Maternal and neonatal outcomes following French Ambulatory Cesarean Section (FAUCS): preliminary results of a prospective study.

Third stage of labour is very crucial period in a women’s life. Previously uneventful first and second stage can become abnormal within a minute with disastrous consequences. In the third stage, the mothers face many problems like haemorrhage, retained placenta and inversion of the uterus. Early skin to skin contact at birth along with the breastfeeding process is protective against the incidence and severity of PPH. This study was conducted to determine the effectiveness of skin to skin contact between mother and baby at birth on maternal and neonatal outcomes among parturients.The objectives were to determine the effectiveness of skin to skin contact between mother and baby at birth on maternal outcomes among parturients and to determine the effectiveness of skin to skin contact between mother and baby at birth on neonatal outcomes among parturients. A quasi experimental research approach was used for the study. After obtaining permission from institutional ethical committee a total of 70 parturients admitted at labour room, Medical college hospital, Kottayam (35 each in control and experimental group) were selected for the study by purposive sampling technique. The data collection instruments were socio – personal and clinical data sheet, APGAR newborn scoring chart, observation checklist during third stage of labour, infant breastfeeding assessment tool (IBFAT), LATCH scale and modified maternal breastfeeding satisfaction evaluation scale (MBFES). Skin to skin contact between mother and baby at birth implemented in experimental group immediately after normal vaginal delivery for 30 minutes. Post-test for duration of third stage of labour, blood loss during third stage of labour, initiation of breast feeding, quality of first breast feeding and maternal satisfaction were performed within 80 minutes after normal vaginal delivery in control and experimental group. The data were tabulated and analyzed using descriptive and inferential statistics.The results of the study revealed that skin to skin contact between mother and baby at birth had statistically significant effect on maternal outcomes (duration of third stage of labour, blood loss during third stage of labour and maternal satisfaction) and neonatal outcomes (initiation of breastfeeding, quality of first breastfeeding and time of initiation of first breastfeeding) (p < 0.05).The result revealed that skin to skin contact between mother and baby at birth had effect on reducing duration of third stage of labour and blood loss during third stage of labour, improving maternal satisfaction, initiation of breastfeeding, quality of first breastfeeding and time of initiation of first breastfeeding.

Maternal and neonatal outcomes after delayed vs early cord clamping at cesarean delivery: a systematic review and meta-analysis.

Background: Labor pain is a profound physical and emotional experience, driven by uterine contractions, cervical dilation, and fetal descent. Effective labor analgesia, widely used in modern obstetric care, alleviates maternal pain and reduces physiological stress, contributing to improved maternal and neonatal outcomes. Neuraxial techniques, including epidural, spinal, and combined spinal-epidural (CSE) analgesia, are considered the gold standard due to their superior efficacy and safety profile. Non-neuraxial methods, such as systemic opioids, nitrous oxide, and non-pharmacologic techniques, provide alternative options but vary in effectiveness and side-effect profiles. Controversies remain regarding the influence of analgesia on labor progression, delivery outcomes, neonatal health, and breastfeeding. Objectives: This review evaluates the impact of labor analgesia techniques on maternal outcomes, including labor progression, mode of delivery, and postpartum recovery, as well as neonatal outcomes, such as Apgar scores, breastfeeding initiation, and long-term neurodevelopment. Additionally, it explores current controversies, highlights benefits and risks, and identifies areas for future research. Methods: A structured narrative review was conducted using PubMed, Embase, Cochrane Library, Scopus, and Google Scholar to identify key or foundational studies. The review included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses focusing on labor analgesia and maternal and neonatal outcomes. Data extraction centered on key themes, including maternal outcomes, neonatal outcomes, and analgesia techniques. Findings: Neuraxial analgesia provides superior pain relief with minimal systemic side effects. However, it is associated with a prolonged second stage of labor and increased rates of instrumental delivery, mitigated by low-dose and programmed intermittent bolus techniques. While early observational studies suggested a link between epidural analgesia and increased cesarean section rates, more recent randomized controlled trials and meta-analyses indicate that when administered during the active phase of labor, epidural analgesia does not significantly increase cesarean rates. Non-neuraxial methods, such as systemic opioids and nitrous oxide, offer moderate pain relief but present risks of maternal sedation and neonatal respiratory depression. Neonatal outcomes, including Apgar scores and breastfeeding success, are generally unaffected by neuraxial analgesia, though transient sedation effects are observed with systemic opioids. Evidence gaps persist regarding the long-term neurodevelopmental impact of nitrous oxide and systemic opioids. Conclusion: Labor analgesia is fundamental to modern obstetric care, significantly enhancing maternal satisfaction and childbirth experiences. An individualized, evidence-based approach is essential to balance effective pain relief with optimal maternal and neonatal outcomes. Further research is needed to clarify causation, explore novel analgesic techniques such as peripheral nerve blocks and programmed intermittent epidural bolus regimens, and standardize outcome reporting in obstetric anesthesia research. These advancements will ensure continuous improvements in maternal healthcare and labor pain management.

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related reversible hepatic disease. The clinical importance of ICP lies in neonatal and maternal ICP-associated complications which include higher rates of perinatal morbidity...

BACKGROUND: Despite the safe nature of the procedure, cesarean section (CS) is still associated with higher maternal mortality and morbidity rates. CS can be performed under spinal, epidural, combined spinal and epidural, or general anesthesia. The choice of anesthesia for CS is still a matter of debate due to its side effects on mothers and neonates. Success in the selection of anesthesia in CS is seen in maternal and neonatal outcomes, where the Apgar score is used for assessing neonates in the first and fifth minutes. AIM: This study aimed to determine the effect of general anesthesia in cesarean section as measured by Apgar score. SUBJECT AND METHODS: This was a cross-sectional analytical retrospective study on a total sample of 7,131 patients who underwent elective cesarean section under general anesthesia during 18 years (July 2004–June 2022) at Melinda Women Hospital Bandung Indonesia. In this study, data from medical records were used to analyze neonatal and maternal outcomes. RESULTS: Of the 7,131 CS under general anesthesia cases, no maternal death or difficult ventilation was found; however, the incidence of postoperative nausea and vomiting (PONV) (15), difficult intubation (6), hypotension (5), and need for blood transfusion (5), and postoperative analgesia (all cases) were observed in the mothers. In neonates, neonatal death caused by IUFD and severe congenital disease (3), and a mean neonatal Apgar score of 9 and 10 at 1 and 5 min were identified. CONCLUSION: No low Apgar score is found as the effect of general anesthesia in cesarean section.

IntroductionHuman pregnancy is considered term from 37+0/7 to 41+6/7 weeks. Within this range, both maternal, fetal and neonatal risks may vary considerably. This study investigates how gestational age per week is related to the components of perinatal mortality and parameters of adverse neonatal and maternal outcome at term.Material and MethodsA registry‐based study was made of all singleton term pregnancies in the Netherlands from January 2014 to December 2017. Stillbirth and early neonatal mortality, as components of perinatal mortality, were defined as primary outcomes; adverse neonatal and maternal events as secondary outcomes. Neonatal adverse outcomes included birth trauma, 5‐minute Apgar score ≤3, asphyxia, respiratory insufficiency, neonatal intensive care unit admission and composite neonatal outcome. Maternal adverse outcomes included instrumental vaginal birth, emergency cesarean section, obstetric anal sphincter injury, postpartum hemorrhage, hypertensive disorders of pregnancy and composite maternal outcome. The primary outcomes were evaluated by comparing weekly prospective risks of stillbirth and neonatal death using a fetuses‐at‐risk approach. Secondly, odds ratios (OR) for perinatal mortality, adverse neonatal and maternal outcome using a births‐based approach were compared for each gestational week with all births occurring after that week.ResultsData of 581 443 births were analyzed. At 37, 38, 39, 40, 41 and 42 weeks, the respective weekly prospective risks of stillbirth were 0.015%, 0.022%, 0.031%, 0.036%, 0.069% and 0.081%; the respective weekly prospective risks of early neonatal death were 0.051%, 0.047%, 0.032%, 0.031%, 0.039% and 0.035%. The OR for adverse neonatal outcomes were the lowest at 39 and 40 weeks. The OR for adverse maternal outcomes, including operative birth, continuously increased with each gestational week.ConclusionsThe prospective risk of early neonatal death for babies born at 39 weeks is lower than the risk of stillbirth in pregnancies continuing beyond 39+6/7 weeks. Birth at 39 weeks was associated with the best combined neonatal and maternal outcome, fewer operative births and fewer maternal and neonatal adverse outcomes compared with pregnancies continuing beyond 39 weeks. This information with appropriate perspectives should be included when counseling term pregnant women.

Tachysystole and risk of cesarean section after labor induction using misoprostol: A cohort study

ObjectivesThe aim of this study was to compare neonatal and maternal outcomes in twin pregnancies with elective cesarean section (ECS) and induction of labor (IOL) to better inform women during the counselling process. Materials and methodsWe conducted a cohort study including all twin pregnancies referred to the Department of Obstetrics at Kolding University Hospital, Denmark between January 2007 to April 2019 (n = 819). The primary analysis compared maternal and neonatal outcomes in pregnancies planned for IOL with those planned for ECS after week 34. A secondary analysis compared maternal and neonatal outcomes in pregnancies who underwent IOL followed by successful vaginal delivery with outcomes in those who underwent ECS. ResultsAmong 587 eligible twin pregnancies, the rates of unplanned CS did not differ between those planned for ECS compared to those planned for IOL (38% vs. 33%; p = 0.27). IOL resulted in successful vaginal delivery in 67% (155/231) of those planned for IOL. Maternal outcomes did not differ between women who were planned for, or received, delivery with either IOL or ECS. Regarding neonatal outcomes, significantly more neonates required treatment with C-PAP in ECS group, than in the IOL group, and a higher median number of maturity days among mothers planned for ECS. However, no other significant difference in neonatal outcomes was observed when comparing successful IOL with successful ECS. ConclusionInduction of labor was not associated with worse outcomes compared to elective caesarean section in this large cohort of routinely handled twin pregnancies. In women with twin pregnancies indicated for delivery, who does not go into spontaneous labor, induction of labor is a safe option for both the mothers and their neonates.

Is meconium-stained amniotic fluid in near-term infants associated with increased rates of adverse maternal and neonatal outcomes?

Background: Cesarean section rates have been increasing globally, with significant variations between elective and emergency procedures. This study aimed to evaluate and compare maternal and neonatal outcomes following elective versus emergency cesarean sections to establish evidence-based guidelines for optimal obstetric care. Methods: An observational study was conducted at our tertiary care center between January 2023 and December 2023. A total of 160 women who underwent cesarean delivery were enrolled, with 80 in the elective cesarean group and 80 in the emergency cesarean group. To control for potential confounding factors, only multigravida women with similar parity were included. Maternal outcomes (including postoperative complications, hospital stay, and blood transfusion requirements) and neonatal outcomes (including Apgar scores, NICU admission, and respiratory morbidity) were compared between the two groups. Data were analyzed using appropriate statistical methods including chi-square test, Student's t-test, and logistic regression analysis. Results: Emergency cesarean sections were associated with significantly higher maternal morbidity compared to elective procedures, including postpartum hemorrhage (14.7% vs. 5.3%, p=0.004), wound infection (11.8% vs. 4.1%, p=0.009), and longer hospital stay (5.4±1.8 days vs. 3.9±1.2 days, p<0.001). Neonatal outcomes were also poorer in the emergency group, with lower 1-minute Apgar scores (6.7±1.9 vs. 8.1±1.1, p<0.001), higher NICU admission rates (27.6% vs. 11.2%, p<0.001), and increased incidence of respiratory distress (18.2% vs. 7.6%, p=0.003). Maternal age, parity, and inadequate antenatal care were identified as significant risk factors for adverse outcomes in both groups. Conclusion: Emergency cesarean sections are associated with significantly higher maternal and neonatal morbidity compared to elective procedures. Proper antenatal care, early identification of high-risk pregnancies, and appropriate timing of elective cesarean delivery can significantly improve maternal and neonatal outcomes. These findings emphasize the importance of careful risk assessment and planning in obstetric care

Outcomes of second stage cesarean section following the use of a fetal head elevation device: A systematic review and meta-analysis

Background: With the increasing need to explore the association between interpregnancy interval (IPI) and adverse maternal and neonatal outcome, numerous studies have been conducted worldwide. However, national reports of the IPI in China are lacking. Furthermore, except for age as a known factor for IPI and adverse maternal and neonatal outcomes, the effect of gestational age in previous pregnancy is unknown. The aim of this study was to determine the IPI distribution between 2010 and 2019 and identify the effect of IPI and gestational age in previous pregnancy on adverse maternal and neonatal outcomes in China. Methods: We used individual data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2010 and 2019. The surveillance system collected data prospectively on all pregnant and postpartum women admitted to the obstetric department. The analysis was restricted to women with records of at least two consecutive singleton births and without any complication that the NMNMSS collected during their previous pregnancy. Multivariable generalized linear models with the restricted cubic spline (RCS) were used to evaluate the effect of IPI on each adverse neonatal and maternal outcome on different categories of gestational age in previous pregnancy. Further analysis was performed in subgroups categorized by the gestational age of previous pregnancy. Results: Over the study period, 408,843 women with 420,810 pregnancies were enrolled in our study. The median and quartile range of IPI was 32 [22, 47] months. Few women (49,084, 11.67%) became pregnant again within an extremely short (≤6 months) or long (≥60 months) IPI, and over half (289,846, 68.88%) of the women became pregnant again after an IPI between 7 and 42 months. The risk of large for gestational age (LGA), Gestational Diabetes Mellitus (GDM) and gestational hypertension was increased with increased IPI, while the risk of spontaneous preterm and small for gestational age (SGA) was inversely decreased with increased IPI. The relationship between IPI and all the other adverse neonatal and maternal outcomes was in a “U” shape. The risk of adverse neonatal and maternal outcomes differs between subgroups stratified by gestational age in the previous pregnancy. The risk of spontaneous preterm and abortion at short IPI, iatrogenic preterm, GDM, preeclampsia or eclampsia and gestational hypertension at long IPI increased more when women were of a greater gestational age in the previous pregnancy. Conclusions: This was the first comprehensive exploration of the IPIs of Chinese women from a national database. In this research, both extreme short and long IPI were associated with a higher risk of adverse maternal and neonatal outcomes. The gestational age in the previous pregnancy was also a determinant factor for the adverse maternal and neonatal outcomes in subsequent pregnancies. Funding Statement: This study was supported by the National Key R&D Program of China (Grant No. 2019YFC1005100), the National Health Commission of the People’s Republic of China, the China Medical Board (Grant No. 11-065), the WHO (Grant No. CHN-12-MCN-004888), and UNICEF (Grant No. 2016EJH016). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the ethics committee of the West China Second University Hospital.

Background: LSCS is a routine obstetric procedure performed under general anesthesia (GA) or regional anesthesia (RA). Choice of anesthesia depends on factors like gestational age, parity, co-morbidities, urgency of situation, etc. Both GA and RA involve the use of various medications which may influence maternal and neonatal outcome. As there are few studies comparing maternal and fetal outcome in RA and GA for LSCS in Indian population, the present study was taken up. Objectives of the study was to compare the maternal and neonatal outcome after RA and GA for LSCS.Methods: 60 subjects with indications for LSCS were assigned non-randomly into two groups, 30 for GA and 30 for RA, at the discretion of anesthesiologist. The demographic, anthropometric and clinical data was recorded for all subjects. The maternal outcome after RA and GA for LSCS was assessed by parameters like maternal blood loss, postoperative pain, postoperative nausea and vomiting, maternal satisfaction and neonatal outcome by parameters like birth weight, APGAR scores and NICU admissions. The maternal and neonatal outcome between the two groups was compared.Results: All subjects had clear indications for CS. In most of the subjects it was undertaken as an emergency procedure. GA was preferred in high risk subjects. Maternal blood loss, postoperative pain, NICU admissions, need for resuscitation was less under RA compared to GA. There was no difference in PONV, maternal satisfaction, birth weight and need for intubation.Conclusions: LSCS under RA showed a more favourable maternal and neonatal outcome.

Background: The knowledge gap was from the fact that the type of anaesthetic drug administered during caesarean section can have effects on neonatal outcome like low Apgar score with most hospitals in developed countries now using more modern inhalational anaesthetic agents with fewer or no cardio-respiratory depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still being used for maintenance of general anaesthesia despite well documented cardio-respiratory depressant effects with very limited research done on its effects on neonatal Apgar score. The Apgar score is a means of rapid evaluation of the physical condition of infants shortly after birth. Thus this study investigated the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Objective and study design: With the view of determining the type of anaesthesia administered during caesarean section with the least effects on neonatal wellbeing shortly after birth, a prospective observational cohort study was conducted at the University Teaching Hospital between May 2015 and January 2016.The scientific objective was to determine the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. This study involved 70 neonates, 54 were born from mothers that had undergone caesarean section under spinal anaesthesia and 16 from mothers that had undergone general anaesthesia. The data was analysed using SPSS version 16.0. Inferential analysis was conducted using logistic regression. Results: 20 neonates out of 54 (37%) in the spinal anaesthetic group had an Apgar score less than 8 at 1 minute[Fig 1]. Out of the 16 neonates in the general anaesthesia group, 14 (87.5%) had Apgar score less than 8 at 1 minute[Fig 1]. One (1.9%) neonate had an Apgar score less than 8 at 5 minutes in the spinal anaesthesia group. While 4 (25%) neonates had Apgar score less than 8 in the GA group[Fig2] The logistic regression at 1 minute Showed that it is over 11 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 11.9), [Table 3]. The Apgar score at 1 minute in the Spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.002). The logistic regression at 5 minutes Showed that it is over 17 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 17.7), [Table 4]. Further, the 5 minutes Apgar score in the spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.014),[Table 4]. Conclusion: With the results pointing to the fact that there is significant difference in neonatal Apgar score outcomes in spinal versus general anaesthesia, the researcher therefore rejected the null hypothesis. It is therefore inferred that spinal anaesthesia method has better neonatal outcomes by Apgar score measure than general anaesthesia method.

BackgroundGestational diabetes mellitus (GDM) exposes mothers and their offspring to short and long-term complications. The objective of this study was to identify the importance of potentially modifiable predictors of adverse outcomes in pregnancies with GDM. We also aimed to assess the relationship between maternal predictors and pregnancy outcomes depending on HbA1c values and to provide a risk stratification for adverse pregnancy outcomes according to the prepregnancy BMI (Body mass index) and HbA1c at the 1st booking.MethodsThis prospective study included 576 patients with GDM. Predictors were prepregnancy BMI, gestational weight gain (GWG), excessive weight gain, fasting, 1 and 2-h glucose values after the 75 g oral glucose challenge test (oGTT), HbA1c at the 1st GDM booking and at the end of pregnancy and maternal treatment requirement. Maternal and neonatal outcomes such as cesarean section, macrosomia, large and small for gestational age (LGA, SGA), neonatal hypoglycemia, prematurity, hospitalization in the neonatal unit and Apgar score at 5 min < 7 were evaluated. Univariate and multivariate regression analyses and probability analyses were performed.ResultsOne-hour glucose after oGTT and prepregnancy BMI were correlated with cesarean section. GWG and HbA1c at the end pregnancy were associated with macrosomia and LGA, while prepregnancy BMI was inversely associated with SGA. The requirement for maternal treatment was correlated with neonatal hypoglycemia, and HbA1c at the end of pregnancy with prematurity (all p < 0.05). The correlations between predictors and pregnancy complications were exclusively observed when HbA1c was ≥5.5% (37 mmol/mol). In women with prepregnancy BMI ≥ 25 kg/m2 and HbA1c ≥ 5.5% (37 mmol/mol) at the 1st booking, the risk for cesarean section and LGA was nearly doubled compared to women with BMI with < 25 kg/m2 and HbA1c < 5.5% (37 mmol/mol).ConclusionsPrepregnancy BMI, GWG, maternal treatment requirement and HbA1c at the end of pregnancy can predict adverse pregnancy outcomes in women with GDM, particularly when HbA1c is ≥5.5% (37 mmol/mol). Stratification based on prepregnancy BMI and HbA1c at the 1st booking may allow for future risk-adapted care in these patients.