Cesarean Birth Research Articles (Page 1)

Previous trial-based or modeling studies of cost differences between births following induction of labor (IOL) and expectant management (EM) showed mixed findings and did not account for the full range of costs at a population level. We included singleton, cephalic, and term live births between 01/07/2016 and 30/06/2018 in public hospitals of one Australian state (Queensland). We excluded individuals with a previous cesarean birth, no labor, and specific maternal conditions. The mean costs per pregnancy (AUD 2021/22), capturing all health service events and prescription medications accessed during the month of labor and birth, were compared. Generalized linear models were used to calculate cost ratios (CR) and their 95% confidence intervals (CI) after adjusting for potential confounders. The analysis included 30,924 births. The mean costs per pregnancy (combined women and neonates) were higher for IOL at each week of gestation (37-40), compared with EM, both before and after adjustment, regardless of parity. The largest ($7684, CR = 1.31; 95% CI: 1.23-1.40) and smallest ($1502, CR = 1.06; 95% CI: 1.03-1.09) cost differences were found among nulliparous women at 37 and 39 weeks, respectively. Maternal inpatient admissions largely drove these cost differences. These findings suggest that higher costs associated with IOL in low-risk women are likely due to the intervention itself-such as increased intrapartum procedures or complications-rather than underlying maternal risk. This supports previous evidence of higher cesarean rates after IOL and highlights the need for further evaluation of its cost-effectiveness in the Australian context.

Plain Language Summary Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these caesarean births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the CB, difficulty in delivery of the baby's head may result—this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stays. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned caesarean births (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby's feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the Avoiding Brain Injury in Childbirth (ABC) programme.

The prevalence of uterine fibroids in pregnancy varies between 1.6% and 10.7%. Pregnancies involving uterine fibroids are generally uncomplicated. However, complications can occur, particularly in cases of multiple fibroids, when the fibroids are larger than 5 cm, or when they are located in the lower uterine segment. Between 10% and 30% of pregnant women with fibroids experience complications during pregnancy, labor, and the postpartum period. The most common complication during pregnancy, which can occur in 8% of women, is red degeneration. High-quality data on the relationship between fibroids and pregnancy outcome are very limited. Potential obstetric complications include preterm birth (increased risk, OR 1.5; 95% CI, 1.3-1.7), malpresentation of the baby (OR 2.65; 95% CI, 1.60-3.70), placental abruption (OR 2.63; 95% CI, 1.38-3.88), placenta previa (OR 2.21; 95% CI, 1.48-2.94), cesarean birth (OR 2.60; 95% CI, 2.02-3.18), postpartum hemorrhage (OR 2.95; 95% CI, 1.86-4.66), and other rare occurrences. Most women with uterine fibroids are able to deliver vaginally without complications. Cesarean birth is typically performed for standard obstetric indications. It is recommended that cesarean myomectomy should be avoided when possible.

To evaluate the comparative effectiveness of four pharmacologic regimens-oxytocin, carbetocin, oxytocin plus tranexamic acid (TXA), and carbetocin plus TXA-for postpartum hemorrhage (PPH) prophylaxis in cesarean deliveries. This prospective cohort study was conducted at a tertiary center in Istanbul, Turkey, between March 2024 and January 2025. A total of 400 women undergoing cesarean delivery at 34+0-39+6weeks of gestation were sequentially assigned to one of four prophylactic intervention groups (n=100 each): oxytocin, oxytocin+TXA, carbetocin, or carbetocin+TXA. Medications were administered post-placental delivery. Third-stage labor management was standardized. Primary outcomes included estimated blood loss (EBL), 24-h hemoglobin change (ΔHb), and need for transfusion or intravenous iron. Baseline neonatal characteristics, including birthweight and Apgar scores, were recorded to ensure comparability across groups. Baseline characteristics were similar across groups. Hemoglobin decline differed significantly (p=0.015), being lowest in the carbetocin+TXA group (7.73±6.68 %) and highest in the oxytocin group (10.70±7.23 %). Although mean EBL was lowest in the carbetocin+TXA group, the difference was not statistically significant (p=0.172). Transfusion and iron supplementation rates were low and comparable. No adverse neonatal outcomes were observed. Carbetocin combined with TXA was associated with the most favorable hematologic profile. These findings support the use of multimodal pharmacologic strategies for PPH prevention in cesarean births and may inform future protocol development.

In Poland, 48 in 100 babies are born by cesarean section, which is among the highest rate of cesarean birth (CB) in the Organization for Economic Cooperation and Development (OECD) countries. Several factors are linked to higher CB rates, including childbirth fear prior to pregnancy (CFPP), and physician versus midwifery led models of care. In order to decrease CB rates, it is crucial to understand modifiable factors that are associated with childbirth preferences. In this study, we tested how confidence in knowledge of pregnancy and birth was related to: (i) fear of childbirth, preference for: (ii) mode of birth and (iii) prenatal care provider type. We recruited 782 women aged 18-35 (mean 24.7, SD 3.19) who had never been pregnant but desired to have at least one child in the future. Women with moderate and high levels of confidence in knowledge had lower odds of high fear of childbirth compared to women with low levels of confidence (aOR = 0.57, 95% CI: 0.39-0.83 and aOR = 0.54, 95% CI: 0.33-0.88, respectively). Neither moderate nor high levels of confidence in knowledge were associated with a preference for CB (aOR = 1.10, 95% CI: 0.73-1.67 and aOR = 0.92, 95% CI: 0.55-1.55, respectively) compared to low levels. In addition, women with high levels of confidence in knowledge had significantly lower odds of preferring obstetricians (aOR = 0.49, 95% CI: 0.26-0.89), compared to midwives. Our study provides evidence that confidence in knowledge is related to fear of childbirth and prenatal care provider preferences.

Maternal mortality is three times higher in Black women compared to non-Hispanic white women. The postpartum period, the time with the least amount of health surveillance, accounts for 65% of maternal deaths. Altered maternal heart rate variability (HRV) may reflect early postpartum cardiovascular complications. Home HRV monitoring could facilitate early detection of postpartum complications and reduce disparities in maternal deaths. To determine the feasibility of a new method for remotely monitoring HRV in postpartum women. A secondary aim was to explore whether HRV metrics differed between postpartum women with cardiovascular morbidities and those recovering from uncomplicated pregnancies. Twenty Black postpartum women were instructed to record heart rhythms at home using a wearable sensor for 10 minutes, twice daily, over 4 weeks. Waveforms were uploaded to a cloud server; data were processed to measure HRV metrics (e.g., standard deviation normal sinus beats [SDNN], root mean square of successive differences [RMSSD]), low-frequency (LF, 0.04-0.15 Hz), high-frequency (HF, 0.15-0.4 Hz) oscillations [continuous wavelet transform, 10 sec segments]). To determine whether HRV profiles differ according to risk factors, we compared women who had vaginal births without complications ( n = 7) to women with elevated risk factors, such as cesarean birth (n = 7) or preexisting cardiovascular conditions ( n = 6). Data were averaged across 4 weeks and reported as mean ± SD. Data were available from 17 participants—one withdrew and two could not obtain internet access. No serious postpartum complications occurred. Women delivering vaginally (no history of cardiovascular disease) had a mean heart rate of 82.2 ± 6.3 bpm ( n = 6), and did not differ significantly ( p = 0.23) from the elevated risk group (87.2 ± 8.9 bpm, n = 13). Groups had statistically similar mean values for R-R intervals (183.6 ± 176.6 versus 263.5 ± 201.4 ms), SDNN (392.1 ± 322.1 versus 512.2 ± 327.5 ms), and RMSSD (0.29 ± 0.64 versus 0.49 ± 0.96 ms). Frequency band powers were similar (LF band [0.04 ± 0.05 versus 0.05 ± 0.06 ms2]; HF band [0.04 ± 0.05 versus 0.06 ± 0.07 ms2]), indicating that there was likely no abnormal autonomic modulation of the heart in this sample. Most participants (85%) completed monitoring, demonstrating the feasibility of our method. Large prospective studies are needed to develop HRV algorithms that could alert postpartum women to seek urgent care for impending complications.

Induction of labor (IOL) is a common intervention in industrialized countries. Failed induction is frequently reported, yet there is no consensus on its definition. Since the primary goal of IOL is to initiate labor, progress to the active phase is a more relevant measure of success than the surrogate of caesarean birth. Previous studies on the influence of body mass index (BMI) on the risk of failed IOL are limited. Most rely on data from the United States and define failed IOL primarily by caesarean delivery. This study aims to explore the association between maternal BMI and failed IOL, defined as failure to progress to the active phase of labor. We studied 22 114 term, singleton women undergoing IOL in the Central Denmark Region from 2013 to 2022. Women with spontaneous prelabor rupture of membranes, uterine scar, or fetal demise were excluded. The main outcome measure was failed IOL, defined as not reaching cervical dilation of 6 cm or more. BMI, our exposure, was modeled as a continuous variable using restricted cubic splines and as a categorical variable stratified according to the World Health Organization BMI groups. Adjusted logistic regression was used in both models to assess the association between BMI and failed IOL. Proportions of nulliparous women with failed IOL ranged between 4% for normal weight and 10% for obesity class III. Adjusted odds ratios for nulliparous women for failed IOL were 1.5 (95% confidence intervals [CI] 1.3, 1.7) for overweight, 1.8 (95% CI 1.4, 2.3) for obesity class I, 2.7 (95% CI 2.2, 3.3) for obesity class II, and 2.9 (95% CI 1.4, 6.0) for obesity class III compared to women with normal weight. In parous women, there was a similar but less pronounced association between BMI and failed IOL with a <2% absolute risk of failed IOL. A similar pattern was found when BMI and failed IOL were modeled using restricted cubic splines. In singleton women with induced labor at term, increasing BMI was associated with higher odds of failed IOL; this association was more pronounced in nulliparous women.

Prediction of vaginal birth after induction of labor with maternal circulating RNA transcripts.

Objective: To determine whether a third-trimester drop in insulin requirements in pregnant people with pre-existing diabetes is associated with a subsequent occurrence of adverse pregnancy outcomes. Research Design and Methods: We conducted a retrospective cohort study of patients with type 1 and 2 diabetes who were followed at a tertiary referral center in Toronto, Canada. We collected data on insulin dosing in the third trimester (after 28 weeks of pregnancy) and compared outcomes in those with and without a third-trimester drop of 15% or more in their total insulin requirements. Our primary outcome was a composite of stillbirth, spontaneous preterm birth or preterm premature rupture of membranes, and iatrogenic preterm birth or cesarean birth for fetal wellbeing concerns, occurring following the drop in insulin requirements. We conducted regression analyses controlling for early pregnancy glycosylated hemoglobin, body mass index, and diabetes-related microvascular disease, and presented results as odds ratios (OR) with 95% confidence intervals (95%CI). Results: We included 350 pregnant people—146 with type 1 and 204 with type 2 diabetes. Of these, 54 (15.4%) had a third-trimester drop of 15% or more in their total insulin requirements. There was no difference in the primary outcome between groups (OR 0.97; 95% CI 0.41–2.10). Conclusions: Based on this single-center study, limited by sample size and analytic constraints, in people with pre-existing diabetes, a third-trimester drop of ≥15% in total insulin requirements was not associated with subsequent occurrence of adverse pregnancy outcomes. Larger prospective studies looking at associations between a drop in insulin requirements and subsequent occurrence of adverse pregnancy outcomes are necessary to inform meta-analyses and clinical decision making.

BackgroundEpileptic seizures during pregnancy may increase the risk of adverse pregnancy outcomes. Socioeconomic disparities in epilepsy incidence may extend to seizure control. We conducted a systematic review and meta-analysis to assess the association between epileptic seizures during pregnancy and adverse pregnancy outcomes. We also evaluated the association between socioeconomic and individual-level factors and seizure occurrence.Methods and findingsWe searched MEDLINE, Embase, CINAHL, and PsycINFO databases from inception to May 2025 for observational studies on pregnant women with epileptic seizures. We compared maternal and foetal outcomes in pregnant women with and without seizures and assessed the association between seizure occurrence and socioeconomic or individual-level factors. We used the Newcastle–Ottawa Scale to assess the risk of bias of included studies. Meta-analyses using random effects model were performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).From 13,381 identified publications, 25 studies (24,596 pregnancies) are included in this analysis. In pregnant women with epilepsy, women with seizures compared to those without had increased odds of caesarean birth (OR 1.62, 95% CI 1.14 to 2.30, p = 0.007), peripartum depression (OR 2.20, 95% CI 1.04 to 4.65, p = 0.04), and small for gestational age baby (OR 1.32, 95% CI 1.03 to 1.69, p = 0.03). The odds of preterm birth (OR 1.66, 95% CI 1.29 to 2.15, p < 0.001), low birthweight (OR 1.47, 95% CI 1.12 to 1.93, p = 0.006), and small for gestational age baby (OR 1.44, 95% CI 1.19 to 1.74, p < 0.001) were higher in women with seizures compared to women without epilepsy. The risk of seizures was greater in pregnant women with epilepsy with low income compared to those with higher income (OR 1.57, 95% CI 1.22 to 2.02, p < 0.001), and in women with focal epilepsy compared to those with generalised epilepsy (OR 1.84, 95% CI 1.54 to 2.20, p < 0.001). The number of studies for some outcomes was small, limiting subgroup analyses and detection of heterogeneity.ConclusionEpileptic seizures are associated with increased risks of adverse maternal and foetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care.

Objective: This study aims to identify the psychological, social, demographic, and environmental factors that influence the preference for caesarean section among women who exercise. Scope: The study focuses solely on caesarean section, with normal delivery being evaluated for comparison purposes. Multidimensional factors such as psychological status, social media usage, previous birth experiences, and socio-economic variables were analyzed within the scope of the study. Method: The scale used in the study consists of a two-part questionnaire. This scale is a validated and reliable questionnaire. The first part of the questionnaire includes demographic information and lifestyle, while the second part includes women's attitudes towards caesarean and normal birth. The research was conducted in Istanbul, Izmir, Ankara, Antalya, and Elazığ provinces of Turkey. The study was conducted using a convenience sampling method based on participant eligibility. The data obtained were analyzed using various statistical methods, using ANOVA, t-test, Mann-Whitney U test, Spearman correlation, factor analysis, and logistic regression. Results: It was found that the preference for caesarean section was based not only on medical reasons but also on psychological and social factors. In particular, attitudes toward cesarean section differed significantly among women with psychological problems and those with a history of miscarriage or abortion. Additionally, social media usage had a strong influence on the preference for cesarean section. On the other hand, exercise habits and certain socioeconomic variables did not have a significant effect on the preference for cesarean section. In conclusion, the decision to undergo a cesarean section is shaped by a combination of multidimensional factors. In this context, health policies should be structured to support individuals in terms of psychological support, access to information, and social environment.

Given the prevalence and consequences of unmet social needs in perinatal populations, there is a critical demand for perinatal care that addresses social needs. To better support health systems in providing comprehensive social and perinatal care services, this quality improvement initiative uses the Donabedian model for care quality to describe the structure, process, and outcomes of embedding an innovative perinatal care program with integrated social care into an established primary care center. The Improving Maternal Outcomes Now! (IMON) program was designed to address the clinical and health-related social needs of patients at highest risk of maternal health disparities. The IMON program offers holistic prenatal and postpartum care through the provision of midwifery services, obstetrician support, intensive social needs support, and around-the-clock virtual care. Program implementation began in June 2023 at a federally qualified health center. During the first 18 months of implementation, 102 pregnant patients received prenatal care. Forty-four percent of patients identified as Hispanic, with more than half (54%) reporting Spanish as their preferred language. Patients were highly engaged with program services. Nearly two-thirds of IMON patients (65%) initiated prenatal care in their first trimester, and most (91%) were assisted with social needs during or after pregnancy. A majority (88%) enrolled to receive adjunctive virtual care services. Among the 61 patients who gave birth, 77% did so vaginally, whereas the remaining 23% did so via cesarean birth. On average, patients gave birth at 39 weeks' gestation, with only 5% giving birth preterm and 3% having a newborn that was small for gestational age. Preliminary findings suggest that IMON can be implemented within a safety-net setting, with high patient engagement and social needs support. Early outcomes show promising maternal and neonatal health indicators.

BackgroundPregnancy induces spinal changes that are generally expected to resolve by the end of the puerperium. However, the mode of delivery may influence this recovery.PurposeThis study aimed to assess pain-free active lumbar spine range of motion (ROM) in postpartum women following Cesarean birth (CB) or vaginal birth (VB), compared to women who had never been pregnant.MethodsA cross-sectional analytical study included 66 women divided into three groups: Group A (n = 25, CB women), Group B (n = 16, VB women), and Group C (n = 25, controls). Lumbar ROM, including flexion, extension, bilateral side bending, and axial rotation, was measured using bubble inclinometers between the 6th and 12th postpartum weeks.ResultsThe Kruskal-Wallis test showed significant differences were found among the groups in extension ROM (P = 0.002) and bilateral side bending ROM (P = 0.002 right, 0.004 left). Post-hoc analysis showed that CB women had significantly decreased extension ROM than controls (P = 0.001), and significantly decreased right and left side bending compared to both VB (P = 0.009, 0.013) and control groups (P = 0.010, 0.014). No significant differences were observed in flexion (P = 0.877) or axial rotation (P = 0.412 right, 0.753 left).ConclusionCB women exhibited persistent limitations in lumbar extension and side bending ROMs beyond the puerperium, possibly due to scar restrictions and core muscle weakness rather than pregnancy itself. VB women demonstrated spinal mobility more comparable to controls, suggesting VB may be more favorable for postpartum spinal recovery.

To evaluate the association of vaginal versus caesarean birth with neonatal and maternal outcomes for breech, singleton deliveries at 22 0/7 to 25 6/7 weeks of gestation. Retrospective cohort study. Hospital births in the United States. This study analysed non-anomalous, singleton, breech live births at 22 0/7 to 25 6/7 weeks of gestation identified in the linked birth-infant death records data from 2016 to 2021. A propensity score analysis was conducted to establish pseudo-randomization based on the mode of delivery, matching vaginal to caesarean deliveries at a ratio of 1:2 using greedy nearest-neighbour matching. The propensity score estimation included year of delivery, maternal age, race/ethnicity, pre-pregnancy body mass index, parity, marital status, maternal education, insurance status, attendant at delivery, smoking status, hypertensive disorders, diabetes mellitus, gestational age, induction of labour and whether a trial of labour was attempted. We estimated the risk differences (RD) and odds ratios (OR) and associated 95% CIs, taking the matching into consideration. Multiple imputation was used to account for missing data. Composite adverse neonatal and maternal outcomes. Of 21,461 periviable breech singleton births, 34.0% (n = 7289) were delivered vaginally. The median gestational age was 24 (IQR: 23-25) and 23 (IQR: 22-24) weeks in the vaginal and caesarean delivery groups, respectively. Earlier gestational age was associated with vaginal birth, while later gestational age was associated with caesarean births. After propensity score matching, the distributions of baseline factors, except for gestational age, were balanced between the vaginal and caesarean delivery groups. A composite of adverse neonatal outcomes occurred among 99.0% (n = 7213) of vaginal and 96.8% (n = 13,716) of caesarean breech births (aRD 1.8%, 95% CI 1.3 to 2.4; aOR 2.25, 95% CI 1.59 to 3.17). Neonatal mortality rates were higher among vaginal compared to caesarean breech births (72.6% versus 36.2%; aRD 26.8%, 95% CI 25.0 to 28.6; aOR 3.15, 95% CI 2.85 to 3.48). A composite of adverse maternal outcomes occurred in 1.6% of vaginal breech and 3.1% of caesarean births (aRD -1.7%, 95% CI -2.2 to -1.1; aOR 0.47, 95% CI 0.35 to 0.63). Vaginal breech birth between 22 0/7 and 25 6/7 weeks of gestation is associated with a lower risk of adverse maternal outcomes but a higher risk of neonatal adverse outcomes and mortality.

We sought to evaluate the impact of a prospective change in practice to dual pharmacologic prophylaxis with oxytocin and misoprostol for patients at moderate or high risk for postpartum hemorrhage (PPH) based on validated hemorrhage risk assessments on PPH rates, quantitative blood loss (QBL) amounts, and morbidities. A quality improvement effort was undertaken with the addition of sublingual misoprostol prophylaxis immediately after birth for patients with moderate or high risk for hemorrhage during pre-birth PPH risk assessment, 200 μg for moderate and 400 μg for high risk. "Oxytocin only" prophylaxis was administered June 2021 to April 2022 and "dual agent" prophylaxis was given April 2022 to April 2023. deliveries ≥20 weeks' gestation with moderate or high-risk pre-birth PPH risk assessment. missing QBL, gestational age <20 weeks or low PPH risk. Primary outcomes were QBL at delivery and total postpartum blood loss (PPBL). Secondary outcomes were PPH rate (≥ 1000 mL) and a composite of maternal morbidity. Data were captured electronically retrospectively for both time periods, with morbidities confirmed by chart review. A total of 2104 (47.9%) patients were treated with oxytocin only prophylaxis and 2293 (52.1%) patients were in the intervention period with dual agent prophylaxis. The cesarean delivery rate for the oxytocin only group was 37.3%, and 39.2% for the dual agent prophylaxis group. Postpartum hemorrhage rate was similar between the two groups, but composite morbidity was significantly lower for the dual agent prophylaxis group (0.4% vs. 1.4% for single agent prophylaxis; P < 0.001). In a subgroup analysis of cesarean delivery, PPH rate and composite morbidity were significantly lower for the dual agent prophylaxis group after adjusting for potential confounders (PPH rate: odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.60-0.95, P = 0.02; composite morbidity: OR: 0.31, 95% CI: 0.12-0.69, P = 0.004). Dual agent prophylaxis with oxytocin and misoprostol immediately after delivery was associated with a significant reduction in total blood loss, PPH rates, and composite morbidity compared to oxytocin only prophylaxis in patients undergoing cesarean birth. Prospective studies are warranted to assess replicability and safety.

The optimal mode of delivery for twins has been debated for decades. The objective of this study is to compare maternal and perinatal outcomes between planned cesarean birth and planned vaginal delivery in twin pregnancies. We conducted searches across MedLine, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and Embase, from database inception to June 13, 2025, for studies that compared planned vaginal delivery with planned cesarean birth regarding maternal and/or neonatal outcomes in twin gestations. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the I2 statistic. The Downs and Black scale was used to assess study quality and risk of bias. Among 11 207 publications, 33 studies met the inclusion criteria. Planned cesarean versus vaginal delivery showed no significant differences in neonatal death (OR 0.99, 95% CI: 0.58-1.67), Apgar score <7 at 5 min (OR 0.74, 95% CI: 0.51-1.08), low umbilical artery pH (OR 0.56, 95% CI: 0.30-1.06), or maternal death (OR 0.68, 95% CI: 0.11-4.31). The analysis of composite adverse outcomes (16 studies) showed a slight advantage for planned cesarean (OR 0.96, 95% CI: 0.94-0.99). Planned vaginal delivery showed lower rates of periventricular leukomalacia (OR 3.14, 95% CI: 1.45-6.83) and maternal wound complications (OR 1.86, 95% CI: 1.25-2.76). Planned cesarean delivery in twin pregnancies shows a small trend toward improved neonatal outcomes but is associated with higher maternal wound complications. Mortality and most individual outcomes were similar between groups. Individualized decisions should guide the choice of delivery mode.

Abstract Background and Aims Pregnancy after kidney transplant or while receiving dialysis remains uncommon. Current cohorts are often single centre with inconsistent outcome reporting. High quality data could lead to improved pre-pregnancy counselling and enhanced patient-centred decision making. The UK Renal Registry (UKRR) collates data from kidney centres and hospital laboratories to improve the care of patients with kidney disease in the UK. Hospital Episode Statistics (HES) data contain admissions, outpatient appointments and historical accident and emergency attendances at NHS hospitals. We aimed to describe pregnancy outcomes for women receiving kidney replacement therapy (KRT) in the United Kingdom using linked population data from UKRR and HES. Method NHS number, ethnicity, cause of kidney failure, date of birth, death, available laboratory data (serum creatinine and proteinuria), date of commencing KRT and KRT modality of all women age 15–50 years were extracted from UKRR (1997–2022) and linked with HES data (1997/98 to 2021/22) by NHS Digital to create a dataset of women with recorded deliveries. Extracted ICD-10 coded comorbidities including diabetes and hypertension, and pregnancy outcomes including parity, mode of delivery, pregnancy induced hypertension, live birth, gestational age and birthweight were reported and birth centiles calculated. Small for gestational age (SGA) was defined as birthweight &amp;lt;3rd centile. Descriptive data were reported according to distribution. Ethical approval was provided by NHS South-West-Central Bristol Research Ethics Committee (14/SW/1088), London Bloomsbury Research Ethics Committee (20/LO/029), UKRR CAG and UKRR operational committee. Results 1,215 pregnancies of individuals receiving KRT at conception were identified of whom: 1134 (93.3%) were kidney transplant recipients, 72 (5.9%) were on haemodialysis (HD) and 9 (0.7%) on peritoneal dialysis (PD). Maternal age, parity, preexisting hypertension and diabetes rates were comparable between HD and transplant groups (Table 1 and 2). Low numbers of PD pregnancies limited comparison statistics. There was a higher proportion of individuals of minority ethnicities in those receiving HD 23/72 (31.9%) compared to transplant 193/1134 (17.1%, p&amp;lt; 0.0001). Transplanted individuals had a higher duration of KRT median duration prior to pregnancy of 7.8 years (IQR 4.8, 12.4) compared to HD 3.0 (IQR 1.5, 7.9) and PD 2.2 (1.8, 3.1). The most common primary renal disease was glomerulonephritis (including lupus) seen in 32/72 (44.4%) HD, and 427/1134 (37.7%) transplant pregnancies. Livebirth rates were high 45/47 (95.7%) HD, and 910/927 (98.2%) transplant but with high rates of caesarean births; 36/72 (50.0%) in HD and 755/1134 (66.6%) in transplant. Gestational age was lower in those receiving HD compared to PD and transplant (median 31 v 35 and 36 weeks, p = 0.047 from Kruskal–Wallis test) with higher rates of early preterm birth (&amp;lt;34 weeks) in HD 27/45 (60.0%) v 217/828 (26.2%) in transplant (p &amp;lt; 0.0001) and SGA &amp;lt;3rd 5/44 (11.4%) HD v 46/785 (5.9%) Transplant (p = 0.14). Conclusion This large linkage study provides invaluable data describing pregnancy outcomes for individuals receiving KRT. Livebirth rates were high in those on dialysis or with kidney transplant, but both KRT modalities have higher rates of pregnancy induced hypertension and caesarean birth than the general obstetric cohort in the UK. Pregnancy on dialysis was associated with earlier gestational age at delivery and high rates of SGA compared to transplant recipients although some of this difference may reflect increasing dialysis intensification in pregnancy in recent years. Prospective data are needed to understand the drivers of early delivery especially in the dialysis population as well as the longer-term impact on the children.

Intraoperative Hypotension After Neuraxial Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Vasopressors for Cesarean Birth Stratified by Maternal Risk

Abstract IntroductionNeuraxial analgesia is the most effective modality for pain relief during labor; yet utilization varies considerably among racial and ethnic groups in the United States—representing a health disparity. Little is known about how maternal and obstetric characteristics may contribute to these differences and whether variation exists among a larger number of racial and ethnic groups. The objective of our study was to evaluate differences in neuraxial labor analgesia use among racial and ethnic groups in the United States.MethodsWe analyzed vital statistics data from in‐hospital spontaneous vaginal births of singletons during 2016 to 2022 in the United States (N = 26,345,765). Race and Hispanic ethnicity were considered as social constructs, measured by self‐report, and combined into seven racial and ethnic groups for analysis. The outcome of interest was neuraxial labor analgesia use. We conducted sequentially adjusted multivariable modified Poisson regression models to estimate relative risks (RRs) with 95% confidence intervals (CIs) for associations between racial and ethnic groups and neuraxial labor analgesia. We first adjusted for delivery year and maternal characteristics: age, body mass index, insurance status, and educational background. We then additionally adjusted for obstetric characteristics: timing of prenatal care initiation, gestational age at delivery, and obstetric history (prior live birth and prior cesarean birth). We further descriptively assessed variation in utilization among Asian, Native Hawaiian or Other Pacific Islander (NHOPI), and Hispanic subgroups.ResultsThe rate of neuraxial labor analgesia use was 74% among 15,373,550 spontaneous vaginal, singleton births in the United States. White individuals had the highest rate (78%), and NHOPI and American Indian and Alaska Native (AI/AN) individuals had the lowest rates (58% and 61%, respectively) of use. After adjustment for covariates, the RR of using neuraxial labor analgesia was lowest in NHOPI individuals (0.78; 95% CI, 0.77–0.79) and AI/AN individuals (0.82; 95% CI, 0.82–0.82) compared with White individuals. The fully adjusted RRs were 0.93 (95% CI, 0.93–0.93) for Hispanic individuals, 0.98 (95% CI, 0.98–0.98) for Asian individuals, 0.96 (95% CI, 0.96–0.96) for Black individuals, and 0.97 (95% CI, 0.97–0.98) for multiracial individuals. In a secondary analysis, utilization ranged from 70% to 82% among Asian subgroups, 60% to 69% among NHOPI subgroups, and 64% to 81% among Hispanic subgroups.ConclusionsNeuraxial labor analgesia use in the United States was lowest among NHOPI and AI/AN individuals, independent of measured maternal and obstetric characteristics. Efforts are needed to understand and address disparities in contemporary practice with a particular focus on healthcare access and NHOPI and AI/AN communities.

Background: Puberty is a natural biological process, yet it can have adverse effects, particularly on rural and tribal girls in India. Early menarche makes them vulnerable to adolescent marriage and early conception, leading to a cascade of negative social and health outcomes. Objectives: This study examines the influence of three key life-course events- age at menarche, marriage, and first conception, on maternal health service utilisation, specifically antenatal care (ANC) and institutional deliveries, among Juang tribal women in Odisha. Materials and Methods: A cross-sectional study was conducted among 158 Juang mothers aged 15-49 (youngest child under five) from eight villages in Banspal block, Keonjhar, Odisha. Data were collected using a pretested interview schedule. Descriptive statistics were used to evaluate socio-demographic, reproductive, and maternal health indicators. Results: The mean age at menarche among Juang women was 12.38 years. Early marriage (67.5%; mean: 16.35 ± 4.12 years) correlated with early conception (mean: 18.47 ± 2.35 years). ANC registration was high (95.6%), the highest rate reported in Odisha and eastern India. However, 50% of the participants reported home delivery, despite 98.1% of women receiving financial benefits. Despite willingness, 77% of participants denied using contraceptives. Caesarean births were rare (8.2%), and no cases of breastfeeding deprivation were reported. Child immunisation coverage was moderate (57.5%). Conclusion: Juang women show reproductive patterns aligning more with eastern India than with northern or southern regions. Despite high ANC uptake, gaps in institutional delivery and contraception persist. Culturally sensitive, community-based interventions are essential for improving maternal and child health outcomes.