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

Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother\'s baby care process.
This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care.
The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales \'Fear of Childbirth and Postpartum Period\', and \'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care\'. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson\'s correlation, and simple linear regression analysis.
A statistically significant and positive correlation was found between participant scores of the \'Fear of Childbirth and Postpartum Period\' and the \'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care\' scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180).
Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.
La ansiedad del parto y el posparto es una condición común entre las mujeres embarazadas por la incertidumbre de vivir el embarazo y el parto por primera vez o por previas experiencias negativas. El miedo al parto puede afectar el proceso del cuidado del bebé de la madre.
Determinar el efecto de las preocupaciones maternas sobre el parto y el puerperio y su efecto sobre las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé.
El estudio se realizó con 260 madres. Los datos fueron recolectados en el formulario de información descriptiva y se usaron la “Escala de miedo al parto y al período posparto” y la de “Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionados con el cuidado del bebé”. Los datos fueron evaluados mediante el software SPSS™ mediante el cálculo de porcentajes, promedio, prueba t, ANOVA, correlación de Pearson y análisis de regresión múltiple.
Se encontró una correlación positiva y estadísticamente significativa entre la “Escala de miedo al parto y del período posparto” y la de “Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionadas con el cuidado del bebé” (p < 0.01). En el modelo creado por análisis de regresión se observó que el 18,0% del cambio en la escala de comportamientos obsesivos-compulsivos estaba explicado por el miedo al parto y al puerperio (R2 corregido = 0,180).
En el estudio se determinó que el miedo al parto y al puerperio era moderado. Sin embargo, a medida que aumentaba el puntaje de miedo al parto y al período posparto, también aumentaban los comportamientos obsesivos y compulsivos de las madres en el puerperio relacionados con el cuidado del bebé.

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.

UNASSIGNED: Episiotomy is a surgical procedure involving the enlargement of the posterior vagina to facilitate the delivery of the baby. This study aims to further investigate the associated risk factors for episiotomy and the specific indications for its use in spontaneous labor.
UNASSIGNED: This institutional-based cross-sectional study was conducted among 349 vaginal births with a ratio of 1:4 from January 2020 to December 2020. We recruited study participants using consecutive sampling techniques. The sample size was calculated with a hypothesis test for two population proportions (one-sided test formula). Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.
UNASSIGNED: In our multivariate analysis, it was found that pregnant women who underwent instrumental delivery (P-value=.00; OR=25.63; 95% CI: 5.76-114.0) and those with fetal birth weight >3,000 grams (P-value=.00; OR=11.31; 95% CI: 3.96-32.32) had the highest risk of undergoing an episiotomy. Subsequently, the duration of the second stage of labor >30 minutes (P-value=.049; OR=16.34; 95% CI: 1.01-264.48) was associated with a slightly increased risk of episiotomy. Fetal head circumference >34 cm was not found to be risk of an increased risk of episiotomy in this study. However, pregnant women aged >30 years (P-value=.049; OR=0.306; 95% CI: 0.94-0.99) showed a reduced risk of episiotomy.
UNASSIGNED: The prevalence of episiotomy practice in this study exceeds the recommended threshold set by the World Health Organization (WHO). Instrumental delivery, high birth weight, and prolonged second-stage labor emerged as significant factors influencing episiotomy practice. Hence, further interventions are warranted to mitigate the prevalence of episiotomy practice.

OBJECTIVE: This study aims to use Recurrence Quantification Analysis (RQA) of uterine vectormyometriogram (VMG) created from the slow wave (SW) and high wave (HW) bands of electrohysterogram (EHG) signals and assess the directionality of the EHG activity (horizontal or X, vertical or Y) in normal-weight (NW) and overweight (OW) women during the first stage of labor.
METHODS: The study involved 41 parturient women (NW=21 and OW=20) during the first stage of labor, all of whom were attended at the Gynecology and Obstetrics Hospital of the Maternal and Child Institute of the State of Mexico (IMIEM) in Toluca, Mexico. Twenty-minute EHG signals were analyzed in horizontal and vertical directions. Linear and nonlinear indices such as dominant frequency (Dom), Sample Entropy (SampEn), and RQA measures of VMG were computed for SW and HW bands.
RESULTS: Significant differences in SampEn and Dom were observed in the SW band between NW and OW in both X and Y directions, indicating more regular dynamics of electrical uterine activity and a higher dominant frequency in normal-weight parturient women compared to overweight women. Additionally, the RQA indices calculated from the VMG of SW were consistent and revealed that NW women exhibit more regular dynamics compared to OW women.
CONCLUSIONS: The study demonstrates that RQA of VMG signals and EHG directionality differentiate uterine activity between NW and OW women during the first stage of labor. These findings suggest that the uterine vector may become more periodic, predictable, and stable in normal-weight women compared to overweight women. This highlights the importance of tailored clinical strategies for managing labor in overweight women to improve maternal and infant outcomes. .

For surgeons and clinicians, nonobstetric surgery during pregnancy has certain difficulties and considerations. In order to aid in decision-making in these situations, this manuscript offers a thorough review of the guidelines currently in place from renowned obstetric and surgical societies, such as the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians & Gynecologists, and others. Using AGREE II-S methodology, a comprehensive analysis of guidelines reveals differences in recommendations for anesthetics, surgical procedures, imaging modalities, and thromboembolic prophylaxis. Furthermore, a thorough discussion of strategic surgical planning is provided, covering aspects such as patient positioning, trocar placement, pneumoperitoneum generation, and thromboembolic risk management. The publication highlights that in order to maximize the results for both the mother and the fetus after nonobstetric surgery performed during pregnancy, a multidisciplinary approach and evidence-based decision-making are essential.

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.

Asynclitism, a misalignment of the fetal head with respect to the plane of passage through the birth canal, represents a significant obstetric challenge. High degrees of asynclitism are associated with labor dystocia, difficult operative delivery, and cesarean delivery. Despite its clinical relevance, the diagnosis of asynclitism and its influence on the outcome of labor remain matters of debate. This study analyzes the role of the degree of asynclitism (AD) in assessing labor progress and predicting labor outcome, focusing on its ability to predict intrapartum cesarean delivery (ICD) versus non-cesarean delivery. The study also aims to assess the performance of the AIDA (Artificial Intelligence Dystocia Algorithm) algorithm in integrating AD with other ultrasound parameters for predicting labor outcome. This retrospective study involved 135 full-term nulliparous patients with singleton fetuses in cephalic presentation undergoing neuraxial analgesia. Data were collected at three Italian hospitals between January 2014 and December 2020. In addition to routine digital vaginal examination, all patients underwent intrapartum ultrasound (IU) during protracted second stage of labor (greater than three hours). Four geometric parameters were measured using standard 3.5 MHz transabdominal ultrasound probes: head-to-symphysis distance (HSD), degree of asynclitism (AD), angle of progression (AoP), and midline angle (MLA). The AIDA algorithm, a machine learning-based decision support system, was used to classify patients into five classes (from 0 to 4) based on the values of the four geometric parameters and to predict labor outcome (ICD or non-ICD). Six machine learning algorithms were used: MLP (multi-layer perceptron), RF (random forest), SVM (support vector machine), XGBoost, LR (logistic regression), and DT (decision tree). Pearson\'s correlation was used to investigate the relationship between AD and the other parameters. A degree of asynclitism greater than 70 mm was found to be significantly associated with an increased rate of cesarean deliveries. Pearson\'s correlation analysis showed a weak to very weak correlation between AD and AoP (PC = 0.36, p < 0.001), AD and HSD (PC = 0.18, p < 0.05), and AD and MLA (PC = 0.14). The AIDA algorithm demonstrated high accuracy in predicting labor outcome, particularly for AIDA classes 0 and 4, with 100% agreement with physician-practiced labor outcome in two cases (RF and SVM algorithms) and slightly lower agreement with MLP. For AIDA class 3, the RF algorithm performed best, with an accuracy of 92%. AD, in combination with HSD, MLA, and AoP, plays a significant role in predicting labor dystocia and labor outcome. The AIDA algorithm, based on these four geometric parameters, has proven to be a promising decision support tool for predicting labor outcome and may help reduce the need for unnecessary cesarean deliveries, while improving maternal-fetal outcomes. Future studies with larger cohorts are needed to further validate these findings and refine the cut-off thresholds for AD and other parameters in the AIDA algorithm.

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.

Inadvertent injection of drugs into the epidural space has a potential for serious morbidity and is probably underestimated and underreported. A 39-year-old female with no medical history presented for delivery. An epidural catheter was requested and correctly placed. Continuous epidural infusion was chosen for labor analgesia. Six hours after the parturient complained about inefficient analgesia, a syringe swap with insulin was identified. Despite the risk of possibly neurotoxic preservatives in the insulin formulation, no neurological sequelae were observed. This case highlights the issue of wrong-route drug administration and the urgent need to adopt route-specific connections.