To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China.
A cross-sectional study was conducted in a tertiary ...hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0.
A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18-54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39-6.29), had low social support (aOR = 2.95, 95% CI 1.39-6.29), were non-local residents (aOR = 2.51, 95% CI 1.15-5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15-5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18-3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67-47.09), had completed higher education (aOR = 12.28, 95% CI 1.24-121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37-8.32).
The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.
Aim and objective
To summarize the evidence on the effects of different techniques during the second stage of labour on reducing perineal laceration depending on available systematic reviews to ...provide optimal evidence for decision‐making.
Background
Preventing perineal laceration has been considered an important part of improving women’s health. Various techniques have been used to prevent perineal laceration during the second stage of labour. However, systematic reviews evaluating the effects of different techniques on reducing perineal laceration show inconsistent results.
Design
Overview of systematic reviews.
Methods
Five English and four Chinese databases were systematically searched for relevant systematic reviews and meta‐analyses published between 1 January 2016 and 31 August 2021. The quality of the included reviews was assessed by the AMSTAR 2 tool. A narrative synthesis was conducted to report the results of moderate‐to‐high quality systematic reviews. The overview was reported according to the PRISMA statement.
Results
Eighteen reviews were included, of which four reviews had moderate‐to‐high methodological quality. Perineal massage and warm compresses significantly decreased the incidence of third‐ or fourth‐degree perineal laceration (moderate‐quality evidence). Hands‐off technique had no impact on perineal laceration (low‐to‐moderate quality evidence). Ritgen’s manoeuvre could reduce the incidence of first‐degree perineal laceration but increase the incidence of second‐degree perineal laceration (very low‐quality evidence). Spontaneous pushing (low‐quality evidence) and delayed pushing (moderate‐quality evidence) had no impact on the incidence of third‐ or fourth‐degree perineal laceration. Upright positions did not increase the risk of third‐ or fourth‐degree perineal laceration (very low‐ to low‐quality evidence) but increased the risk of second‐degree perineal laceration for women without epidural analgesia (low‐quality evidence).
Conclusions
Perineal massage and warm compresses could be the better choice for preventing perineal laceration in the second stage of labour.
Relevance to clinical practice
Midwives and obstetricians could use perineal massage and warm compresses to prevent perineal laceration and should consider women's preferences and experience with perineal techniques.
Aims and objectives
To compare and rank the efficacy and safety of non‐pharmacological interventions in the management of labour pain.
Background
Recently, various non‐pharmacological interventions ...have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non‐pharmacological intervention is more efficient and safer is limited.
Design
Systematic review and Bayesian network meta‐analysis based on PRISMA‐NMA.
Methods
Seven databases were searched from database inception–March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta‐analysis was conducted using either fixed‐effects model or random‐effects model according to statistical heterogeneity. The Bayesian network meta‐analysis was conducted using the consistency model.
Results
43 studies involving nine non‐pharmacological interventions were included. The Bayesian network meta‐analysis showed that acupressure (SMD = −2.00, 95% CrI −3.09 to −0.94), aromatherapy (SMD = −2.01, 95% CrI −3.70 to −0.35) and massage therapy (SMD = −1.26, 95% CrI −2.26 to −0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = −130.85, 95% CrI −212.01 to −59.32) and acupressure (SMD = −10.14, 95% CrI −20.24 to −0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non‐pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5‐min Apgar score.
Conclusions
The evidence in this network meta‐analysis illustrates that non‐pharmacological interventions are effective and safe for labour pain management in low‐risk pregnant women. In the future, well‐designed studies are needed to validate the conclusion of this network meta‐analysis.
Relevance to clinical practice
The results support the use of non‐pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in low‐risk pregnant women. Non‐pharmacological interventions for labour pain management are recommended to apply according to maternal women's preference and values.
The male reproductive toxicity of microplastics (MPs) and nanoplastics (NPs) has attracted great attention, but the latent mechanisms remain fragmented. This review performed the adverse outcome ...pathway (AOP) analysis and meta-analysis in 39 relevant studies, with the AOP analysis to reveal the cause-and-effect relationships of MPs/NPs-induced male reproductive toxicity and the meta-analysis to quantify the toxic effects. In the AOP framework, increased reactive oxygen species (ROS) is the molecular initiating event (MIE), which triggered several key events (KEs) at different levels. At the cellular level, the KEs included oxidative stress, mitochondrial dysfunction, sperm DNA damage, endoplasmic reticulum stress, apoptosis and autophagy of testicular cells, repressed expression of steroidogenic enzymes and steroidogenic acute regulatory protein, disrupted hypothalamic-pituitary-testicular (HPT) axis, and gut microbiota alteration. These KEs further induced the reduction of testosterone, impaired blood-testis barrier (BTB), testicular inflammation, and impaired spermatogenesis at tissue/organ levels. Ultimately, decreased sperm quality or quantity was noted and proved by meta-analysis, which demonstrated that MPs/NPs led to a decrease of 5.99 million/mL in sperm concentration, 14.62% in sperm motility, and 23.56% in sperm viability, while causing an increase of 10.65% in sperm abnormality rate. Overall, this is the first AOP for MPs/NPs-mediated male reproductive toxicity in mammals. The innovative integration of meta-analysis into the AOP analysis increases the rigorism of the results.
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•This is the first meta-based AOP of MPs/NPs’ male reproductive toxicity in mammals.•Burst of ROS is a molecular initiating event in MPs/NPs-related male reproductive toxicity.•Testicular cell apoptosis, impaired BTB, decreased testosterone, and testicular inflammation are identified as KEs.•The KEs lead to spermatogenesis disorder, thus causing male reproductive toxicity.•MPs/NPs could decrease sperm quality and quantity, leading to human infertility.
Aims and objectives
To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations.
Background
Many studies have evaluated the risk factors for severe ...perineal lacerations. However, the results of those studies are inconsistent, and meta‐analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking.
Design
Systematic review and meta‐analysis of cohort studies based on the PRISMA guideline.
Methods
PubMed, Embase, the Cochrane Library, CINAHL, ClinicalTrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random‐effects or fixed‐effects model.
Results
A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12–1.92) and pre‐pregnant underweight (OR: 1.31, 95% CI 1.22–1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42–0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81–2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45–1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations.
Conclusions
Severe perineal lacerations are associated with many factors, and evidence‐based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations.
Relevance to clinical practice
This systematic review and meta‐analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.
Perineal lacerations could lead to substantial morbidities for women. A reliable prediction model for perineal lacerations has the potential to guide the prevention. Although several prediction ...models have been developed to estimate the risk of perineal lacerations, especially third- and fourth-degree perineal lacerations, the evidence about the model quality and clinical applicability is scarce.
To systematically review and critically appraise the existing prediction models for perineal lacerations.
Seven databases (PubMed, Embase, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SinoMed, China National Knowledge Infrastructure, and Wanfang Data) were systematically searched from inception to July 2022. Studies that developed prediction models for perineal lacerations or performed external validation of existing models were considered eligible to include in the systematic review. Two reviewers independently conducted data extraction according to the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies. The risk of bias and the applicability of the included models were assessed with the Prediction Model Risk of Bias Assessment Tool. A narrative synthesis was performed to summarize the characteristics, risk of bias, and performance of existing models.
Of 4345 retrieved studies, 14 studies with 22 prediction models for perineal lacerations were included. The included models mainly aimed to estimate the risk of third- and fourth-degree perineal lacerations. The top five predictors used were operative vaginal birth (72.7 %), parity/previous vaginal birth (63.6 %), race/ethnicity (59.1 %), maternal age (50.0 %), and episiotomy (40.1 %). Internal and external validation was performed in 12 (54.5 %) and seven (31.8 %) models, respectively. 13 studies (92.9 %) assessed model discrimination, with the c-index ranging from 0.636 to 0.830. Seven studies (50.0 %) evaluated the model calibration using the Hosmer–Lemeshow test, Brier score, or calibration curve. The results indicated that most of the models had fairly good calibration. All the included models were at higher risk of bias mainly due to unclear or inappropriate methods for handling missing data and continuous predictors, external validation, and model performance evaluation. Six models (27.3 %) showed low concerns about applicability.
The existing models for perineal lacerations were poorly validated and evaluated, among which only two have the potential for clinical use: one for women undergoing vaginal birth after cesarean delivery, and the other one for all women undergoing vaginal birth. Future studies should focus on robust external validation of existing models and the development of novel models for second-degree perineal laceration.
CRD42022349786.
The existing models for perineal lacerations during childbirth need external validation and updating. Tools are needed for second-degree perineal laceration.
Maternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to ...reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour.
A cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines.
Women who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes.
This study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience.
Aims
To compare the effects of the adoption of lateral positions and lithotomy positions during the passive and active phases of the second stage of labour on perineal outcomes.
Design
An ...observational study with prospectively collected data, conducted in three hospitals in China.
Method
Attending midwives recorded the perineal outcomes and characteristics of women giving birth between July–November 2020. Binary logistic regression was performed to explore the effects of lateral positions on perineal outcomes during different phases of the second stage of labour. The STROBE guidelines guided the reporting of this study.
Results
Among primiparous women, when compared with those who adopted lateral positions during the passive phase of the second stage of labour and changed to lithotomy positions during the active phase, women who assumed lateral positions during both the passive and active phases had a higher rate of intact perineum/first‐degree perineal tears and a reduced risk of episiotomy, and episiotomy/second‐degree perineal tears. No significant difference was found in perineal outcomes between those who assumed lithotomy positions during the passive and active phases and those who adopted lateral positions during the passive phase and changed to lithotomy positions during the active phase. No significant difference was found in perineal outcomes among multiparous women, regardless of different positions adopted at the passive and/or the active phase.
Conclusion
Lateral positions during the active phase may have protective effects on the perineum in primiparous women. However, adopting lateral positions only during the passive phase did not promote better perineal outcomes, regardless of parity.
Relevance to clinical practice
This study will provide a further reference for the use of lateral positions during different phases of the second stage of labour among primiparous and multiparous women in clinical practice, contributing to the perineal protection during childbirth.
OBJECTIVEUpright positions in the second stage of labour are recommended by many labour and birth guidelines, but they have not been widely used in China and the implementation varies greatly. Given ...this, we developed a Practice Programme for Upright Positions in the Second Stage of Labour (UPSSL Programme). Whether the UPSSL Programme can be translated into action in the local context is a crucial issue that needs to be further explored. This study aimed to explore barriers and facilitators to the implementation of the UPSSL Programme in the Chinese context to facilitate the integration of evidence and routine clinical practice. DESIGNA descriptive qualitative design was adopted. SETTINGThe study was conducted in the maternity unit of a tertiary general hospital in China. PARTICIPANTSA purposeful sampling was used to recruit midwives, obstetricians and their leaders. Data were collected through semi-structured face-to-face interviews. The Consolidated Framework for Implementation Research was used to guide the development of interview guide and the analysis of qualitative data. The study was reported following the Standards for Reporting Qualitative Research. FINDINGSTwelve eligible participants were interviewed, including eight midwives, two obstetricians, the head nurse of the delivery room, and the head of the maternity unit. Eight barriers and 10 facilitators were identified by using the directed content analysis. The barriers to implementing the UPSSL Programme were professionals' concerns about the potential risks of the programme (relative advantage), higher complexity (complexity), placement method of upright positions presented without pictures (design quality & packaging), staff shortage (cost), limited understanding of parturients' needs (patient needs & resources), lack of a training protocol for professionals (available resources), professionals' limited knowledge and skills in the programme (knowledge & beliefs about the intervention), and lack of confidence in the successful implementation of the programme (self-efficacy). KEY CONCLUSIONSParticipants expressed several barriers and facilitators to implementing the UPSSL Programme in clinical practice in the Chinese context. IMPLICATIONS FOR PRACTICEThe findings provide a reference for the development of targeted implementation strategies that could promote the integration of evidence and routine clinical practice, and thus facilitate the normative application and promotion of upright positions in China.
Abstract
Background:
Although several prediction models have been developed to estimate the risk of obstetric anal sphincter injuries (OASIS) among laboring women, none have been used in clinical ...practice because of controversial or unavailable predictors included in the prediction models and the format used to present them. Thus, it is essential to develop evidence-based prediction models for OASIS using known antenatal and modifiable intrapartum factors and to present them in user-friendly formats.
Objective:
The objective of this study was to develop evidence-based prediction models for OASIS and a risk calculator to present prediction models.
Methods:
Models were developed based on a systematic review and meta-analysis in which risk factors for OASIS were identified, and the pooled odds ratio for each risk factor was calculated. A logistic regression model was used to develop the prediction models, and MATLAB with a graphical user interface was used to develop the risk calculator.
Results:
Two prediction models for OASIS were established: Model I and Model II. Model I included 7 known antenatal variables: maternal age, parity, prior cesarean delivery, prepregnancy body mass index, gestational age, estimated birth weight, and fetal position. Model II added 5 modifiable intrapartum variables to Model I: epidural analgesia, labor induction, labor augmentation, episiotomy, and operative vaginal birth. The risk calculator developed by writing the parameters in the logistic regression models into MATLAB scripts included 2 interfaces, each consisting of risk factors for OASIS and the possibility of OASIS occurring.
Conclusions:
This study developed 2 prediction models and a risk calculator for OASIS based on a systematic review and meta-analysis. Although the models were more scientific in model development methods and predictors included in the prediction models, they should be externally validated and updated to ensure better performance before they can be widely applied to guide clinical practice.
