Cesarean Delivery In Women Research Articles

Prophylactic Radiologic Interventions for Postpartum Hemorrhage Control in Women With Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-analysis.

To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a systematic review and network meta-analysis. On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.gov retrospectively. Prophylactic radiologic interventions to reduce bleeding during cesarean delivery involved preoperative placement of balloon catheters, distal (internal or common iliac arteries) or proximal (abdominal aorta), or sheaths (uterine arteries). The primary outcome was volume of blood loss; secondary outcomes were the number of red blood cell units transfused and adverse events. Studies including women who received an emergency cesarean delivery were excluded. Two authors independently screened citations for relevance, extracted data, and assessed the risk of bias of individual studies with the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool. From a total of 1,332 screened studies, 50 were included in the final analysis, comprising 5,962 women. These studies consisted of two randomized controlled trials and 48 observational studies. Thirty studies compared distal balloon occlusion with a control group, with a mean difference in blood loss of -406 mL (95% CI, -645 to -167). Fourteen studies compared proximal balloon occlusion with a control group, with a mean difference of -1,041 mL (95% CI, -1,371 to -710). Sensitivity analysis excluding studies with serious or critical risk of bias provided similar results. Five studies compared uterine artery embolization with a control group, all with serious or critical risk of bias; the mean difference was -936 mL (95% CI, -1,522 to -350). Reported information on adverse events was limited. Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this meta-analysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions. PROSPERO, CRD42022320922.

Planned Induction of Labour Versus Planned Caesarean Delivery in Women with Severe Pre-eclampsia at Term—a Randomized Controlled Trial

Planned Induction of Labour Versus Planned Caesarean Delivery in Women with Severe Pre-eclampsia at Term—a Randomized Controlled Trial

Neuraxial clonidine is not associated with lower post-cesarean opioid consumption or pain scores in parturients on chronic buprenorphine therapy: a retrospective cohort study.

Adequate post-cesarean delivery analgesia can be difficult to achieve for women diagnosed with opioid use disorder receiving buprenorphine. We sought to determine if neuraxial clonidine administration is associated with decreased opioid consumption and pain scores following cesarean delivery in women receiving chronic buprenorphine therapy. This was a retrospective cohort study at a tertiary care teaching hospital of women undergoing cesarean delivery with or without neuraxial clonidine administration while receiving chronic buprenorphine. The primary outcome was opioid consumption (in morphine milligram equivalents) 0-6h following cesarean delivery. Secondary outcomes included opioid consumption 0-24h post-cesarean, median postoperative pain scores 0-24h, and rates of intraoperative anesthetic supplementation. Multivariable analysis evaluating the adjusted effects of neuraxial clonidine on outcomes was conducted using linear regression, proportional odds model, and logistic regression separately. 196 women met inclusion criteria, of which 145 (74%) received neuraxial clonidine while 51 (26%) did not. In univariate analysis, there was no significant difference in opioid consumption 0-6h post-cesarean delivery between the clonidine (8 [IQR 0, 15]) and control (1 [IQR 0, 8]) groups (P = 0.14). After adjusting for potential confounders, there remained no significant association with neuraxial clonidine administration 0-6h (Difference in means 2.77, 95% CI [-0.89 to 6.44], P = 0.14) or 0-24h (Difference in means 8.56, 95% CI [-16.99 to 34.11], P = 0.51). In parturients receiving chronic buprenorphine therapy at the time of cesarean delivery, neuraxial clonidine administration was not associated with decreased postoperative opioid consumption, median pain scores, or the need for intraoperative supplementation.

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

BackgroundVenous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early diagnosis of VTE within the Han Chinese population.MethodsOur prospective observational study included 742 women who underwent CUS and D-dimer testing on the first day post-CS. Subsequently, telephone or outpatient follow-ups were conducted until 42 days postpartum. States of hypercoagulation and thrombosis, as indicated by CUS, were classified as CUS abnormal. A D-dimer level ≥ 3 mg/l was considered the D-dimer warning value. Early ambulation and mechanical prophylaxis were universally recommended for all parturients post-CS. A sequential diagnostic strategy, based on the 2015 RCOG VTE risk-assessment tool, was employed. Therapeutic doses of low-molecular-weight heparin (LMWH) were administered for the treatment of thromboembolic disease. Prophylactic doses of LMWH were given for VTE prophylaxis in parturients with hypercoagulative status accompanied by D-dimer levels ≥ 3 mg/l. All high-risk women (RCOG score ≥ 4 points) were additionally treated with preventive LMWH. Statistical analyses were conducted using the R statistical software, with a two-sided P value < 0.05 considered statistically significant.ResultsFifteen cases of VTE and 727 instances without VTE were observed. The overall VTE rate post-CS was 2.02% (15/742), with 66.7% (10/15) being asymptomatic. Eleven patients received a VTE diagnosis on the first postpartum day. Among the 41 parturients exhibiting hypercoagulation ultrasound findings and D-dimer levels ≥ 3 mg/l, despite receiving pharmacological VTE prophylaxis with LMWH, 4.88% (2/41) in the high-risk group were eventually diagnosed with VTE. A total of 30.86% (229/742) exhibited normal ultrasound findings and D-dimer levels < 3 mg/l on the first day post-CS, with no VTE occurrences in the postpartum follow-up. According to RCOG’s recommendation, 78.03% (579/742) of cesarean delivery women should receive prophylactic anticoagulation, while only 20.62% (153/742) met our criterion for prophylactic anticoagulation.ConclusionThe strategy of timely routine bilateral CUS and D-dimer monitoring is conducive to the early diagnosis and treatment of VTE, significantly reducing the use of LMWH in the Chinese Han population.

A vaginal birth is a cost-reduction strategy for women with a low-lying placenta.

Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a low-lying placenta (LLP) is still controversial. Since no previous data are available on the topic, the aim of this study was to evaluate the HCRU and economic impact on the Italian HC system of vaginal birth (VB) and CD in women with a LLP. This retrospective study used patient-level real-world data of a cohort of women with a LLP confirmed at 28-30 weeks. A cost-minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the actual use of hospital resources, a micro-costing analysis (MCA) was performed to more comprehensively evaluate the economic impact of VB and CD. The study included 86 women with a LLP at the third trimester scan, of which 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the resources needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD. The use of patient-level real-world data allowed to generate basic information to assess the value of available interventions in case of LLP. A VB should be promoted in women with LLP, avoiding further burden on the HC system's limited resources.

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

AbstractBackgroundRwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.MethodsA secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.ResultsMore than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.ConclusionResults suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.

Predictive value of cervical length in placenta previa totalis: a single-center experience

Aims: In our study, we aimed to scientifically assess the utility of measuring cervical length in predicting the risk of postpartum hemorrhage and the necessity for emergency preterm cesarean delivery in women diagnosed with placenta previa totalis. Methods: We conducted a retrospective study at a single medical center, comprising 48 pregnant women diagnosed with placenta previa totalis. Cervical length was precisely measured through transvaginal ultrasound. Patients were categorized based on cervical length (CL): CL &amp;gt;30mm, CL 25-30 mm, and CL &amp;lt;25 mm. Primary outcomes included preterm birth, postpartum hemorrhage, and emergency cesarean section. Results: Women with CL &amp;lt;25 mm exhibited a notably elevated risk of postpartum hemorrhage (60%) and emergency cesarean section (80%). While preterm birth rates displayed variations among groups, statistical significance remained elusive. APGAR scores demonstrated consistency across cervical length categories. Conclusion: Evaluation of cervical length holds promise as a valuable tool in the comprehensive management of placenta previa totalis. Women presenting with a cervical length less than 25 mm may warrant intensified monitoring and targeted interventions to mitigate adverse perinatal outcomes. Further research endeavors are imperative to corroborate these findings and advance the care provided for these intricate pregnancies.

The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery.

Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery. Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery. Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery. Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78-1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34-3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN. Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.

230 Trial of labor or repeat caesarean delivery in women with morbid obesity

230 Trial of labor or repeat caesarean delivery in women with morbid obesity

Chorioamnionitis, Cesarean Deliveries, and Racial Disparities in the USA.

Studies showed disparities in management and outcomes of African American when compared to Caucasian population. The presence of chorioamnionitis may affect the decision to have a cesarean delivery (CD); however, it is not known if such a decision is affected by the mothers' race/ethnicity. To assess the interaction between African American race/ethnicity and CD in women with chorioamnionitis. Utilizing the National Inpatient Sample dataset, we examined the association of CD with chorioamnionitis in the overall population and within Caucasian and African American. Logistic regression models were used to control for confounders. The study included 6,648,883 women who delivered 6,925,920 infants. The prevalence of chorioamnionitis was 0.78 and 1.1 in Caucasian and African American, respectively. CD with and without chorioamnionitis was 41.2% and 32.4%, respectively (aOR 1.46 (1.43-1.49), p < 0.001), in Caucasian population and 45.0% and 36.6% in African American population aOR 1.42 (1.37-1.47), p < 0.001. African American population had significantly higher CD after controlling for chorioamnionitis and other confounding variables (aOR of 1.18 (1.17-1.18), p < 0.001). Chorioamnionitis is associated with increased rate of CD. Ethnic disparities exist in CD rates regardless of the chorioamnionitis status. Such findings warrant further investigation to explore factors associated with this discrepancy.

A new technique to preserve the uterus in patients with placenta accreta spectrum disorders

Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until2014. This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. The volume of blood loss was 1.5-fold lower (P=.0010), the number of blood transfusions was 5.1-fold lower (P=.026), and the rate of bladder injuries was 19-fold lower (P=.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P=.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P=.023). The study groups did not differ in terms of placenta accreta spectrum type. The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders.

Invasion anomaly or neovascularization? A new surgical approach for cesarean delivery in pregnant women with invasive placenta accreta spectrum disorder accompanied by placenta previa.

The objective of study is to describe a new surgical approach to cesarean delivery in women with invasive placenta accreta spectrum (PAS) accompanied by placenta previa. Cesarean delivery was initiated with a transverse abdominal (Pfannenstiel) incision. A transverse incision was made above the vascular area in the lower uterine segment, and the fetus was delivered. The uterine fundus was removed from the abdomen and wrapped. Placental removal was started at posteriorly, continuing toward the anterior region. If dense adhesions were encountered, dissection was performed by inserting a finger between the adhesions to carefully separate them. It was recognized that two types of vessels develop to supply blood to the placenta. First, a perforating vessel emerges from adjacent tissues, entering the placental bed by perforating the uterine wall. Second, a superficial vessel runs along the uterine wall to enter the placental bed. The new emerging vessels were identified and ligated. Uterine sparing surgery was performed if the hemorrhage ceased. A cesarean hysterectomy was performed if hemorrhage did not cease. Eight cesarean deliveries were performed using this new surgical approach. Cesarean hysterectomy was performed in three patients in who want to sterilization diser and don't mind fertility preservation. Severe maternal morbidity, invasive procedures, intensive care unit admission, and relaparotomy were not required. The described new surgical approach provide surgeon to perform cesarean delivery without causing increase maternal morbidity and mortality. Although the approach is new and the study population is small, the results have acceptable rationality and applicability.

Clinical outcome analysis of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy: a retrospective study

ObjectiveTo explore the efficacy of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy.MethodsThis retrospective analysis covers the clinical data of 40 women with postpartum haemorrhage caused by uterine inertia during caesarean section in women with twin pregnancy in our hospital from January 2018 to May 2022. These women were divided into the group with modified B-Lynch sutures at the fundus and part of the corpus uteri (Group A, 20 patients) and the group with classic B-Lynch sutures (Group B, 20 patients) according to the treatment received. The treatment effect and safety of the two uterine compression sutures were compared.ResultsIn this study, no statistically significant differences were found in the outcomes of haemostasis or intraoperative and 24-h postoperative blood loss between the two uterine compression suture groups (P > 0.05). Compared to Group B, Group A showed a significantly reduced operative time, postoperative hospital stay, puerperal morbidity rate, pain score and duration of lochia.ConclusionModified B-Lynch sutures at the fundus and part of the corpus uteri can achieve a haemostatic effect similar to that of the classic B-Lynch suture, while it allows for a shortened operative time and reduced postoperative complications. Modified B-Lynch sutures can serve as a safe, rapid and effective haemostatic method for the prevention and treatment of postpartum haemorrhage during caesarean section in women with twin pregnancy, showing certain validity for promotion in clinics.

Cesarean delivery and risk of HIV vertical transmission in Southern Brazil, 2008-2018

Childbirth via cesarean delivery can prevent intrapartum vertical transmission for women who are not virally suppressed at the time of delivery. Few studies have compared cesarean delivery trends between women living with HIV and women without HIV and have examined the role of cesarean delivery in the prevention of vertical transmission in the era of potent combination antiretroviral therapy. We hypothesized that the cesarean delivery rate is high in women living with HIV compared with women without HIV and that cesarean delivery usage decreases over time among women living with HIV with advances in combined antiretroviral therapy in a country with a high national cesarean delivery rate. This study aimed (1) to evaluate cesarean delivery trends in women with and without HIV and (2) to examine its role in preventing vertical transmission among women living with HIV in a setting of free, universal combined antiretroviral therapy coverage in a retrospective cohort of nearly 56,000 deliveries at a major referral institution in a city with the highest prevalence of maternal HIV in Brazil. Data from maternal-infant pairs from January 1, 2008, to December 31, 2018, were extracted. Cesarean delivery rates were compared using the Pearson chi-square test. Cesarean delivery predictors were evaluated by multivariate log-linear Poisson regression using a generalized estimating equations approach. HIV viral suppression was defined as a viral load of <1000 copies/ml at delivery. HIV vertical transmission was determined following national guidelines. Over 11 years, 48,688 pregnancies occurred in 40,375 women; HIV seroprevalence was 2.7%; 18,886 cesarean deliveries (38.8%) were performed; 47.7% of women living with HIV and 38.6% of women without HIV underwent cesarean delivery (P<.001). Although HIV was associated with cesarean delivery (adjusted relative risk, 1.17 [95% confidence interval, 1.05-1.29]), women living with HIV with vertical transmission achieved similar cesarean delivery rates (36.7%) as women without HIV (39.8%) in 2018. Cesarean delivery in women living with HIV with an unknown viral load at delivery (42.6%) did not increase over time. HIV vertical transmission rate was 2.2%, the highest in women living with HIV with an unknown viral load (8.4%) vs women living with HIV without vertical transmission (4.1%) and women living with HIV with vertical transmission (0.5%) (P<.001). In the HIV epicenter of Brazil, women living with HIV with vertical transmission had fewer surgical deliveries, likely because of the use of potent combination antiretroviral therapy. Nearly half of the women living with HIV with an unknown viral load did not undergo cesarean delivery, a potential missed opportunity for the prevention of HIV vertical transmission.

The Association of Anesthesia Type and Neonatal Outcomes Following Category-1 Cesarean Delivery: A Retrospective Cohort Study.

Objectives Neuraxial anesthesia is the preferred anesthesia technique for cesarean delivery due to a decreased risk of adverse events. However, general anesthesia is often employed during emergent cesarean deliveries to achieve a shorter decision-to-delivery interval. The objective of this study was to determine if the conversion of epidural labor analgesia to surgical anesthesia for a category-1 cesarean delivery is associated with significant neonatal morbidity. Study design This was a retrospective cohort study of all intrapartum category-1 cesarean deliveries performed at an academic tertiary care institution between August 2016 and July 2021. The primary outcome was neonatal morbidity, defined as a composite of neonatal umbilical artery pH < 7.10 and/or 5-min Apgar score < 7, and/or neonatal intensive care unit admission. A multivariate regression analysis was performed to control for the presence of covariates and examine the degree to which they influenced the outcome. Results A total of 185 mother-neonate pairs qualified for inclusion, of which 23 had cesarean delivery under general anesthesia and 162 under epidural anesthesia. There was no significant difference in adverse neonatal outcomes between category-1 cesarean deliveries done under general anesthesia compared to epidural anesthesia (47% vs 35%,p = 0.3). The incidence of umbilical arterial pH < 7.10 was higher in the general anesthesia group compared to the epidural anesthesia group (35% vs 12%,p = 0.018). The multivariate regression model showed that gestational age (OR = 0.63; 95% CI = 0.51-0.75, p = <0.001) and non-reassuring fetal heart trace (OR = 0.18; 95% CI = 0.05-0.58, p = 0.005) were significant predictors of adverse neonatal outcome. Conclusion Our results suggest that the conversion of epidural analgesia to surgical anesthesia for category-1 cesarean delivery in women with a functional labor epidural catheter is not associated with poorer neonatal outcomes.

Is there a difference in pain perception after cesarean delivery among women with endometriosis?

Patients with endometriosis known to have altered pain perception. Cesarean delivery (CD) is one of the most prevalent surgeries performed worldwide. Proper pain control following CD is of clinical importance to the recovery and relief of patients. We aimed to assess pain perception and analgetic use after CD in women with and without endometriosis.

FETOMATERNAL OUTCOME IN DIFFERENT MODES OF DELIVERY IN PATIENTS WITH ECLAMPSIA

Objective: To evaluate the fetomaternal outcomes of different modes of delivery in pregnancies complicated by eclampsia at and after 24 weeks. Methodology: We conducted a prospective observational study of 352 women, aged 14-47 years, with eclampsia at &gt;24 weeks of gestation at the Department of Obstetrics &amp; Gynaecology, Women and Children Hospital Bannu, Pakistan from April 2017 to Dec 2018. The primary outcome measures were maternal mortality and maternal near-miss. The secondary outcome measures were perinatal morbidity and mortality. Results: There were 172 women in the vaginal delivery (VD) and 180 in the cesarean delivery (CD) group. The mean age was 31.46 ±10.17 years (range 14-47 years). Most of the women were 21-40 years, 179 (50.85%). There were more unbooked and referred cases in the CD group, 171 (95%) versus 150 (87.2%) (p&lt;0.05), and 131 (72.8%) versus 63 (36.6%) (p&lt;0.000) respectively. The VD group had more maternal deaths, (13.40% versus 6.11%, p&lt;0.021), severe maternal outcomes, (47.09% versus 14.44%, p&lt;0.000), and life-threatening complications, (33.72% versus 8.88%, p&lt;0.000); HELLP (5.81% versus 1.66%, p&lt;0.039), DIC (4.65% versus 0.55%, p&lt;0.015), cardiac dysfunction (3.48% versus 0%, p&lt;0.011), and sepsis (4.65% versus 1.11%, p&lt;0.046). The perinatal outcome was also poor in women with a VD, with higher stillbirths (20.93% versus 07.77%, p&lt;0.000), and perinatal deaths (31.39% versus 12.77%, p&lt;0.000). Conclusion: Eclampsia is associated with grave fetomaternal complications. There is an increase in the number of elective CD in women with eclampsia, which is associated with less morbidity and mortality than VD.

Assessment of the urinary bladder prior to cesarean delivery in women with multiple abdominal scars through operation table ultrasonography: a case report

Bladder injury is a rare but serious complication that can occur during cesarean deliveries with an incidence of between 0.25% and 0.9%. Most bladder injuries (53%) occur upon entering the peritoneal cavity as a consequence of either extensive adhesions, a distorted pelvic anatomy, or an unexpectedly high-situated bladder owing to previous operations including a previous cesarean delivery. Patients with a previous abdominal operation can benefit from a preoperative ultrasound to identify the upper limits of an unexpectedly enlarged urinary bladder, even after preoperative catheterization. A modified surgical approach can then be applied to allow entry into the peritoneum above the bladder, thus preventing severe bladder injury. Surgeons may consider the use of preoperative sonography before operating on women with a previous abdominal surgery, especially following midline incisions, to improve safety and to potentially modify abdominal entry into the peritoneal cavity to avoid bladder injury.

Timing of cesarean delivery in women with uncomplicated placenta previa

Objective The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 360/7 and 376/7 weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 360/7 to 386/7 weeks compared with expectant management in women with uncomplicated placenta previa. Methods A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 360/7 and 386/7 weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management. Results At 360/7–366/7 weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p = .68). Similarly, at 370/7–376/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p = .54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 360/7–366/7, 76.4% of urgent cesarean delivery at 370/7–376/7, and for 70.6% of all urgent cesarean delivery at 380/7–386/7 weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75–92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management. Conclusion Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 380/7 and 386/7 weeks of gestation, especially in women without ante-partum bleeding.

Timing of cesarean delivery for women with four or more previous cesarean sections

Background/Aim: The number of recurrent cesareans is increasing worldwide, but the optimal timing for delivery in women who have had previous cesareans is controversial. The aim of this study is to determine the optimal timing of elective cesarean delivery in women with a history of four or more cesarean sections (CSs). Methods: This retrospective cohort study was conducted in a tertiary hospital; 195 patients with a history of four or more CSs were grouped according to their gestation weeks on operation day and analyzed in terms of demographic features and clinical data as well as maternal and neonatal outcomes. Gestation weeks were grouped as 37-38 weeks and 39 weeks. Logistic regression analysis was used to determine the effect of independent variables on maternal and fetal outcomes. Results: Of the 195 patients, 118 had CS between 37-38 weeks and 77 at 39 weeks. Clinical and demographic characteristics were similar among groups. The overall maternal complication did not differ between the groups (16.1% vs 16.9%, P = 0.885). The 1st and 5th minute APGAR scores were significantly lower in the 37-386 weeks group (P = 0.013 and P = 0.04, respectively). Logistic regression analysis found that neonatal 5th minute APGAR score was associated with a model including maternal age, number of previous CS, anesthesia type, gestational week at delivery, and neonatal birth weight. Conclusion: Timing CS at 39 weeks in patients with a history of four or more CSs was found not to worsen maternal outcomes. Additionally, planning at 39 weeks could improve newborn outcomes.