Cesarean Delivery Research Articles

How does Yoga Exercise affect Anxiety in Pregnant Women? : Pre-Experimental Study

Anxious during pregnancy not only impacts pregnant women's health, but it may also interfere with the delivery process, resulting in early labor, extended labor, cesarean delivery, and low birth weight. According to WHO estimates, psychiatric illnesses affect around 10% of pregnant women and 13% of postpartum women globally. This frequency is greater in underdeveloped nations among pregnant women (15.6%) and postpartum women (19.8%). The goal of this study is to determine the effect of prenatal yoga exercise on the anxiety of pregnant women at TPMB Mamah Suhaeriah in 2022. Method for doing research This sort of study employs the Pre-Experimental technique, using a one-group pretest-posttest design. Total sampling was used, and there were 20 responders in total. An observation sheet was employed as the study instrument. The Wilcoxon Sign Rank Test was performed to analyze the data. The Wilcoxon Sign Rank test yielded a p-value of 0.000, which is less than the threshold of 0.05. This indicates that Ha is accepted. Conclusion: Prenatal yoga practice has an influence on pregnant women's anxiety levels at TPMB Mamah Suhaeriah in 2022. Pregnant women are advised to manage their psychological condition effectively and to exercise often, since exercise has good benefits for survival during pregnancy

Comparison by Mode of Delivery of Preterm Pregnancy Inductions with Cervical Ripening Balloon: A Retrospective Chart Review

Background: Preterm inductions may be necessary for maternal comorbidities or fetal abnormalities. Previous studies have identified risk factors for undergoing a cesarean delivery (CD). Our study examined the insertion-to-expulsion time (IET) of cervical ripening balloons (CRB) in preterm inductions that achieved vaginal delivery (VD) compared to CD. Methods: This was a retrospective cohort study of preterm inductions with CRB between 2010 and 2021. Primary outcome was IET of CRB. IRB approval was obtained. Results: The study included 82 women. IET for cesarean patients was significantly greater, and required more removal of CRB at the allotted 12 h. Dilation before and after CRB was significantly greater in the vaginal cohort. There was no significant difference in maternal comorbidities, indication for induction or neonatal complications. Conclusions: Maternal comorbidities, induction indication and neonatal complications were similar between cohorts, making trial of induction with CRB in preterm women a reasonable option. Spontaneous expulsion of CRB and greater dilation may be predictors of vaginal delivery.

Evaluation of Labour Care Guide: Labor progression in obese women from Basra, Iraq

The prevalence of maternal obesity has emerged as a significant global public health issue. The World Health Organization (WHO) has just introduced a revolutionary tool known as the WHO Labour Care Guide for the purpose of monitoring the well-being of mothers and infants throughout the process of labor. The study aims to evaluate the impact of obesity on the progression of labor, mode of delivery, and subsequent neonatal complications. Our research was conducted on 176 women who fulfilled the inclusion criteria at Basra Maternity and Child Hospital, the number of women with normal BMI was 100, while the class 1 obese was 76 cases. The results show the risk of emergency caesarean section is significantly increased among the class 1 obese woman, the percentages were 40.7%, and 14% respectively (p-value <0.001), regarding the neonatal outcome assessed by the APGAR scoring system, there was a relatively low APGAR score among the total deliveries of class 1 obese women regardless of the mode of delivery, (p-value was significant <0.001) compared with the average Body Mass Index women, the neonatal birth weight was significantly different between the two Body Mass Index groups, there is an increase in the birth weight among class 1 obese women (p-value <0.001). The study concludes obesity has a substantial influence on the increased incidence of caesarean section deliveries among women classified as having obesity class I, and there is a positive correlation between body mass index and the desire for oxytocin administration among obese women.

Comparative Efficacy of Single-Dose versus Multiple-Dose Antibiotic Prophylaxis in Reducing Postoperative Infections in Elective Cesarean Deliveries

Cesarean Sections (CS) were common surgeries that may lead to complications like endometritis and Surgical Site Infections (SSIs). While prophylactic antibiotics reduce these risks, the ideal dosing regimen remains debated. Objective: To evaluates whether a single or multiple-dose antibiotic regimen offers better protection against infections in patients undergoing planned cesarean sections. Methods: A six-month quasi-experimental study was conducted from October 1, 2020, to March 30, 2021, at Lady Reading Hospital in Peshawar. Eighty-two women scheduled for elective CS were assigned into two groups: one received a single 1g dose of intravenous cefazolin before surgery, and the other received the same initial dose followed by two additional doses every eight hours. Primary outcomes assessed were the incidence of endometritis and SSIs within 30 days post-surgery. Results: Postpartum infections were significantly lower in the multiple-dose group (4.9%) compared to the single-dose group (19.5%, p = 0.039). The multiple-dose group also had fewer SSIs (4.9% vs. 14.6%, p = 0.140) and no cases of endometritis (0% vs. 4.9%, p = 0.154), though these differences were not statistically significant. There were no significant differences in adverse drug reactions, hospital stay duration, or antibiotic resistance development between the groups. Conclusions: Multiple-dose antibiotic regimens may reduce infection rates in planned CS without increasing adverse effects or antibiotic resistance. Further studies were needed to confirm these findings and optimize prophylactic strategies.

PREGNANCY OUTCOME IN PERIPARTUM CARDIOMYOPATHY

Background:Peripartum cardiomyopathy(PPCM) is characterized by the onset of heart failure due to left ventricular systolic dysfunction in late pregnancy or shortly after delivery. The incidence of PPCM varies widely globally, with reports ranging from 1 in 100-15000 pregnancies This study aims to evaluate the incidence, clinical characteristics, and outcomes of PPCM in a cohort of women at Basaweshwara General and Teaching Hospital, Kalaburgi. Methods:A retrospective observational study was conducted over one year (January 1 to December 31, 2023). Inclusion criteria were based on NHLBI standards for diagnosing PPCM, while patients with preexisting cardiac conditions, liver disorders, and malignancies were excluded. Data were collected from hospital records, focusing on demographics, clinical presentations,echocardiographic findings, complications, and outcomes. Statistical analysis was performed using SPSS version22. Results:Among 2,200 deliveries, 12 cases of PPCM were identified, yielding an incidence of 0.55%. The mean age of affected women was 26.33 years, with 66% being primigravida. A significant proportion (58.33%) presented with hypertensive disorders.Maternal outcomes included a 25% mortality rate and high rates of cesarean delivery (83.33%).Neonatal outcomes were concerning, with 58.33% of infants requiring NICU admission and 16.66% experiencing intrauterine death. Conclusion:PPCM poses substantial risks to maternal and fetal health, particularly in younger and first-time mothers. Identifying women with risk factors such as hypertensive disorders and anemia is crucial for optimizing care and improving outcomes. Enhanced monitoring and intervention strategies are necessary to address the complexities of PPCM in pregnancy.

Intraoperative temperature management during emergency cesarean section: a retrospective observational study.

Intraoperative hypothermia is a common complication during cesarean section (C-section) and associated with the high maternal mortality and morbidity. This study aimed to explore the risk factors associated with the incidence of intraoperative hypothermia in women who underwent emergency C-section deliveries. We retrospectively enrolled women who underwent emergency cesarean deliveries from August 2022 to Dec 2023 at Suzhou Municipal Hospital of Anhui Province. Baseline characteristics, thermal status, and perioperative information were extracted. Hypothermia was defined as the onset of a core temperature below 36°C. Data were compared between patients with and without a hypothermia during surgery. Logistic regression analyses were performed to determine the risk factors for low-temperature-status. Overall, 87 patients were included, and 30 underwent hypothermia during surgery. For women with a normal temperature status, women in the hypothermia group had a lower incidence of receiving active warming methods (52.6% vs. 30%, P = 0.044). In the logistic regression model involving core temperature, a pre-surgery core temperature < 36.5°C (OR 4.22, 95% CI 1.13-15.63, p = 0.032) and a long surgery duration (per 10min, OR 1.97, 95% CI 1.24-3.11, p = 0.004) were associated with a high probability of hypothermia. Administering active warming methods to women can reduce the risk of experiencing a hypothermia during emergency C-sections (OR 0.19, 95% CI 0.05-0.63; p = 0.007). Hypothermia is common in emergency C-section deliveries. It is recommended that active warming methods should be applied to parturient undergoing emergency C-sections more proactively, especially for women who have a low baseline core temperature (< 36.5°C) and are expected to have a long surgery duration.

Determinants of Success and Complications in Vaginal Birth After Cesarean Section: A Systematic Literature Review

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2–0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby.

A UTERINE RUPTURE NOT TO OVERLOOK IN THE CONTEXT OF RETROPLACENTAL HEMATOMA

Objective: To report a rare case of uterine rupture in the context of a Couvelaire uterus in a patient with no history of uterine surgery or manipulation and to discuss the clinical challenges and management strategies for such cases. Case Summary: A 34-year-old multiparous woman presented at 34 weeks gestation with intrauterine fetal death (IUFD) and preeclampsia. Despite an unremarkable history with no prior cesarean deliveries or intrauterine interventions, she developed sudden hemodynamic instability and was diagnosed with uterine rupture during an emergency laparotomy. Intraoperatively, a large posterior uterine rupture was identified and repaired. Postoperatively, the patient experienced uterine atony and significant hemorrhage, necessitating additional surgical interventions including Tsirulnikov ligation and the B-Lynch uterine compression technique. The patient recovered well following intensive care management. Discussion: Uterine rupture in an unscarred uterus is an exceedingly rare event, particularly in the absence of classic risk factors. This case occurred in the context of a Couvelaire uterus, where extensive intramyometrial hemorrhage due to placental abruption may have weakened the uterine wall. The nonspecific clinical presentation, including the absence of abdominal pain or vaginal bleeding, poses diagnostic challenges. Immediate surgical intervention is crucial, especially in low-resource settings where advanced treatment options may be limited. This case underscores the importance of maintaining a high index of suspicion for uterine rupture, even in patients without typical risk factors, and highlights the need for adaptable management strategies. Conclusion: Uterine rupture should be considered in the differential diagnosis of acute abdomen in pregnancy, regardless of the patients obstetric history. Early recognition, prompt surgical management, and flexible treatment strategies are essential for optimizing outcomes in such rare but potentially life-threatening situations. Further studies are needed to improve understanding and management of this rare complication.

Insights into obstetric anesthesia practices: a quantitative survey among physicians across Arab countries

BackgroundObstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries.MethodsA questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators.ResultsOut of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion.ConclusionThis survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.

Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery without Labor.

This study aimed to compare maternal and neonatal outcomes between labor induction versus cesarean delivery (CD) without labor among nulliparous individuals with class III obesity (body mass index [BMI] ≥40 kg/m2). A retrospective cohort study of all nulliparous singleton deliveries at ≥37 weeks with a BMI of ≥40 kg/m2 at delivery between March 2020 and February 2022. We excluded individuals with spontaneous labor, fetal malformations, and stillbirths. The primary outcome was a composite of maternal mortality and morbidity, including infectious and hemorrhagic morbidity. The secondary outcome was a neonatal composite. A subgroup analysis evaluated patients with a BMI of ≥50 kg/m2. Another subgroup analysis compared outcomes between CD without labor and an indicated CD following induction. A multivariable logistic regression was applied. For adjustment, we used possible confounders identified in a univariate analysis. Among 8,623 consecutive deliveries during the study period, 308 (4%) met the inclusion criteria. Among them, 250 (81%) underwent labor induction, and 58 (19%) had a CD without labor. The most common indications for CD without labor were fetal malpresentation (26; 45%), suspected macrosomia (8; 14%), and previous myomectomy (5; 9%). Indicated CD occurred in 140 (56%) of the induced individuals, with the two leading indications being labor arrest (87; 62%) and non-reassuring fetal heart rate tracing (51; 36%). The rates of composite maternal morbidity (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 0.64-7.13) and composite neonatal morbidity (aOR = 3.62, 95% CI: 0.42-31.19) did not differ following a CD without labor compared to labor induction. The subgroup analyses did not demonstrate different outcomes between groups. Among nulliparous individuals with class III obesity at term who underwent induction, more than 50% had indicated CD; the rate of short-term maternal and neonatal morbidity, however, did not differ between labor induction and CD without labor. · The rate of unplanned CD among those who underwent labor induction was relatively high (56.0%).. · Outcomes did not differ between those who underwent CD without labor and those who were induced.. · Outcomes also did not differ between those who underwent CD without labor and those with CD in labor..

Unintended Upper Uterine Wall Extensions at the Time of Cesarean Delivery: Risk Factors and Associated Adverse Maternal and Neonatal Outcomes.

This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes. A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used. Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage. Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..

Risk of postpartum hemorrhage with increasing first stage labor duration

With increasing rates of postpartum hemorrhage (PPH) in high-income countries, an important clinical concern is the impact of labor duration on the risk of PPH. This study examined the relationship between increasing active first stage labor duration and PPH and explored the role of second stage labor duration and cesarean delivery (CD) in this association. Including 77,690 nulliparous women with spontaneous labor onset, first stage labor duration was defined as the time from 5 cm to 10 cm, second stage duration from 10 cm dilation to birth and PPH as estimated blood loss > 1000 ml. Using modified Poisson regression for risk ratios (RR) and confidence intervals (CI), we found a 1.5-fold (RR, 1.53; 95% CI, 1.41‒1.66) increased PPH risk when first stage of labor exceeded 12.1 h compared to the reference (< 7.7 h). Mediation analysis showed that 18.5% (95% CI, 9.7‒29.6) of the increased PPH risk with a prolonged first stage (≥ 7.7 h) was due to a prolonged second stage (> 3 h) or CD. These results suggest that including first stage duration in intrapartum assessments could improve PPH risk identification in first-time mothers with a singleton fetus in vertex presentation at full term with spontaneous labor onset.

Antibiotic use in cesarean procedures in developing countries: current practices and improvements

Cesarean delivery, a common surgical procedure worldwide, is associated with a significantly increased risk of postoperative infections compared to vaginal births. This risk is notably higher in developing countries due to varying practices in antibiotic prophylaxis and differences in healthcare settings. This study aims to evaluate the current practices and potential improvements in antibiotic use in cesarean sections within these regions. Our analysis revealed that cesarean sections are performed at an increased rate in developing countries, with infection rates ranging from 10% to 40%, primarily due to inconsistent and often inadequate antibiotic prophylaxis. The most common postoperative infections include endometritis, wound infections, and urinary tract infections, largely influenced by factors such as the timing of antibiotic administration, the choice of antibiotic, and the presence of risk factors like prolonged labor and membrane rupture. The standard practice in many developing countries involves the administration of antibiotics post-cord clamping, which has been challenged by recent studies suggesting that preoperative administration can significantly reduce infection rates without adverse effects on neonatal outcomes. A shift towards a single dose of broad-spectrum antibiotics such as cephalosporins administered 30-60 minutes before incision is recommended based on our findings. This approach aligns with the successful reduction of infectious morbidity observed in developed countries and supports the need for standardized guidelines. Furthermore, our study underscores the importance of healthcare provider education and the establishment of clear protocols for antibiotic prophylaxis in cesarean sections. By adopting these improvements, developing countries can achieve a significant reduction in maternal morbidity and contribute to safer childbirth practices.

Significant kidney disease in pregnancy: Feasibility and outcomes of a national population-based study using the Australasian Maternity Outcomes Surveillance System.

Current understanding of clinical practice and care for maternal kidney disease in pregnancy in Australia is hampered by limitations in available renal-specific datasets. To capture the epidemiology, management, and outcomes of women with significant kidney disease in pregnancy and demonstrate feasibility of a national cohort study approach. An Australian prospective study (2017-2018) using a new kidney disease-specific survey within the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with acute kidney injury (AKI), advanced chronic kidney disease (CKD), dialysis dependence or a kidney transplant were included. Demographic data, renal and obstetric management, and perinatal outcomes were collected. Among 58 case notifications from 12 hospitals in five states, we included 23 cases with kidney transplant (n = 12), pre-existing CKD (n = 8), newly diagnosed CKD (n = 2) and dialysis (n = 1). No cases of AKI were reported. Reporting rates were better in states with study investigators and, overall, cases were likely under-reported. Nearly 35% of women had a non-delivery-related antenatal admission. Nephrology involvement was 78.3% during pregnancy and 91% post-partum. Adverse events were increased, including pre-eclampsia (21.7%), and preterm birth (60.9%). Women had high rates of aspirin (82.6%) and antihypertensive (73.9%) use, indwelling catheter for labour/delivery (65.2%), caesarean delivery (60.9%), and blood transfusion (21.7%). This first-ever Australian prospective study of significant kidney diseases in pregnancy provided novel insights into renal-specific clinical patterns and practices. However, under-reporting was likely. Future studies need to overcome the challenges of case identification and data collection burden.

Maternal and newborn outcomes in patients with endometriosis-associated infertility

Aim. To identify the characteristics of pregnancy and childbirth in women with endometriosis-associated infertility (EAI).Materials and Methods. Here we performed retrospective case-control study which included 115 women with histologically verified endometriosis and 250 women without this condition. Statistical analysis was conducted using the IMB SPSS Statistics 20 software package. The data distribution was assessed using the Kolmogorov-Smirnov test. Quantitative data are presented as median (Me) and interquartile range (Q1 – Q3) using the Mann-Whitney test. The level of statistical significance for testing the null hypothesis was set at p &lt; 0.05.Results. Pregnancy in patients with EAI was statistically significantly more often complicated by placenta previa compared to the control group: 6 (5.2%) versus 3 (1.2%) (p = 0.031). Patients with EAI were delivered via cesarean section in 49.6% of cases, compared to 13.2% in those without EAI (p &lt; 0.001). Labor in women with EAI was statistically significantly more often complicated by uterine inertia (hypotonic labor, 7.0% versus 2.4% in those without EAI, p = 0.043), retained placenta (4.3% vs 0.4%, p = 0.013); and hypotonic bleeding (3.5% vs 0.4%, p = 0.036). Maternal and neonatal outcomes including birth weight, Apgar scores at 1 and 5 minutes, and the duration of hospital stay did not differ significantly between the groups.Conclusions. Patients with EAI are characterized by a complicated course of pregnancy and childbirth with a higher incidence of placenta previa, abnormal labor, hypotonic bleeding, retained placenta, and cesarean delivery. Hence, the development of respective therapeutic and preventive measures is required to prevent these complications.

Risk of short-term cardiovascular disease in relation to the mode of delivery in singleton pregnancies: a retrospective cohort study

Cardiovascular disease (CVD) is increasing in prevalence and affects up to 4% of pregnancies in otherwise healthy persons. The specific factors that drive the development of CVD in pregnant people are poorly characterised. This study aimed to determine whether the mode of delivery in singletons affects the risk of cardiovascular morbidity and mortality within one year in patients without prior CVD. We designed a retrospective cohort study utilising the Nationwide Readmissions Database (NRD) to identify singleton delivery hospitalisations in the United States from Jan 1, 2010 to Nov 30, 2018. International Classification of Disease (ICD) versions 9 and 10 codes were used to identify patients with readmission for CVD within the calendar year of index delivery. Patients aged 15-54 who underwent a singleton vaginal or caesarean delivery were included. Patients with pre-existing CVD hospitalisations before or during delivery, ectopic pregnancies, or abortive outcomes were excluded. Participant data was retrieved from the NRD database. The primary outcome was hospital readmission, defined by ICD 9 and 10 codes for fatal or non-fatal CVD in the same calendar year as delivery. Cox proportional hazard regression models were used to adjust for confounders. These included maternal age, hospital bed size, hospital type, hospital teaching status, income quartile, insurance, and year of delivery. Additional sub-analyses were performed adjusting for hypertensive disorders of pregnancy and diabetes mellitus. Of the 14,179,299 singleton deliveries, 32% (n=4,553,492) underwent a caesarean. CVD readmissions occurred in 255.2 per 100,000 (n=11,710) caesarean deliveries compared with 133.9 per 100,000 (n=12,507) vaginal deliveries (rate difference [RD], 121.4, 95% confidence interval [CI], 114.8-127.9; hazard ratio [HR] adjusted for all confounders including hypertensive disorders of pregnancy and diabetes mellitus was 1.42, 95% CI 1.35-1.50). This association was highest in the first 0-29 days following delivery (HR 1.68, 95% CI 1.59-1.78). The risk of readmission for CVD persisted for one year. These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity. We were also unable to determine the reason for the caesarean delivery. None.

Effects of Hand Massage on Women's Pain, Comfort Levels and Flatulence Times after Caesarean Section: A Randomized Controlled Study

IntroductionPractices such as hand massage after cesarean delivery are needed to improve the quality of care. This study was aimed at investigating effects of hand massage given to women who have had a cesarean section on their pain level, comfort level and flatulence time in the postpartum period. MethodsThe data of this randomized controlled experimental study were collected between August 2022 and January 2023. The study was completed with 182 women (intervention group=91, control group=91). The Personal Information Form, Visual Analog Scale (VAS), Postpartum Flatulence and Analgesic Drug Information Form, and Postpartum Comfort Scale (PCS) were used to collect data. Women in the intervention group received a total of 60-minutes of hand massage. ResultsIn the study, the women in the intervention group obtained lower scores from the VAS (t=-7.166; p<0.01), and higher scores from the overall PCS (t=3.301; p=0.001), physical comfort (t=10.277; p<0.001), psychospiritual comfort (t=10.583; p<0.001) and sociocultural comfort (t=7.774; p<0.001) subscales than did the women in the control group. The flatulence time of the women in the intervention group was shorter than that of the women in the control group (t=-6.433; p<0.001). ConclusionIt was concluded that hand massage given to the women after cesarean section reduced their pain level and increased their comfort level, and shortened the flatulence time. Registration numberNCTXXX

Uterine Leiomyomas and Reproduction.

There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.

Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial.

To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics-methylergonovine maleate and carboprost tromethamine. We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0-10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. A total of 1,040 participants were enrolled, with 100 randomized to receive one of the study interventions. Mean±SD 10-minute uterine tone scores were 7.3±1.7 after methylergonovine and 7.6±2.1 after carboprost, with an adjusted difference in means of -0.1 (95% CI, -0.8 to 0.6, P=.76). Additional second-line uterotonics were required in 30.0% of the methylergonovine arm and 34.0% in the carboprost arm (adjusted odds ratio 0.72, 95% CI, 0.27-1.89, P=.505), and geometric mean quantitative blood loss was 756 mL (95% CI, 636-898) and 708 mL (95% CI, 619-810) (adjusted ratio of geometric means 1.06, 95% CI, 0.86-1.31, P=.588), respectively. No differences were detected in the occurrence of other interventions for uterine atony or postpartum hemorrhage. No difference was detected in uterine tone scores 10 minutes after administration of either methylergonovine or carboprost for refractory uterine atony, indicating that either agent is acceptable. ClinicalTrials.gov, NCT03584854.

Investigating the relationship between health and gender equality: What role do maternal, reproductive, and sexual health services play?

Examining the causal nexus between health services and gender equality is of paramount significance in policy formulation and academic inquiry. This paper concentrates on maternal, sexual, and reproductive health, offering a critical narrative review of empirical research exploring the causal relationship between enhanced women's health, stemming from either overall healthcare amelioration or specific interventions, and broader gender equality objectives. A conceptual framework is devised to elucidate the causal pathways between health and gender equality across various dimensions. The final review encompasses 30 empirical papers, revealing both direct and indirect effects of improved maternal, reproductive, and sexual health outcomes on labour participation and educational investment, with fertility decisions and autonomy serving as primary intermediary factors. Evidence predominantly indicates that interventions like contraception, family planning, and abortion policies yield enduring effects beyond health, influencing reproductive choices. Specific medical procedures, such as caesarean deliveries and sterilization, also impact fertility and labour market outcomes. Furthermore, public healthcare infrastructure contributes to combating gender-based violence by facilitating incident reporting and access to protection. Recognizing, documenting, and monitoring these co-benefits arising from improved women's health are pivotal for delineating future health sector priorities and advancing the global gender equality and sustainable development agenda.