BACKGROUND: Women experience medical interventions, episiotomy, and perineal lacerations during childbirth, impacting their physical, psychological, and sexual well-being. This study compares the perineal status of prospective women who had the midwifery intervention of perineal myofascial release during childbirth, to a matched retrospective control sample of women who received standard care during childbirth.
METHODS: A non-randomized pilot study with prospective data collected for 50 women after informed verbal consent was obtained to having the midwifery intervention of perineal myofascial release during childbirth, and the matched retrospective data for the control group of 49 women were collected from a random sample generated from the medical records. Quantitative analyses included descriptive statistics, independent t-tests, regression, and chi-squared analyses. Retrospective trial registration was granted with The Australian New Zealand Clinical Trials Registry ANZTR.
RESULTS: Women were six times (OR=0.15; 95% CI: 0.0-0.37) less likely to have a non-intact perineum and twice (OR=0.44; 95% CI: 0.35-0.56) less likely to have an episiotomy if they were in the intervention group. Chi-squared analysis found no statistically significant differences between groups for normal vaginal birth and instrumental births, excluding cesareans and waterbirth [χ2(1)= -0.37, p=0.542].
CONCLUSIONS: This study found perineal myofascial release benefits women by reducing perineal trauma and episiotomy. However, there were no significant differences in the duration of the active pushing stage of labor or mode of birth. This study has shown some promise in obtaining data for a larger, definitive, randomized controlled trial.
BACKGROUND: The study was registered on the Australian New Zealand Clinical Trials Registry ANZTR.
UNASSIGNED: ID ACTRN12623000807651.

BACKGROUND: Maternal positioning during labor significantly influences maternal comfort. This study aims to identify the preferred maternal lateral position during the latent phase and examine the impact of alignment between maternal lateralization and fetal spine positioning during the active phase of the first stage of labor on maternal comfort.
METHODS: Pregnant women in the first stage of labor beyond 37 weeks of gestation were recruited over six months from March to August 2020 for this prospective cohort study at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia. Eligible individuals were randomly allocated to align with the fetal spine (n=180) or oppose it (n=180). Fetal spine positions were confirmed via transabdominal ultrasound. Maternal mean comfort scores were assessed using the established Maternal Comfort Assessment Tool. Statistical analysis was performed using IBM SPSS version 27, with a p<0.05 considered significant.
RESULTS: There was a significant association between the preferred maternal position during the latent phase and concordance with the same maternal lateralization-fetal spine alignment (p<0.001). Higher mean comfort scores were observed when the maternal lateral position matched the fetal spine alignment during the active phase of labor. There was a significant association of normal CTG tracings when the maternal position was aligned with the fetal spine (p<0.001).
CONCLUSIONS: Parturients preferred lying in alignment with the fetal spine lateralization during the latent phase. This position also offers increased comfort during the active phase of labor. It highlights the importance of considering maternal-fetal alignment as a critical factor in intrapartum care.

BACKGROUND: The type of perineal repair can have significant long-term effects on various functions in a woman\'s postpartum life. The aim was to compare urinary incontinence (UI), women\'s satisfaction, pelvic floor muscle strength (PFMS), and sexual function according to the type of perineal repair (surgical glue or suture thread) during the first eight months after normal childbirth.
METHODS: A controlled randomized clinical trial of 133 primiparous women undergoing perineal repair during birth with surgical glue or sutures, evaluated during labor and monitored up to 8 months postpartum, from March 2017 to September 2018, in the city in São Paulo, Bazil. Descriptive and inferential analyses were carried out.
RESULTS: A total of 133 women were included in the study, 111 (83.5%) were assessed between 10 to 20 days postpartum, 121 (91.0%) between 50 to 70 days, and 54 (40.6%) between 6 to 8 months. There were no significant differences for UI concerning the type of repair; however, there was a significant difference concerning the postpartum period (p=0.031), with a higher prevalence at two months. Most women reported satisfaction, with the highest levels reported two months after birth (p=0.019). For PFMS, the mean of the glue and suture groups were 32.4 cmH2O and 27.4 cmH2O, but not significant. Women in the glue group showed higher mean values in all sexual function domains but without significance.
CONCLUSIONS: Surgical glue showed good aesthetic and functional results in the perineum at eight months postpartum.

OBJECTIVE: To determine the number of sessions required using procedural simulation to acquire the skill of vaginal examination, which is an essential part of obstetrics, but a difficult learned skill.
METHODS: Using a high-fidelity simulator, we conducted a prospective, single-center, single-blind study, at the Angers School of Midwifery. A class of students completed a theory course, and took part in three simulation sessions. During the simulation sessions, each student was asked to describe five different cervixes, under five criteria: position, length, consistency, dilation, and head station. Each participant received individual feedback as part of a debrief session, after completing their description. A pass rate of 80% was set for the entire class.
RESULTS: Twenty-six students participated. The class achieved a mean score of 70.77 ± 10.23% in the first session, 81.85 ± 9.91% in the second session, and 81.23 ± 8.63% in the third session. There was a significant improvement only between the first and second sessions (P < 0.001). Of the 26 participants, 6 (23%) scored over 80% in the first session, 17 participants (65%) scored above 80% in the first two sessions, and 21 participants (80%) scored above 80% over the three sessions.
CONCLUSIONS: Learning vaginal examination by procedural simulation with the aid of a high-fidelity simulator, and receiving individual feedback and debrief, resulted in an 80% pass rate in two practical sessions, working to describe 10 cervixes.

OBJECTIVE: This study aimed to assess whether a partial term prelabor rupture of membranes (partial TPROM) had an impact on the spontaneous onset of labor compared to complete TPROM.
METHODS: We performed a retrospective study in a French level III maternity hospital. We included all singleton cephalic pregnancies presenting with prelabor rupture of membranes ≥37 weeks gestational age. Patients with a partial TPROM (P group) were compared to patients with a complete TPROM (C group). Induction of labor was performed following expectative management of 24-48 h, and antibiotic prophylaxis was started 12 h after rupture. Our main outcome measure was the rate of patients who had spontaneous labor 24 h following prelabor rupture.
RESULTS: Overall, 389 women were included in the study, 148 in the P group, 241 in the C group. The proportion of women who went into spontaneous labor in the 24 h following TPROM was significantly lower in the P group (45% vs 64%, P < 0.001). A partial TPROM was a predictive factor for absence of labor at 24 h following rupture (adjusted odds ratio: 0.44 [0.29-0.68]). There were more cases of induction of labor (50% vs 20%, P < 0.001) and antibiotic prophylaxis (91% vs 73%, P < 0.001) in the P group. However, obstetrical and neonatal outcomes were comparable between the two groups.
CONCLUSIONS: Compared to complete TPROM, partial TPROM is associated with a lower probability of spontaneous labor in the 24 h following rupture. The persistence of a residual membrane has been identified as a risk factor for delaying labor beyond 24 h.

UNASSIGNED: Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD.
UNASSIGNED: In a randomized double-blinded clinical trial, a total of 208 low-risk subjects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23.
UNASSIGNED: The mean age of mothers was 28.98±5.6 years and 120 cases were primigravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than placebo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR=2.83%, 95%CI of 1-8.24).
UNASSIGNED: The results showed that SC can effectively decrease the rate of emergency CS and FD during labor.

BACKGROUND: There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).
METHODS: Twenty-two selected maternity units in Greece will participate in a multicenter stepped-wedge randomized prospective trial involving 20,000 to 25,000 births, with two of them entering the intervention period of the study each month (stepped randomization). The maternity care units entering the study will apply the suggested interventions for a period of 8-18 months depending on the time they enter the intervention stage of the study. There will also be an initial phase of the study lasting from 8 to 18 months including observation and recording of the routine practice (cesarean section, vaginal birth, and maternal and perinatal morbidity and mortality) in the participating units. The second phase, the intervention period, will include such interventions as the application of the HSOG (the Hellenic Society of Obstetrics and Gynecology) Guidelines on labor management, training on the correct interpretation of cardiotocography, and dealing with emergencies in vaginal deliveries, while the steering committee members will be available to discuss and implement organizational and behavioral changes, answer questions, clarify relevant issues, and provide practical instructions to the participating healthcare professionals during regular visits or video conferences. Furthermore, during the study, the results will be available for the participating units in order for them to monitor their own performance while also receiving feedback regarding their rates. Τhe final 2-month phase of the study will be devoted to completing follow-up questionnaires with data concerning maternal and neonatal morbidities that occurred after the completion of the intervention period. The total duration of the study is estimated at 28 months. The primary outcome assessed will be the cesarean section rate change and the secondary outcomes will be maternal and neonatal morbidity and mortality.
CONCLUSIONS: The study is expected to yield new information on the effects, advantages, possibilities, and challenges of consistent clinical engagement and implementation of behavioral, educational, and organizational interventions described in detail in the protocol on cesarean section practice in Greece. The results may lead to new insights into means of improving the quality of maternal and neonatal care, particularly since this represents a shared effort to reduce the high cesarean section rates in Greece and, moreover, points the way to their reduction in other countries.
BACKGROUND: NCT04504500 (ClinicalTrials.gov). The trial was prospectively registered. Ethics Reference No: 320/23.6.2020, Bioethics and Conduct Committee, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

In this study, the aim was to evaluate the preferences and experiences interventions among women in Turkey. A total of 347 women who gave birth vaginally participated in this analytical cross-sectional study. Data were collected using the face-to-face interview technique in the clinic rooms within the first 24 hours after delivery, when the women\'s babies were asleep, allowing the mothers to comfortably answer the questions before discharge. The arithmetic mean, standard deviation and number-percentage distributions of the data were calculated. Of them, 81% had a positive birth experience at birth. The majority of the participating women did not want to undergo non-evidence based interventions with a limited effect during the intrapartum period. While evidence-based intrapartum care is provided, women\'s preferences should be taken into account, they should be informed about evidence-based interventions and these interventions should be performed during the intrapartum period.
Dans cette étude, l\'objectif était d\'évaluer les préférences et les expériences d\'interventions chez les femmes en Turquie. 347 femmes ayant accouché par voie vaginale ont participé à cette étude analytique transversale. Les données ont été collectées à l’aide de la technique d’entretien en face-à-face dans leurs chambres de la clinique dans les 24 heures suivant l’accouchement, lorsque les bébés des femmes dormaient et que les mères pouvaient facilement répondre aux questions avant leur sortie. La moyenne arithmétique, l\'écart type et les distributions en nombre et en pourcentage des données ont été calculées.Parmi eux, 81 % ont vécu une expérience positive à la naissance. La majorité des femmes participantes ne souhaitaient pas subir d\'interventions non fondées sur des données probantes et ayant un effet limité pendant la période intrapartum. Bien que des soins intrapartum fondés sur des données probantes soient fournis, les préférences des femmes doivent être prises en compte, elles doivent être informées des interventions fondées sur des données probantes et ces interventions doivent être effectuées pendant la période intrapartum.

OBJECTIVE: To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (>3 h) and the risk of postpartum hemorrhage (PPH) in a diverse population.
METHODS: We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged ≥18 years, presenting cephalically, and with a gestational age (GA) of ≥24 weeks at a tertiary maternity hospital in China (chictr.org.cn identifier: ChiCTR2200063094). Women undergoing emergency cesarean section in labor were excluded. The primary outcome was PPH, with secondary outcomes including severe postpartum hemorrhage and blood transfusion. We employed propensity score overlap weighting to analyze the association between prolonged second stage labor and PPH.
RESULTS: The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor >3 h and 3566 with a second stage ≤3 h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in >3 h group vs 17.64% in ≤3 h group; weighted odds ratio 1.01; 95% CI: 0.51-2.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third-/fourth-degree perineal laceration, GA >41 weeks, twin pregnancies, episiotomy and GA >37 weeks. Sensitivity analysis did not reveal significant differences.
CONCLUSIONS: This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting >3 h in our population, providing additional evidence for clinical practice.

Background and Objectives: The aim of this study was to analyze the association between maternal risk factors, such as age, body mass index (BMI), and cigarette smoking, and perinatal outcomes. Materials and Methods: We conducted a retrospective analysis based on prospectively collected data at Hospital Universitario de Torrejón (Madrid, Spain) between September 2017 and December 2019. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination at 11+0 to 13+6 weeks\' gestation were invited to participate. The association between preeclampsia, preterm birth, gestational diabetes mellitus (GDM), small-for-gestational-age (SGA) or fetal-growth-restricted (FGR) neonates, and type of delivery and maternal age, BMI, and cigarette smoking was studied. Logistic mixed models were used to analyze the data. Results: A total of 1921 patients were included in the analysis. Women who were ≥40 years old had a significantly higher risk of having GDM (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.08 to 2.36) and SGA neonates (OR 1.54, 95% CI 1.00 to 2.37). Women with a BMI < 18 had an increased rate of giving birth to SGA and FGR neonates (OR 3.28, 95% CI 1.51 to 7.05, and OR 3.73, 95% CI 1.54 to 8.37, respectively), whereas women with a BMI ≥ 35 had a higher risk of GDM (OR 3.10, 95% CI 1.95 to 4.89). Smoking increased the risk of having SGA and FGR neonates (OR 1.83, 95% CI 1.36 to 2.46, and OR 1.91, 95% CI 1.29 to 2.78). Conclusions: Advanced maternal age, low or high BMI, and smoking status are significant risk factors for pregnancy complications. Both clinicians and society should concentrate their efforts on addressing these factors to enhance reproductive health.