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Background Episiotomy is a surgical solution to relieve perineal stress, resulting in an easily repairable incision, in comparison to the risks of serious vaginal trauma during delivery. The midwife typically adopts such a clinical decision, on experience and subjective judgment. However, the association between perineal stress and episiotomy is poorly characterized. Our aim was to identify a threshold value for perineal stress leading to episiotomy, which eventually may be employed as a clinical tool for assessing whether an episiotomy is required or not. Methods In total, 245 nulliparous women were investigated for perineal stress during non-instrumental vaginal delivery in Ningbo Women & Children’s Hospital. During the second stage of labor, a flexible membrane stress sensor was placed between the fetal head and perineal wall above the anal fissure. Once the entire fetal head pressed against the sensor, real-time perineal stress was measured, and the peak value was recorded. Cases were divided into non-episiotomy group (n = 173) and episiotomy group (n = 72). The correlations between perineal stress and episiotomy was assessed through logistic regression with adjustment for maternal age, estimated birthweight, duration of second stage of labor, maternal body mass index, and presence of analgesia. Midwives were blinded to all stress measurement values. The predictive value of perineal stress on performing episiotomy was evaluated, together with the ideal cut-off perineal stress value for performing episiotomy. A ROC analysis was also performed. Results The episiotomy group had significantly higher levels of perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 N versus 118.37 ± 19.21 N, p < 0.01). The episiotomy group was linked to significantly higher perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 VS 118.37 ± 19.21 N, p < 0.01). ROC analysis between perineal stress and episiotomy revealed a high area under the curve (AUC 0.81, 95% CI 0.75–0.86) and a cut-off value for perineal stress of 124.49 N was identified for episiotomy decision. Conclusion The level of perineal stress was an independent predictor of performing episiotomy in nulliparous women during non-instrumental vaginal delivery. Perineal stress exceeding 124.49 N was identified as the cut-off prompting midwives to perform episiotomy.

The objective of this study is to clarify the correlation between uncertainty tolerance (UT) and positive acceptance (PA) in patients with cervical cancer (CC) after surgical treatment. A total of 233 patients with CC who had undergone surgery were included and were scored on the UT Scale and Positive Acceptance Scale. In addition, patients were classified according to the length of stay ≥1 week and length of stay <1 week, and the UT score and satisfaction and enterprising score of the two groups were compared. This was performed in order to analyze the effect of length of hospital stay on UT and PA. The mean UT score of 233 patients was 3.74±0.34 and the mean PA score was 1.96±0.20, with a negative correlation and a significant correlation coefficient (r=-0.342, P 0.05). The UT score of post-operative CC patients with length of stay ≥1 week was significantly higher than that of patients with length of stay <1 week, P<0.05. The score of PA in patients with post-operative CC whose hospital stay was ≥1 week was significantly lower than for patients with hospital stays <1 week (P<0.05). UT was negatively correlated with PA in patients with hospital stays < 1 week (r=-0.358, P<0.05). There was a significant negative correlation between UT and PA in patients with hospital stay ≥1 week (r =-0.493, P<0.05). Increased hospitalization time correlated with increased scores of UT, with reductions in scores of PA. Post-operative patients with CC had higher scores of UT and lower scores of PA, which were negatively correlated. Increased hospitalization time was linked to a detriment in patient UT and reduced PA. Targeted interventions to improve the level of UT and PA within postoperative CC cases should be developed.

Background The beneficial influence of nursing interventions upon the mother during natural childbirth is profound, though it has, as yet, not been tangibly identified. This is particularly important and of clinical relevance in the regulation of pain levels experienced by the mother in such an important life event. Aims This study aims to evaluate the effects of nursing intervention during delivery on pain relief and labor progression in vaginal delivery women. Methods A total of 86 vaginal delivery women from July 2023 to August 2024 were included and divided into two groups through a table of random numbers: Intervention group (n=43, receiving enhanced nursing intervention during delivery) and a Control group (n=43, receiving routine nursing intervention). The pain during delivery, duration of labor, childbirth attitudes questionnaire (CAQ), self-rating anxiety scale (SAS), and delivery outcomes were evaluated between the groups. Results Compared with the Control group, the visual analog scale (VAS) scores of the Intervention group at different time points (latent phase, acceleration phase, and deceleration phase) were lower, and the average time spent on the first, second, and third stages of labor was shorter. The scores of CAQ, SAS, and the usage rate of oxytocin were lower. In addition, there was less bleeding after two hours postpartum in the Intervention group ( <0.05). There was no difference in Apgar scores at five minutes of birth for newborns between the two groups ( >0.05). Conclusion Strengthening nursing interventions during vaginal delivery for vaginal delivery women can alleviate delivery pain, promote labor progression, alleviate childbirth fear and anxiety, and improve delivery outcomes.

Background: To determine whether neuraxial anesthesia (NA) can improve the success rate of external cephalic version (ECV), and evaluate the clinical outcomes. Methods: This study included 201 consecutive participants who had a breech presentation at term and received ECV between 2014 and 2022. Participants who received ECV without NA were included in Group 1, while participants with NA were included in Group 2. Outcomes assessed were the success rate of ECV and clinical outcomes. Results: In total, 201 participants who had a breech presentation at term and received ECV met the inclusion criteria. Totally, 134 participants performed ECV without NA were included in Group 1, while 67 participants performed the ECV with NA were included in Group 2. The success rate of ECV among the participants was 66.2% (133/201). The rate of placental abruption during or after ECV and neonatal intensive care unit (NICU) admission in Group 2 was statistically significant higher than in the Group 1 (p < 0.05). Conclusions: This study suggested that the use of NA did not increase ECV success rates after 37 weeks of gestation. The recommendation of NA for the ECV may be not suitable for all pregnancies unless the participants request. A large and high-quality study should be conducted to verify the role of NA in ECV, if any.

Preeclampsia (PE) is a fundamental cause of preterm labor, intrauterine growth restriction, and persistent postpartum hypertension. In the present study, we aimed to investigate the correlation between 24-h urinary protein excretion, serum markers, and placental growth factor and their adverse pregnancy outcomes in patients with PE. A total of 126 pregnant women with PE (86 cases of mild PE and 40 cases of severe PE, assigned to the observation group) who came to our hospital from March 2019 to December 2021 for regular obstetric checkups and delivery were selected, with 60 healthy pregnant women assigned to the control group. Routine biochemical parameters, 24-h urinary protein quantification, serum parameters, and placental growth factor levels were recorded. The incidence of adverse neonatal pregnancy outcomes and abnormal fetal heart monitoring, neonatal body mass, 1 min Apgar score, and other adverse pregnancy outcomes were also analyzed in the different groups. In comparison with healthy pregnant subjects, PE patients had earlier delivery gestational weeks (P < .05), significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-h urinary protein excretion, total cholesterol (TC), triglyceride (TG), D-Dimer and human chorionic gonadotropin (β-hCG) levels (P < .05), lower albumin (ALB), platelet count, pregnant associated plasma protein A (PAPP-A) and placental growth factor (PLGF) (P < .05), and higher incidence of maternal and perinatal adverse outcomes (P < .05). Combined screening of 24-h urinary protein, PAPP-A, β-hCG, PLGF, and serum indicators in early pregnancy are essential in predicting PE, allowing timely assessment of the risk of adverse pregnancy, and providing a basis for clinical intervention.

This study aims to evaluate the efficacy of integrating nursing early warning systems with doula-assisted childbirth nursing on natural childbirth rates and associated outcomes.ObjectiveThis study aims to evaluate the efficacy of integrating nursing early warning systems with doula-assisted childbirth nursing on natural childbirth rates and associated outcomes.A total of 150 women who underwent childbirth in the obstetrics and gynecology department of our hospital between September 2021 and March 2023 were enrolled as participants. They were randomly allocated into either the observation group or the control group, each comprising 75 individuals. The control group received standard nursing care, while the observation group received nursing early warning systems combined with doula-assisted childbirth nursing. Comparison between the two groups included modes of childbirth, the intensity of childbirth pain, neonatal Apgar scores, the incidence of postpartum hemorrhage, duration of the first and second stages of labor, and maternal satisfaction with nursing care.MethodsA total of 150 women who underwent childbirth in the obstetrics and gynecology department of our hospital between September 2021 and March 2023 were enrolled as participants. They were randomly allocated into either the observation group or the control group, each comprising 75 individuals. The control group received standard nursing care, while the observation group received nursing early warning systems combined with doula-assisted childbirth nursing. Comparison between the two groups included modes of childbirth, the intensity of childbirth pain, neonatal Apgar scores, the incidence of postpartum hemorrhage, duration of the first and second stages of labor, and maternal satisfaction with nursing care.Our findings indicated a higher natural childbirth rate in the observation group compared to the control group (P < .05). Furthermore, the SAS score of the observation group post-nursing was significantly lower than that of the control group. Additionally, neonates in the observation group exhibited higher Apgar scores compared to those in the control group. Moreover, mothers who underwent natural childbirth in the observation group experienced lower childbirth pain scores and reduced postpartum hemorrhage incidence (P < .05). The duration of both the first and second stages of childbirth was shorter in the observation group than in the control group. Furthermore, overall satisfaction with care was significantly higher in the observation group than in the control group, with a statistically significant difference (P < .05).ResultsOur findings indicated a higher natural childbirth rate in the observation group compared to the control group (P < .05). Furthermore, the SAS score of the observation group post-nursing was significantly lower than that of the control group. Additionally, neonates in the observation group exhibited higher Apgar scores compared to those in the control group. Moreover, mothers who underwent natural childbirth in the observation group experienced lower childbirth pain scores and reduced postpartum hemorrhage incidence (P < .05). The duration of both the first and second stages of childbirth was shorter in the observation group than in the control group. Furthermore, overall satisfaction with care was significantly higher in the observation group than in the control group, with a statistically significant difference (P < .05).This study underscores the effectiveness of implementing nursing early warning systems combined with doula-assisted nursing in enhancing maternal satisfaction, reducing postpartum hemorrhage, and improving maternal well-being and neonatal outcomes. The findings advocate for the widespread adoption of this intervention in clinical practice.ConclusionsThis study underscores the effectiveness of implementing nursing early warning systems combined with doula-assisted nursing in enhancing maternal satisfaction, reducing postpartum hemorrhage, and improving maternal well-being and neonatal outcomes. The findings advocate for the widespread adoption of this intervention in clinical practice.

This study aims to evaluate the efficacy of integrating nursing early warning systems with doula-assisted childbirth nursing on natural childbirth rates and associated outcomes. A total of 150 women who underwent childbirth in the obstetrics and gynecology department of our hospital between September 2021 and March 2023 were enrolled as participants. They were randomly allocated into either the observation group or the control group, each comprising 75 individuals. The control group received standard nursing care, while the observation group received nursing early warning systems combined with doula-assisted childbirth nursing. Comparison between the two groups included modes of childbirth, the intensity of childbirth pain, neonatal Apgar scores, the incidence of postpartum hemorrhage, duration of the first and second stages of labor, and maternal satisfaction with nursing care. Our findings indicated a higher natural childbirth rate in the observation group compared to the control group (P < .05). Furthermore, the SAS score of the observation group post-nursing was significantly lower than that of the control group. Additionally, neonates in the observation group exhibited higher Apgar scores compared to those in the control group. Moreover, mothers who underwent natural childbirth in the observation group experienced lower childbirth pain scores and reduced postpartum hemorrhage incidence (P < .05). The duration of both the first and second stages of childbirth was shorter in the observation group than in the control group. Furthermore, overall satisfaction with care was significantly higher in the observation group than in the control group, with a statistically significant difference (P < .05). This study underscores the effectiveness of implementing nursing early warning systems combined with doula-assisted nursing in enhancing maternal satisfaction, reducing postpartum hemorrhage, and improving maternal well-being and neonatal outcomes. The findings advocate for the widespread adoption of this intervention in clinical practice.

The efficacy of episiotomy, particularly the angle of incision in mediolateral episiotomies, remains a significant area of inquiry in obstetrics. This meta‐analysis aimed to evaluate the impact of low‐angle mediolateral episiotomy on perineal wound healing and pain outcomes in women undergoing vaginal childbirth. Adhering to PRISMA guidelines, a systematic review was conducted using the PICO framework. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomised controlled trials (RCTs) involving low‐angle mediolateral episiotomies. Comprehensive literature searches were performed across major electronic databases including PubMed, Embase, Web of Science and Cochrane Library. Data extraction and quality assessments were meticulously carried out by independent reviewers, employing the Cochrane Collaboration's risk of bias tool. A total of 1246 articles were initially identified, with 8 articles meeting the strict inclusion criteria for the final analysis. The meta‐analysis revealed significant heterogeneity among studies regarding postoperative pain (p < 0.0001, I2 = 77.5%), and employed a random‐effects model. Results showed that low‐angle episiotomies significantly reduced postoperative pain (OR = 0.27, 95% CI: 0.17–0.42, p < 0.001), and increased first‐degree healing rates (OR = 2.95, 95% CI: 2.20–3.96, p < 0.001) compared to traditional angles. Sensitivity analyses confirmed the stability of these findings, and no significant publication bias was detected. The analysis suggests that low‐angle episiotomies can potentially reduce postoperative perineal pain and enhance wound healing. However, the limited number and varying quality of the included studies warrant cautious interpretation of these results. Further well‐designed studies are needed to corroborate these findings and guide clinical practice.

The efficacy of episiotomy, particularly the angle of incision in mediolateral episiotomies, remains a significant area of inquiry in obstetrics. This meta‐analysis aimed to evaluate the impact of low‐angle mediolateral episiotomy on perineal wound healing and pain outcomes in women undergoing vaginal childbirth. Adhering to PRISMA guidelines, a systematic review was conducted using the PICO framework. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomised controlled trials (RCTs) involving low‐angle mediolateral episiotomies. Comprehensive literature searches were performed across major electronic databases including PubMed, Embase, Web of Science and Cochrane Library. Data extraction and quality assessments were meticulously carried out by independent reviewers, employing the Cochrane Collaboration's risk of bias tool. A total of 1246 articles were initially identified, with 8 articles meeting the strict inclusion criteria for the final analysis. The meta‐analysis revealed significant heterogeneity among studies regarding postoperative pain ( p  < 0.0001, I 2  = 77.5%), and employed a random‐effects model. Results showed that low‐angle episiotomies significantly reduced postoperative pain (OR = 0.27, 95% CI: 0.17–0.42, p  < 0.001), and increased first‐degree healing rates (OR = 2.95, 95% CI: 2.20–3.96, p  < 0.001) compared to traditional angles. Sensitivity analyses confirmed the stability of these findings, and no significant publication bias was detected. The analysis suggests that low‐angle episiotomies can potentially reduce postoperative perineal pain and enhance wound healing. However, the limited number and varying quality of the included studies warrant cautious interpretation of these results. Further well‐designed studies are needed to corroborate these findings and guide clinical practice.