Cesarean Section Research Articles

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.

Cesarean Section and Its Impact on Uterine Artery Resistance and the Risk of Pre-eclampsia in Subsequent Pregnancies

Background: The purpose of the current study was to compare the color Doppler findings of uterine arteries and perinatal outcomes in pregnant women with and without previous cesarean section (C/S). Methods: This cohort study enrolled 308 pregnant women aged 20-35 without underlying diseases, with at least one previous pregnancy and childbirth. The participants were divided into two groups: 154 women without C/S and 154 women with C/S. Baseline data were collected, followed by uterine artery Doppler scans. Then, the perinatal outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), premature delivery, and birth weight were evaluated. Results: The average age of patients in the C/S group was 30.46±3.81, which was significantly higher than the non-C/S group (28.86±4.64). It was found that uterine artery resistance was higher in women with C/S history (1.11±0.44, p<0.001) compared to those without (1.00±0.37, p<0.001). Pre-eclampsia incidence was also higher in C/S group (16.1%, p=0.042) compared to non-C/S group (9.1%, p=0.042). The incidence of preterm birth in the C/S group (p=0.209), the incidence of IUGR (p= 0.791), and the average birth weight (p=0.291) in the two groups did not differ significantly. The average gestational age in the C/S group was 37.54±1.4, and in the non-C/S group was 38.01±1.99 weeks. The results were not affected by potential confounders such as age, the time interval between pregnancies, and also body mass index. Conclusion: Previous cesarean section can significantly increase the uterine artery resistance in subsequent pregnancy.

MORTALIDADE NO PERÍODO GESTACIONAL POR COMPLICAÇÕES ANESTÉSICAS: NÚMEROS NACIONAIS DOS ÚLTIMOS 10 ANOS

Brazil stands out globally for the number of cesarean sections performed annually, with figures far exceeding the recommendations of the WHO – World Health Organization. Cesarean delivery requires appropriate anesthetic blockade, with various techniques possible, the most common being spinal anesthesia and, less frequently, general anesthesia techniques. Both regional and general anesthesia techniques have advanced significantly in recent years but are not free from complications, which are associated with both maternal history and the anesthetic procedure itself. Maternal morbidity and mortality during the gestational period is a public health issue, which is also linked to the appropriate choice of delivery method and necessary anesthesia procedure. Therefore, the aim of this study is to examine the national number of maternal deaths related to anesthetic procedures over the past 10 years – from 2014 to 2023 – and to compare national data with international data, based on the most recent scientific literature.

Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series

Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy. Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates. Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody. Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers.

Abnormal AFI and Its Implications on Fetomaternal Outcome

Background: The AFI is directly associated with adverse outcomes for both the mother and the foetus; oligohydramnios (AFI ≤8 cm) and polyhydramnios (AFI ≥25 cm) are considered ‘abnormal’. The aim of this study was to compare the maternal and foetal complications in full-term pregnancies with abnormal AFI, as well as to assess the effectiveness of ultrasound and Doppler in identifying possible threats that may affect delivery plans. Methods: The current observational study was conducted in a hospital context at Paropakar Maternity and Women’s Hospital located in Kathmandu, Nepal between October 2019 and February 2020. This study investigates the maternal and fetal outcomes associated with polyhydramnios and oligohydramnios in 60 cases of pregnancy. Data on maternal and foetal results, including the type of birth, problems, and neonatal APGAR ratings, were collected and evaluated. Continuous variables were described as mean ± SD, while categorical data were expressed in percentage. Results: The prevalence of polyhydramnios was 2% and oligohydramnios was 5.33%. Common maternal complications included preeclampsia, postpartum hemorrhage, and gestational hypertension, while fetal outcomes included low APGAR scores, low birth weight, and NICU admissions. Oligohydramnios was found to be predominantly associated with post-term pregnancies (36.36%) and preterm premature rupture of membranes (13.63%), which led to a higher frequency of caesarean sections (70.46%) when compared to polyhydramnios cases. Conclusion: Our findings suggest that ultrasound and Doppler assessments are crucial in identifying high-risk pregnancies and making appropriate delivery decisions to improve maternal and fetal outcomes."

The p-value of a test is not the probability that the null hypothesis is true or false

One of the most common errors made by physicians in all developed countries is to say that the p-value of a test is the probability that the null hypothesis considered in the test is true or false. Eighty percent of those polled in many surveys make this mistake. The p-value of a test is the probability of obtaining a result like the one obtained in the investigation if the null hypothesis is true. The probability of a pregnancy involving three embryos is very small, at 0.00008 (8 in 100,000). In pregnancies with triplets, the probability of a caesarean section being performed is very high, at 0.98 (98%). These are two very different values, and two very different concepts. Saying that 0.98 is the probability of a pregnancy involving triplets would be a serious mistake. We make the same mistake when we say that the p-value of the test is the probability that the null hypothesis is true, or the probability that it is false.

Comparative study on maternal and fetal outcomes in emergency versus elective caesarean section

: The progressive increase in the incidence of caesarean section during the last few decades has been constant worldwide, increasing; at the same time, the indications, many of them unnecessary, resulting in indiscriminate practice, becoming the most frequent surgical intervention performed in health institutions, both private and public. Caesarean section is preferred as an emergency or elective procedure depending on the maternal and fetal conditions. It has been seen that risk of surgical complications is greater with emergency as compared with elective caesarean section. : Present study is a retrospective study, designed to evaluate maternal and fetal outcomes in elective versus emergency caesarean sections performed at our hospital from January 2023 to December 2023.: Out of total 2573 deliveries conducted, 1496 were normal deliveries, 116 were instrumental and 961 were caesarean deliveries, 446 were emergency and 515 were elective caesarean section. In our study overall operative complications were 114(11.8%) which was mainly contributed to emergency group.: The elective caesarean section shows less maternal and perinatal complications as compared to emergency caesarean sections.

A case series on caesarean myomectomy

Uterine leiomyoma is the frequently identified benign tumor and its incidence is about 10%-20% in pregnant women. Treatment of myoma during caesarean section remains a debated subject in spite of advancement in medical treatment. A patient who undergoes myomectomy during cesarean section will not require a second operation, anesthetic complications and increased expenditure. Here, we report a series of 8 cases where myomectomy was performed during caesarean section for large anterior lower segment fibroids ranging in size from 4 to 12 cms.

Chronic Low Back Pain Post-Caesarean Delivery: A Physiotherapist’s Perspective

This short review investigated the connection between neuraxial anaesthesia and chronic low back pain (CLBP) following caesarean sections, highlighting an important area of concern as the prevalence of such surgeries increases. Several risk factors for developing CLBP were identified, including needle size and patient posture during the procedure. Emphasis was placed on the crucial role of physiotherapists in distinguishing between pregnancy-related back pain and pain resulting from anaesthesia, as well as monitoring postoperative symptoms. Effective physiotherapy interventions were discussed, focusing on improving posture, enhancing mobility, and addressing psychosocial factors that may impact recovery. By advocating for a multidisciplinary approach, the review highlighted the necessity for comprehensive strategies that consider both physical and psychological aspects of recovery, ultimately aiming to optimise outcomes for women after caesarean delivery. Keywords: Chronic low back pain, Neuraxial anaesthesia, Caesarean section, Physiotherapy interventions, Risk factors, Multidisciplinary approach

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 <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.

Implementing a colostrum-kit reduces the time to first colostrum for neonates admitted to the NICU - a retrospective observational study.

The World Health Organisation states that newborns should receive colostrum as soon as possible after birth. However, among newborns needing neonatal intensive care, initiation of lactation and access to colostrum might be delayed. At the centre of this study, a tertiary care hospital in Sweden (10,000 deliveries/year), few admitted infants received colostrum within the day of birth, warranting a quality improvement. In order to reduce the time from birth to first colostrum received by infants admitted to the Neonatal Intensive Care Unit (NICU), a new clinical routine including a colostrum-kit, was implemented as standard care in June 2018. The colostrum-kit contained information about hand expression of breastmilk as well as material for collecting, labelling and transporting the colostrum. The kit should be handed to all birthing parents with infants admitted to the NICU. Data on time in minutes from birth to first colostrum administered to the infant (oral mouth care, oral feeding or gavage feeding) was retrieved for all infants born between 1 September 2016 and 31 October 2023, admitted to the NICU within 1h from birth. Infants were divided into four time-cohorts, compared with nonparametric ANOVA. The study included 3618 infants born at 22 + 0 - 43 + 0 weeks gestational age, of whom 2814 (78%) had available data on time to colostrum. Median (IQR) time in hours was 35 (20-36) pre-implementations, followed by 18 (7-38), 11 (4-26) and 8 (3-22) in the subsequent follow-up cohorts, p < 0.001. Subgroups of mode of delivery had median (IQR) pre-implementation of 30 (19-54) for vaginal and 47 (23-72) for caesarean section that reached 7 (2-18) and 9 (3-26) in the last follow-up. Subgroups of gestational age (< 28, 28-31, 32-36, > 36 weeks) had a pre-implementation time of 48 (26-80), 46 (23-73), 33 (20-60) and 32 (19-57), that in the last follow-up was reduced to 4 (2-20), 7 (2-29), 9 (2-33) and 9 (4-19). Implementing a colostrum-kit for infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages. The difference between subgroups of gestational age or mode of delivery was reduced. The effect persisted over time.

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.

The effect of acupressure on postpartum pain and comfort after cesarean delivery: a randomized controlled trial

ABSTRACT This randomized controlled study aims to investigate the effect of acupressure on pain and postpartum comfort following a cesarean section. The study was conducted with 60 women who underwent cesarean delivery. The participants were randomly assigned to either the intervention or control group. In the intervention group, acupressure was applied to the LI4, SP6, and P6 points for 15 minutes at the 2nd and 4th hours after the cesarean section. In the control group, acupressure was not applied and only routine nursing care was given. Data was collected using a personal information form, Visual Analog Scale (VAS), and Postpartum Comfort Questionnaire (PCQ). Acupressure application was applied to the intervention group at the 2nd and 4th hour after cesarean section. All data collection forms were filled out by women in the intervention group before starting acupressure application at 2 hours after cesarean section. VAS was filled out again after acupressure application at 2 hours. VAS was filled out before and after acupressure application at 4 hours after cesarean section. PSQ was filled out in both groups before discharge. In the study, the intervention group’s 2nd (3.03 ± 1.24, p < .001) and 4th (4.06 ± 1.22, p < .001) hour posttest VAS scores were lower and PCQ posttest scores (140.6 ± 9.01, p < .001) were higher than the control group. The results indicate that acupressure intervention applied to points LI4, SP6, and P6 was a useful nonpharmacological treatment for postpartum pain and comfort for the study group.

Is There an Association Between Cesarean Section Delivery with Specific Learning Disabilities (SLD) or/and Attention-Deficit/Hyperactivity Disorder (ADHD)? A Cross-Sectional Study in Greek Population

Background/Objective: Learning difficulties (LDs) are lifelong neurodevelopmental disorders with multifactorial causes, including perinatal factors like mode of delivery. This study aims to explore whether cesarean section (CS) delivery is linked to the occurrence of specific learning disabilities (SLDs), attention-deficit/hyperactivity disorder (ADHD), or their comorbidity. Methods: An online questionnaire was distributed via Google Forms to Greek mothers and parents of children with and without diagnoses, shared through school-related groups and various Greek pages focused on child development, special education, and learning difficulties. Conducted over eight months (October 2023–May 2024), this cross-sectional study involved 256 children, 137 with LDs diagnoses, and 119 controls. Results: In total, 59.9% of CS-born children had a diagnosis, compared to 40.1% of those born vaginally (X²(1) = 4.19, p = 0.045). CS delivery was associated with a 68% increased likelihood of LDs (OR = 1.68, 95% CI [1.02, 2.76]), with higher risks for ADHD (OR = 2.25, 95% CI [1.06, 4.79]) and comorbid SLD/ADHD diagnoses (OR = 2.75, 95% CI [1.17, 6.46]). Stratified analyses showed birthweight and gestational age as effect modifiers rather than confounders. Key postnatal risk factors identified were family history (OR = 4.65, 95% CI [2.41, 8.94]) and language acquisition difficulties (OR = 5.28, 95% CI [1.36, 20.47]). Conclusions: The findings suggest a possible association between CS and LDs, along with a novel link between CS and increased comorbidities. These results underscore the need for further research and provide valuable insights into how CS delivery may influence the risk of LDs, depending on the type of diagnosis.

How does chronic endometritis influence pregnancy outcomes in endometriosis associated infertility? A retrospective cohort study.

Endometriosis (EMS) and chronic endometritis (CE) frequently coexist. This study aimed to examine the impact of CE on reproductive outcomes in patients with EMS. We enrolled 685 patients with endometriosis-associated infertility from January 2018 to December 2020. The patients were divided into CE (318) and non-CE (367) groups. A subset of 123 clinically pregnant women from the CE group and 369 from the non-CE group was selected for detailed comparison. Pregnancy and delivery data were meticulously collected from hospital records and through telephone interviews. CE was diagnosed in 46.42% of EMS patients. Higher pregnancy rates were observed in patients with Endometriosis Fertility Index (EFI) scores of 7-10. EMS patients with CE had increased risks of placenta previa (13.01%), gestational hypertension (5.69%), and cesarean sections (59.34%). CE, which is prevalent among EMS patients, is linked to increased risks of pregnancy complications, including placenta previa, gestational hypertension, and cesarean delivery. Although combined hysteroscopy and laparoscopy improve pregnancy rates, they demand careful management of these complications.

Cell salvage in obstetrics-Background and practical implementation

Postpartum hemorrhage (PPH) remains aleading cause of maternal mortality worldwide, with an increasing incidence in western countries over the past decades. During this period the numbers of PPH-related allogeneic red blood cell (RBC) transfusions have also significantly increased. Given the increasing scarcity and risks of allogeneic RBC transfusions, which are also associated with adverse maternal outcomes, optimized blood management strategies are urgently needed in obstetrics. In recent years, patient blood management (PBM) has been increasingly integrated into medical care, resulting in asignificant improvement in patient outcomes. Cell salvage (CS) is one of the PBM blood-sparing techniques that enables the collection, processing and retransfusion of the patient's own blood during major bleeding events. Although recent evidence indicates that CS can significantly reduce the demand for allogeneic RBC transfusions and improve patient outcomes, the utilization in obstetrics in German hospitals remains low, with ausage rate of only 0.07% of births with peripartum hemorrhage. It must be assumed that concerns about patient-related complications, such as amniotic fluid embolism and maternal alloimmunization contribute to this hesitancy, alongside alack of familiarity with the technique. This article provides an overview of the current evidence on the use and safety of CS in obstetrics. To facilitate a practical implementation, fundamental considerations and organizational precautions were prepared based on the experiences of the University Hospitals in Würzburg and Frankfurt and presented in the form of graphics and checklists for the perioperative use of CS during cesarean sections.

OPTIMIZING THE DELIVERY METHOD FOR EXTREMELY PREMATURE BIRTHS

The contemporary classifi cation of premature birth is predicated on the condition of the newborn, encompassing the severity of respiratory disorders, morpho- functional immaturity, prognosis for survival, and long-term consequences. In accordance with these criteria, newborns with a gestational age of up to 28 weeks are classifi ed as extremely premature, given the inherently challenging nature of their weaning process. This article presents the dynamics of early neonatal mortality and lethality indicators in cases of vaginal and abdominal delivery. This article presents an analysis of contemporary global trends in the selection of delivery methods for premature births and extremely premature pregnancies.The aim of the study. To propose a modifi ed approach to the choice of delivery method in pregnant women in the gestational period of 24-28 weeks.Research materials and methods. The analysis was conducted on 350 cases of extremely premature singleton births (within 24-28 weeks) that occurred at the Perinatal Center of Kyiv between 2019 and 2023. A comparison of the early neonatal mortality rate of newborns with a gestational age of 24-28 weeks was conducted, stratifi ed by the method of delivery. The relative risk of mortality during the fi rst seven days and throughout the fi rst year of life, contingent on the method of delivery, was calculated. Furthermore, the frequency of the most common complications of the neonatal period in newborns with extremely low body weight was analyzed, and the relative risk of their development was calculated depending on the method of delivery. The Foster- Stewart test was employed to substantiate the statistical reliability of the obtained results. The two average indicators are then compared with one another using the Student’s test. A value of ≤0.05 indicates statistically signifi cant changes in the indicator’s dynamics. The research was carried out within the framework of the implementation of scientifi c topics of the Department of Obstetrics and Gynecology No. 1 of the Bogomolets National Medical University: Research work «Preservation and restoration of women’s reproductive health in conditions of rapid medical and social changes» implementation period 01.01.2023-12.2024. Research results and their discussion. An analysis of the dynamics of early neonatal mortality in the category of 24-28 gestationalweeks from 2019 to 2023 was conducted, identifying several factors. These included the active implementation of intranatal magnesium therapy and improvements in the quality of neonatal care at the technical level. As evidenced by the data, the rate of early neonatal mortality in very early premature births reached 43.3 % in 2019, declining to 25.5 % by 2022. In the 2019-2020 period, 50 % of neonatal deaths occurring within the fi rst seven days were infants born by caesarean section. The ratio of vaginal births to births by caesarean section in gestational periods up to 28 weeks is approximately 2:1. In addition to the observed reduction in the rate of early neonatal mortality, a two-fold decrease was noted in the rate among children born by caesarean section. The mortality rate of extremely premature infants, despite a gradual decline, remains relatively high, at approximately 34.2 % in 2023. Our fi ndings, based on the expansion of indications for caesarean section rather than its routine use in preterm birth, indicate that the relative risk of neonatal death before seven days for vaginal delivery compared with caesarean section, calculated with a 95 % confi dence interval, was 2.65. Similarly, the calculated riskof mortality during the fi rst year of life is 1.34. With regard to intraventricular hemorrhage, the relative risk was 3.12, indicating that the route of delivery in this cohort of newborns exerts an infl uence on the frequency of the complication. The risk of hemorrhagic syndrome is 0.97, which does not provide suffi cient evidence to suggest that it can be prevented by selecting an abdominal delivery. The proportion of abdominal deliveries at the Perinatal Center has remained relatively stable since the expansion of indications for premature births, with a slight increase from 14.2 % in 2019 to 15.2 % in 2023. This was accomplished through a logical and evidence- based approach to caesarean section in full-term pregnancies.Conclusions. 1.From 2019 to 2023, a notable decline was observed in the incidence of early neonatal mortality (from 43.3 to 23.6 %) and child mortality (from 61.3 % to 34.2 %) among newborns with a gestational age of up to 28 weeks. 2. The incidence of early neonatal mortality up to 28 weeks is lower among newborns delivered by caesarean section than among those delivered vaginally. 3. The optimization of perinatal indicators is contingent upon an individualized approach to the selection of a delivery method for pregnant women with premature rupture of the membranes up to 28 weeks.

Iron Sucrose versus Ferric Carboxymaltose: Effectiveness in Treatment of Postpartum Anaemia following Caesarian Section

Background: Postpartum anemia is a leading cause of maternal mortality and morbidity throughout the world, particularly in developing countries.The most common causes of postpartum anemia are antepartum iron deficiency anemia and blood loss during childbirth. Treatment of anemia with ferric carboxymaltose during labor can considerably reduce maternal and newborn morbidity. The aim of the study is to compare the effectiveness of iron sucrose and ferric carboxymaltose in the treatment of postpartum anaemia following caesarian section. Materials and methods: A comparative cross-sectional study was carried out among the 234 outdoor patients of the Department of Obstetrics and Gynecology at Sheikh Hasina Medical College Hospital, Tangail during the period from July 2017 to June 2020. Results: The pre-transfusion mean of hemoglobin level was 8.9±0.5 gm/dl and the post-transfusion mean of hemoglobin level was 10.4±0.4 gm/dl in group A. The pre-transfusion mean of hemoglobin level was 8.7±0.7 gm/dl and the post-transfusion mean of hemoglobin level was 11.0±0.4 gm/dl in group B. The mean of increased hemoglobin level was 1.5±0.4 gm/dl and 2.3±0.5 gm/dl respectively in both groups. The pre-transfusion mean of ferritin level was 46.3±16.1 ng/mL and the post-transfusion mean of ferritin level was 171.5±25.8 ng/mLin group A. The pre-transfusion level was 46.5±16.2 ng/mL and the post-transfusion mean ferritin level was ±24.9 ng/mLin group B. The mean of increased ferritin level was 125.2±22.2 ng/mL and 149.0± 20.5 ng/mL respectively in both groups. These differences were statistically significant within the study groups (p&lt;0.05). Conclusions: The study revealed that serum ferritin levels increased significantly in the FCC group than ISC group. Ferric carboxymaltose are more effective and safe for the treatment of iron deficiency anemia in postpartum patients. IAHS Medical Journal Vol 7(1), June 2024; 8-12

KNOWLEDGE REGARDING MODE OF DELIVERY IN PRIMARY GRAVIDA WOMEN

In Pakistan, childbirth knowledge among primary gravida women—those experiencing pregnancy for the first time—plays a crucial role in shaping their decisions regarding the mode of delivery. Misconceptions, cultural beliefs, and social pressures significantly influence these women’s preferences, often leading to an increased rate of elective caesarean sections (CS) without medical necessity. Understanding the knowledge level regarding delivery options in this population is essential to improve maternal and neonatal outcomes. Objective: This study aimed to assess the level of knowledge regarding the mode of delivery among primary gravida women attending antenatal care at Jinnah Hospital, Lahore, and to identify gaps that may influence their decision-making. Methods: A descriptive cross-sectional study design was employed, targeting 150 primary gravida women at Jinnah Hospital, Lahore. A purposive sampling technique was used, and data were collected using a structured questionnaire comprising demographic questions and items related to knowledge and perceptions of vaginal and caesarean deliveries. Data were analyzed using SPSS version 22, with descriptive statistics used to summarize findings. The questionnaire’s reliability was confirmed with a Cronbach’s Alpha of 0.986, and validity was established through the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s Test of Sphericity. Results: The findings indicated that 34.7% of participants had poor knowledge regarding the mode of delivery, 62.0% had moderate knowledge, and only 3.3% demonstrated good knowledge. Most participants preferred CS due to fear of labor pain and misconceptions about vaginal delivery risks. A majority (90%) of respondents viewed seeing the baby immediately after vaginal delivery positively, and 44% believed that the emotional relationship with the baby is enhanced following vaginal delivery. Informal sources, primarily relatives and friends, were the main sources of delivery-related information, contributing to persistent knowledge gaps and misconceptions. Conclusion: The study reveals significant knowledge gaps among primary gravida women regarding delivery options in Pakistan, with many women favoring CS due to fear and lack of accurate information. Structured antenatal education programs are necessary to address misconceptions and empower women to make informed decisions about their delivery mode. Improved education could reduce unnecessary CS rates and support healthier maternal and neonatal outcomes.

Risk of severe influenza infection in women with a history of pregnancy complications: A longitudinal cohort study.

Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30-1.69), preeclampsia (HR 1.45, 95% CI 1.28-1.65), placental abruption (HR 1.36, 95% CI 1.12-1.66), preterm birth (HR 1.40, 95% CI 1.27-1.55), cesarean section (HR 1.22, 95% CI 1.13-1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22-1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization.