2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7a8,The final study population comprised 120 218 births. Among nulliparous women, there were 50 972 (94.8%) births in occiput anterior position and 2798 (5.2%) in occiput posterior position. Corresponding values among parous women were 63 153 (95.0%) and 3295 (5.0%), respectively. The estimated probability of spontaneous delivery within 120 minutes in nulliparous women with occiput anterior delivery was 98.4% (95% confidence interval 98.1-98.6) in women without epidural and 84.3% (83.1-85.4) in women with epidural analgesia. The benefit of pushing more than 120 minutes in women without epidural was marginal, whereas an additional 30 minutes of pushing increased the probability to 90.1% (86.3-92.8) in women with epidural. In nulliparous women with occiput posterior deliveries the corresponding probabilities after 120 minutes were 78.6% (73.4-82.8) in women without epidural and 44.9% (40.5-49.0) in women with epidural. Few spontaneous deliveries occurred after 120 minutes and the benefit of pushing beyond 120 minutes for nulliparous women with persistent occiput posterior position was low. In parous women with occiput anterior deliveries, the probability of spontaneous delivery after 60 minutes pushing was 99.0% (98.9-99.1) in women without epidural analgesia and 94.5% (94.1-94.9) in women with epidural. Women without epidural did not benefit from pushing more than 60 minutes, whereas the probability increased to 97.4% (97.0-97.7) after 90 minutes in women with epidural. The probabilities after 60 minutes of pushing in women with occiput posterior deliveries were 92.5% (91.2-93.6) and 72.9% (69.5-75.9), respectively, and increased to 97.4 (96.3-98.2) and 82.6 (78.3-86.1) with pushing until 90 minutes, but did not increase beyond these time limits. Active pushing more than 30 minutes was associated with higher rates of adverse maternal outcomes and with lower Apgar scores in all women, and with higher rates of pH<7.0 in parous women.31:Td08,Friedman found in 1955 that most nulliparous women without epidural analgesia delivered within two hours in second stage of labor. Estimating the probability of spontaneous delivery and assessing relevant predictors in a contemporary obstetric population is essential for clinical decision making. The aim of this study was to estimate the probability distribution of spontaneous delivery in occiput anterior and occiput posterior position during the pushing phase, stratified by parity and epidural analgesia. The study was a retrospective cohort study at three Norwegian University hospitals from 2012-2024. Women who reached the active second stage of labor and delivered a single fetus in cephalic presentation at term were eligible. The primary outcome was the estimated duration from start of the pushing phase to spontaneous delivery. Fetal position was classified as occiput anterior or occiput posterior at time of delivery. Secondary outcomes were adverse maternal (obstetric anal sphincter injuries and post-partum hemorrhage >1000 ml) and neonatal outcomes (five minutes Apgar score <7 and umbilical cord pH <7.0). The data were analyzed with survival methods. The final study population comprised 120 218 births. Among nulliparous women, there were 50 972 (94.8%) births in occiput anterior position and 2798 (5.2%) in occiput posterior position. Corresponding values among parous women were 63 153 (95.0%) and 3295 (5.0%), respectively. The estimated probability of spontaneous delivery within 120 minutes in nulliparous women with occiput anterior delivery was 98.4% (95% confidence interval 98.1-98.6) in women without epidural and 84.3% (83.1-85.4) in women with epidural analgesia. The benefit of pushing more than 120 minutes in women without epidural was marginal, whereas an additional 30 minutes of pushing increased the probability to 90.1% (86.3-92.8) in women with epidural. In nulliparous women with occiput posterior deliveries the corresponding probabilities after 120 minutes were 78.6% (73.4-82.8) in women without epidural and 44.9% (40.5-49.0) in women with epidural. Few spontaneous deliveries occurred after 120 minutes and the benefit of pushing beyond 120 minutes for nulliparous women with persistent occiput posterior position was low. In parous women with occiput anterior deliveries, the probability of spontaneous delivery after 60 minutes pushing was 99.0% (98.9-99.1) in women without epidural analgesia and 94.5% (94.1-94.9) in women with epidural. Women without epidural did not benefit from pushing more than 60 minutes, whereas the probability increased to 97.4% (97.0-97.7) after 90 minutes in women with epidural. The probabilities after 60 minutes of pushing in women with occiput posterior deliveries were 92.5% (91.2-93.6) and 72.9% (69.5-75.9), respectively, and increased to 97.4 (96.3-98.2) and 82.6 (78.3-86.1) with pushing until 90 minutes, but did not increase beyond these time limits. Active pushing more than 30 minutes was associated with higher rates of adverse maternal outcomes and with lower Apgar scores in all women, and with higher rates of pH<7.0 in parous women. The estimated probability of a spontaneous delivery varied with parity, the use of epidural analgesia, and with fetal position. The time limits of the pushing phase should be individualized accordingly.32:T58a,Blood component administration for major traumatic haemorrhage is established clinical practice in pre-hospital emergency medicine. However, transfusion practices for non-traumatic haemorrhage lack specific guidance. We analysed historical data on non-traumatic major haemorrhage to describe the incidence and current blood product administration practices. This retrospective observational cohort study reviewed Air Ambulance Charity Kent Surrey Sussex patient data from 11 November 2013 to 9 August 2024. The cohort included patients receiving pre-hospital blood components for non-traumatic major haemorrhage. Data included demographics, haemorrhage aetiology, physiology, transfusion volumes, cardiac arrest incidence, and intra-arrest transfusion. Fifty patients were identified, median age was 48 years (IQR 32-64). Gastrointestinal (GI) bleeding was most common (n = 21). Mean presenting systolic blood pressure (SBP) triggering transfusion was 79 mmHg. High-risk bleeding characteristics such as abdominal aortic anneursym required substantial transfusion volumes (median 4 units packed red blood cells). Pre-transfusion shock index significantly improved from 1.39 to 0.97 post-transfusion (p < 0.001). Pre-hospital blood transfusion improved patient physiology in our cohort of non-traumatic haemorrhage patients. Patients with non-traumatic haemorrhage may benefit from a pre-hospital transfusion.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Postpartum Hemorrhage: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Postpartum Hemorrhage (condition). Clinician-written summaries and actionable practice insights. 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WBLL showed the lowest hemoglobin (median 6.3 g/dL) and CFC the lowest fibrinogen (median 168.5 mg/dL), both significantly lower than the other categories (P<0.05).","limitations":"Small overall sample (n=171) with very few DIC cases (n=3), limiting validation of the DIC/LIPC distinction; single-country, multicenter design may reduce generalizability; the algorithm was developed and tested on the same dataset without external validation.","practice_takeaway":"Clinicians managing severe PPH may use a sequential assessment of bleeding rate, fibrinogen, and FDP to distinguish coagulopathic from non-coagulopathic causes, guiding targeted treatment. This is a pilot tool—external validation is needed before broad clinical adoption."}},{"doi":"10.1016/j.chest.2026.01.020","pmid":"42419853","title":"A 38-Year-Old Woman With Sudden Dyspnea After Uterine Artery Embolization","journal_title":"CHEST","journal_issn":"0012-3692","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1016/j.chest.2026.01.020","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-17T13:24:11.116Z","updated_at":"2026-07-17T13:24:11.116Z","tags":[{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"brand","value":"Avitene","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"brand","value":"Embosphere","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"brand","value":"Gelfoam","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"condition","value":"Hypoxia","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"condition","value":"Placenta Increta","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"condition","value":"Postpartum Hemorrhage","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"modality","value":"Uterine Artery Embolization","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"warning","value":"Embosphere and Avitene are listed as alternatives ('or'), suggesting only one was used — exact agent unclear from the abstract.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"warning","value":"The abstract does not reveal the final diagnosis explaining the hypoxia (e.g., pulmonary embolism, non-target embolization, amniotic fluid embolism), so clinical interpretation is limited.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.01.020","tag_type":"warning","value":"This appears to be a clinical case challenge or unknown diagnosis format typical of CHEST journal; the teaching points and outcome are likely in the full article but not available here.","value_numeric":null}],"summaries":{"what_studied":"A case report of a 38-year-old woman at 31 weeks' gestation with placenta increta who developed acute hypoxia and sinus tachycardia during uterine artery embolization (UAE) performed for postpartum hemorrhage prior to planned hysterectomy.","key_result":"The patient developed worsening hypoxia requiring supplemental oxygen (4 L/min) and sinus tachycardia (120–130 bpm) during UAE using Avitene/Embosphere, Gelfoam, glue, and coils, prompting pulmonary consultation; the final diagnosis and outcome are not reported in the abstract.","limitations":"Single case report with no comparator; the abstract does not disclose the final diagnosis, clinical outcome, or cause of hypoxia, limiting clinical applicability.","practice_takeaway":"Clinicians performing UAE in postpartum patients with placenta accreta spectrum should be aware of the risk of sudden respiratory compromise during the procedure. Early pulmonary or critical care involvement is warranted when hypoxia develops intraoperatively."}},{"doi":"10.1186/s12884-026-09405-6","pmid":"42252418","title":"Association of psychological states, sleep patterns, vaccine, and pregnancy outcomes during the COVID-19 pandemic","journal_title":"BMC Pregnancy and Childbirth","journal_issn":"1471-2393","published_at":"2026-06-08T00:00:00.000Z","url":"https://doi.org/10.1186/s12884-026-09405-6","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-19T13:23:30.487Z","updated_at":"2026-06-19T13:23:30.487Z","tags":[{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"condition","value":"COVID-19","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"condition","value":"Depression","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"condition","value":"Perinatal Mental Health","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"condition","value":"Postpartum Hemorrhage","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"modality","value":"Inactivated COVID-19 Vaccine","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"sample_size","value":"n=260","value_numeric":260},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"study_design","value":"Prospective Cohort Study","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09405-6","tag_type":"warning","value":"The unvaccinated group was small (n=56 vs. n=204 vaccinated), which may limit the power of vaccination safety conclusions. The confidence intervals for PPH odds ratios are wide, reflecting the modest sample size. The study was conducted at a single tertiary center in China during a specific pandemic wave (April–November 2022); generalizability to other settings or vaccine types (e.g., mRNA vaccines) is uncertain.","value_numeric":null}],"summaries":{"what_studied":"A prospective cohort study (n=260 pregnant women, April–November 2022) examined whether psychological states (depression, anxiety, stress), sleep quality, and pre-pregnancy inactivated COVID-19 vaccination were associated with postpartum hemorrhage (PPH) as the primary outcome, and other adverse pregnancy outcomes as secondary outcomes.","key_result":"Depression was significantly linked to PPH: mild depression (OR 4.19, 95% CI 1.15–15.18) and moderate-to-severe depression (OR 4.78, 95% CI 1.39–16.40) both raised risk vs. no depression (PPH rates: normal 3.6%, mild 15.0%, moderate-severe 13.0%). Anxiety, stress, COVID-19-related psychological stress, sleep quality, and pre-pregnancy inactivated COVID-19 vaccination were not associated with PPH or other adverse pregnancy outcomes.","limitations":"Single-center study at a tertiary hospital in China limits generalizability. Relatively small sample (n=260) with only 56 unvaccinated participants may reduce power to detect vaccination-related effects. Study period coincided with a specific COVID-19 wave, which may not reflect other pandemic phases.","practice_takeaway":"Screen pregnant patients for depressive symptoms, as even mild depression was associated with a 4-fold increase in PPH risk. Reassure patients that pre-pregnancy inactivated COVID-19 vaccination does not appear to raise the risk of PPH or other adverse pregnancy outcomes."}},{"doi":"10.1111/jog.70337","pmid":"42209248","title":"Association Between Third‐Stage Duration and Postpartum Hemorrhage in Women With Retained Placenta","journal_title":"Journal of Obstetrics and Gynaecology Research","journal_issn":"1341-8076","published_at":"2026-05-28T00:00:00.000Z","url":"https://doi.org/10.1111/jog.70337","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-04T13:23:44.382Z","updated_at":"2026-06-04T13:23:44.382Z","tags":[{"paper_doi":"10.1111/jog.70337","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"condition","value":"Postpartum Hemorrhage","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"condition","value":"Retained Placenta","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"modality","value":"Manual Removal of Placenta","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"sample_size","value":"n=47","value_numeric":47},{"paper_doi":"10.1111/jog.70337","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"warning","value":"MROP timing and indications were not standardized (physician discretion), limiting causal inference about MROP's role in blood loss.","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"warning","value":"The parent cohort size (n=4543) is noted for context, but all key analyses are based on the 47 retained placenta cases only.","value_numeric":null},{"paper_doi":"10.1111/jog.70337","tag_type":"warning","value":"The sample of retained placenta cases (n=47) is very small, making all multivariable estimates — especially the ART odds ratio (aOR 18.50) — highly imprecise and potentially unreliable for clinical decision-making.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study examined the association between third-stage labor duration and total blood loss in 47 women with retained placenta following singleton vaginal deliveries (≥22 weeks gestation) at a single center between 2019–2024.","key_result":"57.4% (27/47) of women with retained placenta developed PPH. Total blood loss positively correlated with third-stage duration (Spearman's ρ = 0.488, p < 0.001). ART pregnancy (aOR 18.50; 95% CI 3.28–104.0) and third-stage duration per 30 min (aOR 1.86; 95% CI 1.10–3.16) were independently associated with PPH. Greater blood loss was seen when manual removal of placenta (MROP) was performed, though third-stage duration did not differ between MROP and non-MROP groups.","limitations":"- Very small sample (n=47 retained placenta cases) yields imprecise effect estimates with wide confidence intervals.\n- Retrospective design with MROP performed at physician discretion introduces selection bias.\n- Single-center study limits generalizability.","practice_takeaway":"In women with retained placenta, a longer third stage signals higher bleeding risk — particularly in those who conceived via ART, who may warrant closer monitoring and earlier intervention planning. MROP was associated with greater blood loss, though this likely reflects severity of the underlying clinical situation rather than the procedure itself."}},{"doi":"10.1016/j.ajog.2026.05.001","pmid":"42107846","title":"How Long Should Women Push? The Effect of Fetal Position, Parity, and Epidural Use on Spontaneous Delivery","journal_title":"American Journal of Obstetrics and Gynecology","journal_issn":"0002-9378","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajog.2026.05.001","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1016/j.ajog.2026.05.001","days":"7","issn":"0002-9378","rank":"7","field":"Clinical Medicine","score":"4","category":"Obstetrics & Gynecology","categories":["Obstetrics & Gynecology"],"_categories":["Obstetrics & Gynecology"]},"pubmed":{"doi":"10.1016/j.ajog.2026.05.001","title":"How Long Should Women Push? The Effect of Fetal Position, Parity, and Epidural Use on Spontaneous Delivery.","journal":"American journal of obstetrics and gynecology","methods":"","results":"$30","abstract":"$31","keywords":["Cesarean delivery","instrumental delivery","labor management","occiput posterior position","second stage of labor"],"pubmed_id":"42107846","conclusions":"The estimated probability of a spontaneous delivery varied with parity, the use of epidural analgesia, and with fetal position. The time limits of the pushing phase should be individualized accordingly.","publication_date":"2026-05-11T00:00:00"},"crossref":{"DOI":"10.1016/j.ajog.2026.05.001","URL":"https://doi.org/10.1016/j.ajog.2026.05.001","ISSN":["0002-9378"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0002937826002498?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0002937826002498?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["How Long Should Women Push? The Effect of Fetal Position, Parity, and Epidural Use on Spontaneous Delivery"],"author":[{"given":"Birgitte","family":"Eide","sequence":"first","affiliation":[]},{"given":"Torbjørn M.","family":"Eggebø","sequence":"additional","affiliation":[]},{"given":"Ingvild","family":"Dalen","sequence":"additional","affiliation":[]},{"given":"Philip","family":"Von Brandis","sequence":"additional","affiliation":[]},{"given":"Jørg","family":"Kessler","sequence":"additional","affiliation":[]},{"given":"Christian","family":"Tappert","sequence":"additional","affiliation":[]},{"given":"Ragnar K.","family":"Sande","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,5]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":null,"created":{"date-time":"2026-05-08T23:57:22Z","timestamp":1778284642000,"date-parts":[[2026,5,8]]},"indexed":{"date-time":"2026-05-09T00:15:42Z","timestamp":1778285742224,"date-parts":[[2026,5,9]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"http://creativecommons.org/licenses/by/4.0/","start":{"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000,"date-parts":[[2026,5,7]]},"delay-in-days":6,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0002937826002498"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"How Long Should Women Push? 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Published by Elsevier Inc."}],"deposited":{"date-time":"2026-05-08T23:57:22Z","timestamp":1778284642000,"date-parts":[[2026,5,8]]},"issn-type":[{"type":"print","value":"0002-9378"}],"published":{"date-parts":[[2026,5]]},"publisher":"Elsevier BV","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S0002937826002498"],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2026,5]]},"reference-count":0,"published-online":null,"references-count":0,"short-container-title":["American Journal of Obstetrics and Gynecology"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.ajog.2026.05.001","is_oa":true,"title":"How Long Should Women Push? The Effect of Fetal Position, Parity, and Epidural Use on Spontaneous Delivery","updated":"2026-05-09T14:24:07+00:00","published_date":"2026-05-01","best_oa_location":{"url":"https://doi.org/10.1016/j.ajog.2026.05.001","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1016/j.ajog.2026.05.001"}}},"created_at":"2026-05-12T13:18:12.510Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"condition","value":"Labor Dystocia","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"condition","value":"Obstetric Anal Sphincter Injury","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"condition","value":"Postpartum Hemorrhage","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"condition","value":"Second Stage Of Labor","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"modality","value":"Epidural Analgesia","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"sample_size","value":"n=120218","value_numeric":120218},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"warning","value":"Fetal position was assessed at time of delivery, not at onset of pushing; this may underestimate the true rate of persistent occiput posterior presentation and introduce misclassification bias.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"warning","value":"The adverse-outcome associations (e.g., OASI, PPH, low Apgar, low cord pH) are observational and likely reflect confounding by indication—longer pushing may be a marker of complicated labor rather than a direct cause of harm.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.05.001","tag_type":"warning","value":"The study population is from Norwegian tertiary centers (2012–2024); applicability to other healthcare systems, ethnicities, or resource settings is uncertain.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study (n=120,218 births, 2012–2024, three Norwegian university hospitals) estimated the probability of spontaneous vaginal delivery by duration of active pushing, stratified by parity, fetal position (occiput anterior vs. posterior), and epidural use.","key_result":"For nulliparous women with occiput anterior position, spontaneous delivery within 120 min was 98.4% (no epidural) vs. 84.3% (epidural); extending to 150 min raised the epidural group to 90.1%. For nulliparous women with occiput posterior position, rates at 120 min were 78.6% (no epidural) and 44.9% (epidural), with little gain beyond 120 min. For parous women with occiput anterior position, 99.0% (no epidural) and 94.5% (epidural) delivered within 60 min; extending to 90 min raised the epidural group to 97.4%. Pushing >30 min was associated with higher rates of obstetric anal sphincter injury, postpartum hemorrhage >1,000 mL, Apgar <7 at 5 min, and umbilical cord pH <7.0 in parous women.","limitations":"- Retrospective design limits causal inference; unmeasured confounders (e.g., reasons for prolonged pushing) may bias adverse-outcome associations.\n- Fetal position was recorded at delivery, not at start of pushing, so occiput posterior classification may undercount true persistent OP presentations.\n- Single-country (Norwegian) tertiary-center population may limit generalizability to other settings or lower-resource environments.","practice_takeaway":"Tailor pushing time limits to each woman: parous women without epidural rarely benefit beyond 60 min, while nulliparous women with epidural may gain from up to 150 min—especially in occiput anterior position. Persistent occiput posterior position markedly reduces spontaneous delivery rates and should prompt earlier reassessment, particularly for nulliparous women with epidural analgesia."}},{"doi":"10.1111/aogs.70238","pmid":"42077135","title":"Ultrasound texture‐based radiomics of placental and myometrial tissue for predicting postpartum blood loss in women with placenta previa and low‐lying placenta","journal_title":"Acta Obstetricia et Gynecologica Scandinavica","journal_issn":"0001-6349","published_at":"2026-05-04T00:00:00.000Z","url":"https://doi.org/10.1111/aogs.70238","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:52.910Z","updated_at":"2026-05-07T22:50:52.910Z","tags":[{"paper_doi":"10.1111/aogs.70238","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"condition","value":"Low-Lying Placenta","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"condition","value":"Placenta Previa","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"condition","value":"Postpartum Hemorrhage","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"modality","value":"Radiomics","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"modality","value":"Ultrasound Imaging","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"sample_size","value":"n=107","value_numeric":107},{"paper_doi":"10.1111/aogs.70238","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"warning","value":"Model construction details (feature selection, regularization, overfitting prevention) are not fully described in the abstract, which limits assessment of methodological rigor.","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"warning","value":"Sample size is small (n=107) and the study is single-center with no external validation; AUC estimates should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1111/aogs.70238","tag_type":"warning","value":"The threshold for 'significant blood loss' (>500 mL) is a standard WHO definition but may not capture all clinically meaningful hemorrhage scenarios (e.g., >1000 mL for cesarean delivery).","value_numeric":null}],"summaries":{"what_studied":"This retrospective single-center study evaluated ultrasound texture-based radiomic features of placental and myometrial tissue — alone and combined with clinical/sonographic data — to predict postpartum blood loss >500 mL in 107 singleton pregnancies complicated by placenta previa or low-lying placenta, using second- and third-trimester images.","key_result":"The integrated radiomics + clinical/sonographic model achieved an AUC of 82.32% (95% CI: 74.18%–90.45%), significantly outperforming the clinical-only model (AUC 71.27%; p=0.001) and nonsignificantly outperforming radiomics alone (AUC 77.17%). 51 of 107 women (47.7%) had blood loss >500 mL; prior cesarean delivery was a key clinical risk factor.","limitations":"- Single-center, retrospective design limits generalizability and introduces selection bias.\n- Small sample size (n=107) may lead to model overfitting and limits statistical power.\n- No external validation cohort was used to confirm model performance.","practice_takeaway":"Adding ultrasound radiomics to standard clinical and sonographic data meaningfully improves prediction of major postpartum hemorrhage in placenta previa/low-lying placenta — consider this approach for personalized peripartum planning when resources allow. Prior cesarean delivery remains a key flag for elevated hemorrhage risk in this population."}},{"doi":"10.1186/s13049-025-01495-z","pmid":"41316317","title":"Pre-hospital blood transfusion in non-traumatic major haemorrhage: a retrospective observational study","journal_title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","journal_issn":"1757-7241","published_at":"2025-11-29T00:00:00.000Z","url":"https://doi.org/10.1186/s13049-025-01495-z","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-02","doi":"10.1186/s13049-025-01495-z","days":"7","issn":"1757-7241","rank":"2","field":"Clinical Medicine","score":"7","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1186/s13049-025-01495-z","title":"Pre-hospital blood transfusion in non-traumatic major haemorrhage: a retrospective observational study.","journal":"Scandinavian journal of trauma, resuscitation and emergency medicine","methods":"This retrospective observational cohort study reviewed Air Ambulance Charity Kent Surrey Sussex patient data from 11 November 2013 to 9 August 2024. The cohort included patients receiving pre-hospital blood components for non-traumatic major haemorrhage. Data included demographics, haemorrhage aetiology, physiology, transfusion volumes, cardiac arrest incidence, and intra-arrest transfusion.","results":"Fifty patients were identified, median age was 48 years (IQR 32-64). Gastrointestinal (GI) bleeding was most common (n = 21). Mean presenting systolic blood pressure (SBP) triggering transfusion was 79 mmHg. High-risk bleeding characteristics such as abdominal aortic anneursym required substantial transfusion volumes (median 4 units packed red blood cells). Pre-transfusion shock index significantly improved from 1.39 to 0.97 post-transfusion (p < 0.001).","abstract":"$32","keywords":[],"pubmed_id":"41316317","conclusions":"Pre-hospital blood transfusion improved patient physiology in our cohort of non-traumatic haemorrhage patients. Patients with non-traumatic haemorrhage may benefit from a pre-hospital transfusion.","publication_date":"2025-11-29T00:00:00"},"crossref":{"DOI":"10.1186/s13049-025-01495-z","URL":"https://doi.org/10.1186/s13049-025-01495-z","ISSN":["1757-7241"],"link":[{"URL":"https://link.springer.com/content/pdf/10.1186/s13049-025-01495-z.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/article/10.1186/s13049-025-01495-z/fulltext.html","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/content/pdf/10.1186/s13049-025-01495-z.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"1","score":1,"title":["Pre-hospital blood transfusion in non-traumatic major haemorrhage: a retrospective observational study"],"author":[{"given":"Harsha","family":"Kodakadath","sequence":"first","affiliation":[]},{"given":"Seán","family":"Dillane","sequence":"additional","affiliation":[]},{"given":"Jo","family":"Griggs","sequence":"additional","affiliation":[]},{"given":"Rob","family":"Greenhalgh","sequence":"additional","affiliation":[]},{"given":"Scott","family":"Clarke","sequence":"additional","affiliation":[]},{"given":"Harriet","family":"Tucker","sequence":"additional","affiliation":[]},{"given":null,"family":null,"sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2025,11,28]]},"member":"297","prefix":"10.1186","source":"Crossref","volume":"33","created":{"date-time":"2025-11-28T12:19:59Z","timestamp":1764332399000,"date-parts":[[2025,11,28]]},"indexed":{"date-time":"2025-11-28T12:32:06Z","timestamp":1764333126446,"date-parts":[[2025,11,28]]},"license":[{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000,"date-parts":[[2025,11,28]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000,"date-parts":[[2025,11,28]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01495-z"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"ArticleHistory","label":"Article History"},"label":"Received","order":1,"value":"16 June 2025"},{"name":"accepted","group":{"name":"ArticleHistory","label":"Article History"},"label":"Accepted","order":2,"value":"9 October 2025"},{"name":"first_online","group":{"name":"ArticleHistory","label":"Article History"},"label":"First Online","order":3,"value":"28 November 2025"},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"},"order":1},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"},"order":2,"value":"All data were routinely collected and met Health Research Authority (HRA, UK) criteria as service evaluation. Research Ethics Committee approval was not required. The project was approved by the KSS Research and Innovation Committee and registered with the University of Surrey. Study conduct was in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines."},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"},"order":3,"value":"The authors declare no competing interests."}],"deposited":{"date-time":"2025-11-28T12:20:10Z","timestamp":1764332410000,"date-parts":[[2025,11,28]]},"issn-type":[{"type":"electronic","value":"1757-7241"}],"published":{"date-parts":[[2025,11,28]]},"publisher":"Springer Science and Business Media LLC","reference":[{"DOI":"10.1186/s13054-023-04327-7","key":"1495_CR1","year":"2023","issue":"1","author":"R Rossaint","volume":"27","first-page":"80","unstructured":"Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, et al. 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Nearly half presented in cardiac arrest (23/50), and only 6/23 achieved sustained ROSC to hospital.","limitations":"Single-centre, small sample (n=50) with retrospective case review. Transfusion decisions were discretionary without standardised triggers, and physiologic data were often incomplete (IBP used in 8%; lactate in 8%; noninvasive BP frequently unrecordable in arrests).","practice_takeaway":"Pre‑hospital blood transfusion for selected non‑traumatic major haemorrhage was feasible and associated with improved haemodynamics; higher‑risk aetiologies such as AAA often required larger volumes (median 4 PRBC units). Outcome benefit is unproven; adhere to local protocols while awaiting larger, prospective studies."}}],"initialOffset":7,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Postpartum Hemorrhage"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Postpartum Hemorrhage"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Postpartum Hemorrhage"}}}]]

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