Risk Of Cesarean Section Research Articles

Overweight and Obesity in Adult Birth by Cesarean Section: A Systematic Review With Meta-analysis.

Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity. The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity. This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model. Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood.

Influence of gestational diabetes in twin pregnancy on the condition of newborns and early neonatal complications.

Diabetes mellitus is the most common metabolic complication in pregnancy and increasing worldwide. In Europe, it occurs in 3-5% of pregnant women. The rate of twin pregnancy has been increased similarly to gestational diabetes mellitus (GDM). Twin pregnancy is associated with a higher complication rate compared to singleton pregnancy. The growing prevalence of GDM and twin pregnancy has given rise to their increasing concurrent presentation. The retrospective analysis included 212 twin-pregnant patients. The analysis excluded cases of miscarriage and early fetal death in the first trimester of pregnancy. The influence of GDM on the condition of newborns and mothers after delivery was analyzed. For statistical analysis R 3.6.2 software was used. No statistically significant relationship between GDM and Non-GDM group and periparturient complications was found. Birth weight was significantly higher in the GDM G2 group. Apgar Score was the lowest in the GDM G1 group. In the group of larger newborns of the GDMG1 group respiratory distress syndrome (RDS) , a higher incidence of second-degree intracranial bleeding and grade II of preterm retinopathy were observed. There was no statistically significant relationship between GDM G1, GDM G2 and other neonatal complications. In summary, our results indicate that GDM in twin pregnancy does not increase the risk of cesarean section but increases some neonatal complications. In conclusion women with twin pregnancies complicated by GDM require specialist care during pregnancy and childbirth should take place in a third-level reference center.

The interaction between age and parity on adverse pregnancy and neonatal outcomes.

Although age and parity are recognized as associated factors for adverse pregnancy outcomes, there are no studies exploring the interaction between the two during pregnancy. This study aimed to investigate the impact of the interaction between age and parity on adverse pregnancy outcomes. This was a retrospective cohort study with 15,861 women aged ≥20 years. All women were grouped according to age, parity, and a mix of the two. The data were analyzed using multivariate logistic regression analysis. Age, parity, and interaction between the two were related with the risk of gestational hypertension, eclampsia/pre-eclampsia, placenta previa, placental implantation, postpartum hemorrhage, preterm birth, cesarean section, and Apgar score <7 within 5 min of birth. The risk of gestational diabetes mellitus and transfer to the neonatal unit was linked with age and the interaction between age and parity, but the impact of parity was not statistically significant. The risk of anemia, placental abruption, premature rupture of the membrane, oligohydramnios, and macrosomia was only associated with parity; the risk of fetal distress was only associated with age. The interaction between advanced age and parity might results in more adverse outcomes for both puerpera and infants, necessitating additional prenatal screening and health education throughout pregnancy.

Inducción del parto en gestaciones gemelares: estudio comparativo de oxitocina vs dinoprostona

IntroductionIn the last few years the number of twin gestations that reach term has increased. Although vaginal delivery route has proven to be a safe alternative to caesarean section when first foetus is in cephalic presentation, available evidence on induction methods applied to this type of pregnancies is limited. MethodsRetrospective observational study conducted in a tertiary hospital. Forty-four pregnant twins, with gestational age greater than 34weeks, and with the first twin in cephalic presentation, who underwent induction of labour, were included. Vaginal prostaglandins (dinoprostone) were used in 17 cases and intravenous oxytocin in 27 cases, indication was randomised according to daily clinical practice. Results of both groups were compared in terms of safety and efficacy. ResultsNo significant differences were found in the rate of caesarean section due to induction failure between oxytocin and prostaglandins (42.9% vs. 57.1%; P=.3). No differences were found either in terms of neonatal or maternal complications. Two pregnant women presented obstetric haemorrhage, the only maternal complication described, both in oxytocin group. Higher risk of caesarean section was found in women with BMI >30kg/m2 (P=.001) and pre-induction Bishop's index ≤6 (RR: 2.06) (P=.005). ConclusionsBoth vaginal prostaglandins and intravenous oxytocin are similar in efficacy, maternal and neonatal safety when used in twin gestations. Bishop's index ≤6 and BMI >30 are associated with higher probability of induction failure.

Fetal growth restriction in diabetic pregnancy: a retrospective single-center study

BACKGROUND: The high risk of adverse maternal and perinatal complications in patients with fetal growth restriction and diabetes mellitus requires a detailed assessment of the major risk factors and outcomes.&#x0D; AIM: The aim of this study was to determine the main risk factors for fetal growth retardation in pregnant women with pregestational and gestational diabetes mellitus, and to assess obstetric and perinatal outcomes in these patients.&#x0D; MATERIALS AND METHODS: We conducted a retrospective single-center cohort study at the premises of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The study included 103 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, or gestational diabetes mellitus with fetal growth retardation who delivered a singleton neonate from January 2017 to December 2021. Based on the antenatal diagnosis, the patients were divided into the following comparison groups: group I early fetal growth retardation (n = 29), group II late fetal growth retardation (n = 27), group III small for gestational age (n = 47). Relative risk calculations were used to assess the contribution of risk factors and the risk of developing secondary outcomes.&#x0D; RESULTS: Pregestational diabetes mellitus was the major risk factor for early fetal growth retardation development (relative risk 1.91; 95% confidence interval 1.043.50); especially type 1 diabetes mellitus (relative risk 1.64; 95% confidence interval 1.022.74) and more than 10 years of pregestational diabetes mellitus duration (relative risk 2.62; 95% confidence interval 1.126.17). Chronic hypertension increases the risk of early fetal growth retardation (relative risk 2.11; 95% confidence interval 2.213.68), while gestational hypertension was a significant risk factor for late fetal growth retardation development (relative risk 1.81; 95% confidence interval 1.013.70). Preeclampsia is associated with both early and late forms of fetal growth retardation. Maternal characteristics, such as age over 35 years, obesity, and in vitro fertilization pregnancy, increased the risk of early fetal growth retardation development. In turn, the presence of fetal growth retardation in patients with diabetes mellitus is associated with increased risk of cesarean section, prolonged stay of the newborn in the neonatal intensive care unit (5 days), low Apgar scores (7 at the 5th minute), and neonatal hypoglycemia. Early fetal growth retardation is a significant risk factor for preterm birth (relative risk 6.23; 95% confidence interval 2.8713.42) and fetal distress (relative risk 5.51; 95% confidence interval 2.2813.33).&#x0D; CONCLUSIONS: Being associated with a highly increased risk of adverse obstetric and perinatal outcomes, early fetal growth retardation in diabetic pregnancy is related to pregestational diabetes mellitus, especially type 1 diabetes mellitus, with a long history, as well as with hypertension in pregnancy.

A Study on the Perinatal Outcomes of Natural Childbirth Led by Midwives: A Retrospective Study

Purpose: The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families.Methods: This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test.Results: Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02.Conclusion: Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women.

To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120-239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Maternal and neonatal outcomes of singleton versus twin pregnancies complicated by gestational diabetes mellitus: A systematic review and meta-analysis.

There is limited evidence exploring the maternal and neonatal complications of gestational diabetes mellitus (GDM) following singleton or twin pregnancies. Further, there have been no reviews completed examining the possible risk factors associated with GDM in singleton compared to twin pregnancies. This study assesses the impact of GDM in singleton and twin pregnancies on maternal and neonatal outcomes. From 1954 to December 2021, a thorough literature search was conducted in the EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar databases and search engines. The risk of bias was calculated using the Newcastle Ottawa (NO) scale. A random-effects model was applied and interpreted as pooled odds ratio (OR) with 95% confidence intervals (CI). Eight studies satisfied the inclusion criteria, with the quality of most studies being good to satisfactory. The risk of caesarean section (pooled OR = 0.32; 95%CI: 0.22 to 0.46), small-for-gestational age (SGA) neonates (pooled OR = 0.40; 95%CI: 0.19 to 0.84), preterm delivery (pooled OR = 0.07; 95%CI: 0.06 to 0.09), respiratory morbidity (pooled OR = 0.26; 95%CI: 0.19 to 0.37), neonatal hyperbilirubinemia (pooled OR = 0.19; 95%CI: 0.10 to 0.40), and NICU admission (pooled OR = 0.18; 95%CI: 0.14 to 0.25) was significantly lower in singleton pregnancies with GDM than in twin pregnancies with GDM. Maternal outcomes like caesarean section and neonatal outcomes like SGA neonates, preterm delivery, respiratory morbidity, hyperbilirubinemia, and NICU admission were significantly greater in twin pregnancies with GDM. It is important for clinicians and policymakers to focus intervention strategies on twin pregnancies with GDM.

Maternal Interleukin-17 and disease activity influence pregnancy outcomes in women with psoriatic arthritis and ankylosing spondylitis

ObjectiveWe aimed in this study to evaluate the impact of maternal interleukin -17A and the activity of the illness on pregnancy outcomes in Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients.MethodsThis prospective cohort research was carried out on 48 Psoriatic arthritis and ankylosing spondylitis pregnant women attending the inpatient and outpatient clinics of the Rheumatology & Rehabilitation and Obstetrics & Gynecology Departments, Faculty of Medicine, Zagazig University Hospitals in Egypt and 30 apparently healthy age- and sex-matched pregnant women between January 1,2018, and December 31, 2019.ResultsThe study group patients had a higher risk of preterm labour (32–36 weeks gestation) (aRR 1.80, 95% CI 0.79–4.17), oligohydramnios (aRR 3.15, 95% CI 1.26–8.42), Caesarean delivery (aRR 1.57, 95% CI 1.41–2.68), and delivering infants small for gestational age (aRR 7.04, 95% CI 2.36–12.42). There was significant difference between the control group and the study groups regarding the level of IL-17A.ConclusionMany females with PsA and AS have uninhibited pregnancy with regard to adverse events, but in comparison with normal pregnancies particularly with high IL-17A during the third trimester we noticed a growing risk of preterm labour, oligohydramnios and cesarean section. Further studies are needed to evaluate high maternal IL-17A levels and fetal outcomes.

LEVEL OF KNOWLEDGE OF WOMEN ABOUT THE RISKS ASSOCIATED WITH OVERWEIGHT DURING PREGNANCY

Worldwide half of women start pregnancy with overweight/obese, which greatly increases the risk of pregnancy and birth complications. Recommendations to improve preconception care emphasize the need to ensure that women of reproductive age understand factors that increase the obstetric and perinatal risks connected with high body mass index (BMI).&#x0D; Aim. Study whether women who start pregnancy with overweight were known of the increased risks of the gestational complications associated with a high (BMI) and the barriers and limitations that women had to optimize their body weight before conception.&#x0D; Materials and methods. total of 117 pregnant were enrolled in the research. The first group included 68 overweight women (BMI 25.0-29.9 kg/m2), the second - 49 normal body weight women (BMI 18.5-24.9 kg/m2) before pregnancy. Two questionnaires were used: "Questionnaire on the assessment of the level of knowledge of women about the risks associated with overweight during pregnancy" and "Barriers and limitations that women had to optimize body weight before conception". Patients filled out the presented questionnaires individually during the first antenatal visit (9-12 weeks). The results were statistically analyzed using Statistica 10.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. The differences between the groups were considered statistically significant at p&lt;0.05.&#x0D; Results. It was shown that the majority of women knew that overweight increased the general risk of pregnancy complications regardless of the woman's BMI. However, the chances of underestimating the high risk of operative delivery in overweight patients were (OR=3.80; 95% CI: 1.83-7.87; p&lt;0.001 and OR=3.69; 95% CI: 1.58 -8.64; p=0.004), premature birth (OR=2.96; 95% CI: 1.47-5.95; p=0.003 and OR=2.99; 95% CI: 1.31-6 .83; p=0.015), adverse neonatal outcomes (OR=2.96; 95% CI: 1.47-5.95; p=0.0031), and especially fetal congenital anomalies of development (OR=5.50; 95 % CI: 2.62-11.54; p&lt;0.001 and OR=12.38; 95% CI: 4.56-33.58; p&lt;0.001) among patients of the first and second groups, respectively. An underestimation of the risk of diabetes, caesarean section, premature birth, and negative perinatal outcomes, and especially congenital fetal abnormalities, has been confirmed if weight loss occurs before conception. The main barriers and limitations for women to optimize their weight before pregnancy were insufficient basic knowledge about the risk of gestational, especially perinatal complications during pregnancy and childbirth associated with overweight, family culture and habits, unsuccessful repeated irregular attempts to weight lose, lack of information and consulting medical professionals on this issue. Only 14.7 % of women reported that they were satisfied with their appearance and health and did not need to lose weight.&#x0D; Conclusions. Being overweight, usually caused by incorrect lifestyle, including dietary choices and lack of physical activity, has long-term negative health consequences for women and their children. The preconception, pregnancy, and postpartum periods are unique opportunities for intervention to establish sustainable healthy lifestyles. It remains relevant to develop programs aimed at improving women's knowledge about overweight as a factor of high obstetric and perinatal risks, and lifestyle modeling with the aim of optimizing body weight at the preconceptional stage.

Fetal scalp stimulation for assessing fetal well-being during labour.

Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. Fetal scalp stimulation (FSS) is a second-line test of fetal well-being that may provide reassurance that the labour can continue. To evaluate methods of FSS as second-line tests of intrapartum fetal well-being in cases of non-reassuring CTG. FSS and CTG were compared to CTG alone, and to CTG with fetal blood sampling (FBS). We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, the WHO ICTRP and conference proceedings), ClinicalTrials.gov (18 October 2022), and reference lists of retrieved studies. Eligible studies were randomised controlled trials (RCTs) that compared any form of FSS to assess fetal well-being in labour. Quasi-RCTs, cluster-RCTs and studies published in abstract form were also eligible for inclusion, but none were identified. Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. Two trials, involving 377 women, met the inclusion criteria for this review. Both trials were conducted in hospital settings and included women with singleton, term (37+0 weeks or more) pregnancies, a cephalic presentation, and abnormal CTG. Follow-up was until hospital discharge after the birth. A pilot trial of 50 women in a high-income country (Ireland) compared CTG and digital fetal scalp stimulation (dFSS) with CTG and fetal blood sampling (FBS). A single-centre trial of 327 women in a lower middle-income country (India) compared CTG and manual fetal stimulation (abdominal or vaginal scalp stimulation) with CTG alone. The two included studies were at moderate or unclear risk of bias. Both trials provided clear information on allocation concealment but it was not possible to blind participants or health professionals in relation to the intervention. Although objective outcome measures were reported, outcome assessment was not blinded or blinding was unclear. dFSS and CTG versus FBS and CTG There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. The risk of caesarean section (CS) may be lower with dFSS compared to FBS (risk ratio (RR) 0.38, 95% confidence interval (CI) 0.16 to 0.92; 1 pilot trial, 50 women; very low-certainty evidence) but the evidence is very uncertain. There were no cases of neonatal encephalopathy reported. The evidence was also very uncertain between dFSS and FBS for assisted vaginal birth (RR 1.44, 95% CI 0.76 to 2.75; very low-certainty evidence) and for the spontaneous vaginal birth rate (RR 2.33, 95% CI 0.68 to 8.01, very low-certainty evidence). Maternal acceptability of the procedures was not reported. FSS and CTG versus CTG alone Manual stimulation of the fetus was performed either abdominally (92/164) or vaginally (72/164). There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. There may be little differences in the risk of CS on comparing manual fetal stimulation and CTG with CTG alone (RR 0.83, 95% CI 0.59 to 1.18; 1 trial, 327 women; very low-certainty evidence), but again the evidence was very uncertain. There were no cases of neonatal encephalopathy reported. There may be no differences in the risk of assisted vaginal birth (RR 1.43, 95% CI 0.78 to 2.60; very low-certainty evidence) or in the rates of spontaneous vaginal birth (RR 1.01, 95% CI 0.85 to 1.21, very low-certainty evidence), but again the evidence is very uncertain. Maternal acceptability of abdominal stimulation/FSS was not reported although 13 women withdrew consent after randomisation due to concerns about fetal well-being. There is very low-certainty evidence available which makes it unclear whether stimulating the fetal scalp is a safe and effective way to confirm fetal well-being in labour. Evidence was downgraded based on limitations in study design and imprecision. Further high-quality studies of adequate sample size are required to evaluate this research question. In order to be generalisable, these trials should be conducted in different settings, including broad clinical criteria at both preterm and term gestational ages, and standardising the method of stimulation. There is an ongoing study (FIRSST) that will be incorporated into this review in a subsequent update.

The combined effect of pre-pregnancy body mass index and gestational weight gain on the risk of pre-labour and intrapartum caesarean section-The ICE-MCH study.

Women who are obese before pregnancy have a higher risk of caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and gestational weight gain on pre-labour and intrapartum caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003-2014 from the Icelandic Maternal and Child Health Study (ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight, overweight and obese. Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34-1.81) and intrapartum caesarean section (AOR 1.92, 95% CI 1.70-2.17) than normal weight women in all categories of gestational weight gain. Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum caesarean section among normal weight (AOR 1.46, 95% CI 1.23-1.73) and overweight women (AOR 1.291, 95% CI 1.04-1.60). Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour caesarean section (AOR 1.64, 95% CI 1.20-2.25), but only among overweight women. Women who are obese before pregnancy have a high risk of caesarean section regardless of gestational weight gain. However, women who are normal weight or overweight before pregnancy and gain weight above the recommended range during pregnancy may also have an increased risk of caesarean section.

The success of vaginal birth by use of trans-labial ultrasound plus vaginal examination and vaginal examination only in pregnant women with labor induction: a comparative study

BackgroundPredicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. Thus, this study aimed to compare the success rate of vaginal birth by using trans-labial ultrasound and vaginal examination, and vaginal examination only in pregnant women with labor induction.MethodsThis was a comparative study including 392 eligible pregnant women with labor induction attending to a teaching hospital affiliated with Iran University of Medical Sciences from April to October 2018 in Tehran, Iran. Women were randomly assigned to two groups; the trans-labial ultrasound plus vaginal examination (group A), and the vaginal examination only (group B). Women were included in the study if they satisfied the following criteria: singleton pregnancy, 37 to 42 weeks of gestational age, fetal head presentation, a living fetus with no abnormalities, uncomplicated pregnancy, and no previous cesarean section or any uterine surgery. We used a partograph for both groups to assess the fetal head position and the fetal head station. In group 1, the Angle of Progression (AoP) and Rotation Angle (RA) were also assessed. Finally, the success and progression of vaginal delivery in two groups were compared by predicting the duration of delivery and mode of delivery.ResultsThe findings showed that 8.68% of women in the trans-labial plus vaginal examination group delivered by cesarean section, while 6.13% in the vaginal examination only group delivered by cesarean section (P = 0.55). In women with cesarean section in positive fetal head stations, Angle of Progression (AoP) was significantly decreased ranging from 90 to 135 degrees compared to women who delivered vaginally (135–180 degrees; P < 0.001). In addition, the Rotation Angle (RA) was significantly decreased in women with cesarean section ranging from 0 to 30 degrees compared to women who delivered vaginally (60-90degrees; P < 0.001). Further analysis indicated that a higher risk of cesarean section was associated with vaginal examination only as compared to trans-labial ultrasound plus vaginal examination (HR: 8.65, P < 0.001).ConclusionAngle of Progression (AoP) and Rotation Angle (RA) indexes might be useful parameters to predict labor progression and successful vaginal delivery among women undergoing labor induction.

Engagement frequency and C-section rates among users of a smartphone-based pregnancy tracking application

To assess how engagement frequency with a smartphone-based pregnancy tracking application impacts Cesarean section rates. An enterprise-level benefits mobile solution in the United States allows pregnant members to track daily symptoms during their pregnancy to detect adverse conditions earlier; read educational content about evidenced-based approaches to reducing the risk of a Cesarean section, such as building a birth team, selecting certified nurse midwives as providers if appropriate, understanding elective vs. medically-necessary Cesarean sections, and managing conditions like preeclampsia or gestational diabetes; and interact with licensed clinicians to answer clinical questions through the app. Participants qualified for inclusion if they were enrolled in the pregnancy solution at any gestational age, were enrolled into a qualifying insurance plan, and were between 15 and 44 years of age. Engagement frequency was defined as the average number of times a user used the solution in a 30-day period throughout their pregnancy, stratified into four cohorts: less than 4 sessions, 4-16 sessions, 17-32 sessions, and greater than 32 sessions. Cesarean section rates were sourced from claims data. A Chi-square test was performed to assess statistical significance between engagement cohorts and Cesarean section rates. A total of 519 participants qualified for inclusion in analysis. Cesarean section rates ranged from 20.8% for participants engaging between 16-32 sessions per month and 34.2% for participants engaging less than 4 sessions per month. There was a statistically significant (p < 0.05) relationship between engagement dosage and C-section rates. Given almost one in three pregnant people deliver by C-section in the United States annually, preventative approaches are required to reduce the national C-section rate. These results suggest that digital solutions designed to engage users on a daily basis can deliver evidenced-based prevention interventions aimed at positively impacting behavior change to reduce personal risk of Cesarean section.

Veza između ginekološkog karcinoma, svesti o reproduktivnom zdravlju i svesti o gojaznosti kod žena - studija preseka

Purpose: This study was conducted to determine the effect of obesity awareness on gynecological cancer and reproductive health awareness in women. Materials and Methods: This study is a crosssectıonal study. The sample of the study consisted of overweight and obese women. Data were collected using the introductory information form, obesity awareness scale, and gynecological cancers awareness scale via a Google form. Results: Obesity was found to have a statistically significant association with reproductive health, including the risk for pregnancy and baby, uterus, ovary and breast cancer, menstrual irregularity, age of first menstruation, polycystic ovary syndrome, cesarean section risk, preeclampsia, gestational diabetes, stillbirth risk, birth defects, the chance of conception, the success of fertility treatment, early menopause, osteoporosis, baby weight, and iron deficiency anemia. The total mean score Obesity Awareness Scale and Gynecologic Cancer Awareness Scale was significantly higher among those who believed in this association. A highly significant positive correlation was observed between total and sub-dimension mean scores of women's Obesity Awareness Scale and Gynecologic Awareness Scale. Conclusion: It has been determined that obesity awareness in women is related to reproductive health and gynecological cancer awareness

Abstract P074: Pregnancy and neonatal outcomes among early-onset colorectal cancer survivors: a nationwide case-control study

Abstract Purpose: Early-onset colorectal cancer (CRC diagnosed before age 50) has risen worldwide, with an increasing number of survivors of reproductive age. We aimed to investigate the risk of adverse pregnancy and neonatal outcomes among early-onset CRC survivors. Methods: We conducted a nationwide case-control study of 207 births in women with early-onset CRC and 1019 births in women without CRC from the general Swedish population (1992-2019), matched on age, calendar year of birth, parity, and county of residence. To control for genetic susceptibility and shared childhood exposures, we additionally identified 146 births in female siblings of the CRC survivors. Early-onset CRC cases were identified through the Swedish Cancer Register (1969-2019), and siblings were identified through the Swedish Multi-generation Register. Maternal characteristics and neonatal outcomes were retrieved from the Swedish Medical Birth Register and National Patient Register. Using conditional logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Compared to women without prior CRC, early-onset CRC survivors who gave birth had increased risk of pre-eclampsia (aOR 2.52, 95% CI 1.25 to 5.08), induced labor (aOR 1.64, 95% CI 1.09 to 2.46) and emergency Cesarean section (aOR 1.79, 95% CI 1.17 to 2.75), after adjustment for maternal education level, country of birth, body mass index and smoking in early pregnancy, and comorbidities. Sibling analyses showed similar trends, especially for higher risk of induced labor (aOR 2.58, 95% CI 1.03 to 6.49). Maternal history of early-onset CRC was also associated with offspring preterm birth (aOR 2.31, 95% CI 1.34 to 3.99) and low birth weight (aOR 2.95, 95% CI 1.40 to 6.21), and risks were particularly pronounced for medically indicated preterm birth (aOR 4.48, 95% CI 2.05 to 9.79). No significant associations were found for small for gestational age birth, low Apgar score, and congenital malformations. Conclusion: In this population-based study, history of early-onset CRC was associated with increased risk of adverse pregnancy outcomes, including pre-eclampsia, induction of labor, and emergency Cesarean section. Offspring to mothers with early-onset CRC also had increased risk of medically indicated preterm birth and neonatal low birth weight. Citation Format: Yin Cao, Stephanie Zhao, Tomas S. Bexelius, Jonas Söderling, Mengyao Shi, Bjorn Roelstraete, Barbara B. Warner, Olof Stephansson, Jonas F. Ludvigsson. Pregnancy and neonatal outcomes among early-onset colorectal cancer survivors: a nationwide case-control study. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P074.

УСТАНОВЛЕНИЕ ФАКТОРОВ, СПОСОБСТВУЮЩИХ ЗАВЕР-ШЕНИЮ РОДОВ ПУТЕМ ОПЕРАЦИИ КЕСАРЕВА СЕЧЕНИЯ

One of the urgent problems in obstetric practice is the disclosure of patho-genetic mechanisms of violation of the contractile activity of the uterus during childbirth, which is accompanied by an increase in the risk of emergency cae-sarean section. Among the reasons, a significant role is assigned to anomalies of labor activity (10–25 %), in which labor activity is inhibited for unknown reasons. The appointment of drugs that stimulate the contractile function of the uterus during childbirth, with a mechanical obstruction not diagnosed in a timely manner, is accompanied by an increased risk of fetal asphyxia, birth trauma and leads to a belated caesarean section. Timely prediction of the course of the birth process and the selection of pregnant women for controlled delivery are one of the main medical problems. In view of the foregoing, we have established factors that are directly related to the formation of the cause of an emergency caesarean section. A retrospective study was conducted based on the analysis of medical documentation (history of childbirth) of 99 puerper-as hospitalized in the 3rd City Clinical Hospital named after E. V. Klumov" in Minsk in 2021–2022. The main group consisted of 52 women after spontane-ous childbirth (the average age of the patients was 26.7 ± 3.6). 49 puerperas of the comparison group were examined after emergency operative delivery (the average age of the patients was 27.6 ± 2.5). All puerperas of the compared groups were prescribed oxytocin infusions during labor in accordance with the clinical protocol. According to the results of our research, most of the signs that contribute to the completion of labor by caesarean section are related to mechanical difficulties. Undoubtedly significant predictors of the completion of labor by caesarean section were: acute fetal hypoxia, chronic decompensation according to cardiotocography and incorrect insertion of the fetal head. The most significant predictors were a decrease in contractile activity (OR = 21.0, CI 11.68–37.09, p &lt; 0.001), cervical dystocia (OR = 10.0, CI 2.41–18.90, p &lt; 0.001) and discoordination of labor according (OR = 6.0, CI 1.6–17.9, p = 0.006), the presence of which increases the chances of operative delivery by 21.0; 10.0 and 6.0 times, respectively. Weakness of labor activity and uter-ine atony in labor are a fairly common cause of emergency caesarean section due to the lack of effect of the therapy or violation of the fetal condition, but the mechanisms of their formation remain unidentified.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030; RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012; RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

Induction of Labor on Maternal Request: Do Not Refuse This Option to Women

Objective: To describe perinatal outcomes in a population of labour induction on maternal request, whatever the obstetrical conditions. Methods: This retrospective single-centre study included all women who underwent labour induction on maternal request between January 2019 and May 2020. The primary outcome was perinatal outcomes: data about maternal and fetal morbidity were collected. The secondary outcome was the cesarean rate. Data were compared according to the delivery outcome (“vaginal delivery” Vs “cesarean section” group) to identify risk factors for cesarean delivery. Multivariate analysis was performed by adjusting for confounding factors such as Bishop score, prior cesarean section, parity, BMI, maternal, fetal presentation, gestational age, method of ripening, and the number of ripening’s stages needed. Results: We included 86 women. There was no risk factor for poor perinatal outcomes. Vaginal delivery occurs in 96,3 % (n=78/86) of all women. In primiparous women and the “prior cesarean-section group”, this rate was 92,9% and 76,9%, respectively. We didn’t find any statistical difference between the “vaginal delivery” and “cesarean section” groups. Conclusion: Induction of labour on maternal request should be widely accepted regarding the low risk of cesarean section and the absence of predictive risk factor of it.

Maternal-fetal outcomes of women with hypertensive disorders of pregnancy.

The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386-3,302; p=0.001) and preterm delivery at <34 weeks' gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19-5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.