METHODS: Set in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice.

RESULTS: There were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] -4.0; 95% confidence interval [CI], -5.8 to -2.2) for all women and from 92.2% to 80.7% (RD -11.5; 95% CI, -13.4 to -9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD -2.0; 95% CI, -2.7 to -1.4) for all women and from 6.7% to 3.0% (RD -3.7; 95% CI, -4.9 to -2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9-4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0-7.5) for nulliparous women.

METHODS: A cross-sectional study, incorporating 195 women involved in a longitudinal cohort study. Palpation for levator integrity was performed, followed by a four-dimensional translabial ultrasound. LAM avulsion defects were diagnosed in the presence of puborectalis muscle detachment from its insertion. Post-processing analysis of ultrasound volumes for LAM integrity on TUI was performed blinded against palpation findings. Agreement between methods was assessed using Cohen's κ.

RESULTS: In all, 388 paired assessments of LAM bilaterally, were available. Sixteen (8.2%) unilateral avulsion defects were detected on palpation. Sonographically, 31 (16%) were diagnosed with avulsions: 4.6% bilateral and 11.3% unilateral. An overall agreement of 91% was observed between digital palpation and TUI, yielding a Cohen's κ of 0.32 (95% confidence interval 0.15-0.48) demonstrating "fair agreement": and implying 25% sensitivity, 98% specificity, 63% positive predictive value, and 92% negative predictive value. Analysis of the first and last 20 palpations showed no change in performance during the 13-day study period.

METHODS: A randomized trial was conducted in a University hospital in Malaysia. Nulliparous women at term who were about to start pushing were randomized to massage during pushing and warm compress to the perineum in between pushes or to standard "hands-off" care. Primary outcome was suturing for perineal injury (episiotomy or tear).

METHODS: A randomized, double-blind, placebo-controlled trial was performed in a university hospital. Women with GDMA1 were recruited at 16-30 weeks of pregnancy and randomized to oral metformin 500 mg twice daily or identical placebo tablets to delivery. Level of HbA1c was taken at recruitment and at 36 weeks of pregnancy. The primary outcome was the change in level of HbA1c at recruitment and 36 weeks of pregnancy.

METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.

RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.

OBJECTIVE: To estimate the prevalence of postpartum dyspareunia.

SEARCH STRATEGY: Web of Science, Scopus, PubMed, and Embase databases were searched to July 2019 using keywords including 'perineal pain,' 'dyspareunia,' and 'sexual pain'.

SELECTION CRITERIA: Observational studies on the prevalence of postpartum dyspareunia were included.

DATA COLLECTION AND ANALYSIS: Two authors independently reviewed articles and extracted data. Study heterogeneity was evaluated by I2 index; publication bias by Egger and Begg tests.

MAIN RESULTS: Twenty-two studies enrolling 11 457 women were included. Based on meta-analysis, the overall estimated prevalence of dyspareunia was 35% (95% confidence interval [CI], 29%-41%). The prevalence was 42% (95% CI, 26%-60%) at 2 months, 43% (95% CI, 36%-50%) at 2-6 months, and 22% (95% CI, 15%-29%) at 6-12 months postpartum. Begg test showed no significant bias in data related to the prevalence of postpartum dyspareunia (p = 0.466).

METHODS: A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9).