Cesarean Section Rate Research Articles

Placental Pathologic Features and Perinatal Outcomes in Pregnant Woman With Autoimmune Connective Tissue Disease.

We aimed to investigate the association between perinatal outcomes and placental pathological features in pregnant women with ACTD, including systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APS), and undifferentiated connective tissue disease (UCTD). Placental tissue from SLE (n=44), APS (n=45), and UCTD (n=45) were included, and contemporaneous deliveries of placenta were served as a control group (n=46) between September 2015 and March 2021. The placental histopathology was evaluated using the Manual of Human Placental Pathology and classified according to the Amsterdam consensus framework. SLE pregnant women have a higher rate of cesarean section (61.40%), premature birth (24.56%), and SGA (26.32%) when compared to control group (p=0.008, p=0.005, and p=0.000, respectively). The rate of vascular malperfusion, inflammatory-immune lesions, and other placental lesions in the SLE group was 47.73%, 56.82%, and 63.64%, which were higher than the control group (p=0.000, p=0.000, and p=0.006, respectively). In the meantime, the incidence of inflammatory-immune lesions in the APS group (42.22%, p=0.004) and vascular malperfusion in the UCTD group (37.78%, p=0.007) were increased when compared to the control group. SLE appeared to confer increased risk for a wide range of adverse perinatal outcomes. We determined elevated placental histopathology risk for most women with ACTD, including vascular maldevelopment, vascular malperfusion, and inflammatory-immune lesions.

Effectivity of Walking Epidural Analgesia in Normal Labor to Reduce Labor Pain and Improve Neonatal Outcome

Background: In Indonesia itself, only 15% of 2,700 labor women felt the pain was tolerable, meanwhile 85% said the pain was moderate until unbearable. Usage of epidural anaesthesia for pain relief in labor is common but controversies still persist about its effect and side effect on labor process. Neuraxial block especially epidural also not yet well known in Indonesia.Objective: This research aims to study maternal visual analogue scale (VAS) score changes before and after walking epidural anesthesia (WELA) and fetal outcome after birth. Methods: This research is an experimental design with one pre-test and post-test group. Data was taken from Unggul Karsa Medika Hospital and Permata Hati Clinic medical records from 2017 until 2022. Ethical approval was approved by Unggul Karsa Medika Hospital Ethical Committee (003/KEP-LIT/III/2023). After that all of 450 patients’ data was then analyzed by Wilcoxon with IBM® SPSS Statistic 26th with α=0.05.Result: Statistical analysis shows there was significant decrease of pain severity with initial VAS 7.58 to 3.37 after WELA procedure (p 0.0001). APGAR scores of all the foetus were normal with no asphyxia present.Conclusion: Our findings demonstrate the benefit of WELA for both of mother and fetus. was significantly decrease in VAS score during labor. Fetal outcome was also notably great after labour process and usage of epidural could decrease the risk of fetal acidemia and distress which reduce caesarean section rate. Usage of WELA in Indonesia could be encourage and recommended as an alternative to elective caesarean section.

The implementation of online and offline hybrid weight management approach for pregnant women based on the Fogg behavior model in Hainan, China: a pilot randomized controlled trial

ObjectiveThis study aimed at evaluating the effects of online and offline hybrid weight management approach based on the Fogg behavior model on total gestational weight gain and perinatal outcomes.MethodsPregnant women in Hainan, the southernmost province of China, were recruited into a randomized controlled trial, which was designed to develop a WeChat platform for pregnancy weight management, and implement individualized and continuous pregnancy weight management services for pregnant women under the guidance of the Fogg behavior model. All pregnant women participating in the study were included in the full analysis set (FAS) for analysis. The pregnant women who completed the intervention and provided all outcome indicators were included in the per protocol set (PPS) for outcome evaluation.ResultsFifty-eight pregnant women were included in FAS analysis, and 52 pregnant women were finally included in PPS analysis. There was no statistically significant difference (P > 0.05) between the two groups at baseline. The gestational weight gain of the intervention group was significantly lower than that of the control group (P < 0.05). In the control group, the rate of appropriate weight gain during pregnancy was 48.26%, the rate of appropriate weight gain during pregnancy was 93.30% in the intervention group, with a statistically significant difference (P < 0.05). In the delivery outcomes, the cesarean section rate in the intervention group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The incidence of gestational diabetes mellitus and gestational hypertension in the intervention group was lower than those in the control group, and the differences were statistically significant (P < 0.05). The neonatal weight and incidence of macrosomia of the intervention group were lower than that of the control group, and the difference was statistically significant (P < 0.05).ConclusionsThis study combined the individualized and continuous pregnancy weight management of the online WeChat platform and offline consultation based on the Fogg behavior model, showing great potential in improving maternal and infant outcomes.Trial registrationThe study was registered with www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry (ChiCTR2200066707, 2022–12-14, retrospectively registered).

How the Mode of Delivery Is Influenced by Patient's Opinions and Risk-Informed Consent in Women with a History of Caesarean Section? Is Vaginal Delivery a Real Option after Caesarean Section?

Background/Objectives: In recent years, there has been a noticeable increase in the rates of caesarean section (CS), being one of the most commonly performed surgical procedures. For the following pregnancy, the previous CS represents the backbone of the risks and complications, such as uterine scar formation, uterine rupture, massive bleeding, and serious negative outcomes for both the mother and child. Our study followed patients with a history of CS from the birth planning prenatal check-up to delivery. Methods: We reviewed the records of 125 pregnant women with previous CS who presented in the third trimester for a prenatal check-up and completed our questionnaire from March 2021 to April 2022 in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. Results: Before the prenatal check-up, 74 patients (59.2%) preferred vaginal delivery (VD), while 51 (40.8%) preferred CS. After discussing birth planning with the obstetrician, 72 women (57.6%) decided upon VD, while 53 (42.4%) preferred CS. Ultimately, 78 (62.4%) of women gave birth through CS (either planned or by medical necessity) and 47 (37.6%) gave birth vaginally (either natural or per vacuum extraction). Conclusions: VD for patients with CS in their medical history is a real option. The patient must be well informed about the risks and benefits of the medical situation and should be empowered and supported on their chosen mode of delivery, which should be respected.

Prevalence of delivery mode in an Italian nationwide cohort with celiac disease: a SIGENP multicenter retrospective study (the CD-deliver-IT)

BackgroundStudies have indicated an association between cesarean section (CS), especially elective CS, and an increased risk of celiac disease (CD), but the conclusions of other studies are contradictory. The primary aim of this study (CD-deliver-IT) was to evaluate the rate of CS in a large population of CD patients throughout Italy. MethodsThis national multicenter retrospective study was conducted between December 2020 and November 2021. The coordinating center was the Pediatric Gastroenterology and Liver Unit of Policlinico Umberto I, Sapienza, University of Rome, Lazio, Italy. Eleven other referral centers for CD have participated to the study. Each center has collected data on mode of delivery and perinatal period of all CD patients referring to the center in the last 40 years.ResultsOut of 3,259 CD patients recruited in different Italian regions, data on the mode of delivery were obtained from 3,234. One thousand nine hundred forty-one (1,941) patients (60%) were born vaginally and 1,293 (40%) by CS (8.3% emergency CS, 30.1% planned CS, 1.5% undefined CS). A statistically significant difference was found comparing median age at time of CD diagnosis of patients who were born by emergency CS (4 years, CI 95% 3.40–4.59), planned CS (7 years, CI 95% 6.02–7.97) and vaginal delivery (6 years, CI 95% 5.62–6.37) (log rank p < 0.0001).ConclusionsThis is the first Italian multicenter study aiming at evaluating the rate of CS in a large population of CD patients through Italy. The CS rate found in our CD patients is higher than rates reported in the general population over the last 40 years and emergency CS seems to be associated with an earlier onset of CD compared to vaginal delivery or elective CS in our large nationwide retrospective cohort. This suggests a potential role of the mode of delivery on the risk of developing CD and on its age of onset, but it is more likely that it works in concert with other perinatal factors. Further prospective studies on other perinatal factors potentially influencing gut microbiota are awaited in order to address heavy conflicting evidence reaming in this research field.

Mode of delivery according to Robson classification and perinatal outcomes in restricted and small for gestational age fetuses.

To evaluate the mode of delivery according to Robson classification (RC) and the perinatal outcomes in fetal growth restriction (FGR) and small for gestational age (SGA) fetuses. Retrospective cohort study by analyzing medical records of singleton pregnancies from two consecutive years (2018 and 2019). FGR was defined according to Delphi Consensus. The Robson groups were divided into two intervals (1-5.1 and 5.2-10). Total of 852 cases were included: FGR (n = 85), SGA (n = 20) and control (n=747). FGR showed higher percentages of newborns < 1,500 grams (p<0.001) and higher overall cesarean section (CS) rates (p<0.001). FGR had the highest rates of neonatal resuscitation and neonatal intensive care unit admission (p<0.001). SGA and control presented higher percentage of patients classified in 1 - 5.1 RC groups, while FGR had higher percentage in 5.2 - 10 RC groups (p<0.001). FGR, SGA and control did not differ in the mode of delivery in the 1-5.1 RC groups as all groups showed a higher percentage of vaginal deliveries (p=0.476). Fetuses with FGR had higher CS rates and worse perinatal outcomes than SGA and control fetuses. Most FGR fetuses were delivered by cesarean section and were allocated in 5.2 to 10 RC groups, while most SGA and control fetuses were allocated in 1 to 5.1 RC groups. Vaginal delivery occurred in nearly 60% of FGR allocated in 1-5.1 RC groups without a significant increase in perinatal morbidity. Therefore, the vaginal route should be considered in FGR fetuses.

Effects of anti-corruption campaigns on cesarean section rate: evidence from China

The excessive utilization of cesarean section (CS) has become a global concern, given the potential short-term and long-term detrimental effects for mothers and infants. Worldwide, the rate of CS continues to rise, but efforts to curtail unnecessary CS procedures have yielded limited success. By combining data from three resources, this study aims to estimate the effects of anti-corruption campaigns under the Xi administration on CS rates. We focus on Shanxi Province, a major coal-producing province in north-central China, with notoriety for the collusion between local politicians and business elites. Using the data from the China Corruption Investigation Dataset and data from publicly listed firms between 2013 and 2016, we found that anti-corruption campaigns significantly changed the social environment as firms’ business entertainment spending experienced substantial reductions. Using discharge records from 137 public hospitals, we adopted an instrumental variable (IV) approach and found that the anti-corruption campaigns led to significant reductions in unnecessary CS rates. The reductions are bigger among patients with second or later deliveries. We also find that the anti-corruption campaigns changed behaviors of attending and resident physicians. Our results provide insights into strategies to reduce corrupt practices within the healthcare sector and implementing interventions to minimize the occurrence of CS among healthy women and newborns.

Correlation between Obesity and Pregnancy Outcomes, Miscarriage, and Mode of Delivery

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The obesity pandemic is a source of problems in both developed countries. The obesity is associated with complications before and during pregnancy and even infant death. The study aims to find out the issue of obesity among women of reproductive age, particularly concerning its impact on maternal and fetal outcomes during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a cross-sectional observational study using secondary data with medical records taken at Sebelas Maret University Hospital (UNS Hospital). Subjects were obese pregnant women who gave birth at UNS Hospital. Data from 284 single births were added maternal parameters, obstetric parameters, and newborn parameters were taken and then analyzed univariately, and bivariate analysis was carried out using the Kruskall-Wallis test and the Spearman test for comparison and correlation of each variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study finds lower incidences of postdate pregnancy and instrumental deliveries among obese mothers, but a higher rate of emergency cesarean sections. Newborn anthropometric measurements increase with maternal BMI, indicating a direct association between maternal obesity and newborn health (p = 0.001), while APGAR scores show no significant differences among maternal BMI groups. The findings underscore the importance of addressing maternal obesity to improve both maternal and newborn health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The research indicates a correlation between maternal BMI, maternal obstetric characteristics, newborn anthropometric measurements, and APGAR scores. This suggests that interventions aimed at promoting healthy maternal BMI, beginning before conception, continuing throughout pregnancy, and extending into the post-pregnancy period, could potentially improve newborn health outcomes and give long-term health benefits.&lt;/p&gt;

Risk Factors and Outcomes of Meconium Stained Liquor Babies in Tertiary Care Neonatal Unit

Objective: The purpose of this research was to examine the variables affecting the mother and the baby when amniotic fluid is tainted with meconium during pregnancy. Methodology: This cross-sectional study was conducted at PNS Shifa Hospital, Karachi, from July 15th, 2023, to December 30th, 2023. It involved non-probability consecutive sampling of patients with a gestational age over 37 weeks who presented with meconium-stained liquor during labor. Newborns with congenital defects were excluded, resulting in a study sample size where basic demographic and clinical data were collected. Data analysis was performed using SPSS 26, with continuous variables expressed as mean ± SD and categorical variables in frequency and percentages. Results: Meconium stained amniotic fluid (MASF) was seen in 60 (4.8%) of the 1232 births that occurred during the research period. Meconium aspiration syndrome affected 22 of 60 (36 %) newborns with MSAF. There was a substantial correlation between thick meconium stained liquor and a low Apgar score, an unsettling CTG, MAS, or the need for an emergency C-section. A total of 41 newborns (68% of the total) were diagnosed with thin meconium, although only 85% of those infants showed no symptoms. Important risk variables for MAS were PIH, anemia and GDM (P 0.002, 0.002, &lt;0.0001 respectively), and parity was related in a significant manner Conclusion: Low Apgar scores, higher rates of emergency caesarean sections, and meconium aspiration syndrome were all linked to meconium-stained amniotic fluid. Risk factors for MAS included maternal anemia, hypertension, and gestational diabetes.

Optimizing Cesarean Section Rates in India: Insights, Challenges, and Evidence-Based Strategies from an Expert Committee Meeting

Optimizing Cesarean Section Rates in India: Insights, Challenges, and Evidence-Based Strategies from an Expert Committee Meeting

The Impact of Continuous Labor Support on Cesarean Section Rates among Nulliparous Women: A Randomized Controlled Trial

Cesarean section (CS) rates are increasing globally, raising concerns about maternal and neonatal morbidity. Continuous labor support (CLS) has been shown to reduce CS rates in some settings, but its impact in Indonesia remains understudied. This study aimed to evaluate the effect of CLS on CS rates among nulliparous women in Purwakarta Regency, Indonesia. A randomized controlled trial was conducted at the Purwakarta Regional Hospital from January 2022 to December 2023. Eligible nulliparous women in labor were randomized to receive either CLS (n=210) from a trained midwife or standard care (n=205). The primary outcome was the rate of CS. Secondary outcomes included duration of labor, use of analgesia, maternal satisfaction, and neonatal outcomes. The CS rate was significantly lower in the CLS group (18.1%) compared to the standard care group (29.3%) (p=0.02). Women in the CLS group also reported higher satisfaction with their birth experience. No significant differences were found in other secondary outcomes. Continuous labor support provided by a trained midwife significantly reduces CS rates among nulliparous women in Purwakarta Regency, Indonesia. Implementing CLS as a routine practice may help address the rising CS rates and improve maternal birth experiences in this setting.

Caesarean section rates in a tertiary teaching hospital in northern Uganda: a retrospective analysis using the robson ten group classification system

BackgroundThe Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS.MethodsWe conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS.ResultsWe reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58).ConclusionOur study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.

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.

A modern view of pregnancy management tactics with a tendency to post-term pregnancy

This analytical review article compares elective induction of labor with expectant management for a tendency to post-term pregnancy and examines its impact on maternal and neonatal outcomes and caesarean section rates. Currently, the issue of management tactics during pregnancy beyond 41 weeks remains hotly debated and requires further research.

Upright Versus Recumbent Position in the Second Stage of Labor for Women With Epidural Analgesia: A Randomized Clinical Trial

Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.

The significance of delivery methods and fetal gender in reducing stillbirth rate: Using the generalized regression model

AimDespite stillbirth being a significant burden for maternal lives, families, and communities worldwide, it is often neglected and overlooked in many countries. The fetal gender and the delivery method are two interaction factors that directly impact the stillbirth rate. This study aimed to identify the impact of fetal gender on stillbirth delivery methods, either cesarean section or vaginal delivery. MethodThe current research analyzed the stillbirths recorded over ten years between January 1st, 2008, and December 31st, 2017, obtained from the Maternity Teaching Hospital in Erbil City, the capital of the Kurdistan Region of Iraq. ResultsThe results showed that stillbirths remain a significant public health concern in the region, with 11.7 stillbirths occurring for every 1000 deliveries. The generalized regression model for each normal, beta, and gamma distribution was used to determine the best fit of the data. The study found that for fetal males, vaginal delivery reduced the stillbirth rate by 4.2 % and the cesarean section rate by 3.6 % while for fetal females, vaginal delivery reduced the stillbirth rate by 4.7 % and the cesarean section rate by 6 %. ConclusionThe findings suggest that healthcare in the region should prioritize reducing the incidence of stillbirths during pregnancy and delivery, considering factors such as fetal gender and delivery mode.

Changes in adverse obstetrical and neonatal outcomes over time in American women with polycystic ovary syndrome: an 11-year study of a population database.

To determine whether the prevalence in American demographic and resultant adverse obstetric outcomes changed in women with polycystic ovary syndrome between the years of 2004-2014 inclusively, based on data derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. This is a retrospective population-based study using data derived from the HCUP-NIS database from the years of 2004-2014, inclusively. Within this group, all pregnancies to women with PCOS were identified and separated by year, creating 11 groups. Risk factors including non-Caucasian race, lower socioeconomic status, andrates of obesity and thyroid disease increased over time.The rates of gestational diabetes mellitus demonstrated a slight decrease, (21.3% in 2004 to 18.0% in 2014, P = 0.01). The number of women with preterm premature rupture of membranes decreased from 3.0% in 2004 to 2.0% in 2014 (P = 0.04). Rates of preterm delivery decreased from 14.8% in 2004 to 9.8% in 2014 (P < 0.001). Rates of cesarean section decreased from 57.3% in 2004 to 45.7% in 2014 (P < 0.001), while rates of spontaneous vaginal delivery increased from 37.4% in 2004 to 50.1% in 2014 (P < 0.001). The rate of wound complications decreased from 2.1% in 2004 to 0.4% in 2014 (P < 0.001). However, the rate of congenital anomalies increased from 0.5% in 2004 to 1.2% in 2014 (P = 0.001). In spite of increases in demographic risk factors associated with increased pregnancy complications, we hypothesize that the interventions made to minimize the risks of cesarean section and manage metabolic complications in women with PCOS during the period of study have resulted in improved pregnancy outcomes during the period of study.

Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh.

Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh.

Trends in Indications, Intraoperative Findings and Outcome of Relaparotomy after Caesarean Section at a Tertiary Hospital in Eastern Zone Tanzania; Five Years’ Review

Background: The increased incidences of caesarean section rate is associated with a number of post-operative complications; one being re-laparotomy which is considered a maternal near-miss. The purpose of a re-laparotomy is to manage complications of the previous surgery such as unsecured hemostasis, manage intraabdominal infection, repairing of iatrogenic damaged organs like bowels, ureters and bladder, relieve intestinal obstruction and maintain intestinal continuity or to carry out delayed curative surgery. In general, second surgery increases not only the morbidity but also the risk of maternal mortality. Methods: The study was cross sectional, conducted at the Department of Obstetrics and Gynecology in MNH. It involved review of medical records of all women who necessitated re-laparotomy following Caesarean Section (CS) that was performed either at MNH or from referring health facilities during the study period. Results: There were 193 relaparotomy cases, 98% were referrals. Atonic uterus and sepsis (septic uterus, pelvic abscess and pus in peritoneal cavity) as intraoperative finding showed statistical significance in our study. Atonic uterus for those women who underwent relaparotomy due to post-partum hemorrhage (PPH) increase from 1(7.7%) in 2017 to 6(14%) in 2021 with an average increase of 2.31 % every year. Number of cases for sepsis (combination of septic uterus, pelvic abscess and pus in peritoneal cavity) was significant decreasing every year from 22(37.3%) in 2018 to 7(16.3%) 2021with an average decrease of 3.15% every year from 2017 to 2021. The number of cases who had hysterectomy as one of the post-operative outcomes was statistically significant decreasing from 44(74.6%) to 26(60.5%) over the study period with an average decrease of 5.89% every year from 2018 to 2021. Conclusion: The most frequent indication for relaparotomy after CS was a burst abdomen. For the women who had relaparotomy due to uncontrollable PPH, the main intraoperative .......

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BackgroundIn recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of “Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model”.Methods/designThe current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants’ attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants’ average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.DiscussionThis is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.Ethical codeIR.MUMS.NURSE.REC. 1403. 014.