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Eur J Obstet Gynecol Reprod Biol 2022 Jun 15;275:46-53. Epub 2022 Jun 15.

Post-Graduate Program on Integral Medicine, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil. Electronic address:

Background And Purpose: Most women suffer some degree of perineal trauma during vaginal delivery. Second stage management strategies, including vocalization, to protect the perineum have been investigated.

Objective: To compare the frequency and degree of perineal trauma at vaginal delivery, with and without use of the vocalization maneuver during the second stage of labor. Read More

BMC Pregnancy Childbirth 2022 Jun 17;22(1):498. Epub 2022 Jun 17.

Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.

Background: Postpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Early recovery is a performance indicator and better health outcome of patients with postpartum hemorrhage. Therefore, this study aimed to assess time to recovery from postpartum hemorrhage and its predictors in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020. Read More

Comput Intell Neurosci 2022 26;2022:1343358. Epub 2022 May 26.

Jiangsu Vocational College of Information Technology, Wuxi, Jiangsu 214153, China.

With the increasing pressure on college students in terms of study, work, emotion, and life, the emotional changes of college students are becoming more and more obvious. For college student management workers, if they can accurately grasp the emotional state of each college student in all aspects of the whole process, it will be of great help to student management work. The traditional way to understand students' emotions at a certain stage is mostly through chats, questionnaires, and other methods. Read More

Am J Obstet Gynecol MFM 2022 May 7;4(5):100661. Epub 2022 May 7.

From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA. Electronic address:

During the third stage of labor, oxytocin and tranexamic acid, oxytocin and misoprostol, oxytocin and methylergometrine, or carbetocin is recommended for the prevention of postpartum hemorrhage after vaginal delivery. Intravenous oxytocin (10 IU) immediately after delivery of the neonate (after either anterior shoulder or whole-body delivery) and before delivery of the placenta is recommended. If oxytocin and tranexamic acid combination is chosen, intravenous tranexamic acid (1 g) in addition to intravenous oxytocin (10 IU) immediately after delivery of the neonate and before placental delivery is recommended. Read More

J Obstet Gynaecol Res 2022 May 3. Epub 2022 May 3.

Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Aim: To reassess the normal duration of each stage of labor in a contemporary Japanese cohort, and to determine whether prolongation of each stage of labor increases the rate of postpartum hemorrhage (PPH) in vaginal deliveries.

Methods: Clinical data of women who delivered at term at 12 facilities between 2012 and 2018 were retrospectively collected. A total of 31 758 women were subdivided into three or four subgroups according to the duration of each stage of labor and parity. Read More

Am J Obstet Gynecol 2022 Apr 19. Epub 2022 Apr 19.

Department of Obstetrics and Gynaecology, Assistance Publique- Hôpitaux de Marseille, Gynepole-North Hospital, Marseille, France.

Background: Uncertain fetal head engagement represents 4% of obstetrical situations associated with an increased risk of postpartum hemorrhage, notably in cases of cesarean delivery and increased neonatal impairment owing to failed vaginal instrumental delivery. In this obstetrical condition, cesarean delivery is recommended, but vaginal delivery is possible in two-thirds of the cases. During the second stage of labor, the descent of the fetal head can be assessed by sonography, particularly by measuring the angle of progression. Read More

J Gynecol Obstet Hum Reprod 2022 Jun 9;51(6):102378. Epub 2022 Apr 9.

Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Objective: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that inspected the efficacy and safety of prophylactic TXA compared with control (placebo/no treatment) among women undergoing vaginal delivery on reducing postpartum blood loss and related morbidities.

Methods: Six databases were screened from inception until 06-December-2021. The pooled data were summarized as mean difference or risk ratio, respectively, with 95% confidence interval in a fixed- or random-effects model. Read More

J Med Case Rep 2022 Apr 8;16(1):141. Epub 2022 Apr 8.

Department of Obstetrics and Gynecology, Jimma Medical Center, Jimma University, Jimma, Ethiopia.

Background: Uterovaginal prolapse is the descent of the uterus and vagina down the birth canal toward the introitus. The occurrence of uterovaginal prolapse in a primigravida is very rare. It can cause preterm labor, fetal demise, spontaneous abortion, postpartum hemorrhage, maternal urinary complications, sepsis, and death. Read More

Gynecol Obstet Invest 2022 16;87(1):46-53. Epub 2022 Mar 16.

Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.

Objectives: The aim of the study was to estimate the impact of epidural analgesia (EA) during delivery on maternal and infant outcomes.

Design: This was a prospective cohort study.

Participants: In total, 159 pregnant multiparas in Women and Children's Hospital, School of Medicine, Xiamen University from November 2019 to May 2020 were enrolled. Read More

Eur J Midwifery 2022 10;6. Epub 2022 Feb 10.

Neonatology research group, Section of Pediatrics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.

Introduction: The timing of cord clamping impacts children's short- and long-term well-being. When making clinical decisions, midwives incorporate their tacit and professional knowledge, experience and current evidence. There appears to be a lack of knowledge regarding Swedish midwives' management of the third stage of labor and cord clamping practice. Read More

Pan Afr Med J 2021 17;40:238. Epub 2021 Dec 17.

Department of Nursing, Federal University, Oye Ekiti, Ekiti State, Nigeria.

Introduction: despite large investments in maternal health services in the world, postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Misoprostol is the most available, accessible, and affordable uterotonic agent in the management of the third stage of labor and has been found to be effective in PPH prevention in low-income countries. This study, therefore, assessed the influence of nursing interventions improving midwives´ awareness of misoprostol use in the management of PPH at selected health facilities. Read More

BMC Womens Health 2022 02 11;22(1):36. Epub 2022 Feb 11.

Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania.

Background: Health care providers (HCPs) knowledge and skills are both crucial in saving the lives of mothers and their newborns during childbirth. This study aimed to assess the knowledge and skills of HCPs on active management of third stage of labor (AMTSL) for prevention of PPH in Lake Zone Tanzania.

Methods: A cross-sectional analytical hospital-based study which included 340 HCPs who were randomly selected, the study was conducted from March to May 2019 in lake zone, Tanzania. Read More

Complement Ther Clin Pract 2022 Feb 5;46:101545. Epub 2022 Feb 5.

Delivery Room, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China; Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China. Electronic address:

Background And Purpose: The pain and uncertainty of the labour process can lead to anxiety. Birth ball exercises are one of the pain relief methods for the labour process. This study aimed to explore the outcomes of the use of the labour roadmap with birth balls in primiparas. Read More

BMC Pregnancy Childbirth 2022 Feb 4;22(1):99. Epub 2022 Feb 4.

American Association of Birth Centers, 3123 Gottschall Road, Perkiomenville, PA, 18074, USA.

Background: Current guidelines for second stage management do not provide guidance for community birth providers about when best to transfer women to hospital care for prolonged second stage. Our goal was to increase the evidence base for these providers by: 1) describing the lengths of second stage labor in freestanding birth centers, and 2) determining whether proportions of postpartum women and newborns experiencing complications change as length of second stage labor increases.

Methods: This study is a retrospective analysis of de-identified client-level data collected in the American Association of Birth Centers Perinatal Data Registry, including women giving birth in freestanding birth centers January 1, 2007 to December 31, 2016. Read More

BMC Pregnancy Childbirth 2022 Jan 21;22(1):57. Epub 2022 Jan 21.

Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Background: Uterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women. Read More

Obstet Gynecol Int 2021 31;2021:9207541. Epub 2021 Dec 31.

School of Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia.

Background: World Health Organization strongly recommends that every obstetrical provider at birth needs to have knowledge and skills on active management of the third stage of labor and use it routinely for all women. However, implementation of this lifesaver intervention by skilled birth attendants is questionable because 3% to 16.5% of women still experience postpartum hemorrhage. Read More

BMC Pregnancy Childbirth 2021 Dec 30;21(1):849. Epub 2021 Dec 30.

Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Background: Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. Read More

Gac Sanit 2021;35 Suppl 2:S284-S287

Faculty of Medicine, Hasanuddin University, Indonesia.

Objective: This research was aimed to develop and test virtual reality-based learning media in improving active management skills of the third stage labor in midwifery students.

Methods: This study uses a Research and Development (R&D) research design method developed by Borg and Gall. The stages of this study consisted of; analysis of the needs of virtual reality-based learning media about active management of the third stage, planning of the development of instructional media development, development of instructional media, expert validation, one-on-one trials, small group trials, large group trials, and the final product of learning media. Read More

PLoS One 2021 16;16(11):e0259926. Epub 2021 Nov 16.

Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway.

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. Read More

Anesthesiol Clin 2021 Dec;39(4):597-611

Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital, Patient Blood Management Program, 300 Halket Street, Pittsburgh, PA 15213, USA.

Obstetric hemorrhage is a leading cause of morbidity and mortality. Prevention includes identifying patients with risk factors and actively managing the third stage of labor. The anesthesiologist should be ready to manage hemorrhage with general strategies as well as strategies tailored to the specific cause of hemorrhage. Read More

Reprod Health 2021 Nov 14;18(1):230. Epub 2021 Nov 14.

Women's and Children's Health Research Unit JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.

Background: Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. Read More

J Matern Fetal Neonatal Med 2021 Sep 1:1-4. Epub 2021 Sep 1.

Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.

Objective: To compare maternal outcomes using Carbetocin versus Oxytocin for the active management of the third stage of labor, given a temporary national shortage of Oxytocin.

Methods: We conducted a retrospective observational study on a cohort of 866 women with vaginal deliveries at our center, >36 weeks of gestation, between November 2018 and March 2019. During the shortage period, each woman received a single slow intravenous injection of Carbetocin 100 µg at delivery of the anterior shoulder, rather than Oxytocin 5 UI, as postpartum hemorrhage prophylaxis. Read More

Afr Health Sci 2020 Dec;20(4):1908-1917

Clinical Nursing department, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS).

Background: Despite the fact that it is possibly preventable, postpartum haemorrhage (PPH) is the global most deadly form of obstetric bleeding, mainly sub-Saharan Africa with at least one-fourth of maternal deaths in East African regions. Active management of third stage of labour (AMTSL) is recommended to prevent PPH. However, AMTSL guidelines have been revised since 2006. Read More

Int J Obstet Anesth 2021 Nov 21;48:103207. Epub 2021 Jul 21.

Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, United States. Electronic address:

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, and uterine atony is the leading cause of postpartum hemorrhage. Risk factors for uterine atony include induced or augmented labor, preeclampsia, chorio-amnionitis, obesity, multiple gestation, polyhydramnios, and prolonged second stage of labor. Although a risk assessment is recommended for all parturients, many women with uterine atony do not have risk factors, making uterine atony difficult to predict. Read More

Health Care Women Int 2021 Aug 9:1-17. Epub 2021 Aug 9.

Faculty of HealthScience, Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Trabzon, Turkey.

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and disability. A need for simple, inexpensive techniques to prevent PPH and provide treatment exists, particularly in cases where uterotonics cannot be accessed. Uterine massage is recommended as part of the routine active management of the third stage of labor. Read More

J Matern Fetal Neonatal Med 2021 Jun 28:1-6. Epub 2021 Jun 28.

Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.

Purpose: To investigate the effect of the COVID-19 pandemic on healthcare utilization related to labor and delivery and to assess the effect of the COVID-19 pandemic on intra-partum and delivery complications.

Methods: This retrospective study was performed at a university-affiliated, tertiary medical center. It included women admitted to the delivery room from 1 March 2020 to 23 July 2020 during the first wave of the COVID-19 pandemic. Read More

PLoS One 2021 25;16(6):e0253765. Epub 2021 Jun 25.

Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.

Background: Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy.

Objective: We hypothesize that in early PPH a restrictive fluid administration results in less progression to moderate PPH. Read More

Nurs Womens Health 2021 Aug 18;25(4):e1-e4. Epub 2021 Jun 18.

J Obstet Gynecol Neonatal Nurs 2021 Jul 17;50(4):499-502. Epub 2021 Jun 17.

Am Fam Physician 2021 06;103(12):745-752

Travis Air Force Base Family Medicine Residency, Travis Air Force Base, CA, USA.

Obstetric lacerations are a common complication of vaginal delivery. Lacerations can lead to chronic pain and urinary and fecal incontinence. Perineal lacerations are defined by the depth of musculature involved, with fourth-degree lacerations disrupting the anal sphincter and the underlying rectal mucosa and first-degree lacerations having no perineal muscle involvement. Read More