Cesarean Section Delivery Research Articles

Prevalence of postpartum post-traumatic stress disorder and associated factors among postnatal mothers in West Arsi zone, South West Ethiopia, 2024: a community-based cross-sectional study

BackgroundUp to one-third of women globally experience giving birth as traumatic, which can lead to postpartum post-traumatic stress disorder. Postpartum post-traumatic stress disorders have significant health consequences for the mother, child, and other family members. Although it has tragic health impacts, little is known about this problem in the study area.ObjectivesThe study aimed to assess the prevalence of postpartum posttraumatic stress disorder and associated factors among postnatal mothers.MethodsA community-based cross-sectional study was employed among 635 mothers in the first year after childbirth by using simple random sampling techniques from March 20 to April 20, 2024 in West Arsi zone, Ethiopia. Face-to-face interviewers administered structured questionnaires that were used to collect the data. The collected data were cleaned, coded, and entered into Epidata and exported to Statistical Package for Social Sciences for further analysis. Both bivariate and multivariable analyses were done by using binary logistic regression.ResultOut of 635, 624 postnatal mothers participated in the study, for a response rate of 98.27%. The prevalence of postpartum post-traumatic stress disorder was 21.60% (95% CI: 18.40%, 24.87%). Primiparous mothers (AOR = 2.26, 95% CI: 1.38, 3.70), have no antenatal care follow-up (AOR = 2.48, 95% CI: 1.47, 4.20), cesarean section delivery (AOR = 2.86, 95% CI: 1.50, 5.61), instrumental delivery (AOR = 3.06, 95% CI: 1.75, 5.34), maternal morbidity (AOR = 2.94, 95% CI: 1.71, 5.05), and postpartum intimate partner violence (AOR = 7.43, 95% CI: 4.53, 12.20) were the identified factors.Conclusion and recommendationAs identified, one out of five mothers had postpartum posttraumatic stress disorder. Thus, healthcare providers should focus on identified factors like cesarean section and instrumental deliveries while counseling, as this enhances the mothers’ psychological readiness. In addition, the West Arsi Zonal Health Office should develop effective strategies to alleviate the problem by focusing on the identified factors.

Birth registry-based cohort study of COVID-19 in pregnancy and adverse maternal outcomes in Georgia

Abstract Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery. We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99-84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05-6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03-1.20). Key messages • Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission. • Most pregnant women were not vaccinated against COVID-19 and these findings should alert stakeholders that adherence to public health preventive measures needs to be improved.

Assessment of enoxaparin‐related knowledge, administration technique, and self‐reported adherence among women after caesarean section delivery

AbstractBackgroundVenous thromboembolism is among the main causes of maternal morbidity and mortality, with caesarean section (CS) delivery carrying greater risk. Outpatient thromboprophylaxis, such as enoxaparin, is administered subcutaneously and prescribed as an outpatient; raising the issue of medication adherence.AimThis study aimed to evaluate women's adherence to enoxaparin administration after CS delivery, explore the reasons for non‐adherence, and assess the factors associated with patients' adherence to enoxaparin.MethodWomen after CS delivery, who had been given enoxaparin at discharge were included in the study. Eligible patients were contacted via telephone at the middle and the end of the enoxaparin treatment. Syringe count determined the main outcome of adherence during direct telephone interviews with the patient. Optimal adherence was defined as all the doses of enoxaparin being administered and suboptimal adherence was at least one dose not administered. Ethical approval was granted by the Malaysian Registry Ethics Committee belonging to National Medical Research Registry (Reference no: NMRR ID‐22‐02859‐P41) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants through completion of written consent forms, after an explanation of the study was provided by investigators.ResultsOut of 201 women included, the majority (91.5%) were fully adherent to enoxaparin, while 8.5% missed at least one dose. Most patients administering at home missed the dose due to reporting they were unwell (n = 6), busy (n = 4), or forgot to administer (n = 2). Among missed doses in patients administered in a healthcare setting, all participants (n = 5) forgot to bring their medication to the appointment. Only medication knowledge had a significant association with adherence to enoxaparin administration (p = 0.008).ConclusionThe study raised concern about the substantial percentage of patients missing at least one dose of enoxaparin, particularly among patients injecting at home. Initiatives should focus on customised enoxaparin administration counselling and providing educational materials.

The Annual Economic Burden of Uterine Fibroids in the United States (2010 Versus 2022): A Comparative Cost-Analysis.

In 2010, the estimated annual cost of uterine fibroids in the United States ranged from 5.9 to 34.4billion USD. In the past decade, more uterine-sparing and fertility preserving interventions have become available to treat symptomatic fibroids. This comparative cost-analysis aims to evaluate change in societal costs of uterine fibroids in the US between 2010 and 2022 given changing fibroid and obstetric management, population growth, and inflation. A systematic review was conducted to update uterine fibroid, treatment, and obstetric complication prevalence, direct costs of medical and surgical interventions, indirect productivity costs, and obstetric costs attributable to fibroids in 2022. A comparative cost-analysis with paired t-tests was performed using baseline data published in 2010. Percent (%) changes between 2010 and 2022 were reported. NIH research funding for fibroids and other common diseases was compared. All costs were converted to 2023 USD. The number of US women with uterine fibroids increased by 10.6% from 2010 to 2022. Over this period, the economic burden of uterine fibroids increased up to 41.4billion USD compared to 34.4billion USD in 2010. Overall costs increased to 42.2billion USD after incorporating new costs associated with MRgFUS and infertility. Direct costs of medical management decreased while costs of surgical interventions increased as a result of evolving treatment-seeking behavior. Lost work costs continue to account for the largest proportion of the economic burden for fibroids. Cesarean section delivery remains the largest contributor (average 80.0%) to indirect obstetrical costs. Despite the rise in the number of individuals affected by uterine fibroids and its sizable annual cost to society, uterine fibroids research continues to be underfunded.

Evaluation of Some Antioxidant Parameters (Vitamin E & C), MDA and Hemoglobin Levels, in Women of Reproductive Age, Based on Mode of Child Delivery, in Owerri, Imo State, Nigeria

Childbirth indicates the positive outcome of pregnancy in humans, in which mode of child delivery, which is either by vaginal delivery (VD) or cesarean-section delivery (CS) is considered critical in maintaining maternal health. Antioxidants delay or inhibit cellular damage, mainly through their free radical-scavenging property. Changes in vitamin E and vitamin C antioxidants, lipid peroxidation (MDA) and hemoglobin (Hb) can lead to complications, forming reactive oxygen species (ROS) and cellular imbalance, bringing about oxidative stress (OS). These parameters remove the ROS efficiently and protect the body from the adverse effects of oxidative stress. The purpose of our study was to evaluate the effect of mode of child delivery on maternal VE, VC, MDA and Hb status, in women of reproductive age in Owerri, Imo state, Nigeria. It involved 200 pregnant women, within the reproductive ages of 20 to 39 years, with 100 subjects being those who gave birth through VD and 100 being those who gave birth through CS. Data were analyzed using SPSS version 23, with results expressed as mean ± standard deviation and presented in tables. Independent t-tests and ANOVA were used for comparisons, with p≤0.05 considered significant. The results from this study showed that, women who gave birth through VD had significantly lower VE (p<0.001) and VC (p<0.001) levels compared to those who had CS. Similarly, the levels of MDA were significantly (p<0.001) reduced in women who gave birth through VD compared to those who had CS. The antepartum Hb of VD women was significantly higher than postpartum levels, while the antepartum Hb of CS women was significantly lower compared to the postpartum levels. The results indicate that women who gave birth through VD had significantly reduced VE, VC, MDA and Hb levels, after childbirth, compared to births of CS delivery. It is recommended that antioxidant parameters (Vitamin E & C), MDA and hemoglobin (Hb) levels, be assessed in women during childbirth in order to help in the management of their postpartum conditions.

Caesarean section and operative vaginal delivery in Estonia and Finland from 1992 to 2016: registry-based study.

Proportion of normal deliveries is decreasing worldwide. This study analysed operative vaginal deliveries (OVD) and Caesarean sections (CS) with some background factors in Estonia and Finland from 1992 to 2016. Data on all deliveries from 1992 to 2016 were obtained from the Finnish Medical Birth Registry (1 481 160 births) and the Estonian Medical Birth Registry (356 063 births). Time trends were analysed by joinpoint regression, and factors associated with OVD and CS by logistic regression. Odds ratios with 95% CIs were calculated, adjusted for year, maternal age, foetal birthweight, and use of epidural/spinal anaesthesia. One out of four deliveries were operative in Estonia and in Finland by 2016. By 2016, the Estonian CS rate had tripled to 20.9% and the OVD rate had increased by nine times to 5.6%. In Finland, the CS rate increased slightly to 16.4% while the OVD rate nearly doubled to 9.4%. In Estonia, the incidence of OVD was 24% lower (aOR 0.76, 95% Cl 0.74-0.78) and the incidence of CS 9% higher (aOR 1.09, 95% Cl 1.07-1.10) than in Finland. Use of epidural/spinal anaesthesia and foetal birthweight increased the risk of OVD in both countries, maternal age increased the risk of CS in both countries. Even if the CS and OVD rates are different, operative delivery rates may be similar in different countries. Combined analysis of operative deliveries together with background factors gives a better understanding of the trends in birthcare than monitoring CS rates alone.

Determinants of Caesarean Deliveries in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Caesarean section, a frequently conducted surgical procedure in obstetrics, is instrumental in safeguarding the well-being of both mothers and infants by addressing complications related to pregnancy and childbirth. While it significantly contributes to reducing maternal and infant mortality rates, its overuse can pose serious health risks. The prevalence of caesarean deliveries has surged globally, including in Bangladesh. This rise in caesarean deliveries has prompted this research to investigate the prevalence and various associated factors in the country. To achieve the study objectives, data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted from 2017 to 2018. After preprocessing the data, a total of 4,884 women were included in the study. Frequency analysis was conducted to illustrate the distribution of sociodemographic characteristics among Bangladeshi women. Chi-square tests were performed to assess their association with caesarean delivery. Furthermore, multi-level logistic regression analysis was employed to identify the variables that have a significant impact on the likelihood of caesarean delivery. The study revealed that in Bangladesh, the prevalence of caesarean section deliveries was approximately 33.1%, with the majority of these occurring in the Dhaka division, accounting for approximately 25.3%. Women aged 20 or older were 1.62 times more likely to opt for a C-section during childbirth (OR 1.62, [1.38-1.89]) compared to those under 20. Overweight or obese women had twice the likelihood of delivering via C-section. Higher socioeconomic status also increased the probability of choosing a caesarean delivery. Women who had exposure to any form of media were 57% more likely to opt for a caesarean delivery (OR 1.57 [1.31-1.87]), while not working women had a 48% higher likelihood of having a C-section. Additionally, the study found that the use of caesarean delivery was positively associated with the husband's education level, the number of children previously born, and the number of antenatal care visits. The study revealed that the rate of C-sections in Bangladesh surpasses WHO recommendations significantly. It also identified various factors driving this trend, including women's education levels, socioeconomic status, media exposure, female obesity, age at first childbirth, and husband’s education. These insights may serve as a foundation for developing strategies to regulate the caesarean delivery rate. Urgent policy directives are essential within Bangladesh's healthcare system, coupled with vigilant monitoring of clinical indications for C-sections, to mitigate the adverse effects of unnecessary procedures. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 31−44

Factors Associated with Cesarean Section in Primiparous Women at the Bernard Kouchner Communal Medical Centre in Coronthie, Conakry, Guinea

<i>Objective</i>: to analyse the factors associated with Caesarean section in primiparous women. <i>Methods</i>: This was a 12-month (1 January to 31 December 2022) retrospective case-control study conducted at the Bernard Kouchner Communal Medical Centre (CMC) in Coronthie. Correctly completed records of primiparous women with a singleton pregnancy were included, with a live foetus in cephalic presentation having been delivered (by Caesarean section or vaginal delivery) from 28 weeks' gestation with a weight ≥ 1000 g. The "cases" consisted of records from primiparous women who had undergone caesarean section. The "controls" were composed by matching each "case" with the record of a patient who had undergone vaginal delivery, according to the order in the delivery register. Socio-demographic, clinical and obstetric characteristics were analysed and compared. A univariate analysis comparing cases to controls and a multivariate analysis looking for an association between maternal determinants were performed. <i>Results</i>: The prevalence of caesarean section in primiparous women was 31%. The average age of primiparous women was 24 ± 5 years. The 20-24 age group was the most represented in both groups, with 35% of caesareans and 42% of vaginal deliveries. The factors significantly associated with caesarean section in primiparous women were advanced maternal age (OR=1.13 CI=1.07-1.20), prolonged pregnancy (OR=25.1 CI =3.23 - 5.40), arterial hypertension (OR=4.98 CI= 2.24 -11.6), premature rupture of membranes (OR= 4.25 CI: 2.27 - 8.05), haemorrhagic complications (OR=8.56 CI=3.05 - 26.6), foetal distress (OR=68.4 CI=18.3 - 45.1) and macrosomia (OR=12.7 CI= 4.83 - 38.6). <i>Conclusion</i>: correct antenatal care and delivery by qualified personnel could help prevent some of these factors and thus reduce the caesarean section rate among primiparous women in our health facility.

Regional differences in autism and intellectual disability risk associated with cesarean section delivery.

Prior epidemiological studies investigating the association between delivery mode (i.e., vaginal birth and cesarean section [C-section]) and autism spectrum disorder (ASD) and intellectual disability (ID) risk have reported mixed findings. This study examined ASD and ID risks associated with primary and repeat C-section within diverse US regions. During even years 2000-2016, 8-years-olds were identified with ASD and/or ID and matched to birth records [ASD only (N = 8566, 83.6% male), ASD + ID (N = 3445, 79.5% male), ID only (N = 6158, 60.8% male)] using the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network methodology. The comparison birth cohort (N = 1,456,914, 51.1% male) comprised all births recorded in the National Center for Health Statistics corresponding to birth years and counties in which surveillance occurred. C-section rates in the birth cohort demonstrated significant regional variation with lowest rates in the West. Overall models demonstrate increased odds of disability associated with primary and repeat C-section. Adjusted models, stratified by region, identified significant variability in disability likelihood associated with repeat C-section: increased odds occurred for all case groups in the Southeast, for ASD only and ID only in the Mid-Atlantic, and no case groups in the West. Regional variability in disability risk associated with repeat C-section coincides with differences in birth cohorts' C-section rates. This suggests increased likelihood of disability is not incurred by the procedure itself, but rather C-section serves as a proxy for exposures with regional variability that influence fetal development and C-section rates.

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49

Increase in Cases of Perinatal HIV Transmission in Maryland in 2022.

The perinatal transmission of HIV is preventable through a regimen that includes testing of all pregnant individuals, antiretroviral treatment (ART) for the pregnant individual, prophylactic or preventative ART for the infant, and cesarean section delivery for mothers with HIV viremia at the time of delivery. Under this protocol, the United States has seen a significant decline in the perinatal transmission of HIV and achieved a perinatal HIV transmission rate of 0.9% in 2019. However, despite this progress nationally and after zero transmissions in 2021, Maryland recorded 6 cases of perinatal HIV diagnoses in 2022. Each of the 3 major referral centers for pediatric HIV patients in Maryland reported 2 new cases in 2022. A root cause analysis of the cases identified risk factors including delayed entry into perinatal and HIV care, premature birth, maternal adherence challenges in the setting of substance use and other adverse social determinants of health, and failure to diagnose maternal HIV infection in a timely way. All patients were successfully linked to care and initiated on ART. Multiple factors contributed to the 2022 increase in cases of perinatal HIV in Maryland. To achieve and then sustain the elimination of perinatal HIV transmission, the constancy of systems that eliminate barriers for all pregnant people to access testing, prevention, and treatment is critical.

Comparison of intestinal and pharyngeal microbiota in preterm infants on the first day of life and the characteristics of pharyngeal microbiota in infants delivered by cesarean section or vaginally.

This study aimed to explore the distribution of intestinal and pharyngeal microbiota on the first day of life in preterm infants and compare the composition of microbiota in infants delivered by cesarean section or vaginally. This study included 44 late preterm infants with a gestational age of 34-36 + 6 weeks. Stool and throat swab samples were collected from the preterm infants on the first day of life. The infants were divided into cesarean section and vaginal delivery groups. Illumina NovaSeq high-throughput sequencing technology was used to sequence the V3-V4 hypervariable region of the 16S rRNA gene of all bacteria in the samples. Venn diagram was used to identify shared operational taxonomic units (OTUs) in the intestines and pharynges. Microbial analysis was conducted at the phylum and genus levels, and α and β diversity comparisons were performed. (1) Gestational age may have significantly affected the microbial colonization of the intestines and pharynges of preterm infants on the first day after birth (p ≤ 0.001). (2) More OTUs were detected in the pharynx than in the intestines, both have a total of 819 shared OTUs. Proteobacteria, Firmicutes, and Bacteroidota were the dominant phyla in both. At the genus level, Streptococcus had a lower relative abundance in stool samples (0.5%) compared to throat samples (0.5% vs. 22.2%, p = 0.003). 3) The relative abundance of Streptococcus in pharyngeal samples was 26.2% in the cesarean section group much higher than the 3.8% in the vaginal delivery group (p = 0.01). The early postnatal period is a critical time for the establishment of an infant's microbiota. Gestational age at birth may influence microbial colonization, while birth weight, gender, and mode of delivery do not. The intestinal and pharyngeal microbiota composition of preterm infants on the first day after birth showed high similarity, but larger samples are needed for further validation.

Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification

BackgroundThe worldwide rise in cesarean section rate is a major public health concern and cause of significant debate. Despite multiple studies showing that higher cesarean rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean births increases continuously. In the Republic of Moldova, the cesarean section has increased from 15.75% in 2012 to 27.42% in 2022, however, the perinatal mortality remains unchanged - constituting 11.6‰. In order to understand the factors that determine the increasing trend of cesarean section and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean section rates. ObjectiveTo assess changes in cesarean section rates and trends and to evaluate the contribution of different obstetrical populations to overall cesarean rates in Municipal Clinical Hospital using the Robson Classification. Study DesignA cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study includes 13882 women who gave birth in 2017, 2019, and 2022 in this hospital. All births were classified into 10 Robson groups, using six basic variables (parity, cesarean section delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi INFO program. ResultsThe overall cesarean section rate was 20.02% (2779/13882) with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252), P=0.0003. Approximately one-third 39.55% (1099/2279) of all cesarean deliveries were performed before the labor onset. The main contributor in all study years is Group 5 - 34.44% (957/2779). The next valuable group as a contributor to the overall cesarean rate are the women from Group 2 representing 14.14% (393/2779), followed by women of Group 1 with 11.98% (333/2779). ConclusionsThe use of the Robson Ten-groups classification offers a clear and detailed record of the cesarean section trends, and due to its simplicity and exclusivity, it can be implemented in the Republic of Moldova as well. The main contributors to the overall cesarean rate are women with a previous cesarean delivery - Group 5, followed by nulliparous women of Group 2 and Group 1.

Gene expression profiles in placenta and their association with anesthesia, delivery mode and maternal diabetes

IntroductionFetal development is dependent on placenta and affected by multiple factors including maternal diabetes. Here we aimed to identify maternal diabetes-associated changes in placentas and analyzed placental gene expression to understand its modulation by maternal diabetes and birth mode. MethodsPlacental RNAseq transcriptome analyses were performed on maternally-derived decidua and fetal-derived villous tissue from pregnancies of mothers with type 1 diabetes (n=14), gestational diabetes (n=6) and without diabetes (n=14). Information on delivery mode and anesthesia were included as covariables. Analyses were performed separately for decidua and fetal tissues and adjusted for sex. ResultsSubstantial placenta gene expression variation was associated with factors other than maternal diabetes, including site, sex, anesthesia type and delivery mode. Two dominant gene expression clusters aligned to anesthesia and delivery mode were observed for decidua and villous tissue. Upregulation of genes within pathways related to organ morphogenesis and downregulation of immune response to steroid- and hypoxia pathway genes was characteristic of placentas from primary cesarean section deliveries with spinal anesthesia. Opposite profiles were observed for placentas from secondary cesarean and epidural anesthesia deliveries. Placentas from vaginal delivery had intermediate gene expression profiles. More subtle changes were associated with maternal diabetes: upregulation of ribosome activity, down-regulation of maternally-derived decidua chemokine signaling pathways and for gestational diabetes, alteration in hypoxia response genes. DiscussionThe findings reveal suppression of immune pathways and upregulation of ribosome activity in the placenta by maternal diabetes highlighting the importance of confounding factors when examining cell and tissue expression profiles. Further studies should determine whether the observed gene expression differences are related to underlying causes for cesarean section deliveries.

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.

Application of the mesh bridging technique in the excision of abdominal endometriosis lesions: Case report and literature review.

Abdominal wall scar endometriosis (AWE) is a rare endometriosis that usually occurs after gynecological or obstetric surgery and for which surgical resection is the standard treatment. For large tissue defects after resection, abdominal wall reconstruction is needed. Here, we describe a mesh bridging technique using biological and polypropylene meshes for abdominal wall reconstruction. A 34-year-old woman visited the center with complaints of low abdominal wall pain during menstruation for more than 5 years. Her surgical history included undergoing a cesarean section delivery twice. A mass measuring 6 cm × 5 cm × 3 cm was found above the symphysis pubis in the lower part of the abdominal incision. Endometriosis lesion was considered based on abdominal ultrasound and magnetic resonance imaging findings. After a multidisciplinary discussion that included surgical experts and gynecologists, the decision was made to perform abdominal endometrial focus excision plus abdominal wall reconstruction. Two kinds of mesh were skillfully used in the operation of this patient. Biological mesh was used close to the peritoneal side and covered with polypropylene mesh to reduce the stimulation by the polypropylene mesh of the peritoneum, enhance the strength of the biological mesh, and reduce the incidence of abdominal wall hernia. Our case demonstrates that accurate diagnosis of AWE followed by complete resection and reconstruction of the abdominal wall using a combination of biological and polypropylene mesh bridging can achieve good therapeutic results and patient satisfaction.

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.

Exploring Cesarean Section Delivery Patterns in South India: A Bayesian Multilevel and Geospatial analysis of Population-Based Cross-Sectional Data

BackgroundThis paper focuses on the period from 2019 to 2021 and investigates the factors associated with the high prevalence of C-section deliveries in South India. We also examine the nuanced patterns, socio-demographic associations, and spatial dynamics underlying C-section choices in this region. A cross-sectional study was conducted using large nationally representative survey data.MethodsNational Family Health Survey data (NFHS) from 2019 to 2021 have been used for the analysis. Bayesian Multilevel and Geospatial Analysis have been used as statistical methods.ResultsOur analysis reveals significant regional disparities in C-section utilization, indicating potential gaps in healthcare access and socio-economic influences. Maternal age at childbirth, educational attainment, healthcare facility type size of child at birth and ever pregnancy termination are identified as key determinants of method of C-section decisions. Wealth index and urban residence also play pivotal roles, reflecting financial considerations and access to healthcare resources. Bayesian multilevel analysis highlights the need for tailored interventions that consider individual household, primary sampling unit (PSU) and district-level factors. Additionally, spatial analysis identifies regions with varying C-section rates, allowing policymakers to develop targeted strategies to optimize maternal and neonatal health outcomes and address healthcare disparities. Spatial autocorrelation and hotspot analysis further elucidate localized influences and clustering patterns.ConclusionIn conclusion, this research underscores the complexity of C-section choices and calls for evidence-based policies and interventions that promote equitable access to quality maternal care in South India. Stakeholders must recognize the multifaceted nature of healthcare decisions and work collaboratively to ensure more balanced and effective healthcare practices in the region.

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.

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. .