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Introduction Vacuum‐assisted delivery is a major risk factor for obstetric anal sphincter injury (OASI), yet agreement is lacking on whether mediolateral episiotomy mitigates risk. The objective of this study was to evaluate whether episiotomy during vacuum‐assisted delivery in nulliparous women affects the risk of OASI and to identify subgroups who may benefit from it. Material and Methods A retrospective cohort study including all nulliparous singleton pregnancies delivered by vacuum‐assisted delivery at a tertiary center (January 2011–December 2022). Twin deliveries and multiparous women were excluded. Mediolateral episiotomy was performed according to the physician's preference and clinical judgment. The primary outcome was the risk of OASI. The diagnosis of OASI was based on a clinical assessment immediately after delivery. Multivariable logistic regression was used to assess the association between mediolateral episiotomy and OASI while adjusting for potential confounders: maternal age, prepregnancy BMI, gestational age, prolonged second stage, occiput posterior, and epidural analgesia. Results Among 7951 vacuum‐assisted deliveries, 7201 (90.6%) had an episiotomy and 750 (9.4%) did not. The groups were similar, though episiotomy cases more often had a prolonged second stage (32.0% vs 25.9%, p = 0.001), occiput posterior (12.7% vs 9.6%, p = 0.03), and birthweight ≥3500 g (25.4% vs 21.7%, p = 0.03). OASI occurred twice as often without episiotomy (2.8% vs 1.4%, p = 0.01). After adjustment, episiotomy remained (adjusted odds ratio 0.42, 95% CI 0.25–0.70). The number needed to treat (NNT) with episiotomy to prevent one OASI was 64 overall, and was lower in the presence of intrapartum risk factors: 16 with prolonged second stage, 33 with occiput posterior, and 27 when birthweight exceeded 3500 g. Postpartum hemorrhage requiring transfusion occurred more frequently with episiotomy (3.9% vs 1.5%; p = 0.001), corresponding to a number needed to harm (NNH) of 43. Neonatal outcomes did not differ significantly. Conclusions In nulliparous women, mediolateral episiotomy during vacuum‐assisted delivery was associated with a 50% reduction in OASI. The preventive effect of mediolateral episiotomy was greater when multiple intrapartum risk factors were present. Mediolateral episiotomy during vacuum‐assisted delivery in nulliparous women was associated with lower obstetric anal sphincter injury (1.4% vs 2.8%; adjusted odds ratio 0.42, 95% CI 0.25–0.70). The protective effect was greater when intrapartum risk factors were present, including prolonged second stage, occiput posterior position, and birthweight ≥3500 g.

Objective: We sought to compare common neonatal and maternal morbidity outcomes amongst operative vaginal delivery (OVD) versus cesarean delivery performed in the setting of failed attempt at labor. We planned to stratify outcomes by type of OVD (vacuum-assisted vaginal delivery (VAVD) and forceps-assisted vaginal delivery (FAVD)). Methods: This was a retrospective cohort study of singleton live births in the United States, using the 2023 National Vital Statistics birth certificate dataset. The primary outcome of interest was the risk of neonatal morbidity, as listed on the birth certificate. The secondary outcome of interest was the risk of maternal morbidity. Neonatal morbidities were planned to be analyzed independently (i.e., risk of NICU admission, need for antibiotics) as well as in aggregate (i.e., the risk of any morbidity occurring). Three groups were planned: FAVD, VAVD, and cesarean in the setting of attempted labor or attempted induction of labor (referent group). Differences in demographic and clinical characteristics were compared and subsequently adjusted for, and odds ratios (aOR) were calculated using multivariable logistic regression. Results: Of the 3,605,081 births from 2023, there were 15,384 FAVDs; 83,134 VAVDs; and 325,310 cesareans after failed labor. Neonatal morbidity was lower in FAVD (aOR 0.71, 95% CI 0.66–0.76) and VAVD (aOR 0.57, 95% CI 0.55–0.59) compared to cesarean delivery, with VAVD showing the lowest rates, in particular, the need for assisted ventilation (aOR 0.52 95% CI 0.48–0.57 with VAVD and aOR 0.74 95% CI 0.68–0.81 with FAVD) and NICU admissions aOR 0.66, 95% CI 0.60–0.71 with FAVD and aOR 0.48, 95% CI 0.46–0.51 with VAVD) were reduced with operative vaginal delivery. Antibiotic usage was only reduced in VAVD, not FAVD. Maternal morbidity was highest FAVD; however, this was driven by perineal lacerations. ICU admission, hysterectomy, and ruptured uterus were all higher in cesarean delivery than FAVD or VAVD. Conclusions: Operative vaginal delivery, particularly VAVD, is associated with reduced neonatal morbidity compared to cesarean delivery in the setting of labor.

Objective: This study aims to compare the clinical outcomes of forceps‐assisted vaginal delivery (FAVD) and vacuum‐assisted vaginal delivery (VAVD) in primiparous women and to identify risk factors contributing to moderate and severe postpartum hemorrhage (PPH) associated with these delivery methods. Methods: A retrospective analysis was conducted on clinical data from 1237 primiparous women who delivered at the Obstetrics Department of Hunan Maternal and Child Health Hospital between April 2018 and April 2022. Among these, 711 underwent FAVD and 526 underwent VAVD. Maternal and neonatal characteristics, including age, gestational age, prepregnancy body mass index (BMI), pregnancy weight gain, neonatal weight, and labor duration, were evaluated. The study assessed labor duration, neonatal weight, maternal complications, neonatal complications, and the incidence and severity of PPH. Binary logistic regression analysis was performed to identify risk factors for moderate (500–1000 mL blood loss) and severe (> 1000 mL blood loss) PPH associated with the two delivery methods. Results: Compared with FAVD, VAVD was associated with a higher incidence of uterine atony ( p < 0.05) and increased risks of both moderate and severe PPH ( p < 0.05). Pregnant women with significant gestational weight gain more frequently underwent VAVD ( p < 0.05), which also correlated with prolonged second and total labor stages compared with FAVD ( p < 0.05). Logistic regression revealed that uterine atony was a significant risk factor for both moderate and severe PPH ( p < 0.05). Prolonged total labor independently increased the risk of severe PPH in VAVD cases ( p < 0.05 and OR 1.575), while gestational weight gain and prolonged labor were independent risk factors for moderate PPH in FAVD cases ( p < 0.05, OR 1.047 and OR 1.287, respectively). Conclusions: VAVD is associated with longer labor duration, a higher likelihood of PPH, and increased neonatal scalp hematoma incidence compared with FAVD. Prolonged total labor significantly contributes to moderate PPH risk in FAVD and severe PPH risk in VAVD. Uterine atony is an independent predictor of both moderate and severe PPH.

Laser-assisted exosome delivery (LAED) combines ablative fractional lasers with immediate topical application of exosomes. Here, we introduce the LAED concept and report two uncontrolled feasibility observations: a 62-year-old man with atrophic acne scars and a 68-year-old woman with diffuse dyschromia underwent fractional CO2 laser treatment followed by topical exosomes. Both cases showed early, encouraging signals of clinical improvement and shorter downtime, with good tolerability. An exploratory day-7 patient self-evaluation using a 5-point Likert scale for speed/comfort of recovery yielded 5/5 in both cases. Given the two-case, non-comparative design, causality cannot be inferred, and efficacy remains hypothesis-generating. These preliminary findings motivate controlled trials with standardized objective and patient-reported measures and longer follow-up to determine whether LAED truly enhances the cosmetic benefits of fractional laser treatment.

Nanoparticle transport into plants is an evolving field of research with diverse applications in agriculture and biotechnology. This article provides an overview of the challenges and prospects associated with the transport of nanoparticles in plants, focusing on delivery methods and the detection of nanoparticles within plant tissues. Passive and assisted delivery methods, including the use of roots and leaves as introduction sites, are discussed, along with their respective advantages and limitations. The barriers encountered in nanoparticle delivery to plants are highlighted, emphasizing the need for innovative approaches (e.g., the stem as a new recognition site) to optimize transport efficiency. In recent years, research efforts have intensified, leading to an evendeeper understanding of the intricate mechanisms governing the interaction of nanomaterials with plant tissues and cells. Investigations into the uptake pathways and translocation mechanisms within plants have revealed nuanced responses to different types of nanoparticles. Additionally, this article delves into the importance of detection methods for studying nanoparticle localization and quantification within plant tissues. Various techniques are presented as valuable tools for comprehensively understanding nanoparticle–plant interactions. The reliance on multiple detection methods for data validation is emphasized to enhance the reliability of the research findings. The future outlooks of this field are explored, including the potential use of alternative introduction sites, such as stems, and the continued development of nanoparticle formulations that improve adhesion and penetration. By addressing these challenges and fostering multidisciplinary research, the field of nanoparticle transport in plants is poised to make significant contributions to sustainable agriculture and environmental management.

Alongside the rise of ‘last-mile’ delivery in contemporary urban logistics, drones have demonstrate commercial potential, given their outstanding triple-bottom-line performance. However, as a lithium-ion battery-powered device, drones’ social and environmental merits can be overturned by battery recycling and disposal. To maintain economic performance, yet minimise environmental negatives, fleet sharing is widely applied in the transportation field, with the aim of creating synergies within industry and increasing overall fleet use. However, if a sharing platform’s transparency is doubted, the sharing ability of the platform will be discounted. Known for its transparent and secure merits, blockchain technology provides new opportunities to improve existing sharing solutions. In particular, the decentralised structure and data encryption algorithm offered by blockchain allow every participant equal access to shared resources without undermining security issues. Therefore, this study explores the implementation of a blockchain-enabled fleet sharing solution to optimise drone operations, with consideration of battery wear and disposal effects. Unlike classical vehicle routing with fleet sharing problems, this research is more challenging, with multiple objectives (i.e., shortest path and fewest charging times), and considers different levels of sharing abilities. In this study, we propose a mixed-integer programming model to formulate the intended problem and solve the problem with a tailored branch-and-price algorithm. Through extensive experiments, the computational performance of our proposed solution is first articulated, and then the effectiveness of using blockchain to improve overall optimisation is reflected, and a series of critical influential factors with managerial significance are demonstrated.

In a near future drones are likely to become a viable way of distributing parcels in a urban environment. In this paper we consider the parallel drone scheduling traveling salesman problem, where a set of customers requiring a delivery is split between a truck and a fleet of drones, with the aim of minimizing the total time required to service all the customers. We present a set of matheuristic methods for the problem. The new approaches are validated via an experimental campaign on two sets of benchmarks available in the literature. It is shown that the approaches we propose perform very well on small/medium size instances. Solving a mixed integer linear programming model to optimality leads to the first optimality proof for all the instances with 20 customers considered, while the heuristics are shown to be fast and effective on the same dataset. When considering larger instances with 48 to 229 customers, the results are competitive with state-of-the-art methods and lead to 28 new best known solutions out of the 90 instances considered.

Background The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant. Methods We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P  < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P  < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

Vacuum-assisted delivery (VAD) uses a vacuum cup on the fetal scalp to apply traction during uterine contractions, assisting complicated vaginal deliveries. Despite its widespread use, VAD presents a higher risk of neonatal morbidity compared to natural vaginal delivery and biomechanical evidence for safe VAD traction forces is still limited. The aim of this study is to develop and assess the feasibility of an experimental VAD testing setup, and investigate the impact of traction forces on fetal brain deformation. A patient-specific fetal head phantom was developed and subjected to experimental VAD in two testing setups: one with manual and one with automatic force application. The skull phantom was 3D printed using multi-material Polyjet technology. The brain phantom was cast in a 3D-printed mold using a composite hydrogel, and sonomicrometry crystals were used to estimate the brain deformation in three brain regions. The experimental VADs on the fetal head phantom allowed for quantifying brain strain with traction forces up to 112 N. Consistent brain crystal movements aligned with the traction force demonstrated the feasibility of the setup. The estimated brain deformations reached up to 4% and correlated significantly with traction force ( p  < 0.05) in regions close to the suction cup. Despite limitations such as the absence of scalp modeling and a simplified strain computation, this study provides a baseline for numerical studies and supports further research to optimize the safety of VAD procedures and develop VAD training platforms.

ObjectiveTo assess and compare maternal and neonatal outcomes of vacuum-assisted vaginal delivery in primigravid versus multigravid women.MethodThis retrospective study analyzed the obstetric outcomes of 65 women who underwent vacuum-assisted vaginal delivery and statistically compared maternal and neonatal outcomes between the primigravid and multigravid groups.ResultsSignificant differences were observed between groups in labor duration, neonatal birth weight, and head circumference (p<0.05). Primigravid women had significantly longer labors, whereas multigravid women delivered neonates with higher birth weights and larger head circumferences. Episiotomy rates were notably higher in the primigravid group (p<0.001); however, no significant differences were found between groups for neonatal intensive care unit admissions, neonatal complications, or maternal complications (p>0.05).ConclusionThis study demonstrated that parity influences outcomes of vacuum-assisted vaginal deliveries, with no significant differences in neonatal outcomes between groups. The use of vacuum assistance in vaginal deliveries appears to prevent, rather than cause, asphyxia by expediting labor. Vacuum-assisted vaginal delivery can serve as an effective intervention to reduce unnecessary cesarean sections.