Cesarean Delivery Research Articles

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran’s I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff’s SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers’ age (AOR = 1.07, 95% CI 1.02–1.12), mother’s had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother’s higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Limb-girdle muscular dystrophy in pregnancy: a narrative review.

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood.

Human Papillomavirus, Cervical Intraepithelial Neoplasia, and Quantitative Blood Loss at Delivery.

Studies using estimated blood loss show the association of either human papillomavirus (HPV) or cervical intraepithelial neoplasia (CIN) with postpartum hemorrhage (PPH). We study the association of HPV or CIN with either blood loss or PPH as measured by the more precise measure of quantitative blood loss (QBL). We retrospectively studied 2,334 peripartum women with a documented Pap smear prior to de- livery. The main predictor variable had categories for HPV and CIN as compared to normal cytology. Covariates included demographics, medical/surgical history, and pregnancy variables. Model 1 included the whole sample. Model 2 included only those with an operative vaginal delivery or a cesarean delivery. Outcome measures were QBL and PPH measured by QBL. We found in model 1 that those HPV positive and those with CIN were each not significantly associated with QBL. In model 2, those HPV positive were significantly associated with increased QBL (B = 0.11, SE = 0.05, p = 0.047), while CIN was not significantly associated with QBL. In model 1, those HPV positive and those with CIN were each not significantly associated with PPH. In model 2, those HPV positive were significantly associated with increased odds for PPH (OR:11.03, 9% CI:1.77, 68.74, p = 0.01) while CIN was not significantly associated with PPH. In conclusion, the presence of HPV was positively associated with an increase in the QBL and PPH at time of delivery for those with operative vaginal and cesarean deliveries. We suggest that clinicians take HPV results of Pap smears into consideration when considering a patient's risk of PPH.

Early feasibility and usability study of a novel obstetric blood loss quantifying device

ObjectiveTo study the accuracy and usability of a novel obstetric blood loss quantifying tool in clinical settings. MethodsA mixed-methods study was conducted in an Irish tertiary maternity unit. The accuracy of measuring the blood content (hemoglobin concentration) of elective Caesarean section birth waste with a novel obstetric blood loss quantifying device was compared, using Bland-Altman and correlation analysis, with staff volumetry and a reference hemoglobinometer. Hospital staff (nurses, midwives and doctors) opinion of the usability of the device was studied by an anonymous questionnaire which generated a System Usability Scale (SUS) score. SUS scores range from 0 to 100 with higher scores reflecting greater usability. ResultsThe device was used by 19 different hospital staff members (nine nurses, four midwives and six doctors) in 19 elective Caesarean deliveries that had varying levels of PPH risk. Bland-Altman analysis produced mean biases of −0.7 ± 1.5 g/dL and 0.2 ± 1.2 g/dL for the device and staff measurements respectively. The width of the limits of agreement was narrower for device measurements than for staff measurements (4.5 g/dL and 5.7 g/dL respectively). The device’s measurements of hemoglobin content correlated more strongly with the hemoglobinometer rather than with hospital staff measurements (Spearman correlation coefficients of 0.9 and 0.6 respectively). This suggests that the device is more accurate in determining the blood content of the birth waste than hospital staff volumetric measurements. Hospital staff members assigned the device a mean SUS score of 82 which suggests that the device is highly usable. ConclusionAn early feasibility study in clinical settings suggests that a novel device for quantifying obstetric blood loss was more accurate than volumetry in measuring the hemoglobin content of birth waste. Health professionals also found the device highly usable. This data suggests that there is much potential in transitioning from a “human-made” to a “machine-made” assessment of blood loss. Future studies will entail additional testing of the device to assess its impact on the morbidities associated with postpartum hemorrhage.

Preoperative Multidisciplinary Team Huddle Improves Communication and Safety for Unscheduled Cesarean Deliveries: A System Redesign Using Improvement Science.

Optimal communication between care teams is a critical component in providing safe, timely, and appropriate patient care. Labor and delivery (L&D) units experience rapidly changing clinical scenarios often requiring escalation in care and unplanned cesarean deliveries (CDs). The University of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care. Using the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases. Our primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure. Huddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion. In an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care.

False-Positive Human Immunodeficiency Virus-1 Test Results With Rapid Seroreversion After Third-Trimester Tdap Booster Vaccination.

False-positive and false-negative results in human immunodeficiency virus (HIV) testing are expected at some frequency. False-positive results have been reported in association with various conditions, including pregnancy, autoimmune disease, and infection. We present an atypical case of a pregnant patient receiving false-positive HIV results for both screening and antibody confirmatory tests after a recent routine vaccination. A 34-year-old woman, G4P1021, with a negative first-trimester HIV test result received a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster at 35 2/7 weeks of gestation. Test results at 36 2/7 weeks of gestation were positive in both HIV-1/2 antigen-antibody screening and a confirmatory HIV-1 antibody differentiation immunoassay, but follow-up test results at 36 5/7 weeks and later were negative. Repeat testing and erythrocyte typing confirmed that this was not a result of laboratory error or specimen mishandling. HIV antiretroviral therapy was started and was later discontinued. A scheduled primary cesarean delivery performed at 39 1/7 weeks of gestation due to breech presentation was uncomplicated. False-positive results in HIV screen and confirmation testing were associated with receipt of a Tdap vaccine booster 7 days prior. This test result pattern is similar to that seen very rarely in previous cases, and the rapid seroreversion to negative suggests an acute immunologic trigger leading to a falsely reactive antibody. Clinicians should be aware of the potential for false-positive HIV test results in patients who recently received vaccination or with other immune triggers and retest at a short interval if suspected.

Deferred Cord Clamping in Twin Pregnancies Across Canada: A National Survey of Practices

ObjectiveGuidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada. MethodsA web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units. ResultsThe site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother’s thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother’s abdomen, 32% on the mother’s thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion. ConclusionsDCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.

Evidence-based surgery for cesarean hysterectomy secondary to placenta accreta spectrum: A systematic review

ObjectiveIn this systematic review, we aim to propose evidence-based management for perioperative care to improve outcomes at the time of planned cesarean hysterectomy for placenta accreta spectrum, a procedure associated with significant maternal and neonatal morbidity. Data SourcesWe conducted a literature search for studies published in MEDLINE (via Ovid), Embase, CINAHL, and Cochrane/CENTRAL up until February 25, 2022. The search included free-text and controlled-vocabulary terms for cesarean section, cesarean delivery, and hysterectomy. Study Eligibility CriteriaWe included randomized controlled trials, prospective cohort, retrospective cohort, and case-control studies published in English that reported on a perioperative intervention in the performance of a planned CH for PAS. Studies must have included a comparator group. Of the 8,907 studies screened in this systematic review, 79 met the inclusion criteria. Study Appraisal and Synthesis MethodsArticles examining each step or intervention of the CH were grouped together and reviewed qualitatively as a group. Evidence levels and recommendations were made by consensus of all authors according to the terminology of the United States Preventive Services Task Force (USPSTF). We synthesized the results of 79 articles, and provided 28 recommendations. ResultsBased on USPSTF criteria, 21.4 % of the recommendations were level B (n = 6), 39.3 % were C (n = 11), 10.7 % were D (n = 3) and 28.6 % were I (n = 8). The interventions with the highest level of recommendation included delivery at a hospital with high cesarean hysterectomy volume, implementation of a standardized hospital protocol, delivery via a planned procedure, neuraxial anesthesia, and transverse skin incision (all level B recommendations by USPSTF criteria). ConclusionsDevelopment of a standardized hospital protocol, delivery at a center with high CH surgical volume, and utilization of neuraxial anesthesia garnered B evidence levels. Recommendations were limited due to the lack of prospective trials. Further research into the technical aspects of this high-risk procedure is warranted.

Association between Gestational Weight Gain and Pregnancy Outcomes in Various Body Mass Index Groups: A Retrospective Observational Study

Abstract Introduction: Body mass index (BMI) has been known to be an important determinant of pregnancy morbidities. However, multiple studies show that the effects are equally dependent on the gestational weight gain (GWG). There is a lack of data in the Indian population, especially using the Asia–Pacific guidelines of BMI. This study is meant to identify the degree of association between the GWG in different BMIs and the development of pregnancy morbidities. Materials and Methods: This was a retrospective study, in which case records of women who delivered in our hospitals during 1 year were analyzed. Pregnancy outcomes, such as growth restriction, preterm deliveries, development of hypertensive disorders, gestational diabetes, inductions, and cesareans, were analyzed in three classes of GWG inadequate, adequate, and excess GWG (as per institue of medicine guidelines). The Chi-square test was done to see the difference in the pregnancy outcomes. Results: Of the 1396 women enrolled, women with inadequate GWG had higher preterm deliveries (13.8% vs. 4.4%, P < 0.001) and fetal growth restriction (8.8% vs. 3.9%, P = 0.003) with higher odds in underweight women with inadequate GWG (odds ratio [OR] of 2.6 and 1.75, respectively). Excess GWG had a significantly higher induction (34.9% vs. 29%, P > 0.05) and cesarean delivery rate (34.3% vs. 21.6%, P = 0.003) with higher odds seen in obese women with excess GWG (OR of 2.6 and 1.75, respectively). Conclusion: All women having out-of-range BMI should be identified during the first antenatal contact. Inadequate GWG in underweight women and excess GWG in obese women should be strictly monitored and targeted to prevent a wide spectrum of maternal morbidities.

Recovery quality of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery: A randomized trial

Study objectiveThis study aimed to investigate the effect of liposomal bupivacaine in transversus abdominis plane block (TAP) on recovery quality after cesarean delivery. DesignA randomized trial. SettingAn operating room, a post-anesthesia care unit, and a hospital ward. PatientsA total of 147 women scheduled for cesarean delivery under spinal anesthesia were enrolled and randomized to receive a TAP block with plain bupivacaine (bupivacaine group), liposomal bupivacaine (liposomal group), or a mixture of plain bupivacaine and liposomal bupivacaine (mixture group). InterventionsThe bupivacaine group received bilateral TAP blocks with plain bupivacaine 50 mg alone. The liposomal group received bilateral TAP blocks with liposomal bupivacaine 266 mg alone. The mixture group received bilateral TAP blocks with plain bupivacaine 50 mg followed by liposomal bupivacaine 266 mg. MeasurementsThe primary outcome was the Quality of Recovery−15 (QoR − 15) score assessed 24 h postoperatively. Secondary outcomes encompassed the QoR − 15 score at 48 h post-surgery, the VAS pain score at rest and with movement at 24, 48, and 72 h postoperatively, opioid consumption within the 0–24 h and 24–48 h periods following surgery, as well as patient's satisfaction with analgesic. Main resultsThe QoR − 15 score at 24 h postoperatively was significantly higher in both the liposomal group and the mixture group compared to the bupivacaine group. Specifically, the QoR − 15 score for the liposomal group versus the bupivacaine group (median [IQR]: 120 [107, 128] vs. 109 [104, 120]; median difference, 7; 95 % CI, 2 to 13; P = 0.011) and for the mixture group versus the bupivacaine group (median [IQR]: 122 [112, 128] vs. 109 [104, 120]; median difference, 9; 95 % CI, 4 to 14; P = 0.001). The QoR − 15 score in both the liposomal group and the mixture group were also higher than those in the bupivacaine group at 48 h postoperatively, though the difference was not clinically meaningful. Additionally, both the liposomal and mixture groups exhibited lower pain score at 24 h and 48 h postoperatively compared to the bupivacaine group, but no significant clinical differences were achieved in either pain scores or opioid consumption. Patients in both the liposomal and mixture groups reported higher satisfaction score with analgesia than those in the bupivacaine group. ConclusionsTAP block using either liposomal bupivacaine or a mixture of plain bupivacaine and liposomal bupivacaine provided superior quality of recovery at 24 h after cesarean delivery compared to using plain bupivacaine alone.

Target Trial Emulation: Impact of C-Section on Birth Outcomes for Spontaneous Preterm Breech Presentations

Breech presentation is a risk factor for poor birth outcomes. Guidance for safest mode of delivery in breech presenting full term pregnancies is available but there is a lack of evidence on the optimal mode of delivery in breech presenting preterm spontaneous births. The aim of this study is to evaluate the causal effect of mode of delivery on extended perinatal death (EPD) in this population using a trial emulation. Randomized experiments are the gold standard for estimating causal effects; however, previous attempts to conduct them in this context has resulted in recruitment challenges. Causal inference methods provide a framework for drawing causal conclusions from observational data. A trial emulation aims to overcome limitations common to observational studies by specifying core components of a randomized trial using observational data. Our trial emulation uses national Scottish health data to identify an eligible study sample and adjust for confounding characteristics between groups undergoing caesarean and vaginal deliveries to simulate randomized assignment of mode of delivery. We were able to estimate the per-protocol impact of caesarean delivery on EPD. Our data, containing all recorded potentially eligible births in Scotland between 1997 and 2019, was provided by eDRIS in a trusted research environment. After applying our eligibility criteria, our data contained 3,457 birth records, (2,361 c-section and 1,096 vaginal deliveries). There were 212 EPDs (1.7% (39) of c-sections and 16% (173) of vaginal deliveries). Our preliminary results suggest that caesarean delivery reduces the odds of EPD by 73% among breech presenting spontaneous preterm births.

Profiling births via Caesarean delivery in Northern Ireland (2011-2019) using the Robson classification: a population-based cohort study using administrative maternity system data.

Objective and ApproachCaesarean delivery (CD) rates are increasing globally. Over one-third of babies born in Northern Ireland (NI) during 2021-22 were via CD. Reducing the CD rate was cited as an important public health priority in the Strategy for Maternity Care in Northern Ireland (2012-2018). In 2015, WHO advocated that the Robson Ten Group Classification System (TGCS) be used to audit, analyse, and compare CD rates across countries. TGCS is currently not implemented in NI. ResultsAnalysis of NI’s administrative maternity system (NIMATS) is on-going (accessed via Honest Broker Service Project P045) to address this study’s objectives, which will be completed for presentation: (1) describe the characteristics (maternal, obstetric practice, and fetal/infant features) of all deliveries during 2011-2019; (2) group all births over this period into TGCS categories and calculate the relative size of each group and the absolute contribution of each group to the overall CD rate; (3) compare the NI population distribution of TGCS group-specific CD rates against WHO-recommended benchmarks; (4) test for temporal trends in CD rates here over time; and (5) estimate the ability of a range of maternal, infant, and obstetric factors in predicting the overall CD rate and by TGCS group in NI over time. ConclusionsApplication of the Robson TGCS to NIMATS data has potential to address a critical knowledge gap relating to the use of CD in NI. ImplicationsAvenues to extend this work to investigate longer-term outcomes (via possible linkage to the NI Child Health System) will be considered.

Effect of Music Therapy on Anxiety in Pregnancy: A Systematic Review of Randomized Controlled Trials.

Pregnancy can heighten anxiety levels, impacting both maternal and fetal well-being. This systematic review synthesizes evidence from 33 randomized controlled trials exploring the effects of music therapy on anxiety in pregnant women. The studies included diverse populations, ranging from women undergoing in vitro fertilization (IVF) to those facing high-risk pregnancies. Music therapy interventions varied widely, including virtual reality experiences, classical music, lullabies, and patient-selected music, administered at different pregnancy stages such as IVF treatments, elective cesarean sections, and high-risk hospitalizations. The findings consistently demonstrated that music therapy significantly reduces anxiety levels in pregnant women. Positive outcomes included reductions in both state and trait anxiety, improved pregnancy rates, and enhanced maternal-fetal parameters. Additionally, music therapy showed promise in reducing anxiety during labor, cesarean deliveries, and high-risk hospital stays. These varied interventions and their positive outcomes highlight the potential of music therapy as an effective, non-pharmacological approach to managing pregnancy-related anxiety. This review provides a comprehensive overview of the existing evidence on music therapy's efficacy in alleviating anxiety during pregnancy. It underscores the need for further research to standardize interventions and incorporate music therapy into routine prenatal care. By enhancing the overall well-being of expectant mothers, music therapy could become a valuable adjunct to conventional prenatal care practices.

Analysis of Risk Factors Associated with the Incidence of Placenta Accreta at an Indonesian Tertiary Hospital

Highlights:1. The increased incidence of placenta accreta is contributed significantly by parity classification, a history of cesarean section, body mass index, and interbirth interval.2. The findings of this study can be used as an additional reference in determining the risk of placenta accreta in pregnant women, specifically as an input in screening and antenatal care programs for pregnant women to provide early detection and appropriate management. Abstract The incidence of placenta accreta during pregnancy constitutes a serious problem in reproductive health. This complication has increased significantly over the last few decades, especially in developed countries where cesarean deliveries have also risen. Placenta accreta spectrum can cause very severe bleeding and potentially lead to other serious complications. The purpose of this study was to analyze the risk factors associated with the incidence of placenta accreta in women giving birth at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This quantitative study used an analytical observational research design, specifically the case-control approach. The study sample was all mothers who gave birth at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, between 2019 and 2023. In addition to a univariate analysis, the data were subjected to bivariate analysis using a two-sample independent t-test or Mann-Whitney test for ordinal data and for nominal data using the Chi-square test as well as multivariate analysis using logistic regression (p<0.05). The results showed that parity, a history of cesarean section, body mass index, and interbirth interval were the variables identified as significantly associated with placenta accreta. According to the logistic regression analysis, parity, a history of cesarean section, and a history of curettage were identified as the primary determinants of placenta accreta incidence. The classification of parity was found to have the most significant relationship to the incidence of placenta accreta. This study concluded that parity classification, a history of cesarean section, body mass index, and interbirth interval are the significant risk factors contributing to the increased incidence of placenta accreta at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Safety of labor, Valsalva maneuver, and neuraxial anesthesia for pregnant women after decompressive craniectomy: Case series and review of the literature.

Decompressive craniectomies are a neurosurgical operation aimed at normalizing intracranial pressure (ICP). Occasionally, there is delayed replacement of the skull resulting in an acquired skull defect. When managing laboring patients with an acquired skull defect there is often fear associated with traditional labor involving the Valsalva maneuver and with neuraxial anesthesia. These fears typically stem from potential ICP changes and risk of herniation. In reviewing the literature, only 15 cases are described detailing labor management after decompressive craniectomy (DC), mostly with incomplete labor histories. We aim to expand that literature by reporting two cases of safe labor with epidural anesthesia in patients with large skull defects. The first described patient underwent a cranioplasty during pregnancy because of trauma. Later, because of concerns for pre-eclampsia, induction of labor was initiated and she received neuraxial anesthesia via epidural. The patient ultimately underwent cesarean delivery 48 h after induction began due to nonreassuring fetal heart tones. The second patient underwent a cranioplasty because of infection prior to pregnancy. Once in labor, she was cleared by neurosurgery and the anesthesia team placed her epidural. She later underwent an uncomplicated standard vaginal delivery. The existing literature on labor following DC is sparse. Retrospective review of case reports can advance discussion and standardization regarding care for laboring women with a history of DC. We advocate that the Valsalva maneuver and epidural anesthesia is safe for pregnant women who are neurologically asymptomatic.

Association between mode of delivery and early neurodevelopment: A prospective birth cohort study.

This study suggested that the adverse impact of CD on child neurodevelopment stems from the procedure itself rather than CD-related medical conditions. It is important to minimize the use of CD when there is no medical necessity. • Caesarean delivery (CD) may influence child neurodevelopment and other long-term outcomes. • In China, approximately one-quarter of CD are performed due to maternal request without medical indications. • The negative impact of CD on the neurodevelopmental outcomes of children may be primarily attributed to the procedure itself, as opposed to related medical conditions. • In the absence of medical indications, unnecessary CD may have adverse impacts on children's neurodevelopment.

The Prevalence of Metabolic Syndrome After Cesarean and Natural Delivery in Southwest Iran, 2021 - 2022

Background: The prevalence of abdominal obesity appears to vary depending on the mode of delivery. Abdominal obesity is the most common manifestation of metabolic syndrome and plays a significant role in diagnosing metabolic disorders. Objectives: This study aimed to determine whether the mode of childbirth is associated with metabolic syndrome (MetS). Methods: A total of 350 women who had either an elective cesarean section (CS) or natural vaginal delivery (NVD) at least three years ago were included in this cross-sectional study. The sample was recruited from the integrated health system (Sib) affiliated with Ilam University of Medical Sciences in southwest Iran, 2020 - 2021, using cluster randomization. Metabolic syndrome was assessed according to the 2005 revised NCEP ATP III criteria. Descriptive data were presented as means (standard deviations, SD) or frequencies (%). A t-test was used for comparison between groups, and logistic regression analysis was employed to estimate odds ratios (ORs). Results: Metabolic syndrome was found in 18.29% of women in the NVD group and 30.29% in the elective CS group. Multivariate logistic analysis revealed that breastfeeding duration (P < 0.001) and NVD (P = 0.04) were significantly associated with a decreased likelihood of MetS among mothers. Each additional month of breastfeeding was shown to reduce the likelihood of MetS by 30%. The results also demonstrated that NVD had a protective effect against MetS (Adjusted Odds Ratio (OR): 0.57, 95% CI: 0.34 - 0.97, P = 0.04) after adjusting for age and breastfeeding duration. Conclusions: Women with a history of CS were found to have a higher prevalence of MetS than those in the NVD group. This suggests that the mode of delivery may play a role in the development of MetS after childbirth. Therefore, obstetricians and midwives should consider the potential risk of disorders such as MetS when deciding on elective cesarean sections.

The Underlying Molecular Mechanisms of the Placenta Accreta Spectrum: A Narrative Review.

Placenta accreta spectrum (PAS) disorders are characterized by abnormal trophoblastic invasion into the myometrium, leading to significant maternal health risks. PAS includes placenta accreta (invasion < 50% of the myometrium), increta (invasion > 50%), and percreta (invasion through the entire myometrium). The condition is most associated with previous cesarean deliveries and increases in chance with the number of prior cesarians. The increasing global cesarean rates heighten the importance of early PAS diagnosis and management. This review explores genetic expression and key regulatory processes, such as apoptosis, cell proliferation, invasion, and inflammation, focusing on signaling pathways, genetic expression, biomarkers, and non-coding RNAs involved in trophoblastic invasion. It compiles the recent scientific literature (2014-2024) from the Scopus, PubMed, Google Scholar, and Web of Science databases. Identifying new biomarkers like AFP, sFlt-1, β-hCG, PlGF, and PAPP-A aids in early detection and management. Understanding genetic expression and non-coding RNAs is crucial for unraveling PAS complexities. In addition, aberrant signaling pathways like Notch, PI3K/Akt, STAT3, and TGF-β offer potential therapeutic targets to modulate trophoblastic invasion. This review underscores the need for interdisciplinary care, early diagnosis, and ongoing research into PAS biomarkers and molecular mechanisms to improve prognosis and quality of life for affected women.

Abdominal Circumference and Hypotension Incidence in Caesarean Section Under Spinal Anaesthesia.

Hypotension is a common side effect during caesarean deliveries under spinal anaesthesia, influenced by factors like obesity, physiological changes and abdominal circumference (AC). This study delves into the intricate relationship between abdominal circumference and hypotension incidence, spinal anaesthesia levels, hemodynamic shifts, and vasopressor requirements in caesarean sections. Method: A prospective observational study with 232 term pregnant women undergoing caesarean sections was categorized into two groups based on their abdominal circumference, group A (AC < 95 cm) and group B (AC > 109 cm). The studycompared hypotension incidence, achieved spinal anaesthesia levels, hemodynamic changesand ephedrine necessity and dosage between the two groups. Results: Group B with a larger abdominal circumference, exhibited a significantly higher rate of hypotension, more pronounced hemodynamic changes,higher level of spinal anaesthesia andrequired more doses of ephedrine to manage hypotension compared to group A with a smaller abdominal circumference. Conclusion: This study highlights the crucial role of abdominal circumference as a predictive factor for hypotension during caesarean sections under spinal anaesthesia. Recognizing this association enables targeted preventive measures, potentially enhancing maternal and fetal outcomes during such procedures. Awareness of this correlation emphasizes the necessity for tailored interventions to mitigate the risk of hypotension, ensuring safer caesarean deliveries under spinal anaesthesia.

Type 2 diabetes mellitus, obesity, cesarean section delivery, and lack of exclusive breastfeeding exposure in patients from the Guadalajara Metropolitan Area, Mexico.

the combination of cesarean section delivery and limited exposure to exclusive breastfeeding (EBF) in the first six months of life may increase the risk of obesity and diabetes mellitus. This study aimed to establish an association between type 2 diabetes mellitus (T2DM) in adulthood, cesarean section delivery and incomplete breastfeeding (FBF) in individuals from the metropolitan area of Guadalajara, Mexico. this analytical cross-sectional study included patients over 18 years of age with T2DM and normal weight, overweight or obesity, regardless of sex. Informed consent was obtained. Variables encompassed T2DM, type of delivery method, first-year diet, family history, demographic, socioeconomic, and educational characteristics, and anthropometric measurements. For statistical analysis, Student's t test, chi-square tests and odds ratios were employed. the study evaluated 218 patients with an average age of 57.8 years (± 12.7) and an average age at T2DM diagnosis of 46.2 years (± 12.5). FBF (65.6 %) and partial breastfeeding (PBF) (23.8 %) prevailed in the first six months. The average age at T2DM diagnosis was 46.7 years (± 12.1) for vaginally born patients and 30.7 years (± 15.5) for cesarean-born patients (p = 0.001). Cesarean delivery increased obesity risk by nine times in patients with T2DM [OR = 8.9 (CI, 1.05, 75.2), p = 0.02]. prioritizing the limitation of nonmedically justified cesarean section deliveries is crucial to mitigate the risk of obesity and T2DM in adulthood. .