Cesarean Delivery Research Articles

Gut dysbiosis as a susceptibility factor in childhood idiopathic nephrotic syndrome

Idiopathic nephrotic syndrome (INS) is a relatively common renal disorder of childhood characterized by severe proteinuria and associated hypoproteinemia and edema. Although the pathogenesis of INS remains unknown, the prevailing theory of its pathogenesis is as follows. Antigenic stimulation, such as viral infections or vaccines, in children with susceptibility factors for INS triggers abnormal immune responses, resulting in production of pathogenic substances that injure podocytes (renal glomerular epithelial cells). The injured podocytes then change their function and morphology, resulting in increased permeability of plasma proteins. Consequently, plasma proteins, especially albumin, are leaked into urine and massive proteinuria ensues. Research on susceptibility factors for INS has focused on polymorphisms in several genes including human leukocyte antigen class II genes. However, we propose that dysbiosis of the intestinal microbiota could be a susceptibility factor for relapse. This proposal is based on our research group finding that children with INS and frequent relapses have gut dysbiosis characterized by a decreased proportion of beneficial bacteria such as short-chain fatty acid-producing bacteria. Dysbiosis from the neonatal period to infancy may result from environmental factors, such as cesarean section delivery and antibiotic administration, which prevent the establishment of a normal intestinal microbiota. Dysbiosis leads to aberrant gut immunity and is characterized by a decreased ratio of T helper 1 cells/T helper 2 cells and an increased ratio of T helper 17 cells/regulatory T-cells. Therefore, relapse occurs when immunologically pathogenic factors that injure podocytes are produced in response to trigger events in children with INS and gut dysbiosis. Our recent clinical trial suggested that long-term oral administration of butyric acid-producing bacterium as a probiotic is promising for suppressing relapse. Therefore, studying the causal relationship between dysbiosis and relapses in patients with INS in a larger number of patients is necessary.

Impact of vaginism on mode of delivery and obstetrical outcomes

IntroductionAccording to ICD 10, vaginism is defined as the presence of spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening. Intromission is impossible or painful. Vaginism, whose prevalence is estimated at 1%, is often diagnosed during pregnancy follow-up, when clinical examination is difficult or impossible. However, few studies report obstetrical complications and pregnancy outcomes associated with this pathology. ObjectiveEvaluate the impact of vaginism on mode of delivery and obstetrical complications. Materials and methodsComparative, monocentric, retrospective study at the Montreuil maternity hospital between January 2019 and January 2024 that included all singleton deliveries in cephalic presentation at term. Vaginism was defined as an involuntary contraction of the pelvic muscles that made clinical examination during pregnancy impossible. Mode of delivery (caesarean section during labour, operative delivery, spontaneous vaginal delivery) and obstetric complications (episiotomy, OASIS, complex tear, Postpartum haemorrhage (PPH) due to tear) were compared between patients with vaginism and a control group, in univariate analysis and multivariate logistic regression with adjustment for maternal age, BMI, maternal origin, gestational age, high obstetrical and medical risk level, diabetes with or without insulin use, pregnancy complications, Robson group and birthweight. A propensity score adjustment with matching 1 case to 3 controls was conducted. ResultsDuring the study period, 13,469 patients were included, among which 440 patients had vaginism. In univariate analysis, patients with vaginism had a higher rate of caesarean section (16,8% versus 9,4%, p < 0.001), operative delivery (29,3% versus 13,3%, p < 0.001), episiotomy (12,5% versus 5.3 %, p < 0.001), OASIS (3.4 % versus 1.0 %, p < 0.001), complex tear (17,5% versus 7,7%) and PPH due to tear (2,5% versus 1,1%, p = 0,009).After adjustment, vaginism appeared to be an independant risk factor for cesarean section with a psaOR of 1.38 [1.02–1.85], operative delivery psaOR 2.39 [1.83–3,10], OASIS psaOR 2,19 [1.10–4,27], and complex tear psaOR 1,39 [1,02–1,87] ConclusionVaginism appears to be an independent risk factor for cesarean section, operative delivery, OASIS, and complex tear. Further studies should evaluate the impact of early and appropriate follow-up during pregnancy on adverse obstetrical outcomes.

Childbirth at advanced reproductive age: the impact of biopsychosocial factors on the mode of delivery

Introduction Contemporary society reflects a clear trend towards delayed motherhood, raising significant concerns in the management of pregnancy and childbirth in women of advanced reproductive age. In this context, the mode of delivery and associated risks for this age category require increased attention. Birth methods have been thoroughly examined to identify risks and influencing factors within this specific cohort. Material and methods A descriptive cross-sectional study was conducted on a sample of 528 women. Data were collected using a pre-tested semi-structured questionnaire, and respondents were divided into three groups based on the mode of delivery: vaginal delivery, planned cesarean section, and emergency cesarean section. Sociodemographic, anthropometric, medical, and obstetric characteristics were analyzed using linear regression. Statistical analyses included descriptive and inferential statistics (Chi-square), with a 95.0% confidence interval. Results The analysis revealed statistically significant variations in the mode of delivery based on maternal age (p=0.013) and paternal age (p=0.001), with an increased rate of cesarean sections at more advanced ages. Significant variations were also found in relation to area of residence (p=0.003), education level (p=0.001), nature of work (p=0.028), GP appointments (p=0.020), number of GP appointments(p&lt;0.001), number of obstetrician appointments (p=0.032), time of informing on risk factors (p=0.005), parity (p&lt;0.001), multiple pregnancies (p=0.016), mode of first delivery (p&lt;0.001), pregnancy complications (p=0.003), delivery complications (p&lt;0.001), gestational age at birth (p=0.017), Apgar scores at 1 and 5 minutes (p&lt;0.001). Conclusions Advanced reproductive age has been associated with a higher risk of cesarean section compared to vaginal delivery. The influence of age is modulated by various sociodemographic, medical, and obstetric characteristics, including area of residence, education level, history of cesarean section, parity, pregnancy and delivery complications, pre-existing chronic conditions, antenatal care and provision of information on risk factors.

Perioperative mortality of caesarean section in North-West Ethiopia: a prospective cohort study

ObjectiveThis study aimed to assess 7-day perioperative maternal mortality and risk factors at Tibebe Ghion Specialized Hospital.DesignA single-centre prospective cohort study.SettingA tertiary hospital in North-West Ethiopia, 01 June 2019 to...

Comparison of mephentermine and norepinephrine infusions for prevention of post-spinal hypotension during elective caesarean delivery: a randomised, double-blind trial

Comparison of mephentermine and norepinephrine infusions for prevention of post-spinal hypotension during elective caesarean delivery: a randomised, double-blind trial

Mode of birth and clinical factors associated with exclusive breastfeeding at hospital discharge: a retrospective cross-sectional study of women and full-term infants in Greece

World Health Organization recommends exclusive breastfeeding for six months. Despite its well- documented benefits, breastfeeding rates worldwide do not meet the recommended goals. The aim of this study was to identify factors that could influence exclusive breastfeeding at hospital discharge. All live, singleton, term births in a private hospital of Athens, Greece between January and December 2019 were included with a final study sample of 7336 women and newborns. Our study identifies several factors associated with nonexclusive breastfeeding ta hospital discharge: nullipara women compared to multipara (OR 0.73; 95% CI 0.66, 0.82), cesarean delivery compared to vaginal delivery (OR 1.83; 95% CI 1.65, 2.03), smoking during pregnancy (OR 1.28; 95% CI 1.15, 1.44), gestational age at 37+0- 38+6 weeks compared to 39+0- 41+6 weeks (OR 0.70; 95% CI 0.62, 0.78), birthweight &lt;2500g (OR 0.38; 95% CI 0.22, 0.35), and admission to neonatal intensive unit (NICU) after delivery (OR 8.19; 95% CI 6.65, 10.08). No association was observed for maternal age, pregnancy after assisted reproductive technology, gestational diabetes, obstetric complication, and sex of the newborn. It is expected that our results will allow future comparisons between different hospitals in the same country, as well as comparison of practices with other countries. Several perinatal factors related to nonexclusive breastfeeding at hospital discharge, most noteworthy were caesarean section and admission to NICU.

The characteristics of a fibroid in pregnancy can influence the perinatal outcome.

To determine whether fibroids affect perinatal outcomes and whether women who undergo fibroid surgery before pregnancy have better perinatal outcomes than those who have fibroids during pregnancy. The study also analyzes the optimal time interval between myomectomy and pregnancy and the characteristics of fibroids during pregnancy that affect perinatal outcomes. In both groups, fibroids' size, number, and location were analyzed to determine their influence on perinatal outcomes. The perinatal outcome is determined by gestational age, birth weight, Apgar score, intrauterine growth retardation, placental complications, and delivery method. A study was conducted on the perinatal outcomes of 338 women who had uterine fibroids during pregnancy and those who had undergone fibroid surgery before pregnancy. The medical records of women who gave birth at a tertiary university hospital were analyzed in this retrospective study. Women with submucosal fibroids have a lower gestational age of delivery (P = 0.0371), and those who operated on a higher number of fibroids before pregnancy had newborns with lower birth weights (P < 0.0001). Submucosal fibroids during pregnancy increase the chances of cesarean delivery (P = 0.0354). 14% of newborns have an Apgar score of less than seven within the first minute of birth in fibroids larger than 7cm (P < 0.0001). There is a statistically significant difference in the perinatal outcome of newborns depending on the number, size and placement of uterine fibroids in both observed groups.

Fetal Surveillance in High-Risk Fetal Cardiac Disease: Frequency, Results and Relationship with Survival

ObjectivesWe hypothesized that pregnancies with high-risk fetal heart disease (FHD) would benefit from frequent prenatal surveillance, abnormal fetal surveillance results would be associated with worse outcomes, and cardiovascular profile scoring (CVPS) could identify FHD cases at highest risk of death. MethodsA retrospective single-centre study of all actively treated pregnancies with high-risk FHD from 2006–2020. Frequency and results of fetal surveillance, survival, and mode of delivery were collected. Frequent fetal surveillance was defined as ≥ once weekly fetal wellbeing testing commencing by 28–32 weeks of gestation, or from later diagnosis, until delivery. Where possible, the CVPS was calculated. ResultsFetal surveillance results were available in 92% (56/61) of pregnancies with high-risk FHD and were abnormal in 18% (10/56). A final CVPS of ≤7 carried a higher mortality (11/21, 52%) than ≥8 (6/31, 19% (P = 0.01)). There was a trend toward worse survival at last follow-up when fetal surveillance was abnormal versus normal (40%, 4/10 vs 72%, 33/46, P = 0.07). Survival did not differ between frequent versus infrequent surveillance (13%, 4/30 vs 3%, 1/31, P = 0.20); nor when comparing abnormal versus normal surveillance results (20%, 2/10 vs 7%, 3/46, P = 0.21). Where fetal surveillance was abnormal, emergency cesarean delivery was more common (70%, 7/10 vs. 4%, 2/46, P < 0.001). ConclusionAbnormal fetal surveillance results and/or a CVPS ≤7 may identify compromised fetuses with high-risk FHD who could benefit from altered management or expedited delivery. Given the high rates of abnormal fetal surveillance in high-risk FHD, frequent fetal surveillance in the third trimester should be considered.

Prospective Observational Study Of The Outcome Of Pregnancies With Sonologically Detected Nuchal Cord At Term

Background: Nuchal cord refers to the condition where the umbilical cord wraps around the fetal neck, potentially leading to complications during pregnancy and delivery. The prevalence of nuchal cords at delivery ranges between 6% and 37%, with possible adverse outcomes including fetal asphyxia, hypoxia, and in severe cases, stillbirth. The current study aims to evaluate the impact of nuchal cord detection via ultrasound in fullterm pregnancies and assess its prognostic significance concerning perinatal outcomes. Materials and Methods: This prospective observational study involved a cohort of pregnant women at term (37- 42 weeks of gestation) with sonologically detected nuchal cords. Ultrasound evaluations were conducted to determine the presence and characteristics of nuchal cords, including the number of loops and tightness. The outcomes measured included the mode of delivery, fetal distress, Apgar scores, and neonatal complications such as hypoxic-ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Statistical analysis was performed to assess the correlation between nuchal cord characteristics and perinatal outcomes. Results: The study found that the presence of nuchal cords was associated with an increased rate of cesarean deliveries and a higher incidence of fetal distress during labor. However, the degree of tightness and the number of loops significantly influenced the severity of outcomes. Neonates with tightly looped nuchal cords showed a higher incidence of low Apgar scores and required more intensive neonatal care. The study also observed a slight increase in the occurrence of neonatal complications, including MAS and HIE, among those with multiple nuchal cord loops. Conclusion: The detection of nuchal cords at term via ultrasound is a valuable tool in predicting potential delivery complications. While many nuchal cords do not adversely affect perinatal outcomes, those with multiple loops or tight cords pose a higher risk of complications. This study emphasizes the importance of careful monitoring and tailored management strategies for pregnancies complicated by nuchal cords to optimize maternal and fetal outcomes.

Impact of high-order repeat cesarean deliveries on early maternal complications among major placenta previa patients in Southern Saudi Arabia.

To investigate the rates and odds ratios (ORs) of early maternal complications among patients with major placenta previa (PP) who have undergone high-order repeat cesarean deliveries (HOR-CDs) in comparison to those with low-order repeat cesarean deliveries (LOR-CDs). We carried out a retrospective review of all major PP patients (n=184) who delivered through second or subsequent repeat CDs, from January 2012 to December 2021 (Abha Maternity and Children's Hospital, Abha, Saudi Arabia). The patients were categorized into 2 groups: the LOR-CDs group (n=100), comprising individuals with their second and third CDs (CD2-CD3) and the HOR-CDs group (n=84), consisting of those undergoing their fourth to seventh CDs (CD4-CD7). In comparison to the LOR-CDs, the HOR-CDs group with major PP exhibited significantly higher rates and ORs of early maternal complications, including MRI-diagnosed placenta accreta spectrum (PAS, OR=2.67), transfusions of packed red blood cells (OR=2.71), moderate to severe intra-operative bleeding (OR=1.80), emergency hysterectomy (OR=2.96), urological injuries (OR=3.17), and length of post-operative hospital stay (OR=3.91). The major PP subgroup undergoing CD6-CD7 showed the highest rates and ORs for PAS diagnosis at 84.6% (OR=3.98) and emergency hysterectomy at 28.6% (OR=4.04). Among patients with major PP, undergoing more than 3 CDs is associated with a notable increase in both the rates and ORs of various early maternal complications. This trend of increasing many complications correlates directly with an ascending number of CDs.

Maternal and Neonatal Consequences of Early Augmentation of Labor Among Women With Spontaneous Onset of Labor: A National Population-Based Study.

While some labor interventions are essential in preventing maternal and neonatal morbidity, there is little evidence to support systematic early augmentation of labor (EAL). Our objective was to assess the association between EAL and cesarean delivery rate, postpartum hemorrhage and adverse neonatal outcomes. Population-based study using data from the 2016 French Perinatal Survey. Women with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. "EAL" was defined by artificial rupture of the membranes (AROM) and/or oxytocin within 1 h of admission and/or duration between interventions of less than 1 h. Women without EAL were women without labor augmentation or without EAL. The primary endpoint, cesarean delivery and the secondary endpoints were compared between women with and without EAL using univariate analysis. A multivariable logistic regression was adjusted on the suspected confounders and a propensity score approach was then performed. Among the 7196 women included, 1524 (21.2%) had EAL. Cesarean delivery rates were significantly higher in the EAL group compared with the no EAL group, 8.40% versus 6.15% (p < 0.01). EAL was associated with cesarean delivery in the multivariable analysis aOR 1.45 95% CI [1.15-1.82] and in the cohort matched on the propensity score, OR 1.56 [1.17-2.07]. EAL was not associated with severe postpartum hemorrhage, low 5-min Apgar score, low neonatal cord pH or transfer to NICU. EAL is frequent, involving one in five spontaneous laboring women in France. This practice is associated with an increased cesarean delivery risk.

A STUDY OF MATERNAL OUTCOME IN SEVERE PRE-ECLAMPSIA

Background&amp;MaterialsandMethods:Pre-eclampsiaisapregnancy-induced hypertensive disorder seen after 20 weeks of gestation with multi-systeminvolvement.Inhealthynulliparouswomen,theprevalenceofpreeclampsia ranges between 2% and 7%. It is a major cause of maternal morbidity and mortality in healthy nulliparous women.Itis amultisystemdisorderthatleadstocertaincomplicationslikeplacentalabruption,HELLPsyndrome,eclampsia,DIC,pulmonaryedema,adultrespiratory distress syndrome (ARDS), and acute renal failure leading to highmaternal morbidity and mortality. The aim of the study is to evaluate the maternaloutcomein severe preeclampsia. Cases with severe preeclampsia (B.P readingof 160/110mmHgwith1+ormorealbuminuria)after 28weeksof gestational age were included in the study and followed upto 6weeks postpartum.Atotal number of 100 cases were included in the study. Study variables were modeofdelivery,maternalmorbidity-mortality. Result: This study analyzed 100 patients with severe preeclampsia.Out of the 100 patients in the present study, maximum (43.0%) cases were inthe agegroupof 21to 25years,most (62.0%) of them were primigravida,and most of the cases were &lt; 34 weeks of pregnancy. Inourstudy,themostcommonmodeofdelivery(61.0%) was cesarean delivery. (39.0%) of patients delivered vaginally. Outof all normal deliveries, (29.0%) of patients delivered spontaneously, around(9.0%) of all deliveries are preceded by labor induction, and (1.0%) ofpatients needed vacuum delivery during the secondstage of labor. The most common maternal complication in the present studywas abruption (10.0%), followed by oligohydramnios (9.0%) and PPH(6.0%),HELLP(6.0%),eclampsia (4.0%), posterior reversible encephalopathy syndrome (PRES-3.0%), PPCM (2.0%), multiple organ dysfunction syndrome (2.0%), pulmonaryedema(1.0%) andDIC (1.0%). In ourstudyabruptio placenta was the most common one. Conclusion:Preeclampsia continues to be a significant cause of maternal morbidity and mortality. Regular antenatal check-ups are very important to emphasizeearlywarningsymptoms&amp;signssothatlife-threateningcomplications can beprevented.Provision ofqualitymaternalhealth careservices,increasingpatientawarenessaboutvariouswarningsymptoms, investigations, timely referral of patients to higher centers, the timely use ofantihypertensivedrugs,timelydelivery&amp;intensivemonitoringintheintrapartum &amp;postpartum period can result in improvement in maternaloutcome.

Effect Of Cerclage Suture Type On Pregnancy And Newborn Results: Mersylene Suture Versus Prolene Suture

Purpose: The aim of this study is to compare pregnancy and neonatal outcomes according to the type of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who underwent transvaginal cervical cerclage due to cervical insufficiency in a tertiary health center between 2020 and 2024 were evaluated retrospectively. Demographic data regarding cerclage indications (ultrasound-based, prophylactic or physical examination-based), number of weeks of gestation in cerclage, cerclage suture type (prolene, mersilen), gestational week at cerclage insertion and delivery, routes of delivery were recorded. In addition, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups according to cerclage suture type (mersilene or prolene) and maternal, newborn and pregnancy outcomes were compared between these groups. Results: Comparison of the groups in terms of age, gravidity, parity, number of miscarriages and BMI revealed significantly higher mean gravidity in group 1 compared to group 2 (P0.05). No difference was determined with regard to gestational week at cerclage application, cervical length, cervical dilatation just before cerclage insertion, gestational age at cerclage removal and delivery and birth weight (p&gt;0.05). Groups were comparable in terms of subgroups established according to their numbr number of previous deliveries (p&gt;0.05). Groups were comparable in terms of indications for cerclage insertion (p&gt;0.05). Cesarean delivery rate was 40 % in group 1 while it was 43.6 % in groups 2, no statistical difference was determined in terms of rate of cesarean delivery (p&gt;0.05). Similar number of newborns needed NICU admission between the two groups following delivery (17.5% versus 17.9 %p&gt;0.05). Mean APGAR scores at 1st (6.8 versus 7.4) and 5 th (7.8 versus 8.3) min were comparable between the groups (p&gt;0.05) Conclusion: Although mersilen stitch is commonly preferred, data analysis revealed similar results with prolene stitch in terms of maternal and neonatal outcomes.

The Influence of Prenatal Yoga Exercise on Mother Anxiety Pregnant

Anxiety during pregnancy not only affects the health of pregnant women but can also have an impact on the delivery process such as premature labor, prolonged labour, cesarean delivery, low birth weight. Based on WHO data, there are around 10% of pregnant women with psychological disorders and about 13% of postpartum women worldwide. This incidence is higher in developing countries in pregnant women, namely 15.6% and 19.8% in postpartum women. The purpose of this study is The Effect of Prenatal Yoga Exercise on the Anxiety of Pregnant Women at TPMB Mamah Suhaeriah in 2022. Research method This type of research uses the Pre-Experimental method with a one group pretest-posttest design approach. Sampling using total sampling with a total sample of 20 respondents. The research instrument used was an observation sheet. The data analysis used is the Wilcoxon Sign Rank Test statistical test. Research results based on the results of statistical tests using the Wilcoxon Sign Rank test, the p-value (0.000

Efficacy of B-Lynch Compression Suture for Control of Primary Post-Partum Hemorrhage

OBJECTIVES This study aimed to evaluate the efficiency of the B-Lynch compression suture for primary post-partum hemorrhage control. METHODOLOGY It is a prospective cross-sectional study performed for two years, i.e., 1 November 2021 to 31 October 2023, at the Department of Obstetrics and Gynaecology in a tertiary care hospital. This study included 65 study cases out of 23,964 with primary post-partum hemorrhage (PPH) due to uterine atony during cesarean delivery not responding to pharmacological treatment and was managed by applying B-Lynch compression sutures. The amount of blood loss, demographic characteristics, birth weight of babies, causative factors, and other related complications were studied in such selected cases. RESULTSB-Lynch compression suture presented a success rate of 97% in the present study. 52% had blood loss of 1000-1500ml, 29% had loss between 1501-2000ml and 18% had 2001-2500ml blood loss. 6% had wound gaping, 10.7% had a fever, and 8% had more than seven days stay in hospital, and wound infections were noted. CONCLUSION Our study concluded that the B-Lynch compression suture had a success rate of 97% in the management of primary post-partum hemorrhage, with few post-operative complications. The current research demonstrates the efficacy of B-Lynch as a lifesaving, easy, effectual technique that avoids hysterectomy and thus avoids heavy blood loss.

Association Between Household Food Insecurity and Low Birth Weight: A Population-Based Case-Control Study.

Low birth weight (LBW) is a major public health issue associated with increased neonatal morbidity and mortality. This study aimed to examine the association between household food insecurity and LBW in Mashhad, Iran. Study Design: A population-based case-control study. This study involved 6294 mothers (3247 cases and 3247 controls) who visited healthcare centers affiliated with Mashhad University of Medical Sciences for term births between March 2019 and March 2022. Cases included women who delivered neonates weighing<2500 g, while controls delivered babies≥2500 g. Food security was measured using the validated Household Food Insecurity Access Scale. Logistic regression models examined the associations between food insecurity and LBW. Geographic information system techniques mapped LBW distribution in Mashhad. Household food insecurity was significantly associated with higher odds of LBW (adjusted odds ratio [AOR]=1.25, 95% confidence interval [CI]: 1.03, 1.53). Other risk factors included younger maternal age (AOR=1.03, 95% CI: 1.01, 1.04), lower maternal education (AOR=0.55, 95% CI: 0.43, 0.71), cesarean delivery (AOR=1.70, 95% CI: 1.40, 2.06), and exposure to secondhand smoke (AOR=1.68, 95% CI: 1.02, 2.75). Gestational diabetes demonstrated a protective effect (AOR=0.37, 95% CI: 0.15, 0.91). Geographic mapping revealed that regions with higher food insecurity had elevated LBW prevalence. These findings underscore the importance of addressing food insecurity among pregnant women to reduce the risk of LBW and improve newborn outcomes.

Pulmonary Embolism in the Post-partum Period: A Case Report

Background: One well-known hypercoagulable state that raises the risk of venous thromboembolism is pregnancy and it is more common in cesarean delivery. Pulmonary embolisms are difficult to identify based solely on postpartum symptoms. Most of the symptoms are non-specific, therefore they are typically underdiagnosed throughout pregnancy and the postpartum period. Objective: This work presented information on the treatment of high-risk pulmonary embolism in the postpartum phase. Case presentation: This paper reported the case of a 33-year-old female, admitted to the emergency room for shortness of breath. Her personal history showed that she had just given birth to her sixth child by caesarian section a month ago and had a history of hysterectomy due to severe infection. Result: She suffered a high-risk pulmonary embolism in the post-partum period. It takes a strong index of suspicion to diagnose and treat patients in a timely manner. Conclusion: Echocardiography and Multislice Computerized Tomography are the best diagnostic methods. Venous thromboembolism prophylaxis should be taken into account, particularly in patients who have risk factors.

A Review of Third-Trimester Complications in Pregnancies Complicated by Diabetes Mellitus.

Pregnancies affected by both pregestational and gestational diabetes mellitus carry an increased risk of adverse maternal and neonatal outcomes. While the risks associated with diabetes in pregnancy have been well documented and span across all trimesters, maternal and neonatal morbidity have been associated with select third-trimester complications. Further, modifiable risk factors have been identified that can help improve pregnancy outcomes. This review aims to examine the relationship between select third-trimester complications (large for gestational age, intrauterine fetal demise, hypertensive disorders of pregnancy, preterm birth, perineal lacerations, shoulder dystocia, and cesarean delivery) and the aforementioned modifiable risk factors, specifically glycemic control, blood pressure control, and gestational weight gain. It also highlights how early optimization of these modifiable risk factors can reduce adverse maternal, fetal, and neonatal outcomes. KEY POINTS: · Diabetes mellitus in pregnancy increases the risk of third-trimester complications.. · Modifiable risk factors exist for these complications.. · Optimizing these modifiable risk factors improves maternal and neonatal outcomes..

USE OF PROPHYLACTIC ANTIBIOTICS IN PATIENTS UNDERGOING CAESAREAN SECTION AT CUT MEUTIA GENERAL HOSPITAL, NORTH ACEH 2021-2022

Caesarean section is a surgical procedure to remove the fetus through an incision in the lining of the abdomen and uterus. Cesarean delivery is performed by considering clinical signs of the mother and fetus, such as placenta previa, abnormal location of the fetus, as well as different signs that may endanger the existence of the mother or embryo. According to the World Health Organization (WHO), the number of cesarean deliveries has increased, which is directly relative to the increase in the contamination rate of surgical wound infection (ILO). Prophylactic antibiotics are one of the prevention of surgical wound infection. The research method used is retrospective descriptive. The sampling technique in this research uses non-probability sampling, namely total sampling. The aftereffects of this review show that the use of prophylactic antibiotics in caesarean section patients, namely ceftriaxone 51.2% and cefotaxime 48.8%, the use of prophylactic antibiotics at the Cut Meutia Aceh General Hospital based on ASHP, the use of antibiotics ceftriaxone, cefotaxime, and reponem is 100% inappropriate and based on PPRA RSU Cut Meutia which is 100% compliant. The aftereffects of this study presumed that the utilization of anti-toxins based on ASHP is not appropriate and based on PPRA Cut Meutia Hospital is appropriate.

Maternal and fetal outcome of postdated pregnancy; A cross sectional study

Background: Postdated pregnancy refers to a pregnancy that extends beyond the expected date of delivery, which is 280 days. When a pregnancy surpasses 42 weeks (more than 294 days), it is termed as post-term pregnancy. Postdated pregnancy is one of the most common obstetric problems associated with increased maternal and foetal morbidity, and mortality. Gestational age is among the most important determinants of perinatal outcomes, but studies have focused more on preterm births (&lt;37 completed gestational weeks) and less on the understanding and prevention of post term births. Objectives: To assess the maternal and fetal outcome of postdated pregnancy. Material and Methods: Present observational descriptive cross sectional study was conducted for the period of 1 year from 1st April 2023 to 31st March 2024. Total 150 postdated pregnant women included in present study as per predefined after satisfying the inclusion and exclusion criteria. Results: During study period out of total deliveries 110 were postdated deliveries. Out of them 46.36% and 28.18% were of 21-25 years and 26-30 years of age respectively. The mean age of all participants was 25.51 ± 4.58 years. A statistically significant association was found between the gestational age of postdated women and their mode of delivery. Out of 110 postdated women, 68.18% and 31.81% had vaginal and caesarean deliveries, respectively. Conclusion: Adverse maternal and fetal outcomes of post-dated pregnancy should be anticipated and counseling of women at risk of post-term pregnancy and timely management for its prevention is recommended