Acute Caesarean Section Research Articles

Critical postpartum bleeding caused by an acquired uterine arteriovenous malformation: A Case Report

Introduction Postpartum uterine bleeding is a common occurrence in the field of Obstetrics and varies in severity from harmless to life- threatening. The majority of the cases are due to atony, retained tissue or lesions in the birth canal, making up more than 99% of the cases. However, rare causes, such as structural abnormalities and coagulopathies, are important to keep in mind during diagnostics, when the common causes of postpartum bleeding are ruled out, particularly when the symptoms present in an unconventional manner. Methods A case report of a healthy woman presenting with acute life-threatening postpartum bleeding due to an acquired arteriovenous malformation of the uterus. Results A 43-year-old healthy woman presented with acute life-threatening gynecological bleeding 16 days after acute caesarean section. Ultrasound raised the suspicion of arteriovenous malformation. However, due to uncertainty of the diagnosis no initial treatment was preformed until the patient presented with heavy bleeding once more, resulting in a life-saving hysterectomy. Conclusion Arteriovenous malformation is an important diagnosis to consider, as early and effective diagnostics brings the opportunity for a safe and fertility-preserving treatment in the form of radiological coiling embolization. Advances in ultrasound skills of clinicians has made fast and bedside diagnostics possible, therefore the number of hysterectomies should decrease in favor of fertility-preserving treatment.

P-450 Maternal-fetal SARS-CoV-2 antibody transfer in relation to the trimester of infection

Abstract Study question What does the maternal-fetal SARS-CoV-2 antibody transfer look like depending on the trimester of infection? Summary answer There is a statistically significant tendency for newborns of SARS-CoV-2 positive mothers to have a higher IgG antibody level compared to their mother’s at delivery. What is known already Passive maternal-fetal transfer of SARS-CoV-2 antibodies has been demonstrated, whilst the degree of transfer depending on the trimester of infection is lacking, and so far, there is no stratification on all three trimesters of SARS-CoV-2 infection in relation to maternal antibody levels in SARS-CoV-2 positive women, and the degree of transfer of SARS-CoV-2 antibodies to the newborn. It is known that for perinatal infections such as Rubella and Toxoplasmosis the timing of infection related to gestational age is crucial for the severity of fetal/obstetric outcomes, hence the trimester of SARS-CoV-2 infection could potentially be crucial. Study design, size, duration This is a large prospective cohort study with full medical record of all 3,026 participating women and 3,073 of their newborns, as well as antibody measurements on all women who participated between April 4’th 2020 until April 30’st 2021. Of the 3,026 participating women 459 were SARS-CoV-2 positive. Participants/materials, setting, methods The positive cohort consisted of women who had a positive SARS-CoV-2 PCR test, antigen test or antibody test and participated with a maternal blood sample and an umbilicalcord blood sample at delivery. The negative cohort was established at Hvidovre Hospital (CHH), where all women with a first trimester double marker blood test taken at CHH could participate, all woman attending their second trimester ultrasound or giving birth were invited to participate with a blood sample. Main results and the role of chance This prospective cohort study found a strong and statistically significant tendency for newborns of SARS-CoV-2 positive mothers to have a higher IgG antibody level compared to their mother’s IgG antibody level at delivery. In total, 87.5%, 95.3% and 60.3% of newborns of women who tested positive in their first, second and third trimester respectively, had higher IgG antibody levels than their mother’s at delivery. The higher level of antibodies in the newborns’ cord blood compared to their mother’s demonstrated in this study, correlates with findings of for instance pertussis toxin antibodies during pregnancy and aligns with general findings on maternofetal transport of immunoglobins. Our findings indicates that the fetus is either able to concentrate antibody levels or maintain the level of IgG antibodies transferred. Limitations, reasons for caution With only 40 women being SARS-CoV-2 positive in their first trimester, analysis in this group should be taken with caution. Other limitations are the 56 newborns of positive women who did not have an umbilical cord blood sample taken due to PPH, acute cesarean section or blood sample coagulated. Wider implications of the findings This knowledge of the maternal-fetal antibody transmission pattern is valuable for the basic understanding of SARS-CoV-2 in pregnancy and for future investigation on expected degree of early life protection against SARS-CoV-2 but could also be of interest if investigating the paradoxically concept of blunting when considering vaccination of neonates. Trial registration number H-20022647

Factors infl uencing delivery in women with multiple fetus pregnancy.

This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022. Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

Factors related to a positive childbirth experience – a cross-sectional study

ABSTRACT Background/aims Giving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience. Design/Methods A digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation. Results Overall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors. Conclusion Although Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.

Three-year follow-up results of two children born from a transplanted uterus.

To evaluate the 3-year follow-up results of two children delivered at our institution in 2019 from mothers with a transplanted uterus. Observational data on pregnancy outcomes, neonatal course, and growth trajectory in two children born to mothers after uterus transplantation, including 3-year follow-up and neurodevelopmental status assessed using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Both children were born prematurely via uneventful caesarean sections, to mothers with Mayer-Rokitansky-Küster-Hauser syndrome and a transplanted uterus. An acute caesarean section was performed in one mother because of the onset of regular uterine contractions at 34 weeks and 6 days of pregnancy; in the other mother, an elective caesarean section was performed at 36 weeks and 2 days of gestation. The children were born healthy with no congenital malformations. They had an uneventful postnatal course and showed a normal growth trajectory during 3 years of follow-up. The Bayley-III neurodevelopmental scores of both children were within the normal ranges at ages 2 and 3 years. Though pregnancy after uterus transplantation is associated with the risk of premature delivery, no abnormalities were observed in the neonatal course and 3-year follow-up results, including the neurodevelopmental status, of two children born prematurely to mothers with a transplanted uterus. This is the first report on neurodevelopmental outcomes in children born after uterus transplantation. More data on children born after this radical procedure of uterine factor infertility treatment are required to support our promising results.

Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis

BackgroundIt has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared with standard care comparable to the Swedish setting where the same midwife usually provides antenatal care and the checkup postnatally, but does not assist during birth and the first week postpartum.MethodsMedline, Embase, Cinahl, and the Cochrane Library were searched (Nov 4th, 2021) for randomized controlled trials (RCTs). Retrieved articles were assessed and pooled risk ratios calculated when possible, using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE.ResultsIn all, 7,594 patients in eight RCTs were included, whereof five RCTs without major risk of bias, including 5,583 patients, formed the basis for the conclusions. There was moderate certainty of evidence for little or no difference regarding the risk of Apgar ≤ 7 at 5 min, instrumental birth, and preterm birth. There was low certainty of evidence for little or no difference regarding the risk of perinatal mortality, neonatal intensive care, perineal tear, bleeding, and acute caesarean section. Caseload midwifery may reduce the overall risk of caesarean section. Regarding breastfeeding after hospital discharge, maternal mortality, maternal morbidity, health-related quality of life, postpartum depression, health care experience/satisfaction and confidence, available studies did not allow conclusions (very low certainty of evidence). For severe child morbidity and Apgar ≤ 4 at 5 min, there was no literature available.ConclusionsWhen caseload midwifery was compared with models of care that resembles the Swedish one, little or no difference was found for several critical and important child and maternal outcomes with low-moderate certainty of evidence, but the risk of caesarean section may be reduced. For several outcomes, including critical and important ones, studies were lacking, or the certainty of evidence was very low. RCTs in relevant settings are therefore required.

Pregnancy outcomes of women with untreated ‘mild’ gestational diabetes (gestational diabetes by the WHO 2013 but not by the WHO-1999 diagnostic criteria) – A population-based cohort study

AimsWe compared pregnancy outcomes of untreated ‘mild’ GDM (GDM by WHO 2013 but not by WHO-1999) to normal glucose tolerant women (NGT). MethodsIn a universal screening program 4333 pregnant women had a 3-point 75 g OGTT in Hungary in 2009–2013. By WHO-2013 untreated NGT was diagnosed in n = 3303, ‘mild’ GDM in n = 336 cases. Results‘Mild’ GDM women were older (mean difference, SE: 1.4, 0.3 yrs), had higher fasting (1.0, 0.02), 60-minute (1.0, 0.09), and 120-minute (0.4, 0.06 mmol/l) blood glucose, and blood pressure (2.6, 0.5/2.0, 0.5 mmHg). Weight gain was similar in both groups (−0.3, 0.3 kg). GDM newborns were heavier (142, 50 g) and were more frequently macrosomic (>4000 g, OR 1.85, 95 %CI 1.35–2.54). Hypertension during pregnancy was more prevalent in the GDM group (OR 1.55, 95 %CI 1.05–2.28), as well as induced (OR 1.38, 95 %CI 1.10–1.74) and instrumental delivery (OR 1.34, 95 %CI 1.07–1.68), and acute caesarean section (OR 1.32, 95 %CI 1.04–1.64). Most of these differences substantially attenuated or became non-significant after adjustment for pre-pregnancy BMI. ConclusionsPregnancy outcomes of ‘mild’ GDM were worse compared to normal glucose tolerant women however these differences were explained by the pre-pregnancy BMI difference between groups.

Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37-42 in Norway during 1999-2019.

Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37-42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37-42 in Norway, 1999-2019 (n=1127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999-2004 to 0.13% during 2015-2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience.

Vagus nerve stimulation (VNS) has been employed worldwide as an adjunctive therapy in drug-resistant epilepsy patients. However, the mechanisms of VNS action potentially increase the risk of obstetric complications. The study presents the long-term single-center experience with pregnancies and childbirth in women with VNS for refractory epilepsy based on prospectively collected epileptologic data and a retrospective analysis of pregnancy, childbirth, and data about long-term child development. From a group of patients with VNS implanted for refractory epilepsy between October 1999 and January 2018, all the women of childbearing age (younger than 40 years) were identified. After checking their hospital records for data about any pregnancies, the women with confirmed childbirth during active VNS stimulation and their general practitioners were interviewed based on a prepared questionnaire regarding their gynecologic history, the course of pregnancy and childbirth, gestational week, birth weight and length, any congenital anomalies of the child, and the child's psychomotor development, school performance, and somatic health problems. From the group of 257 patients implanted with VNS for refractory epilepsy, 4 women (1.5%) became pregnant and gave birth (all on polypharmacotherapy). The mean interval from VNS implantation to birth was 44.3 months. Slight seizure worsening during the last trimester was reported in one woman. In one patient, acute caesarean section was required due to placental separation. Planned birth induction and caesarean section were used in the other two women because of their seizure disorder. No malfunction of the stimulation system was detected during pregnancy or after birth. No congenital malformations were observed. The two children who were of school age at the time of this study require special schooling. The study results confirmed a high rate of obstetric interventions in patients with VNS. Although no teratogenic effect of VNS has been proven, the higher incidence of children exposed to VNS needing special education requires attention.

The risk of urine bacterial colonisation in patients with a permanent catheter after caesarean section

We present an observational study, conducted in Slovakia, concerning the occurrence of newly acquired urine colonisations in women with Foley catheters after a Caesarean section. A sample of urine was taken from each patient when the Foley catheter was first inserted, before the operation and was sent to the lab for culture. Later, a sample of urine was taken during the removal of the Foley catheter. Out of 176 women, the second urine sample culture result was positive in 13 women. Of those nine women had a positive pathogenic strain (5.1%). The prevalence of asymptomatic bacteriuria in our cohort was 7.7%. De novo acquired colonisation of urine was confirmed in 5.1% of cases. The only confirmed risk factor was delivery by an acute Caesarean section. Impact statement What is already known on this subject?: It is well known that catheterisation increases risk of colonisation of lower urinary tract by pathogens. However, the extent of this risk is not determined because there are no studies of de novo colonisation in women with sterile urine before catheterisation. According to literature approximately 8% of women have asymptomatic bacteriuria, which could be confounding factor in previous studies. What do the results of this study add?: Our study excluded women with positive bacteriuria before insertion of Foley catheter. Therefore, the study only assesses de novo colonisation, dependent on insertion of Foley catheter during caesarean section. What are the implications of these findings for clinical practice and/or further research?: De novo colonisation was observed in 5.1% of women in our cohort, with emergency caesarean section as a confirmed risk factor. Therefore, practitioners should consider avoiding catheterisation during caesarean section.

SAT-400 Pregnancy Outcome in Women with Hypoparathyroidism:Aswedishpopulation-Based Cohort Study

Context: The majority of patients with hypoparathyroidism (HypoPT) are women. It is not known whether the presence of hypoparathyroidism influences the pregnancy outcomes. Sweden has excellent conditions for research in this area, with high-quality population-based registers covering essentially all inpatient care and birth records. In this study, data were linked from the Swedish National Patient Register and Swedish Medical Birth Register to examine the potential influence of maternal hypoPT on the number of childbirths and various pregnancy outcomes. Design and Setting: Population-based cohort study in Sweden. Patients: Through the Swedish National Patient Register and the Total Population Register, we identified 1267 women with HypoPT and 12 670 age-matched controls who gave birth between 1997 and 2016. Results: There was no significant difference in mean age at delivery for women with HypoPT (32 (SD, 5.2)) years and controls (32.5 (5.0)). There were significantly more women with HypoPT who smoked at baseline (p= 0.007) and within 3 months of pregnancy (p=0.022) compared to controls. Significantly more women with HypoPT had part time work or were not working during pregnancy compared to controls (p = 0.002). The mean number of infants per woman was 0.30 (SD, 0.62) in the HypoPT group and 0.33 (SD, 0.60) in the control group (p=0.644). Compared with the control group, the risk of elective cesarean section was higher in the HypoPT group (p=0.002). However, there was no difference in the proportion of women undergoing an acute cesarean section between cases and controls (p=0.754). The mean pregnancy duration in women with HypoPT was 38.87 (2.11) weeks compared to 39.23 (2.04) weeks for the controls (p= 0.001). Infants born to mothers with HypoPT were significantly shorter (p=0.016), but no difference was seen in weight or head circumference compared to infants born to controls. No difference was observed in prevalence of small- or large-for gestational age compared to controls. There were no differences between groups with respect to infant sex or Apgar scores at 1, 5 and 10 min, congenital malformations or stillbirth. There was furthermore no difference in pain medication use by mothers during delivery between the groups (p=0,733). Conclusion: The majority of women with HypoPT had normal pregnancy outcomes, and the overall risks must be considered to be low. Still, our findings are of importance for antenatal counseling in women with HypoPT as their risk for elective cesarean section was significantly higher compared with controls. Their children were shorter and the higher rate of smoking among HypoPT women may be an additional risk factor.

Relationship between a uterine fibroid diagnosis and the risk of adverse obstetrical outcomes: a cohort study

ObjectiveThe aim was to investigate the association between clinically significant uterine fibroids and preterm birth, caesarean section (CS), postpartum haemorrhage (PPH), placental abruption, intrauterine growth restriction (IUGR) and uterine rupture.Methods,...

Ultrasound cesarean scar assessment oneyear postpartum in relation to one- or two-layer uterine suture closure.

IntroductionThis study compared healing of the scars after cesarean section during the first postpartum year using a single‐ or double‐layer suturing technique. Scarring was assessed by a transvaginal ultrasound. We explored the appearance and localization of uterine scars with regard to the obstetric history. Our aim was to compare the position of the scar or defect, if present, its dimensions, and any residual myometrium with respect to the suturing technique during the cesarean section.Material and methodsWomen with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in three consecutive visits at 6 weeks, 6 months and 12 months.Results324 women attended the 12‐month visit; of these, 149 underwent single‐layer closure of the uterine incision and 175 double‐layer technique. A higher proportion of the defects is seen in the single‐layer closure technique of suturing. Defects in the single‐layer group were wider (0.002) and the residual myometrial thickness in the single‐layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). The position of the uterus varies greatly between controls (0.000). The combination of uterine position and scar defect presence changed significantly between controls (0.001), and was significantly dependent on the suturing method (0.003). Defects with or without contact with the uterine cavity changed statistically between controls (0.017). Both types of defects were more common in the single‐layer closure technique group.ConclusionsThe findings of this study demonstrate that double‐layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness. No difference was observed between single‐ and double‐layer closure for the presence of maternal infectious morbidity, wound infection or blood transfusion.

The influence of mode of anaesthesia for caesarean delivery on neonatal Apgar scores in the Czech Republic and Slovakia: secondary analysis of the results of an international survey in 2015.

The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.

Active surveillance of incidence and risk factors of hemolysis, elevated liver enzymes and low platelets syndrome in Slovakia.

Hemolysis, Elevated Liver Enzymes, Low Platelets syndrome (HELLP syndrome) is one of the actively haunted maternal morbidity through Slovak Obstetric Survey System (SOSS), the organisation for surveillance of severe maternal morbidity and mortality in Slovakia. The questionaires were sent in 55 Obstetric Units in Slovakia. The analyzed and here presented data had been collected cases those happened in the period from 1.1.2012 till 31.12.2014. Controls were women from SR during observed years, who delivered without HELLP syndrome. The return rate of questionnaires was 89.67 %, thus covering 146 972 deliveries during the study period in Slovakia. The exact incidence of HELLP syndrome was 0.63/1000 deliveries (CI 95 % 0.51-0.78). Risk factors were age > 30 (OR = 1.63), nuliparous (OR = 2.96), pregnancy after assisted reproduction technology (OR = 8.29) and multiple pregnancy OR = 9.19). The mean gestation age at delivery was 33.8th weeks. Vaginal delivery was by 10 (10.8 %) patients with HELLP syndrome and in the 83 (89.2 %) patients pregnancy was terminated with acute caesarean section. There were reported 45050 cases (30.7 %) of the caesarean section in the control group throughout the study period. The older age, nulliparity, multiple pregnancy and pregnancy after assisted reproduction techniques was identified as a significant risk factors of HELLP syndrome (Tab. 5, Fig. 1, Ref. 21).

Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway.

Background and purposeStudies in women with epilepsy (WWE) regarding pregnancy and labour complications have disclosed contradictory results. Our purpose was to investigate whether WWE have a higher risk of acute caesarean section (CS) or pregnancy complications than women without epilepsy or women with other chronic diseases and, if we found a higher risk, to explore potential explanations.MethodsThe study used prospectively registered obstetric data from the Oppland Perinatal Database in the period 2001–2011, containing information on 18 244 births, including 110 singleton pregnancies in mothers with validated epilepsy. Data regarding epilepsy were collected retrospectively from medical records.ResultsEpilepsy was a significant risk factor for acute CS, breech presentation and low birth weight in offspring [odds ratio (OR), 1.93, 95% confidence interval (CI), 1.2–3.1; OR, 2.29, 95% CI, 1.2–4.6 and OR, 2.10, 95% CI, 1.0–4.2, respectively]. In multivariate logistic regression analysis, antiepileptic drug exposure was an independent risk factor for acute CS (OR, 2.00; 95% CI, 1.06–3.77) and polytherapy was a significant risk factor for breech presentation (OR, 5.37; 95% CI, 1.13–25.57). Seizure frequency during pregnancy had no influence on the complication rate.ConclusionsWe found that WWE using antiepileptic drugs during pregnancy had increased rates of acute CS, breech presentation and low birth weight, and that seizure frequency during pregnancy did not influence the complication rate.

Impact of obesity and other risk factors on labor dystocia in term primiparous women: a case control study

BackgroundPurpose of this study was to investigate differences between primiparous term pregnancies, one leading to vaginal delivery (VD) and the other to acute cesarean section (CS) due to labor dystocia in the first stage of labor. We particularly wanted to assess the influence of body mass index (BMI) on CS risk.MethodsA retrospective case-control study in a tertiary delivery unit with 5200 deliveries annually. Cases were 296 term primiparous women whose intended vaginal labor ended in acute CS because of dystocia. Controls were primiparas with successful vaginal delivery VD (n = 302). The data were retrieved from medical records. Multiple logistic regression analyses were used to assess the associations between BMI and covariates on labor dystocia.ResultsIn the cases ending with acute CS, women were older (OR 1.06 [1.03–1.10]), shorter (OR 0.94 [0.91–0.96]) and more often had a chronic disease (OR 1.60 [1.1–2.29]). In this group fetal malposition (OR 42.0 [19.2–91.9]) and chorioamnionitis (OR 10.9 [5.01–23.6]) were more common, labor was less often in an active phase (OR 3.37 [2.38–4.76]) and the cervix was not as well ripened (1.5 vs. 2.5 cm, OR 0.57 [0.48–0.67] on arrival at the birth unit.BMI was higher in the dystocia group (24.1 vs. 22.6 kg/m2, p < 0.001), and rising maternal pre-pregnancy BMI had a strong association with dystocia risk. If BMI increased by 1 kg/m2, the risk of CS was 10% elevated. Among obese primiparas, premature rupture of membranes, chorioamnionitis and induction of labor were more common. Their labors were less often in an active phase at hospital admission. Severely obese primiparas (BMI ≥ 35 kg/m2) had 4 hours longer labor than normal-weight parturients.ConclusionsLabor dystocia is a multifactorial phenomenon in which the possibility to ameliorate the condition via medical treatment is limited. Hospital admission at an advanced stage of labor is recommended. Pre-pregnancy weight control in the population at reproductive age is essential, as a high BMI is strongly associated with labor dystocia.

Is there any association between abdominal strength training before and during pregnancy and delivery outcome? The Norwegian Mother and Child Cohort Study

BackgroundAbdominal strength training before and during pregnancy has been recommended to enhance normal vaginal birth by enabling increased force needed for active pushing. However, to date there is little research addressing this hypothesis. ObjectiveTo investigate whether nulliparous pregnant women reporting regular abdominal strength training prior to and at two time points during pregnancy have reduced risk of cesarean section, instrumental assisted vaginal delivery and third- and fourth-degree perineal tears. MethodsAnalysis of 36124 nulliparous pregnant women participating in the Norwegian Mother and Child Cohort Study during the period 1999–2009 who responded to questions regards the main exposure; regular abdominal strength training. Data on delivery outcomes were retrieved from the Medical Birth Registry of Norway. Logistic regression analyses were used to evaluate the association between exposure and outcome before pregnancy and at gestational weeks 17 and 30. ResultsAmongst participants, 66.9% reported doing abdominal strength training exercises before pregnancy, declining to 31.2% at gestational week 30. The adjusted odds ratios were 0.97 (95% CI 0.79–1.19) for acute cesarean section, among those training with the same frequency before and during pregnancy compared to those that never trained. The results were similar for instrumental assisted vaginal delivery and third- and fourth-degree perineal tear. ConclusionThere was no association between the report of regular abdominal strength training before and during pregnancy and delivery outcomes in this prospective population-based cohort.

Association Between Mode of Delivery and Risk of Infection in Early Childhood: A Cohort Study.

Infections are the leading cause of morbidity and mortality in children. Caesarean section as a potential risk factor for infection has recently gained interest. Delivery by caesarean section has increased greatly, with nonmedical reasons playing an increasing role. We aimed to analyze the association between mode of delivery and hospitalizations because of infection and symptoms of infection at home in early childhood. A cohort study, based on the Odense Child Cohort, following infants from gestation until a mean age of 3.5 years. Data on hospitalization because of infections were collected from the Danish National Patient Registry. Data on symptoms of infection at home were collected via a text message-based questionnaire. A total of 1921 children were born by vaginal delivery, 283 by elective caesarean section and 227 by acute caesarean section. An adjusted regression model showed an incidence rate ratio for hospitalizations because of infection in children born by elective caesarean section compared with children born by vaginal delivery of 1.45 (95% confidence interval: 1.16-1.80; P = 0.001). The analyses on symptoms of infection at home found no associations between any symptom of infection and mode of delivery. Symptom-specific subanalyses showed contrasting results. Mode of delivery showed a strong association to hospitalization because of infectious disease during early childhood. Overall, no association was present between rate of symptoms of infection at home and mode of delivery.

Spontaneous Sigmoid Colon Perforation Based on Endometriosis in Term Pregnancy Case Report

The case report describes a woman with acute, spontaneous sigmoid colon perforation based on deep endometriosis in advanced stage of pregnancy. The 33-yearold white woman was admitted to our clinic at 37+6 weeks of pregnancy with symptoms of increasing abdominal pain successively changing the site of maximum. Due to suspicion of acute appendicitis, acute caesarean section, sigmoid resection and end-to-end anastomosis, appendectomy was performed. Spontaneous perforation associated with intestinal endometriosis in pregnancy is scarcely reported, some seven cases have been published in the English literature. To the best of our knowledge, this is the second case report of sigmoid colon perforation due to endometriosis during pregnancy.