Uterine incision-to-delivery interval and neonatal outcomes among nonurgent, term, cesarean deliveries.

Postoperative pain after caesarean delivery is frequently moderate to severe, and insufficient analgesia may lead to chronic pain, prolonged opioid use, delayed functional recovery, and postpartum psychological distress. Structured postoperative pain management programmes may improve outcomes; however, they are rarely implemented in obstetric practice. This study evaluated the impact of an anaesthesialed acute pain service designed to standardise multimodal postoperative analgesia and early recovery processes. We conducted a single-centre retrospective before-after cohort study at a tertiary care centre, including women who underwent caesarean delivery under neuraxial anaesthesia. We excluded women receiving general anaesthesia or with missing postoperative outcomes. The primary outcome was the maximum pain score on an 11- point numerical rating scale within 24h. Secondary outcomes included the proportion of women with moderate-to-severe pain, postoperative opioid use, time to first oral fluid intake, and postoperative adverse effects. A total of 955 women were analysed. After implementation of the anaesthesia-led service, maximum 24-hour pain scores were significantly lower (3.4±1.9 vs. 5.0±2.0, P <0.001), and fewer women experienced moderate-to-severe pain (42% vs. 74%, P<0.001). Time to first oral fluid intake was shorter (233±162 vs. 441±142min, P<0.001). The proportion receiving postoperative systemic opioids increased slightly (18.7% vs. 13.1%, P=0.02), but total morphine-equivalent dose remained similar (0.65±1.58 vs. 0.78±2.25mg, P =0.29). An anaesthesia-led acute pain service significantly improved postoperative pain and enabled earlier oral intake after caesarean delivery without increasing complications. This structured approach may support enhanced recovery pathways in obstetric.

The safety of vaginal delivery following obstetric anal sphincter injury- A retrospective pilot study using transperineal ultrasound algorithm.

Patient-reported pain, pressure, and intraoperative analgesic use during cesarean delivery: a prospective descriptive study

Resuscitative cesarean delivery: prioritizing team preparedness for one of the most challenging obstetric emergencies.

Developing a concise multivariable predictive model for cesarean delivery following neuraxial analgesia during labor: a prospective observational cohort study.

To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure. Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population. Of 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43). Opioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.

Anaesthesia for caesarean delivery in patients with placenta accreta spectrum: a retrospective cohort study in two referral centres in Ireland (2017-2024).

Alternating versus coadministration of multimodal non-opioid analgesia after cesarean delivery and pain outcomes: a single center quality improvement study (2024).

Factors associated with conversion from neuraxial to general anesthesia for cesarean delivery: mixed-effects analysis from the multicenter perioperative outcomes group

Neuraxial anesthesia in obstetric patients with rare spinal pathologies: a scoping review.

Methodological Considerations in Studies of Preoperative Pain Education for Cesarean Delivery.

Hyperfibrinolysis and reduced functional fibrinogen in haemorrhagic caesarean delivery: a secondary analysis of the TRACES trial evaluating fibrinogen kinetics following fibrinogen concentrate or plasma infusion.

Association between early pregnancy thyroid function and placental-to-fetal weight ratio (PWR): A large-scale retrospective cohort study.

Incidence of general anesthesia for cesarean delivery according to urgency: Prospective multinational multicenter observational study of 31 European countries, 9989 cases

To develop a practical risk-stratification framework for unplanned cesarean delivery (CD) among term nulliparous individuals with hypertensive disorders of pregnancy (HDP) undergoing induction of labor (IOL). This was a retrospective cohort study at a single tertiary care center (January 2010-March 2025) of nulliparous individuals with singleton gestations diagnosed with HDP undergoing IOL at ≥ 37 + 0 weeks. We excluded multiple gestations, major fetal anomalies, planned CD, or intrauterine fetal death. We included demographic and pregnancy characteristics available prior to induction and evaluated association with unplanned CD. Stepwise backward logistic regression was used to build a model for identifying independent predictors of unplanned CD. Sensitivity, specificity, and likelihood ratios (LR) were calculated. Among 1,326 eligible individuals, 347 (26.2%) underwent unplanned CD. Independent predictors of CD were age > 35 years (adjusted odds ratio [aOR] 1.97, 95% CI 1.45-2.66), body mass index ≥ 30 kg/m2 (aOR 2.07, 95% CI 1.58-2.70), HDP with severe features (aOR 1.71, 95% CI 1.17-2.49), thrombocytopenia (aOR 2.66, 95% CI 1.17-6.06), and need for cervical ripening (aOR 1.63, 95% CI 1.23-2.16). Cesarean risk increased stepwise with accumulation of risk factors: 28.4% with ≥ 1 factor, 36.7% with ≥ 2, 44.7% with ≥ 3, and 64.7% with ≥ 4. The presence of ≥ 4 factors yielded a positive LR of 5.17 (95% CI 1.92-13.99). In term nulliparous individuals with HDP undergoing induction, approximately one in four require CD. A simple model based on five routinely available pre-induction factors enables individualized counseling and shared decision-making at the bedside.

Background/Aim: The COVID-19 pandemic disrupted healthcare systems, affecting pregnant women's access to routine antenatal care. Changes in health policies and heightened anxiety may have influenced care utilization and outcomes. This study aimed to assess the pandemic's impact on antenatal attendance and compare pregnancy and neonatal outcomes with the pre-pandemic period in a tertiary center. Methods: We retrospectively included all women who delivered at Ankara Training and Research Hospital between September 2020 and January 2021 (pandemic period) and those who delivered between September 2019 and January 2020 (pre-pandemic control). Pregnancies with any documented SARS-CoV-2 infection were excluded. Demographics, number of antenatal visits, antenatal screening tests, obstetric complications, and perinatal outcomes were compared. Results: A total of 532 women delivered during the pandemic and 650 before the pandemic. The cesarean section rate was higher during the pandemic (40.4% vs 33.8%; P=0.020), with a higher primary cesarean rate (18.4% vs 11.2%; P&lt;0.001). Antenatal visit categories were &lt;4, 4–10, and &gt;10 visits for pandemic vs pre-pandemic groups as follows: 39.4% vs 38.5%, 36.8% vs 42.1%, and 23.8% vs 19.4%, respectively (overall comparison P=0.087). While not statistically significant, there was a trend toward fewer women having 4–10 visits and more having &gt;10 visits during the pandemic. Antenatal screening tests (Down syndrome screening, gestational diabetes screening, and second-trimester anomaly screening) were performed more frequently during the pandemic (all P&lt;0.05). The mean gestational age at delivery was higher during the pandemic (39.25 (1.42) vs 38.65 (2.84) weeks; P&lt;0.001), with fewer preterm (&lt;37 weeks) births and more post-term (&gt;41 weeks) births (P=0.012). Other neonatal outcomes were comparable, except for a small but statistically significant difference in 1-minute Apgar scores (9.02 (0.71) vs 9.10 (1.19); P=0.001). Conclusion: During the pandemic, overall antenatal attendance did not differ significantly from the pre-pandemic period, although screening tests were utilized more frequently and cesarean delivery was more common. Despite these changes, pregnancy and neonatal outcomes were largely similar between periods.

Risk factors associated with maternal complications of caesarean delivery in Rwanda: a retrospective cross-sectional study.

To develop antenatal prediction models for shoulder dystocia and birth trauma using routinely collected maternal and sonographic variables. Retrospective cohort study. Single tertiary referral centre in the UK. All singleton term liveborn pregnancies delivered between January 2016 and November 2024 with a third-trimester ultrasound performed at or beyond 36 weeks' gestation. Multivariable logistic regression was used to develop antenatal prediction models for shoulder dystocia and birth trauma, incorporating maternal characteristics and fetal biometry including abdominal circumference (AC; centile or mm) and estimated fetal weight (EFW; grams or centile). Model performance was assessed using tests for multicollinearity, discrimination (area under the ROC curve, AUC) and calibration. Shoulder dystocia and birth trauma, the latter defined as a composite of shoulder dystocia, postpartum haemorrhage requiring blood transfusion, caesarean delivery at full dilatation, or hypoxic-ischaemic encephalopathy (HIE ≥ 1). A total of 24 334 singleton term pregnancies were included; 432 (1.8%) were complicated by shoulder dystocia and 1210 (5.0%) by birth trauma. The model including maternal characteristics and AC centile demonstrated the best discrimination. For shoulder dystocia, the apparent AUC was 0.706 (95% CI 0.682-0.730); the optimism-corrected AUC after bootstrap validation was 0.699. For birth trauma, the apparent AUC was 0.669 (95% CI 0.654-0.685); the optimism-corrected AUC was 0.665. At a 10% false-positive rate, sensitivity was 31.5% for shoulder dystocia and 22.8% for birth trauma, compared with 20.4% and 14.0%, respectively, using EFW ≥ 90th centile. Antenatal models combining fetal AC centile with maternal risk factors outperform EFW-based thresholds currently used in clinical practice. Although discrimination was modest, the model may be useful for antenatal risk stratification and counselling, rather than as a stand-alone clinical test. Such models may help identify pregnancies at increased risk of delivery-related complications associated with fetal overgrowth and inform future studies evaluating targeted interventions.

Pregnancy in teenagers and emerging adults is associated with an increased risk of adverse outcomes. Similarly, pregnancies complicated by pregestational and gestational diabetes mellitus (GDM) carry a higher risk of complications. However, limited data exist on the intersection of these two high-risk conditions. Our objective was to establish the prevalence of teenage and emerging adult pregnancies complicated by diabetes in a population-based cohort and compare outcomes to pregnancies uncomplicated by diabetes, noting a background prevalence of GDM of 8.1% and pregestational diabetes of 1.2% across all age groups in the United States. This is a retrospective cohort study conducted in Olmsted County, Minnesota, USA. It includes female residents aged ≤21 years with a pregnancy ICD-10 code between January 1, 2013, and December 31, 2022. The main outcome measures assessed include maternal characteristics and maternal and fetal pregnancy outcomes. A total of 1491 pregnancies in 1379 individuals were identified and included. In total, 68 (4.6%) pregnancies were complicated by diabetes: 51 (3.4%) with GDM and 17 (1.1%) with pregestational diabetes. In this study, pregnancies with diabetes had higher rates of adverse outcomes including cesarean delivery (GDM 29.4% vs. pregestational 60.0% vs. no diabetes 17.0%, P < 0.001), preeclampsia (GDM 15.7% vs. pregestational 40.0% vs. no diabetes 7.3%, P < 0.001), large-for-gestational-age neonates (GDM 13.7% vs. pre-existing 50.0% vs. no diabetes 5.8%, P < 0.001), and neonatal hypoglycemia (GDM 42.6% vs. pregestational 60.0% vs. no diabetes 13.3%, P < 0.001). The prevalence of pregestational diabetes in our teenage and emerging adult population is similar to that of the general pregnancy population; however, the prevalence of GDM is significantly lower. Overall, diabetes in teenage pregnancy is associated with an elevated risk of adverse maternal and neonatal outcomes. Future research should evaluate interventions aimed at reducing adverse pregnancy outcomes in this vulnerable population.