Search Results (45)

Background/Objectives: Perineal obstetrical trauma sustained during vaginal delivery has a profound impact on female quality of life. The aim of the cross-sectional study was to analyze the association between active bacterial cervical infection and group B Streptococcus (GBS) rectovaginal colonization in the 35th–37th weeks of pregnancy with the degree of delivery perineal trauma. Methods: The study included 778 women after vaginal delivery. Maternal characteristics, including age, concomitant diseases, parity, obstetrical history, and cervical swab results conducted at admission and rectovaginal bacterial swabs at the 35th–37th weeks of pregnancy, were analyzed. The rates of perineal tears were compared between the physiological and pathological cervical swab groups and between the GBS-positive and GBS-negative colonization groups. Results: At admission to delivery, active cervical infection was diagnosed in 269 (35.9%) women. After vaginal delivery, 361 (49.3%) women had an intact perineum, and 288 (39.3%), 78 (10.7%), 4 (0.6%), and 1 (0.1%) had 1st–4th-degree perineal tears, respectively. Statistical analyses of the logistic regression model found that GBS colonization at the 35th–37th weeks of pregnancy (OR 1.56, p = 0.035) and pathological flora at admission (OR 1.54, p = 0.019) were associated with perineal tears. A higher vaginal parity was found to be a protective factor (OR 0.49, p < 0.000). Conclusions: High birthweight, longer second stage of labor duration, and primiparity were associated with increased rates of perineal trauma. Active cervical infection at admission and GBS colonization at the 35th–37th weeks of pregnancy were found to be risk factors for perineal tears. A protective factor for an intact perineum was a higher number of prior vaginal deliveries. 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

Background: Physical activity during pregnancy plays an important role in influencing the course of pregnancy, the health of the mother, and neonatal outcomes. Regular exercise can positively affect maternal well-being, reduce the risk of pregnancy-related complications, and support optimal fetal development. Additionally, physical activity may contribute to a reduced need for C-sections and better postpartum recovery. Despite these benefits, global trends indicate a decline in physical activity levels, exacerbated by lifestyle changes such as remote work. This highlights the importance of promoting healthy habits among women of reproductive age to improve perinatal outcomes and the long-term health of both mothers and their children. Objective: The aim of this study was to investigate the effects of physical activity during pregnancy on the health of mothers and babies after birth. Methods: A prospective cohort study was conducted in a tertiary care hospital in northern Poland from October 2024 to December 2024. Participants were 205 pregnant women with no medical contraindications to physical activity. The group was selected on the basis of a questionnaire with original questions and the Get Active Questionnaire for Pregnancy (GAQ-P). The effects of physical activity during pregnancy on maternal and infant health after delivery were assessed using questionnaire data and medical records. Frequency analysis supported by chi-squared coefficient; Cramer’s V coefficient and Spearman’s rank correlation were used to answer the research questions. Results: The study showed that the frequency of physical activity had an effect on the incidence of perineal trauma, the baby’s birth weight, and the baby’s degree of saturation after birth. The intensity of physical activity during pregnancy may influence the duration of the first stage of labor, while the duration of physical activity may influence the duration of the second stage of labor and reduce the number of operative deliveries. Conclusions: Although physical activity has a huge impact on the course of pregnancy and the health of both mother and child after birth, more research is needed to draw clear conclusions. In our study, a beneficial effect of physical activity on the reduction in cesarean sections can be observed. However, the effects on perineal injuries, length of labor, and birth weight require further research, as our findings indicate that higher exercise frequency was associated with both positive outcomes, such as fewer cesarean sections, and potential risks, including an increase in macrosomia and perineal tears. A broader analysis of co-factors influencing these results is needed to fully understand these relationships. Full article

Background/Objectives: Female sexual dysfunction (FSD) involves persistent issues with desire, arousal, orgasm, or pain during intercourse. The Female Sexual Function Index (FSFI), a validated 19-item questionnaire, is widely used to assess FSD. Childbirth, particularly vaginal delivery with perineal trauma, can increase FSD risk, with 41–83% of women affected at six months postpartum. However, early postpartum FSD remains underexplored. This study examines FSD risk factors in first-time mothers delivering vaginally, using longitudinal FSFI assessments before and after the delivery. Methods: A prospective observational study was conducted involving 80 primiparous women who delivered vaginally. The FSFI questionnaire was provided before childbirth and three months postpartum. We compared the group of women who developed early FSD after delivery (N = 45) with those with a normal FSFI score (>26.6). Results: Three months after vaginal delivery, participants exhibited a significant decrease in overall FSFI scores (−9.61 [95%CI: −11.6; −7.6]; p = 0.008). A total of 45 patients (56.2%) developed early FSD. Marital status emerged as a significant factor, with marriage acting as a protective factor (OR 0.27 [95%CI 0.05–1.24]; p = 0.044). Clitoral and periclitoral tears were associated with a higher risk of FSD than high-degree perineal lacerations (OR 3.02 [95%CI 1.56–6.24]; p = 0.021). Conclusions: At three months post vaginal delivery, primiparous women face a relevant risk of developing transient sexual dysfunction. Marital status and type of perineal tears are identified as key factors influencing postpartum sexual function. Further research is warranted to explore these factors comprehensively and provide timely clinical and psychological support to couples navigating the challenges of early family life. 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

Background and Objectives: The primary objective of this study was to assess the impact of pelvic floor muscle (PFM) strengthening on the pelvic floor function in women who have experienced OASIS two years after delivery, and the secondary objective was to educate women about PFM strengthening and instruct them on the correct way to exercise. Methods and Materials: A prospective case-control study was conducted. The participants were divided into two groups: the case group (women who experienced OASIS) and the control group (women who did not experience perineal tears but had similar obstetric-related data to the case). Women were invited for a gynecological exam, PFM assessment, and consultation on PFM training. Women in the case group had three consultations, and women in the control group had two. Women were presented with four sets of questions about pre-pregnancy condition and questions related to UI and FI after delivery. Results were considered significant when p < 0.05. Results: OASIS were detected in 13 (0.4%) women in 2021. Risk factors for OASIS were found to be fetal macrosomia (p = 0.012), fetal occiput posterior position (p = 0.001), and epidural analgesia (p = 0.003). After one year of performing PFM strengthening exercises, some women in the study group exhibited stronger PFM contractions (p = 0.076), while others held the contracted PFM for a longer time (p = 0.133). UI affected women in the control group more often (p = 0.019). Two years after delivery, gas incontinence was mentioned significantly more frequently in the case group (p = 0.019). One year after initial consultation, gas incontinence was also more significantly common in the case group (p = 0.037). Conclusions: This study found that PFM strengthening exercises significantly improved pelvic floor function in women who experienced OASIS two years after delivery. Participants exhibited stronger PFM contractions and an increased ability to maintain these contractions. Women reported a better understanding of PFM exercises and proper techniques. Full article

Background: Obstetric lesions of the anal sphincter (OASIS) are tears intersecting the structure of the anus after vaginal delivery. Our aim is to provide data on the incidence of OASIS and investigate potentially connected risk factors. Methods: This is a retrospective analysis of 464 parturient patients admitted to the AOU Maggiore della Carità, Novara (Italy), in the last ten years (2013–2023), comparing 116 cases (with OASIS) versus 348 controls (with no OASIS). Results: The incidence of OASIS was 1.1%. Among the significant risk factors associated with the risk of severe perineal laceration in our sample, we observed nulliparity, previous caesarean sections, assisted reproduction technology, kilos gained during pregnancy, induced delivery, the use of oxytocin for augmentation, epidural analgesia, delivery after 40 weeks of gestation, position at delivery, the duration of labor, the application of a vacuum cup, newborn weight and head circumference. Conclusions: It was a challenge to find data on OASIS and on more preventable and modifiable risk factors. Beyond the improvement of the corresponding diagnostic and therapeutic tools, a new aim could be to stratify women giving birth based on possible risk factors. Full article

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries. Full article

Background/Objectives: Perineal injuries, including episiotomies and spontaneous tears, are common complications during childbirth, often leading to significant discomfort and prolonged recovery for women. This retrospective observational cohort study aimed to explore the relationship between antenatal anovaginal distance (AVD) and the incidence of perineal injuries in a cohort of pregnant women evaluated for pelvic floor health at 28 to 32 weeks of gestation. Methods: Conducted at the University Hospital of Padua over 18 months, the study included 416 women who underwent vaginal delivery at term. Based on AVD, the study participants were divided into two groups: AVD-N group, which included 252 patients with AVD ≥ 2 cm, and the AVD-R group, which included 164 with AVD < 2 cm. The results of the pelvic floor assessment and those related to childbirth were then examined in relation to AVD (reduced vs. normal). Results: The study found that women with reduced AVD were more likely to experience perineal injuries. Specifically, the incidence of episiotomy and severe perineal tears (3rd and 4th degree) was significantly higher in the reduced AVD group (p < 0.05). Furthermore, a lower AVD was associated with increased perineal muscle hypertonicity and a higher likelihood of operative delivery with episiotomy. Logistic regression analysis confirmed that reduced AVD was an independent risk factor for perineal injuries, regardless of other maternal or neonatal characteristics. Conclusions: These results suggest that AVD measurement during pregnancy may help identify women at higher risk of perineal trauma, enabling more personalized obstetric care to mitigate these outcomes. Full article

Hydrotherapy, including the use of therapeutic showers and bathtubs, has been studied for its potential benefits in labor pain management. Previous research has indicated that hydrotherapy can alleviate pain, but comparative studies between therapeutic showers and bathtubs are scarce. Objective: This study aims to compare the effects of therapeutic showers and bathtubs on pain perception, labor duration, use of epidural analgesia, and maternal and neonatal outcomes during labor. Methods: A total of 124 pregnant women were included in this study. Participants were divided into two groups: those who used a therapeutic shower and those who used a bathtub during labor. Pain levels were measured using a visual analog scale (VAS). Labor duration, use of epidural analgesia, types of delivery, maternal outcomes (postpartum hemorrhage, perineal status, maternal hypotension, fever, and breastfeeding), and neonatal outcomes (APGAR scores, fetal heart rate, complications, and neonatal unit admissions) were recorded and analyzed. Results: Both the therapeutic shower and the bathtub effectively reduced pain perception, with the bathtub showing a greater reduction in VAS scores. The therapeutic shower group experienced a significantly shorter labor duration compared to the bathtub group. The majority of participants in both groups did not require epidural analgesia, with no significant differences between the groups. There were no significant differences in the types of delivery. Maternal outcomes indicated a lower incidence of perineal tears and episiotomies in the therapeutic shower group. Neonatal outcomes, including APGAR scores and fetal heart rate, were similar between the groups, with no significant differences in complications or neonatal unit admissions. Conclusions: Both therapeutic showers and bathtubs are effective for pain relief during labor, with the bathtub showing a higher reduction in pain intensity. The therapeutic shower is associated with a shorter labor duration and a lower incidence of perineal tears and episiotomies. Both methods are safe for neonatal well-being, making hydrotherapy a viable non-pharmacological option for pain management in labor. However, the therapeutic shower may offer additional benefits in terms of labor duration and maternal outcomes. Full article

Background: With the increasing popularity of elective induction after 39 + 0 weeks, the question of whether induction of labor (IOL) is safe in women with isolated polyhydramnios has become more relevant. We aimed to evaluate the pregnancy outcomes associated with IOL among women with and without isolated polyhydramnios. Methods: This was a multicenter retrospective cohort that included women who underwent induction of labor at term. The study compared women who underwent IOL due to isolated polyhydramnios to low-risk women who underwent elective IOL due to gestational age only. The main outcome measure was a composite adverse maternal outcome, while the secondary outcomes included maternal and neonatal adverse pregnancy outcomes. Results: During the study period, 1004 women underwent IOL at term and met inclusion and exclusion criteria; 162 had isolated polyhydramnios, and 842 had a normal amount of amniotic fluid. Women who had isolated polyhydramnios had higher rates of the composite adverse maternal outcome (28.7% vs. 20.4%, p = 0.02), prolonged hospital stay, perineal tear grade 3/4, postpartum hemorrhage, and neonatal hypoglycemia. Multivariate analyses revealed that among women with IOL, polyhydramnios was significantly associated with adverse composite maternal outcome [aOR 1.98 (1.27–3.10), p < 0.01]. Conclusions: IOL in women with isolated polyhydramnios at term was associated with worse perinatal outcomes compared to low-risk women who underwent elective IOL. Our findings suggest that the management of women with polyhydramnios cannot be extrapolated from studies of low-risk populations and that clinical decision-making should take into account the individual patient’s risk factors and preferences. Full article

This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences. Full article

This study aimed to examine the impact of fractional CO₂ laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO₂ laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration. Full article