Search Results (66)

Perineal tears are common during vaginal delivery and are associated with significant maternal morbidity. While chorioamnionitis and intrapartum fever are known to affect labor dynamics and perineal tissue integrity, their relationship with perineal trauma in spontaneous vaginal deliveries has not been established. This study aimed to evaluate the prevalence of perineal tears among women with intrapartum fever who delivered spontaneously. This retrospective cohort study included women who underwent spontaneous vaginal delivery during 2013–2021 in Israel. The study group comprised women diagnosed with intrapartum fever (≥38 °C), while afebrile women served as controls in a 1:2 ratio matched by age (<35 or ≥35 years) and gestational age (preterm/term). Perineal tears were classified according to the Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Multivariable logistic regression was performed to adjust for statistically significant variables including obesity, induction of labor, epidural analgesia, amniotomy, delivery week, gestational diabetes, birth number, duration of the second stage of labor, and episiotomy. The cohort included 373 women with intrapartum fever and 746 controls. The overall rate of perineal tears was similar between febrile and afebrile women (42% vs. 40%; adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.72–1.36). However, the rate of obstetric anal sphincter injury (OASIS) was lower among women with intrapartum fever (0.5% vs. 2.0%; aOR 0.10, 95% CI 0.02–0.52). Intrapartum fever was associated with higher rates of postpartum hemorrhage, manual exploration of the uterus, endometritis, anemia, and blood transfusion. Bacterial cultures were positive in 31% of febrile women, predominantly Escherichia coli and Group B Streptococcus, without association with perineal trauma. Alltogether, Intrapartum fever did not increase the risk of perineal tears in spontaneous vaginal deliveries and was paradoxically associated with a lower rate of OASIS. Further studies are warranted to explore the underlying physiological mechanisms linking temperature and perineal tissue resilience. Full article

Background and Objectives: Epidural analgesia remains the gold standard for intrapartum pain relief; however, its influence on labor dynamics and neonatal outcomes in nulliparous women continues to be debated. This prospective cohort study aimed to investigate the effects of epidural analgesia on labor progression and neonatal outcomes among women experiencing spontaneous term labor. Materials and Methods: A total of 100 nulliparous women with singleton, cephalic pregnancies at 37–41 weeks of gestation were prospectively enrolled. Participants self-selected into either the epidural analgesia group (n = 50) or the no epidural analgesia group (n = 50) after standardized counseling on pain management options. Demographic data, labor characteristics, and neonatal outcomes, including the durations of the active and second stages of labor, the use of episiotomy or instrumental delivery, and the 1- and 5-min Apgar scores, were recorded and compared between groups. Group comparisons showed statistically significant differences when p values were below 0.05. Results: The active phase of labor was significantly longer in women receiving epidural analgesia compared with those without it, showing an approximately 60-min difference with a p value less than 0.001. The second stage was also modestly prolonged in the epidural group (p < 0.001). Although the episiotomy rate was higher among women with epidural analgesia, there were no significant differences in perineal tears or instrumental delivery. Neonatal outcomes were comparable between groups, with similar 1- and 5-min Apgar scores. Conclusions: Epidural analgesia modestly prolongs the active and second stages of labor in nulliparous women but does not adversely affect neonatal well-being. These findings support the continued use of epidural analgesia as a safe and effective option for labor pain management, providing substantial maternal comfort without compromising neonatal outcomes. Full article

Aims: Gestational diabetes mellitus (GDM) represents an increasing global challenge. Mediterranean diet interventions have proven benefits, but their implementation is limited by the absence of nutritionists in many public health systems. This study aimed to evaluate whether a video intervention guided by a nutritionist could increase compliance to Mediterranean diet and reduce the incidence of GDM and adverse maternal–neonatal outcomes. Methods: In this randomized controlled trial, 1750 consecutive pregnant women were allocated (1:1) to standard care (verbal, printed advice) or to a video designed by a nutritionist promoting a Mediterranean and physical activity. The primary outcome was the incidence of GDM; secondary outcomes included other pregnancy-related complications. Dietary adherence was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS) score. Results: The experimental group increased their MEDAS score from baseline to GDM screening (mean difference (95% CI) 0.41 (0.23; 0.60); p < 0.001), mainly through greater extra virgin olive oil and nut intake and lower consumption of juices and confectionery. GDM incidence declined from 25.1% to 20.7% (p = 0.025), with significant reductions in gestational hypertension, episiotomy and neonatal intensive care unit admissions. Conclusions: Nutritionist-guided video intervention improves adherence to Mediterranean diet and reduces GDM incidence and adverse outcomes. This low-cost, scalable approach may help overcome structural limitations in public health systems. Full article

Background/Objective: Dyspareunia negatively affects women’s lives. Up to 35% suffer from postpartum dyspareunia. Many factors may influence the occurrence of postpartum dyspareunia, but little is known about them. This study aimed to look at the frequency of dyspareunia one year postpartum in a cohort of primiparae. Which perinatal factors influence the frequency of postpartum dyspareunia? Methods: A total of 3264 primiparae were included in this observational cohort study. Perinatal factors were documented, and a specially designed questionnaire was sent to them one year postpartum. The primary outcome was the frequency of dyspareunia one year postpartum. The secondary outcomes included potential influencing factors such as birthing method (spontaneous bed delivery, spontaneous delivery other than bed, water delivery, and vacuum-assisted delivery); perineal injuries (first- and second-degree perineal tears, obstetric anal sphincter injuries (OASIs), and episiotomies); and the use of oxytocin. Results: Postpartum dyspareunia was observed in 15% of the 3264 primiparae. In multivariate analysis, there were influences found in the perineal injury group, especially for first- and second-degree perineal tears and OASIs. In the oxytocin group, a trend toward a higher rate of postpartum dyspareunia was observed. No influence of the different birthing methods was found. Conclusions: Postpartum dyspareunia, affecting 15% of women one year after vaginal delivery, is associated with perineal injuries, particularly minor perineal tears and OASIs. This highlights the importance of good preparation of the perineum and pelvic floor before delivery, efficient perineal protection during labor, and the use of a precise repair technique for all perineal injuries. Full article

Background: Pelvic organ prolapse (POP) significantly impairs women’s quality of life (QoL), particularly in resource-limited settings where surgical options may be restricted. Vaginal pessaries provide a conservative and cost-effective treatment, yet local evidence on their effectiveness in Vietnam remains scarce. Methods: In this six-month prospective study, 130 women with stage II–IV POP received vaginal pessaries. QoL was evaluated using validated PFDI-20 and PFIQ-7 questionnaires, and changes in symptoms, satisfaction, and adverse events were analyzed. Results: Most women presented with advanced POP (65.4% stage III, 19.2% stage IV). Ring pessaries were most frequently used (64.6%), followed by Gellhorn (23.9%) and Donut (11.5%). Successful fitting was achieved in 95.4% of participants, with six women discontinuing use due to expulsion or discomfort. QoL scores improved significantly after six months: mean PFDI-20 total decreased from 78.5 ± 51.4 to 42.2 ± 38.3 (p < 0.001), and PFIQ-7 total decreased from 62.6 ± 43.2 to 25.1 ± 22.9 (p < 0.001), with all subscales showing consistent improvement. Nearly all women (98.5%) reported symptomatic improvement, and 95.4% were satisfied with treatment. Correlation analyses showed no significant relationships between POP stage and obstetric factors (vaginal delivery, macrosomia, and episiotomy). In multivariate regression analysis including only age, BMI, and POP stage, none were significantly associated with QoL improvement. Conclusions: Vaginal pessary use was safe, highly effective, and well tolerated, leading to symptom and QoL improvements among Vietnamese women with advanced POP. These findings support pessary use as a first-line management option, especially for women who are elderly, have comorbidities, or lack access to surgery. Full article

Background/Objectives: Rarely, primary (PriCs) or metastatic (metECs) carcinomas occur in the episiotomy site. Methods: A systematic literature review of metECs was carried out. We reviewed the PRISMA guidelines and the Scopus, Pubmed, and Web of Science databases. Results: We found 21 carcinomas; all of them were cervical carcinomas (11 squamous, SCC; 6 adenocarcinomas; 3 adenosquamous; 1 SCC or adenocarcinoma) diagnosed during pregnancy (38%) or 0.25–8 months postpartum (57%). SCCs were larger (mean size: 4.8 cm). At presentation, only two cases were pN+, and no distant metastases were found, excluding four episiotomy metastases (one anticipating the cervical cancer diagnosis); the remaining episiotomy metastases (mean size: 3 cm; one multifocal) were found at follow-up (these were first metastases in 86% of cases). The time range from the episiotomy/last delivery to first episiotomy metastasis was 1–66 (mean, 12.3) months. Treatment was variable: hysterectomy (71%) ± lymphadenectomy (67%) and/or adjuvant treatment (19%); chemoradiation/radiotherapy alone (24%). A total of 90% of cases recurred after 18 days to 66 months (mean, 12 months). At last follow-up, ten patients (48%) were disease-free after 12–120 (mean, 63.5) months, two patients (10%) were alive with disease, and nine (42%) patients died of disease after 6–36 (mean, 12.5) months (including two never-cleared/progressing cases). Conclusions: PriCs and metECs are rare. Iatrogenic/obstetric implantation or vascular dissemination of cervical cancer at the site of episiotomy may occur. For episiotomy lesions, accurate gynecological/perineal examination is required, and biopsy can be considered. Larger studies are required in order to determine treatment guidelines. Compared to PriCs, metECs occurred in younger (premenopausal) patients, were not associated with endometriosis, and demonstrated slightly smaller size and shorter mean time from episiotomy to episiotomy metastases, with a higher likelihood of a less favorable prognosis. Full article

Background/Objectives: A perineal incision (episiotomy) is a surgical procedure involving the controlled cutting of perineal tissues to widen the vaginal outlet during the second stage of labor. The aim of this study was to assess Polish women’s knowledge regarding perineal incision. Methods: This study was conducted using an unvalidated, anonymous questionnaire created in Google Forms. Results: Women with higher education, those who had undergone childbirth, and those who identified the Internet, medical personnel, medical personnel on social media, and medical journals as sources had significantly higher levels of knowledge. Respondents aged 25 years or younger had significantly lower knowledge levels compared to those aged over 26. Additionally, respondents living in cities with populations of up to 500,000 had significantly lower levels of knowledge compared to women living in larger cities. Conclusions: The level of women’s knowledge about perineal incision varies and is influenced by several factors. Significant determinants of higher levels of knowledge were higher education, having a history of obstetric delivery, being over 25 years old, and using information provided by medical personnel, including those present on social media. Full article

Background: Episiotomy-related morbidity remains a substantial challenge in postpartum recovery, often affecting maternal quality of life. Given the crucial role of local microbiota and wound environment in perineal healing, intravaginal lactic acid gel emerges as a promising adjunctive therapy. Objective: To evaluate the effectiveness and safety of intravaginal lactic acid gel (Canesbalance^®, Bayer) in enhancing scar healing and reducing pain following mediolateral episiotomy. Methods: In this single-center randomized controlled trial, 100 postpartum women with mediolateral episiotomy were allocated to either a treatment group receiving intravaginal lactic acid gel (Canesbalance^®, Bayer) or a standard care group. Scar healing was assessed at 7 and 40 days postpartum using POSAS, VAS, and NRS scores; hematological parameters were also monitored. Results: The lactic acid gel group demonstrated significantly greater reductions in scar severity and pain scores over time (p < 0.05), with no adverse hematological effects. Effect sizes (Cohen’s d) were moderate to high for scar healing (d = 0.76) and pain reduction (VAS: d = 0.83; NRS: d = 0.79), indicating clinical relevance beyond statistical significance. Conclusions: Intravaginal application of lactic acid gel may offer a safe and effective strategy to enhance perineal wound healing and pain relief after episiotomy. Further large-scale studies are warranted to validate these promising findings and explore underlying mechanisms. Full article

Background/Objectives: The COVID-19 pandemic has significantly restricted clinical training for midwifery students, highlighting the need for alternative teaching methods. With the disruption of traditional face-to-face education, online simulation-based training has emerged as an effective alternative for developing essential clinical skills. The acquisition of hands-on skills has a direct impact on students’ self-confidence and clinical performance. Interactive online simulations support the learning process by enhancing both theoretical knowledge and practical competencies. This study aims to evaluate the impact of online simple simulation-based episiotomy repair training on students whose clinical practice was limited due to the COVID-19 pandemic. Methods: A mixed-method approach was used, considering the outcomes from 61 midwifery students. Data were collected via observational questionnaires, which provide an online learning readiness scale and scales for student satisfaction and self-confidence. The analysis included descriptive statistics, McNemar’s, binary logistic regression, and the Mann–Whitney U test. Results: Students who trusted themselves in both opening and repairing an episiotomy after training had more readiness for online learning (t(43) = 2.73, p = 0.009; t(43) = 2.40, p = 0.02). Students with better training performance are more likely to obtain higher scores on the final exam of the Clinical Practice module (rho = 0.33, p = 0.01). Additionally, their performance was a positive and significant predictor of achieving a full mark (b = 0.11, s.e. = 0.05, p = 0.01). Conclusions: Interactive online simulation training improved midwifery students’ hand skills and self-confidence in clinical practice. Such methods should be promoted in circumstances like COVID-19. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background: Over recent years, several pain management techniques have been proposed to control labour pain, including pharmacological and non-pharmacological interventions. Transcutaneous electrical nerve stimulation (TENS) is considered a safe, non-invasive, easily applicable, and inexpensive pain relief method. This study aimed to investigate the impact of TENS on consecutive labour stages and on maternal and neonatal outcomes. Methods: This retrospective, single-centre cohort study covered a two-year period (1 January 2022–31 December 2023). A total of 1451 women met the inclusion criteria. TENS was applied in 203 of them. In 54.67% of cases, TENS was combined with water immersion and, in 42.85%, with water immersion and Entonox (N₂O and O₂ mixture). Two groups of patients that either made use of TENS, or not, to reduce labour pain, were compared to assess the effect of TENS on the course of labour and the condition of the newborn. Results: The women in the TENS group experienced a significantly longer first stage of labour. There was no statistically significant difference between the groups in terms of oxytocin usage, perineal tearing, episiotomy, and umbilical cord blood pH. The simultaneous application of TENS and water immersion contributed to prolonging the first stage of labour relative to their independent effects. Conclusions: The application of TENS may prolong the first stage of labour, without increasing the rate of perineal tearing and episiotomy and without any adverse effects on the condition of the newborn. Full article

Episiotomy is a common obstetric intervention aimed at facilitating childbirth and reducing severe perineal trauma. Lactic acid, a naturally occurring alpha-hydroxy acid (AHA), has emerged as a promising alternative to conventional wound-care methods due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective: This systematic review evaluates the effectiveness of lactic acid in episiotomy wound healing compared to conventional wound-care methods, focusing on healing time, infection rates, and patient-reported outcomes. Methods: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus using the keywords “lactic acid”, “episiotomy wound healing”, “perineal wound care”, and “infection prevention”. Inclusion criteria covered randomized controlled trials (RCTs), observational studies, and systematic reviews. The Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle–Ottawa Scale were used for quality assessment. Results: Eight studies met the inclusion criteria. Lactic acid-treated wounds demonstrated 30% faster healing rates, 50% lower infection rates, and reduced pain scores compared with standard wound-care methods (e.g., povidone-iodine or saline). A meta-analysis of five RCTs found a significant reduction in post-episiotomy infections (RR = 0.68, 95% CI: 0.52–0.85). Conclusions: Lactic acid shows promise in episiotomy wound care by improving healing outcomes and reducing infection and discomfort. However, further large-scale RCTs are needed to confirm its safety and long-term efficacy. Full article

Background and Objectives: This study aimed to assess the impact of early epidural analgesia (EA) on the progression of labor and delivery outcomes among nulliparous women. Materials and Methods: A retrospective analysis was conducted utilizing data from the Birth Registry of the Department of Obstetrics and Gynecology at LUHS. The dataset encompassed women who underwent childbirth between 1 January 2021 and 31 December 2021 and who received EA for labor pain management. A total of 89 women with low-risk deliveries and EA were included in the study. The cohort was divided into two groups: Group I—parturients who underwent early EA with cervical dilatation ≤3 cm—and Group II—parturients who underwent EA with cervical dilatation >3 cm but <7 cm. The results were processed using IBM SPSS. Results: Group I consisted of 25 (28.1%) women and Group II consisted of 64 (71.9%). The prevalence of obesity was higher in Group II (p = 0.021). Bishop score was statistically elevated in Group II (p = 0.018). Upon hospital admission, Group II exhibited greater cervical dilation (p = 0.001). The rate of cervical dilation was higher in Group II at 1.54 cm/h (p = 0.033). Episiotomy was more frequently performed in Group II (p = 0.014). The average durations of the first stage of labor (p = 0.045), the second stage of labor (p = 0.033), and the overall labor (p = 0.023) were prolonged in Group I. Conclusions: The cervical dilation up to 10 cm occurs at a swifter pace when EA is administered following cervical dilation exceeding 3 cm. Notable associations were observed between EA and the incidence of episiotomy as well as the duration of labor stages. Early EA exhibited no impact on neonatal outcomes. Full article

Vacuum-assisted and forceps-assisted vaginal births are associated with higher rates of formula supplementation and shorter breastfeeding duration compared to unassisted vaginal births; however, the reasons for this are unclear. Factors such as maternal knowledge, partner support, and parity significantly influence breastfeeding initiation and duration. The prevalence of perineal trauma, neonatal and maternal birth complications, and decreased birth satisfaction is higher after assisted births and may also impact breastfeeding outcomes. Given the limited research on the specific effects of different vaginal birth modes on breastfeeding, this study aimed to examine women’s experiences of establishing breastfeeding after unassisted, vacuum-assisted, and forceps-assisted vaginal birth. A mixed-methods study design was employed using an anonymous online questionnaire, which included binary, multiple choice, and open-ended questions, and Likert scale items. Using social media, we recruited Australian women who had an unassisted, vacuum-assisted, or forceps-assisted birth within the last year. Details of participant demographics, breastfeeding history, initiation and establishment, postpartum mobility, and pain ratings were recorded. Additionally, qualitative data on postpartum recovery and breastfeeding support were analysed using an inductive thematic analysis framework. A total of 565 women were recruited between May and June 2024, of which 488 responses were retained for analysis. Thematic analysis of the qualitative responses identified four central themes that defined women’s experiences of establishing breastfeeding and were similar between unassisted or assisted vaginal birth modes: Experience of Care, Environment, Expectations, and Health Complications. A range of both positive and negative experiences of breastfeeding support, environmental factors, and expectations of the realities of breastfeeding impacted women’s experiences. For many women, various maternal and/or newborn health issues, nipple pain, and latching difficulties made breastfeeding more difficult. Commercial milk formula supplementation during the hospital stay was more prevalent after a forceps-assisted birth when compared to unassisted vaginal birth (41% vs. 17%, respectively; p < 0.001). Further, during the first two weeks at home, commercial milk formula supplementation was more prevalent after both forceps-assisted (26%) and vacuum-assisted (23%) births than after unassisted vaginal birth (8%, p < 0.001). Pain ratings in the early days following birth and in the first two weeks at home were significantly higher for the forceps-assisted group than for the other vaginal birth modes (p ≤ 0.005). Women that had an unassisted vaginal birth with an intact perineum had the lowest pain ratings in the early days and weeks after birth, while pain ratings were similar between women that had a vacuum-assisted birth and those who had an unassisted vaginal birth with a perineal tear or episiotomy (p = 0.05). Early commercial milk formula supplementation is associated with shorter breastfeeding duration, while postpartum pain is known to impede maternal mobility and may partially inhibit the milk ejection reflex, potentially negatively impacting breastfeeding and increasing formula use. Therefore, women who have an instrumental assisted vaginal birth, particularly those who have a forceps-assisted birth, are at greater risk of suboptimal breastfeeding outcomes including short durations of exclusive and any breastfeeding. Improvements to early postpartum pain management, breastfeeding education, and the judicious use of commercial milk formula may improve breastfeeding and subsequent maternal and health outcomes after instrument-assisted vaginal birth. Full article

Background/Objectives: During vaginal delivery, the perineum can be damaged either by episiotomy or by a spontaneous perineal tear, leading to several complications. The wound healing process should proceed as quickly and properly as possible without an infection. Medical grade honey (MGH) may be a potent treatment option due to its antimicrobial and pro-healing activities. This literature study investigated the role of honey in the treatment of vaginal wounds after delivery. Methods: Studies published before 17 July 2024 in the PubMed, Web of Science, Embase, Scopus, EBSCO host/CINAHL, Cochrane Library, and Google Scholar databases about honey, episiotomy wounds, and perineal tears, as well as those investigating wound healing and/or pain, were assessed. Results: Ten studies were included (six RCTs, of which three were double-blind, one was quasi-experimental with a posttest only, and three were observational studies without a control group), with 723 participants in total. Six of the seven controlled studies showed honey significantly improved various outcome measures, such as improved wound healing, and reduced need for pain medication. The three non-controlled studies also had a positive outcome, improving wound healing and decreasing pain intensity and prickling sensation. However, the overall quality of available evidence is limited. Different types of honey concentrations, origins, and additives were used in the included studies. Using a standardized MGH formulation may help to maintain consistent and potent effects. Therefore, additional research is needed to determine the efficacy of MGH in perineal trauma and to establish guidelines for clinical use. Conclusions: Honey potentially has a great effect on wound healing of perineal trauma; however, more research is necessary to substantiate the findings in the current literature. Full article