The effect of prenatal education on health anxiety of primigravid women.

BACKGROUND AND AIM: Health anxiety is a mental disorder that characterized by an excessive fear about health and physical symptoms. High anxiety in pregnancy is associated with adverse outcomes. The aim of this study was to investigate the effect of prenatal education on health anxiety of primigravid women. METHODS: The present study was quasi-experimental study. 122 primiparous pregnant women referred to comprehensive health services Shahrekord (A city in the southwest of Iran) clinics in 2019, after receiving consent to participate in the study, randomly divided into two intervention and control groups. The intervention group participated in 8 sessions (1.5-h), once every 2 weeks, from 20 to 37th weeks of gestation. The health anxiety questionnaire was completed on 20th (before the beginning of the courses), 28th and 37th weeks by two groups. Consequences of pregnancy included weight, Apgar score, delivery type, labor time and first breastfeeding time. SPSS version 16 software was used for data analysis. RESULTS: No significant difference was found type of delivery, gestational age, height, weight, head length, Apgar score, duration of hospitalization and first breastfeeding time. The duration of the active and latent phase of labor was significantly lower and the weight of newborn was significantly higher in the intervention group than the control group (P < 0.05). At 37th week, the scores of illness concern, negative consequence and total health anxiety in the intervention group decreased by 3.42, 0.93 and 4.36 respectively and in control group increased by 2.82, 0.03 and 2.86. CONCLUSION: Pregnancy educational courses has positive effects on health anxiety, decrease duration of labor time and increased newborn weight. In order to improve the outcome of pregnancy, educational classes during pregnancy should be considered.

Is the surge in cesarean section rates during the COVID-19 pandemic truly substantiated?

BACKGROUND: Cesarean section (C-section) rates, deemed a critical health indicator, have experienced a historical increase. The advent of the COVID-19 pandemic significantly impacted healthcare patterns including delays or lack of follow-up in treatment and an increased number of patients with acute problems in hospitals. This study aimed to explore whether the observed surge is a genuine consequence of pandemic-related factors. METHODS: This study employs an Interrupted Time Series (ITS) design to analyze monthly C-section rates from March 2018 to January 2023 in Kurdistan province, Iran. Segmented regression modeling is utilized for robust data analysis. RESULTS: The C-section rate did not show a significant change immediately after the onset of COVID-19. However, the monthly trend increased significantly during the post-pandemic period (p < 0.05). Among primigravid women, a significant monthly increase was observed before February 2020 (p < 0.05). No significant change was observed in the level or trend of C-section rates among primigravid women after the onset of COVID-19. CONCLUSION: This study underscores the significant and enduring impact of the COVID-19 pandemic in further increasing the C-section rates over the long term, the observed variations in C-section rates among primigravid women indicate that the COVID-19 pandemic had no statistically significant impact.

Influence of Physical Activity Including Squat Exposure on Trunk Muscle Strength and Labour Outcome in Pregnant Women.

Daily living physical activities of rural pregnant women, across most continents in the world, involve adoption of high-flexion postures like deep-squat. Deep-squat elicits substantial activation of major trunk and lower extremity muscles. Adequate strength of trunk muscles is known to facilitate forward-downward propulsion of baby during labour. Therefore, current study aimed to explore influence of overall physical activity including squat exposure on trunk and lower-extremity muscle strength and labour outcomes in rural and urban primigravida women. Twenty-eight primi-gravida women were stratified into 2 groups: rural habitual-squatters (n=14) and urban non-squatters (n=14). Daily squat exposure was measured using MGM-Ground-Level-Activity-Questionnaire; lower-lumbar spine motion with modified-Schober-test; lower-extremity muscle strength using 30-sec-chair-raise-test, trunk muscle endurance with pressure biofeedback, calf muscle endurance was measured using calf raise test. Duration of second stage of labour and type of delivery was recorded. Habitual Squatters (average squat exposure=68.9±25.3 min) demonstrated lower waist: hip ratio (p=0.02); greater overall physical activity level (p=0.001), lumbo-pelvic mobility (p=0.02), lower-extremity muscle strength (p=0.001); and shorter duration of 2nd stage of labour (p=0.001) compared to non-squatters. Excellent positive correlation was observed between daily-squat exposure and back muscle endurance (Spearman's rho=0.98, p=0.001). Normal vaginal delivery was conducted in 83% squatters and in 71% non-squatters. Present findings indicate strong influence of habitual physical activity including squat exposure on improved trunk-lower-extremity strength, lumbo-pelvic mobility and shorter duration of second stage of labor.

Pregnancy Concerns as Predictors of Sleep Quality in Primigravid Women: A Cross-Sectional Study.

Introduction Poor sleep quality may be a risk factor for adverse pregnancy outcomes. Identifying the predictors of sleep disorders can help design effective interventions. The present study aimed to evaluate the impact of pregnancy concerns on the sleep quality of primigravid women. Methods This cross-sectional study was conducted on 220 primigravid women referred to health centers in Hamadan, Iran. In addition to completing the demographic characteristics questionnaire, the Parkinson's Disease Questionnaire (PDQ) questionnaire was completed to determine the level of pregnancy concerns, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed to determine the quality of sleep by pregnant women. Data were analyzed using descriptive statistics, the Pearson correlation coefficient, independent t-test, and univariate and multivariate logistic regression models with a backward method at a 95% confidence level. Results Pregnant women's total PSQI score was 13.8 ± 3.08, and with a PSQI ≥ 5 as a cut-off point, 76.3% of the study's participants had poor sleep quality. There was a significant direct correlation between the total score of PDQ and its subscales with the total PSQI score (P < 0.05). The adjusted regression logistic model showed a significant relationship between the PDQ scores, women's educational level (adjusted odds ratio (AOR) 1.19; confidence interval (CI) 95%: 0.19-2.18), and their spouse's educational level (AOR 1.03; CI 95%: 0.02-2.03) with sleep quality scores. Conclusion Pregnancy concerns, including concerns about birth and the baby, concerns about physical symptoms and body image, and concerns about emotions and relationships, can reduce the sleep quality of primigravid women. Designing and implementing effective interventions to reduce or modify these common concerns can improve the sleep quality of pregnant women and prevent the adverse effects of poor sleep quality on pregnancy outcomes.

Saudi Arabian Primigravid Women's Experiences of Mindfulness to Reduce Childbirth Stress: A Qualitative Study.

Introduction: Pregnancy is a significant transitional life experience. It can also be one of the most stressful experiences in life and some women go on to develop postpartum depression. Adopting mindfulness techniques during childbirth may allow women to experience less labor pain and require fewer medical interventions, which improve the mother's health. Objective: To investigate the effectiveness of mindfulness in reducing childbirth stress in primigravid women in Saudi Arabia. Methods: The researcher recruited primigravid women from an antenatal clinic in a government hospital in the Eastern Province of Saudi Arabia. The study adopted a qualitative interpretive descriptive design, using individual interviews to collect the data before conducting thematic content analysis using NVivo 10.1 software. Results: Five key themes emerged from the data: (a) stress reduction, (b) recognition of thoughts and feelings, (c) life satisfaction, (d) insufficient knowledge leads to challenges, and (e) empowerment of a spiritual aspect. Conclusions: Mindfulness is an effective technique that supports a mother's physical and psychological well-being.

Differences in Immune phenotype in decidual tissue from multigravid women compared to primigravid women.

PROBLEM: Women with a previous uncomplicated pregnancy have lower risks of immune-associated pregnancy disorders in a subsequent pregnancy. This could indicate a different maternal immune response in multigravid women compared to primigravid women. In a previous study, we showed persistent higher memory T cell proportions with higher CD69 expression after uncomplicated pregnancies. To our knowledge no studies have reported on immune cells in general, and immune memory cells and macrophages specifically in multigravid and primigravid women. METHOD OF STUDY: T cells and macrophages were isolated from term decidua parietalis and decidua basalis tissue from healthy primigravid women (n = 12) and multigravid women (n = 12). Using flow cytometry, different T cell populations including memory T cells and macrophages were analyzed. To analyze whether a different immune phenotype is already present in early pregnancy, decidual tissue from uncomplicated ongoing pregnancies between 9 and 12 weeks of gestation from multigravida and primigravid women was investigated using qRT-PCR. RESULTS: Nearly all T cell subsets analyzed in the decidua parietalis had significantly higher CD69+ proportions in multigravid women compared to primigravid women. A higher proportion of decidual (CD50- ) M2-like macrophages was found in the decidua parietalis in multigravid women compared to primigravid women. In first trimester decidual tissue higher FOXP3 mRNA expression was found in multigravid women compared to primigravid women. CONCLUSIONS: This study shows that decidual tissue from multigravid women has a more activated and immunoregulatory phenotype compared to decidual tissue from primigravid women in early pregnancy and at term which could suggest a more balanced immune adaptation towards pregnancy after earlier uncomplicated pregnancies.

Evaluation of a Novel Infrared Thermography Projection to Assess Udder Health in Primigravid Dairy Heifers.

Heifer mastitis in early lactation impacts negatively on animal welfare, milk production and longevity. A major challenge for the prevention and control of mastitis in dairy heifers is to establish when intramammary infection occurs because pre-partum secretum sampling is risky. We evaluated a ventrodorsal projection to capture thermal images of the entire udder of primigravid and compared results against caudocranial projection, which is used in lactating cattle. Based on the analysis of 119 heifers and images taken at 2 months and 2 weeks pre-partum, a very strong positive correlation (r = 0.91 and r = 0.96, respectively) was shown between caudocranial and ventrodorsal projections of hind quarters. Quarter maximum gradient temperatures were consistently greater on ventrodorsal projection than on caudocranial projection, and less variable than minimum gradient temperatures. The collection of ventrodorsal images is a simple one-step method involving the imaging of the entire udder in a manner safe for both the cattle and handlers. Together, these results demonstrate that a single projection can be used to scan the entire udder of primigravid dairy heifers in commercial farm conditions, with the potential to implement this as a routine method for the early detection of intramammary infection based on udder surface temperature.

Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study.

BACKGROUND AND AIM:  The aim of this study was to compare the effects of epidural analgesia on relief of labor pain, progress, and outcome of labor in primigravid parturients to those who did not receive any analgesia. METHODS: This was a hospital-based, quasi-experimental study conducted on 70 primigravid parturients at term with a single fetus in a cephalic presentation in active labor. Parturients who were willing to receive epidural analgesia formed group S (n=35) and parturients who refused epidural analgesia formed group C (n=35). The primary objective was to compare alleviation of pain measured by the Visual Analogue Scale (VAS) score. Secondary objectives were to compare the duration of labor, mode of delivery, and neonatal outcome. RESULTS: Pain intensity was significantly lower in group S compared to group C at all measured points of time (p<0.001). There was a quick fall in mean VAS score in group S from 7.94 to 3.86 within 20 min with the bolus dose, it further dropped to 1.03 after 3 h. Further, 88.6% of parturients in groups rated their pain relief as excellent and good satisfaction score. Prolongation of active phase of the first stage of labor (>6 h) was not significant (17.1 % in epidural group versus 5.7% in control group; p=0.259). However, prolongation of the second stage of labor (> 2h) was significant (18.2% in study group versus 0% in control group; p=0.024). The rate of cesarean section, instrumental vaginal delivery, and neonatal outcome was similar in both groups. No adverse effects were observed on maternal vitals, fetal heart rate and Apgar score at 5 min. CONCLUSION:  Epidural analgesia alleviated labor pain in all primigravid parturients who opted for it, without an increase in cesarean section and instrumental vaginal birth. Improved parturients' satisfaction with associated neonatal safety provides a positive birth experience. There was no effect on duration of active phase of the first stage of labor, but the duration of the second stage of labor was slightly prolonged.

An exploratory study of associations with spontaneous preterm birth in primigravid pregnant women with a normal cervical length.

BACKGROUND: Predictors of spontaneous preterm birth in primigravid women remain undetermined. AIM: We evaluated whether biomarkers in vaginal secretions and/or differences in the dominant bacterium in the vaginal microbiome predicted the risk for spontaneous preterm birth in primigravid women with a cervical length >25mm. STUDY DESIGN: In a prospective study, 146 second trimester pregnant women with their first conception and a cervix >25mm were enrolled. The vaginal microbiome composition was characterized by analysis of 16S ribosomal RNA gene sequences. The concentrations of d- and l-lactic acid, matrix metalloproteinase (MMP) 2, 8 and 9 and tissue inhibitor of metalloproteinase (TIMP) 1 and 2 in vaginal secretions were measured by ELISA. Cervical length was determined by vaginal ultrasonography. Pregnancy outcome data were subsequently collected. There was a spontaneous preterm birth (SPTB) in 13 women (8.9%) while in an additional 8 women (5.5%) preterm delivery was medically indicated. Lactobacillus iners was the dominant vaginal bacterium in 61.5% of women with a SPTB but only in 31.2% of those who delivered at term (p = .0354). The vaginal concentration of TIMP-1 (p = .0419) and L-lactic acid (p = .0495) was higher in women with a SPTB as compared to those who delivered at term. Lactobacillus iners dominance was associated with elevated levels of TIMP-1 (p = .0434) and TIMP-2 (p = .0161) and lower levels of D-lactic acid (p < .0001) compared to when L. crispatus was dominant. CONCLUSION: In this exploratory study of primigravid women, elevations in vaginal TIMP-1 and L- lactic acid and L. iners dominance in the vaginal microbiome are associated with an increased occurrence of SPTB.

Caesarean section rates in primigravid women categorised by age and BMI.

The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women <20 years/BMI < 18.5 was 8.8 versus 57.6% for women 35 - 39 years/BMI 30 - 34 and 76 - 100% for all women >45 years (p<.005). The development of customised charts subdivided by age and BMI may be a useful counselling tool and assist in the comparison of rates between units.Impact statementWhat is already known on this subject? It is well known that along with rising CS rates globally, there have also been significant changes in maternal demographics-with increasing maternal age at first birth and increasing maternal BMI. It is well established that both of these factors affect the rate of CS in a population.What do the results of this study add? This study sought to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. The results of the study showed an increasing CS rate for increasing age and BMI categories that was statistically significant.What are the implications of these findings for clinical practice and/or further research? Additional research using larger population data sets could allow the development of customised charts for nulliparous women subdivided by age and BMI which could act as a useful counselling tool in clinical practice, as well as assist in the comparison of CS rates between units.

Spontaneous unscarred uterine rupture in a primigravid patient at 11 weeks of gestation managed surgically: A rare case report.

INTRODUCTION: Spontaneous rupture of the primigravid uterus is a rare but catastrophic obstetrical emergency. It usually occurs late in pregnancy or during labour, mainly in multiparous women. But, spontaneous unscarred uterine rupture in a primigravid patient that also in first trimester is very rare. There are only 12 papers in Pub Med database regarding spontaneous unscarred uterine rupture in primigravid in early pregnancy. CASE PRESENTATION: A 23-year-old primigravid female at 11th week of pregnancy, with no significant medical or surgical history, presented with sudden onset of generalised abdominal pain for four hours with multiple episodes of vomiting. On physical examination, patient was pale, in haemorrhagic shock with diffuse abdominal tenderness. Ultrasonography showed extra uterine gestational sac with massive haemoperitoneum. Eventually, patient was subjected to emergency laparotomy after resuscitation. CLINICAL DISCUSSION: Spontaneous rupture of unscarred gravid uterus is a catastrophic rare condition that can be missed leading to maternal and foetal mortality. There are no pathognomonic features indicating the condition therefore it should be differentiated from other causes of acute abdominal emergencies. CONCLUSION: Spontaneous rupture of unscarred gravid uterus should be differentiated from other acute abdominal emergencies. Patient may land up in emergency department in the state of shock, emergency physicians should be aware of its symptoms or presentations.

Evaluating the Effectiveness of Childbirth Preparation Courses on Women's Self-Efficacy among Ultra-Orthodox Jewish Religious Women in Israel.

Background: This study examined the effectiveness of a birth preparation course on coping with childbirth among primigravid ultra-orthodox Jewish women in Israel. Methods: In total, 130 ultra-orthodox 25-35-week primigravid women were divided into a study (n = 100, participated in birth preparation courses) and a control (n = 30, did not participate in the courses) group. A questionnaire was delivered three times: T1-before the course/delivery, T2-two-three days after delivery, and T3-a month after delivery. Results: At T3, self-efficacy among the study group was higher than in the control group. Differences in self-efficacy were found over time regardless of the group (F(2,246) = 12.83, p < 0.001), as a time-group interaction effect (F(2,246) = 10.20, p < 0.01). Self-efficacy in the study group (Mean, M = 3.40, Standard deviation, SD = 0.63 at T1) dropped to M = 3.06, SD = 0.76 at T2 and rose to M = 3.34, SD = 0.64 at T3. In the control group, self-efficacy (M = 3.53, SD = 0.56 at T1) dropped to M = 3.26, SD = 0.63 at T2 and to M = 2.95, SD = 0.76 at T3. Discussion: The childbirth preparation course was found to be effective in raising self-efficacy among primigravid ultra-orthodox religious women when compared to the control group.

An psychoeducation programme based on self-efficacy theory to improve experience of natural birth for primigravid women: Study protocol for a randomised controlled trial.

AIM AND OBJECTIVES: To present a study protocol for estimating the feasibility, effectiveness and safety of an individual (five sessions), group (one session) and face-to-face psychoeducation programme based on self-efficacy theory to improve childbirth experience of primigravid women. BACKGROUND: In present China, fertility rates are falling and ageing is accelerating. How to improve the fertility level of childbearing women is of great significance. However, about 10%-20% of women have negative childbirth experience after birth, which seriously affects maternal and child health and family functions, and even fertility desires and intentions in the future. Nevertheless, due to the lack of a series of well-designed randomised controlled trials(RCTs), there is no specific methodology to guide the most effective intervention for primigravid women. In this regard, based on Bandura's self-efficacy theory, an intervention programme to promote a positive childbirth experience for primigravid women has been designed and will be evaluated to determine its impact on primigravid women. DESIGN: A non-blinded randomised controlled trial. METHODS: We report the study protocol for this randomised controlled trial based on the SPIRIT2013 statement. A total of 238 eligible primigravid women will be randomly divided into the control group (n = 119) or the intervention group (n = 119). The control group will receive care as usual, that is, six routine prenatal examinations. In addition to the routine examinations, the intervention group will also receive six face-to-face interventions. Baseline assessment will occur at about 24th week of gestation and follow up at 37th weeks of gestation, intrapartum, 1-3 days postpartum and 42 days postpartum. The primary outcomes are childbirth experience, childbirth self-efficacy; others are fear of childbirth, labour control, labour pain and labour satisfaction. IMPACT: From the perspective of clinical work, this protocol provides practical guidance for cultivating the positive childbirth experience of the primigravid women. From the perspective of sociology, the positive experience and emotion of primigravid women can improve the fertility intention of women of childbearing age, which is relatively conducive to optimising Chinese demographic structure and reducing the pressure of ageing population in the long term.

Successful deliveries of uterine prolapse in two primigravid women after obstetric management and perinatal care: case reports and literature review.

Uterine prolapse as a common form of pelvic organ prolapse (POP) is very rare during pregnancy. The literature was extremely limited concerning the management and causation of uterine prolapse during pregnancy women, especially in nulliparous women. We reported two cases of uterine prolapse in two primigravid female. Analysis and recommendations regarding the reasons and management of this condition was provided with past 20-year literature review. In our report, two patients noticed a lump protruding from vagina in the third and second trimester of pregnancy and were found uterine prolapse (28+3 weeks and 24 weeks of gestation respectively). One patient' prolapsed uterus cannot be returned spontaneously, vaginal packing with sterilized oil gauze and indwelling catheter were executed. She was hospitalized and with careful antenatal care. Corticosteroids were administered for fetal lung maturation. But the patient underwent emergency cesarean section because of obstetric factors two days later and two healthy twins were born. Another one treated with conservative antenatal management for a month, and with cesarean delivery at 33+6 weeks of pregnancy. After the delivery, patients were found no uterine prolapse at one-month post-partum examination. Successful pregnancy outcome of uterine prolapse depending on symptomatology, severity of the prolapse, obstructed status and the preference of patients; based on these facts require individualized management and treatment.

A case of spontaneous uterine artery pseudoaneurysm in a primigravid woman at 16 weeks gestation.

We report a case of a uterine artery pseudoaneurysm in a 29-year-old primigravid woman at 16 weeks gestation. The woman presented to the emergency room with lower left quadrant pain and vaginal bleeding. Ultrasound revealed a left adnexal mass consistent with a pseudoaneurysm. Percutaneous thrombin injection was chosen to avoid contrast and radiation risks to the fetus. Ultrasound demonstrated thrombosis of the pseudoaneurysm with no evidence of fetal distress. On postprocedure day 2, the patient presented again with similar complaints of lower quadrant pain and vaginal bleeding. The pseudoaneurysm was found to have recanalized and a decision was made to treat with computed tomography angiography and coil embolization. The procedure was successful, with angiography revealing an incidental branch of the pseudoaneurysm that was subsequently embolized.

The impact of gravidity, symptomatology and timing of infection on placental malaria.

BACKGROUND: Placental malaria is associated with increased risk of adverse perinatal outcomes. While primigravidity has been reported as a risk factor for placental malaria, little is known regarding the relationship between gravidity, symptomatology and timing of Plasmodium falciparum infection and the development of placental malaria. METHODS: The aim of this study was to investigate the relationship between the development of placental malaria and gravidity, timing of infection, and presence of symptoms. This is a secondary analysis of data from a double-blind randomized control trial of intermittent preventive therapy during pregnancy in Uganda. Women were enrolled from 12 to 20 weeks gestation and followed through delivery. Exposure to malaria parasites was defined as symptomatic (fever with positive blood smear) or asymptomatic (based on molecular detection of parasitaemia done routinely every 4 weeks). The primary outcome was placental malaria diagnosed by histopathology, placental blood smear, and/or placental blood loop-mediated isothermal amplification. Multivariate analyses were performed using logistic regression models. Subgroup analysis was performed based on the presence of symptomatic malaria, gravidity, and timing of infection. RESULTS: Of the 228 patients with documented maternal infection with malaria parasites during pregnancy, 101 (44.3%) had placental malaria. Primigravidity was strongly associated with placental malaria (aOR 8.90, 95% CI 4.34-18.2, p < 0.001), and each episode of malaria was associated with over a twofold increase in placental malaria (aOR 2.35, 95% CI 1.69-3.26, p < 0.001). Among multigravid women, the odds of placental malaria increased by 14% with each advancing week of gestation at first documented infection (aOR 1.14, 95% CI 1.02-1.27, p = 0.02). When stratified by the presence of symptoms, primigravidity was only associated with placental malaria in asymptomatic women, who had a 12-fold increase in the odds of placental malaria (aOR 12.19, 95% CI 5.23-28.43, p < 0.001). CONCLUSIONS: Total number of P. falciparum infections in pregnancy is a significant predictor of placental malaria. The importance of timing of infection on the development of placental malaria varies based on gravidity. In primigravidas, earlier asymptomatic infections were more frequently identified in those with placental malaria, whereas in multigravidas, parasitaemias detected later in gestation were associated with placental malaria. Earlier initiation of an effective intermittent preventive therapy may help to prevent placental malaria and improve birth outcomes, particularly in primigravid women.

Occurrence of ß-lactam-resistant Staphylococcus aureus in milk from primiparous dairy cows in the northeastern region of Brazil.

The objective of the current study was to isolate and identify Staphylococcus (S.) aureus strains resistant to beta-lactam antibiotics from primiparous cows' milk. A total of 432 milk samples were collected from all primiparous dairy cows in early lactation that originated from 9 dairy properties. All samples were cultured in Mannitol salt agar enriched with egg yolk emulsion. Determination of genotypic resistance of S. aureus was achieved by polymerase chain reaction (PCR) for amplification of the blaZ, mecA, and mecC genes. Phenotypic resistance of S. aureus strains was evaluated by minimal inhibitory concentration (MIC) technique using broth microdilutions of penicillin G and oxacillin. From all the mammary quarters examined, S. aureus strains were detected in 27 out of 432 (6.25%) milk samples (CI95%, 4.33-8.84). From all dairy properties visited, only two out of 9 were found to have S. aureus. Hence, it was possible to evaluate genotypic and phenotypic resistance in 27 samples from two dairy farms. The isolates of S. aureus had a frequency of (20/27) 74.07% to blaZ gene (CI95%, 57.5-90.6), whereas mecA and mecC genes were not observed. According to MIC results, penicillin G had a 74.07% (20/27) resistance rate (CI95%, 57.5-90.6) and oxacillin had a 14.81% (4/27) resistance rate (CI95%, 1.4-28.2). Thus, the circulation of S. aureus strains resistant to beta-lactams has been confirmed in primiparous dairy cows in the northeastern region of Brazil, indicating the need for new management strategies involving the use of beta-lactam drugs to treat mastitis, discouraging and/or limiting their use. Also, it is important to highlight the need for further studies on epidemiology and traceability of the pathogen.

Vacuum extraction delivery at first vaginal birth following cesarean: maternal and neonatal outcome.

OBJECTIVE: To evaluate the maternal and neonatal morbidity outcome associated with vacuum assisted (VA) vaginal delivery at first vaginal birth following a previous cesarean delivery (CD). STUDY DESIGN: This is a retrospective computerized study conducted at a single tertiary center, between 2005 and 2018. The study compared the morbidity outcome of VA vaginal delivery between two groups of parturients at their first vaginal birth; primigravid and those in second delivery with a prior cesarean. The primary outcome was the maternal adverse outcome: postpartum hemorrhage (PPH), anal sphincter injuries, retained placenta, shoulder dystocia, uterine rupture, and intensive care unit (ICU) admissions. Secondary outcome was the neonatal adverse outcome: Apgar score, NICU admission, meconium aspiration, jaundice, sepsis, birth trauma, and death. Univariate analysis was followed by a multiple logistic regression model controlling for potential confounders, adjusted odds ratios (95% confidence interval). RESULTS: During the study period, we identified 3695 parturients that engaged in Trial of labor after cesarean with no previous vaginal birth, among which 679 (18.4%) delivered by Vacuum (VA-VBAC). These were compared to 6544/43,083 (15.2%) primigravid delivered by Vacuum. The VA-VBAC group had higher risk of PPH (10.5% vs. 7.2%, p < 0.01), blood transfusions (5.6% vs. 3.5%, p < 0.01), retained placenta (10.2% vs. 4.7%, p < 0.01), and uterine rupture (0.4% vs. 0%, p < 0.01). The adverse neonatal outcomes were comparable among groups. CONCLUSION: The VA-VBAC has a higher risk of maternal postpartum hemorrhagic complications; preventive measures should be directed to this selected group of operative vaginal deliveries.

Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi.

BACKGROUND: In resource-limited settings, childbirth remains a matter of life and death. High levels of childbirth fear in primigravid women are inevitable. To date, few studies have explored interventions to reduce childbirth fear in primigravid women. This study aimed to evaluate the efficacy of companion-integrated childbirth preparation (C-ICP) during late pregnancy for reducing childbirth fear and improving childbirth self-efficacy, birth companion support, and other selected pregnancy outcomes in primigravid women. METHODS: A quasi-experimental study was carried out using a non-equivalent control group design to recruit a sample of 70 primigravid women in hospital maternity waiting homes in the intervention and control groups, with 35 in each group. The primigravid women and their birth companions in the intervention group received two sessions of companion-integrated childbirth preparation, whereas the control group received routine care. A questionnaire that incorporated the childbirth attitude questionnaire (CAQ), the childbirth self-efficacy inventory (CBSEI), the birth companion support questionnaire (BCSQ), and a review checklist of selected pregnancy outcomes was used to collect data. Pretest and post-test data were analyzed using simple linear regression. Beta coefficients were adjusted at a 95% confidence interval with statistical significance set at a P-value of < 0.05 using Statistical Package for the Social Sciences version 25. RESULTS: At pretest, mean scores were similar in the intervention and control groups. At post-test, being in the intervention group significantly decreased childbirth fears (ß: = - .866, t (68) = - 14.27, p < .001) and significantly increased childbirth self-efficacy (ß: = .903, t (68) = 17.30, p < .001). In addition, being in the intervention group significantly increased birth companion support (ß: = - 0.781, t (68) = 10.32, p < .001). However, no statistically significant differences regarding pregnancy outcomes were observed between the study groups (Mann-Whiney U test, p > .05). CONCLUSION: The findings of our study suggest that C-ICP is a promising intervention to reduce childbirth fear while increasing childbirth self-efficacy and maternal support. We recommend the inclusion of C-ICP for primigravid women during late pregnancy in resource-limited settings.

The effectiveness of utilizing the Zhang's criteria compared to Friedman's criteria in increasing the rate of successful vaginal delivery among primigravid parturient in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#To determine the effectiveness of utilizing the Zhang's criteria as compared to Friedman's criteria in increasing the rate of successful vaginal delivery among primigravid parturient in a tertiary government hospital. @*Material and Methods@#This is a prospective cohort study conducted in a tertiary hospital. The population consisting of primigravid parturient of any age admitted at term pregnancy with a gestational age between 37 and 42 weeks. Included were singleton pregnancy, with no co-morbidities, vertex position on admission, with intact amniotic membranes, and in active phase of labor (either 4cm or 6cm cervical dilatation), who consulted at the emergency room of the institution. Multigravid patients, those with multiple pregnancy and ruptured membranes were excluded from the study. Two groups of cohorts were recruited based on the internal examination of the principal investigator upon admission. Cohort A is composed of pregnant women admitted at 6cm cervical dilatation fulfilling the Zhang's criteria whereas Cohort B is composed of pregnant women admitted at 4cm cervical dilatation fulfilling the Friedman's criteria. Socio-demographic characteristics were recorded. Their course of labor was monitored; contractions were augmented accordingly if needed. The mode of delivery was noted such as spontaneous vaginal delivery or cesarean section. The neonatal outcome was recorded as to apgar scores obtained for both groups. @*Results@#A greater proportion of parturients were young, single and with normal body mass index. A higher proportion of those under Friedman's group was augmented with oxytocin (100% vs. 53.4%). A greater proportion of those in Zhang's group had successful vaginal delivery (98.2% vs. 81.8%) (p=0.011, OR=18.167, 95% CI: 1.943, 169.867). Parturients under Zhang's group had achieved less hours of active labor. @*Conclusion@#The rate of successful vaginal delivery is significantly different between the two groups. A greater proportion of pregnant women under Zhang's group achieved successful vaginal delivery as compared to Friedman's group.