Cesarean Childbirth Research Articles

Machine Learning Approaches Predicting the Best Features of Child Birth Using Support Vector Machine (SVM) Algorithm

Cesarean childbirth, though often necessary for medical reasons, carries inherent risks and impacts maternal and neonatal health. Predicting the likelihood of cesarean delivery can assist healthcare providers in making informed decisions and optimizing maternal care. In this study, we propose an ensemble machine learning approach to predict cesarean childbirth based on maternal and fetal health data. First, we collect comprehensive data including maternal age, BMI, gestational age, fetal weight, previous cesarean history, and other relevant factors. After preprocessing the data to handle missing values and encode categorical variables, we select informative features using correlation analysis and domain expertise. Next, we employ various ensemble machine learning methods, including Voting Classifiers, Bagging, Random Forest, Boosting, and Stacking. These methods combine predictions from multiple base learners, leveraging their diverse strengths to enhance predictive accuracy.

The Management of Spinal and Epidural Anesthesia-Related Hypotension in the United States During Cesarean Childbirth.

This study delves into the prevalence of spinal anesthesia-induced hypotension during cesarean (c-section) childbirth, focusing on existing treatments and their efficacy. Currently, neuraxial analgesia is the most efficient method for alleviating pain during c-sections, but its major side effect, hypotension, necessitates a thorough understanding of the available treatment options. A scoping review was conducted using PubMed and Rayyan, with inclusion criteria being English peer-reviewed articles from the last five years, involving nulligravida/primigravida women under 35 years old in the United States. The research reveals various treatments to mitigate spinal anesthesia-induced hypotension. Norepinephrine and epinephrine have demonstrated effectiveness in maintaining blood pressure while reducing adverse maternal outcomes following delivery. When comparing fixed-rate infusions of norepinephrine to phenylephrine, norepinephrine demonstrated lower rates of bradycardia (p=0.004), thereby reducing the necessity for bolus atropine rescue (p=0.01). Furthermore, the use of colloid solutions during c-sections significantly decreased the incidence of hypotension when compared to crystalloid solutions (p<0.00001). Non-pharmacological methods, such as lower extremity wrapping and elevation, exhibited higher systolic and diastolic blood pressures, along with higher usage of ephedrine when compared to control groups. Pharmacological treatments proved more effective than non-pharmacological interventions in preventing maternal hypotension during c-sections. Notably, colloid preloading emerged as the most effective approach, helping to maintain maternal blood pressure, cardiac output, and heart rate while also minimizing the amount of ephedrine required and reducing anesthesia-related adverse effects. However, the study suggests the need for further investigations to determine the optimal dosage for colloid preloading. This research provides valuable insights into enhancing maternal well-being during c-sections by addressing the issue of neuraxial anesthesia-induced hypotension.

Bayesian binary regression using power and power reverse link functions: an application to premature birth data

This study aims to determine factors associated (and quantify) with prematurity through binary regression models, considering power and reverse power link functions, with asymmetric characteristics. As criteria for the model selection, the Bayesian Deviance Information Criterion (DIC), predictive evaluation, and residual analysis. All models analyzed presented similar predictive capacity, however, the model with a reverse power logit link function, with asymmetry parameter =0.336 was chosen, since it presented the lowest value of DIC=3,203, residues that indicated a good fitted of the model. There was an association of prematurity with the following variables: maternal - age over 35 years (OR=1.485), with a partner (OR=0.731), and primiparous (OR=1.307); of pregnancy and childbirth - multiple pregnancy (OR=36.360), cesarean childbirth (OR=1.337) and number of prenatal consultations less than seven (OR=3.305); and newborns of white race/skin (OR=0.731) and presence of congenital malformation (OR=2.663). Considering the proposed criteria, an asymmetric link function (reverse power logit) was the most parsimonious for the model. From this, there were high chances of factors associated with the occurrence of prematurity, indicating the need for actions to minimize them.

Semelhanças e diferenças intergeneracionais entre mães e filhas trabalhadoras rurais: características sociodemográficas e reprodutivas

ABSTRACT Objective To analyze similarities and differences involving socio-demographic and reproductive characteristics between rural working mothers and daughters. Method An analytical and quantitative study was developed in February 2018 with 21 dyads, rural working mothers and daughters, of reproductive age registered in the Chapéu de Palha Mulher Program in Pernambuco State, Brazil. The National Health Survey questionnaire was adopted to verify socio-demographic and reproductive characteristics. Results Mothers and daughters did not show statistical differences for marital status (p = 1.00), education level (p = 0.053), skin color/race (p = 1.00), religion (p = 1.00), age when started working (p = 0.433) and working hours per week (p = 1.00), participation in a family planning group (p = 0.344), use of contraceptive methods (p = 0.065), miscarriage (p = 1.00), and cesarean childbirth (p = 0.459). Conclusion and implications for practice The results suggest that the modeling process took place in numerous aspects, meaning these mothers fulfilled a reference role for their daughters in decision-making and behaviors. It requires a greater understanding of intergenerational relationships, especially amongst health professionals, for them to provide a better qualification in assistance, such as in reproductive care.

Breastfeeding Self Efficacy Ibu Post Seksio Saesarea

The one factor that causes mothers to stop breastfeeding is low self- efficacy. The lowest breastfeeding self-efficacy causing the mother to stop breastfeeding too quickly even at the beginning after giving birth to the mother breastfeeding her baby. The goal of this study is to determine the scale of Breastfeeding Self Efficacy in mothers with cesarean childbirth. Descriptive research type, sampling technique with purposive sampling with criteria mothers who give birth with cesarean section, do not experience complications after childbirth and are eager to become respondents. This type of research was descriptive with a purposive sampling technique, the criteria were mothers who gave birth by cesarean section, did not experience postpartum complications, and willing to be respondents. The sample in this study was 52. The study used the Breastfeeding Self Efficacy Scale to explore breastfeeding self-efficacy. Data analysis used univariate analysis in the form of frequency and proportion distributions. The results indicated that most respondents who had a high BSE score were the high-risk age group (56.3%), worker (54.2%), tertiary education (62.5%), breastfeeding experience (51.6%), multipara (53.3%). To increase BSE score, it is necessary to promote breastfeeding so that it is hoped that it will increase the duration of exclusive breastfeeding

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses.

Objective:to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France.Method:a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries.Results:the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health.Conclusion:the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Profile and spatial distribution on maternal mortality

Abstract Objectives: to describe profile and spatial distribution on maternal mortality in a city in the North of Minas Gerais-Brazil. Methods: a descriptive, cross-sectional, documentary and quantitative study was carried out in 31 (100%) Fichas de Investigação de Óbito Materno do Comitê de Mortalidade Materna (Maternal Mortality Investigation Data Forms from the Maternal Mortality Committee) from 2009 to 2013. Results: prevalence is observed in women between 20 and 34 years old, mixed race, single and with low schooling. Of the deaths classified, 48.2% are direct obstetric death and 74.2% would be likely avoidable. The most prevalent causes of death were pregnancy-specific hypertensive disease; circulatory system disease; neoplasms; coagulopathies and post-abortion infection. In relation to prenatal care, only 20 women performed it, and most performed less than six prenatal consultations and in relation to the end of gestation, 68.1% underwent cesarean childbirth. Regarding to the descriptive spatial analysis, we identified a higher occurrence of maternal deaths in the areas of medium and high social vulnerability. Conclusions: maternal mortality is a strong indicator of women's healthcare, there is a necessity to readjust women’s healthcare in the puerperal pregnancy cycle. New healthcare practices for women are needed, due to the referred bond and responsible care.

\u201cIf we\u2019re here, it\u2019s only because we have no money\u2026\u201d discrimination and violence in Mexican maternity wards

BackgroundStructural and gender violence in Mexico take on various forms, obstetric violence among them. The objective of our study consisted in analyzing experiences of structural and gender discrimination against women during childbirth care at two public hospitals in Mexico.MethodsWe conducted a cross-sectional mixed methods study including a survey of closed questions administered to all women who received health care for vaginal or cesarean childbirth at two public hospitals from May 7 to June 7, 2012 (N = 512). Those who reported some form of abuse on the part of health-care professionals were then invited to complete a semi-structured interview (20 women agreed to participate). In addition, three focus groups were organized with health-care professionals from both institutions (31 participants): two were composed of nurses and one of obstetrician-gynecologists (OB-GYNs). This work deals with the qualitative component of the study.ResultsThe narratives of the health-care professionals interviewed contained expressions of health discrimination relating to certain characteristics of their clients, namely poverty, ignorance, failure to understand instructions and being women. The women, on the other hand, perceived themselves as belonging to a low social class and, as a result, behaved passively with staff throughout their hospital stay. They reported both physical and psychological abuse during care. The first included having their legs manipulated roughly, being strapped to the bed, and being subjected to multiple and careless pelvic examinations. Psychological abuse included reprimands, insults, disrespectful remarks, neglect and scowling gestures when requesting assistance.ConclusionsThe results of our study bear implications for the doctor-client relationship and for the health system in general. They suggest a need to dismantle medical practice – particularly with regard to obstetrics and gynecology - as it has been historically learned and internalized in Mexico. It is imperative to design public policies and strategies based on targeted interventions for dismantling the multiple forms of structural and gender violence replicated daily by actors in the health system.

The relationship between quality of life after childbirth and the childbirth method in nulliparous women referred to healthcare centers in Sanandaj, Iran.

Background and aimPostpartum period is associated with significant changes in the quality of women’s lives. These changes can affect the health of both the mother and child. Given the importance of the postpartum period and the factors influencing quality of life after childbirth especially the method of childbirth, the aim of this study was to determine the relationship between quality of life after childbirth and the childbirth method in nulliparous women referred to healthcare centers in Sanandaj, Iran.MethodsIn this cross-sectional study, ten healthcare centers in Sanandaj, Iran from 2014-to 2015 were chosen using a cluster random sampling method. The samples consisted of 410 nulliparous women. The Edinburgh postnatal depression scale was used for data collection in the third trimester of pregnancy. Those women with a score greater than 12 were excluded from this study. The quality of life in physical, psychological, social, environmental domains and the overall quality of life were measured and compared using the World Health Organization quality of life brief questionnaire. Data were analyzed using SPSS version 22. We used descriptive statistics, Chi-square, and t-test for the analyses of outcomes.ResultsThe means of quality of life in the groups of vaginal and cesarean childbirth were 98.29±11.82 and 100.4±10.26, respectively, which had no statistically significant differences.ConclusionWomen with vaginal childbirth had the slightly higher quality of life scores than cesarean during 6 weeks after birth and later. Thus, providing more information to pregnant women to encourage them to use vaginal childbirth is suggested.

Management of Full Term Births in Women with Prior Cesarean Section in a University Maternity of Cotonou-Benin (CUGO/CNHU-HKM) in 2015

Introduction: Increased prevalence of uterus with prior cesarean sections is due to rising rate of cesarean births worldwide. Birth management after a prior cesarean section is a challenging issue, since medical practices are divergent. Objectives: Analyze pregnancy outcome and management of childbirth from a uterus with one cesarean scar. Setting and method: It was an observational, descriptive and cross-sectional study carried out from December 15, 2014 to September 14, 2015 in the University Clinic of Gynecology and Obstetrics (CUGO) of the National University Teaching Hospital (CNHU-HKM) of Cotonou. It involved 132 female patients. The data were analyzed with Epi Info 7 software. Results: The prevalence of childbirth on uterus with one prior C-section is 7.57%. Patients' mean age was 30 years. Most of them were admitted for second childbirth. Most pregnancies were singleton ones (94.70%). The interval between cesarean section and current childbirth is higher than 24 months in most cases (83.76%). The rate of uterine contraction is low (29.55%); the same applies to the one of vaginal birth (25%). The main indications for repeat cesarean section were narrowing of the pelvis (19.19%), acute fetal distress (14.14%) and renal vascular diseases (11.11%). The maternal and perinatal prognosis for vaginal birth had been better than the one of repeat cesarean section. Conclusion: The challenging issue of childbirth management in women with one prior C-section is still a matter of concern in Cotonou. Some efforts still have to be made to improve technical medical equipment so as to extend the indications for uterine contraction during labor, thereby contributing to reduce the rate of repeat cesarean section.

Dados epidemiológicos de deficientes mentais matriculadas no Instituto Londrinense de Educação para Crianças Especiais

Este trabalho teve o objetivo de analisar alunos portadores de deficiência mental matriculados em uma instituição de Londrina-Pr. Os dados foram obtidos por meio de informações contidas em 157 prontuários de alunos e entrevistas realizadas pelos pesquisadores com o responsável por cada aluno, matriculados no ano de 2010. Através de um estudo descritivo, avaliamos a prevalência das principais doenças que acarretam deficiência mental, em relação ao gênero, idade dos pais, peso neonatal, antecedentes familiares, período de amamentação, uso de drogas, álcool e medicamentos controlados, assim como tipo de concepção, de parto e tempo de gestação. Para a analise estatística dos dados foi aplicado o teste Qui-quadrado, após correção de Yates. As principais doenças encontradas foram: retardo mental – casos isolados 29,3%; paralisia cerebral (25,5%); atraso no desenvolvimento neuropsicomotor (24,2%); síndrome de Down (13,4%) e outras síndromes genéticas (7,6%). As variáveis que apresentaram maiores diferenças foram: tipo de parto cesariana (58%), com maior prevalência do que o parto normal (38%); e porcentagem de casos com antecedentes familiares (50%). A distribuição das doenças associadas à deficiência mental na população estudada foi semelhante a outros estudos em diferentes populações. No entanto, diferente de outros trabalhos, observamos maior frequência de cesarianas e de antecedentes familiares. Em conclusão, espera-se que as informações relatadas neste trabalho resultem em contribuição para os programas de atenção à saúde dos portadores de deficiência mental, bem como sua inclusão junto à sociedade civil.

How different modes of child delivery influence abdominal muscle activities in the active straight leg raise.

[Purpose] The purpose of this study was to examine the activities of the abdominal muscles of women who had experienced vaginal delivery in comparison with those who had experienced Cesarean childbirth. [Subjects and Methods] A total of 14 subjects (7 vaginal delivery, 7 Cesarean section) performed an active straight leg raise to 20 cm above the ground, and we measured the activities of the internal oblique abdominal muscle, the external oblique abdominal muscle, and the rectus abdominal muscle on both sides using electromyography. The effort required to raise the leg was scored on a Likert scale. Then, the subjects conducted maximum isometric contraction for hip joint flexion with the leg raised at 20 cm, and maximum torque and abdominal muscle activities were measured using electromyography. [Results] During the active straight leg raise, abdominal muscle activities were higher in the Cesarean section subjects. The Likert scale did not show a significant difference. The activities of the abdominal muscles and the maximum torque of the hip joint flexion at maximum isometric contraction were higher in the vaginal delivery subjects. [Conclusion] The abdominal muscles of Cesarean section subjects showed greater recruitment for maintaining pelvic stability during the active straight leg raising, but were relatively weaker when powerful force was required. Therefore, we consider that more abdominal muscle training is necessary for maintaining pelvic stability of Cesarean section subjects.

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women's accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).

Pelvic floor disorders 5–10years after vaginal or cesarean childbirth

Pelvic floor disorders 5–10years after vaginal or cesarean childbirth

Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth

Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth

Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth

To estimate differences in pelvic floor disorders by mode of delivery. We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders. Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2-14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7-20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures. Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth. II.

Banco de leite humano: uma análise das diferenças entre doadoras adultas e adolescentes

The objectives of the study were to analyze the population profile and point out differences among adult and adolescent donors. It was a cross sectional, analytic study carried out at the Human Milk Bank (HMB) of Maringá, Paraná State. The population of the study consisted of all registered donors in the year 2004 (443), and the source of the data was the Donor Registration Record. Socioeconomic, demographic and perinatal variables related to breast milk donation were analyzed. The age variable was divided into adolescent donors (< 20 years old) and adult donors (≥ 20 years old); from that, the condition of being an adolescent donor was considered a dependent variable, testing interactions and differences between this and the other variables of the study. A frequency of 16.35% of adolescents was observed. A significant statistical association (p < 0.001) was found between adolescents and low family income, living without companion, prematurity and cesarean childbirth. Results show that adolescent donors need greater incentive for the practice of breastfeeding, as they present unfavorable socioeconomic and perinatal conditions. The adolescent group was quite expressive, and human milk donors present differences among one other, requiring skills from professionals to work with these peculiarities.

Maternal Goals for Childbirth Associated with Planned Vaginal and Planned Cesarean Birth

We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P = 0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P < 0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience.

Is planned cesarean childbirth a safe alternative?

Cesarean birth rates have risen dramatically during the past decade, reaching more than 50% in some regions of the world, despite a lack of evidence of any increase in obstetric emergencies.[1][1],[2][2] The marked increase in primary elective cesarean delivery, particularly among women without an

Childbirth preferences after cesarean birth: a review of the evidence.

Conflicting evidence on maternal and fetal safety of vaginal and cesarean childbirth after a previous cesarean makes patients and practitioners uncertain about pursuing a trial of labor or an elective repeat cesarean delivery. This review systematically evaluated and summarized the evidence related to women's preference for delivery. The Cochrane Database of Systematic Reviews and Registry of Controlled Trials and the MEDLINE, HealthSTAR, PsycINFO, and CINAHL databases were searched from 1980 to August 2002. We reviewed controlled trials, case-control studies, and observational studies that contained original patient data on preference for women with a previous cesarean delivery and that were of "good" or "fair" quality. Women with a previous vaginal delivery were more likely to select trial of labor than women who did not have one. The most commonly cited reason for selecting trial of labor was ease of recovery and desire to return quickly to caring for other children (reported in 6 of 7 studies). Safety for the mother and/or infant was cited as an important reason for delivery choice in 4 of 11 studies. Important ethnic differences were reported. Nonwhite women were more likely to identify their provider as an important influence (39% vs 19%), and perceived labor as something to be avoided if another option resulted in a healthy baby compared with white women, who perceived labor as a challenge and an experience not to be missed. A woman's choice for delivery was often based on family obligations, such as the need for a shorter recovery so that she could care for her infant and children at home, rather than the safety of herself or her infant. It remains unclear if education on vaginal birth after cesarean increases the proportion of women who choose trial of labor. Future studies should evaluate the impact of education and timing of education on patient preference.