ObjectiveTo investigate the current status and related factors of maternal influenza vaccination willingness among pregnant and postpartum women in Shanghai and Liaoning Province, China, and to explore the facilitators and barriers affecting vaccination uptake, so as to provide references for future practices in promoting maternal influenza immunization in China. MethodsA convergent mixed-methods research was conducted. From January to March 2024, a questionnaire survey was conducted among women attending prenatal and postnatal care at 7 medical institutions in Shanghai and Dalian, Liaoning Province, which aimed to assess pregnant women’s knowledge about influenza vaccine and their willingness to vaccination during pregnancy, as well as to identify the related factors. In addition, purposive sampling method was used to conduct in-depth interviews with pregnant women and perinatal healthcare service providers to explore their perspectives on influenza vaccination during pregnancy, including the reasons for their willingness or unwillingness to receive ( or recommend) the vaccine, and the relevant facilitators and barriers to vaccination. ResultsA total of 366 pregnant and postpartum women participated in the questionnaire survey, and 9.56% (35/366) of them were willing to receive the influenza vaccine during pregnancy. The results of multivariate logistic stepwise regression analyses showed that primipara (aOR=0.158, 95%CI: 0.037‒0.671, P=0.012), family members’ support for influenza vaccination during pregnancy (aOR=0.015, 95%CI: 0.003‒0.082, P<0.001) were associated with higher willingness to receive influenza vaccine during pregnancy. Absence of influenza infection during pregnancy (aOR=5.383, 95%CI: 1.801‒16.092, P<0.001), and lack of knowledge regarding influenza vaccination during pregnancy (aOR=11.294, 95%CI: 3.593‒35.496, P<0.01) were associated with lower willingness to receive influenza vaccine during pregnancy. Qualitative findings indicated that the facilitators to vaccination willingness among pregnant and postpartum women included the recommendation of healthcare service providers, adequate knowledge of influenza vaccine information and family members’ support for vaccination. Conversely, the barriers to vaccination willingness included low recommendation from the healthcare service providers, lack of knowledge about the safety of influenza vaccine during pregnancy and inadequate attention to influenza and influenza vaccine. ConclusionThe willingness to receive influenza vaccination among pregnant and postpartum women in Shanghai and Liaoning Province is relatively low. It is recommended that China should promptly improve the evidence-based system for the safety and efficacy of influenza vaccines for pregnant and postpartum women, along with an establishment of the mechanism for addressing adverse reactions. Furthermore, it is essential to enhance educational outreach to pregnant and postpartum women, their families, and healthcare service providers, thereby increasing the accessibility of information regarding influenza vaccination, which are expected to enhance the willingness of pregnant and postpartum women to receive the vaccine.

Objective:To investigate the incidence of common complications following vaginal delivery and analyze their influencing factors among women of reproductive age.Methods:This prospective cohort study consecutively enrolled women who delivered vaginally at two campuses of the Obstetrics and Gynecology Hospital of Fudan University between February and July 2023. Participants were categorized into groups according to complication occurrence: those with obstetric laceration versus those without, postpartum hemorrhage versus non-hemorrhage, and retained placenta/membranes without hemorrhage vs. non-retention. Data were collected using a self-developed questionnaire on risk factors for vaginal delivery complications. Group comparisons of demographics, obstetric history, intrapartum assessments, and delivery outcomes were performed using Chi-square test (or Fisher's exact test), independent samples t-test, and Mann-Whitney U test. Multivariate logistic regression identified risk factors for the three complication types. Results:Among 1 966 vaginal deliveries, the overall complication rate was 8.1% (159/1 966), with obstetric lacerations representing the most frequent complication at 4.6% (91/1 966), followed by postpartum hemorrhage at 2.7% (53/1 966) and retained placenta/membranes without hemorrhage at 1.4% (27/1 966). Multivariate logistic regression analysis identified distinct sets of independent risk factors for each complication. For obstetric lacerations, adequate gestational weight gain was associated with a reduced risk ( OR=0.547, 95% CI: 0.332-0.900, P=0.018), while precipitous labor ( OR=2.633, 95% CI: 1.321-5.248, P=0.006), shoulder dystocia ( OR=2.495, 95% CI: 1.093-5.691, P=0.030), poor maternal cooperation ( OR=1.887, 95% CI: 1.061-3.359, P=0.031), and specific perineal conditions—particularly reduced skin folds ( OR=2.341, 95% CI: 1.247-4.395, P=0.008) and tight/thick/edematous skin ( OR=2.511, 95% CI: 1.248-5.054, P=0.010)—emerged as significant risk factors. Regarding postpartum hemorrhage, conception through assisted reproductive technology ( OR=3.286, 95% CI: 1.189-9.076, P=0.022), presence of obstetric comorbidities ( OR=2.460, 95% CI: 1.070-5.656, P=0.034), elevated D-dimer levels ( OR=1.157, 95% CI: 1.049-1.277, P=0.004), reduced fibrinogen ( OR=0.521, 95% CI: 0.319-0.851, P=0.009), weak uterine contractions ( OR=20.175, 95% CI: 10.352-39.321, P<0.001), abnormal placentation ( OR=2.434, 95% CI: 1.167-5.078, P=0.018), and absence of early skin-to-skin contact ( OR=0.141, 95% CI: 0.067-0.295, P<0.001) were independently associated with increased risk. For retained placenta/membranes without hemorrhage, prolonged thrombin time ( OR=0.117, 95% CI: 0.034-0.318, P<0.001) and abnormal placentation ( OR=51.843, 95% CI: 14.988-179.324, P<0.001) were identified as primary risk factors. Conclusions:While the overall incidence of complications following vaginal delivery among women of reproductive age is relatively low, high-risk groups warrant particular attention. Precipitous labor, shoulder dystocia, poor maternal cooperation, and unfavorable perineal conditions increase laceration risk. Assisted conception, obstetric comorbidities, elevated D-dimer levels, uterine atony, and placental abnormalities elevate hemorrhage risk. Furthermore, placental abnormalities are strongly associated with retained placenta/membranes without hemorrhage.

Objective:To investigate the incidence of common complications following vaginal delivery and analyze their influencing factors among women of reproductive age.Methods:This prospective cohort study consecutively enrolled women who delivered vaginally at two campuses of the Obstetrics and Gynecology Hospital of Fudan University between February and July 2023. Participants were categorized into groups according to complication occurrence: those with obstetric laceration versus those without, postpartum hemorrhage versus non-hemorrhage, and retained placenta/membranes without hemorrhage vs. non-retention. Data were collected using a self-developed questionnaire on risk factors for vaginal delivery complications. Group comparisons of demographics, obstetric history, intrapartum assessments, and delivery outcomes were performed using Chi-square test (or Fisher's exact test), independent samples t-test, and Mann-Whitney U test. Multivariate logistic regression identified risk factors for the three complication types. Results:Among 1 966 vaginal deliveries, the overall complication rate was 8.1% (159/1 966), with obstetric lacerations representing the most frequent complication at 4.6% (91/1 966), followed by postpartum hemorrhage at 2.7% (53/1 966) and retained placenta/membranes without hemorrhage at 1.4% (27/1 966). Multivariate logistic regression analysis identified distinct sets of independent risk factors for each complication. For obstetric lacerations, adequate gestational weight gain was associated with a reduced risk ( OR=0.547, 95% CI: 0.332-0.900, P=0.018), while precipitous labor ( OR=2.633, 95% CI: 1.321-5.248, P=0.006), shoulder dystocia ( OR=2.495, 95% CI: 1.093-5.691, P=0.030), poor maternal cooperation ( OR=1.887, 95% CI: 1.061-3.359, P=0.031), and specific perineal conditions—particularly reduced skin folds ( OR=2.341, 95% CI: 1.247-4.395, P=0.008) and tight/thick/edematous skin ( OR=2.511, 95% CI: 1.248-5.054, P=0.010)—emerged as significant risk factors. Regarding postpartum hemorrhage, conception through assisted reproductive technology ( OR=3.286, 95% CI: 1.189-9.076, P=0.022), presence of obstetric comorbidities ( OR=2.460, 95% CI: 1.070-5.656, P=0.034), elevated D-dimer levels ( OR=1.157, 95% CI: 1.049-1.277, P=0.004), reduced fibrinogen ( OR=0.521, 95% CI: 0.319-0.851, P=0.009), weak uterine contractions ( OR=20.175, 95% CI: 10.352-39.321, P<0.001), abnormal placentation ( OR=2.434, 95% CI: 1.167-5.078, P=0.018), and absence of early skin-to-skin contact ( OR=0.141, 95% CI: 0.067-0.295, P<0.001) were independently associated with increased risk. For retained placenta/membranes without hemorrhage, prolonged thrombin time ( OR=0.117, 95% CI: 0.034-0.318, P<0.001) and abnormal placentation ( OR=51.843, 95% CI: 14.988-179.324, P<0.001) were identified as primary risk factors. Conclusions:While the overall incidence of complications following vaginal delivery among women of reproductive age is relatively low, high-risk groups warrant particular attention. Precipitous labor, shoulder dystocia, poor maternal cooperation, and unfavorable perineal conditions increase laceration risk. Assisted conception, obstetric comorbidities, elevated D-dimer levels, uterine atony, and placental abnormalities elevate hemorrhage risk. Furthermore, placental abnormalities are strongly associated with retained placenta/membranes without hemorrhage.

ObjectiveTo use the maternal morbidity WOICE Tool（Chinese version）to investigate the maternal morbidity in Shanghai， and to examine the current situation and associated factors of adverse symptoms and impaired functioning in the third trimester and postpartum period. MethodsPregnant women who made their initial visit and established a medical record at a tertiary obstetrics and gynecology hospital in Shanghai from March to August 2021 were recruited and a baseline survey was completed. The prevalence of maternal morbidity was surveyed in the third trimester and first 6 weeks postpartum. ResultsSelf-reported adverse physical symptoms were observed in 89.8% of women in the third trimester and 86.1% in first 6 weeks postpartum. The prevalence rates of anxiety and depression were 4.1% and 6.2% in the third trimester， and 6.2% and 7.5% in first 6 weeks postpartum， respectively. The proportions of women reporting impaired functioning were 80.3% in the third trimester and 64.1% in first 6 weeks postpartum， respectively. Physical symptoms were associated with parity， education， the newborn’s health status， and risk of experiencing violence. Psychological symptoms were associated with age， household responsibilities， employment status， the newborn’s health status， pre-pregnancy body mass index （BMI）， and risk of experiencing violence. Functionality was associated with the type of registered residence， education level， household responsibilities， and risk of experiencing violence. ConclusionThe physical health status of pregnant and postpartum women in Shanghai is better than that in the middle-income regions abroad， with anxiety and depression at average levels compared to national statistics in China. Physical， psychological， and functional status are affected by multiple factors including personal， health， family， and work conditions. Preventive measures should be taken from various perspectives to mitigate adverse symptoms and impaired functioning， and to improve the positive experience of pregnancy and childbirth.

Objective:To analyze the implementation of early essential newborn care (EENC) in baby-friendly hospitals in China.Methods:This is an investigation carried out using convenience sampling method. People in charge of labor ward, obstetric wards or neonatology department of the selected hospitals, such as baby-friendly hospitals with birth facilities, primary or higher level of hospitals, or general hospitals or those specialized in obstetrics and gynecology or materal and child health care centers, were selected as the subjects of the survey. Information about EENC practices in these hospitals was collected using a self-designed questionnaire sent through WeChat from April 1 to 30, 2021. Chi-square test was used for statistical analysis. Results:A total of 126 questionnaires were distributed and 124 (124 baby-friendly hospitals) were withdrawn. There were 74 hospitals in the eastern, 18 in the central and 32 in the western region. Among the 124 hospitals, tertiary hospitals, general hospitals, and maternity and child care hospitals accounted for 72.6% ( n=90), 64.5% ( n=80) and 35.5% ( n=44), respectively. There were no significant differences in the hospital type, levels, EENC coverage and training, or implementation of mainly recommended EENC practices among the hospitals in the eastern, central and western regions (all P>0.05). The implementation rate of at least one mainly recommended EENC practice was 79.0% (98/124) and there was no significant difference in the implementation rates among eastern, central and western regions [86.4% (64/74), 13/18 and 65.6% (21/32), χ2=6.60, P=0.159]. A total of 80 (64.5%) hospitals implemented 10 or more recommended EENC practices, and the implementation rates in eastern, central and western regions were 71.6% (53/74), 10/18 and 53.1% (17/32), respectively ( χ2=4.08, P=0.130). Among the 17 mainly recommended measures of EENC, in eastern, central and western hospitals, the implementation rates were 10.8% (8/74), 2/18 and 18.8% (6/32) for mother-infant skin-to-skin contact for 90 min after birth; 66.2% (49/74), 11/18 and 68.8% (22/32) for delayed umbilical cord clamping; and 25.7% (19/74), 7/18 and 21.9% (7/32) for delayed routine care following skin-to-skin contact, respectively ( χ2=6.57, 0.34 and 4.53, all P>0.05). Conclusions:There is a big gap between the implementation of EENC in most baby-friendly hospitals in eastern, central and western China and the recommendation of the World Health Organization. It is necessary to further strengthen and standardize the implementation of EENC practices in baby-friendly hospitals in our country to continuously improve the health of newborns.

Objective: This study aimed to explore the existing knowledge about midwives' views and experiences of providing care for women in the context of task shifting.Methods: We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting. Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts. A grid was made to identify core findings and compare them reciprocally. Results: Thirty-six qualitative studies met the inclusion criteria. The literature comprised of 32 first key concepts. Eight second-order constructs emerged, and three third-order interpretations were generated. The three overarching themes were: (1) midwives perceived themselves as providing culturally competent and high quality women-centered care; (2) they valued their profession but saw it as complex and challenging; (3) as health professionals, they reported a variety of organizational, cultural, and professional barriers to providing women-centered care. Conclusions: While performing a specific task in the task shifting context, midwives perceived their crucial roles and responsibilities, along with achieved value and reward. However, due to a range of existing barriers, the caring task posed great challenges in completely implementing women-centered care. It is essential for systems to identify and eliminate these barriers early, to consider midwives' emotional well-being, and to develop overall strategies to better support the midwifery workforce. Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.

Decision on mode of delivery (MOD) is a process involved by both clients and health care providers, based on specific clinical situations and women′s values. To help each woman obtain the best MOD is crucial for obstetric health professionals to provide women-centered high quality of care. There is a steep upward trend in cesarean sections in China due to the introduced advanced technologies, overused antenatal monitoring methods, flexible indications for cesarean sections, delayed childbearing ages and people′s misconceptions, etc.. Recently the conditional and comprehensive two-child policy have been implemented in China, which might initiate changes in fertility and birth intentions of many families, and in subsequent decisions on MOD. This review illustrates the pros and cons of MOD, decision process on MOD, influencing factors and strategies to promote decision on MOD, in order for the obstetric professionals to provide evidence-based best care for women and their families in the process of decision-making.

Objective To establish a midwife-obstetrician collaboration-based management model for pregnant women after caesarean sections and to evaluate its effectiveness on women′s childbirth outcomes. Methods A panel of experts including obstetricians and midwives was established. A revised management scheme for women after cesarean sections was finally formed through multiple expert consultation method. A historical control method was implemented in our study. Women giving birth before the implementation of collaboration-based management scheme between 2011 and 2013 were recruited in the control group;and women giving birth afterwards between 2014 and 2016 were recruited in the intervention group. Childbirth outcomes such as the mode of delivery, rate of trial of labor after cesarean sections, and vaginal birth rate after cesareans were compared between the two groups. Results A total of 3326 women in intervention group, of those women 281 (8.4%) under trial of labor after cesarean, of the women who under trial of labor 264(94.0%) had successful vaginal birth. A total of 1625 women in control group, of those women 28(1.7%) under trial of labor after cesarean, of the women who under trial of labor 22(78.6%) had successful vaginal birth. The trial of labor after cesarean sections rate and the vaginal birth rate after cesareans rate was significantly higher in intervention group than that in control group (P<0.01). Conclusions The midwife-obstetrician collaboration-based management model can promote vaginal birth for women after cesarean sections, and has no adverse effect on other childbirth outcomes, which is worthy of being implemented more widely in China.

Objective To evaluate the training effects of obstetric nurses in training center of Shanghai. Methods Totally 63 trainees of Obstetrics & Gynecology Hospital of Fudan University(Shanghai obstetric nurse training center) who received training from December 2012 to September 2015,were investigated by questionnaires,focus group interviews,written and practice examinations,etc. Kirkpatrick's four-level model of training evaluation was used to assess the training effects.Results Five themes were extracted from fifteen focus group discussions,and they were normative,characteristic,frontier,practical and humanistic. Satisfaction rate of trainees towards training schedules was 100.0%;satisfaction rate towards clinical teachers was 96.8%;satisfaction towards practical training environment was 95.2%;satisfaction towards instructional mode and content was 98.4%;and the satisfaction towards examination and evaluation was 100.0%. The total score of obstetric knowledge and skills was (50.83±11.37) before training and was (62.52±8.61) after training (t=-6.508, P<0.05). Within six months after practical training,89.7% of trainees thought that they could apply the learned professional knowledge into clinical practice,and 93.1% of trainees thought that they could apply the learned obstetric skills into nursing practice. Within 12 months after practical training,25 trainees worked as clinical teachers,nine trainees became head nurses,and six trainees implemented the learned new model of obstetric care and techniques into their clinical settings.Conclusions Shanghai obstetric nurse training center provides a resource platform for professional nurses' continuing education. The training improves trainees' obstetric knowledge and skills,and has a positive impact on nurses' actual job performance.

Objective To understand the clinical practice behavior and definite the role function of subspeciality nurses in department of gynaecology and obstetrics.Methods A total of 17 nurse specialisms in department of gynaecology and obstetrics were selected by purposive sampling with the method of field research. Participant observation was used in their clinical nursing activities. And then, field note were recorded timely. Besides, the data was sorted out and analyzed again and again.Results A total of six clinical practice behavior of subspeciality nurses in department of gynaecology and obstetrics were refined including specialty evaluation, professional skills, health education, psychological instruction, continuity management, and teaching and research.Conclusions The rudiment of mode of clinical practice of subspeciality nurses in department of gynaecology and obstetrics firstly appears at the present stage. It still needs to refer the mode of management and cultivation of nurse specialism abroad, improve the the clinical practice behavior and specialist team building of subspeciality nurses in department of gynaecology and obstetrics.