Epidural analgesia and the risk of operative delivery among women at term: A propensity score matched study.

OBJECTIVE: To investigate the correlation between epidural analgesia (EA) administered during labour and the risk of requiring an operative delivery (caesarean section or operative vaginal delivery). METHODS: This was a retrospective, multicentric cohort study. All singleton births of viable foetuses in cephalic presentation with a gestational age ≥ 37 weeks delivered between 2016 and2019 were included. A propensity score (PS) matching analysis was used to obtain comparable groups, balancing the maternal and pregnancy characteristics that required epidural analgesia during labour. The risk of operative delivery in women with and without epidural analgesia was estimated following PS-matching analysis (1:1 ratio). RESULTS: As per the unmatched analysis, the occurrence of Caesarean section (CS) was significantly higher in women administered EA compared with the non-EA group (14.0 % vs 5.0 %; p < 0.001). The incidence of operative vaginal delivery (OVD) (9.1 % vs 4.0 %; p < 0.001) showed a similar pattern. The PS algorithm matched 16.301 cases who were administered EA with 16.301 cases not administered EA and found a significantly increased risk of CS (OR, 1.6; 95 %CI 1.5-1.7) and OVD (OR, 1.2; 95 % CI 1.1-1.2) in the former group. CONCLUSION: The risk of operative delivery almost halved in the EA group compared with the non-EA group, compared with the baseline risk of the unmatched subjects.

Routine perineal shaving on admission in labour.

BACKGROUND: Pubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perineal tear or if an episiotomy is performed. OBJECTIVES: To assess the effects of routine perineal shaving on admission in labour on maternal and neonatal outcomes, according to the best available evidence. SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. In addition, the Cochrane Controlled Trials Register was searched. Date of last search: July 2000. SELECTION CRITERIA: All controlled trials (including quasi randomised) which compared perineal shaving versus no perineal shaving were included in the review. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion, without consideration of their results. MAIN RESULTS: Only two trials fulfilled the prespecified criteria. In the earlier trial, 389 women were alternately allocated to receive either skin preparation and perineal shaving (control) or clipping of vulval hair only (experimental). In the second trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. The primary outcome for both trials was maternal febrile morbidity. No differences were found (combined odds ratio (OR) 1.26, 95% confidence interval (CI) 0.75, 2.12). In the smaller trial, fewer women who had not been shaved had gram negative bacterial colonisation compared with women who had been shaved (OR 0.43, 95% CI 0.20, 0.92). REVIEWER'S CONCLUSIONS: There is insufficient evidence to recommend perineal shaving for women on admission in labour.

[Cesarean section: descriptive epidemiology. Increase in frequency of indications for cesarean section]. / Epidemiologia descrittiva del taglio cesareo. L'incremento della frequenza delle indicazioni al taglio cesareo.

The use of caesarean section is constantly increasing in all countries of the western world. This article considers various aspects of the phenomenon, from the most frequent justifications for the increase in caesarean sections, to the consequences of this practise on the health of the mother and of the fetus/newborn infant. The often-suggested link between the increase in the number of caesarean births and the decrease of the perinatal mortality rate is also discussed. The caesarean section is potentially capable of offering large benefits, but at the same time is not without risk for the mother and the child. In order to reduce this risk meticulous attention must be paid to the anesthesiological and surgical techniques employed and surgery must be used only when absolutely necessary.

Moxibustion and breech presentation: preliminary results.

Moxibustion at the Zhiyin acupuncture point (67 B) is an ancient method of obtaining the version of abnormal presentation of the fetus during the last three months of pregnancy. The authors reviewed the Chinese references on this subject and stressed the importance of parity and gestational age in testing the efficacy of this therapy. Preliminary results are described and compared with those reported in Chinese articles. Success rates in version by moxibustion versus spontaneous version are also compared.