Aims and objectives To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations. Background Many studies have evaluated the risk factors for severe perineal lacerations. However, the results of those studies are inconsistent, and meta‐analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking. Design Systematic review and meta‐analysis of cohort studies based on the PRISMA guideline. Methods PubMed, Embase, the Cochrane Library, CINAHL, http://clinicaltrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random‐effects or fixed‐effects model. Results A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12–1.92) and pre‐pregnant underweight (OR: 1.31, 95% CI 1.22–1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42–0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81–2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45–1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations. Conclusions Severe perineal lacerations are associated with many factors, and evidence‐based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations. Relevance to clinical practice This systematic review and meta‐analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.

Aims and objectives: To compare and rank the efficacy and safety of nonpharmacological interventions in the management of labour pain. Background: Recently, various non-pharmacological interventions have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non-pharmacological intervention is more efficient and safer is limited. Design: Systematic review and Bayesian network meta-analysis based on PRISMA-NMA. Methods: Seven databases were searched from database inception-March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta-analysis was conducted using either fixed-effects model or random-effects model according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model. Results: 43 studies involving nine non-pharmacological interventions were included. The Bayesian network meta-analysis showed that acupressure (SMD = −2.00, 95% CrI −3.09 to −0.94), aromatherapy (SMD = −2.01, 95% CrI −3.70 to −0.35) and massage therapy (SMD = −1.26, 95% CrI −2.26 to −0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = −130.85, 95% CrI −212.01 to −59.32) and acupressure (SMD = −10.14, 95% CrI −20.24 to −0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non-pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5-min Apgar score. Conclusions:The evidence in this network meta-analysis illustrates that nonpharmacological interventions are effective and safe for labour pain management in low-risk pregnant women. In the future, well-designed studies are needed to validate the conclusion of this network meta-analysis. Relevance to clinical practice:The results support the use of non-pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in

Objectives To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China. Methods A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0. Results A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18–54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39–6.29), had low social support (aOR = 2.95, 95% CI 1.39–6.29), were non-local residents (aOR = 2.51, 95% CI 1.15–5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15–5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18–3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67–47.09), had completed higher education (aOR = 12.28, 95% CI 1.24–121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37–8.32). Conclusions The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Aim and objective:To summarize the evidence on the effects of different techniques during the second stage of labour on reducing perineal laceration depending on available systematic reviews to provide optimal evidence for decision-making. Background: Preventing perineal laceration has been considered an important part of improving women's health. Various techniques have been used to prevent perineal laceration during the second stage of labour. However, systematic reviews evaluating the effects of different techniques on reducing perineal laceration show inconsistent results. Design: Overview of systematic reviews. Methods: Five English and four Chinese databases were systematically searched for relevant systematic reviews and meta-analyses published between 1 January 2016 and 31 August 2021. The quality of the included reviews was assessed by the AMSTAR 2 tool. A narrative synthesis was conducted to report the results of moderate-tohigh quality systematic reviews. The overview was reported according to the PRISMA statement.Results: Eighteen reviews were included, of which four reviews had moderate-tohigh methodological quality. Perineal massage and warm compresses significantly decreased the incidence of third-or fourth-degree perineal laceration (moderate-quality evidence). Hands-off technique had no impact on perineal laceration (low-to-moderate quality evidence). Ritgen's manoeuvre could reduce the incidence of first-degree perineal laceration but increase the incidence of second-degree perineal laceration (very low-quality evidence). Spontaneous pushing (low-quality evidence) and delayed pushing (moderate-quality evidence) had no impact on the incidence of third-or fourth-degree perineal laceration. Upright positions did not increase the risk of third-or fourthdegree perineal laceration (very low-to low-quality evidence) but increased the risk of second-degree perineal laceration for women without epidural analgesia (low-quality evidence).Conclusions: Perineal massage and warm compresses could be the better choice for preventing perineal laceration in the second stage of labour.

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