Cesarean Section In Pregnant Women Research Articles

High-flow nasal oxygen versus conventional oxygen therapy during cesarean section under neuraxial anesthesia in pregnant women with heart disease: a randomized controlled trial

To evaluate the beneficial effects of high-flow nasal cannula (HFNC) oxygen therapy during cesarean section in pregnant women with heart disease. We conducted a single-center, single-blinded randomized trial of HFNC oxygen therapy in pregnant women with heart disease undergoing cesarean section under neuraxial anesthesia.The participants were randomly assigned to receive either HFNC oxygen therapy with inspiratory flow of 30 L/min with 40% FIO2(n=27) or conventional oxygen therapy (COT) with oxygen flow rate of 5 L/min via a nasal cannula (n=31).The primary outcome was maternal desaturation (SpO2 < 94% lasting more than 3 min or PaO2/FIO2≤300 mmHg). Maternal desaturation was observed in 7.4%(2/27) of the women in HFNC group and in 32.3%(10/31) in the COT group.None of the cases required tracheal intubation during the perioperative period.The HFNC group had a significantly higher incidence of postoperative leukocytosis (P < 0.05) but without pyrexia or other inflammation-related symptoms.There were no significant differences between the two groups in the secondary maternal outcomes (need for respiratory support, maternal ICU admission, postoperative respiratory complications, and cardiovascular complications) or neonatal outcomes (P>0.05). In pregnant women with heart disease, HFNC therapy can significantly reduce the rate of maternal desaturation during the perioperative period of cesarean section without adverse effects on short-term maternal or fetal outcomes.

IMPROVING THE DIAGNOSTICS OF UTERUS SCAR AFTER CESAREAN SECTION

Around the world, the number of caesarean sections is increasing every year. The purpose of the study was tostudy the consistency of the uterine scar after cesarean section in pregnant women of reproductive age; 103 pregnant women and the outcomes of their births were studied. Research and scientific work were carried out for 2020-2022. on the basis of the obstetric department of the multidisciplinary clinic of SamSMU. Based on clinical data, objective examination, ultrasound and Doppler measurements, as well as the amount of collagen type XXVI, in 66 pregnant women the condition of the postoperative scar was assessed as satisfactory and in 37 as insolvent

Is There a Relationship Between TP-e/QT Ratio and Spinal Anesthesia-Related Cardiovascular Events in Pregnant Women?

Introduction and Objective: Prolonged TPe interval has been reported to reflect the abnormal distribution of ventricular repolarization which can be used as a marker of ventricular arrhythmias. Since prolonged TPe/QT ratio is associated with cardiac pathologies, it is thought that it may also be associated with cardiovascular adverse events that occur during and after spinal anesthesia. The aim of this study is to investigate whether there is a relationship between prolonged TPe/QT ratio, which is routine preoperative non-invasive patient data that can be evaluated easily, and perioperative adverse cardiovascular events during cesarean section in pregnant women undergoing spinal anesthesia.&#x0D; Materials and Methods: Voluntary consent was obtained for our study in which 144 pregnant women who were planned for elective cesarean section were included. QT interval was measured based on the initial point where the Q wave or the R wave in the absence of the Q wave started to the last point where the T wave ended. TPe interval measurement was based on the peak point of the T wave and the end point of the T wave convexity. Lead V5 was primarily used for TPe measurement. TPe/QT ratios were calculated in Microsoft office excel program. Patients' demographic characteristics, heart rate, systolic, diastolic and mean arterial pressures were recorded every five minutes intraoperatively.&#x0D; Results: A weak positive correlation was found between the height variable and the Tpe/QT ratio (p=0.022, r=0.191). As the height increased, the TPe/QT ratio increased. Although it did not reach the level of statistical significance, we found that the TPe/QT ratio was longerin cases with intraoperative bradycardia and hypotension than in cases without complications. The TPe/QT ratio was above 0.21 in patients who developed bradycardia and hypotension. Examination of the correlation between the amount of ephedrine use and TPe/QT ratio revealed a weak positive correlation (p=0.012, r=0.208).&#x0D; Conclusion: TPe/QT ratio is a novel cardiac marker with high predictive power, is non-invasive, quite inexpensive, and very practical to measure in the early detection of cardiac events, especially arrhythmia. This novel predictive marker can be used in anesthesia practice, preoperative examination and patient follow-up in the intraoperative operating room to predict fatal cardiac arrhythmias or intraoperative hypo/hypertension. &#x0D; Keywords: Spinal anesthesia, pregnancy, TPe/QT ratio, cardiovascular event

Neuraxial Anesthesia for Cesarean Section in Pregnant Women with Ruptured Arteriovenous Malformation

Background: Maternal stroke as a result of ruptured arteriovenous malformation (AVM) in pregnancy is rare. However, AVM rupture can result in high morbidity during pregnancy and the puerperium. In its management, several special considerations are needed to ensure the welfare of the mother and fetus. This article will discuss anesthesia in pregnant patients after hemorrhagic stroke due to AVM rupture under neuraxial anesthesia.&#x0D; Case presentation: A 25-year-old patient with a second pregnancy with twins at 33 weeks came with complaints of water coming out of the birth canal 1.5 hours before admission to the hospital. The patient was diagnosed with G2P0010 33 Weeks 3 days Gemelli H/H head presentation, buttocks presentation, intracerebral hemorrhage (ICH) et cause suspected AVM rupture, premature rupture of membranes, and first-day febrile observation and planned to undergo cito cesarean section.&#x0D; Conclusion: Neuraxial anesthesia is one of the safe options for pregnant patients after a hemorrhagic stroke with controlled intracranial pressure.

Risk factors of emergency cesarean section in pregnant women with severe placenta accreta spectrum: a retrospective cohort study.

Placenta accreta spectrum (PAS) may cause enormous and potentially life-threatening hemorrhage in the intrapartum and postpartum periods in emergency cesarean section. How to reduce the occurrence of emergency cesarean section in patients with severe PAS is the key to reducing the adverse outcomes of them. This study aimed to investigate the impact of emergency cesarean section on the perioperative outcomes of pregnant women with PAS and neonates, and also aimed to explore the risk factors of emergency cesarean section in pregnant women with PAS. A retrospective investigation was conducted among 163 pregnant women with severe PAS. Of these, 72 were subjected to emergency cesarean sections. Data on the perioperative characteristics of the mothers and neonates were collected. Multivariable linear regression analysis was used to detect associations between maternal and perioperative characteristics and volume of intraoperative bleeding. Binary logical regression was used to analyze the association between maternal preoperative characteristics and emergency cesarean section. Linear regression analysis is used to analyze the relationship between gestational age and emergency cesarean section. The risks of emergency cesarean section increase 98, 112, 124, and 62% when the pregnant women with PAS accompanied by GHD, ICP, more prior cesarean deliveries and more severe PAS type, respectively. Noteworthy, the risk of emergency cesarean section decreases 5% when pre-pregnancy BMI increases 1 kg/m2 (OR: 0.95; CI: 0.82, 0.98; p = 0.038). Moreover, there is no significant linear correlation between emergency cesarean section and gestational age. GHD, ICP, multiple prior cesarean deliveries and severe PAS type may all increase the risk of emergency cesarean section for pregnant women with PAS, while high pre-pregnancy BMI may be a protective factor due to less activity level. For pregnant women with severe PAS accompanied by these high risk factors, more adequate maternal and fetal monitoring should be carried out in the third trimester to reduce the risk of emergency cesarean section.

Pregnancy outcomes of COVID-19 infection in Iraqi women presented to primary health care center

Background: COVID-19 pandemic disease had great impact on health status in Iraq. The pregnant women and their infants might be at higher risk after infection by COVID-19 disease. Aim of study: To evaluate the maternal and neonatal characteristics of pregnant women infected by COVID-19 disease and assessing the maternal and neonatal outcomes in Iraqi from a sample of pregnant women. Patients &amp; Methods: A clinical prospective follow up study carried out in Obstetrics care unit of Al-Jamiaa health care center of Al-Adil Health sector of Al-Karkh Health Directorate in Baghdad city-Iraq. The duration of the study was six months through the period from 1st of July to end of December, 2020. A convenient sample of 132 pregnant women at labour was selected after eligibility to inclusion and exclusion criteria. The pregnant women enrolled in the study were tested by COVID-19-Reverse transcription polymerase chain reaction test at their admission to hospital. The diagnosis was done by clinical and laboratory investigations including neutophilia and lymphopenia, very high CRP, elevated D-dimer and sometimes on extent of lung involvement by x-ray. Results: The present study showed that 63.6% of pregnant women at labour room had positive COVID-19 infection, while only 6 (4.5%) fetuses had positive COVID-19 infection after delivery. There was a highly significant association between first cesarean section of pregnant women and positive COVID-19 infection (p&lt;0.001). A significant association was observed between preterm labour of fetuses and positive maternal COVID-19 infection (p=0.01). There was a significant association between meconium aspiration of fetuses and positive maternal COVID-19 infection (p=0.001).Conclusions: The incidence of maternal and fetal COVID-19 infection among sample of Iraqi pregnant women presented to primary health care center for antenatal care is high

Эффективность применения терлипрессина (Реместипа) при выполнении миомэктомии во время кесарева сечения

A study was conducted on the effectiveness of terlipressin during myomectomy during cesarean section in pregnant women with uterine fibroids. The drug has demonstrated high efficacy, significantly reducing the level of intraoperative blood loss and shortening the duration of surgery.

Early versus delayed umbilical cord clamping during cesarean section of pregnant women with preeclampsia: Maternal and neonatal outcome

Early versus delayed umbilical cord clamping during cesarean section of pregnant women with preeclampsia: Maternal and neonatal outcome

Outcome of Vaginal Birth After Cesarean Section (VBAC)

Background: Generally, it is agreed that all women who previously had a cesarean section should be attempted for normal vaginal delivery. Of course, post-cesarean normal vaginal delivery is associated with potential risks and is sometimes clinically indicative of recurrent cesarean section. Objectives: This study aimed to evaluate the success and complications of vaginal birth after a cesarean section in pregnant women referred to Ali Ibn Abi Talib Hospital in Zahedan in 2016 - 17. Methods: The present descriptive-analytical study was carried out after the approval of the Student Ethics Committee by visiting the archive of Ali Ibn Abi Talib Hospital in Zahedan to review the hospital records of women admitted to the gynecological ward for vaginal birth after a cesarean section. The researcher abstracted data into predetermined checklists. Finally, SPSS software was used for data analysis. Results: In this study, 176 patients were evaluated. The mean gestational age was 37.64 ± 3.13 weeks. The success rate of vaginal birth after one cesarean section was 92% (162 patients), and the failure rate was 8% (14 patients). Also, the complications of vaginal birth after cesarean section were transfusion (n = 4, 2.3%), cervical rupture (n = 3, 1.7%), neonatal death (n = 4, 1.7%), and uterine rupture (n = 1, 6%) (P = 0.0). Conclusions: In the present study, the success rate of vaginal birth after one cesarean section was 92% (162 patients), and the failure rate was 8% (14 patients). Complications included blood transfusion with 2.3%, cervical rupture with 1.7%, infant mortality with 1.7%, and uterine rupture with 0.6%.

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

BackgroundTo evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM.MethodsA retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups.ResultsWomen who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07–1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45–4.15) were significant independent predictors of adverse outcomes after CM.ConclusionsCM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.

Determinants of Premature Rupture of Membrane (PROM) Among Pregnant Women in Southern Ethiopia: A Case-Control Study.

BackgroundPremature rupture of membrane (PROM) varies from country to country and complicates 4 to 10% of pregnancies worldwide it has an overwhelming effect on maternal and newborn health. Even though many interventions implemented to tackle it, the problem is persisted.ObjectiveTo identify determinants of premature rupture of membrane among pregnant women who have visited labor wards in four hospitals found in Gedeo zone, Southern Ethiopia.MethodsHospital-based unmatched case-control study was conducted from February to May 2020. Data were collected among 75 cases and 223 controls using face-to-face interviews. Cases and controls were recruited consecutively from pregnant women who have visited the labor ward. Data were entered into Epi-data version 3.1 and analyzed by using SPSS version 20. Bivariable and Multivariable logistic regression was used to check the association between dependent and independent variables, statistically significant association was declared at p-value < 0.05.ResultsA total of 75 cases and 233 controls were enrolled in the study. Hypertension during index pregnancy [AOR = 2.81 (95% CI: 1.09 −7.23)], history of abortion [AOR = 3.7 (95% CI: 1.41–9.73)], history of caesarean section [AOR = 3.46 (95% CI: 1.34–8.9)] and history of PROM [AOR = 4.77 (95% CI: 2.31–9.89)] were associated with premature rupture of membranes.ConclusionHypertension during the index pregnancy, history of abortion, history of PROM, and history of cesarean section has an association with premature rupture of membrane. The result of the study suggests early identification and treatment of abortion, hypertension, and cesarean section in pregnant women mitigates the risk of premature rupture of membrane.

The effect of the two-child policy on cesarean section in China: Identification using difference-in-differences techniques

BackgroundChina has one of the highest rates of cesarean section in the world. One of the possible reasons for such high rates was China's one-child policy. Relaxation of the one-child policy might be associated with a reduction in the rate of cesarean section. ObjectivesTo assess the effect of China's universal two-child policy on cesarean section rates using patient-level data from one large municipal-level obstetrics and gynecology hospital in Shanghai, East China. Data sourcesThe study used inpatient hospital records data on all infants delivered between January 1, 2013 and May 31, 2018 at the Shanghai First Maternity and Infant Hospital, which is one of the largest obstetrical hospitals in China. Study designA quantitative study design with difference-in-differences (DID) estimation techniques were used to control for socio-economic and health-related factors in order to identify the impact of the universal two-child policy on cesarean section rates in China. Moreover, DID analysis stratified by maternal migrant status and age were conducted. ResultsAnalysis of 133,358 deliveries suggests that China's universal two-child policy resulted in a statistically significant reduction in cesarean section rates from 49.5 to 43.3 per 100 deliveries over the study period. ConclusionOur findings suggest that the significant reduction in cesarean section rates may be due to a shift in health risk perceptions resulting from the relaxation of the one-child policy when mothers consider the possibility of having a second child. Health education on the risk of repeat cesarean section in pregnant women should be enhanced.

Comparative study of oxytocin versus tranexamic acid and ethamsylate in preventing primary postpartum hemorrhage in women undergoing lower-segment cesarean section

Background: Worldwide, 21% of deliveries are by elective cesarean sections (C/S) as a procedure to reduce maternal and neonatal mortality and morbidity. Blood loss during C/Ss is more than vaginal delivery. Therefore, reducing blood loss during the C/Ss is essential and challenging for anesthesiologists and obstetricians. This study aimed to assess the efficacy of intravenous oxytocin versus tranexamic acid + ethamsylate (TXA + Eth) in reducing blood loss in pregnant women at high risk of primary PPH undergoing elective lower-segment cesarean section. Materials and Methods: A single-center, prospective, randomized, and double-blind study was started after obtaining institutional ethical approval. The study involved women undergoing elective C/Ss at full-term pregnancy at high risk for primary postpartum hemorrhage (PPH) at the SAMSRI between September 2021 and March 2022. The study participants received an infusion of either oxytocin 10 International Unit or TXA 1 g + Eth 250 mg before the skin incision. The primary outcome was the blood loss calculation, alongside hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into primary PPH and required blood transfusion. Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly reduced bleeding during and after cesarean section in pregnant women at high risk for PPH. In oxytocin and TXA + Eth groups, postoperative blood loss was (613.7 ± 123.7 and 406.2 ± 116.5) ml, respectively, P < 0.001. The duration of surgery in oxytocin and TXA + Eth groups were (48.5 ± 9.3) and (44.3 ± 9.8) minutes, respectively (P = 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups were 10.69% and 0.75%, respectively (P = 0.023). The PPH in the oxytocin and TXA + Eth groups were 2.30% and 0%, respectively (p < 0.017). Pre- and postoperative hemoglobin and hematocrit values at 24 h after cesarean section in the oxytocin (10.78 and 8.29) and (32.23 + 25.10) and TXA + Eth groups were (11.07 and 10.02) and (33.20 and 30.73), respectively (P < 0.001). Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss, and the demand for blood transfusion after cesarean section.

Anesthetic management of obese and morbidly obese parturients.

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

Maternal and neonatal outcomes in prolonged second stage deliveries in nulliparous

Introduction: The prolongation of the second stage of labor in pregnant women, in order to reduce the rate of cesarean sections, constitutes a scientific and clinical dilemma. This controversy is generated because the increase in the prolonged second stage time can increase the maternal and neonatal risks. Objective: To analyze differences in maternal and neonatal outcomes between pregnant women who have a prolonged vs non-prolonged delivery. To study those pregnant women who have prolonged second stage (&gt;180 minutes) and identify differences between them according to mode of delivery (non-operative, operative or cesarean delivery). Material and methods: Prospective cohort study of all nulliparous pregnant women treated at the Hospital Universitario de Fuenlabrada between January 1, 2018 and December 31, 2019. Differences in pregnant women with prolonged versus non-prolonged delivery are analyzed. Those cases in which the prolonged second stage period was equal to or greater than 180 minutes were selected and differences according to the mode of delivery were studied. During the study period, 944 women met the inclusion criteria, of which 445 (47.1%) had prolonged second stage periods equal to or greater than 180 minutes. Results: Prolonged second stage is associated with a higher rate of operative delivery 44.5% vs. 28.1% and a higher rate of cesarean section 6.7% vs. 2% (p: 0.000), a higher rate of shoulder dystocia 3.8% vs. 1.6%, greater weight at birth of the newborn 3279 g vs 3119 g and greater perinatal trauma 13.3 vs 6.6% compared with non-prolonged second stage delivery. By selecting only pregnant women with prolonged delivery, we observed a higher rate of complications of surgical wound in caesarean sections 13.3%, vs 1.5% in operative delivery and 0% in spontaneous vaginal delivery and a higher rate of grade III-IV degree perineal lacerations in deliveries eutocic and instrumental. With respect to the neonate, a greater weight of the newborn is observed in caesarean sections 3445 grams compared to eutocic deliveries 3230 grams and operative delivery 3275 grams (p: 0.001), a higher rate of type III resuscitation in those neonates born by caesarean section 26, 7% vs 4.2% in spontaneous vaginal delivery and 5.6% in operative delivery and a higher rate of admission to the neonatal ICU in caesarean sections 26.7% vs 6.9% spontaneous vaginal delivery and 9.1% operative delivery (p: 0.002) . Conclusion: A higher rate of operative delivery and cesarean sections has been observed in pregnant women with prolonged second stage, as well as a higher rate of shoulder dystocia, newborn weight, and perinatal trauma compared with non-prolonged delivery. When studying the cohort of pregnant women with prolonged second stage, there is a higher rate of cesarean section in pregnant women with a previous suspicion of fetal macrosomia, a higher weight of the newborn at birth, a higher rate of type III neonatal resuscitation and admission of the newborn to the neonatal ICU in pregnant women. that end in caesarean section with respect to spontaneous vaginal delivery or operative delivery.

Increasing the effciency of spinal anesthesia in a cesarean section in pregnant women with diabetes mellitus

Objective. To increase the effciency of spinal anesthesia (SA) in operative delivery of pregnant women with type 1 diabetes mellitus (DM).Materials and methods. A dynamic assessment of the clinical effciency of spinal anesthesia in cesarean sections was performed in 123 pregnant women with DM. The level of the sensor and motor block was determined depending on the dose of a 0.5% hyperbaric solution of bupivacaine calculated according to the original method.Results. The SA method in cesarean sections in pregnant women with diabetes mellitus has been proposed taking into account the dosage of a hyperbaric solution of bupivacaine depending on the patient`s height and gestational age. The application of this method provided the development of the necessary degree of the sensory and motor block by the eight minute and created the requisite conditions for a cesarean section.Conclusion. The proposed method of the calculation of the hyperbaric solution dosage for subarachnoid anesthesia taking into account the patients` height and gestational age makes it possible to ensure the necessary degree of the sensor block at the level of 4-5 thoracic segments and suffcient relaxation in the surgical area during a cesarean section.

Differentiated Approach to the Choice of Anesthesia Method for Cesarean Section in Pregnant Women with Myasthenia Gravis

Differentiated Approach to the Choice of Anesthesia Method for Cesarean Section in Pregnant Women with Myasthenia Gravis

Comparison of perinatal outcomes between controlled-release dinoprostone vaginal delivery system (PROPESS) and metreurynter for cervical ripening in labor induction: A retrospective single-center study in Japan.

This study aimed to compare the efficacy and safety of a controlled-release dinoprostone vaginal delivery system (PROPESS) and a metreurynter for labor induction. This retrospective case-controlled study included 117 pregnant women (51 and 66 in the PROPESS and metreurynter groups, respectively) who required labor induction after >37 weeks' gestation at Mie University Hospital between January 2018 and September 2020. The primary outcome was the success rate of vaginal delivery. The secondary outcomes were changes in the Bishop score from the first insertion of PROPESS or the metreurynter to removal, uterine hyperstimulation and non-reassuring fetal status during the first insertion, proportion of pregnant women who needed pre-delivery oxytocin after removal, time to vaginal delivery after the first insertion, proportion of pregnant women who delivered vaginally within 12 or 24 h after the first insertion, and neonatal outcomes. The proportion of pregnant women, especially primiparas, who delivered vaginally was significantly higher in the PROPESS group (26/34 [76.5%]) than in the metreurynter group (25/52 [48.1%]; p=0.01). Moreover, among multiparas in the PROPESS group who delivered vaginally, nine (56.3%) out of 16 women delivered vaginally within 3h of labor onset. PROPESS for cervical ripening may reduce the risk of undergoing cesarean section in pregnant women requiring labor induction, especially primiparas. It is important to consider the possibility of precipitate labor when using the PROPESS in multiparas.

Effect of Face-to-Face and Group Health Counseling on Attitude and Practice of Birth Method Selection in Primiparous Pregnant Women Referring to Health Centers in Dezful City, Khuzestan Province, Iran: A Comparative, Randomized Controlled Trial

Background: Although childbirth is a natural process, the choice of birth method is one of the concerns of pregnant women. Proper counseling for pregnant women can ensure a safe and healthy delivery. Objective: This study We aimed to compare the effects of group and face-to-face health counseling on the attitude of mode of delivery and reduction of Cesarean section in pregnant women. Methods: This study was a comparative randomized controlled trial that was conducted in health centers of Dezful city, in the south west of Iran from April to October 2016. Participants in the study included 150 pregnant women who had no contraindications for normal vaginal delivery, but opted for a cesarean delivery. Initially, multi-stage sampling method was used based on the study objectives, and then the participants were randomly assigned into three groups: group counseling, face-to-face, and control. Demographic characteristics and attitude questionnaires were used for data collection. Data were analyzed through SPSS 22 using One-Sample Kolmogorov-Smirnov test, and Chi-square, ANOVA, McNemar, and t- tests. The P&lt; value less than 0.05 was considered significant. Results: All the participants (100%) in the face-to-face counseling group, 92% in the group counseling, and 12% in the control group changed their selected birth method to vaginal delivery after the consultation. In terms of attitude level, there was a significant difference in all three study groups before and after the intervention (P&lt;0.001). Conclusion: The face-to-face as well as the group health counseling sessions promoted the attitude of pregnant women to the normal vaginal delivery. Individual counseling for people who cannot coordinate with the group is better than group counseling. This way more pregnant women can be consulted.

Perioperative factors affecting the length of hospital stay after cesarean section of pregnant women with heart disease

Objective: To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section. Methods: A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models. Results: (1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS (P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), β=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), β=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), β=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), β=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), β=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade (β=0.198, P=0.028) and intraoperative blood loss (β=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion: Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.