Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Medicine
Risk factors for episiotomy during vaginal birth: A systematic review and meta-analysis
BACKGROUND: Despite the numerous harms associated with episiotomy during vaginal birth, the risk factors for this procedure remain a topic of controversy. This study aimed to identify the potential risk factors for episiotomy during vaginal birth. METHODS: A systematic search was conducted across 7 databases, including PubMed/MedLine, Embase, Cochrane, Web of Science, Chinese Knowledge Infrastructure (CNKI), and Wanfang, up to January 2025. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using Stata 18.0 and Review Manager 5.4. RESULTS: A total of 16 articles were included in this meta-analysis, comprising a sample size of 17,502 individuals. Newborn weight (odds ratio [OR] = 2.393; 95% confidence interval [CI] = 1.627-3.520; P < .001) and oxytocin use (OR = 2.341; 95% CI = 1.652-3.318; P < .001) were identified as significant risk factors for episiotomy. In contrast, maternal age (OR = 0.978; 95% CI = 0.922-1.038; P = .466), the type of childbirth attendant (OR = 0.920; 95% CI = 0.569-1.488; P = .733), and the duration of the second stage of labor (OR = 1.299; 95% CI = 0.781-2.162; P = .314) were not statistically significant risk factors for episiotomy. CONCLUSION: High newborn weight and oxytocin use are associated with higher rates of episiotomy. However, other potential risk factors are still controversial due to a lack of sufficient evidence, highlighting the need for more rigorous studies to strengthen the evidence base.
13 July 2026
Read appraisal →International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
Integrated artificial intelligence and omics for prediction and monitoring of pre-eclampsia
Pre-eclampsia is a difficult pregnancy condition that causes high blood pressure and can lead to health complications in both mother and newborn, resulting in a higher fatality rate. It presents with a wide range of symptoms and lacks specific indicators, as the contemporary diagnostic techniques, including proteinuria testing and blood pressure measurements, are not reliable. The current evolution in artificial intelligence (AI) technology tends to show a promising transformation of pre-eclampsia management. AI algorithms are applied to process larger sets of clinical, biochemical, and image data that facilitate timely medical interventions by bringing up the early-onset and severity of pre-eclampsia. By analyzing the red cell distribution width (blood test indicators for pre-eclampsia), it is recognized as a cost-effective way of detecting inflammation. The application of AI technology on non-invasive diagnostic (wearable) devices enables continuous monitoring with imaging techniques for the placenta and retina via cloud-based systems. These developments are not only applied for early detection of pre-eclampsia, but also assist decision making capabilities in both high- and low-resource environments. This article explains how the growing use of AI is changing the way that pre-eclampsia is understood and managed, with the aim of improving accuracy and offering more personalized care for pregnant women.
1 July 2026
Read appraisal →Archives of women's mental health
Moderators, mediators, and components of a standalone smartphone application for postpartum depression: secondary analysis of a randomized controlled trial
PURPOSE: The purpose of this study was to identify potential moderators, mediators, and efficacious components of a standalone app intervention on postpartum depression symptoms and functional impairment. METHODS: A total of 264 women were randomized to intervention (Motherly app) or to an active control group. We analyzed depressive symptoms assessed by the Edinburgh Postnatal Depression Scale and functional impairment by the Clinical Global Impression at post-treatment as outcomes. Various potential moderators were assessed at baseline. Potential mediation variables were the level of behavioral activation (BA) measured by the Behavioral Activation for Depression Scale - Short Form and the Response-contingent positive reinforcement (RCPR) by the Reward Probability Index, at post-treatment. Intervention component analysis was evaluated using app engagement data. RESULTS: The results indicate that intervention effects on depressive symptoms were moderated by the number of children and pediatric consultations, with stronger effects observed among mothers with fewer children and higher consultation frequency. Functional impairment was moderated by time spent with the child, with greater improvements among mothers with lower caregiving demands. Mediation analyses showed BA and RCPR mediated the effect of our intervention on depressive symptoms and functional impairment. Total and BA achievements were significantly associated with reduction in depressive symptoms. CONCLUSION: Our findings suggest that our app intervention efficacy is influenced by maternal characteristics and childcare responsibilities. BA and RCPR are key mechanisms, and higher engagement with app components produce greater symptom reduction.
24 May 2026
Read appraisal →European journal of pediatrics
Effect of intranasal breast milk administration on cerebral oxygenation, vital signs, and transition time to full oral feeding in preterm infants: a randomized controlled study
UNLABELLED: This study examined the effects of intranasal breast milk administration on cerebral oxygenation, vital signs, and time to transition to full oral feeding in preterm infants. This assessor-blinded, randomized controlled trial included 40 preterm infants with gestational ages between 28+0 and 36+6 weeks. Infants in the intervention group received 0.2 mL of fresh breast milk intranasally three times daily for 3 days. The control group continued to receive routine clinical care. During each intervention period, cerebral oxygenation and vital signs were recorded at baseline (T0), 5 (T1), 15 (T2), and 30 (T3) minutes after the intervention. The time required for preterm infants to achieve full oral feeding was monitored until discharge. Cerebral oxygenation levels of preterm infants who received intranasal breast milk were significantly higher than the control group and respiratory rate was lower at some measurement times. No significant differences were found between groups in oxygen saturation, heart rate, time to full oral feeding, length of hospital stay, vomiting frequency and defecation frequency. CONCLUSION: Intranasal breast milk administration has the potential to increase cerebral oxygenation in preterm infants. The maintenance of oxygen saturation and heart rate, along with good tolerance of the procedure, suggests that this intervention may be safe and feasible. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov on 21 May 2024 (Identifier: NCT06706115). WHAT IS KNOWN: • Intranasal breast milk administration has been reported to have therapeutic potential in improving brain injury in preterm infants. • Intranasal administration of breast milk is known not to cause significant side effects in preterm infants diagnosed with intraventricular hemorrhage. WHAT IS NEW: • Intranasal breast milk administration may increase cerebral rSO₂ in preterm infants. • Intranasal breast milk administration did not affect preterm infants' heart rate, SpO₂ levels, time to transition to full oral feeding, length of hospital stay, daily vomiting, and stooling frequency.
17 Apr 2026
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