped. Blood was allowed to drain into a plastic bag placed under the women's buttocks. If an episiotomy or perineal tear was observed, pressure packing was applied to reduce bleeding. The collected blood was measured in milliliters after placental expulsion. ResultsA total of 212 women were recruited of whom 104 underwent placental cord drainage and 108 received standard care without drainage. No significant differences were observed between the intervention and control groups in mean duration of the third stage of labor (10.56±6.12 vs 10.95±6.33 minutes, P=.65), incidence of postpartum hemorrhage (3.84% vs 7.41%, P=.38), or mean amount of bleeding during the third stage of labor (292±200 vs 300±242 mL, P=.79). Furthermore, there were no significant between-group differences in the mean amount of bleeding on separate analysis of nulliparous women (356±246 vs 330±240 mL, P=.68), multiparous women (265±171 vs 289±244 mL, P=.50), women who were not exposed to external oxytocin during labor (287±204 vs 317±250 mL, P=.59), and women who were exposed to external oxytocin (296±198 vs 289±238 mL, P=.39). ConclusionPlacental cord drainage during the third stage of labor showed no statistically significant impact on bleeding amount, third-stage length, or postpartum hemorrhage rate. The findings suggest that placental cord drainage may not offer additional benefits in preventing postpartum hemorrhage in women with uncomplicated pregnancies.

Clinical algorithms for the monitoring and management of spontaneous, uncomplicated labour and childbirth.

To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. Health facilities in low- and middle-income countries. We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.

Approaches to the Prevention and Treatment of Postpartum Hemorrhage: A Systematic Review of Past Advances, Recent Developments, and Best Practices.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, with uterine atony being the most significant contributing factor. Other risk factors for PPH include increased maternal age, coagulation abnormalities, retained placenta, and prolonged third-stage labor. Despite the potential for prevention through early detection and management, PPH can still occur even in the absence of known risk factors. For this reason, adequate preparation and comprehensive management strategies must be implemented. This study, which comprises research from 2006 to 2023, reviews and analyzes various prevention and management techniques for PPH, including surgical and nonsurgical approaches. Key findings indicate that the presence of well-trained critical control teams is essential for the effective management of PPH. In addition, early detection techniques have significantly reduced mortality outcomes associated with PPH, highlighting their importance in patient care.

Assessment of Uterine Contraction and Atonic Bleeding during the Third Stage of Labor Using Shear Wave Elastography.

This study aimed to clarify the relationship between fluctuations in uterine stiffness during the third stage of labor and blood loss upon placenta delivery using shear wave elastography. This prospective cohort study enrolled consecutive singleton pregnant women above 37 weeks of gestation who delivered infants transvaginally at a single perinatal center. Shear wave velocities (SWV) were continuously measured during the third stage of transvaginal labor using transabdominal ultrasound and these values were compared between groups with large (≥500 g) and small amounts of bleeding during this stage. In total, 8 cases of large bleeding and 47 cases of small bleeding were compared. The large amount of bleeding group had a significantly lower median of minimum SWV values (0.97 [0.52-1.01] m/s than the small amount of bleeding group (1.25 [1.04-1.48] m/s p = 0.02). However, no significant differences were observed between the two groups in terms of median, mean, and maximum SWV values. The time from delivery of the infant to placental delivery was significantly longer in the large amount of bleeding group (median time: 370.5 s vs. 274 s, p < 0.05). Ultrasound quantification of uterine stiffness using shear wave elastography demonstrated that uterine contractions may influence the biological hemostasis of the uterus during the third stage of labor. Baseline uterine stiffness was weak and a longer duration of placental separation might be associated with cases of large amounts of bleeding during this stage.

Comparing Intravenous Carbetocin and Intravenous Oxytocin for Third-stage Labor Management: A Narrative Review

Comparing Intravenous Carbetocin and Intravenous Oxytocin for Third-stage Labor Management: A Narrative Review

Effects of epidural analgesia at 1 cm cervical dilatation on multiparae: A retrospective cohort study using propensity score-matching.

The aim of the present study was to investigate the effects of epidural analgesia (EA) administered at cervical dilatation of 1 cm on multiparae who underwent vaginal delivery. This propensity score-matched retrospective cohort research was conducted between 2021 and 2022. All the singleton multiparae who had previous successful vaginal deliveries and epidural analgesia during this delivery were screened for eligibility. The primary outcome was the effect of EA on the duration of labor. The main secondary outcomes included the incidence of cesarean delivery and umbilical arterial pH. This study incorporated 686 multiparae who were divided into two cohorts: EA 1 (cervical dilatation = 1 cm, n = 166) and EA 2 (cervical dilatation >1 cm, n = 520). In the propensity score-matched cohort (including 164 women in each group), there were no statistically significant differences in the incidence of cesarean delivery (4 [2.4%] vs 4 [2.4%], P = 1.000), umbilical arterial pH (7.28 ± 0.06 vs 7.28 ± 0.07, P = 0.550) and other secondary outcomes between the two groups. Based on a comparative assessment of the women who delivered vaginally to the Kaplan-Meier curves and propensity score-matching (including 160 women in each group), there was no statistical significance in the duration of the first, second and third stages of labor (log rank P, P = 0.811; P = 0.413; P = 0.773, respectively). Initiation of epidural analgesia at cervical dilatation of 1 cm in multiparae did not cause adverse effects with regard to the duration of labor, increased cesarean deliveries, and bad neonatal outcomes.

Assisted reproductive technology and prolonged third stage of labour: a multicentre study in Japan

Research questionWhat are the risk factors for a prolonged third stage of labour, closely related to postpartum haemorrhage, and what is the effect of assisted reproductive technology (ART) on the third stage of labour? DesignClinical data of women who delivered vaginally at term at 12 primary maternity hospitals in Japan (2010–2018) (n = 25,336) were obtained; 1148 (4.5%) conceived through ART and 2246 (8.9%) through non-ART treatments. The risk of a prolonged third stage of labour (defined as ≥20 min) was evaluated by univariable and multivariable regression analyses. Adjusted odds ratios (aOR) of a prolonged third stage of labour were evaluated, stratified by the type of ART, with natural conception as a reference. ResultsMultivariable analysis showed that pregnancy achieved through ART (aOR 4.38, 95% CI 3.12 to 6.15), history of spontaneous miscarriage (OR 1.40, 95% CI 1.06 to 1.84) and prolonged labour (OR 1.52, 95% CI 1.09 to 2.12) were identified as independent risk factors. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC–FET) and blastocyst-stage embryo transfer were significantly associated with a prolonged third stage of labour (aOR 4.07, 95% CI 2.75 to 6.04, aOR 4.11, 95% CI 2.58 to 6.57 and aOR 2.13, 95% CI 1.15 to 3.95, respectively). No significant difference was observed in the duration of third stage of labour between natural conception and non-ART treatment (P = 0.61). ConclusionPregnancy achieved through ART, particularly FET, HRC–FET and blastocyst-stage embryo transfer, was a significant risk factor for a prolonged third stage of labour.

Third-Stage Complications Among In Vitro Fertilization Pregnancies: An Observational Study.

This study aimed to determine the third-stage complications and their risk factors in in vitro fertilization (IVF) pregnancies. This prospective observational study was conducted from March 2022 to November 2023 at a tertiary care university hospital in South India. We included a total of 217 women following IVF conception, and details of the third-stage labor complications were documented and expressed as the frequency with percentage. The risk factors were analyzed using a logistic regression model. Among 217 participants, 51 (23.5%) had third-stage complications. Postpartum hemorrhage (PPH) was the most common, complicating 20% of the deliveries. Multiple gestations (adjusted odds ratio (aOR) 2.7, 95% confidence interval (CI) 1.03-7.46, p = 0.04), operative vaginal delivery (aOR 57, 95% CI 4.2-770, p = 0.002), and emergency cesarean section (aOR 14.8, 95% CI 1.3-160.5, p = 0.026) were the risk factors for PPH. Intrapartum infection was found to be associated with a risk for the retained placenta (aOR 8, 95% CI 1.37-46.4, p = 0.02) and adherent placenta (aOR 6.06, 95% CI 1.07-34.3, p = 0.04). Assisted reproductive technology (ART)-related factors were not found to be significantly associated with third-stage complications. There is a risk of third-stage complications, especially postpartum hemorrhage, among IVF pregnancies. The type of embryo transfer was not associated with third-stage complications.