Caesarean Section Birth Research Articles

Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Early gestational diabetes mellitus (eGDM) refers to elevated blood glucose levels not meeting the criteria for overt diabetes before 20 weeks gestation. Observational studies link eGDM to adverse outcomes, but randomized controlled trial (RCT) evidence on early intervention benefits remains inconclusive. To address this, we performed a systematic review and meta-analysis (SRM) of RCTs on this subject. We searched electronic databases to identify RCTs comparing early treatment versus observation for eGDM. The primary neonatal outcomes analyzed were large-for-gestational-age (LGA) and macrosomia. The primary maternal outcome was pregnancy-related hypertension. Secondary neonatal outcomes included neonatal respiratory distress (NRD), neonatal intensive-care unit (NICU) admission, small-for-gestational-age (SGA), cord-blood C-peptide ≥90th percentile, and neonatal hypoglycemia. Secondary maternal outcomes were cesarean section (CS), emergency CS, labor induction, preeclampsia, and preterm birth. Seven RCTs involving 4,427 pregnancies were analyzed. The studies differed in their timing and methods of inclusion. Six studies used a combination of lifestyle and pharmaceutical interventions, while one relied solely on lifestyle modifications. Early treatment did not reduce LGA [OR 0.84 (95%CI: 0.53-1.32); P=0.44], macrosomia [OR 0.68 (95%CI: 0.43-1.06); P=0.09], or pregnancy-related hypertension [OR 1.04 (95%CI: 0.68-1.57); P=0.87]. Among the secondary outcomes, only NRD was significantly reduced in the treatment arm [OR 0.52 (95%CI: 0.34-0.80); P=0.003]. However, sensitivity analysis, omitting the lifestyle-only study, demonstrated a lower risk of macrosomia with early intervention [OR 0.55 (95%CI: 0.34-0.91); P=0.02]. The SRM demonstrates early intervention does not improve most pregnancy outcomes, except NRD. Sensitivity analysis, excluding the lifestyle-only study, additionally revealed a reduction in macrosomia. The findings must be interpreted cautiously due to the variability in study designs. Replication in well-designed multicenter trials is required before clinical application.

Caesarean section and risk of infection in offspring: systematic review and meta-analysis of observational studies

ObjectiveTo compare the risk of hospital admissions with infections and infections not in hospital in children born by caesarean section with children born by vaginal birth.Data sourcesMedline, Embase, and PubMed...

Maternal mortality in Panama from 1998 to 2022.

To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R 2 was performed to analyze the data. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R 2 = 0.1 (y = -0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R 2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

Adverse maternal and fetal outcomes among tribal pregnant women suffering from sickle cell disease: A retrospective cohort study in a community-based hospital situated in a tribal block of Gujarat, India.

The study presents the risk of the maternal-fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity. This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal-fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal-fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression. A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted-odds-ratio [AOR] 13.7, 95% CI: 4.5-42.7), anemia (AOR 6.8, 95% CI: 4.5-10.2), severe anemia (AOR 4.3, 95% CI: 3.3-5.6), preterm delivery (AOR 4.5, 95% CI: 3.6-5.7), cesarean section (AOR 5.5, 95% CI: 4.7-7.0), stillbirth (AOR 3.4, 95% CI: 2.3-5.3), and low birth weight (AOR 3.1, 95% CI: 2.4-39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities. We concluded that SCD might be an independent risk-factor for developing maternal-fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest.

Impact of postpartum hospital length of stay on infant gut microbiota: a comprehensive analysis of vaginal and caesarean birth

BackgroundThe primary concern with prolonged hospitalization following birth is the risk of acquiring hospital-acquired infections (HAIs) caused by opportunistic bacteria, which can alter the early establishment of gut microbiota. ObjectiveThis study aimed to assess the association between postpartum hospital length-of-stay (LOS) and the composition of gut microbiota at 3 and 12 months of age according to birth mode. MethodsA total of 1313 Canadian infants from the CHILD Cohort Study were involved in this study. Prolonged hospital LOS was defined as > 2 days following vaginal and > 3 days after caesarean section (CS) birth. Infants' gut microbiota was characterized by Illumina 16S rRNA sequencing of faecal samples at 3-4 months and 12 months. FindingsFollowing a prolonged hospital LOS, vaginally-delivered (VD) infants with no maternal intrapartum antibiotic (IAP) exposure had a higher abundance of bacteria in their gut known to cause HAIs, including Enterococcus at 3 and 12 months, Citrobacter at 3 months and C. difficile at 12 months. Enterococcus or Citrobacter abundance at 3 months significantly mediated the association between LOS, and low abundance of Bacteroidaceae, or higher Enterococcaeae/Bacteriodaceae or Enterobacteriaceae/Bacteroidaceae abundance ratios at 12 months of age in VD infants without IAP exposure. HAI-causing Enterobacteriaceae were also more abundant in later infancy with a longer hospital LOS following CS. In the absence of exclusive breastfeeding for 3 months or any breastfeeding at 12 months, the Porphyromonadaceae (of Bacteroidota) become depleted in CS infants with a prolonged LOS. ConclusionsProlonged hospital stay after birth is associated with infant gut dysbiosis.

Improving Admission Temperature in Infants ≥34 Weeks' Gestation: A Quality Improvement Initiative.

NICU admission for hypothermia is a problem worldwide, with associated morbidity, mortality, and financial costs. Many interventions have been studied for smaller infants, but there has been little focus on infants born ≥34 weeks' gestational age (GA), though most deliveries occur at this gestation. Our primary aim was to improve the proportion of infants ≥34 weeks' GA with normal NICU admission temperature. Secondary outcomes included improvement of the proportion of normal first temperature in all infants ≥34 weeks' GA, independent of NICU admission, and improvement of predefined outcome measures. We completed a root cause analysis, using fishbone and process mapping to determine what factors were contributing to hypothermia. A series of changes were trialed using plan-do-study-act cycles to develop a standard operating procedure, covering both vaginal and cesarean section births. Outcome measures were analyzed using a P-chart as well as traditional statistical tests. We successfully increased the proportion of infants ≥34 weeks' GA with normothermia on NICU admission from 62% to 80% without increasing hyperthermia. In addition, the interventions improved the proportion of delivery room normothermia in all infants born ≥34 weeks' GA and were associated with a decreased need for intravenous therapy for hypoglycemia and the incidence of metabolic acidosis. This quality improvement initiative was successful at improving our institution's rates of normal infant temperature. The methodology used can be applied to other similar centers to improve this common problem.

“Where’s my baby?” A feminist phenomenological study of women experiencing preventable separation from their baby at caesarean birth

ProblemSeparating women and babies immediately after birth contributes to poor birth experience and reduced satisfaction. BackgroundA negative birth experience can impact a woman’s transition to motherhood and emotional well-being beyond the newborn period. Separating women from their baby at birth is known to reduce birth satisfaction and is more likely to happen at caesarean section births. QuestionWhat is the experience of women who are separated from their baby after caesarean section birth without medical necessity? MethodsUnstructured, in-depth phenomenological interviews were conducted with fifteen women who had been separated from their well-baby at caesarean section birth. Data was analysed using a Modified van Kaam approach. A novel feminist phenomenological framework with two birthing theories was used to explore the experience of the participants. FindingsFour major themes emerged – Disconnection, Emotional Turmoil, Influence, and Insight. These demonstrated significant trauma that both the separation and perinatal care created. DiscussionThe participants recognised their vulnerability and the lack of power and control they had over themselves and their baby, which was seemingly not acknowledged. Provider and hospital needs were valued above those of the women. ConclusionWoman-centred care was not evident in the treatment of these women despite the attendance of a midwife at each birth. This research challenges midwives and other health care providers to support and advocate for those birthing by caesarean section to return power and control and support them to remain in close physical contact with their baby immediately after birth.

Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

Background/Aims Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes. Methods This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically. Results A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years. Conclusions Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care. Implications for practice Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Impact of Early Dressing Removal After Cesarean Section on Wound Healing and Complications: A Systematic Review.

The global increase in cesarean section (C-section) births has heightened concerns about surgical site infections (SSIs), a significant risk associated with this common obstetric procedure. This literature review evaluates the impact of early dressing removal after C-sections, drawing from randomized controlled trials and clinical studies to assess potential benefits and risks. The review found no definitive evidence favoring a specific timing for dressing removal to reduce SSIs. However, earlier removal before hospital discharge generally enhances patient comfort. Factors such as high BMI, urgent C-sections, preterm premature rupture of membranes (PPROM), and chorioamnionitis are linked to higher wound healing complications, irrespective of when the dressing is removed. Removing staples before discharge is advised for convenience, with close monitoring recommended for high-risk patients. The findings emphasize the need for further research to optimize wound healing protocols, particularly for high-risk groups, to improve patient outcomes and minimize complications. A personalized approach to postoperative care, tailored to individual risk factors, may offer the best strategy for reducing SSIs and enhancing recovery after C-sections.

The Fetomaternal Outcome of Pregnancy in Women with Thyroid Disease

OBJECTIVES To determine the frequency of fetomaternal outcomes in women with pregnancy with thyroid disease presented to Khyber Teaching Hospital Peshawar. METHODOLOGY A descriptive observational study was conducted in Khyber’s Obstetrics and Gynecology Department Teaching Hospital Peshawar from February to July 2022. A total of 160 pregnant patients with thyroid disease were included in the study. All patients were followed till delivery, and fetomaternal outcomes (gestational hypertension, pre-eclampsia, postpartum hemorrhage, mode of delivery, Oligohydramnios, birth weight, neonatal hyperbilirubinemia) were noted. RESULTSThe age range in this study was from 18 to 40 years with a mean age of 29.787 +2.23 years, mean gestational age of 25.331+4.14 weeks, mean parity of 1.818+1.23 and mean weight of 68.462+3.30 kg. Hypothyroidism was seen in 76.9% of patients, and hyperthyroidism was seen in 23.1%. Gestational hypertension was observed in 11.9%, pre-eclampsia in 5%, postpartum haemorrhage in 47.5%, the cesarean section in 27.5%, Oligohydramnios in 11.3%, low birth weight in 21.3% and neonatal hyperbilirubinemia in 10.6%. CONCLUSION The most frequent complication observed in pregnancy with thyroid disease was postpartum haemorrhage, followed by cesarean section and low birth weight.

Early feasibility and usability study of a novel obstetric blood loss quantifying device

ObjectiveTo study the accuracy and usability of a novel obstetric blood loss quantifying tool in clinical settings. MethodsA mixed-methods study was conducted in an Irish tertiary maternity unit. The accuracy of measuring the blood content (hemoglobin concentration) of elective Caesarean section birth waste with a novel obstetric blood loss quantifying device was compared, using Bland-Altman and correlation analysis, with staff volumetry and a reference hemoglobinometer. Hospital staff (nurses, midwives and doctors) opinion of the usability of the device was studied by an anonymous questionnaire which generated a System Usability Scale (SUS) score. SUS scores range from 0 to 100 with higher scores reflecting greater usability. ResultsThe device was used by 19 different hospital staff members (nine nurses, four midwives and six doctors) in 19 elective Caesarean deliveries that had varying levels of PPH risk. Bland-Altman analysis produced mean biases of −0.7 ± 1.5 g/dL and 0.2 ± 1.2 g/dL for the device and staff measurements respectively. The width of the limits of agreement was narrower for device measurements than for staff measurements (4.5 g/dL and 5.7 g/dL respectively). The device’s measurements of hemoglobin content correlated more strongly with the hemoglobinometer rather than with hospital staff measurements (Spearman correlation coefficients of 0.9 and 0.6 respectively). This suggests that the device is more accurate in determining the blood content of the birth waste than hospital staff volumetric measurements. Hospital staff members assigned the device a mean SUS score of 82 which suggests that the device is highly usable. ConclusionAn early feasibility study in clinical settings suggests that a novel device for quantifying obstetric blood loss was more accurate than volumetry in measuring the hemoglobin content of birth waste. Health professionals also found the device highly usable. This data suggests that there is much potential in transitioning from a “human-made” to a “machine-made” assessment of blood loss. Future studies will entail additional testing of the device to assess its impact on the morbidities associated with postpartum hemorrhage.

Association between Flexibility, Measured with the Back-Scratch Test, and the Odds of Oxytocin Administration during Labour and Caesarean Section.

Objective: This study explored whether assessing flexibility levels in clinical settings might predict the odds of oxytocin administration and caesarean section to stimulate labour. Methods: Pregnant women from the GESTAFIT Project (n = 157), participated in this longitudinal study. Maternal upper-body flexibility was assessed at 16 gestational weeks (g.w.) through the Back-scratch test. Clinical data, including oxytocin administration and type of birth, were registered from obstetric medical records. Results: Pregnant women who required oxytocin administration or had caesarean sections showed lower flexibility scores (p < 0.05 and p < 0.01, respectively). The receiver operating characteristic curve analysis showed that the Back-scratch test was able to detect the need for oxytocin administration ((area under the curve [AUC] = 0.672 (95% confidence interval [CI]: 0.682 (95% CI: 0.59-0.78, p = 0.001)). The AUC to establish the ability of flexibility to discriminate between vaginal and caesarean section births was 0.672 (95% CI: 0.60-0.77, p = 0.002). A Back-scratch test worse than 4 centimetres was associated with a ~5 times greater increased odds ratio of requiring exogenous oxytocin administration (95% CI: 2.0-11.6, p = 0.001) and a ~4 times greater increased odds ratio of having a caesarean section (95% CI: 1.7-10.2, p = 0.002). Conclusions: These findings suggest that lower flexibility levels at the 16th g.w. discriminates between pregnant women who will require oxytocin and those who will not, and those with a greater risk of a caesarean section than those with a vaginal birth. Pregnant women below the proposed Back-scratch test cut-offs at 16th g.w. might specifically benefit from physical therapies that include flexibility training.

RidStress 2 randomised controlled trial protocol: an Australian phase III clinical trial of intrapartum sildenafil citrate or placebo to reduce emergency caesarean birth for fetal distress in women with small or suboptimally grown infants at term (≥37 weeks)

IntroductionSmall for gestational age (SGA) infants are at increased risk of fetal distress in labour requiring emergency operative birth (by caesarean section (CS), vacuum or forceps). We have previously shown...

Effect of ART treatments on maternal and neonatal outcomes in singleton live births: A large-scale retrospective cohort study

BackgroundThe increased risk of pregnancy complications in the ART population has been reported, but the source of these risks remains controversial. The study aims to evaluate the association between ART treatments and patient characteristics with maternal and neonatal outcomes. MethodsThis was a retrospective analysis of 45,159 singleton pregnant women at a hospital between 2018 and 2021. The maternal and neonatal outcomes included pregnancy-induced hypertension (PIH), preeclampsia (PE), gestational diabetes mellitus (GDM), placental abruption (PA), placenta accreta spectrum (PAS), postpartum hemorrhage (PPH), cesarean section, iatrogenic and spontaneous preterm birth, small for gestational age (SGA), low birth weight (LBW), macrosomia, and birth defects. We assessed the outcomes among the fresh embryo transfer (ET), frozen embryo transfer (FET), and spontaneous conception (SC) groups. Potential risk factors were further analyzed in the ART population. ResultsFET was associated with higher risks for PIH (SC: AOR, 1.97(1.51–2.57); fresh ET: AOR, 1.68(1.03–2.72)), PE (SC: 2.28(1.86–2.80); fresh ET: AOR, 1.61(1.11–2.33)), PAS (SC: AOR, 3.89(3.39–4.46); fresh ET: AOR, 2.23(1.70–2.92)), PPH (SC: AOR, 3.46(2.76–4.34)); fresh ET: 2.09(1.39–3.14)), and macrosomia (SC: 1.53(1.25–1.86); fresh ET: AOR, 2.87(1.89–4.35). Fresh ET was associated with higher risks for PA (SC: AOR, 2.19(1.51–3.18); FET: AOR, 0.39(0.17–0.90)), SGA (SC: AOR, 1.56(1.06–2.31), FET: AOR, 0.42(0.19–0.91)), and LBW (SC: AOR, 2.24(1.82–2.77), FET: AOR, 0.63 (0.44–0.89)), and fresh ET is an independent risk factor for PA and SGA. Furthermore, the risk of GDM was associated with the biological characteristic of low-fertility patients. ConclusionsEmbryo status (fresh or frozen) is a key factor affecting the maternal and neonatal outcomes in ART treatments, while biological characteristics of infertile patients also play a certain role.

Maternal and Neonatal Predictors of Asphyxia: A Case-Control Study at Salatiga Regional General Hospital

Neonatal asphyxia remains a significant contributor to neonatal mortality and morbidity globally. Identifying maternal and neonatal predictors of asphyxia is crucial for developing targeted interventions to improve neonatal outcomes. This study aimed to investigate the association between various maternal and neonatal factors and the occurrence of asphyxia in newborns at Salatiga Regional General Hospital. A case-control study was conducted at Salatiga Regional General Hospital from January 1st to December 31st, 2023. Cases were newborns diagnosed with asphyxia based on an Apgar score ≤ 6 at 5 minutes. Controls were newborns without asphyxia. Data on maternal factors (premature rupture of membranes, mode of delivery, maternal age, parity, and gravidity) and neonatal factors (birth weight and gestational age) were collected from medical records. Bivariate and multivariate analyses were performed to assess the associations between these factors and asphyxia. The study included 234 newborns (117 cases and 117 controls). Bivariate analysis revealed significant associations between asphyxia and premature rupture of membranes (p = 0.027), mode of delivery (p = 0.000), birth weight (p = 0.000), and gestational age (p = 0.000). Multivariate logistic regression analysis identified the mode of delivery (OR = 83.468, 95% CI: 18.624-374.079) and birth weight (OR = 69.576, 95% CI: 8.781-551.277) as independent predictors of asphyxia. Cesarean section and low birth weight are significant predictors of neonatal asphyxia. These findings highlight the importance of careful consideration of delivery mode and close monitoring of newborns with low birth weight to prevent and manage asphyxia effectively.

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case-Control Study.

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

Main factors of infant mortality in different regions of the Republic of Tajikistan

Purpose of the study. Identification of the main medical factors leading to the death of newborns.Material and method of research. To determine the structure of child mortality in the Republic of Tajikistan for 2017-2021 and 9 months of 2022 for selected cities and regions (the cities of Kulyab, Bokhtar, Penjikent, Istaravshan, Khujand, Kanibadam, Isfara, Vahdat)., Tursunzade and the districts of Bobojon Gafurov, Rudaki, Rasht, Fayzabad and Sh. Shahin) data on infant mortality were collected and entered into special questionnaires.To determine the structure of newborn mortality in the Republic of Tajikistan in 2017-2021 and the 9-month period of 2022 from selected cities and districts (the cities of Kulob, Bokhtar, Penjikent, Istaravshan, Khujand, Kanibadam, Isfara, Vahdat, Tursunzade and the districts of Bobojon Gafurov, Rudaki, Rasht, Faizabad and Sh. Shahin) data on newborn mortality were collected and entered into specially designed questionnaires. The study and evaluation used statistical, analytical and social criteria.Research results. Preliminary results of the analysis show that in most cases (61.5%) newborns died in the early neonatal period, a third of their losses in the early neonatal period most often died in the first 6 days after birth. The age of mothers of deceased newborns is mainly from 20 to 29 years (62.2%). This situation is almost the same in all regions of the republic.Conclusion. The analyzes indicate that mothers of deceased newborns had a low health index. During pregnancy, 47.2% of mothers experienced symptoms such as (preeclampsia, poliomyelitis, dehydration, eclampsia and preeclampsia, nephropathy, etc.). There are also discharges during labor such as preterm labor, meconium contamination of water, and cesarean section birth.

Association between subchorionic hematoma in the first trimester and outcomes of singleton pregnancies achieved through assisted reproductive technology: a systematic review and meta-analysis.

To evaluate the association between first trimester (≤ 12 weeks gestation) subchorionic hemorrhage (SCH), and maternal and neonatal outcomes in women who conceived with the help of assisted reproductive technique (ART). PubMed, Embase, Web of Science, and Scopus databases were searched for observational studies that specifically focused on women who achieved pregnancy via ART and investigated the relationship between early pregnancy (within 12 weeks of gestation) SCH and maternal and neonatal outcomes. Only studies with singleton pregnancies and reporting data on the comparator group (women without SCH) were included. Primary outcomes of interest included incidences of early (within 20 weeks of gestation) pregnancy loss, preterm delivery, caesarean section, and live birth rates. Pooled effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI). Nine studies were included. All studies had a cohort design. In all studies, the primary assisted reproduction technique used was in-vitro fertilization (IVF). Compared to pregnancies without SCH, women with diagnosed early pregnancy SCH have a similar risk of preterm birth (< 37 weeks) (OR 1.01, 95% CI 0.83, 1.22), low birth weight (< 2500 g) (OR 1.01, 95% CI 0.59, 1.73) and fetal growth restriction (OR 1.57, 95% CI 0.62, 4.02). The gestational age (in weeks) (weighted mean difference (WMD) - 0.06, 95% CI - 0.18, 0.06) and the birth weight (in grams) (WMD - 16.5, 95% CI - 62.9, 29.8) were also similar in the two groups. The odds of early pregnancy loss (OR 1.39, 95% CI 0.97, 2.01), live birth (OR 0.77, 95% CI 0.55, 1.08) and caesarean delivery (OR 0.97, 95% CI 0.81, 1.16) were statistically similar in both groups. The risk of maternal adverse outcomes such as gestational diabetes (OR 0.98, 95% CI 0.74, 1.29), hypertensive disorder (OR 0.95, 95% CI 0.63, 1.43), premature rupture of membranes (PROM) (OR 1.36, 95% CI 0.90, 2.05) and placental abruption (OR 2.44, 95% CI 0.57, 10.5) was also similar in both the groups. There was no evidence of publication bias. The findings suggest that SCH may not significantly increase the risk of adverse maternal and perinatal outcomes in pregnancies conceived through ART, particularly IVF. PROSPERO registration number CRD42024533996.

Study on the Association between Cesarean Section Birth and Asthma Risk in the Pediatric Population of the Health Area of Palencia between 1993 and 2020.

Both asthma prevalence and the percentage of cesarean sections have increased in parallel in recent years. Research studies suggest an increased risk of developing atopic diseases and asthma after cesarean section birth compared to vaginal delivery. The main objective of this study is to analyze the risk of asthma admission after cesarean section birth compared to vaginal delivery in the pediatric population. Retrospective observational analytical case-control study from 1993 to 2020. The cases include all admitted patients to our health area hospital, for patients aged 7 to 16 diagnosed with asthma. For each case, a control without a diagnosis of asthma is selected with the same age, and that has also caused an episode of admission. A total of 290 admission episodes with a diagnosis of asthma were obtained, caused by 155 patients. Out of these, 145 cases with documented delivery types were selected. For cases, 155 controls were selected. The historical proportion of cesarean sections in the asthmatic group is 18.6%, compared to 14.2% in the non-asthmatic group. There is a statistically non-significant difference of 4.4% more cesarean sections in the asthmatic group compared to the control group. We have not demonstrated a statistically significant association between being born by cesarean section and an increased risk of asthma admission. Based on this finding, we cannot conclude that there is an association between being born by cesarean section and a higher risk of suffering from asthma, unlike what has been postulated in other research studies.

Delayed colonization of Bifidobacterium spp. and low prevalence of B. infantis among infants of Asian ancestry born in Singapore: insights from the GUSTO cohort study.

The loss of ancestral microbes, or the "disappearing microbiota hypothesis" has been proposed to play a critical role in the rise of inflammatory and immune diseases in developed nations. The effect of this loss is most consequential during early-life, as initial colonizers of the newborn gut contribute significantly to the development of the immune system. In this longitudinal study (day 3, week 3, and month 3 post-birth) of infants of Asian ancestry born in Singapore, we studied how generational immigration status and common perinatal factors affect bifidobacteria and Bifidobacterium longum subsp. infantis (B. infantis) colonization. Cohort registry identifier: NCT01174875. Our findings show that first-generation migratory status, perinatal antibiotics usage, and cesarean section birth, significantly influenced the abundance and acquisition of bifidobacteria in the infant gut. Most importantly, 95.6% of the infants surveyed in this study had undetectable B. infantis, an early and beneficial colonizer of infant gut due to its ability to metabolize the wide variety of human milk oligosaccharides present in breastmilk and its ability to shape the development of a healthy immune system. A comparative analysis of B. infantis in 12 countries by their GDP per capita showed a remarkably low prevalence of this microbe in advanced economies, especially Singapore. This study provides new insights into infant gut microbiota colonization, showing the impact of generational immigration on early-life gut microbiota acquisition. It also warrants the need to closely monitor the declining prevalence of beneficial microbes such as B. infantis in developed nations and its potential link to increasing autoimmune and allergic diseases.