Cesarean Section Rate Research Articles

Impact of screening for large-for-gestational-age fetuses on maternal and neonatal outcomes: a prospective observational study.

Debates on the management of macrosomia are still current. We have to consider the consequences of screening to contribute to these discussions. Our aim is to study the consequences of the 3rd trimester fetal macrosomia screening protocols used in several centres in the same French region in order to determine whether this screening affects maternal and neonatal outcomes: mode of delivery, maternal complications (haemorrhage, perineal lesions), neonatal health (pH, Apgar score) and the occurrence of neonatal trauma during delivery. Prospective observational, multicenter cohort study (Reims, Châlons en Champagne and Charleville-Mézières hospitals). All women with low-risk pregnancies who could benefit from screening for fetal macrosomia were included. Neonatal macrosomia was defined as a weight above the 90th percentile according to AUDIPOG adjusted growth curves. The principal outcome was the cesarean section rate. Secondary outcomes were instrumental deliveries and maternal and neonatal morbidity and mortality. 2,217 women were included. Rates of cesarean section and instrumental delivery were higher if macrosomia had been screened, whether rightly, in large-for-gestational-age newborns (respectively 9,802 [1.638-190.290], p=0.038 and 3,021 [1.099-8.846], p=0.036) or wrongly, in newborns who were ultimately appropriate-for-date (respectively ORa 3.562 [1.377-10.128], p=0.01 and 3.042 [1.139-8.596], p=0.36). This screening did not reduce maternal and neonatal morbidity and mortality. Screening for fetal macrosomia may be associated with increased rates of cesarean section and instrumental delivery for large-for-gestational-age and appropriate-for-date newborns. These results do not show any impact of these variations on maternal or neonatal health, and do not allow us to change practices directly. They do, however, alert us to the consequences of widespread screening for LGA and its possible side effects, which could be better targeted to high-risk populations or improved according to other criteria.

Racial Disparities in Cesarean Section Rates Between Non-Hispanic Black and Non-Hispanic White Populations in the United States

AbstractThis study uses national natality data from the National Vital Statistics System, provided by the National Center for Health Statistics, covering the years 2011 to 2018 (N = 23,810,031) to investigate racial disparities in cesarean section (C-section) rates between non-Hispanic Black and non-Hispanic White mothers in the United States. This analysis offers a comprehensive perspective on the factors contributing to C-section disparities by considering mothers' demographic characteristics, health conditions, and infant health status. Using multivariable logistic regression, the findings reveal consistently higher C-section rates for non-Hispanic Black mothers compared to non-Hispanic White mothers, with the gap widening over time. Even after adjusting for sociodemographic and health-related factors, non-Hispanic Black mothers remained more likely to undergo C-sections. Using Blinder-Oaxaca decomposition methods, key factors contributing to this C-section rates disparity include maternal age, the source of delivery payment, and fetal presentation. This study highlights the pressing need for further investigation into healthcare system factors and racial inequities driving these disparities, alongside the growing urgency for policy and practical interventions to reduce unnecessary C-sections.

Obstetric outcomes in women with vulvodynia and vaginismus: a systematic review.

Vulvodynia and vaginismus are pain disorders associated with adverse pregnancy outcomes. The few published studies addressing this topic were limited in terms of the different outcomes studied; hence, the purpose of our study was to perform the first systematic review examining maternal, neonatal and obstetric outcomes in patients with vulvodynia and/or vaginismus (VV). We conducted a systematic review searching PubMed, EMBASE, Cochrane Library and SCOPUS until November 2023 for observational studies reporting maternal and/or neonatal outcomes of VV in pregnancy. Data on maternal characteristics and obstetric outcomes were independently extracted from the included studies by two reviewers and then summarized between those with and without VV. The search strategy yielded 1118 citations, of which 10 were included. A total of 2209 patients with a diagnosis of VV prior to pregnancy were identified over a 27-year study period. Compared with women without VV, women with VV were more likely to deliver by cesarean sect. (40.3 vs 29.8%, p < 0.001). Cesarean sections were more likely elective (41.0 vs 35.7%) and performed in response to maternal request (26.0 vs 9.5%) for women with VV. Of those who delivered vaginally, instrumental deliveries were more common among women with VV (16.7 vs 6.2%, p < 0.001), with more perineal injuries as well (43.0 vs 32.7% p < 0.001). Vaginismus/vulvodynia are high-risk conditions during pregnancy with increased rates of cesarean sections performed for elective reasons and upon maternal request. Offering support, education, and treatment for these conditions prior to pregnancy is important to reduce the rate of avoidable cesarean sections.

Current concepts on the use of the partogram to monitor labor progression.

The partogram is a graphic tool used to monitor labor progression. This article reviews the recent literature on the use of the partogram, aiming to evaluate whether its implementation reduces cesarean section rates and to determine which model is more appropriate. Studies that compared using the partogram with not using it were analyzed, as well as studies that contrasted different partogram models. The results indicate that partogram use is not associated with a significant reduction in cesarean section rate, particularly in countries with low cesarean section rates. However, the modified World Health Organization partogram, which eliminates the latent phase, appears to have advantages over the classic 1994 model, with significantly lower cesarean section rates. Although the partogram has not shown significant benefits in reducing cesarean sections, it is still a useful tool for graphically documenting the progress of labor, which could improve clinical decision-making. In Chile, the high cesarean section rates, close to 45%, suggest that implementing the WHO 2000 partogram could be beneficial. However, local studies are needed to confirm the potential benefits of reducing cesarean sections.

Effects of factors influencing cesarean section rates between 2008 and 2018 in Taiwan: A population-based cross-sectional study.

Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician's sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625-.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician's sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.

The association among fetal head position, fetal head rotation and descent during the progress of labor: a clinical study of an ultrasound-based longitudinal cohort study in nulliparous women.

To elucidate the effects of the timing of fetal head rotation on the labor progress and outcomes. A paired ultrasound measurement was performed at each of the three stages of labor: latency stage, active stage, and full-cervical-dilatation stage. The measurements included fetal head position, head-perineum distance (HPD) and the angle of progression (AOP). A total of 46 pregnancy women were included and a total of 102 effective measurements were collected. The cases in occipital anterior position were all eutocia. The rate of cesarean section in the left transverse occipital group was the highest (15.7 %, 3/19). There were 13 cases (37.1 %) with fetal head rotation occur during active phase, changing from occipital transverse to anterior. Ten cases (28.6 %) rotated in the second stage of labor. The average rotation degree of occipital transverse to anterior position was 62.6°. When AoP <95°, 100 % of the women were occipital transverse; When AoP≥125°, 66.7 % was occipital anterior. The rate of oxytocin utilization and epidural analgesia in the occipital posterior group was higher than that in the other groups (71.4 and 85.7 %, respectively). Occipital transverse is the most common fetal head position in the early stage of labor and fetal head rotation occurs mostly in the active phase and the second stage of labor. Sufficient time should be given in labor management for women that who tried vaginal delivery without contraindications.

Iranian mothers’ perceptions of contextual factors helping them manage pain in labor

BackgroundThe rate of caesarean section in Iran has significantly increased. The main reason cited by Iranian mothers for it is labor pain and fear of it. However, the experience of pain during childbirth has different meanings for mothers in various conditions. Therefore, this study aims to examine the components from the mothers’ perspective that helped them manage pain in labor. The findings of this article may help prevent unnecessary medical interventions.MethodsThe current article is one component of a mixed-method study conducted in Iran. Its primary objective was to develop protocols for maternity unit design to enhance maternal satisfaction, promote husbands’ involvement, and improve pain management. The current study focuses on examining contextual components that are effective in managing pain among 25 mothers selected through stratified purposive sampling. Data collection from mothers who gave birth in four large hospitals in Iran was carried out through unstructured in-depth interviews. The data were analyzed using interpretative phenomenological analysis.FindingsThe data show that two major environmental factors affect mothers’ perception of pain and their ability to control it: (1) Internal and (2) External environments. The main components of the internal factor are identified as “Personal beliefs”, “Self-confidence and lack of fear”, and the external environment includes three subfactors: “Spatial environment”, “Social environment”, and “Interactive environment”. The overall meaning attributed to pain caused by these factors determines how mothers can cope with it.ConclusionIn this study, self-confidence and a positive mindset were significant factors in managing pain during labor among this group of mothers. Furthermore, each mother’s perception of pain was shaped by a combination of physical, social, and interactive influences. The research identified the importance of support during labor according to mothers’ individual, subjective needs, while improving the physical environment, with a view to reducing interventions and promoting positive experiences for mothers and husbands. Consequently, enhancing internal resources and the birthing environment during labor which involve identifying the optimal blend of physical, mental, and emotional strategies tailored to the specific needs of mothers, can be considered to a potential reduction in the perceived intensity of pain in future.

Maternal, Fetal, and Kidney Outcomes of Viable Pregnancies in Women with Underlying Kidney Disease: Experience from a Single Tertiary Care Center in India

Background There is a dearth of data from resource-limited settings on pregnancy outcomes in women with kidney disease. We investigated the maternal, fetal, and renal outcomes of pregnancies amongst women with kidney disease and compared these outcomes with normal pregnancy outcomes. Materials and Methods This was a single-center retrospective observational study. The maternal, fetal, and renal outcomes of women with kidney dysfunction who delivered at the study center after at least 22 weeks of gestation (viable pregnancy) between January 2012 and December 2021 were analyzed. The study results were also compared with the outcomes of normal pregnancy. Results Two hundred and one deliveries were included in the study, constituting 0.14% of all deliveries during the study period. Lupus nephritis (39.3%) and Immunoglobulin A nephropathy (11.4%) were the most common underlying kidney diseases. The mean (±SD) gestational age at delivery was 34.9 (±3.7) weeks. A higher cesarean section rates (45.3%) were observed in these high-risk pregnancies. Low birth weight was observed in 51.7% of all deliveries. Renal outcome regarding proteinuria and estimated glomerular filtration rate was excellent. Renal transplant patients had unfavorable outcomes. More than 45% of patients had term deliveries with normal birth weight. Conclusion Satisfactory maternal, fetal, and renal outcomes can be achieved with proper pre-pregnancy counseling and multidisciplinary care in women with kidney diseases, even in resource-limited settings.

Application of comprehensive nursing combined with ISBAR handover approach in the nursing of patients with placental abruption.

The research for this paper was conducted to unveil the effect of comprehensive nursing combined with the Identification-Situation-Background-Assessment-Recommendation (ISBAR) handover approach in the nursing of patients with placental abruption. The 40 cases of placental abruption patients admitted to the Women's Hospital School of Medicine Zhejiang University from May 2021 to May 2022 were subjected to conventional basic nursing combined with traditional handover tool intervention, which was recorded as the control group; the 40 cases of placental abruption patients admitted to the Women's Hospital School of Medicine Zhejiang University from June 2022 to June 2023 were subjected to comprehensive nursing combined with ISBAR handover tool intervention, which was recorded as the observation group. Maternal and infant outcomes, the quality of nurse handover, and the psychological burden [State Anxiety Inventory (S-AI), Trait Anxiety Inventory (T-AI), Distress Thermometer (DT), and General Self-Efficacy Scale (GSES)] were observed in the two groups, and the satisfaction with nursing was also assessed by using a self-administered satisfaction scale in the two groups. The rate of normal delivery of patients in the observation group was higher and the rate of cesarean section and the total incidence of complications were lower than that of the control group. The 1- and 5-min Apgar scores of the newborns in the observation group were higher and the total complication rate was lower than that in the control group. Nurses in the observation group had higher scores for nurses' shift handover quality. S-AI, T-AI, and DT scores were lower in both groups after the intervention and were lowest in the observation group; GSES scores were higher and were highest in the observation group. Satisfaction with nursing was higher in the observation group than in the control group. Comprehensive nursing combined with the ISBAR handover approach applied to the clinical care of patients with placenta abruption can effectively improve the outcomes of mothers and infants, enhance the quality of nurses' shift handovers, reduce the psychological burden of patients and increase nursing satisfaction.

Analysis and trends of caesarean sections using Robson’s classification over 7-year period at a rural teaching hospital

ABSTRACT Background: A ten-group classification system of caesarean section was proposed by Michael Robson in 2001. It is helpful in comparing the rates of caesarean section between hospitals. The objective of this study was to determine the caesarean section rates to analyse trends of caesarean section and classify according to Robson’s categories. Methods: This cross-sectional study was conducted from 2016 to 2022. A total of 3176 women who underwent caesarean section were grouped under Robson’s ten-group classification system. Results: The most common group was Group 5 (All multiparous women with at least one previous uterine scar, with single cephalic pregnancy, ≥37 weeks gestation) followed by Group 2 (Nulliparous women, with single cephalic pregnancy, &gt;37 weeks gestation who either had labour induced or were delivered by caesarean section before labour). Results were obtained for the specified period (from 2016 to 2022), and Group 5 contributes more to the total CS rates (45% in 2016, 46% in 2017, 46% in 2018, 57% in 2019, 49% in 2020, 52% in 2021, 54% in 2022), followed by Group 2 (20% in 2016, 17% in 2017, 18% in 2018, 19% in 2019, 26% in 2020, 24% in 2021, 24% in 2022). Conclusion: Pregnant women with prior uterine scars contribute more to caesarean section rates according to Robson’s categories. Hence, strategies must be implemented to lower the primary caesarean section rates.

High efficiency removal of Cs+ by Fe-Co framework PBAs from radioactive wastewater

The widespread application of nuclear energy has increased the risk of contamination by radionuclide 137Cs. Prussian blue analogues are considered to be excellent materials for the removal of 137Cs from wastewater due to their unique structure. In this work, Cs+ adsorbent for PBAs with Fe-Co framework, potassium iron hexacyanocobaltate (PBAFe), was synthesized by room temperature precipitation method. Systematic structural characterization and performance results of PBAFe showed that it has a specific surface area of 452.8 m2/g and an average pore size of 8.6nm, providing more active sites for Cs+. The adsorption of Cs+ on PBAFe exhibited fast reaction kinetics (within 10min) and high adsorption capacity (82.90mg/g), and the removal rate of Cs+ reached 98.57%. The efficient removal of Cs+ by PBAFe in various real water environments showed its excellent selectivity and potential for practical application. In addition, adsorption mechanism studies showed that the adsorption of Cs+ was achieved by ion exchange with K+ in the PBAFe lattice. PBAFe has the advantages of simple synthesis and good selectivity, and has potential application in the harmless treatment of Cs+ in radioactive wastewater.

Strategies to reduce cesarean deliveries: surveying polish obstetricians on external cephalic version practices.

The cross-sectional survey was conducted aiming to evaluate the knowledge and experiences of the Polish obstetricians and gynecologists regarding the External Cephalic Version (ECV) and investigate their practices concerning this procedure. An online survey constituting author-created questionnaire with 22 questions, was distributed among gynecologists and obstetricians. The questionnaire evaluated participants' knowledge about ECV, work experiences, and workplace practices. Out of 461 respondents, 56.20% were specialists in gynecology and obstetrics. Elective cesarean section (CS) was preferred by 78.70% for primiparas and 73.50% for multiparas with non-cephalic presentation, while ECV would be chosen by 21.3% and 23.6%, respectively. While 73.80% knew centers performing ECV, only 16.70% had actively participated in the procedure. Major differences in the experiences and knowledge regarding ECV were observed based on work experience, and workplace reference level. Experienced physicians showed higher concerns about ECV complications and emergency CS risks. The most common concerns regarding the procedure referred to periprocedural pain, perceived low efficacy, and complications, and were more prevalent among respondents with longer experience and from lower-reference centers. The study demonstrated that among Polish obstetricians for term pregnancies with non-cephalic presentation, elective cesarean section is preferred over ECV, especially among experienced practitioners. Knowledge about ECV was relatively low, indicating a need for improved educational efforts. Addressing concerns about ECV's safety and efficacy, particularly through enhanced training and anesthesia options, could promote its adoption and reduce CS rates.

A model for predicting severe intra-abdominal adhesions following prior cesarean sections.

The increasing rate of cesarean sections (CS) raises concerns over severe intra-abdominal adhesions, which are associated with numerous complications. We aimed to identify risk factors and predictive tools for severe adhesions. In a prospective study at a tertiary medical center from January-July 2021, women with at least one prior CS were evaluated. Surgeons assessed adhesions at four anatomical sites, scoring them from 0 (none) to 2 (dense), with a total possible score of 0-8. Severe adhesions were defined as a score of ≥5. Risk factors were analyzed using logistic regression to create a prediction model. Overall, 341 women were included in the study. Significant predictors included the number of previous CS, maternal BMI, maternal morbidity at the time of the previous CS, and operation time. The model predicted severe adhesions with 79.1% accuracy, a positive predictive value of 68.4%, and a negative predictive value of 79.5%. The severity of most cases of post-CS adhesions can be predicted by a model which considers common risk factors.

Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model.

Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context. We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia. Our sample comprised singleton term pregnant women (n = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783-0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565-0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery. This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.

Isthmotsele: modern aspects of diagnosis, therapy and prevention of complications (Literature review)

Worldwide there is an increased rate of caesarean section (CS), which leads to an growth in the percentage of intra- and postoperative complications compared to natural childbirth. One of such longterm complications after abdominal delivery is a scar defect on the uterus after SC (isthmocele).This literature review provides up-to-date scientific information on the etiology, risk factors, diagnosis, modern methods of correction and prevention of complications of this pathology.Isthmocele, by definition, is a scar defect after SC or a niche of the uterine wall, which has the appearance of a myometrial tear or a triangular anechoic defect of the anterior uterine wall, which can be classified as a small or large defect depending on the thickness of the residual (remaining) myometrium. Pathognomonic clinical symptoms are abnormal uterine bleeding, chronic pelvic pain, and infertility.In addition, pregnancy in the scar after SC, placenta previa or placenta accreta spectrum (PAS), rupture of the uterus in the area of the postoperative scar can be complications of this pathology during gestation.The main risk factors for isthmocele, proven to date, are previous SC and retroflexion of the uterus, and the influence of the technique of suturing the uterus during SC requires further research.In order to diagnose isthmocele and determine the thickness of the residual myometrium, transvaginal ultrasound, infusion sonohysterography with physiological solution, and magnetic resonance imaging are used.Treatment of isthmocele can be medical or surgical, depending on the size of the niche, the thickness of the remaining myometrium, the presence of symptoms and the woman’s reproductive plans. In case of refusal or contraindications to medical treatment, surgical correction of the isthmocele should be offered. Surgical treatment includes minimally invasive approaches using hysteroscopy, laparoscopy, or transvaginal techniques.Hysteroresectoscopy involves partial removal of the myometrium along the edges of the niche with coagulation of vessels. Therefore, this technique if the residual thickness of the myometrium is &lt;3 mm should not be used in women who want to get pregnant. In these cases, myometrial repair is of primary importance and can be achieved by laparoscopic, laparotomy, or vaginal access. The review also provides information on the most serious complication of isthmocele – the development of a pregnancy in a scar/niche and modern approaches to managing such pregnancy.

Using the Robson’s Classification System to Analyze the Trend of Cesarean Section in a Tertiary Care Hospital: An Observational Study from Bangladesh

Introduction: A caesarean section (CS) is an obstetric procedure often performed when it is determined that vaginal delivery could be harmful to either mother or the baby. There is a growing concern about the increasing percentage of CS globally and this is particularly dramatic in many middle- and high-income countries, but at a lower degree in low-income countries. Hence, this study aimed to analyze the trends in cesarean section rates at a tertiary care hospital in Bangladesh using the Robson’s classification system. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Islami Bank Hospital, Dhaka, Bangladesh from January 2023 to September 2024. Our study included 486 pregnant women who underwent a caesarean section under the Department of Obstetrics and Gynaecology of our hospital during the study period. Result: In this study, we found that group 5 (multiparous with previous CS, single cephalic, ≥37 weeks- with one previous CS and two or more CS) had the highest frequency with 220 cases (45.27%). Most of our patients (68.72%) were aged between 18-30 years and the majority (95.47%) of the deliveries occurred at gestational ages &gt;37 weeks. Out of 229 caesarean sections, 67.08% were elective, and 32.92% were emergency cases. The most common indication for CS was PCS (45.27%), followed by poor progress in labour (21.60%) and foetal distress (13.37%). Conclusion: Our study found that the use of the Robson’s classification of CS is increasing, and Robson group 5 is the main contributor to the overall CS rate.

Family Size and Past Obstetric History of Married Women Aged 45 Years and Older in Erbil.

The family size plays an important role in fulfilling the primary needs of each family member and providing a quality life for them. This research studies the association of family size with various socioeconomic and demographic factors and the lifetime fertility patterns of previous decades. This cross-sectional study was conducted at the Maternity Teaching Hospital in Erbil, Kurdistan Region of Iraq (KRI). The data was collected from December 11, 2023, to April 15, 2024, after the ethics committee of the Kurdistan Higher Council for Medical Specialties approved the proposal. A convenience sample of 400 women aged 45-74 years who had completed their families were directly interviewed. The data was analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). The prevalence of large family size (seven members and above) was 78.5%. The lifetime fertility rate of the women was 6.78 live births per woman. Large family size is significantly (p < 0.001) associated with age <18 years at marriage, short birth spacing interval, and unplanned pregnancies. The majority (91.7%) of the participants were grand multipara. The Cesarean section (CS) rate was 7.3%, 60.2% of the births were delivered at home, and 46.6% of the live births were delivered with a preceding birth interval of less than two years. The majority (82.2%) of the pregnancies were unplanned. Large family size is highly prevalent among women who have completed their families in Erbil. Many demographic and socioeconomic factors are associated with large family sizes, such as rural residency, age <18 years at marriage, low socioeconomic status (SES), short birth spacing interval, and unplanned pregnancies.For a more desired family size, it is recommended that young females be empowered by encouraging their education and providing occupation opportunities. In addition to that, prohibiting early marriageand providing/strengthening premarital programs focusing on the importance of family planning including birth spacing and utilizing contraceptive methods properly play a great role.

A Prospective Evaluation of Health Literacy Levels of Pregnant Women in Antenatal Classes: Impact on Delivery Outcomes in Nulliparous and Multiparous Women.

Backgrounds/Objectives: Modern technology and educational activities, such as antenatal classes (ACs), increase patient informedness in medicine and improve collaboration between physicians and patients. The present study aimed to evaluate and compare the impact of maternal health literacy (HL) on delivery outcomes between nulliparous and multiparous women who attended antenatal classes. Methods: This prospective study recruited 281 pregnant women who regularly attended ACs, but only 188 who gave birth at our academic tertiary hospital were included in the final analysis. Socio-demographic characteristics, peripartum data (cervical dilatation at the time of admission to the hospital, duration of labor, and mode of delivery), and obstetric interventions (cesarean section (C/S) rate and rate of instrumental vaginal birth and episiotomy) were recorded, and the level of HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HL levels did not significantly affect peripartum and postpartum outcomes. Results: The study results showed that HL levels did not impact labor duration and newborn Apgar scores (p > 0.05). Patient education levels and employment status affected the peripartum duration of labor (p = 0.048 and p = 0.001, respectively). There were no differences in the HL total score and subscale scores (p > 0.05) between nulliparous and multiparous patients, and the rate of primary C/S was similar in both groups. Conclusions: HL levels did not impact delivery (peripartum) outcomes in pregnant women who attended antenatal classes. However, the primary C/S rate was similar between the nulliparous and multiparous groups, which may indicate that antenatal education services can correct the negative impact of low HL levels on the primary C/S rate.

A 5-years cross-sectional study of risk-factors feto-maternal outcomes in placenta accreta spectrum at single tertiary care centre in South India

: PAS is an abnormal placental trophoblastic invasion into the myometrium, serosa and surrounding structures causing severe maternal morbidity and mortality due to massive obstetric hemorrhage (MOH). The incidence of PAS is on the rise due to increasing rate of Cesarean Section (CS) worldwide. : This study aimed to assess the risk factors associated with Placenta accreta spectrum (PAS) and to compare the feto-maternal outcomes in elective and emergency delivery in PAS.This is a 5 years single centre cross-sectional study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included. A total of 38 cases of PAS were studied. Chi-square test and T-test were used to compare the categorical variables with p value 0f &amp;#60;0.05 as statistically significant.The incidence of PAS was 1.85/1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors. MOH was the commonest complication. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Prematurity and low birth weight were the most important perinatal outcomes. Adequate blood and blood products prior to surgery is important as even in expert hands blood loss can be massive. Early referral and specialized regional team to manage PAS at tertiary care are needed. Future studies should emphasize on easy and early detection of PAS.

Feasibility, safety, and clinical outcomes of modified laparoscopic cervicoisthmic cerclage for refractory cervical insufficiency: A single-arm clinical trial-Part 1.

To assess the feasibility, safety, and outcomes of modified laparoscopic transabdominal cerclage in patients with refractory cervical insufficiency. This single-arm clinical trial examined women with refractory cervical insufficiency who underwent modified laparoscopic transabdominal cerclage at a specialized center in Japan between December 2017 and May 2022. Various parameters related to patient demographics, surgical techniques, outcomes, and complications were evaluated. The study enrolled 30 women with a median age of 36 years. The modified laparoscopic transabdominal cerclage was technically successful in all cases. The delivery rate and fetal survival rate at 28 days in the third trimester were both 93%. Surgical complication involving small bowel injury occurred in one case and was promptly repaired. No fetal complications or pregnancy losses occurred within 28 days of the procedure. Perinatal outcomes included a cesarean section rate of 93%, a neonatal intensive care unit admission rate of 30%, and an overall fetal survival rate of 93%. Additionally, no absence or reversal of end-diastolic flow in the uterine artery was identified at the time of cerclage in any of the cases. This study demonstrated the feasibility and safety of modified laparoscopic transabdominal cerclage for refractory cervical insufficiency. The procedure achieved a high delivery rate in the third trimester and a good overall fetal survival rate. The study findings highlight the importance of anatomical precision during thread placement in modified laparoscopic transabdominal cerclage. This technique is promising for treating refractory cervical insufficiency and potentially preventing second-trimester losses and extreme preterm births.