Interpregnancy interval planning after caesarean section: A feminist thematic analysis of women's understanding and decision making when planning another pregnancy.

Explore women's experience and decision making around interpregnancy interval after caesarean section . A sequential mixed methods approach was used to identify themes from qualitative interviews conducted across Australia. Data from the qualitative interviews informed a survey that was distributed nationally, via social media, over two months. In this time 332 women consented to participate in the survey. Descriptive statistics for closed questions and content analysis for open ended questions was used for analysis. Over half (58.8 %) of women reported an interpregnancy interval of 18 months or more and perception of risk for next pregnancy after caesarean birth was not recognised by 50.6 % of women. The definition of interpregnancy interval, from birth of the previous infant to conception of the next pregnancy, was confused with interbirth interval (29.9 %) or unknown (25.3 %) by most women. More than half of women reported trauma affected planning another pregnancy (54.4 %), psychological or physical. Most women (78.5 %) sought information independently from online resources including websites (51 %), social media (46.7 %) and peer groups (42.9 %). The greatest value was placed on online peer support (40.6 %), whilst evidence based information (77.9 %) had the greatest influence on pregnancy planning. Women are seeking information outside of maternity services suggesting they are not receiving the information they need from their maternity care providers. Maternity services could learn the lessons of online groups in supporting women with evidence based accessible information. Interpregnancy interval continues to be poorly understood potentially impacting on choices women make in their next pregnancy. Given the value placed on online support for women who have had a caesarean birth maternity service providers should address this by providing appropriate resources. This is particularly relevant as this group of women report high rates of trauma.

ObjectiveOfficial guidelines advocate abstinence from alcohol during pregnancy. However, a number of women consume alcohol while pregnant. Understanding women's reasons and the context for drinking during pregnancy outside the context of an alcohol use disorder may be helpful for interventions of healthcare providers and health policymakers. This paper reports a systematic review of qualitative studies focusing on women's perspectives of the issue of alcohol consumption during pregnancy on one hand, and on recommendations on the other. DesignSeven electronic databases and citation lists of published papers were searched for peer‐reviewed articles published between 2002 and 2019 in English and French, reporting primary empirical research, using qualitative design and exploring women's views and experiences about the issue of alcohol and pregnancy. Studies involving participant women identified as having an alcohol use disorder while pregnant were excluded. Using the thematic synthesis method, we extracted and coded findings and recommendations from the selected studies. Setting and participantsWomen who mostly reported being abstinent or having reduced their alcohol consumption during pregnancy, and non-pregnant women FindingsWe included 27 studies from 11 different countries. The quality of studies was assessed using the CASP tool. We developed five analytical themes synthesising women's views and experiences of abstinence and occasional alcohol consumption during pregnancy: lack of reliable information; inadequate information from health professionals; women's perception of public health messages; women's experiences and perception of risk; and social norms and cultural context. Six analytical themes synthesising recommendations were generated: improving health professionals’ knowledge and screening practice; diversification of information sources; improving women's information; empowering women's choice; delivering appropriate messages; and addressing socio-structural factors. Key conclusionsOur review provides evidence that information on the issue of alcohol consumption during pregnancy should be improved in both qualitative and quantitative terms. However, the reasons for pregnant women's occasional drinking are complex and influenced by a range of socio-cultural factors. Therefore, healthcare professionals and policymakers should take into account women's experiences and the context of their everyday lives when conveying preventive messages. Our review demonstrates that awareness strategies should not focus solely on women's individual responsibility. They should also address a wider audience and foster a more supportive socio-structural environment. Implications for practiceThe understanding of women's perspective is essential to designing sound prevention interventions and credible messages. Our review provides a comprehensive summary of the state of qualitative research on women's experience of the risk of alcohol use during pregnancy, as well as the literature's recommendations about how to address this issue. This review also contributes to identifying overlooked areas of recommendations that require further reflection and research.

Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake?

Influence of Caesarean section-pregnancy interval on uterine rupture risk and IVF pregnancy rates: systematic review and mathematical modelling.

Although guidelines exist regarding optimal interpregnancy interval (IPI) after live birth, both optimal IPI and counseling regarding recommended IPI (rIPI) after stillbirth or neonatal death is not well established. Our goal was to describe the counseling bereaved parents receive regarding IPI, parents' reactions to that counseling, and actual IPI after loss. Bereaved parents who had a previous pregnancy result in stillbirth or neonatal death participated in a web-based survey. Questions included demographics, details of stillbirth or neonatal death, IPI counseling, and pregnancy after loss. Demographic information, rIPI, and ac'tual IPI were reported using descriptive statistics. The Wilcoxon's rank sum test was used to test the association between rIPI and mode of delivery. The Spearman's correlation was used to test the association between rIPI and maternal age. A total of 275 surveys were analyzed. Mean gestational age of stillbirth delivery was 33.1 (standard deviation: 6.6) weeks. A total of 29% delivered via cesarean. Median rIPI was 6 (interquartile ratio [IQR]: 2-9) months, with the primary reason for IPI reported as the need to heal (74%). Delivery via cesarean was associated with longer rIPI, 9 versus 4.2 months (p < 0.0001). Maternal age was not associated with rIPI. Of 144 people who pursued pregnancy again, median time until attempting conception was 3.5 (IQR: 2-6) months. Median actual IPI was 6 (IQR: 4-10) months. Bereaved parents receive a wide range of counseling regarding rIPI. The majority receive rIPI and pursue actual IPI shorter than current national and international recommendations for optimal IPI. · There is variation in IPI recommendation after stillbirth/neonatal death.. · Cesarean birth is associated with longer IPI recommendation, but maternal age is not.. · Median IPI after stillbirth or neonatal death was short: 6 (IQR: 4-10) months..

Fear of childbirth prolongs interpregnancy interval: A nationwide register-based quantile logistic regression analysis

Background The possible impact of interpregnancy interval (IPI) on perinatal outcomes has long been studied, however, a definition of the optimal interval is still not clear. Both short and long IPIs have been associated with obstetrical syndromes and short and long-term complications. In this study, we sought to explore the impact of IPI on the hazard for neoplasm of the offspring, thus contribute to the present literature in determining the preferred birth spacing. Objective We aim to investigate the association between short and long IPIs and the hazard for childhood neoplasm of the offspring. Methods A population-based retrospective cohort analysis comparing offspring neoplasm hazard following three different IPIs. Exposure was defined as short (<6 months), or long (>60 months) IPIs, whereas intermediate IPI (6 months − 60 months) served as the comparison group. The study included singleton live births in a tertiary regional hospital between 1991 and 2014. Offspring were followed for 18 years, and all hospitalization records for neoplasm diagnoses were collected. Kaplan–Meier survival curves were used for the cumulative incidence of neoplasm morbidity, and Cox proportional hazards models were used to control for confounders. Results During the study period, 144,397 deliveries met the inclusion criteria. Of those, 18,947 (13.1%) occurred in women with short IPI, 114,012 (79%) in women with intermediate IPI, and 11,438 (7.9%) in women with long IPI. 61 benign neoplasms and 80 malignant neoplasms were registered in offspring born after long IPI. The total percentage of neoplasm were the highest in the long IPI group versus the intermediate and short IPI groups (malignant − 0.7%, 0.6%, 0.5% respectively, benign − 0.5%, 0.4%, 0.3% respectively). Controlling for maternal age, diabetes mellitus, preterm delivery, birth weight, smoking, cesarean section, and fertility treatments, long IPI was found to be independently associated with high hazard for long-term pediatric neoplasm related hospitalizations (adjusted HR 1.39, 95% CI 1.09, 1.77). Short IPI may be associated to decreased hazard for childhood neoplasms (adjusted HR 0.74, 95% Cl 0.59, 0.92). Conclusions Long IPI is associated with a high hazard for childhood neoplasms, compared with intermediate and short IPIs. Short IPI may be associated with decreased hazard for childhood neoplasms.

Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) recommends an Inter-pregnancy Interval (IPI) of at least 24 months to lower the risk of adverse maternal and perinatal outcomes in the subsequent pregnancy. However, whether the recommendation confers obstetric benefits is unclear as there’s paucity of data in low- and medium-income countries (LMIC). The objective was to determine the association between IPI length and maternal and neonatal outcomes in women with one previous caesarian section undergoing a repeat caesarian delivery at term in Pumwani Maternity Hospital between 1st January 2014 and 31st December 2018. A cross-sectional study was done where patients who had delivered via repeat caesarean section at term between 1st January 2014 and 31st December 2018 were evaluated. The files of 625 patients were retrieved and IPI was determined from the time interval between a previous caesarean section delivery and the beginning of the subsequent pregnancy, established from the date of the last normal menstrual period as recorded or extrapolated from an early trimester obstetric scan. The files were allotted to study groups as follows: = 170), 24 - 29 months/intermediate IPI (n = 384), and 60+ months/long IPI (n = 121) and data on sociodemographic/reproductive characteristics and maternal and neonatal outcomes abstracted and uploaded to SPSS (version 21) worksheet. Descriptive, bivariate, and multivariate logistic regression analyses were done and a p-value of 0.05 was considered statistically significant. The demographic and reproductive characteristics were comparable across the three IPI groups. Maternal outcomes such as uterine rupture, post-partum haemorrhage (PPH), blood transfusions, preeclampsia, and maternal mortality were comparable across short, intermediate, and long IPI. Some neonatal outcomes, however, showed evidence of an association with IPI. These were prematurity (p = 0.03) and developing congenital malformations (p = 0.01). Other neonatal outcomes (birth outcomes, birth weight, Apgar at 5, and NBU admission) were similar. In conclusion, maternal outcomes are comparable when the IPI after a repeat caesarean section at term is short, intermediate, and long. Congenital anomalies and premature births should be anticipated when the IPI is long (more than 59 months).

Background: The interpregnancy interval (IPI) is a significant factor influencing pregnancy outcomes, particularly in women with a prior cesarean section. Understanding how IPI influences maternal complications and pregnancy outcomes is crucial for guiding post-cesarean pregnancy management. Methods: A retrospective cohort study was conducted on 1803 women who underwent cesarean delivery at Guangzhou Women and Children’s Medical Center between January 1, 2011, and June 30, 2022. Those with a first cesarean delivery followed by one or more subsequent births were included. Participants were assigned into four IPI-based groups for comparison. Data of clinical characteristics (including age, marital status, mode of delivery, newborn weight, and medical history), maternal complications [including gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, polyhydramnios, oligohydramnios, placenta accreta, and placenta previa], and pregnancy outcomes [including fetal distress, macrosomia, postpartum hemorrhage, premature rupture of membranes (PROM), and preterm birth] were collected and analyzed using univariate and multivariate logistic regression. Results: Significant differences in clinical characteristics and maternal complications were observed across the IPI groups after cesarean section. Women with IPIs of ≥60 months had the highest mean age (34.09 ± 2.92, p &lt; 0.001) and increased risks of GDM (26.04%, p = 0.021) and placenta accreta (7.29%, p = 0.010). The IPI group of &lt;18 months exhibited the highest rates of gestational hypertension (15.15%) and oligohydramnios (4.55%). Significant associations between IPI and adverse pregnancy outcomes, such as fetal distress and PROM, were observed, particularly at the extremes of IPI (&lt;18 months and ≥60 months). After adjusting for potential confounding factors, including age and history of gestational hypertension, preeclampsia, postpartum hemorrhage, macrosomia, placenta previa, and fetal distress, multivariate logistic regression analysis revealed that the risk of GDM was significantly reduced in the 18–23 months IPI group compared to the 24–59 month group [adjusted odds ratio (OR) = 0.630; 95% confidence interval (CI): 0.431–0.920; p &lt; 0.017]. Gestational hypertension was strongly associated with shorter IPIs, whereas preeclampsia and placenta accreta were more common with longer IPIs. The risk of PROM increased with both very short and very long IPIs. Postpartum hemorrhage was more frequent in the 18–23 months group, and preterm birth risk increased significantly with IPIs of ≥60 months. Conclusion: Both short and long IPIs following a cesarean section are associated with specific adverse maternal complications and pregnancy outcomes. Individualized counseling and planning for subsequent pregnancies may benefit women with a history of cesarean delivery to minimize these risks.

Background: There is a rise in the caesarean section rates throughout the world due to which obstetricians see more women with caesarean section scar. As a result of this operation, late scar dehiscence may occur leading to uterine rupture in a subsequent pregnancy. Abundant works have been done regarding complication and outcome of caesarean section. However, very limited work is noticed regarding the relationship of interpregnancy interval with caesarean scar thickness. Objective: To find out the relationship of interpregnancy interval (IPI) with ultrasonographic measurement of lower uterine segment caesarean scar thickness at 3rd trimester. Methods: This cross-sectional analytical study was conducted at the Department of Gynaecology and Obstetrics in Sir Salimullah Medical College and Mitford Hospital (SSMC &amp; MH) for a period of six months. Pregnant women of 36 to 40 weeks with history of 1 previous caesarean section were approached for inclusion in the study. Eighteen (18) months interpregnancy interval were used to categorize the study population into two groups. Group I is ≥ 18 months IPI &amp; group II is &lt; 18 months IPI. Written informed consent was taken from each subject and ethical issues were ensured properly. Data collection was done with an aid of a preformed questionnaire. Collected data was analyzed by the SPSS 23. Results: Among 50 study participants, mean age was 23.53±3.65 (SD) years in group I and 23.54±3.95 (SD) in group II. Majority of study population were well-nourished (62.20% in group I and 56.43% in group II). About 64% of patients’ IPI was ≥ 18 months (group I) and 36% patients’ IPI was &lt; 18 months (group II). In group II, majority patients (88.90%) scar thickness was &lt;2.5 mm and in group I only 6.20% patients’ scar thickness was &lt;2.5 mm. Scar tenderness was also associated with IPI where most of the patients of group II were observed to be present with scar tenderness. Conclusion: Short interpregnancy interval is proportionately associated with scar thickness in our settings. However, further study with larger sample size is recommended.

Objective: To evaluate the feasibility and safety of vaginal delivery after ultrasound-guided high-intensity focused ultrasound (HIFU) ablation treatment for women with uterine fibroids of child-bearing ages.Methods: A prospective study was conducted on women who underwent ultrasound-guided HIFU therapy for uterine fibroids at the Chinese PLA General Hospital from January 2008 to December 2014. Patients were interviewed yearly to assess their fertility outcomes, including conception method, delivery mode, neonatal outcomes and complications during pregnancy, labor, and delivery.Results: A total of 174 patients with plans for future pregnancy were included, and 88 pregnancies in 81 women occurred. The pregnancy rate was 46.6% (81/174), and the median follow-up time was 76 months. The rate of pregnancies that ended in miscarriages was 10% (9/88), the rate of elective pregnancy termination was 6% (5/88), and 84% (74/88) of the pregnancies resulted in deliveries, with 3 of the 71 women having two deliveries. A cesarean section was requested by 50% (37/74) of the women, and 50% (37/74) opted for a vaginal delivery. Eleven of the 37 pregnancies were scheduled for elective cesarean sections, owing to pregnancy complications; the remaining 26 pregnancies were scheduled for vaginal delivery, and 21 (80.8%) were successful. None of the patients with a vaginal delivery experienced any complications during pregnancy and labor.Conclusions: Ultrasound-guided HIFU ablation could be considered a promising clinical treatment for women with uterine fibroids and plans for future pregnancy, and vaginal delivery after ultrasound-guided HIFU ablation treatment appear to be feasible and safe.

Objective: Preterm birth is associated with high rates of neonatal morbidity and mortality. This study aimed to investigate the relationship between inter-pregnancy interval and the incidence of preterm birth.Materials and methods: In a case-control study, 185 women with preterm delivery and 185 women with term delivery were included. Data including inter-pregnancy interval, demographic characteristics, history of prenatal and neonatal complications, parity, gravidity, type of delivery, and smoking status were collected.Results: The mean of the inter-pregnancy interval in the case and control groups were 79.84 ± 45.55 months and 78.49 ± 41.29 months, respectively (P = 0.767). Inter-pregnancy interval 12-month or less in comparison with Inter-pregnancy interval more than 24 months significantly increased the odds of preterm delivery (OR: 4.05, 95% CI: 1.06-15.39, p = 0.040). However, inter-pregnancy interval of 13-24 months was not a risk factor when compared with more than 24-month inter-pregnancy interval (OR: 1.54, 95% CI: 0.62-3.80, p = 0.351). Having an educational level less than high school in comparison with tertiary level decreased the odds of preterm delivery (OR: 0.25, 95% CI: 0.11-0.56, P = 0.040). With each increase in number of gravidity odds of preterm delivery increased by 1.5 times (95% CI: 1.11-2.04, P = 0.009). Having a history of preterm delivery (OR: 2.57, 95% CI: 1.17-5.64, P = 0.019) and experiencing preeclampsia (OR: 1.98, 95% CI: 1.06-3.68, P = 0.032) increased the odds of preterm delivery.Conclusion: Inter-pregnancy interval of 12-month or less in comparison with more than 2-year inter-pregnancy interval, experiencing preeclampsia, history of preterm delivery and increased number of gravidity increase the risk of preterm delivery. Health care providers need to be informed with the appropriate inter-pregnancy interval and counsel women to make an informed decision regarding their pregnancy.

ObjectivesOur objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth.MethodsThis secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women’s and Children’s Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1.ResultsOf 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome.ConclusionOutcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.

Objective: To determine the effect of short inter-pregnancy interval on the outcome of vaginal birth after cesarean section.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Obstetrics and Gynecology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Oct 2021.&#x0D; Methodology: A total of 400 pregnant females were selected for this study. For every consecutive pregnant woman with a previous cesarean section and short inter-pregnancy interval (&lt;18 months) recruited into the study, a suitable control with inter-pregnancy interval ≥18 months were recruited.&#x0D; Results: Only 107(53.5 %) females with short interpregnancy interval had a successful vaginal birth after cesarean section, whereas 143(71.5 %) females with &gt;18 months’ inter-pregnancy interval had a successful VBAC. In patients with a history of vaginal delivery, the success of vaginal birth after the cesarean section was significantly higher than in those without previous vaginal delivery or VBAC (p=0.005). 231 out of 250(92.4%) pregnant females with spontaneous onset of labour had a successful VBAC compared to those who had induction of labour, 19(7.6%) (p=0.005). Patients who needed augmentation during delivery had a higher rate of undergoing a cesarean section than VBAC (p=0.003). However, no significant difference was observed in the spontaneous onset of labour and the need for induction and augmentation of labour for the inter-pregnancy interval.&#x0D; Conclusion: Our study concluded that with increasing inter-pregnancy interval, the chances of a successful VBAC increase (p=0.001) with fewer reported complications.

Reproductive health of women electing bariatric surgery