Objective. Dystocia in labour is the most common indication for primary caesarean sections. We have investigated how Italian midwives are informed and aware of the diagnosis of dystocia in labour, which strategies they implement and how their culture can affect clinical decisions. Methods. Purpose-built questionnaire using convenience sampling on a voluntary basis. The research was carried out on a population of Italian midwives. The questionnaire was divided into three macro-areas: socio-demographic information; a clinical case with decision questions; operators' knowledge and clinical choices. Results. 300 questionnaires were collected, and 289 were analysed. 60% of midwives would have not diagnosed active labour before 6 cm of dilation and would have adopted conservative management. 81% would adopt methods such as change of maternal posture, movement, and emotional support to solve dystocia rather than oxytocin and artificial rupture of membranes. 76% is aware that there is no single definition of dystocia, 80% do not know the definition of latent phase. The discussion on dystocia is rarely addressed in a context such as an audit. Conclusions. Culture considered as experience, knowledge, and work context, could affect clinical practice. Most midwives showed interest in the subject by tackling it with a view that was mainly physiological. The need for training and structured discussion meetings is, in any case, important.

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Maternal mortality is a worldwide alarming concern, and sepsis is the third most frequent cause for its occurrence. Pregnancy and the postpartum period are an intrinsically vulnerable period during women's life, which may make the mothers more susceptible to develop sepsis, due to the physiological and immunological changes that regulate host capacity to counteract pathogens infection, such as bacteria, viruses, fungi, and protozoa. The physiological adaptations of pregnancy could additionally mask signs and symptoms of infection and limit the sensitivity and specificity of the available scores. On this basis, the obstetric-modified quick SOFA and the Modified Early Warning System were proposed to overcome these issues. Early recognition and treatment are vital to prevent mortality. Nevertheless, the evidence guiding the current management of maternal sepsis are derived from the general population and do not take into account the physiological changes of pregnancy. In pregnant women early fluid resuscitation should be carefully addressed, and the management of the source of infection may require expedite delivery, making the management of sepsis particularly challenging during gestation. Further studies are needed to establish pregnancy-related diagnostic criteria and therapeutic protocols for sepsis and septic shock in the obstetrical population.

Purpose To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal–fetal outcomes. Methods We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal–fetal outcomes were retrieved from the prospectively collected delivery room database and medical records. Results SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06–1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34–0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes. Conclusions SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal–fetal outcomes will allow concluding about the superiority of one technique upon the other.

Purpose: To compare the effects of epidural analgesia (EA) and combined spine epidural analgesia (SEA) on labor and maternal-fetal outcomes.Methods: We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records.Results: SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 minutes. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p=0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p=0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes.Conclusions: SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other.