Disproportion Research Articles

Uterine Rupture and its Fetomaternal Outcome: A Tertiary Care Hospital Study

Objective: To analyse the frequency, predisposing factors, site of rupture management and fetomaternal outcome in uterine rupture. Study design: prospective observational study Methods: This study was conducted at the Department of obstetrics and gynecology in Lalla Ded hospital, from august 2020 to august 2022. All cases of ruptured uterus, who were either admitted with this complication or who developed it in the hospital, were included in the study. Patients having ruptured uterus due to congenital abnormality were excluded from the study. Patient’s parity, age, details of predisposing factors, type of rupture, the management, maternal and fetal outcome were taken into consideration for analysis. Data was analyzed using SPSS version 20.0.(SPSS Inc., Chicago, Illinois, USA). Continuous variables were expressed as Mean ± SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams. Results: The total number of deliveries during the course of 2 years from august 2020 to august 2022 were 44236. There were 15 cases (0.034%) of uterine rupture. Out of these only three (20%) were booked. Most of the patients (53.3%) presented between the ages 30-35. Majority of uterine rupture occurred in para 3 (46.7%) followed by para 2 (33.3%). Common cause of uterine rupture was prolonged neglected obstructed labour (60%). Rupture of Previous caesarean section scar was found in 40%. Anterior uterine wall was involved in 46.7% of cases. Posterior wall rupture in 33.3% and posterior along with lateral wall in 20%. Hysterectomy was performed in 40%. There were two maternal (13.3%) and 8 intrauterine deaths (53.3%). Live birth rate was 46.6%. Conclusion: This study showed that prolonged neglected obstructed labour is the main cause of uterine rupture followed by scarred uterus in our setting. Proper antenatal care and timely intervention with prompt referral to higher center and updated training programs for health care providers is the need of time to prevent this catastrophic but avoidable complication. Keywords: uterine rupture, scarred uterus, obstructed labour (cephalopelvic disproportion)

Post-C-Section Pain Management with the Enhanced Recovery after Surgery and Multimodal Analgesia Methods: A Case Series

Introduction: This study aims to present the management of postoperative c-section pain using multimodal analgesia.
 Case presentation: There were two patients who received multimodal analgesia as a treatment for postoperative C-section pain. The first patient, a woman 15 years old, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and cephalopelvic disproportion (CPD). The second patient, a 23-year-old woman, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and 1x umbilical cord. Physical examination of both patients showed vital signs within normal limits. Laboratory evaluation within normal limits. Both patients were included in the ASA II category. The anesthetic method used intraoperatively was subarachnoid block with hyperbaric bupivacaine 0.5% 10 mg and morphine 50 mcg. Lidocaine infiltration injection is performed intraoperatively in combination with the following; lidocaine 2% (3 ampoules), dexamethasone 4 mg, ketorolac 60 mg, and morphine 4000 mcg dissolved in aquabides into 20 ml subcutaneously.
 Conclusion: A multimodal analgesia is an appropriate approach for postoperative pain management in patients undergoing cesarean section.

Study of fetomaternal outcome of teenage pregnancy in a tertiary care hospital

Background: The objective is to study the fetomaternal outcome in teenage pregnancy at Government Maternity Hospital, S V Medical College, Tirupathi for the study period of 1 year from June 2021 to May 2022. Teenage pregnancy is a worldwide health problem. WHO defined adolescence as the period from 10-19 years? It is a serious health problem in a developing country like India. Teenage pregnancy is associated with high risk of prematurity, low birthweight, preeclampsia and anaemia.Methods: It is a retrospective study conducted in a tertiary care hospital at GMH, SVMC, Tirupathi over a period of 1 year. 1325 teenage pregnant women were included in the study out of 12992 pregnant women admitted for delivery during the study period. Results: Study showed the incidence of teenage pregnancies as 10.1%. Among these teenage pregnant women 87% had anemia, 21.6% had gestational hypertension, 7% had eclampsia, 6% had intrauterine death and malpresentations were noted in 4%. Intrapartum complications noted in the study are preterm labor (41.9%), cephalopelvic disproportion(25.8%), fetal distress(22.4%) and obstructed labor(0.3%). 52 cases were complicated with postpartum hemorrhage, 2 with puerperal sepsis and 6 with retained placenta. 2 cases of maternal deaths occurred due to antepartum eclampsia and pulmonary edema. LSCS rate was 27%, 65.9% had normal vaginal deliveries and 11.9% had instrumental deliveries. Among the total births 57.8% were low birth weight.Conclusions: Teenage pregnancy is associated with increased incidence of anemia, pre-eclampsia, eclampsia, preterm delivery, instrumental delivery, low birth weight and perinatal death. The healthcare provider should consider teenage pregnancy as high risk pregnancy and should emphasise for more number of antenatal visits to identify the risk as early as possible.

Association Between Female Bony Pelvimetry Using Magnetic Resonance Imaging and Cesarean Delivery due to Cephalopelvic Disproportion

Purpose: To analyze the difference in bony pelvimetry using magnetic resonance imaging (MRI) in women who delivered vaginally and those who underwent cesarean section (CS) due to cephalopelvic disproportion (CPD).Methods: This retrospective case-control study enrolled Korean women who gave birth to their first child between 37 and 42 weeks of pregnancy and underwent pelvic MRI between January 2014 and June 2020. These women were classified into 3 groups: vaginal delivery (VD), CS due to CPD (CPD-CS), and CS due to reasons other than CPD (Other-CS). In MRI images, true conjugate (TC), obstetric conjugate (OC), mid anterior-posterior (AP) distance (MAD), outlet AP distance (OAD), ischial spine distance (ISD), ischial tuberosity distance (ITD), and pubic angle (PA) were measured.Results: In total, 392 women were enrolled. There were no significant differences in maternal height and body mass index at birth among the 3 groups. The ISD was statistically different between the VD group (106.2±6.4 mm) and the Other-CS group (110.4±8.8 mm) (p=0.014). After multiple regression analysis, short ISD (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.87-0.97; p=0.002), short MAD (aOR, 0.95; 95% CI, 0.89-0.99; p=0.047), and short ITD (aOR, 0.95; 95% CI, 0.91-0.99; p=0.019) were significantly associated with CS due to CPD.Conclusion: Short ISD, MAD, and ITD, measured using MRI, are important parameters that can predict CS due to CPD. The accumulation of related research could promote the development of an excellent imaging method in terms of cost-effectiveness. Thus, it may be possible to establish a method to reduce obstetric and perinatal complications due to dystonia.

Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019: A cross-sectional study.

Obstructed labour is a type of abnormal labour that is one of the causes of obstetric complications such as maternal and fetal mortality and morbidity. Early detection is the key to reducing complications. This study aimed to assess the prevalence, causes, and factors associated with obstructed labor among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia. An institution-based cross-sectional study was conducted from November 10 to December 30, 2019 among 318 women who gave birth at public health facilities in Mojo Town. Face-to-face interviews and participants' medical record reviews were utilized to gather data. The collected data were checked, coded, and entered into EpiData version 3.1 and then exported to SPSS version 23 for analysis. A binary logistic regression model was used to test the association between the dependent and independent variables. In bivariate analysis, all variables with a p-value less than 0.25 were included in multivariate analysis. Finally, a significant statistical association was declared at a p-value less than 0.05. The prevalence of obstructed labour in this study was 51 (16%), and cephalo-pelvic disproportion (66%), mal-presentation (22%), and mal-position (12%) were reported as causes of obstructed labour. Primgravidity (AOR = 7.74: 95%CI = 2.13, 18.2) and a one-time antenatal care follow-up (AOR = 9.50: 95%CI: 1.91, 33.07) were found to be associated factors with obstructed labour, while labour duration of 12-24 hours (AOR = 0.20: 95%CI = 0.17, 0.87) was identified as a factor decreasing the risk of obstructed labour. The prevalence of obstructed labour in this study was higher than in the majority of previous similar local and global studies. In this study setting, cephalo-pelvic disproportion, mal-presentation, and mal-position were found to be the causes of obstetric labour. Additionally, factors such as gravidity, frequency of antenatal follow-up, and duration of labour were significantly associated with obstructed labour. Therefore, the concerned entities need to work to curb young age pregnancy as well as to strengthen counselling mothers on the importance of subsequent antenatal-follows in the prevention of obstructed labour.

Obstructed Labour as Seen in Umuahia; Southeast Nigeria

Background: Obstructed labour is one of the leading causes of maternal mortality accounting for 8% of maternal deaths globally and consuming scare resources budgeted for healthcare in Nigeria and Sub-Saharan Africa. Materials and Methods: This was a retrospective study carried out at the department of obstetrics and gynecology, Federal Medical Center Umuahia, Southeast Nigeria. The folders of all women who were diagnosed with obstructed labor in a 10-year period between January 2006 and December 2015 were retrieved and data extracted. The data was analyzed using proportions, frequencies, and percentages. Objective: To evaluate the sociodemographic profile, causes and feto - maternal outcomes of obstructed labor at the Federal Medical Center Umuahia. Results: The incidence of obstructed labor was 2.2%. Most of the women (93.7%) were between 20 and 39 years of age, (58.2%) were nulliparous while. Majority (61.1%) had secondary education though (93.7%) of the patients were unbooked. The commonest cause was cephalopelvic disproportion (61.2%) followed by malpresentation (30.5%). Commonest mode of delivery was emergency caesarean section (90.0%) and the least was symphysiotomy 3(1.2%). Hysterectomy 10 (4.2%) or uterine repair 11(4.6%) with or without bilateral tubal ligation were done for those with uterine rupture. The most frequent maternal complication was puerperal sepsis (26.2%) and there were 3(1.3%) maternal deaths. Majority (72.4%) of the babies were live births while 27.6% were stillbirths. Conclusion: Over ninety percent of the cases of obstructed labor were unbooked in this study. There is a need for education on the importance of antenatal care and skilled supervision during labor.

Peripartum Anesthetic Management of Patient with Osteogenesis Imperfecta: Case Report and Literature Review

Osteogenesis Imperfect (OI) (Brittle Bones Disease) is the most common hereditary connective tissue disease. The main clinical forms of OI are quantitative and qualitative anomalies of type I collagen, the most common protein in bones [8]. In modern literature, cases of successful delivery of patients with imperfect osteogenesis are described, however this disease is considered a contraindication to pregnancy, and when it is advised, an artificial interruption is recommended. Such tactic is associated with the occurrence of a significant number of complications, during pregnancy and delivery, sometimes fatal for both the mother and the fetus [8]. Caesarean section is conducted more often in such patients due to maternal pelvic deformity, cephalopelvic disproportion, abnormal fetal position variants [1,8]. In literature, there are few cases of an anesthetic aid for Cesarean Section (CS) in patients with OI (types 3-4). The clinical observation that is presented, describes features of labor management of a patient with OI type IV.

The sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study

Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size of the birth canal and that of the fetus, a condition usually referred to as cephalopelvic disproportion. This study aimed to describe a new ultrasound predictor of labor arrest leading to cesarean delivery because of suspected cephalopelvic disproportion. This was a multicenter prospective study conducted at 3 maternity units from January 2021 to January 2022. A nonconsecutive series of singleton pregnancies with cephalic-presenting fetuses, gestational age of 34 weeks+0 days or above, and no contraindication to vaginal delivery attending at the antenatal clinics of each institution were considered eligible. Between 34+0 and 38+0 weeks of gestation, all eligible patients were submitted to transabdominal 2D ultrasound measurement of the obstetrical conjugate. On admission to the labor ward, the fetal head circumference was measured on the standard transthalamic plane by transabdominal ultrasound. The primary outcome of the study was the accuracy of the ratio between the fetal head circumference and the obstetrical conjugate measurement (ie, head circumference/obstetrical conjugate ratio) in predicting the occurrence of cesarean delivery secondary to labor arrest. The secondary outcome was the relationship between the head circumference/obstetrical conjugate ratio and labor duration. A total of 263 women were included. Cesarean delivery for labor arrest was performed in 7.6% (20/263) of the included cases and was associated with more frequent use of epidural analgesia (95.0% vs 45.7%; P<.001), longer second stage of labor (193 [120-240] vs 34.0 [13.8-66.5] minutes; P=.002), shorter obstetrical conjugate (111 [108-114] vs 121 [116-125] mm; P<.001), higher head circumference/obstetrical conjugate ratio (3.2 [3.2-3.35] vs 2.9 [2.8-3.0]; P<.001), and higher birthweight (3678 [3501-3916] vs 3352 [3095-3680] g; P=.003) compared with vaginal delivery. At logistic regression analysis, the head circumference/obstetrical conjugate ratio expressed as Z-score was the only parameter independently associated with risk of cesarean delivery for labor arrest (odds ratio, 8.8; 95% confidence interval, 3.6-21.7) and had higher accuracy in predicting cesarean delivery compared with the accuracy of fetal head circumference and obstetrical conjugate alone, with an area under the curve of 0.91 (95% confidence interval, 81.7-99.5; P<.001). A positive correlation between the head circumference/obstetrical conjugate ratio and length of the second stage of labor was found (Pearson coefficient, 0.16; P=.018). Our study, conducted on an unselected low-risk population, demonstrated that the head circumference/obstetrical conjugate ratio is a reliable antenatal predictor of labor arrest leading to cesarean delivery.

Fetal Disseminated Malignant Rhabdoid Tumor.

Fetal Disseminated Malignant Rhabdoid Tumor.

Association between prenatal provision of lipid-based nutrient supplements and caesarean delivery: Findings from a randomised controlled trial in Malawi.

In populations with a high prevalence of childhood and adolescent undernutrition, supplementation during pregnancy aiming at improving maternal nutritional status and preventing fetal growth restriction might theoretically lead to cephalopelvic disproportion and delivery complications. We investigated whether the prenatal provision of small‐quantity lipid‐based nutrient supplements (SQ‐LNS) was associated with an increased risk of caesarean section (CS) or other delivery complications. Pregnant Malawian women were randomised to receive daily i) iron–folic acid (IFA) capsule (control), ii) multiple micronutrient (MMN) capsule of 18 micronutrients (second control), or iii) SQ‐LNS with similar micronutrients as MMN, plus four minerals and macronutrients contributing 118 kcal. We analysed the associations of SQ‐LNS, CS, and other delivery complications using log‐binomial regressions. Among 1391 women enrolled, 1255 had delivery information available. The incidence of CS and delivery complications was 6.3% and 8.2%, respectively. The incidence of CS was 4.0%, 6.0%, and 8.9% (p = 0.017) in the IFA, MMN, and LNS groups, respectively. Compared to the IFA group, the relative risk (95% confidence interval) of CS was 2.2 (1.3–3.8) (p = 0.006) in the LNS group and 1.5 (0.8–2.7) (p = 0.200) in the MMN group. We found no significant differences for other delivery complications. Provision of SQ‐LNS to pregnant women may have increased the incidence of CS. The baseline rate was, however, lower than recommended. It is unclear if the higher CS incidence in the SQ‐LNS group resulted from increased obstetric needs or more active health seeking and a better supply of services. Trial registered at clinicaltrials.gov, NCT01239693.

Safety of vaginal delivery in women with placental chorioangiomas diagnosed by prenatal ultrasound: A retrospective cohort study.

This study aimed to examine the maternal and neonatal outcomes in different mode of delivery in pregnant women with placental chorioangiomas, in order to determine the safety of vaginal delivery.We conducted a retrospective study of 54 women with placental chorioangioma diagnosed by prenatal ultrasound and subsequently proven histologically, excluding those who underwent cesarean section for obstetric indications. The mode of delivery was divided into a vaginal delivery group (23 women) and a cesarean section group (31 women). The indication of cesarean section group was only for placental chorioangioma, no other obstetric indications. The maternal characteristics, pregnancy outcomes and the color doppler imaging characteristics of placental chorioangioma of the 2 groups were compared, and the clinical characteristics of women in the vaginal delivery group were described in detail.The incidence of placental chorioangioma was nearly 0.43‰ in our study. There was no significant difference in the maternal characteristics and pregnancy outcomes between the 2 groups. 82.6% (19/23) of the women successfully delivered vaginally and 4 failed who turned to cesarean section in the vaginal delivery group; among them, 17 women had giant chorioangiomas (>4 cm in diameter). The direct cause of vaginal delivery failure was fetal distress, persistent occiput posterior fetal position and cephalopelvic disproportion.Pregnant women with placental chorioangiomas and no other obstetric indications for cesarean section may attempt a vaginal delivery, even with giant chorioangiomas. If there are risk factors of vaginal delivery failure, the progress of labor needs to be closely monitored.

Analysis of predictive variables of success of the mechanical cervical ripening with Foley catheter in patients with a prior cesarean section and a postterm pregnancy

Objectives: Analysis of success variables of cervical ripening with the Foley catheter in patients with prior cesarean section (PCD), post-term pregnancy (PP), and a Bishop score £6. Evaluation of technique’s safety. Study design: Prospective cohort trial in which 120 patients were enrolled, from April 2014 to May 2018. PCD was codified in four groups: 1) failed Induction (FI); 2) non-progressive labor (NPL) or cephalopelvic disproportion (CPD); 3) abruptio placentae (AP), risk of fetal distress (RFD) or placenta previa; or 4) other causes. Inclusion criteria: singleton pregnancy; &gt;40+6 weeks’ gestation; cephalic presentation; Bishop Score £6; PCD &gt;18 months; signed consent of vaginal delivery (VD). Exclusion criteria: myomectomy with entry into the endometrial cavity; &gt;1 PCDs or uterine rupture; other presentations; macrosomia; multiple pregnancy; placenta or vasa previa; premature rupture of membranes (PROM); inferior genital tract infection. Used material and protocol: Foley catheter insertion at 9 am, followed by 2 hours of fetal cardiotocograph register (CR). This was repeated 6 hours later. Catheter removal 12 hours after the insertion. Intravenous oxytocin was started at 8 am the following day. Statistical analysis: multivariable logistic regression to assess the similarity of populations. Assessment of the relation between VD and APL with the PCD indication and the CL through logistic regressions. The analysis were performed using R (3.5.1), clickR packages (0.3.64), and Boot Validation (0.1.6). Results: A total of 86/109 (78.9%) achieved APL. Whereas 52/86 (60.47%) finished by VD, 34/86 (39.53%) had a cesarean delivery (CD). No significant differences were found between populations. PCD indications for AP, RFD or placenta previa (OR = 7.85 IC95% [1.87, 39], p=0.007) have a higher likelihood of VD. The PCD indication for NPL or CPD; and AP, RFD and placenta previa, have a higher likelihood of achieving APL (OR 14,55 [IC 95% 2.01, 308.5], p=0.023; OR 15,81 [IC 95% 2.03, 359.78], p=0.024; respectively). As CL was higher, the likelihood of APL was lower (OR=0.92 IC95% [0.84, 0.99], p=0.034). No uterine rupture registered. Conclusions: Cervical ripening with the Foley catheter was satisfactory in 78.9% (86/109). PCD indications that are different from FI associate a higher likelihood of VD. CL has a decreasing effect on the likelihood of APL. The Foley catheter is a safe method for cervical ripening.

The Pathophysiology of Labor Dystocia: Theme with Variations.

Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.

Study of indications of primary cesarean section in multigravida patients: A retrospective study

Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. Multiparous means those who had delivered once or more after the age of viability. It includes multipara (para 2, 3, 4) and grand multipara (para more than 4). Primary Caesarean section in the multipara means first Caesarean section done in the patients who had delivered vaginally once or more. Aims and Objectives: The aims of this study were to study the indications for the primary cesarean section in multigravida women at tertiary care center, Medical College Jhalawar. Materials and Methods: Retrospective record-based study of all primary cesarean section in multigravida women admitted at Janana Hospital, Medical college Jhalawar during the period of 3 months. Retrospective analysis of case sheet was done in parous women who had previous vaginal deliveries. Inclusion criteria were all multigravida who went for the lower segment cesarean section (LSCS). Results: During the study period of 3 months, total 1968 deliveries occurred, out of which 806 (40.95%) underwent cesarean section and 208 (25.80%) among these cesarean sections were underwent primary cesarean section in multigravida. Maximum number of the patients were in the age group of 25–30 years 120 (57.69%). Maximum number of patients were gravida 2 (G2) 135 (63.67%) and gravida 3 (G3), 52 (24.52%). Almost all of them (96.63%) underwent emergency cesarean section. The most common indication for the primary LSCS in multigravida patients was fetal distress 46 (22.11%) followed by malpresentation 38 (18.26%) cases, meconium stained liquor with fetal distress 23 (11.05%), severe oligohydramnios 15 (7.21%), non-progress of labor 13 (6.25%), pre-eclampsia and big baby 8 (3.84%) each, elective CS with bad obstetric history, obstructed labor and placenta praevia 7 (3.36%) reach, APH and cephalopelvic disproportion 6 (2.28%) each, and PIH 5 (2.24%). Conclusion: The most common indication for the primary LSCS in multigravida patients was fetal distress 46 (22.11%) followed by malpresentation 38 (18.26%) cases in our study.

Teenage Pregnancy and its Outcomes in a Tertiary Care Hospital in Assam

Background: Teenage pregnancy is one of the determinants of high maternal morbidity and mortality. Assam is known for its highest contribution of maternal death in India. In Assam, around 31% of teenage girls get married before the age of 18, and around 12% teenage girls become mothers before they turn out to be 18 years. Objectives: The objective of this study is to know the maternal and fetal outcomes of teenage pregnancy and its determinants in a tertiary care setting in Assam. Materials and Methods: A cross-sectional study was conducted among 118 teenage mothers admitted to Jorhat Medical College and Hospital from June to August 2019. Required data on sociodemographic characteristics of the mother, antenatal, intranatal, and postnatal histories, and maternal and fetal outcomes of the pregnancy, were collected in predesigned and pretested schedule. Data analysis was done using Microsoft Excel software. Ethical approval was obtained from the Institutional Ethics Committee. Results: Among the 118 teenage mothers which constitute 14.6% of total deliveries conducted during the study period, 61% were anemic during pregnancy and 75.42% of teenagers had term delivery while 19.49% had either preterm or postterm deliveries. Cesarean section was done for 50.85% of pregnancies and 45.77% of teenage mothers had complications such as eclampsia, prolonged labor, cephalopelvic disproportion, and premature rupture of membrane during labor. About 42.73% of the newborns were found to be low birth weight babies. A statistically significant association was found between determinants such as lower socioeconomic class, younger age at marriage, less education of mothers, lack of knowledge about contraceptives, and teenage pregnancy. Conclusion: Our study findings indicated a high percentage of teenage pregnancy and increased complications among teenage mothers and newborns.

Socio-demographic, obstetric and non-obstetric factors influencing the incidence of cesarean section (C-section)

Cesarean sections (CS) and regular vaginal births are two processes for childbirth. Cesarean section is an intricate surgery involving numerous risks such as blood loss, organ damage, allergic reaction to anesthesia, infections and blood clots. Now a days rate of CS is increasing in developed countries. The increased rate of caesarean section can be described by socio-economic status (SES), medical and non-medical factors. Socioeconomic status (SES) is linked to a wide range of maternity services including Cesarean section (CS), whereas the most common medical and non-medical factors are labor dystocia, fetal mal-presentation, multiple gestations, suspected fetal macrosomia, placenta previa, placenta abruption, prolonged labor, fetal distress, birth defects, repeated cesareans, chronic health condition, cord prolapse, cephalopelvic dis-proportion (CPD), preeclampsia, bleeding, IUGR (Intrauterine growth restriction), uterine rupture, gestational diabetes, pelvic tumors, vesico-vaginal fistula repair, AP (anterior and posterior) repair and IUD (intrauterine devices).The aim of this study was to determine the rate of CS and socio-demographic, obstetric and non-obstetric factors influencing the incidence of cesarean section (C-section). This study was conducted at Combined Military Hospital (CMH), Peshawar for a period of 8 months. A standardized questionnaire was made by investigator to evaluate social and physiological status, obstetric factors, and non-obstetric- factors. 400 CS patients participated in this study. The findings of this study showed different socio-economic factors (ethnic variances, age occupation, income status) affecting cesarean section (C- section) delivery rates. The highest CS rate (39.25%) was in the age group of 26-30 years and in non-working women (61.5%). Moreover the high education of pregnant females is greatly associated with C-section rates because of the frequent visits for antenatal care during their pregnancy. Frequency of CS in overweight and obese women were found 139 (34.75%) and 198 (49.5%) of the total cases. As far as obstetric code was concerned, nulliparous women (62.5%) are more likely to be delivered by caesarean section as compared to Multipara 36.8% and Grand Multipara 0.8% when labor is induced.

Analysis of Medical and Social Causes of Obstructed Labour

Background: Obstructed labour is one of the major causes of maternal mortality (8%) in Bangladesh. It is also responsible for high rate of maternal and fetal morbidity. If we can identify the medical and social causes of obstructed labour in our country it may be helpful to find out the way to prevent this disease. Objectives: This study was to find out the medical and social causes of obstructed labour in our country. It also finds out the cause of delay in seeking care.Material &amp; Methods:This study is a prospective observational study has been done in Dhaka Medical College Hospital, Dhaka from August 2004 to December 2005. One hundred patients who were admitted with obstructed labour during study period were included in this study.Results:In this study prevalence of obstructed labour was 3.59%. Among the patients who were admitted with obstructed labour 52% were within 20 to 25 years of age, 55% were primigravida, only 30% were on regular antenatal checkup. The medical causes of obstructed labour were cephalopelvic disproportion in 30%, malposition and malpresntation in 69% and cervical fibroid in 1 %. In this study 72% of study population had monthly income below 3,000 BTD, 27% had 3,001 – 5,000 BDT and only 1 % had above 5,000 BDT. Among them 8% patient had crossed the primary level of education and 35% were illiterate. The patients who were admitted with obstructed labour could not utilize the health facility in time and they had to go for trial of home delivery first. In 25% cases their husband and family members did not agree to bring them to hospital, 31.3% was because of ignorance, 14% was due to economic constraints, 13.3% wanted to avoid operative delivery, 9.4 % patient herself did not agree to come to hospital because it would disrupt house hold work and the rest 7% could not come due to long distance between home and health center and tertiary hospital. Modes of delivery were LSCS in 85%, craniotomy in 9% and evisceration in 4%. Maternal outcome was WF in 7% and puerperial sepsis in 18%. Perinatal death was 45%, MMR was 3% due to obstructed labour.Conclusions:SThe causes of obstructed labour are not only due to medical causes but also have social causes. The social causes depend on the socio-economic status and the level of education.

Do the Externally Measurable Pelvic Diameters Estimate the Relevant Birth Canal Parameters in A Reproductive-Age Woman? Pelvimetry by Reformatted Computed Tomography at Sodo Christian Hospital, Southern Ethiopia

Introduction: Assessment of the size of the female pelvis is an important obstetric practice to identify mothers at risk of cephalopelvic disproportion. Due to the problem of accessing radiological instruments to carry out pelvimetry in health centers of resource-limited countries, clinical pelvimetry remains a routine practice. The present study was aimed at assessing the prediction capability of intertuberous diameter, anterior interspinal diameter, and bi-trochanteric diameters on the pelvic inlet and mid-pelvis diameters as an alternative method to estimate different birth canal parameters. Subjects and Methods: Institution-based retrospective cross-sectional study design was conducted on randomly selected 423 abdominopelvic computed tomography images of reproductive-age women who visited Sodo Christian hospital from September 2018 to November 2020. Pelvic diameters were measured on a 3D workstation using multiplanar reconstruction and volume rendering images. Pearson’s correlation, partial correlation, and multivariate regression analysis were done for assessing the relationship between the variables by using STATA 16. Results: The present study demonstrated that the intertuberous diameter (ITD) is a significant predictor of obstetric conjugate diameter (OCD), the transverse diameter of the pelvic inlet (TDI), and interspinous diameter (ISD). A millimeter increase in ITD is associated with 0.552 mm, 0.558 mm, and 0.74 mm increase in OCD, TDI, and ISD, respectively. The TDI is the only lesser pelvis diameter significantly predicted by the anterior interspinal diameter (AISD). A millimeter increase in AISD is associated with a 0.229 mm increase in TDI. Jointly the ITD and AISD were shown to predict 81% of TDI. The bi-trochanteric diameter (BTD) was found statistically insignificant predictor of OCD, TDI, and ISD. Conclusion: As to the present study, the ITD is a potential predictor of the pelvic inlet and mid pelvic diameters. Besides, only the TDI could be estimated from AISD, whereas the BTD could not estimate any of the birth canal parameters.

Caesarean delivery and the attendant FETO-maternal aftermath at a rural hospital in South Southern Nigeria

Background: Caesarean delivery is a necessary tool in the management of obstetric patients when indicated. However, there is general apprehension about the increasing proportion of births by caesarean section (CS) across the globe. Objectives: To ascertain the CS rate (CSR), the indications and the outcomes of caesarean delivery in the hospital. Methodology: The obstetric and theatre records of all caesarean deliveries at Federal Medical Centre Yenagoa, Otuoke outreach, South-South Nigeria, between January 2017 and December 2021 were assessed retrospectively. Generated data were analyzed using SPSS version 23. Results:There were 770 deliveries, out of which 104 were caesarean deliveries, giving a CSR of 13.5%. The majority, 71 (68.3%) of the patients had emergency caesarean delivery while 33 (31.7%) had an elective caesarean delivery. The commonest indication for caesarean delivery was cephalopelvic disproportion (CPD) (27.9%) followed by previous CS and breech in primigravida (17.3% and 7.7% respectively). The majority of the patients, 58 (55.8%) were booked while 46 (44.2%) were unbooked. The commonest morbidity encountered was anaemia which complicated 21.1% of cases. There was one maternal death and six perinatal deaths giving maternal and perinatal mortality rates of 960/100,000 and 49/1000 respectively. Conclusion: The caesarean section rate was within the limits laid down by the World Health Organization. CPD was the chief indication for CS followed by repeat CS and breech in primigravida. Efforts to maintain the CS rate, within acceptable limits, as noted in this study, should be continued.

Vaginal birth after cesarean section: Experience from a regional hospital

ObjectiveTrial of labor after cesarean section (TOLAC) is an option for women with previous cesarean section. However, few women choose this option because of safety concerns. We evaluate the safety and risks associated with TOLAC and the success rate of vaginal birth after cesarean delivery (VBAC). Material and methodsWe reviewed all patients with a history of previous cesarean section that underwent elective repeat cesarean section (ERCS) or TOLAC in a regional teaching hospital from Nov, 2013 to May, 2018. Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were analyzed. Results199 pregnant women with a history of at least one previous cesarean section were enrolled. 156 women received ERCS and 43 women (21.6%) underwent TOLAC, with 37 (86.0%) who underwent successful VBAC. The VBAC rate was 18.6%. Higher success rate was found in women with previous vaginal birth than in women without vaginal birth (100% vs. 81.8%). One case (2.3%) in the VBAC group was complicated with uterine rupture and inevitable neonatal death during second stage of labor. The uterus was repaired without maternal complications. In another case, the newborn's condition was complicated with low APGAR score (<7) at birth due to maternal chorioamnionitis. Among indications for previous cesarean section, cephalo-pelvic disproportion (CPD) was associated with TOLAC failure and uterine rupture after VBAC. ConclusionVBAC is a feasible and safe option. Modes of delivery should be thoroughly discussed when considering TOLAC for women with history of previous cesarean section due to CPD, considering its association with TOLAC failure in second stage of labor.