Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Background Postpartum urinary retention (PUR) may lead to bladder neuromuscular damage and subsequently voiding dysfunction. However, the literature regarding the incidence of and risk factors for PUR remains unclear. Moreover, previously reported studies are limited to small sample sizes. Thus, this study aimed to assess the incidence of and risk factors for overt PUR after vaginal delivery. Methods This retrospective case-control study included all primiparas who delivered vaginally between July 1, 2017, and June 30, 2019, at our institution. The case group comprised 677 women diagnosed with overt PUR who required catheterisation after delivery. The control group comprised 677 women without overt PUR randomly selected in a 1:1 ratio matched for date of delivery and who delivered immediately after each woman with overt PUR to minimise the impact of variations over time in obstetric practice. Univariate and multivariate logistic regression analyses were performed to investigate the factors associated with overt PUR. Results Of the 12,609 women included in our study, 677 were diagnosed with overt PUR (incidence 5.37%). Univariate analysis identified epidural analgesia, episiotomy, perineal tears, instrument-assisted delivery, duration of labour stage, intrauterine operation, and vulvar oedema as risk factors for PUR. Multivariate logistic regression identified epidural analgesia (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.11–1.79, P = 0.005), vulvar oedema (OR = 6.92, 95% CI: 4.65–10.31, P < 0.001), forceps delivery (OR = 8.42, 95% CI: 2.22–31.91, P = 0.002), episiotomy (OR = 1.37, 95% CI: 1.02–1.84, P = 0.035), and second-degree perineal tear (OR = 3.42, 95% CI: 2.37–4.94, P < 0.001) as significant independent risk factors for PUR. Conclusions PUR was highly associated with epidural analgesia, forceps delivery, vulvar oedema, episiotomy, and second-degree perineal tears. More attention should be paid to women at high risk to reduce the incidence of PUR.

Delivery in water, experiences in a population of Mexican women in Mexico City

Background: Labor is a physiological process during which the fetus, the membranes, the umbilical cord and the placenta are expelled from the uterus and water delivery has become popular, although its prevalence is unknown, it is supported by healthy women with full-term pregnancies, without complications; although there is insufficient evidence to support or discourage it. Objective: To identify obstetric and neonatal outcomes and complications in women who delivered in water and to compare them with traditional deliveries. Material and methods: It is a retrospective, observational and cross-sectional study, where 2486 women were included from a database of 4223 women assisted from 2004 to 2020 in private hospitals; Of the 2486 patients included, 1025 had a water delivery and 1461 had a conventional delivery, discarding 1737 women who underwent caesarean section from the study. The information obtained from the patients, their data obtained for this study were kept in the anonymity of the patients, where they were analyzed: non-parametric data reported in percentages using Chi square; Parametric, perinatal and neonatal data are reported as mean plus standard deviation (±SD) and analyzed using Student's T, using the SPSS version 25 statistical package. Results: A total of 2486 women were included in this study, the birth in 1025 was water delivery (24%) and 1461 was conventional delivery (35%), 1737 caesarean section (41%) were excluded from the study, no difference was observed maternal age; unlike weight, height, body mass index; they were higher in women with water birth compared to conventional. No difference was demonstrated between nulliparous (45.99%) and multiparous (53.86%) when comparing both birth in water and conventional; only increase in previous caesarean sections (9.36 vs 6.5%, p=0.008) and decrease in previous abortions (16.19 vs 20.94%, p=0.002) in water delivery with the conventional one; complications were not different: administration of oxytocin (3.2 vs 3.1) or postpartum hemorrhage (0.29 vs 0.13) in both deliveries; no differences in first degree perineal tears (21.4 vs 18.5%). Conclusion: Water birth reduces stress, pain sensation, second and third degree perineal lacerations and contributes to better newborn outcomes; the selection and inclusion of patients with low-risk pregnancies allows better perinatal results than conventional delivery; but, further studies are required to use it routinely.

A Protocol for Developing a Clinical Practice Guideline for Prevention and Management of Perineal Tears at Vaginal Delivery

Introduction: Perineal tear is a distressing obstetric complication affecting females globally. More than 85% of women sustain some degree of perineal tears during childbirth, resulting in potential effects on women’s well-being and quality of life. Although different institutions around the world have developed some related clinical practice guidelines (CPGs), a few recommendations are inconsistent, unspecific, and some CPGs are silent on certain matters, which might confuse guideline users. Nowadays, there is still no domestic CPG for prevention and management of perineal tears in China to guide clinical practice.Methods: This CPG will be developed in line with the latest guideline definition from Institute of Medicine (IOM) and comply with the World Health Organization handbook for guideline. We will adhere closely to the six domains of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and apply the Grade of Recommendations Assessment, Development and Evaluation (GRADE) system to appraise the quality of evidence and develop recommendations. We have established a guideline working group (including a guideline steering group, a guideline development group, a guideline secretary group, and a system evaluation group), formulated 21 questions in the form of Population, Intervention, Comparison, Outcome (PICO) and completed a literature search. The recommendations will be formed via evidence search, syntheses, and 2 to 3 rounds of Delphi process to reach consensus. We will also consider patients’ values or preferences, peer review results in this CPG. Ethics and dissemination: The CPG has been registered on the International Practice Guidelines Registry Platform. The need for ethics approval has been exempted by the Institutional Review Boards of the Southern Medical University. The CPG is to be published in peer-reviewed journals and will form the care standard for perineal care for Chinese women with vaginal delivery.

Hubungan Paritas dengan Kejadian Rupture Perineum pada Persalinan Normal

Introduction: Even though labor was going normally, after giving birth the mother had various risks of complications that might occur, such as bleeding due to uterine atony, retained placenta, and perineal ruptur. Objective: to see the relationship between parity and the incidence of perineal ruptur in normal delivery. Methods: this type of research uses an analytical method based on a cross sectional design. The population is all mothers who give birth at the Kassi Kassi Health Center Makassar City can use 30 people. The sampling technique used was Consecutive Sampling. Results: The results showed 76.7% of respondents experienced perineal tears, of which 26.7% of respondents experienced 1st degree perineal tears and 50.0% of respondents had grade 2 perineal tears. 23.3% of respondents did not experience perineal tears. From the results of the chi-square test with a value of p=0.05, the probability of the result is greater than a significant tarf of 5% (0.071> 0.05), meaning that there is no parity relationship with perineal tears in mothers with normal delivery at the Kassi-Kassi Community Health Center, Makassar City. 2020. The strength of the relationship between variables is rather low, the value of the Phi coefficient (μ) = 0.488 or 48.8%. Conclusion: Based on the results of the research that has been done, it can be denied that there is no relationship between parity and perineal tearing in normal delivery.

A core outcome set for clinical trials of first- and second-degree perineal tears prevention and treatment: a study protocol for a systematic review and a Delphi survey

Background Perineal tear is a common consequence of vaginal births affecting females globally. Even mild perineal tears could cause short- and long-term complications for females. Though many studies of interventions to prevent or treat perineal tears to minimize the consequences have been conducted, there is a significant heterogeneity in the outcomes measured and reported in existing studies, which makes meaningful comparison difficult and makes the generalizability to clinical practice challenging. Developing a core outcome set (COS) could solve these methodological concerns. In this paper, we report a protocol to develop a COS for clinical trials of mild perineal tears, which shall assist in establishing the evidence base and implementation of effective measures to reduce the incidence and minimize the consequences of mild perineal tears. Methods/design The development of this COS will be guided by a study advisory group composed of obstetricians, midwives, nursing managers, service users, and methodologists. This study will include four stages: (1) a systematic research of the literature to identify outcomes reported in prior studies, (2) a semi-structured interview with key stakeholders to collect their opinions on important outcomes, (3) a panel of experts will be invited to conduct a three-round Delphi survey to prioritize these outcomes, and (4) a consensus meeting with key stakeholders to determine the list of outcomes included in the final COS. Discussion The development of this COS will provide international standards for the outcomes to be collected and reported in all clinical trials and audits of practice, which involve prevention and treatment of first- and second-degree perineal tears for women with vaginal delivery. This will facilitate comparing and contrasting of studies and allow for combining of appropriate studies with the ultimate goal of improved perineal care for women choosing vaginal delivery. Trial registration This study was registered in the database of Core Outcome Measures in Effectiveness Trials (COMET) on June11th, 2021 (https://comet-initiative.org/Studies/Details/1884).

Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study

Objective To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. Materials and methods Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd−/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. Results The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57–0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48–3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57–0.93, p = 0.010). Conclusions The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.

Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications

Background Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Study design Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student’s t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. Results Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41–15.56, p< 0.001). Conclusion In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.

Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial

The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8–10 to 38–39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.