Childbirth experiences of women with a history of physical, sexual, and child abuse: a cross-sectional study of 2,575 Russian women.

BACKGROUND: A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour. METHODS: A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma. RESULTS: Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(ß) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(ß) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth. CONCLUSION: This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.

Perinatal Outcome in Overweight Women: An Audit.

BACKGROUND: Obesity in pregnancy is associated with a myriad of well-documented complications. However, the outcomes of pregnancy in overweight females, who are not classified as obese, have not been studied. The aim of the study was to assess foeto-maternal outcomes in primigravida who are overweight and compare them to normal-weight patients. MATERIAL AND METHODS: This was a prospective observational cohort study and included primigravida with full-term gestation (between 38 and 42 weeks), with a single live foetus in vertex presentation, who were admitted for labour induction. Based on pre-pregnancy weight, patients were divided into normal weight (body mass index, BMI<23kg/m2) and overweight (BMI≥23kg/m2 and<25kg/m2) categories labelled as groups A and B, respectively. Data was collected for gestational age, demographics (age, education, occupation), and obstetric and labour-related parameters per pre-designed proforma. Parameters included were the reason for induction, number of doses of prostaglandin E2 (PGE2) gel used, duration of labour, induction to delivery interval, and mode of birth- operative/ non-operative. Data was also collected for peri-partum maternal complications, neonatal Apgar score, and need for Neonatal Intensive Care Unit (NICU) admissions. RESULTS: One hundred and fifty patients were recruited in the study and divided based on weight into two groups- 115 in Group A (normal weight) and 35 in Group B (overweight). Compared to Group A, a higher proportion of patients in Group B needed a third dose of PGE2 gel (n=24, 20.8% vs n=18, 51.4%). Also, more patients in Group B had an induction to delivery time of longer than 30 hours (n=7, 20% vs n=5, 4.3%) and had a higher incidence of failed induction needing caesarean section (n=9, 25.7% vs n=13, 11.3%). Neonates born to overweight mothers had a poor Apgar score at 1 min. However, on reassessment, Apgar improved at 5 minutes, and no statistically significant difference was seen for admission to NICU- 5.7% (n=2) in Group B vs 1.7% (n=2) in Group A Conclusion: Pregnancy in overweight females is associated with prolonged labour, higher instances of failed induction, and poor neonatal outcomes at initial assessment. Thus, perinatal counselling and management should focus on weight control while also planning appropriate strategies for monitoring and treating pregnancy-related complications if weight control measures fail. Although obesity is the main focus of research, we suggest including overweight but non-obese females in such studies as they have similar adverse outcomes and complications.

Long-term trends in the incidence and management of shoulder dystocia in a tertiary obstetric unit in Hong Kong.

INTRODUCTION: Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019. METHODS: This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital's electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods. RESULTS: The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045). CONCLUSION: More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.

Obesidad pregestacional y alteraciones del parto

Objetivo . Establecer la asociación entre obesidad pregestacional y el riesgo de alteraciones del parto. Diseño. Estudio de cohortes retrospectivo. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Métodos . Resultante obstétrica de pacientes según índice de masa pregestacional -obesidad (grupo A), sobrepeso (grupo B) y peso normal (grupo C)- atendidas entre enero y diciembre de 2021. Principales medidas de estudio. Duración del embarazo y duración, tipo y alteraciones del parto. Resultados . Se atendió 2,250 partos durante el periodo de estudio, de los cuales se seleccionó 226 gestantes para el análisis. La mayoría de gestantes (60,5%) fueron asignadas al grupo A, 47 (20,8%) al grupo B y 41 (17,5%) al grupo C. Las gestantes del grupo A presentaron una mayor probabilidad de cesárea (razón de probabilidad (RP) 1,76; intervalo de confianza del 95% (IC95%), 1,03 a 2,98), de parto prolongado (RP 2,09; IC95%, 1,23 a 3,53) y de embarazo prolongado (RP 2,30; IC95%, 1,32 a 4,01) comparadas con las embarazadas del grupo C. Las gestantes del grupo B no mostraron diferencias estadísticamente significativas en la frecuencia de las variables obstétricas comparado con las gestantes del grupo C (p = ns). Conclusión . Existió asociación significativa entre la obesidad pregestacional y el riesgo de alteraciones del parto.

Objective : To establish the association between pregestational obesity and the risk of birth alterations. Design: Retrospective cohort study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Obstetric outcome of patients according to pregestational mass index -obese (group A), overweight (group B), and normal weight (group C)- attended between January and December 2021. Main study measures: Duration of pregnancy and duration, type and alterations of delivery. Results : A total of 2,250 deliveries were attended during the study period, of which 226 pregnant women were selected for analysis. The majority of the pregnant women (60.5%) were assigned to group A, 47 (20.8%) to group B, and 41 (17.5%) to group C. Pregnant women in group A had a higher probability of cesarean section (odds ratio (OR) 1.76; 95% confidence interval (95%CI), 1.03 - 2.98), prolonged labor (OR 2.09; 95%CI, 1.23 - 3.53) and prolonged pregnancy (OR 2.30; 95%CI, 1.32 - 4.01) compared to pregnant women in group C. The pregnant women in group B did not show statistically significant differences in the frequency of obstetric variables compared to the pregnant women in group C (p = ns). Conclusion : There was a significant association between pregestational obesity and the risk of birth alterations.

Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times.

OBJECTIVE: To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. METHODS: An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. RESULTS: The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P < 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P < 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P < 0.010). CONCLUSIONS: Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.

Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study.

OBJECTIVES: Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH). METHODS: The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis. RESULTS: Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team. CONCLUSION: The participants' experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.

Balões de tamponamento intrauterino na hemorragia pós-parto ­ Atualizações / Uterine balloon tamponade in postpartum hemorrhage ­ Updates

A hemorragia pós-parto continua sendo uma condição relacionada a elevada morbimortalidade materna, sendo essenciais o diagnóstico precoce e o início do tratamento farmacológico. Em caso de falha, os balões de tamponamento uterino são uma alternativa eficiente, com aplicabilidade crescente na prática clínica. Esses dispositivos são seguros, apresentam baixa incidência de eventos adversos e reduzem as taxas de procedimentos cirúrgicos. Existe uma ampla variedade de modelos, tanto industriais quanto artesanais, com acúmulo de relatos na literatura demonstrando sua eficácia. Este artigo descreve os principais balões intrauterinos, com ênfase nos modelos mais novos, aplicabilidade, taxas de sucesso e eventos adversos.(AU)

Postpartum hemorrhage continues to be a condition related to high maternal morbimortality, early diagnosis and initiation of pharmacological treatment are essential. In case of failure, uterine balloon tamponade is an efficient alternative, with increasing applicability in clinical practice. These devices are safe, have a low incidence of adverse events and reduce the overall rates of surgical procedures. There is a wide variety of models, both industrial and artisanal, with an accumulation of reports in the literature demonstrating their effectiveness. This article describes the main intrauterine balloons, with an emphasis on newer models, applicability, success rates and adverse events.(AU)

Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial.

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed.

Detection of the most influential variables for preventing postpartum urinary incontinence using machine learning techniques.

Background: Postpartum urinary incontinence is a fairly widespread health problem in today's society among women who have given birth. Recent studies analysing the different variables that may be related to Postpartum urinary incontinence have brought to light some variables that may be related to Postpartum urinary incontinence in order to try to prevent it. However, no studies have been found that analyse some of the intrinsic and extrinsic variables of patients during pregnancy that could give rise to this pathology. Objective: The objective of this study is to assess the most influential variables in Postpartum urinary incontinence by means of machine learning techniques, starting from a group of intrinsic variables, another group of extrinsic variables and a mixed group that combines both types. Methods: Information was collected on 93 patients, pregnant women who gave birth. Experiments were conducted using different machine learning classification techniques combined with oversampling techniques to predict four variables: urinary incontinence, urinary incontinence frequency, urinary incontinence intensity and stress urinary incontinence. Results: The results showed that the most accurate predictive models were those trained with extrinsic variables, obtaining accuracy values of 70% for urinary incontinence, 77% for urinary incontinence frequency, 71% for urinary incontinence intensity and 93% for stress urinary incontinence. Conclusions: This research has shown that extrinsic variables are more important than intrinsic variables in predicting problems related to postpartum urinary incontinence. Therefore, although not conclusive, it opens a line of research that could confirm that the prevention of Postpartum urinary incontinence could be achieved by following healthy habits in pregnant women.

Desfechos de partos em gestantes que positivaram COVID-19 em município paranaense / Outcomes of deliveries in pregnant women who tested positive for COVID-19 in a municipality in Paraná

A Síndrome Respiratória Aguda Grave Coronavírus 2 foi declarada pela Organização Mundial da Saúde como pandemia, em março de 2020. O quadro clínico da COVID-19 é bastante variável, visto que alguns pacientes são assintomáticos. Diante desta problemática objetivou-se quantificar e descrever os principais desfechos de partos em gestantes e recém-nascidos com resultado positivo para COVID-19. Trata-se de pesquisa epidemiológica, documental, retrospectiva, com abordagem quantitativa, utilizando-se das fichas de notificação das gestantes positivas para COVID-19 e a declaração de nascidos vivos dos casos com desfecho do parto. O estudo foi realizado com 119 gestantes, destas, 48 eram puérperas, sendo pacientes que tiveram resultado positivo para COVID-19, apresentando maior contaminação mulheres em idade fértil de 15 a 39 anos, solteiras e com ensino superior incompleto. Os sintomas mais relatados nas gestantes com COVID-19 foram cefaleia e tosse. A grande maioria dos casos teve desfecho positivo em relação à gestação.

Severe Acute Respiratory Syndrome Coronavirus 2 was declared a pandemic by the World Health Organization in March 2020. The clinical picture of COVID-19 is quite variable, as some patients are asymptomatic. In view of this problem, the objective was to quantify and describe the main outcomes of childbirth in pregnant women and newborns with a positive result for COVID-19.This an epidemiological, documentary, retrospective research, with a quantitative approach, using the notification forms of pregnant women positive for COVID-19 and the declaration of live births of cases with delivery outcome. The study was carried out with 119 pregnant women, of which 48 were postpartum women, being patients who tested positive for COVID-19, with greater contamination women childbearing age from 15 to 39 years old, single and with incomplete higher education. The most reported symptoms in pregnant women with

Pulse perfusion index for predicting intrapartum fever during epidural analgesia.

STUDY OBJECTIVE: To assess whether pulse perfusion index (PI) values could be employed to predict intrapartum fever and to provide a cut-off PI value for predicting intrapartum fever occurrence. DESIGN: We conducted a single-center, prospective, observational study. SETTING: Delivery room at the Department of Obstetrics, Affiliated Hospital of Jiangsu University. PATIENTS: 117 parturients who intended to have a vaginal delivery. INTERVENTIONS: Each parturient received epidural analgesia. MEASUREMENTS: We checked each parturient's tympanic temperature before analgesia (T0), at 1 h (T1) and 2 h (T2) after analgesia, immediately at the end of the second (T3) and third (T4) stages of labor, and at 1 h postpartum (T5). A temperature of ≥38°C was defined as fever. PI, measured on the right second toe, was recorded before analgesia (PI0) and at 10 min (PI10), 20 min (PI20), and 30 min (PI30) after analgesia. The PI change rate was calculated as the incremental change in PI30 from PI0, divided by the PI0. Receiver operating characteristic (ROC) curves were used to verify the utility of the PI30 and PI change rate values for predicting intrapartum fever. MAIN RESULTS: We found that peak temperature (TP) occurred at the end of the second or the third stage of labor. Within 30 min after analgesia, the PI showed a significant increase over time and there was a linear correlation between PI30 and TP values (P < 0.001, r = 0.544). The PI10, PI20, PI30 and PI change rate in febrile parturients were higher than those in afebrile parturients (P < 0.001). The area under the ROC (AUROC) for PI30 was 0.818 (P < 0.001) with a cut-off of 9.30. The AUROC of the PI change rate was 0.738 (P < 0.001) with a cut-off of 3.45. CONCLUSIONS: PI30 and PI change rate values could be used to predict intrapartum fever in parturients after epidural analgesia.

Nonpharmacological labor pain management methods and risk of cesarean birth: A retrospective cohort study.

BACKGROUND: Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth. METHODS: We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor. RESULTS: Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR = 0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR = 2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR = 2.46; 95% CI 2.22-2.72), and primiparity (RR = 2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort. DISCUSSION: The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor.

Efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome / 中国基层医药

Objective:To investigate the efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome.Methods:A total of 150 parturient women who underwent delivery in the First People's Hospital of Yongkang from June 2019 to June 2020 were included in this study. They were randomly assigned to undergo either conventional delivery (control group, n = 75) or Doula delivery combined with painless delivery (observation group, n = 75). Analgesic effect, mode of delivery, duration of labor and pregnancy outcome as well as mood score before and after intervention were compared between the two groups. Results:Total analgesia-effective rate in the observation group was significantly higher than that in the control group [100.00% (75/75) vs. 65.33% (49/75), χ2 = 31.45, P < 0.05]. Vaginal delivery rate in the observation group was significantly higher than that in the control group [84.00% (63/75) vs. 66.67% (50/75), χ2 = 6.60, P < 0.05]. The length of the first stage of labor, the second stage of labor, the third stage of labor and total labor length in the observation group were (398.42 ± 35.41) minutes, (43.65 ± 5.78) minutes, (8.36 ± 1.08) minutes and (450.87 ± 37.98) minutes, which were significantly shorter than those in the control group [(543.21 ± 47.87) minutes, (76.73 ± 16.56) minutes, (9.76 ± 1.23) minutes, (629.34 ± 45.26) minutes, t = 21.05, 16.33, 7.40, 26.15, all P < 0.05]. The incidence of neonatal asphyxia, fetal distress and postpartum hemorrhage in the observation group were [1.33% (1/75), 2.67% (2/75) and 2.67% (2/75), respectively, which were significantly lower than those in the control group [13.33% (10/75), 17.33% (13/75), 18.67% (14/75), χ2 = 7.94, 8.96, 10.07, all P < 0.05]. Self-rating Anxiety Scale score and Self-Rating Depression Scale score in the observation group were (43.25 ± 4.28) points and (40.28 ± 3.45) points, which were significantly lower than those in the control group [(52.12 ± 3.95) points, (47.79 ± 3.72) points, t = 13.18, 12.81, both P < 0.05). Conclusion:Doula delivery combined with painless delivery can relieve women's emotional changes, alleviate pain, shorten labor duration, and improve pregnancy outcomes.

Application of unprotected perineum delivery technique for natural childbirth in primiparas / 中国基层医药

Objective:To investigate the application effects of unprotected perineum delivery technique for normal vaginal delivery in primiparas.Methods:A total of 260 primiparas who underwent natural childbirth in Tengzhou Central People's Hospital between January 2019 and September 2020 were included in this study. They were randomly assigned to undergo childbirth either with an unprotected perineum delivery technique (study group, n = 130) or the conventional delivery technique (control group, n = 130). Delivery-related indicators were compared between the two groups. Results:The rate of first-degree perineal tear in the study and control groups was 71.52% and 29.23%, respectively, the rate of second-degree perineal tear were 7.16% and 3.16%, respectively, and the episiotomy rate in the two groups were 21.32% and 67.51%, respectively. There were significant differences in rate of first-degree perineal tear, rate of second-degree perineal tear and episiotomy rate between the two groups ( χ2 = 7.19, 7.03, 8.35, all P < 0.05). The length of hospital stay in the study and control group was 3.27 ± 5.79 days and 5.18 ± 7.26 days, respectively. The numerical rating scale score of postpartum perineal pain in the two groups was 1.23 ± 2.51 points and 3.24 ± 2.79 points, respectively. The incidence of postpartum complications was 3.33% and 11.67%, respectively. There were significant differences in length of hospital stay, numerical rating scale score of postpartum perineal pain and incidence of postpartum complications between the two groups ( t = 2.23, 2.06, χ2 = 2.52, all P < 0.05). There were no significant differences in length of second stage of labor and Apgar score in new born infants between the study and control groups (all P > 0.05). Conclusion:Unprotected perineum delivery technique can greatly decrease episiotomy rate, alleviate perineal tear, reduce pain, reduce complications, shorten length of hospital stay, and improve quality of obstetric care.

Combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection in midwifery / 中国基层医药

Objective:To investigate the clinical efficacy of intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination in midwifery.Methods:A total of 160 primiparous women who were subjected to full-term vaginal delivery in Suqian Hospital of Nanjing Drum Tower Hospital Group between January 2019 and January 2021 were included in this study. They were randomly assigned to undergo either bilateral pudendal nerve block combined with modified perineal protection (control group, n = 80) or intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination (observation group, n = 80). Each clinical index was compared between the control and observation groups. Results:Duration of labor in the observation group was significantly shorter than that in the control group [(7.23 ± 2.11) hours vs. (9.35 ± 3.79) hours, t = 4.27, P < 0.05). Cesarean section rate in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 52.5% (42/80), χ 2 = 17.18, P < 0.05]. Incidence of perineal tears in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 32.5% (26/80), χ 2 = 15.48, P < 0.05]. Third-degree perineal tears occurred in neither group. Time of postpartum off-bed ambulation and length of postpartum hospital stay in the observation group were (1.37 ± 0.13) days and (3.22 ± 0.31) days, respectively, which were significantly shorter than those in the control group [(2.52 ± 0.22) days, (5.23 ± 0.62) days, t = 25.90, 25.94, both P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group [7.5% (6/80) vs. 23.7% (19/80), χ 2 = 8.01, P < 0.05]. There were no significant differences in incidence of neonatal asphayxia, 2-hour postpartum hemorrhage and postpartum hemorrhage between the two groups (all P > 0.05). Conclusion:During midwifery of full-term vaginal delivery, combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection can shorten duration of labor and decrease cesarean section rate.

Macrosomía fetal y factores de riesgo asociados en la provincia Camagüey

Introducción: La macrosomía fetal, de manera tradicional, ha sido definida por un peso arbitrario al nacer; la misma, ya sea definida por un límite de peso o grande para la edad gestacional, se asocia con numerosas complicaciones perinatales y maternas. Objetivo: Describir los factores de riesgo asociados a la macrosomía fetal en los partos del Hospital Universitario Ginecobstétrico Provincial Ana Betancourt de Mora durante el año 2019. Métodos: Se realizó un estudio observacional descriptivo de corte transversal. El universo quedó constituido por la totalidad de gestantes que tuvieron recién nacidos con peso al nacimiento mayor o igual a 4 000 gramos, el cual ascendió a 526 gestantes. Se utilizó estadística descriptiva. Se calculó media y desviación estándar a las variables cuantitativas. Resultados: Las gestantes estudiadas tenían una media de edad de 27,86 años y un IMC a la captación como promedio de 26,77 con un valor medio de ganancia de peso de 13,68 Kg. Entre los 26 y 35 años hubo 290 gestantes con recién nacidos macrosómicos, respecto a la paridad las que paren sin experiencia de este reunió a 222 grávidas. En las embarazadas catalogadas de sobrepeso con ganancia de 10 a 15 kg se reúnen 104 de los recién nacidos macrosómicos. Respecto al tipo de parto la cesárea representó el 61,4 %. Se observó en 40 gestantes la presencia de diabetes gestacional o pregestacional y preeclampsia respectivamente. Conclusiones: La ganancia excesiva de peso en gestantes con evaluación nutricional de sobrepeso u obesas tuvo la mayor incidencia en la génesis de la macrosomía en los recién nacidos.

Introduction: Fetal macrosomia has traditionally been defined by an arbitrary birth weight. Fetal macrosomia, whether defined by borderline weight or large for gestational age, is associated with numerous perinatal and maternal complications. Objective: To describe the risk factors associated with fetal macrosomia in deliveries at Ana Betancourt de Mora Provincial Gyneco-Obstetric University Hospital during 2019. Methods: A cross-sectional descriptive observational study was carried out. The study universe was made up of all pregnant women who had newborns with a birth weight greater than or equal to 4 000 grams, which amounted to 526 pregnant women. Descriptive statistics were used. Average and standard deviation were calculated for the quantitative variables. Results: The studied pregnant women had an average age of 27.86 years and an average BMI at uptake of 26.77 with an average value of weight gain of 13.68 Kg. Between 26 and 35 years there were 290 pregnant women with newborn macrosomic births, with respect to parity those who give birth without experience of this brought together 222 gravid women. In pregnant women classified as overweight with a gain of 10 to 15 kg, 104 of the macrosomic newborns are gathered. Regarding the type of delivery, cesarean section represented 61.4%. The presence of gestational or pregestational diabetes and preeclampsia, respectively, was observed in 40 pregnant women. Conclusions: The excessive weight gain in pregnant women with nutritional evaluation of overweight or obese were those that had the highest incidence in the genesis of macrosomia in newborns.

Physiological breech birth training: An evaluation of clinical practice changes after a one-day training program.

BACKGROUND: The "physiological breech birth" one-day training program is based on evidence about the physiology of breech births and how clinicians learn breech skills. Previous evaluations have demonstrated positive effects on confidence and knowledge, but the training's effect on clinical practice and outcomes is unknown. METHODS: A mixed-methods evaluation was conducted in eight National Health Service hospitals in England and Northern Ireland. Changes in confidence and knowledge were assessed using pretraining and post-training surveys. Mode of birth and maternal birth positions were evaluated using audit data covering one year before the training and one year after, for all singleton vaginal breech births at term. FINDINGS: A total of 263 participants completed the surveys. Confidence in managing breech births in both upright and supine positions significantly increased, as did participant knowledge. Audited data for 1402 women were collected. Overall vaginal birth rates remained similar in both periods. Among singleton vaginal breech births >37 weeks, the use of upright birthing positions increased significantly (P = .002). The study was not powered to detect differences in other outcomes, but pilot data were collected to inform the design of future studies. CONCLUSIONS: Increase in use of upright birthing positions suggests that physiological breech birth training is likely to lead to clinical practice changes, which may help support maternal choice in line with current guidance. However, provision of a one-day training program did not change overall vaginal breech birth rates. Adequately powered research is needed to determine effects of clinical practice changes on clinical outcomes.

Documenting Perineal and Obstetrical Anal Sphincter Injury Care at Childbirth: A Cross-Sectional Study.

OBJECTIVE: This study evaluates whether maternity care providers document guideline-based recommendations for the prevention and care of obstetrical anal sphincter injuries (OASIS) for their labour and delivery patients. METHODS: We performed a cross-sectional study, aiming for a convenience sample of 60 primiparous women, over 19 years of age, equally representative of patients who experienced severe (third- and fourth-degree) and minimal (intact or first-degree) tears during vaginal birth. Information on patient demographics, delivery details, and guideline-endorsed preventative and management measures were collected. Descriptive statistics were used when appropriate. RESULTS: We enrolled a total of 73 women, 34 of whom had severe tears and 39 of whom had minimal tears. Preventative measures, including fetal head control and perineal support during delivery, were documented for 1 out of 73 patients. The use of perineal massage and warm compress to the perineum was not documented. A rectal exam after delivery was documented for 30% (22/73) of all patients and 62% (21/34) of patients with OASIS. Sixty-five percent (22/34) of patients with OASIS received intravenous antibiotics, 88% (30/34) received laxatives, and 100% received nonsteroidal anti-inflammatory drugs. Post-void residual was not documented for any patients. Patients recalled being informed about their OASIS in 68% (23/34) of cases and being referred to pelvic physiotherapy in 47% (16/34) of cases. CONCLUSION: In our study, perineal care practices during and after childbirth, as detailed in the national OASIS guideline, were incompletely documented. This may indicate partial guideline adherence or suboptimal medical record-keeping.

An Initiative to Increase Resident Performance of Operative Vaginal Deliveries.

The objective of this single-centre, action research study was to increase resident experience performing operative vaginal deliveries. The secondary objective was to assess the incidence of maternal and neonatal complications. The rate of forceps deliveries increased in the post-training period (1.8%-4.0%; P < 0.001) but the overall rate of operative vaginal delivery did not change. The composite maternal complications rate following forceps delivery was lower in the post- training period (P = 0.006). There were no significant differences in maternal or neonatal complications with vacuum delivery between the periods before and after the initiative. Experiential training of residents may be a viable alternative to simulation training as it does not require expensive state-of-the-art simulation technology.