Evaluating the performance of an AI-powered VBAC prediction system within a decision-aid birth choice platform for shared decision-making.

Background: Vaginal birth after cesarean (VBAC) is generally regarded as a safe and viable birthing option for most women with prior cesarean delivery. Nonetheless, concerns about heightened risks of adverse maternal and perinatal outcomes have often dissuaded women from considering VBAC. This study aimed to assess the performance of an artificial intelligence (AI)-powered VBAC prediction system integrated into a decision-aid birth choice platform for shared decision-making (SDM). Materials and Methods: Employing a retrospective design, we collected medical records from a regional hospital in northern Taiwan from January 2019 to May 2023. To explore a suitable model for tabular data, we compared two prevailing modeling approaches: tree-based models and logistic regression models. We subjected the tree-based algorithm, CatBoost, to binary classification. Results: Forty pregnant women with 347 records were included. The CatBoost model demonstrated a robust performance, boasting an accuracy rate of 0.91 (95% confidence interval (CI): 0.86-0.94) and an area under the curve of 0.89 (95% CI: 0.86-0.93), surpassing both regression models and other boosting techniques. CatBoost captured the data characteristics on the significant impact of gravidity and the positive influence of previous vaginal birth, reinforcing established clinical guidelines, as substantiated by the SHapley Additive exPlanations analysis. Conclusion: Using AI techniques offers a more accurate assessment of VBAC risks, boosting women's confidence in selecting VBAC as a viable birthing option. The seamless integration of AI prediction systems with SDM platforms holds a promising potential for enhancing the effectiveness of clinical applications in the domain of women's healthcare.

[The Impact of Late Umbilical Cord Clamping on Neonatal Jaundice and Postpartum Hemorrhage: A Randomized Controlled Trail].

BACKGROUND: The current evidence supports the clinical benefits of late umbilical cord clamping. These benefits include increased blood volume and total body iron. Furthermore, delayed cord clamping facilitates the transplantation of stem cells, which helps the development of infant bodily systems. However, due to concerns related to postpartum hemorrhaging and neonate jaundice, most maternity units still clamp the cord immediately after a child is born. PURPOSE: This study investigates the impact of delaying cord clamping on neonatal jaundice and postpartum hemorrhage. METHODS: A randomized, controlled trial was conducted at a regional teaching hospital in northern Taiwan. One hundred and five healthy nulliparous women at 36 weeks of pregnancy were included and allocated randomly to the experiment group (n=44) and the control group (n=61). Participants in the experiment group received delayed cord clamping (DCC) at 3 minutes after delivery. Participants in the control group received early cord clamping (ECC) at around 1 minute after delivery. Clinical measures of the outcomes were measured by the infant transcutaneous bilirubin levels (TcB) and postpartum hemorrhage at birth. A structured questionnaire and biophysical measures were used to collect data on participant demographics, obstetrical information, maternal blood loss at birth, neonate weight and TcB level at hospitalization, and whether or not the infant received phototherapy at 4-7 days postpartum. RESULTS: Overall, there was no significant difference between the two groups in terms of neonatal jaundice, maternal hemorrhage at birth, and phototherapy rates at time of hospitalization and at 4-7 days postpartum. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of the present study support that late umbilical cord clamping does not increase the risk of maternal postpartum hemorrhaging or neonate jaundice. Thus, we suggest that clinicians inform clients during prenatal classes of the benefits of delayed cord clamping and also use current, evidence-based knowledge to dispel client worries regarding the dangers to maternal-neonate health of delayed cord clamping.

Factors related to milk supply perception in women who underwent cesarean section.

BACKGROUND: Perceived insufficient milk supply is common among postpartum women and is a major reason for early weaning. Studies indicate a significantly higher incidence of insufficient milk supply in women who undergo cesarean section as compared with women who undergo vaginal delivery. PURPOSE: This study was designed to determine perceived milk supply in postpartum women who underwent a planned cesarean section, as well as related factors. METHODS: Authors employed a descriptive correlational study design. Factors associated with milk supply perception in postpartum women (at 3 days postpartum) were collected from 141 postpartum women who planned to undergo cesarean section at a regional teaching hospital in northern Taiwan. A demographic data sheet, the Birth Practice Inventory, a visual pain analog scale, and the Hill and Humenick Lactation Scale were used to identify factors affecting the perceived milk supply of participants. RESULTS: The study used multiple linear regression to identify significant predictors of milk supply perception. Four factors, including parity, type of anesthesia, time to initial breastfeeding, and use of formula, explained 23.1% of total variance among participants. Women who experienced epidural patient-controlled analgesia, those with delayed initial breastfeeding or lower breastfeeding frequency, and those who used formula supplementation earned relatively lower perceived milk supply scores. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study results indicate that medical staff should encourage postpartum women to commence breastfeeding, based on infant need, as early as possible and reduce formula use to increase breastfeeding frequency. Shifting to nonnarcotic analgesic medications from epidural patient-controlled analgesia as early as possible is also recommended to increase breastfeeding success.

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial.

BACKGROUND: In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans. OBJECTIVE: The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences. DESIGN: A randomised, single-blind controlled trial study design was used. SETTINGS: This study involved seven hospitals and 10 obstetricians in Taiwan. PARTICIPANTS: Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n=155) or control (n=141) groups. METHODS: The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations. RESULTS: The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t=2.48, p=0.01). The experimental group also showed a higher degree of childbirth control (t=9.60, p<0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t=2.63, p=0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t=3.74, p<0.001) in the experimental group than in the control group. CONCLUSIONS: The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.