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J Obstet Gynaecol Res 2019 Jan 20. Epub 2019 Jan 20.

Department of Obstetrics & Gynaecology, Govt Medical College, Ambikapur, India.

Aim: To evaluate the effect of low dose (1 g) of intravenous tranexamic acid (TXA) before caesarean delivery upon the mean blood loss during and after surgery as well side effects of the drug and to compare these effects with those who did not receive this medication in a referral hospital situated at the tribal terrain of Chhattisgarh.

Methods: Total 100 women fulfilling inclusion criteria and shifted for caesarean section were studied. Fifty women comprising the study group were given one gram TXA (10 mL) intravenously over 10-20 min before skin incision whereas the other 50 women did not receive the drug (control group). Read More

Am J Obstet Gynecol 2019 Feb 25;220(2):191.e1-191.e7. Epub 2018 Oct 25.

Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address:

Background: A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor.

Objective: To examine the effect of prolonging the second stage of labor on the rate of cesarean delivery, and maternal and neonatal outcomes. Read More

Obstet Gynecol Surv 2018 Dec;73(12):695-702

Consultant in Maternal-Fetal Medicine, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Importance: Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.

Objective: The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.

Evidence Acquisition: Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. Read More

Mymensingh Med J 2018 Oct;27(4):793-797

Dr Parul Akhter, Assistant Professor, Department of Gynae & Obs, Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh.

The third stage of labour is considered to be the most critical part of child birth due to the risk of post partum haemorrhage (PPH). To compare the effectiveness of carbetocin and oxytocin in the management of 3rd stage of labour in preventing post partum hemorrhage, this experimental clinical trial was conducted in the Department of Obstetrics and Gynecology, Sir Salimulla Medical College Hospital, Dhaka, Bangladesh from January 2015 to June 2016. Three hundred women undergoing normal vaginal delivery were consecutively enrolled. Read More

Eur J Obstet Gynecol Reprod Biol 2019 Jan 28;232:22-29. Epub 2018 Oct 28.

Aurora Health Care, Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, WI, United States.

Background: Retained placenta is the most common second-trimester delivery complication. As the optimal third stage of labor duration remains undefined, complications associated with retained placentas are difficult to study.

Objective(s): To determine the optimal third stage of labor duration in second-trimester deliveries based on estimates of time-specific probabilities of placental delivery, placental intervention, and postpartum complication. Read More

Women Birth 2018 Oct 18. Epub 2018 Oct 18.

Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Shared Decision Making Resource Center, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Aromatherapy is a treatment method that applies fragrant extracts from herbal plants, existed long ago in medical history as a major treatment approach and now used as an auxiliary treatment and sometimes a major treatment for pain and stress management, including those that occur in labor.

Aim: We aimed to conduct a meta-analysis of randomized controlled trials of the effectiveness of aromatherapy on labor pain and duration reduction.

Methods: We searched the Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar and Clinicaltrials. Read More

Syst Rev 2018 10 20;7(1):170. Epub 2018 Oct 20.

School of Health Sciences, Health Professions 2239, Central Michigan University, Mount Pleasant, MI, USA.

Background: Postpartum hemorrhage (PPH) and the amount of blood loss are directly related to management of the third stage of labor. No previous report has compared the effects of carbetocin to those of misoprostol. The aim of this systematic review was to compare the effects of carbetocin to those of misoprostol for management of the third stage of labor and for the prevention of PPH. Read More

Int J Gynaecol Obstet 2019 Jan 22;144(1):56-61. Epub 2018 Oct 22.

ClinAmygate, Cairo, Egypt.

Objective: To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH).

Method: The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. Read More

Cochrane Database Syst Rev 2018 09 22;9:CD009332. Epub 2018 Sep 22.

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland, CH-1211.

Background: There is general agreement that oxytocin given either through the intramuscular or intravenous route is effective in reducing postpartum blood loss. However, it is unclear whether the subtle differences between the mode of action of these routes have any effect on maternal and infant outcomes. This is an update of a review first published in 2012. Read More

Turk J Obstet Gynecol 2018 Sep 3;15(3):188-192. Epub 2018 Sep 3.

University of Health Sciences, İzmir Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, İzmir, Turkey.

Postpartum hemorrhage is a potentially life-threatening, albeit preventable, condition that persists as a leading cause of maternal death. It occurs mostly during the third stage of labor, and active management of the third stage of labor (AMTSL) can prevent its occurrence. AMTSL is a recommended series of steps, including the provision of uterotonic drugs immediately upon fetal delivery, controlled cord traction, and massage of the uterine fundus, as developed by the World Health Organization. Read More

Pregnancy Hypertens 2018 Jul 9;13:166-170. Epub 2018 Jun 9.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address:

Objective: To examine the association between hypertensive disorders of pregnancy and third stage placental complications.

Methods: A retrospective cohort study based on Soroka Medical Center institutional computerized database. All vaginal deliveries of women between the years 1998-2013 were included. Read More

Birth 2019 Mar 30;46(1):69-79. Epub 2018 Aug 30.

Oregon Health and Science University, Portland, Oregon.

Background: Postpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Read More

BMC Pregnancy Childbirth 2018 Jun 15;18(1):232. Epub 2018 Jun 15.

Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California in San Francisco, (UCSF), San Francisco, California, USA.

Background: A significant proportion of newborn and maternal deaths can be prevented through simple and cost-effective strategies. The main aim of this study was to evaluate the impact of the PRONTO obstetric-emergency management training for improving evidence-based birth attendance practices among providers attending the training at 12 hospitals in three states of Mexico from 2010 to 2012, and to estimate dissemination of the training within the hospitals.

Methods: The average treatment on the treated effect of the PRONTO intervention for the probability of performing certain practices during birth attendance was estimated in a sample of 310 health providers. Read More

Indian J Community Med 2018 Apr-Jun;43(2):90-96

Save the Children, Gurgaon, Haryana, India.

Background: Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention.

Objectives: This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR. Read More

BMC Pregnancy Childbirth 2018 Jun 13;18(1):223. Epub 2018 Jun 13.

Jhpiego Baltimore, Baltimore, MD, USA.

Background: Tanzania has a maternal mortality ratio of 556 per 100,000 live births, representing 21% of all deaths of women of reproductive age. Hemorrhage, mostly postpartum hemorrhage (PPH), is estimated to cause at least 25% of maternal deaths in Tanzania. In 2008, the Ministry of Health, Community Development, Gender, Elderly and Children launched interventions to improve efforts to prevent PPH. Read More

Birth 2018 Dec 22;45(4):377-384. Epub 2018 May 22.

Hillel Yaffe Medical Center, Hadera, Israel.

Background: We aimed to describe the length of second stage of labor in a contemporary cohort. We calculated the 5th, 50th, and 95th percentiles for second-stage length stratified by parity and epidural analgesia use and evaluated the effect of labor induction and oxytocin augmentation in our cohort.

Methods: We did a retrospective analysis of all live, singleton, term vaginal deliveries in one tertiary hospital. Read More

Cochrane Database Syst Rev 2018 05 16;5:CD000111. Epub 2018 May 16.

Faculty of Health Sciences, University of Southampton, Nightingale Building (67), Highfield, Southampton, Hants, UK, SO17 1BJ.

Background: Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS). This is an update of a review last published in 2011. Read More

Pain Manag Nurs 2018 06 19;19(3):288-294. Epub 2018 Apr 19.

Midwifery Department, College of Nursing, The Center for Research and Education in Women's Health, Hawler Medical University, Erbil City, Kurdistan Region, Iraq. Electronic address:

Background: Labor is one of the most painful events in a women's life. Frequent change in positions and back massage may be effective in reducing pain during the first stage of labor.

Aim: The focus of this study was to identify the impact of either change in position or back massage on pain perception during first stage of labor. Read More

Eur J Obstet Gynecol Reprod Biol 2018 May 20;224:188-191. Epub 2018 Mar 20.

Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland. Electronic address:

Background: The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally.

Objectives: The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Read More

Cochrane Database Syst Rev 2018 03 28;3:CD009290. Epub 2018 Mar 28.

National Institute of Complementary Medicine (NICM), Western Sydney University, Locked Bag 1797, Penrith, New South Wales, Australia, 2751.

Background: Many women would like to avoid pharmacological or invasive methods of pain management in labour, and this may contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012. Read More

Eur J Obstet Gynecol Reprod Biol 2018 May 9;224:47-51. Epub 2018 Mar 9.

Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey.

Objective: Postpartum hemorrhage is still the most significant cause of maternal mortality and morbidity worldwide. Our aim was to evaluate the effect of timing of oxytocin administration on postpartum hemorrhage incidence in parturients with low-risk for postpartum hemorrhage.

Study Design: A randomized controlled trial was completed on 343 women at a level-three care hospital. Read More

Eur J Obstet Gynecol Reprod Biol 2018 May 5;224:1-5. Epub 2018 Mar 5.

Department of Obstetrics and Gynecology, Assaf Harofe Medical Center (Affiliated with the Sackler Faculty of Medicine), Tel Aviv University, Tel Aviv, Israel.

Objective: To investigate whether women who were surgically treated for retained products of conception (RPOC) by either suction curettage or hysteroscopy are at risk for recurrent RPOC on their subsequent pregnancies.

Study Design: Retrospective analysis of 442 women surgically treated for RPOC following delivery or abortion by suction curettage (N = 63, 14.3%) or hysteroscopy (N = 379, 85. Read More

Midwifery 2018 Apr 31;59:118-126. Epub 2018 Jan 31.

Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom. Electronic address:

Objective: Women's planned place of birth is gaining increasing importance in the UK, however evidence suggests that there is variation in the content of community midwives' discussions with low risk women about their place of birth options. The objective of this study was to develop an intervention to improve the quality and content of place of birth discussions between midwives and low-risk women and to evaluate this intervention in practice.

Design: The study design comprised of three stages: (1) The first stage included focus groups with midwives to explore the barriers to carrying out place of birth discussions with women. Read More

BMC Pregnancy Childbirth 2018 02 6;18(1):47. Epub 2018 Feb 6.

Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands.

Background: Active management of the third stage of labor (AMTSL) describes interventions with the common goal to prevent postpartum hemorrhage (PPH). In low- and middle-income countries, implementation of AMTSL is hampered by shortage of skilled birth attendants and a high percentage of home deliveries. Task shifting of specific AMTSL components to unskilled birth attendants or self-administration could be a strategy to increase access to potentially life-saving interventions. Read More

J Midwifery Womens Health 2018 Jul 31;63(4):446-454. Epub 2018 Jan 31.

Introduction: Midwives and physicians incorporate their knowledge, experiences, and other variables in making clinical decisions. Variations in the management of the third stage of labor may be a result of variables that influence providers' decision making. The purpose of this study was to describe variables that influence US midwives' and physicians' management of the third stage of labor. Read More

Reprod Health 2018 Jan 27;15(1):14. Epub 2018 Jan 27.

Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway.

Background: Making use of good, evidence based routines, for management of normal childbirth is essential to ensure quality of care and prevent, identify and manage complications if they occur. Two essential routine care interventions as defined by the World Health Organization are the use of the Partograph and Active Management of the Third Stage of Labour. Both interventions have been evaluated for their ability to assist health providers to detect and deal with complications. Read More

Reprod Health Matters 2017 Nov 12;25(51):140-150. Epub 2017 Dec 12.

e Statistician , U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA.

Providing quality health care services in humanitarian settings is challenging due to population displacement, lack of qualified staff and supervisory oversight, and disruption of supply chains. This study explored whether a participatory quality improvement (QI) intervention could be used in a protracted conflict setting to improve facility-based maternal and newborn care. A longitudinal quasi-experimental design was used to examine delivery of maternal and newborn care components at 12 health facilities in eastern Democratic Republic of Congo. Read More

BMC Pregnancy Childbirth 2017 Nov 29;17(1):399. Epub 2017 Nov 29.

Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Background: Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women requiring cesarean delivery constitute a subset of patients that may exhibit an unpredictable response to oxytocin. Read More

Trials 2017 Nov 15;18(1):541. Epub 2017 Nov 15.

Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin & Coombe Women & Infants University Hospital, Dublin 8, Ireland.

Background: Primary postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. The most common cause of primary PPH is uterine atony. Atonic PPH rates are increasing in developed countries despite routine active management of the third stage of labour. Read More

Women Birth 2018 Jun 26;31(3):158-165. Epub 2017 Oct 26.

Hospital "Mancha-Centro", Alcázar de San Juan, Spain.

Background: Postpartum anaemia is a frequent and potentially preventable complication that has serious repercussions on health and maternal well-being.

Aim: Determine the incidence and perinatal risk factors associated with postpartum anaemia in women who gave birth vaginally.

Methods: An observational and analytical retrospective cohort study conducted at the Mancha-Centro Hospital during the 2010-2014 period. Read More

BMC Pregnancy Childbirth 2017 Sep 7;17(1):292. Epub 2017 Sep 7.

School of Public and Environmental Health, College of Medicine and health sciences, Hawassa University, Hawassa, Ethiopia.

Background: Active management of third stage of labor played a great role to prevent child birth related hemorrhage. However, maternal morbidity and mortality related to hemorrhage is high due to lack of knowledge and skill of obstetric care providers 'on active management of third stage of labor. Our study was aimed to assess knowledge, practice and associated factors of obstetric care providers (Midwives, Nurses and Health officers) on active management of third stage of labor in Sidama Zone, South Ethiopia. Read More

BMJ Open 2017 Aug 29;7(8):e016288. Epub 2017 Aug 29.

School of Nursing and Midwifery and the Family and Community Health, University of Western Sydney, Sydney, Australia.

Objective: To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in a freestanding primary level midwife-led maternity unit (PMU) or tertiary level obstetric-led maternity hospital (TMH) in Canterbury, Aotearoa/New Zealand.

Design: Prospective cohort study.

Participants: 407 women who intended to give birth in a PMU and 285 women who intended to give birth at the TMH in 2010-2011. Read More

J Midwifery Womens Health 2017 Jul;62(4):397-417

Introduction: Despite widespread use of exogenous synthetic oxytocin during the birth process, few studies have examined the effect of this drug on breastfeeding. Based on neuroscience research, endogenous oxytocin may be altered or manipulated by exogenous administration or by blocking normal function of the hormone or receptor. Women commonly cite insufficient milk production as their reason for early supplementation, jeopardizing breastfeeding goals. Read More

J Midwifery Womens Health 2017 Jul 13;62(4):418-424. Epub 2017 Jul 13.

Introduction: Maternity care providers administer oxytocin prophylactically to prevent postpartum hemorrhage (PPH). Prophylactic oxytocin is generally considered effective and safe and is promoted by national organizations for standardized use. In this article, the evidence supporting prophylactic oxytocin administration for women undergoing spontaneous labor and birth compared with women whose labors included administration of exogenous oxytocin for induction or augmentation is explored. Read More

Int J Gynaecol Obstet 2017 Oct 19;139(1):14-20. Epub 2017 Jul 19.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Objective: To describe stage of labor at admission among women with a prior cesarean, and examine its impact on intrapartum management and delivery mode.

Methods: In a prospective cohort study, women admitted to Mbarara Regional Referral Hospital, Uganda, for delivery were enrolled between March and June 2015. Rates of vaginal delivery (VBAC) and in-hospital trial of labor (TOL) were compared between early (<4 cm dilation) and late (≥4 cm) presenters. Read More

Arch Gynecol Obstet 2017 Aug 14;296(2):223-229. Epub 2017 Jun 14.

Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany.

Purpose: The aim of this study was to evaluate the perinatal and maternal outcomes at term at a single tertiary, university hospital in women with low-risk pregnancies.

Patients And Methods: We performed a retrospective cohort study of women with low-risk pregnancies, who delivered at University Women's Hospital Magdeburg between January 2010 and December 2014. Data were compared with data published by Brocklehurst et al. Read More

Cochrane Database Syst Rev 2017 06 13;6:CD006672. Epub 2017 Jun 13.

Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.

Background: Most vaginal births are associated with trauma to the genital tract. The morbidity associated with perineal trauma can be significant, especially when it comes to third- and fourth-degree tears. Different interventions including perineal massage, warm or cold compresses, and perineal management techniques have been used to prevent trauma. Read More

Am J Perinatol 2017 Dec 7;34(14):1375-1381. Epub 2017 Jun 7.

Division of Newborn Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania.

Isr Med Assoc J 2017 Apr;19(4):234-236

Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.

Background: In recent years, the role of intrapartum sonography has expanded in childbirth management, in subjective clinical situations such as arrested deliveries, or prior to instrumental deliveries.

Objectives: To assess the current use of intrapartum ultrasound by obstetricians in Israel.

Methods: An anonymous questionnaire was completed by 79 obstetricians in second- and third level- hospitals in Israel. Read More

Pan Afr Med J 2016 26;25(Suppl 2):11. Epub 2016 Nov 26.

Kenyatta University, Nairobi City, Kenya.

Introduction: Post-Partum Hemorrhage (PPH) accounts for 34% of maternal deaths in Kenya. Active management of third stage of labour (AMTSL) is a World Health Organization and Ministry of Health of Kenya approved protocol for reducing maternal mortality and morbidity arising from post-partum hemorrhage. Kiambu County in Kenya records an average of six maternal deaths per month, out of which, two are due to PPH. Read More

Am Fam Physician 2017 Apr;95(7):442-449

HealthPartners Institute for Education and Research, Bloomington, MN, USA.

Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Read More

J Med Assoc Thai 2017 Apr;100(4):382-8

Background: Postpartum hemorrhage (PPH) is major cause of morbidity and mortality globally. Although the majority of PPH could be avoided through the use of pharmacologic prevention during the third stage of labor, the maternal mortality rate from PPH is unchanged and the blood transfusion rate is increasing. In rural hospital or primary care unit, most health care workers are general practitioners and intern doctors, they are inexperienced in managing PPH case and lack of medication, blood component, medical instrument, and surgical team. Read More

BMC Pregnancy Childbirth 2017 03 28;17(1):101. Epub 2017 Mar 28.

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. Read More

Obstet Gynecol 2017 04;129(4):e73-e89

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. Read More

Obstet Gynecol 2017 04;129(4):766-768

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. Read More

Birth 2017 09 21;44(3):252-261. Epub 2017 Mar 21.

Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA.

Background: Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery.

Methods: A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. Read More

PLoS One 2017 20;12(3):e0172623. Epub 2017 Mar 20.

Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health (INSP), Cuernavaca, Morelos, México.

Background: In Mexico, although the majority of births are attended in hospitals, reports have emerged of obstetric violence, use of unsafe practices, and failure to employ evidence-based practices (EBP). Recent attention has refocused global efforts towards provision of quality care that is both patient-centered and evidence-based. Scaling up of local interventions should rely on strong evidence of effectiveness. Read More

Curr Opin Obstet Gynecol 2017 Apr;29(2):66-70

aInserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes UniversitybDepartment of Obstetrics and Gynecology, Trousseau Hospital, APHP, Université Pierre et Marie Curie, Paris, France.

Purpose Of Review: Examine the available results from population-based studies to test the hypothesis that differences between countries in medical practices for the management of labour, delivery and early bleeding may lead to a differential risk of post-partum haemorrhage (PPH)-related maternal morbidity and in the need for PPH-related invasive therapies.

Recent Findings: International comparison of ratios of maternal mortality due to PPH shows significant differences between developed countries. Direct international comparisons of PPH rates to investigate these differences are difficult because PPH definition is not homogeneous. Read More

BJOG 2017 Aug 20;124(9):1307-1309. Epub 2017 Feb 20.

Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK.

Risk Manag Healthc Policy 2017 17;10:1-6. Epub 2017 Jan 17.

Academic Centre for Women's Health, North Bristol NHS Trust, Bristol, UK.

Background: Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. Read More