Abstract Background Women on probation (community supervision) report high rates of adverse childhood experiences (ACEs) and ongoing trauma, yet little research has examined how trauma across the life course relates to perinatal outcomes during community supervision. This study examined associations between lifetime trauma and perinatal violence, infant separation, and postpartum mood symptoms among women who experienced pregnancy, childbirth, and postpartum while on probation. Methods We conducted a cross-sectional secondary analysis from N = 60 women in South-Central Texas who had a pregnancy within the past five years while on community supervision. Trauma exposures included selected ACEs and adulthood/perinatal trauma (domestic, intimate partner, and sexual violence). Outcomes were perinatal violence, permanent infant removal after childbirth, and postpartum mood symptoms (PHQ-2/GAD-2). We used logistic regression to examine associations between trauma exposures and outcomes; given the ordinal structure of key trauma measures, we used Kendall’s tau to estimate correlations between cumulative ACEs/lifetime trauma and perinatal outcomes. Results Participants spent an average of 5 years (SD = 3) on community supervision, and most reported partner violence ( n = 52, 87%); no mental health care in the year prior to their last arrest ( n = 55, 92%); and possible major depressive disorder ( n = 20, 33%) and generalized anxiety disorder ( n = 34, 57%). ACE prevalence included caregiver incarceration ( n = 34, 56%), physical abuse ( n = 25, 42%), witnessing abuse ( n = 27, 45%), foster care ( n = 17, 8%), and childhood sexual abuse ( n = 29, 48%); 25% reported four ( n = 9, 16%) or five ( n = 6, 10%) ACEs. Cumulative ACE exposure was correlated with perinatal violence ( p = 0.03), and childhood forced sexual intercourse was associated with perinatal violence ( p = 0.04). Trauma in adulthood was associated with permanent infant removal ( p = 0.003). Sexual violence in adulthood was correlated with cumulative ACE exposure and postpartum mood symptoms ( p = 0.006). Conclusions Trauma across the life course is associated with perinatal violence, infant removal, and postpartum mood symptoms among women on community supervision. Trauma-informed, gender-responsive perinatal and community supervision interventions are needed to improve safety, mental health, and family stability. Trial registration NA
BACKGROUND: Radiofrequency ablation of the mitral isthmus (MI) is unreliable. Vein of Marshall (VOM) ethanol infusion can improve MI ablation success and eliminate local MI autonomic innervation. The role of pulsed field ablation (PFA) in MI ablation and its autonomic effect is unclear. We evaluated the transmurality of endocardial PFA at the MI and its autonomic effects, using real-time epicardial VOM electrograms and VOM high-frequency stimulation. METHODS: Patients undergoing atrial fibrillation ablation (n=71) were prospectively enrolled. MI ablation (endocardial to VOM) was delivered using FaraPulse (N=31), PulseSelect (N=9), or Affera (N=31) while monitoring VOM epicardial electrograms to assess transmurality, defined as VOM signal elimination after 20 minutes. MI block was assessed using differential pacing from the left atrial appendage and VOM. High-frequency stimulation from the VOM was performed before and after PFA. VOM ethanol infusion was administered when MI ablation was incomplete. RESULTS: Endocardial PFA led to durable epicardial electrogram attenuation in 52.1% (FaraPulse in 38.7%, PulseSelect in 44.4%, and Affera in 67.7%; P <0.05). Myocardial capture with VOM pacing persisted in 43.7% (FaraPulse in 45.2%, PulseSelect in 100%, and Affera in 25.8%; P <0.05). Pseudoblock (epicardial-only MI conduction and MI delays) was present in 38%. MI block was achieved with PFA alone in 45% (32/71) of patients; VOM ethanol infusion achieved MI block in an additional 38% (27/71) of patients for a cumulative 83% (59/71); and coronary sinus ablation was required in the remaining 17% (12/71). After PFA, VOM high-frequency stimulation elicited intact parasympathetic responses evidenced as atrioventricular block. CONCLUSIONS: Across all 3 PFA platforms, endocardial ablation of the MI is not reliably transmural and does not ablate VOM parasympathetic innervation. VOM ethanol infusion can complete transmurality and denervation of the MI.
BACKGROUND:Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation, but randomized controlled trials have primarily focused on composite end points, potentially obscuring differences in individual clinical outcomes. We compared the efficacy and safety of LAAC versus OAC with an emphasis on individual clinical outcomes. METHODS:A systematic review and meta-analysis of randomized controlled trials comparing LAAC with OAC in adults with atrial fibrillation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from January 2000 to March 2026. The primary efficacy end point was any stroke, and the primary safety end point was major bleeding. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model. RESULTS:Six randomized controlled trials comprising 7004 patients (3681 LAAC; 3323 OAC) were included. LAAC was associated with a higher risk of ischemic stroke (RR, 1.41 [95% CI, 1.04-1.91]; P=0.03; 3.2% versus 2.1%), without a significant difference in any stroke (RR, 1.08 [95% CI, 0.82-1.42]; P=0.60) or the composite of stroke, systemic embolism, or death (RR, 0.99 [95% CI, 0.77-1.29]; P=0.96). Cardiovascular mortality (RR, 0.88; P=0.40) and all-cause mortality (RR, 0.92; P=0.36) were similar between groups. Major bleeding, including procedural events, did not differ significantly (RR, 0.93; P=0.40), although LAAC was associated with a significantly lower risk of nonprocedural major bleeding (RR, 0.57 [95% CI, 0.43-0.77]; P<0.01; 6.2% versus 10.7%). CONCLUSIONS:In patients with atrial fibrillation, LAAC is associated with a higher risk of ischemic stroke, but lower risk of nonprocedural major bleeding compared with OAC, with no significant differences in composite thromboembolic outcomes or mortality, underscoring the importance of individualized risk-benefit assessment in stroke prevention strategies.
To assess whether third-trimester fetal frontal lobe biometry and ventricular–cranial proportionality differ between pregnancies with gestational diabetes mellitus (GDM) and normoglycemic controls, and whether these markers vary by treatment (diet vs. insulin) or composite adverse perinatal outcome (CAPO). In this single-center prospective observational study, 73 singleton GDM pregnancies and 73 low-risk controls underwent ultrasound at comparable gestational ages (30–38 weeks). On the transventricular plane we measured frontal anteroposterior diameter (FAPD) and occipitofrontal diameter (OFD), and derived two indices (100×FAPD/OFD; 100×FAPD/head circumference [HC]). Maximal width of the frontal horns (MWFH) and maximal inner cranial diameter (MID) were recorded and the fetal Evans index (EI, MWFH/MID) calculated. Obstetric and neonatal outcomes were compared, with subgroup analyses within the GDM cohort. Multiple linear regression adjusted the main neurosonographic outcomes for estimated fetal weight, gestational age at ultrasound, maternal age, BMI, and parity. Gestational age at scan was similar (33.8 ± 1.9 vs. 33.6 ± 2.0 weeks), while estimated fetal weight was higher in GDM (2504 ± 514 vs. 2320 ± 531 g; p = 0.035). FAPD was modestly higher in GDM (median 39.4 vs. 38.9 mm; p = 0.040) with comparable OFD, and both frontal indices were higher (FAPD/OFD 37.61 vs. 36.59, p < 0.001; FAPD/HC 12.74 vs. 12.55, p < 0.001). MWFH and MID were slightly larger (p = 0.025 and 0.006), yet EI was unchanged (0.263 ± 0.011 vs. 0.262 ± 0.014; p = 0.574). After adjustment, GDM remained linked to a lower OFD (− 2.516 mm; 95
To compare four unidimensional pain assessment scales during the first stage of labor by evaluating agreement among the scales and women’s preferences for pain assessment tools in a clinical setting. A cross-sectional comparative study was conducted between August 2023 and June 2024 with 135 women who experienced spontaneous vaginal births at a state hospital in Türkiye. Four commonly used unidimensional pain scales—the Visual Analog Scale (VAS), Facial Pain Scale (FPS), Numerical Rating Scale (NRS), and Verbal Descriptive Scale (VDS)—were compared in terms of inter-scale agreement during the latent and active phases of labor. Participants were also asked to indicate their preferred pain scale. The FPS was the most preferred scale, chosen by 41.5
Agenesis of the corpus callosum (ACC) is one of the most common structural brain malformations, with a highly variable prognosis. The aim of this study was to investigate all cases of ACC managed at our clinic and to provide a comprehensive assessment of its prenatal features, associated conditions, and postnatal outcomes. We conducted a retrospective cohort study including all prenatally diagnosed cases of ACC in our maternal-fetal medicine unit between October 2020 and November 2024. Maternal characteristics, gestational age at diagnosis, associated anomalies, genetic testing results, and perinatal outcomes were recorded. Postnatal neurodevelopmental outcomes were assessed using the Denver II test, with a follow-up duration ranging from 6 to 40 months. A total of 82 fetuses with ACC were collected. Of these, 59.8
Abstract Aim To evaluate the predictive value of serum beta-human chorionic gonadotropin (β-hCG) measured at 11–14 days after frozen-thawed embryo transfer (FET) for clinical pregnancy, and to explore the potential associations of blastocyst transfer and other serum markers (total protein, albumin, red blood cell distribution width) with pregnancy outcomes. Methods A retrospective cohort study was performed on 268 infertile patients who underwent FET at our hospital from January 2025 to December 2025. Patients were divided into clinical pregnancy ( n = 132) and non-pregnancy ( n = 136) groups. Baseline characteristics and serum markers (TP, Alb, RDW) measured on day 7 post-transfer were compared between groups. The predictive performance of β-hCG was evaluated using receiver operating characteristic (ROC) curve analysis. Univariate and multivariable logistic regression analyses were performed to identify factors independently associated with clinical pregnancy. Results Serum β-hCG levels were significantly higher in the clinical pregnancy group ( P < 0.001). ROC analysis showed that β-hCG predicted clinical pregnancy with an area under the curve (AUC) of 0.994 (95% CI: 0.989–0.999). The optimal cut-off value was 112.0 mIU/mL, yielding a sensitivity of 96.2% and a specificity of 98.5%. Multivariable logistic regression identified ln(hCG + 1) (OR = 12.55, 95% CI: 5.13–30.69, P < 0.001). Blastocyst transfer showed a trend towards an association in univariate analysis (OR = 1.59, 95% CI: 0.92–2.75, P = 0.10) but was not statistically significant in multivariable analysis (OR = 1.39, 95% CI: 0.30–6.32, P = 0.67). TP showed a trend towards an association in univariate analysis (OR = 0.95, 95% CI: 0.89–1.01, P = 0.10) but was not statistically significant, and was not an independent factor for clinical pregnancy (OR = 0.84, 95% CI: 0.68–1.03, P = 0.10). Alb and RDW showed no significant differences between groups. Conclusion In this retrospective cohort study, serum β-hCG measured 11–14 days after FET demonstrated excellent predictive performance for clinical pregnancy (AUC 0.994). While both blastocyst transfer and total protein showed trends toward association in univariate analysis, neither remained an independent predictor in multivariable analysis. Other serum markers (Alb, RDW) provided no incremental predictive value beyond β-hCG. These findings support the clinical utility of early post-FET β-hCG measurement; however, the potential roles of blastocyst transfer and total protein require further investigation in larger, prospective cohorts.
BACKGROUND:Isthmus conduction velocity (CV) predicts ventricular tachycardia risk in tetralogy of Fallot and traditionally is calculated using electrogram-based methods (electrogram CV index [EGM-CVi]). Isochronal activation mapping approximates CV in adults with ischemic and nonischemic cardiomyopathy but has never been tested in congenital heart disease populations. Our objectives were to (1) investigate the diagnostic performance of isochronal CV index (ISO-CVi) in predicting inducible ventricular tachycardia and (2) compare it to traditional EGM-CVi in a population of patients with repaired tetralogy of Fallot undergoing electrophysiology study before transcatheter pulmonary valve replacement. METHODS:Retrospective cohort subanalysis of the CATAPULT-TOF registry (Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot). The primary outcome was inducible monomorphic ventricular tachycardia (MMVT) at electrophysiology study. Predictor variables were ISO-CVi and EGM-CVi. Electroanatomic activation maps profiling anatomic isthmus 3 were centrally adjudicated to measure anatomic isthmus 3 ISO-CVi; real-world anatomic isthmus 3 EGM-CVi values reported by contributing centers per the parent registry protocol were used as the comparator. Multivariable logistic regression and receiver operating characteristic analyses quantified associations between predictors and outcomes. RESULTS:Seventy patients with tetralogy of Fallot underwent pretranscatheter pulmonary valve replacement electrophysiology study at a median age of 40 (interquartile range, 24.8-51) years. Inducible MMVT was observed in 24 (34%). Median ISO-CVi was lower in those with versus without MMVT (0.17 versus 0.30 m/s; P<0.001). Median EGM-CVi did not differ between groups (0.43 versus 0.70 m/s; P=0.055). Coefficients of variation were higher for EGM-CVi (79%) than ISO-CVi (45%). On multivariable analysis, ISO-CVi was associated with MMVT (odds ratio, 0.14 [95% CI, 0.04-0.40]; P=0.0009) with a sensitivity and specificity of 88% and 70%, respectively, at a threshold of 0.22 m/s. CONCLUSIONS:ISO-CVi strongly associates with inducible MMVT and is measured with less variability than legacy EGM-CVi methods in a real-world sample. If external validity is confirmed, ISO-CVi may represent a more standardized method of isthmus CV estimation that could be broadly implemented across centers.
BACKGROUND:Peritricuspid, or cavotricuspid isthmus-dependent, atrial flutter is the most common arrhythmia in patients with dextro-transposition of the great arteries treated with atrial switch surgery, but its underlying mechanisms remain poorly understood. METHODS:Twenty consecutive patients with prior atrial switch surgery referred for atrial flutter ablation were included. All underwent transbaffle puncture and high-density mapping. Anatomic barriers, activation patterns, conduction velocities, and low-voltage areas were assessed. RESULTS:In all cases of peritricuspid atrial flutter, surgical incisions defined the posterior boundary of the circuit. The narrowest segment of the reentry was consistently located within a septal corridor bounded posteriorly by the baffle incision and anteriorly by the tricuspid annulus. Slow conduction (<30 cm/s) was identified in this septal corridor in 92% of peritricuspid flutters and in 85% of patients during sinus or paced rhythm. Low-voltage areas were limited and frequently colocalized with regions of slow conduction. No patient exhibited slow conduction or low voltage at the cavotricuspid isthmus. The septal corridor was also involved in 60% of nonperitricuspid reentrant atrial tachycardias. Programmed atrial stimulation with S2 mapping accentuated conduction delay in this region, with demonstration of functional block and induction of atrial flutter. CONCLUSIONS:In patients with dextro-transposition of the great arteries corrected by atrial switch, surgical incisions define posterior boundaries and create a narrow septal corridor, or baffle-tricuspid isthmus, characterized by slow conduction and a propensity for functional block. These anatomic and electrophysiological features likely underlie the high prevalence of peritricuspid reentry in this population, representing a ubiquitous critical substrate for arrhythmia initiation and maintenance. Systematic cavotricuspid isthmus ablation should, therefore, be considered in these patients.
Pregnancy is a period marked by anatomical, physiological, and psychological changes that may be associated with women’s perceptions of risk and their attitudes toward sexuality during pregnancy. Risk perception during pregnancy is a subjective experience shaped by personal, medical, psychological, and cultural factors. Sexuality during pregnancy may also be associated with myths, misconceptions, physiological changes, and concerns about maternal or fetal safety. Although previous studies have examined sexual function, sexual beliefs, and body image during pregnancy, limited evidence is available on the relationship between pregnancy-related risk perception and attitudes toward sexuality during pregnancy. This study aimed to examine this relationship among pregnant women in Türkiye. A descriptive, cross-sectional study was conducted with 306 pregnant women who applied to family health centers in a district in Türkiye. The sample size was determined using statistical power analysis, and data were collected through structured face-to-face interviews. Data collection tools included a Personal Information Form, the Perception of Pregnancy Risk Questionnaire (PPRQ), and the Attitude Scale toward Sexuality during Pregnancy (ASSP). Descriptive statistics, independent samples t-tests, one-way analysis of variance with Bonferroni post-hoc tests, and Pearson correlation analysis were performed using IBM SPSS Statistics version 25. Statistical significance was accepted at p < 0.05. The mean total PPRQ score was 41.75 +/- 13.97. The mean score for risk perception toward oneself was 42.37 +/- 17.13, and the mean score for risk perception toward the baby was 40.98 +/- 16.58. The mean total ASSP score was 104.99 +/- 23.23, and 23.9
Egypt has one of the highest reported cesarean section (CS) rates globally. Aggregate CS rates alone, however, do not identify which obstetric populations contribute most to CS use or whether interventions are clinically appropriate. The Robson Ten-Group Classification System (TGCS) provides a standardized method for institutional audit and benchmarking. We conducted a prospective observational study at El-Shatby Maternity University Hospital, Alexandria, Egypt, from September 1, 2021, to March 1, 2022. All women admitted for delivery at ≥ 28 weeks’ gestation and/or fetal weight > 500 g were included. Women were categorized into Robson groups using the six core obstetric variables. Proportions and 95
Preeclampsia is one of the leading causes of maternal morbidity and mortality, disproportionately impacting women from diverse backgrounds. Early identification of risk factors is critical for timely preventive interventions. This study examined the impact of socioeconomic factors, prior substance use, and pre-existing health conditions on the development of preeclampsia using the data from the NIH All of Us Research Program. Participants aged 18 to 55 with at least one pregnancy in the NIH All of Us research program between 2018 and 2023 were included. Relative factors considered include socioeconomic status (education, income, health insurance), substance use disorders (alcohol, cannabis, cocaine, nicotine, opioid, stimulant), and pre-existing health conditions (blood clotting, depression, diabetes, hypertension, liver failure, renal failure, thyroid-stimulating hormone). Electronic health records and surveys were used to identify the study cohort and risk factors. We conducted multivariate analysis using a generalized linear model, along with subgroup analysis. A total of 12,098 individuals were identified with 14,354 pregnancy episodes after applying the inclusion and exclusion criteria, and 8.7
Pregnant women’s emotional well-being is a major determinant of maternal and pregnancy outcomes. This study aimed to estimate the prevalence of pregnant women’s perceived unhappiness with their current pregnancy, and to examine the reasons and factors associated with such feelings in Quelimane district, Central Mozambique. A population-based pregnancy surveillance study was conducted during 2023–2024. Data included pregnant women’s perceived status of unhappiness with their current pregnancy at realization, reasons for such feelings, and perceived reactions of their sexual partners. Variables associated with women’s unhappiness were investigated within a couple-centered conceptual framework that views pregnancy-related unhappiness as the result of interacting socio-demographic, reproductive, and partner-level factors; using descriptive statistics and multivariate logistic regression (three sequentially adjusted models). Among the 1546 participating women, 24.5
Postpartum hemorrhage (PPH) and Hypertensive Disorders of Pregnancy (HDP) remain leading causes of maternal death. This multi-country survey asked key informants to assess uptake of evidence-based practices; determine their country’s implementation of updated WHO global guidelines; and describe the private sector’s role in PPH and HDP management. To our knowledge, this is among the few multi-country assessments to examine national implementation of updated WHO recommendations for PPH and HDP alongside private-sector engagement across three major regions—sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean—providing a comparative view to guide advocacy and programme planning. From January to May 2022, 35 countries in sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean were invited to complete a survey (based on 2011 and 2012 surveys) on PPH and HDP management across public and private sectors on PPH and HDP management. Using purposive sampling, country-based focal persons assembled national expert teams from public and private sectors in health policy, education, procurement/distribution, logistics, and information systems to complete the survey. Teams produced consensus-based answers by reviewing nationally available data and policy documents. The Study Team developed composite scores for key quantitative indicators and thematically analyzed qualitative data. Thirty-one countries completed the survey. Despite significant progress since 2012, several gaps remain. Oxytocin was reported as regularly available in public facilities by 77
Abstract Objective To investigate the association between gestational-age-adjusted gestational weight gain (GWG) and adverse maternal and neonatal outcomes among women of advanced maternal age (AMA). Methods This retrospective cohort study included 714 singleton pregnant women aged 35 years or older who received antenatal care and delivered at Hebei Provincial Hospital of Traditional Chinese Medicine between January 2022 and December 2025. GWG was calculated as the difference between pre-delivery weight and pre-pregnancy weight. Based on the Chinese standard WS/T 801–2022, participants were classified into insufficient, adequate, and excessive GWG groups using gestational-age-adjusted recommended ranges according to pre-pregnancy body mass index. Baseline characteristics, pregnancy complications, maternal outcomes, and neonatal outcomes were compared across GWG categories. Multivariable logistic regression models were used to estimate the associations between GWG categories and adverse outcomes, with adequate GWG as the reference group. Results Among the 714 women included in the analysis, 112 (15.7%) had insufficient GWG, 282 (39.5%) had adequate GWG, and 320 (44.8%) had excessive GWG. After adjustment for potential confounders, insufficient GWG was associated with increased risks of premature rupture of membranes (aOR = 1.65, 95% CI: 1.01–2.69), gestational hypothyroidism (aOR = 1.89, 95% CI: 1.08–3.30), and low birth weight (aOR = 2.12, 95% CI: 1.05–4.29). Excessive GWG was associated with increased risks of cesarean delivery (aOR = 1.47, 95% CI: 1.04–2.08), postpartum anemia (aOR = 1.78, 95% CI: 1.12–2.84), preeclampsia (aOR = 1.71, 95% CI: 1.01–2.89), and macrosomia (aOR = 2.12, 95% CI: 1.16–3.88). The association between GWG category and preterm birth was attenuated after adjustment. Sensitivity analysis restricted to term pregnancies yielded generally consistent results. Conclusion Among women of advanced maternal age, both insufficient and excessive gestational-age-adjusted GWG were associated with increased risks of adverse maternal and neonatal outcomes. These findings suggest that individualized monitoring and management of GWG during pregnancy may help improve pregnancy outcomes in this high-risk population.
External cephalic version (ECV) is an obstetric procedure that involves manually turning the fetus inside the pregnant woman’s abdomen to change a breech or transverse presentation to a cephalic presentation. It can significantly increase the proportion of cephalic presentations during delivery and reduce the cesarean section rate for term singleton breech presentations, making it a relatively safe operation. In this case, we report a case of fetal cephalohematoma following ECV, which has not been previously documented in the literature. A 33-year-old multiparous woman with a breech presentation underwent an ECV at 39 weeks and 1 day of gestation. Nifedipine was taken orally before the procedure to inhibit uterine contractions, and combined spinal-epidural anesthesia was performed. ECV was successful on the third attempt. On the 10th postoperative day, an ultrasound examination revealed a fetal cephalohematoma, and a cesarean section was eventually performed. The fetal cephalohematoma gradually resolved after birth, without causing severe adverse effects on the newborn. ECV has few complications and can significantly reduce the cesarean section rate in breech presentations. However, during the procedure, it is important to strengthen perioperative management and improve the operator’s professional skills to reduce the risk of complications. The procedure should be performed gently, without unnecessary force.
Most prior studies on anemia in pregnancy, preterm birth (PTB), and non-reassuring fetal status (NRFS) use only single-trimester hemoglobin concentrations and fail to capture gestational hemoglobin changes. This study aimed to assess the associations of pregnancy hemoglobin trajectories with these two adverse perinatal outcomes. A retrospective cohort study was conducted using pregnancy records from Longquanyi District of Chengdu Maternity and Child Health Care Hospital (from July 2024 to June 2025) , involving 2,954 pregnant women with complete serial hemoglobin measurements. The outcome measures were PTB and NRFS. Latent growth mixture modeling was applied to identify distinct hemoglobin trajectories during pregnancy. Binary logistic regression was constructed to explore the association between hemoglobin trajectories and birth outcomes. The incidence of anemia during pregnancy was 29.8
Effective postoperative pain management after cesarean section is essential for maternal recovery and patient comfort. This prospective randomized controlled study aimed primarily to evaluate the effect of intermittent abdominal ice application on postoperative pain after elective cesarean section. Postoperative opioid consumption, patient satisfaction, and other recovery outcomes were evaluated as secondary outcomes. This prospective randomized controlled study included 80 patients undergoing elective cesarean delivery under spinal anesthesia between May 2022 and October 2022. Patients were randomly allocated into two groups using a computer-generated randomization sequence in a 1:1 ratio: the ice group (n = 40) and the control group (n = 40). Allocation concealment was achieved using sequentially numbered opaque sealed envelopes prepared by an investigator who was not involved in patient recruitment or postoperative assessment. In the ice group, intermittent abdominal ice application was performed during the first 12 postoperative hours with a total application duration of 2 h. Postoperative pain intensity was evaluated using the Numeric Rating Scale (NRS) at postoperative 0, 2, 6, 12, and 24 h. Secondary outcomes included rescue tramadol and morphine use, time to first rescue analgesic administration, patient satisfaction, and length of hospital stay. Additional secondary analyses included the area under the postoperative NRS–time curve, responder analysis, and effect size assessment. Baseline demographic and perioperative characteristics were similar between the groups. Compared with the control group, the ice group demonstrated significantly lower median postoperative NRS scores at 2, 6, and 12 h (all p < 0.001), whereas no significant difference was observed at 24 h. Tramadol consumption [25.0 (0.0–25.0) mg vs. 50.0 (50.0–50.0) mg, p < 0.001] and morphine consumption [0.0 (0.0–0.0) mg vs. 0.0 (0.0–2.0) mg, p < 0.001] were significantly lower in the ice group. Patient satisfaction scores were significantly higher in the ice group [4.0 (3.0–4.0) vs. 3.0 (3.0–4.0), p < 0.001]. AUC analysis demonstrated a significantly lower postoperative pain burden in the ice group. Responder analysis demonstrated higher rates of acceptable postoperative pain control in patients receiving abdominal ice application. Intermittent abdominal ice application was associated with lower early postoperative pain scores and higher patient satisfaction after elective cesarean section. Lower postoperative opioid consumption was also observed; however, this secondary finding should be interpreted cautiously because the initial rescue tramadol dose differed between the study groups. The intervention may serve as a simple adjunct to multimodal analgesia protocols after cesarean delivery. ClinicalTrials.gov, NCT07626138. Registered on 29 May 2026. Retrospectively registered.
This study aimed to examine the effect of a pregnancy pillow used in the last trimester on fatigue and comfort in pregnant women. This study used an RCT design. The study was conducted with 77 primiparous pregnant women (39 intervention, 38 control) who met the inclusion criteria and were admitted to the obstetrics outpatient clinic of a university hospital in the Black Sea region. The pregnant women were randomly assigned to groups using “Random Allocation Software”. Data were collected through a Personal Information Form, the Chalder Fatigue Scale (CFS), and the Prenatal Comfort Scale (PCS). The Pearson chi-square test, Yates corrected chi-square test, Fisher’s Exact test, Fisher-Freeman-Halton test, Robust Mixed ANOVA, and partial eta-squared (η²) values were employed for effect size calculations and reported with 95
Studies indicate that pregnant individuals sometimes feel inadequately prepared for caesarean section (CS) in antenatal classes. This suggests that the antenatal classes may not sufficiently address the information needs of those planning an elective CS. As antenatal classes provide valuable information beyond preparation for vaginal birth, they may nevertheless be relevant for this group. This study aims to examine how antenatal classes in Germany address elective CS and what factors influence the participation of pregnant individuals planning to have an elective CS according to midwives. We conducted a qualitative study using semi-structured interviews with midwives, who were sampled via a convenience sampling technique. The eligibility criteria required midwives currently offering antenatal classes who had conducted at least one antenatal class in Germany that included a pregnant individual planning an elective CS. Recruitment was carried out via telephone or email and through midwifery associations. The 15 interviews took place between October and December 2023. We performed data analysis using a content-structured approach (Mayring), employing MAXQDA 2022 (VERBI Software, Berlin, Germany). Midwives reported, as a barrier to participation, that pregnant individuals preparing for an elective CS often assume that antenatal classes are not relevant for them. This is partly due to a lack of information regarding the importance of their participation as well as insufficient awareness about the content of antenatal classes. Moreover, midwives noted that, as another barrier of participation, other participants and midwives in antenatal classes sometimes respond negatively to the decision of having a CS. All midwives generally take CS as a topic into account and most generally discuss the content of elective CS. The majority of midwives in the study considered addressing the informational needs of pregnant individuals preparing for an elective CS to be important. The idea of offering a separate course was subject to extensive discussion during the interviews. Some participants raised concerns regarding its practical feasibility. A more comprehensive education of all pregnant individuals regarding the content of antenatal classes is necessary. Tailored course formats could improve access to and relevance of antenatal classes for pregnant individuals planning an elective CS.
