Cesarean Section Rate Research Articles

Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh.

Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh.

Trends in Indications, Intraoperative Findings and Outcome of Relaparotomy after Caesarean Section at a Tertiary Hospital in Eastern Zone Tanzania; Five Years’ Review

Background: The increased incidences of caesarean section rate is associated with a number of post-operative complications; one being re-laparotomy which is considered a maternal near-miss. The purpose of a re-laparotomy is to manage complications of the previous surgery such as unsecured hemostasis, manage intraabdominal infection, repairing of iatrogenic damaged organs like bowels, ureters and bladder, relieve intestinal obstruction and maintain intestinal continuity or to carry out delayed curative surgery. In general, second surgery increases not only the morbidity but also the risk of maternal mortality. Methods: The study was cross sectional, conducted at the Department of Obstetrics and Gynecology in MNH. It involved review of medical records of all women who necessitated re-laparotomy following Caesarean Section (CS) that was performed either at MNH or from referring health facilities during the study period. Results: There were 193 relaparotomy cases, 98% were referrals. Atonic uterus and sepsis (septic uterus, pelvic abscess and pus in peritoneal cavity) as intraoperative finding showed statistical significance in our study. Atonic uterus for those women who underwent relaparotomy due to post-partum hemorrhage (PPH) increase from 1(7.7%) in 2017 to 6(14%) in 2021 with an average increase of 2.31 % every year. Number of cases for sepsis (combination of septic uterus, pelvic abscess and pus in peritoneal cavity) was significant decreasing every year from 22(37.3%) in 2018 to 7(16.3%) 2021with an average decrease of 3.15% every year from 2017 to 2021. The number of cases who had hysterectomy as one of the post-operative outcomes was statistically significant decreasing from 44(74.6%) to 26(60.5%) over the study period with an average decrease of 5.89% every year from 2018 to 2021. Conclusion: The most frequent indication for relaparotomy after CS was a burst abdomen. For the women who had relaparotomy due to uncontrollable PPH, the main intraoperative .......

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BackgroundIn recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of “Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model”.Methods/designThe current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants’ attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants’ average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.DiscussionThis is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.Ethical codeIR.MUMS.NURSE.REC. 1403. 014.

Study on the clinical value of the wearable foetal electrocardiogram monitoring system.

Electronic foetal monitoring (EFM), a method to monitor foetal intrauterine conditions and foetal reserve capacity, is the most extensively used intrauterine monitoring technology in obstetrics. This study aims to compare the Thoth wearable foetal electrocardiogram (foetal ECG [FECG]) monitoring system with a traditional Doppler foetal heart monitoring system before labour to investigate their respective values in clinical application. A total of 393 pregnant women admitted to our hospital between 2020 and 2022 participated in this study. They were recruited using the convenience sampling method. We employed a paired design to assess the confusion rate, trend overlap, and foetal heart rate/ECG monitoring consistency, whereas a completely randomised design was used to measure pregnancy outcome indicators. The participants were divided into two groups using a random number table: the Thoth group (n= 196) and the traditional Doppler group (n= 197). Each group was monitored using the corresponding system. The Thoth monitor demonstrated a lower confusion rate compared with the traditional Doppler monitor (0.25% vs 2.04%; χ2= 5.508, P= 0.019). The trend overlap in foetal heart rates was consistently 100%, with 91.2% of readings showing a consistency rate of ⩾ 95%. Additionally, the Thoth monitor recorded a higher cumulative interruption time in the foetal heart rate curve (12.13 ± 2.22 vs 21.02 ± 2.34; t= 18.471, P< 0.001) and more abnormal ECGs (21.21 ± 4.32 vs 18.21 ± 2.91; t= 7.582, P< 0.001) than the traditional Doppler system. The Thoth wearable FECG monitor offers several advantages over the traditional Doppler foetal heart monitoring system. These include a reduced confusion rate, more accurate data collection, a lower rate of clinical misjudgement, reduced workload for medical staff, and enhanced comfort during vaginal delivery. The rates of emergency caesarean sections and neonatal asphyxia in the Thoth group were marginally lower than those in the Doppler group, which may be attributed to issues such as ECG disconnection or interference from the maternal heart rate.

P-301 Real life experience with myolysis by radiofrequency in infertile patients with type 2 and 3 fibroids

Abstract Study question Can transvaginal radiofrequency myolysis (TVRF) be a safe alternative to reduce the fibroid volume without interfering with subsequent RA treatment? Summary answer RFTV myolysis is a safe and effective alternative for the treatment of type 2-3 uterine fibroids &amp;lt; 4cm that compromise the endometrial cavity. What is known already The most common benign tumors among women who are in their reproductive years are uterine fibroids. Although most of them are not symptomatic, when they compromise the endometrial cavity, they can lead to reproductive problems. Type 2 and 3 fibroids that are smaller than 4 cm in diameter can cause compromise to the endometrial cavity and are difficult to remove through laparoscopy/hysteroscopy. Study design, size, duration The fibroid volume and % of reduction after 3 months were primary variables. All fibroids were examined with 2D/3D transvaginal ultrasonography to record nº of myomas, volume (the volume of an ellipsoid in cm3 = 4/3 (distance1xdistance2xdistance3), type of fibroid according to the FIGO. The secondary variables were mean procedure time, complications, and reproductive outcome after ART (pregnancy rate (PG), miscarriage Rate (MR), Live born rate (LBR) and obstetrics complications, and type of delivery way. Participants/materials, setting, methods We evaluated thirty-four patients between 2019-2023 with type 2-3 fibroids under 4 cm evaluated by 2D/3D ultrasound, confirming that they compromised the uterine cavity and with a complex surgical approach. Myolysis was carried out by TVRF Main results and the role of chance The average age of our patients was 42 years (range 37-50). In our patients, 52% had fibroids of type 3, and 48% had fibroids of type 2. According to FIGO classification. The average TVRF time for the patients was 4.17 minutes. The average volume was initially 21 cm3, but it decreased to 10 cm3 after one month, and finally dropped to 4.6 cm3 after three months. The volume reduction was &amp;gt;75% when evaluated three months after the TVRF. No complications were reported during the procedure except for mild pain that was controlled with oral analgesia in 21% of patients, and minimal bleeding. In eight patients, the fibroid was extruded towards the endometrial cavity and removed by hysteroscopy. Twenty four out of 34 patients (71%) underwent ART, at least 4 months after TVRF. The reproductive outcome was comparable to what was expected, with a 63% pregnancy rate, 17% miscarriage rate, and 50% ongoing pregnancy rate. Live birth rate was 46%, with 83% reaching term pregnancy, and 16% premature births at 36 and 34 weeks. The rate of cesarean section was 66%. Among the obstetric complications, only one case or IUGR was described Limitations, reasons for caution The main limitation of these data is retrospective analysis of the date and the small sample size, as this is the earliest date on the impact of TVRF on infertile patients. Wider implications of the findings TVRF myolysis is a safe and effective alternative for the infertile women with type 2-3 uterine fibroids &amp;lt; 4 cm that compromise the endometrial cavity that have a complex surgical approach by hysteroscopy/laparoscopy. It appears that TVRF has no impact on reproductive outcomes. Trial registration number not applicable

P-749 Maternal and obstetric outcomes following the transfer of embryos warmed with fatty acid supplemented solutions

Abstract Study question Does fatty acid (FA) supplementation into warming solutions influence maternal and obstetric outcomes after single vitrified-warmed cleavage stage embryo transfer (SVCT)? Summary answer FA-supplemented warming solutions improve the live birth rate after SVCTs without exerting any adverse effects on maternal and obstetric outcomes. What is known already Vitrification procedures decrease the intracellular lipid content and impair developmental competence. Adding fatty acids (FAs) to the warming solution has been shown to recover the lipid content of the cytoplasm and improve developmental competence and clinical pregnancy by stimulating the beta-oxidation pathway in warmed embryos. Recently, the FA-supplemented warming solutions have been commercially released. However, influence of the FA-supplemented supplementation on live birth rate after embryo transfers and perinatal outcomes remains unknown. Study design, size, duration The clinical records of 701 treatment cycles in 701 women who underwent SVCTs were retrospectively analysed. Vitrified embryos were warmed using solutions (from April 2022 to June 2022, control group, n = 340) or FA-supplemented solutions (from July 2022 to September 2022, FA group, n = 361). All pregnant women were invited to respond to the questionnaire at 9 weeks of gestation and after delivery. Maternal and obstetric outcomes were obtained from a self-reported questionnaire completed by the patients. Participants/materials, setting, methods The embryos in the FA group were warmed with the FA-supplemented solutions (VT526, Kitazato Corporation) while the embryos in the control group were warmed with the non-supplemented solutions (VT506, Kitazato Corporation). SVCTs were performed on day 2 after ovulation in natural cycles. The live birth rate, incidence of pregnancy complications, and neonatal outcomes were compared between the control and FA groups. Main results and the role of chance The live birth rate was higher in the FA group than in the control group (P = 0.0399). The miscarriage rates were comparable between the groups. Multivariate logistic regression analysis also demonstrated a higher probability of live births in the FA group than in the control group (adjusted odds ratio, 1.46; P = 0.0404). Patients were stratified by median maternal age for further analysis (37 years). This subgroup analysis showed that the live birth rate was significantly higher in the FA group than in the control group in women younger than 37 years of age. However, the live birth rate was comparable between the two groups for women aged 37 years or older. The incidence and types of pregnancy complications were comparable between the control and FA groups. Furthermore, caesarean section rates were similar between the groups. The average gestational age and incidence of preterm delivery were comparable between the groups. Birth length and weight, incidence of low birth weight, incidence of small for gestational age and large for gestational age, and infant sex were comparable between the groups. The incidence of birth defects was similar between the groups. Multivariate logistic regression analysis revealed a similar trend. Limitations, reasons for caution The single-centre retrospective study limits the strength of the study, necessitating further multicentre studies to ascertain the generalizability of these findings to other clinics with different protocols and/or patient demographics. Furthermore, the number of perinatal cycles was low. Wider implications of the findings The FA-supplemented warming solutions improved the live birth rates after SVCTs, particularly in young patients. Furthermore, the incidence of pregnancy complications and infant health was not affected by the FA-supplemented solutions. Therefore, FA-supplemented solutions can be considered safe and effective at improving clinical outcomes and reducing the patient burden. Trial registration number not applicable

P-288 How do pregnancy complications, intrapartum, and neonatal risks differ in bicornuate and didelphys uteri. A population-based study

Abstract Study question Are there differences between didelphys and bicornuate uteri regarding obstetrical and neonatal outcomes based on an analysis of a population database? Summary answer Didelphys uteri present higher risks of preeclampsia, preterm delivery, PPROM, and cesarean delivery; while bicornuate uteri present higher risks of placenta previa, and placental abruption. What is known already Didelphys and bicornuate uteri are similar congenital anomalies with duplication of the uterine corpus. It is thought that both defects are similar when it comes to pregnancy complications, with increased risks of preterm delivery (PTD), malpresentation, and cesarean delivery, when compared to women without uterine anomalies. The didelphys uterus has two cervixes and a double vagina while the bicornuate uterus has one cervix and a single vagina. This minor difference may or may not alter the risks of pregnancy complications in these groups. However, obstetric and perinatal outcomes for didelphys and bicornuate uteri have never been directly compared. Study design, size, duration This retrospective population-based cohort study utilized data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusively. There were 3,846,342 births between 2010 and 2014, 1146 women with didelphys uteri and 6327 women with bicornuate uteri were included in the database and the study. Women were included only once per pregnancy. Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and is comprised of hospitalizations throughout the USA. It provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of Americans. Multivariate logistic regression was conducted to explore associations between bicornuate uteri and delivery outcomes while controlling for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance No significant difference was seen between the groups in regard to age, income, medical insurance plan, rates of obesity, illicit drug use, chronic hypertension, diabetes, thyroid disease, HIV, tobacco smoking during pregnancy, previous cesareans, pregnancy from IVF, and multiple gestations (P &amp;gt; 0.05). The only difference was in racial distribution, which was controlled for in the subsequent analysis (p &amp;lt; 0.05).In comparison to pregnant women with bicornuate uteri, patients with didelphys uteri were more likely to experience preeclampsia (aOR 1.38 95%CI: 1.05-1.80 P = 0.020), preterm premature rupture of membranes (PPROM) (aOR 1.76 95%CI1.32-2.34 P = 0.000), preterm delivery (aOR 1.39 95% CI1.18-1.64P=0.000), and higher chances of cesarean delivery (aOR 1.41 95% CI1.20-1.64 P = 0.000), after controlling for confounding demographics. Additionally, women with didelphys uteri have less risks of developing placenta previa (aOR 0.26 95%CI: 0.08-0.84 P = 0.024) and Abruptio placenta (aOR 0.52 95%CI 0.31-0.87 P = 0.013). No significant difference was seen between the groups regarding pregnancy induced hypertension, eclampsia, gestational diabetes, chorioamnionitis, operative vaginal delivery, hysterectomy, post-partum hemorrhage, wound complications, blood transfusion, maternal death, maternal infection, venous thromboembolism, pulmonary embolism or DIC (P &amp;gt; 0.05). Moreover, there was no significant difference between the two groups when comparing neonatal outcomes, including small for gestational age fetuses and intrauterine fetal demise (P &amp;gt; 0.05). Limitations, reasons for caution The limitation of our study are related to its retrospective nature and use of administrative database, which relies on the accuracy, and consistency of the individual coding the data, and the masking of undetected bias. Wider implications of the findings The present study demonstrates that women with bicornuate and didelphys uteri have certain differences when it comes to pregnancy, and intrapartum complications, including rates of preeclampsia, placenta previa, placental abruption, cesarean section, PPROM, and preterm delivery. These findings emphasize the importance of individualized perinatal care in these two cases. Trial registration number not applicable

P-742 In-vitro fertilization outcomes after laparoscopic repair of cesarean scar defect

Abstract Study question Does laparoscopic repair of cesarean scar defect improve in-vitro fertilization (IVF) outcomes? Summary answer Laparoscopic (LSC) repair of cesarean scar defect (CSD) should selectively indicated to patients experiencing repetitive pregnancy failure or having an increased depth of niche What is known already Cesarean section (CS) rate has markedly from 7% in 1990 to an estimated 29% of all births by 2030. CSD, also known as isthmocele or uterine niche, has emerged as a cause of secondary infertility, frequently encountered with recurrent implantation failures and cycle cancellations because of the endometrial fluid collection both in endometrium and uterine lower segment of cesarean scar. Study design, size, duration This is a retrospective study encompassing total of 62 patients. With 50 patients undergoing expectant management, 12 undergoing LSC repair of CSD at a single IVF center from 2019 to 2023. Primary outcomes included the clinical pregnancy rate and time to pregnancy, while secondary outcomes were the depth of CSD and residual myometrial thickness. Of the 72 patients, 68 patients underwent frozen embryo transfer. Participants/materials, setting, methods Patients with secondary infertility who had experienced more than two instances of implantation failure or cycle cancellation due to endometrial fluid collection were included. Laparoscopic repair of CSD was performed by a single gynecologic oncologist in accordance with the physician’s preference and patient consent. For patients in expectant management, diagnostic hysteroscopy and endometrial fluid suction were conducted prior to embryo transfer. Main results and the role of chance The age, BMI, gravidity, parity, or the number of previous cesarean section showed no statistical differences between the expectant management and the LSC repair group. The uterine position, either anteflexion was similar across groups. (all p value &amp;gt;0.05). Both the clinical pregnancy rate and live birth rate did not significantly differ between the expectant management group and the LSC repair group (26.0% vs 50.0%, p = 0.149, and 32.0% vs 60.0%, p = 0.149, respectively). The mean time to pregnancy was 7.38 months in the expectant management group and 9.80 months in LSC repair group, showed no significant difference (p = 0.240). Correlation analysis revealed a significantly moderate correlation between the initial depth of CSD and the depth of CSD at embryo transfer with clinical pregnancy (r = -0.424, P = 0.001). Furthermore, our data indicated that the CSD depth at embryo transfer was significantly impacted on clinical pregnancy outcomes from the multivariate regression logistic analysis (OR = 0.522, 95% CI [0.332 – 0.823]). Limitations, reasons for caution This study is retrospectively designed and including small sample size, caution is required in interpreting the findings. Wider implications of the findings This study suggests that the depth of niche influences clinical pregnancy outcomes. Laparoscopic repair may offer a viable treatment option who have experienced multiple failed cycles and increased depth of niche. Future studies with larger population studies may further indicate the LSC repair based on the depth of CSD. Trial registration number not applicable

Impact of Diabetes in Pregnancy on Stage II Lactogenesis among Postpartum Diabetic Women Compared to Non-Diabetics

Abstract Background Diabetes in pregnancy -whether preexisting or gestational can have negative impact on pregnancy, labor and lactation. Infants of diabetic mothers benefit most from early establishment of breastfeeding as it helps them regulate their blood glucose levels on the short term and decrease their risk of developing diabetes later on life. Aim of the Work This study aims to compare diabetic and non-diabetic pregnant women regarding the onset of stage II lactogenesis at 72 hours postpartum and to associate the degree of diabetes control in antepartum period with the delay in stage II of lactogenesis. Subjects and Methods This study is an observational prospective cohort study, carried out on 203 pregnant women aged from 18 to 40 years old during their routine antenatal care visits in the third trimester of pregnancy at Ain-Shams University Maternity hospital outpatient clinic from December 2020 to August 2021, Cairo, Egypt. Results We found that Diabetes in pregnancy can cause a delay in the onset of Lactogenesis stage II regardless of the degree of control. We can also say that diabetes can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother and delayed initiation of first breastfeed which was found to cause DOLII. And early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers. Conclusion Diabetes can cause series of unfortunate events in pregnancy, labor, and lactation. Many of diabetes implications on peripartum health can affect lactation directly and indirectly. For example, Diabetes can cause higher rates of cesarean section, infant separation from mother, delayed initiation of first breastfeed and other birth complications. All these can cause DOL II. Diabetes itself is a risk factor for delayed onset of lactogenesis II which can cause further neonatal hypoglycemia and/or early introduction of infant formula. The cascade of these events can hinder the breastfeeding establishment when it is most needed. The control of diabetes was not found to have impact on DOL II. Further research needs to be done in this regard. Early initiation of lactation can be a modifiable risk factor to protect from DOLII especially in Diabetic mothers.

Clinico-microbiological evaluation of post-cesarean surgical site infections

Objectives: With increasing rates of cesarean section (CS), the incidence of post-operative complications is bound to increase, which includes surgical site infections (SSIs), being one of the common and distressing complication. This study was aimed to evaluate the various determinants of post-CS SSI, their clinical spectrum, prevalent microbiology, and their susceptibility and resistance patterns. Materials and Methods: This was a prospective longitudinal hospital-based study undertaken in Government Medical College and Hospital (GMCH), Chandigarh. Six hundred and eighty-eight patients were included from April, 2021, to September, 2022, and were followed up till 42nd day post-procedure. Results: The incidence of SSI in the study was 3.49%. The risk factors identified were gestational diabetes mellitus (GDM), thrombocytopenia, chorioamnionitis, prolonged labor, multiple per vaginum examinations, prolonged surgery, post-partum hemorrhage, and blood and blood product transfusions. Most patients presented on or after day 8 of surgery with discharge from the wound site being the most common presentation. Staphylococcus aureus emerged as the most prevalent organism and out of five patients having S. aureus, three had methicillin-resistant S. aureus. Linezolid was found to be the most susceptible antibiotic, whereas ciprofloxacin was mostly resistant among the prevalent isolates. Conclusion: Some of these determinants are modifiable such as GDM and thrombocytopenia and if detected and managed early may help in reducing the risk of developing SSI. Linezolid must be used empirically for treatment of SSI until the reporting of culture and sensitivity is done because routine antibiotics used for antibiotic prophylaxis in CS were found to be highly resistant. Periodic analysis of clinical spectrum and culture and sensitivity patterns is imperative for the early diagnosis and appropriate empirical management of SSI.

Effect of acidic vaginal pH on the efficacy of dinoprostone (PGE2) vaginal tablet for labor induction in full term pregnant women: a randomized controlled trial.

There is controversial evidence that acidification of vaginal pH may increase the efficacy of vaginal prostaglandins in labor induction, with research being mainly focused on misoprostol. This study aims to evaluate the impact of this intervention on the progress of labor induction with dinoprostone (PGE2) vaginal tablet. This double-blind, parallel-group, randomized study was conducted between October 2021 and December 2022 at Alexandra General Hospital, Athens, Greece. A total of 230 women with singleton, full term pregnancy that were scheduled for labor induction were randomly divided into two groups: Group A, who received acidic vaginal wash (5 % acetic acid) and Group B, who received a normal saline vaginal wash. Afterwards, participants received a vaginal tablet of 3 mg dinoprostone every 6 h (maximum two doses). There were no statistically significant differences in mode of delivery, duration of different labor stages, Bishop score changes and possible complications. Participants in the acidification group needed less often labor augmentation with oxytocin and epidural anesthesia (p=0.03). Vaginal acidification seems to have no effect on the efficacy of the dinoprostone vaginal tablet. Even though it may reduce the need for oxytocin augmentation, there is no apparent benefit on clinical outcomes, such as reduction in cesarean section rates or shorter labor duration. Future research is necessary in order to validate these findings.

Impact of the midwife-led care model on mode of birth: a systematic review and meta-analysis

Background/Aims Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies.

Comparison of the rate and indications of caesarean section in primigravida and multigravida in a maternity hospital of Pakistan.q

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value &lt;0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

Cesarean Scar Ectopic Pregnancy: A Do-Not-Miss Diagnosis.

The rate of cesarean section (CS) for delivery has increased internationally, reaching 50% in some countries. Abnormal implantation of a new pregnancy at the site of the prior hysterotomy is an important complication because of the risks of hemorrhage, uterine rupture, and progression to placenta accreta spectrum (PAS), a condition with high morbidity with potential for catastrophic obstetric hemorrhage, maternal and fetal mortality, and loss of fertility. Cesarean scar ectopic pregnancy (CSEP) is the recommended term to describe these pregnancies, which are recognized on the basis of the sac implantation site, growth pattern, and associated abnormal perfusion. The true incidence of CSEP is unknown because the condition is likely underdiagnosed and underreported. The 2022 Society for Maternal-Fetal Medicine consult series notes that severe maternal morbidity and mortality are linked to difficulty in making the diagnosis of CSEP. The authors review the signs of CSEP at imaging, some pitfalls that may lead to delayed or missed diagnosis, and the consequences thereof. CSEPs must be differentiated from low implantation of a normal pregnancy, cervical ectopic pregnancy, and evolving pregnancy loss. Early recognition allows prompt and safe treatment that is usually surgical. Early treatment results in decreased health care costs, a shorter hospital stay, preservation of fertility, and prevention of iatrogenic preterm delivery, which is typical in cases that progress to PAS. Hysterectomy has serious negative psychologic consequences for patients of childbearing age; early diagnosis and prompt treatment of CSEP can prevent this often-ignored complication. ©RSNA, 2024 Supplemental material is available for this article.

Proportion of Emergency Cesarean Section in Maternity Hospitals in Kirkuk Governorate, in 2022–2023

Abstract Background: Emergency cesarean sections are undertaken before or during labor when there is an immediate concern for the mother or the fetus. Inadequate maternal management and unreliable referral systems are responsible for the massive incidence of emergency cesarean section. Objectives: This study aims to identify the rate of emergency cesarean section in Kirkuk governorate. Subjects and Methods: A cross-sectional study was conducted at the postoperative Obstetrical and Gynecological wards in Azadi Teaching Hospital and Kirkuk General Hospital, Kirkuk, Iraq, from December 1st, 2022, to February 28th, 2023. Four hundred women, who have had cesarean sections, were directly interviewed using a structured questionnaire. Official approval was obtained. Categorical data were analyzed using the Chi-square or Fisher’s exact tests P &lt; 0.05 was considered statistically significant. Results: One hundred and ninety-nine (49.8%) mothers were within 26–35 years of age. One hundred and forty-three (35.8%) had an emergency cesarean section, whereas 257 (64.3%) had an elective cesarean section. Emergency indications included failure to progress 45 (31.5%), cephalopelvic disproportion (CPD) 36 (25.2%), fetal distress 32 (22.4%), and severe preeclampsia 22 (15.4%). Poor pregnancy outcomes included bad obstetrical history 49 (12.3%), macrosomia 7 (1.8%), premature rupture of membrane 4 (1.0%), and postterm 21 (5.3%). Elective cesarean sections were significantly higher in husbands &gt;35 years, with husbands’ education (primary school), parity of 2–4, and with no pregnancy-induced hypertension (P = 0.035, P = 0.034, P &lt; 0.001, and P &lt; 0.001), respectively. Emergency cesarean sections (CSs) were significantly higher among diabetic mothers; P = 0.022. Conclusions: One-third of all CSs in Kirkuk were done as emergency operations with failure to progress, CPD, and fetal distress as the main indications.

Three-dimensional ultrasound versus magnetic resonance imaging in the diagnosis of placenta accreta spectrum

Background Placenta accrete spectrum (PAS), is an increasing obstetric issue. The prevalence of PAS has fundamentally increased because of the global increase in cesarean section (CS) rates over the past few decades. To diagnose PAS in utero. Aim This study aimed to assess and compare the diagnostic accuracy of two imaging modalities: magnetic resonance imaging (MRI) and three-dimensional (3D) ultrasound (US). Patients and methods This prospective observational study included 60 pregnant women between the ages of 21 and 43 who were between 26- and 38 weeks’ gestation and met the clinical criteria of having had placenta previa central and prior uterine surgery (such as cesarean section, myomectomy, or curettage). 3D US and MRI were performed on each patient. Results 3D US can significantly diagnose accurately compared with clinical diagnosis (P value &lt;0.001) with 100% sensitivity, 72.7% specificity, 86.4% positive predictive value (PPV), 100% negative predictive value (NPV), and 90% accuracy, area under the curve=0.864. MRI can significantly diagnose accurate compared with Clinical diagnosis (P value &lt;0.001) with 97.4% sensitivity, 63.6% specificity, 82.2% PPV, 93.3% NPV, and 85% accuracy, area under the curve= 0.805. Conclusions MRI and 3D US were observed to be able to diagnose PAS prenatally with no difference between them and the clinical diagnosis (intraoperative findings). However, 3D US exhibited increased sensitivity, specificity, PPV, NPV, and accuracy compared with MRI.

Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe: Evidence from the 2019 National Multiple Indicator Cluster Survey.

Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.

A Review of High-Risk Pregnancy Complications in the Resident Clinic

Introduction: A high risk status can develop during a patient’s pregnancy or can be present from conception. These include maternal pre-existing conditions such as hypertension, diabetes, infection such as HIV, and obesity. Fetal complications such as anomaly or multiple gestation also constitute high risk pregnancies. The Corewell Health East Dearborn resident high risk clinic helps to manage these patients’ pregnancies and deliveries. This study aims to analyze the current complications and delivery outcomes of pregnancies from this clinic. Methods: The prenatal care data and pregnancy outcomes from patients in our high-risk resident clinic was collected from Jan 1st 2023 to Jan 1st 2024. The prenatal care data was analyzed for maternal and fetal complications along with delivery outcomes. Results: During the year 2023, 100 patients delivered from the high-risk clinic. Fetal complications were found in 32% of these deliveries. These included 12% twin gestation, 14% growth restriction, 6% fetal anomalies. Maternal complications included 27% with chronic hypertension, 23% with prior cesarean section, 27% with a BMI of 40 or higher, 10% cardiac complications, 4% pre-existing renal complications, 26% with pre-existing diabetes, 3% wtih HIV, and 6% with polysubstance use. The deliveries included 62% cesarean sections and 34% vaginal deliveries. Discussion: The results from our cross-sectional study revealed a high rate of maternal and fetal complications among patients from our high-risk clinic when compared to national averages. There was a high cesarean section rate for these patients. Conclusions: This study allowed us to better understand the patient population that receives care through the resident high-risk clinic. Future studies can explore how to decrease the cesarean section rate.

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals