Disproportion Research Articles

Perception and Attitude of First-Time Mothers Towards Caesarean Section in Secondary Health Care Facility (A Mixed-Method Study)

Abstract Background: Despite the global rise in caesarean section (CS), Nigeria has a CS rate of 2.8%, which is far below the World Health Organisation recommendation of 10%–15%. Primigravida and/or first-time mothers constitute a cohort of women who are prone to obstetric emergencies such as cephalo–pelvic disproportion and obstructed labour. Objectives: To evaluate the first-time mothers’ knowledge, perceptions, and attitudes towards CS. Materials and Methods: This was a mixed-methods study conducted among first-time mothers (primigravids >28weeks and first-time CS-delivered) at Adeoyo Maternity Teaching Hospital, Ibadan, using questionnaires that assessed knowledge and attitude for the quantitative aspect and in-depth interviews for the qualitative aspect using a structured topic guide. Responses from the quantitative aspect were analysed using STATA 15, and each participant’s level of knowledge was scored and categorised as: Good knowledge >70%, fair knowledge 50%–70% and poor knowledge <50%. Content analysis was done for the qualitative aspect, and emerging themes on perception and interpretation in CS were summarised and presented as results for interpretation. Results: About 275 mothers (178 pregnant and 97 CS-delivered) were sampled. Only a few (13.45%) of the participants had good knowledge with an equivocal attitude towards CS. The majority (84%) believed that CS helped in saving lives. Also, there was a statistically significant difference between their knowledge and their educational level, occupation, religion, ethnicity, and family income (P < 0.05). The multinomial regression showed that gainfully employed Christian women significantly had more fair and good knowledge than Muslims (RR = 2.01, 95% CI = 1.13–3.57, P = 0.017) (RR = 2.71, 95% CI = 1.23–5.95, P = 0.013). Conclusion: Only a small number of the participants had good knowledge, and their perceptions about CS varied. The attitudes of participants towards CS appeared mixed, as nearly equal proportions of participants had positive and negative attitudes. Hence, there is a need to increase advocacy, antenatal education, and counselling during antenatal clinic visits. Also, first-time mothers need to be put on insurance to reduce the burden of costs.

Risk factors and consequences of a rare obstetric complication: Intrapartum fetal decapitation

Intrapartum fetal decapitation is an extremely rare and devastating birth complication that involves the horizontal laceration and discontinuation of the neck and its contained soft structures. This article examines the limited literature on this topic, identifying risk factors and complications associated with fetal decapitation during childbirth. Risk factors such as macrosomia, high body mass index, cephalopelvic disproportion, high gestational age, prolonged second stage of labor, maternal diabetes, and breech position increase the likelihood of this traumatic event. Complications such as shoulder dystocia can progress to fetal decapitation, especially in cases involving vacuum-assisted deliveries. The article highlights the importance of appropriate management and ethical considerations in cases of fetal decapitation, emphasizing the need for transparency and communication with the parents. The involvement of medical staff’s competence and education is also addressed as a crucial factor in preventing such tragic outcomes. The article suggests that pre-birth checkups should assess the risk factors and guide obstetricians in determining the appropriate mode of delivery to minimize the chances of fetal decapitation. Effective risk management and improved staff qualifications are advocated to mitigate the occurrence of such rare but devastating events. Ultimately, this article underscores the importance of comprehensive evaluation, communication, and education to prevent fetal decapitation and ensure the well-being of both mothers and infants during childbirth.

Prevalence rate, perinatal outcome and causes of obstructed labour A hospital based study

Background and objective: Obstructed labor is a serious intrapartum emergency especially seen in women deprived of modern healthcare delivery. It could be one of the major reasons of morbidity and mortality for both the mother and the newborn. This study was aimed at determine the rate, causes and perinatal outcomes of women who have obstructive labor during delivery. Methods: A cross-sectional study that was conducted on 150 delivering women having obstructed labor at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq from 1st of March 2021 to 1st of March 2022 The rate, socio-demographic characters (age, parity, smoking, antenatal care, residency, education level, gestational age), causes like (malposition, malpresntation, cephalo-pelvic desorption) and perinatal outcomes were recorded. Results: of 9137 labor, 150 were obstructed labor; the total rate was 1.6% during the period of the study. There was no statistically significant associated between socio-demographic characters like age, smoking, gestational age, residency, education level, antenatal care and obstructed labor except multiparity that has significant association. There was a significant association between the causes like cephalo-pelvic disproportion, malposition, malprsentation, sized baby and having fracture to spine and pelvis or trauma and obstructed labor. Also there was no statistically significant associated between Apgar score and admission to neonatal intensive care unit. Conclusion: Obstructive labor is common during labor. Malposition was most common the cause of obstructive labor and parity has association with it too. Neonatal morbidity and mortality are dependent on the type of presentation.

Effect of maternal age on the rate, type, and indications of caesarean section deliveries: A study from a maternity hospital of Peshawar, Pakistan.

Objective: To evaluate the effect of maternal age on the rate, type (elective or emergency) and indications of caesarean section. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2020 to January 2021. Methods: The normal labor register, which contains data of each, and every delivery conducted in the mentioned hospital, was used to find out total number of caesarean sections during the period of study. All those patients were included in the study who underwent caesarean section during the study period. Total number of caesarean sections was 603 after excluding the patients with ruptured uterus, multiple pregnancies, ectopic pregnancy and cephalopelvic disproportion. Maternal age was noted and compared with the rate of caesarean section. Maternal age was further categorized as <20; 21-25; 26-30; 31-35; 36-40 and >40 years. Results: Among 603 patients, the majority of patients who underwent caesarean section were in 26-30 years age group followed by 21-25 years. When the indications for caesarean section were compared based on the already defined categories of age, a significant difference (p<0.001) was found. Previous caesarean sections were found to be the topmost cause in all age groups while the second common cause was malpresentation. Elective caesarean section rate was found to be significantly higher than emergency ones with p-value<0.001. Conclusion: Our results revealed a greater number of caesarean sections in the younger age group; therefore, it can be concluded that maternal age has no direct effects on the rate, type, and indications of caesarean section.

Neonatal head circumference to maternal mid-transverse pelvic distance ratio as a key anatomical predictor for dystocia: Retrospective case-control study.

This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent-phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups. This retrospective case-control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal-pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery. Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p-value = 0.002), had higher pre-pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p-value = 0.012) and term-BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p-value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p-value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p-value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent-phase prolongation exhibited the lowest birthweight/term-BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p-value = 0.013). The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term-BMI could potentially mitigate latent-phase prolongation. Further research assessing the maternal mid-pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy.

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

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

Effects of applying high-pass filtering in pelvimetry with Martius images.

The aim of this study is to investigate whether the results of pelvimetry using original radiographic Martius images and the same images with high-pass filtering applied ("edge images") would be consistent. A total of 30 primagravidas were included in this study. Three obstetricians independently measured the anteroposterior and transverse diameters of the pelvic inlet in the original and the edge images, recording the x- and y-coordinates of the four endpoints. A Wilcoxon signed rank sum test was performed on the coordinate data to evaluate differences between the original and edge images. In the analysis of all coordinate data, statistically significant differences were found in both x- and y-coordinates of the sacral promontory point (SPP). In the y-coordinate of the SPP, a statistically significant difference was found in 9 of 30 pairs of images, and in all 9 the anteroposterior diameter was shorter in the edge images compared to the original images due to the more caudal placement of the SPP. The coordinates of the SPP on original radiographs and their edge images were not consistent in pelvimetry using Martius images. Our results suggest that improved image contrast will allow obstetricians to better assess pelvic narrowing and cephalopelvic disproportion and even reduce radiographic dose, thereby reducing risks for pregnant women and their fetuses.

Association of Maternal Height with Mode of Delivery and Perinatal Outcome

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances.

Surfactant Therapy in Meconium Aspiration Syndrome: A Case Report

Background: Meconium aspiration syndrome (MAS) is one of many causes of respiratory distress in newborns. Data regarding MAS in Indonesia is still very limited, but a study revealed MAS is related to a high mortality rate. The latest study revealed surfactant therapy is related to better clinical outcomes in MAS cases. This study aimed to present a case of a baby with meconium aspiration syndrome given bolus surfactant therapy.
 Case presentation: A day-old baby was referred to our emergency department with respiratory distress, delivered by cito caesarean section due to cephalopelvic disproportion with premature rupture of membranes. The baby didn’t cry immediately; bluish skin and green amniotic fluid were found. The baby was already intubated from the referring hospital, and the physical examination revealed rales on both lungs with severe work of breath. Chest radiography revealed patchy opacities in the right lung hemisphere, suggesting MAS. Echocardiography revealed a small patent ductus arteriosus, and head ultrasonography revealed mild brain oedema. The baby received bolus bovine surfactant therapy at 16 hours of age, delivered through an endotracheal tube. Clinical improvement was observed, and supplementary oxygen was reduced gradually. The baby was able to maintain good oxygenation without supplemental oxygen by day 12th and was able to breastfeed and drink from the bottle. He was discharged with good condition.
 Conclusion: Surfactant therapy can become a safe and effective treatment modality in MAS. Further study is still needed regarding time, method, and types of surfactants used in MAS management.

POSTTERM PREGNANCY: MATERNAL AND FETAL OUTCOMES

Postterm Pregnancy is one of the commonest obstetric conditions which associated with an increased risk of fetal and neonatal mortality and morbidity as well as an increased maternal morbidity. The aim of the present study is to determine the maternal and fetal outcomes of postterm pregnancy at Al-Sadaqa Teaching Hospital. A prospective case–control study was conducted at Al-Sadaqa Teaching Hospital, Aden from January 1st to December 31th 2020. Cases were considered postterm pregnancy (≥ 42 weeks) while control term pregnancy (37weeks - 41weeksand 6 days). Significant association between gestational age and the studied variables of postterm and term pregnancy were analyzed using appropriate statistical methods. A total of 185 cases of postterm pregnancy and 370 control group of term birth, the frequency of postterm pregnancy was (2.78%), we found statistically significant association between some of socio-demographic factors and postterm pregnancy, cesarean section was higher in postterm group (OR 2.80) with the indications were cephalopelvic disproportion (OR 12.38). Maternal complications were significantly association to postterm birth like prolonged labor (OR 12.99) and postpartum hemorrhage (OR 8.32). Regarding to fetal outcomes, Postterm pregnancy has showed a significant association with neonatal low Apgar score(p=0.000), Oligohydramnios (OR 42.24) asphyxia (OR 2.86), meconium aspiration (OR 9.41) and Perinatal death (p value 0.012). This study concluded that postterm pregnancy is associated with adverse maternal outcomes such as, prolonged labor and postpartum hemorrhage, and associated with adverse fetal outcomes like oligohydramnios, asphyxia and meconium aspiration syndrome. The outcome of prolonged pregnancy can be improved by proper counselling for follow up during pregnancy and proper monitoring and appropriate management during labor.

A randomized controlled trial reducing cesarean delivery rates in China by introducing trial of labor after cesarean and electrohysterography

Objective A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. Methods In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. Results After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p = .48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p = .21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. Conclusion This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. Trial registration The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199).

A retrospective study on proportion and indications of cesarean section in a tertiary care hospital

Background: The cesarean section (CS) stands as a prevalent and frequently conducted surgical procedure in obstetrics, both within India and globally. The rising rates of cesarean deliveries prompt a necessity to examine the factors that influence this trend. Aims and Objectives: To analyze the proportion and different indications of CS to reduce the CS rate (CSR) in a tertiary care hospital. Materials and Methods: This was a retrospective observational study, conducted over a period of 6 months, from July 1st, 2022, to December 31st, 2022, in the Department of Obstetrics and Gynaecology at Midnapore Medical College and Hospital, West Bengal, India. The data pertaining to patients who underwent C-section deliveries at our hospital during the specified period was documented, followed by a statistical analysis conducted to assess the proportions and various indications for CS. Results: Out of 6365 women who gave birth during the study period, 2296 women underwent CS. This indicates that the proportion of CSs was 36.07%. The primary indication for CS was previous CS, accounting for 39.50%, followed by fetal distress (16.38%), preeclampsia with severe features and eclampsia (13.50%), severe oligohydramnios (7.40%), arrest of labor (5.70%), malpresentation (4.18%), antepartum hemorrhage (2.96%), premature rupture of membrane (2.70%), cephalopelvic disproportion (1.83%), induction failure (1.44%), fetal growth restriction (1.18%), multifetal gestation (1.09%), bad obstetric history (0.60), big baby (0.48%), cord prolapse (0.35%), and medical disorder (0.70%). Conclusion: As a tertiary care hospital, we observed a high rate of cesarean deliveries. However, by individualizing indications and conducting careful evaluations in accordance with standardized guidelines, practicing evidence-based obstetrics, and conducting audits within the institution, we can work towards limiting the CSR. In addition, encouraging a trial of labor after a cesarean can be beneficial in reducing the overall rate of CS.

Analysis of the maternal and fetal adverse outcomes of 154 pregnant women with cesarean section in the second stage of labor

Objective: To investigate the perinatal maternal and fetal adverse outcomes of cesarean section in the different duration of the second stage of labor. Methods: A retrospective cohort study was conducted on the clinical data of 154 pregnant women with singleton head pregnancy who underwent cesarean section at different times of the second stage of labor due to maternal and fetal factors in the First Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2021. According to the duration of the second stage of labor, they were divided into <2 h group (54 cases), 2-<3 h group (61 cases), and ≥3 h group (39 cases). The general data of pregnant women and neonates, preoperative maternal and neonatal conditions related to labor stages, surgical indications, surgical procedures, and perioperative maternal and neonatal adverse outcomes were compared among the three groups. Results: (1) General Information: there were no significant differences in maternal age, gravidity and parity, proportion of primipara, gestational age at delivery, body mass index before delivery, pregnancy complications, labor analgesia rate and the duration of the first stage of labor among the three groups (all P>0.05). The differences of the gender composition, birth weight and incidence of macrosomia of the three groups were also not statistically significant (all P>0.05). (2) Maternal and fetal status and surgical indications: the incidence of intrapartum fever and type Ⅱ and Ⅲ fetal heart rate monitoring in the <2 h group were higher than those in the 2-<3 h group and the ≥3 h group, and the preoperative fetal head position in the ≥3 h group was lower than that in the 2-<3 h group, with statistically significant differences (all P<0.05). The proportion of cesarean section due to "fetal distress" was 40.7% (22/54) in the <2 h group, which was higher than that in the 2-<3 h group (4.9%, 3/61) and the ≥3 h group (2.6%, 1/39). The proportions of surgical indication of "relative cephalo-pelvic disproportion" were 98.4% (60/61) and 94.9% (37/39) in the 2-<3 h group and ≥3 h group, respectively, and the surgical indication of "fetal head descent arrest" were 41.0% (25/61) and 59.0% (23/39), respectively. Compared with <2 h group [63.0% (34/54), 13.0% (7/54)], the differences were statistically significant (all P<0.05). There were no significant difference in surgical indications between 2-<3 h group and ≥3 h group (all P>0.05). (3) Intraoperative conditions and perioperative complications of cesarean section: the puerperal morbidity rate of <2 h group was 37.0% (20/54), which was higher than those of 2-<3 h group (18.0%, 11/61) and ≥3 h group (7.7%, 3/39), the difference was statistically significant (P<0.05). There were no significant differences in operation time, intraoperative blood loss, incidence of fetal head inlay, uterine incision tear, modified B-Lynch suture for uterine atony, postpartum hemorrhage, perioperative blood transfusion, preoperative hemoglobin (Hb) level, perioperative Hb change, and postoperative hospital stay among the three groups (all P>0.05). (4) Adverse neonatal outcomes: non-hemolytic neonatal hyperbilirubinemia in ≥3 h group was 35.9% (14/39), which was significantly higher than that in <2 h group (13.0%, 7/54; P<0.05). Among the neonates admitted to neonatal intensive care unit (NICU) within 1 week after birth, the proportion of neonates admitted to NICU due to neonatal hyperbilirubinemia in ≥3 h group (15/19) was significantly higher than that in <2 h group (9/17) and 2-<3 h group (10/19), and the differences were statistically significant (all P<0.05). However, there was no significant difference between the <2 h group and the 2-<3 h group (P>0.05). There was no perinatal death in the three groups. Conclusions: The rate of puerperal morbidity is higher in patients who were transferred to cesarean section within 2 hours of the second stage of labor. In the early stage of the second stage of labor, the monitoring of fetal heart rate and amniotic fluid characteristics should be strengthened, especially the presence or absence of prenatal fever. In good maternal and neonatal conditions, conversion to cesarean section after 2 hours of the second stage of labor does not significantly increase the incidence of serious adverse maternal and neonatal outcomes. For the second stage of labor more than 3 hours before cesarean section, it is necessary to strengthen the monitoring of neonatal bilirubin.

Twins found in a Late Dynastic/Coptic Egyptian mummy

AbstractDuring research conducted in 2019 regarding pelvic shape in population groups and its effects on successful delivery, one of the individuals studied was a Late Dynastic/Coptic Egyptian female mummy approximately 14–17 years old (USNM catalogue number 258601). She had an associated fetus that was wrapped and placed between her legs during mummification (USNM 258602). In 1908, the mother and child were excavated and autopsied for analysis. Field notes from 1908 said she had died from obstetric complications. For our 2019 study, the mummy was CT scanned to acquire the measurements of her pelvis and determine if cephalopelvic disproportion played a role in her death. While examining the CT images, elements of what was believed to be the fetus were identified in the mother. However, there were repetitions of elements, and a second fetus was discovered in the chest cavity of the mummy. The mother was carrying twins. For this study, re‐scanning by CT and plain film radiography of the torso were performed on the mother as well as plain film radiography on the external fetus. Additionally, records and photographs from the 1908 expedition were reviewed to gather additional information on the mummy. Results note this mummy was pregnant with twins and in the middle of the birthing process at the time of her death.

Relationship between Parental Head Circumference and Birth Type: A Pilot Study

Aim: Is there an association between Parental Head Circumference and Birth Type? Background: A mismatch between fetal size, especially the fetal head, with the mother's pelvis, also known as cephalo-pelvic disproportion (CPD), can lead to obstructed labor and, ultimately, cesarean section. However, so far, not much focus has been done on the father's anthropometric indices along with maternal anthropometric indices, especially head circumference (HC) and pelvic dimensions in the birth type and prediction of cesarean risk. Objective: In this study, anthropometric parameters of parents, such as height, weight, HC, and pelvic circumference and their relationships with the birth type in the first pregnancy, have been studied. Methods: This cross-sectional pilot study was conducted on healthy couples over 18 years of age. The mothers were primiparous, which had their first and full pregnancies with natural vaginal delivery or cesarean section (without elective cesarean). A trained expert measured the anthropometric data of parents, and the babies ‘data were collected from the neonatal record. Result: 33 cases completed full-term pregnancy, and of these mothers, 23 (69.7%) experienced natural vaginal deliveries (NVD) and 10 (30.3%) cesarean section (CS). The mean of the parent's HC in the CS group was significantly higher than those in the NVD group. Conclusion: The results showed that an increased average size of the parent's HC, especially in the mother with a smaller pelvic size, can logically increase the risk of cesarean section.

Factors Associated With a Maternal Lower-limb Neurological Deficit After Vaginal Delivery

(Acta Obstet Gynecol Scand. 2023;102:51–58) Women experience lower-limb neurological deficit following vaginal delivery at a rate of 0.1% to 2%. The manifestation varies between transient with resolution within weeks to significant discomfort and prolonged disability. To better understand risk factors that contribute to this occurrence, maternal characteristics were assessed including neurological history, maternal obesity, nulliparity, gestational age &gt;41 weeks, labor positions, prolonged labor duration, large newborn weight, instrumental delivery, epidural analgesia, and cephalopelvic disproportion. Better understanding of the mechanism of this injury may allow for prevention.

Towards Optimizing Caesarean Section: Robson Ten Group Analysis of Caesarean Section and It’s Determinants in a Tertiary Hospital in South-South, Nigeria

Background: To optimize caesarean section (CS), Robson classification is useful for audit of CS rates within and across hospitals and regions. Valid conclusions are also possible by analyzing other characteristics of parturients that determine CS rates based on Robson groups. This study aimed to analyzed CS rate and determine the impact of parturients’ age and booking status on delivery by CS based on Robson classification. Subjects and Method: A cross-sectional descriptive study that classified parturients into Robson 10-groups using data from hospital records at the Federal Medical Centre Yenagoa (FMCY) in Bayelsa State, south-south, Nigeria. The dependent variable was mode of delivery. The independent variables were parturients’ age and booking status by Robson group. The study instrument was a predesigned spreadsheet used to collect real-time relevant data on all deliveries from patients’ hospital records. Descriptive statistics were presented using frequencies, percentages, mean and standard deviation. Chi-square, Exact test and logistic regression were used to determine association of parturients’ age and booking status with mode of delivery. Level of significance was p &lt;0.05. Results: There were 556 deliveries during the study period and 269 CSs, giving a CS rate of 48.4%. Robson group 3 made the highest (27.9%) contribution to CS rate, followed by group 10 (22.3%), 5 (13.8%) and 1 (11.2%). The commonest indication for CS was cephalopelvic disproportion, followed by severe preeclampsia. Booked parturients in Robson groups 1 and 3 had 61.0% reduced odd (OR= 0.39; 95% CI = 0.15 to 0.99; p = 0.050) and 74.8% reduced odd (OR= 0.25; 95% CI= 0.14 to 0.45; p &lt; 0.001) of delivery by CS, respectively. Conclusion: The CS rate at the FMCY was contributed largely by group 3, 10, 5 and 1 parturients. Using Robson classification, CS rate can be focused to targeted intervention to optimize CS. Keywords: caesarean section rate, hospital, Robson classification, Robson 10-group. Correspondence: Olakunle Ifeoluwa Makinde. Department of Obstetrics and Gynaecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria. Email: olakunleife@gmail.com. Mobile: +2348032136315.

Correlation Between The Body Height Of Pregnant Mother With The Case Of Cephalopelvic Disproportion (CPD) At The General Hospital In Mandau Subdistrict Bengkalis Regency

Cephalopelvic Disproportion (CPD) is a condition that describes a discrepancy between maternal and fetal pelvic capacity caused by maternal pelvic abnormalities (pelvic bone size and architecture) or abnormalities in the fetal head (size or presentation) or a combination of both. The dominance of sectio caesarea surgery for cephalopelvic disproportion according to the Basic Health Research Survey in Indonesia in 2010 was quite high at 4.40% of all childbirths. Factors affecting cephalopelvic disproportion can be influenced by both mother and baby. Factors of the mother include body height less than 145 cm, and, the size of the outer and inner pelvis is below normal that the baby is unable to pass through whereas factors in the baby is that the large baby size. Previous studies on pregnant women found that the majority of those who experienced cephalopelvic disproportion were mothers with short postures or a body height of less than 145 cm. Objective : To determine the relationship between maternal height and the incidence of cephalopelvic disproportion at the General Hospital in Mandau Subdistrict, Bengkalis Regency period 1 January - 31 December 2017. Method : This type of research is analytic observational with cross sectional design. The sampling technique used is simple random sampling. The sample in this study amounted to 253 respondents. Data for height and incidence of CPD using medical record records of Mandau District Hospital Bengkalis Regency period 1 January - 31 December 2017. The data obtained will then be analyzed using the Spearman correlation test. Results : There was a significant relationship between the height of pregnant women with the incidence of CPD in the District Hospital of Mandau, Bengkalis Regency, period 1 January - 31 December 2017 with a p value of 0.00 (p &lt;0,01) and correlation coefficient (r=-0,737) with strength relationship is very strong and negative direction. Conclusion : There is a significant relationship between the height of pregnant women with the incidence of CPD in the District Hospital of Mandau, Bengkalis Regency, period 1 January - 31 December 2017.

Fetal outcomes and their correlates following caesarian section in a rural setting in Ghana.

Regular evaluation of caesarean section (CS) is required due to their rising trend and outcomes. Many women recently opt for elective CS, even in resource-constrained settings. Data evaluating the outcomes of CS is however sparse. Hence, this study sought to determine the rate of fetal mortalities and their determinants following CS in the Tatale District Hospital of the Northern Region, Ghana. A retrospective cross-sectional study was employed to analyze the medical records of 275 women who underwent CS from 2019 to 2021. Data were collected from the hospital's record of CS cases from 2019 to 2021. Descriptive statistics were used to summarize the data and Pearson's chi-square/Fisher's exact test was used to examine the relationship between maternal and obstetric characteristics and fetal mortality. At a 95% confidence interval (95% CI), logistic regression was fitted to assess significant variables and reported the results using odds ratio. Of 1667 deliveries, 16.5% of the mothers gave birth by CS. A fetal mortality rate of 76.4 per 1000 total births was recorded following CS. Babies born with low Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores (0-3) at fifth-minute had an increased risk of fetal mortality (AOR = 523.19, 95%CI: 49.24-5559.37, p = <0.001). Having a history of previous CS, cephalopelvic disproportion and delayed labour were the major indications for CS. Overall, this study found a high rate of CS based on the World Health Organization's recommended CS rate. Interventions such as reducing the waiting time for surgery and early diagnosis of the need for CS, and ensuring the availability of modern equipment to resuscitate infants with low APGAR scores can significantly improve fetal outcomes following CS.

Differential diagnosis of bulging scalp: beyond cephalohematoma and subgaleal hematoma

A 30-day-old infant was brought to the pediatric emergency room with a bulge in the scalp in the parieto-occipital region, mobile and without associated phlogistic signs. He had no history of fever or any other complaints. The mother reported that the bulge appeared at 20 days of life and showed progressive growth. There was no history of trauma. The boy was born at term by cesarean delivery due to cephalopelvic disproportion.&#x0D; For initial evaluation, skull X-ray and cerebral ultrasound were performed (Figure 1). A magnetic resonance imaging and tomography of the brain were also performed (Figure 1). &#x0D; Faced with the diagnostic challenge, neurosurgery proceeded with drainage of the collection and biopsy of the galea. No malignant cells were found and the biopsy only found an inflammatory change. Given these findings, the diagnosis of delayed subaponeurotic fluid collection (DSFD) was made. There was no recurrence of the collection and the patient had a good evolution.&#x0D; DSFD are a rare condition, which occurs spontaneously between the 4th and 18th week of life, and makes the differential diagnosis with cephalohematoma, caput succedeneum and subgaleal hematoma [1]. Its pathophysiology is not fully elucidated; however, most reports share a similar history of prolonged or instrumented delivery [1,2]. Patients are otherwise healthy and with no history of trauma [2].&#x0D; The management of DSFD is conservative and the natural history is spontaneous resolution within 1 to 2 months [1,2].