European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"The effect of high-intensity TESLA stimulation (HITS) therapy on pelvic floor electromyography (EMG) and potential clinical implications for use","authors":"Geetika Shah ,&nbsp;Khaing Thu Thu ,&nbsp;Christian Phillips","doi":"10.1016/j.ejogrb.2025.02.007","DOIUrl":"10.1016/j.ejogrb.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can significantly impact quality of life for affected women. The compliance and tolerability of strategies such as physiotherapy with or without electrical stimulation is variable. Non-invasive, extracorporeal treatments such as High Intensity Tesla (HITS) therapy have become increasingly promoted as an alternative to physiotherapy but the evidence to support HITS^TM is limited.</div></div><div><h3>Objectives</h3><div>To assess the impact of a short course of 8–10 sessions using HITS^TM on Electromyographic (EMG) activity of pelvic floor muscles (PFMs) and participant’s satisfaction using the HITS^TM chair.</div></div><div><h3>Study Design</h3><div>Participants utilised the HITS^TM chair, twice a week for 30 min over 4-to-6-weeks (8–10 sessions in total). For each session, the first 10 min was delivered at a frequency of 10 Hz followed by 10 min at 23 Hz and lastly 10 mins at 35 Hz as this has been shown to be optimal for improving PFM strength. Prospective electromyography measurements at rest, maximum voluntary contraction and endurance of nine volunteers were recorded using the MAPLe® device at baseline and after completion of treatments.</div></div><div><h3>Results</h3><div>Paired <em>t</em>-test showed statistically significant differences for both endurance and maximum voluntary contraction of PFMs when compared to EMG measurements prior to interventions (p = 0.0003 and p = 0.0002 respectively). Hence, this study demonstrated that all participants had improvement in their EMG muscle activity.</div></div><div><h3>Conclusion</h3><div>The HITS chair can effectively increase PFM strength and may be a useful outpatient treatment to manage patients with pelvic floor dysfunction such as SUI and POP.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 247-251"},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor: Comparison of the effectiveness of levonorgestrel intrauterine system and dienogest in the management of adenomyosis: A systematic review and meta-analysis","authors":"Zhe Zhang ,&nbsp;Junjie Li","doi":"10.1016/j.ejogrb.2025.02.010","DOIUrl":"10.1016/j.ejogrb.2025.02.010","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Page 273"},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of bacterial vaginosis treatment during pregnancy on maternal-fetal outcome: A systematic review and network meta-analysis","authors":"Jianru Wu ,&nbsp;Xiaoqi Zhu ,&nbsp;Biyu Tang ,&nbsp;Jingying Wu ,&nbsp;Fenfang Wei ,&nbsp;Xinru Wang ,&nbsp;Limin Li ,&nbsp;Hongqiao Li ,&nbsp;Yi Zhang ,&nbsp;Bei Wang ,&nbsp;Wenyu Wu ,&nbsp;Xiang Hong","doi":"10.1016/j.ejogrb.2025.02.008","DOIUrl":"10.1016/j.ejogrb.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>Bacterial vaginosis (BV) can lead to adverse pregnancy outcomes such as preterm delivery. However, it is unclear whether BV treatment during pregnancy can reduce the incidence of adverse maternal-fetal outcomes.</div></div><div><h3>Methods</h3><div>We performed a meticulous literature search across various databases, including PubMed, EMBASE, Web of Science, and the Cochrane Database. Utilizing <em>meta</em>-analysis, we delved into the relationship between diverse drug treatments, encompassing probiotics, antibiotics, and combination therapy, and their potential impact on adverse pregnancy outcomes. We also used network <em>meta</em>-analysis to explore the effects of different medications on the primary outcome of preterm delivery and ranked the intervention effects using P-scores.</div></div><div><h3>Results</h3><div>Twenty-four eligible randomized controlled trials (RCTs) were included. Regardless of the type of treatment administered, the <em>meta</em>-analysis demonstrated that there was no decrease in the occurrence of preterm delivery following BV treatment during pregnancy (RR = 1.00, 95 % CI = 0.80–1.24, <em>P</em> = 0.96). But among the UK population, it was found that BV treatment during pregnancy was significantly associated with a reduced risk of preterm delivery (RR = 0.47, 95 % CI = 0.30–0.73, <em>P</em> &lt; 0.001). Through network <em>meta</em>-analysis, oral probiotics obtained the highest P-scores (P-score = 0.86), but with a low quality evidence. This was followed by vaginal clindamycin plus clotrimazole (P-score = 0.78), and oral clindamycin (P-score = 0.58). Furthermore, it has not been discovered that BV treatment during pregnancy can decrease the likelihood of various other adverse outcomes, such as puerperal infections, miscarriages, premature rupture of membranes, low birth weight, and neonatal intensive care unit (NICU) admission rates.</div></div><div><h3>Conclusion</h3><div>The current evidence fails to endorse the treatment of BV during pregnancy as a means to mitigate the risk of preterm delivery. Although probiotic therapies exhibit promising potential, the available data remains inadequate. Future research is necessary to further establish the safety and effectiveness of antibiotics and probiotics in the prevention or management of BV during pregnancy.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 175-183"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kwashiorkor during pregnancy: A rare complication of bariatric surgery with fetal health consequences","authors":"Marie Mawet ,&nbsp;Geraldine Brichant ,&nbsp;Vincianne Thielen ,&nbsp;Véronique Masson ,&nbsp;Frédéric Chantraine","doi":"10.1016/j.ejogrb.2025.02.003","DOIUrl":"10.1016/j.ejogrb.2025.02.003","url":null,"abstract":"<div><div>Bariatric surgery, while beneficial for managing obesity and improving fertility, can lead to serious nutritional deficiencies that impact maternal and fetal health. We report the case of a 31-year-old woman with a history of gastric bypass who developed Kwashiorkor, a rare and severe complication of malnutrition, during the second trimester of her twin pregnancy. This condition was associated with severe intrauterine growth restriction. Kwashiorkor, typically seen in young children suffering from famine in low-income regions, is characterized by severe protein deficiency. In this case, parenteral nutrition led to rapid maternal improvement and a noticeable resumption of fetal growth within days. This case highlights the importance of tailored monitoring and nutritional management for pregnant women with a history of bariatric surgery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 277-278"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic treatment of cesarean scar pregnancy: A scoping review","authors":"Elie Barakat ,&nbsp;Gaetano Riemma ,&nbsp;Antonio Simone Laganà ,&nbsp;Lea Nehme ,&nbsp;Aline Khazzaka ,&nbsp;Marco Noventa ,&nbsp;David Lukanovic ,&nbsp;Sevil Hakimi ,&nbsp;Zaki Sleiman","doi":"10.1016/j.ejogrb.2025.02.006","DOIUrl":"10.1016/j.ejogrb.2025.02.006","url":null,"abstract":"<div><div>Cesarean Scar Pregnancy (CSP) is a life-threatening condition that may lead to uterine rupture and severe bleeding when left untreated. Treatment includes expectant, medical, and surgical options. This review aimed to evaluate the role of laparoscopy in the management of CSP.</div><div>A comprehensive search of PubMed and The Cochrane Library was carried out with findings dating up to May 2024. Several screening processes were done by two reviewers and 48 articles mentioning the laparoscopic management were included in this review.</div><div>Laparoscopy allows adhesiolysis, bladder dissection, and complete CSP excision in addition to simultaneous repair of the isthmocele, reinforcing the scarred myometrium to prevent abnormal uterine bleeding, pelvic pain, CSP recurrence, and rupture. To ensure a successful indication of laparoscopy as the main treatment option, the CSP gestational sac should be &gt; 32.5 mm, with a myometrial thickness of &lt; 2 mm. Laparoscopy for CSP excision is a durable and highly effective method with minimal complication rates reported in the current literature. Moreover, it seems to be the most effective in the case of CSP embedded within myometrium with or without serosal involvement.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 154-163"},"PeriodicalIF":2.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of the 19Fr. Intrauterine BIGATTI Shaver in operative hysteroscopy for benign intracavitary lesions: A feasibility study","authors":"Stefan Timmerman ,&nbsp;Helena Van Kerrebroeck ,&nbsp;Ashleigh Ledger ,&nbsp;Kobe Dewilde ,&nbsp;Rik Van Severen ,&nbsp;Thierry Van den Bosch ,&nbsp;Wouter Froyman","doi":"10.1016/j.ejogrb.2025.02.005","DOIUrl":"10.1016/j.ejogrb.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of common benign intracavitary lesions of the uterus, such as endometrial polyps, submucosal myomas, and retained products of conception (RPOC) has evolved significantly over the past decades. Hysteroscopic tissue removal (morcellation) was introduced as an alternative to the traditional operative hysteroscopy with bipolar resectoscopic excision, due to concerns regarding thermal damage and impaired visibility. Recently, with the aim of promoting a minimally invasive approach and the possibility of use in an office setting, smaller diameter hysteroscopic tissue removal systems were designed, such as the reusable 19 Fr. Intrauterine BIGATTI Shaver (IBS®). This prospective study aims to assess the feasibility and outcomes of using the 19 Fr. Intrauterine BIGATTI Shaver (IBS®) for benign intracavitary lesions.</div></div><div><h3>Methods</h3><div>We performed a multicentric prospective cohort study among patients with suspected benign intracavitary lesions. Procedures were performed using the 19 Fr. BIGATTI Shaver under sedation or general anaesthesia. Data on procedure characteristics and complications were collected prospectively.</div></div><div><h3>Results</h3><div>Fifty-eight patients were included, of which the majority had endometrial polyps. Complete resection was achieved in all cases, with only in 5 % need for additional techniques after hysteroscopic tissue removal during the same intervention. Operator satisfaction was generally high, particularly for endometrial polyps. However, challenges were encountered with RPOC, including 2 cases of excessive bleeding and longer tissue removal times (2 min for endometrial polyps vs 4.5 for RPOC). Postoperative complications were rare (2 %).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the feasibility and safety of using the 19 Fr. IBS® for benign intracavitary lesions, particularly for endometrial polyps. Further research is warranted to validate the device’s utility in broader clinical contexts and to address specific challenges associated with different lesion types.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 197-202"},"PeriodicalIF":2.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How women understand and use a tool to predict early pregnancy outcome: A qualitative analysis","authors":"Kim Lawson ,&nbsp;Jennifer Hall ,&nbsp;Tom Bourne ,&nbsp;Cecilia Bottomley","doi":"10.1016/j.ejogrb.2025.02.004","DOIUrl":"10.1016/j.ejogrb.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>To explore how women, understand, interpret and use a validated individualised early pregnancy outcome prediction score tool.</div></div><div><h3>Study Design</h3><div>Qualitative interview study nested within a larger quantitative randomised controlled trial (RCT) within the Early Pregnancy Unit of a London teaching hospital. Women with an ultrasound diagnosis of an early intrauterine pregnancy of uncertain viability (PUV) were randomised to receive a validated outcome prediction score or routine care. Those who received the prediction were invited to interview. Thematic analysis was conducted with a focus on women’s experiences of receiving the prediction model. The study was complete when no further themes emerged.</div></div><div><h3>Results</h3><div>Eleven interviews were completed. Five themes emerged from the data: 1) Credibility, 2) Setting Expectations, 3) Sharing, 4) Reflecting and 5) Risks. Scientific development of the tool and delivery by a healthcare professional lent credibility. Women mostly found the prediction tool helpful in anticipating and preparing for the actual outcome. Women largely did not share their prediction outside immediate family. Where women perceived that the tool did not take sufficient account of individual previous experience, less value was attributed. Women also believed in a potential psychological risk from a high prediction of viability being followed by a poor outcome.</div></div><div><h3>Conclusion</h3><div>This study presents a nuanced understanding of women’s use of an outcome prediction tool, which is not found from standard quantitative data. Recognising how women rationalise and use information is as important as statistical performance of a tool when implementing supportive care interventions. Whilst the results give better understanding in cases of PUV, it is not known whether the findings can be generalised to other early pregnancy scenarios.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 259-264"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between preoperative vaginal dysbiosis and endometrial polyp recurrence after hysteroscopic polypectomy: A retrospective-prospective cohort study","authors":"Caini Wei ,&nbsp;Lei Ye ,&nbsp;Shuli Tang ,&nbsp;Peiyue Chen ,&nbsp;Jiezhuang Huang ,&nbsp;Zhifu Zhi","doi":"10.1016/j.ejogrb.2025.02.002","DOIUrl":"10.1016/j.ejogrb.2025.02.002","url":null,"abstract":"<div><h3>Aim</h3><div>To explore whether preoperative vaginal dysbiosis influences the recurrence of endometrial polyps after hysteroscopic polypectomy.</div></div><div><h3>Design</h3><div>Retrospective-prospective observational cohort study.</div></div><div><h3>Methods</h3><div>A total of 679 patients from our university-affiliated hospital were included in this study. All patients underwent hysteroscopic polypectomy and were subsequently monitored for endometrial polyp recurrence through transvaginal ultrasonography at six-month intervals. Comprehensive clinical data were collected, encompassing preoperative vaginal dysbiosis, parity, polyp size, polyp number, the presence of uterine fibroids, polycystic ovary syndrome, endometriosis, and body mass index. The cohort was categorized into recurrence and non-recurrence groups, with comparative analyses conducted to assess the impact of these factors.</div></div><div><h3>Results</h3><div>Preoperative vaginal dysbiosis and endometriosis were significantly associated with endometrial polyp recurrence (P &lt; 0.05). The odds ratio (OR) for preoperative vaginal dysbiosis was 3.286 (95 % confidence interval [CI]: 2.675–3.786), and for endometriosis, it was 3.328 (95 % CI: 2.567–3.643). Further analysis revealed that bacterial density, bacterial diversity, and the <em>Lactobacillus</em> detection rate were significantly higher in the non-recurrence group compared to the recurrence group (P &lt; 0.05). In contrast, increased leukocyte esterase activity, Gardnerella vaginalis presence, and <em>Candida</em> detection were significantly more prevalent in the recurrence group than in the non-recurrence group (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study identifies preoperative vaginal dysbiosis as an independent risk factor for Endometrial Polyp recurrence after Hysteroscopic Polypectomy. Endometriosis is also associated with recurrence. Close monitoring of preoperative vaginal microecological parameters and targeted interventions could help manage dysbiosis and reduce recurrence.</div></div><div><h3>IRB Approval</h3><div>The First Affiliated Hospital of Guangxi Medical University Ethical Review Committee. Approval number: 2024-E817-01.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 148-153"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ibuprofen use and male infertility: Insights from a nationwide retrospective cohort study","authors":"Wan-Ting Huang ,&nbsp;Jen-Hung Wang ,&nbsp;Dah-Ching Ding","doi":"10.1016/j.ejogrb.2025.02.001","DOIUrl":"10.1016/j.ejogrb.2025.02.001","url":null,"abstract":"<div><div>Previous studies have indicated that nonsteroidal anti-inflammatory drugs, including ibuprofen, may have varying effects on the male reproductive system. This study aimed to evaluate the impact of ibuprofen on male infertility in Taiwan. This nationwide retrospective cohort study used the Taiwan National Health Insurance Database from January 1, 2000, to December 31, 2021. The study participants were males aged 20–59 years who had used ibuprofen or acetaminophen between 2000 and 2020. The primary outcome was the incidence of male infertility. Cox regression analysis estimated cumulative incidences and hazard ratios (HRs) with their corresponding 95 % confidence intervals (CIs). The Kaplan–Meier method was used to illustrate cumulative incidence curves. The participants using ibuprofen and acetaminophen were 11,194 and 11,194. After the propensity score matching, the two groups did not show differences in age, medication year, and disease prevalence. Ibuprofen usage for &gt;60 days per year had a higher HR (2.01, 95 % CI: 1.03–4.01) of male infertility than acetaminophen usage for the same duration. The cumulative incidence of male infertility over time showed that ibuprofen use for &gt;60 days per year was significantly associated with a higher incidence of male infertility compared to acetaminophen (p &lt; 0.001). The association between ibuprofen use and male infertility has broad public health implications. If further confirmed through prospective studies, these findings may impact medical advice and inform discussions on drug use, particularly among individuals of reproductive age.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 128-133"},"PeriodicalIF":2.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143221755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of intrapartum bundles and interventions in reducing vaginal delivery-related perineal trauma: a systematic review","authors":"Giovanni Morganelli ,&nbsp;Stefania Fieni ,&nbsp;Sara dell’Omo ,&nbsp;Vito Andrea Capozzi ,&nbsp;Maurizio Di Serio ,&nbsp;Andrea Dall’Asta ,&nbsp;Tullio Ghi","doi":"10.1016/j.ejogrb.2024.12.008","DOIUrl":"10.1016/j.ejogrb.2024.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this systematic review is to summarize the current evidence on preventive interventions and bundles, including combinations of multiple techniques, aimed at reducing vaginal delivery-related perineal injury.</div></div><div><h3>Methods</h3><div>A systematic research of literature was independently conducted on different databases (PubMed, MEDLINE, EMBASE) by the authors, using a combination of the identified keywords and index terms as per current PRISMA guidelines. The research was restricted to papers published in English starting by 2000. Similar papers as previously published reviews and metanalysis satisfying the inclusion criteria were used as cross-reference to check for potential further inclusions.</div></div><div><h3>Findings</h3><div>In total 14 papers have been identified to be included in our review, divided into 2 randomized controlled trials and 12 cohort studies (4 prospective cohort studies, 6 retrospective cohort studies, 1 prospective case-control study and 1 multicenter step-wedge cluster study).</div></div><div><h3>Conclusions</h3><div>Bundles and interventions, including combinations of techniques and tools aimed at enhancing intrapartum perineal care are effective in reducing adverse perineal outcome after vaginal delivery. Most common features include training programs for labor professionals, pushing instructions and communication, hands-on technique for both reducing speed of delivery and perineal support, and restrictive use of medio-lateral episiotomy.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"305 ","pages":"Pages 107-116"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}