Risk factors and surveillance for postdischarge surgical site infections: A prospective analysis.

There are several maternity care models in Australia providing varying levels of continuity of care in the private and public maternity system. These were disrupted to varying degrees during the pandemic. To examine the impact of the five main maternity care models in Australia on perinatal outcomes for women who gave birth during the COVID-19 pandemic and their babies. A national survey, was conducted from March to December 2020, and again from August 2021 to March 2022. A weighted sample of 3682 postnatal women provided information on birthing outcomes. Survey tabulations of prevalence and weighted logistic regressions examined associations between five models of maternity care and perinatal outcomes. Compared with standard care, continuity of care in both public (MWCOC) and private midwife (PPM) models was associated with higher odds of: spontaneous labour (MWCOC AOR 1.66; CI 1.35-2.04; PPM AOR 11.01; CI 0.6.29-19.28), spontaneous vaginal birth (MWCOC AOR 1.84; CI 1.49-2.28; PPM AOR 3.14; CI 2.08-4.73), postnatal midwife visits at home, feeling supported postnatally, feeling the care provider showed commitment, and feeling known by the care provider; as well as lower odds: of induction, elective and emergency caesarean section, augmentation with oxytocin, perceived traumatic birth (MWCOC AOR 0.57; CI 0.45-0.73; PPM AOR 0.49; CI 0.31-0.77), fetal distress, and infant admission to special/neonatal intensive care. Compared to standard care, private obstetric care was associated with lower rates of postpartum haemorrhage, perceived traumatic birth (AOR 0.56; CI 0.45-0.69), spontaneous labour (AOR 0.45; CI 0.37-0.54), spontaneous vaginal birth (AOR 0.54; CI 0.45-0.65), postnatal home visits from a midwife, and higher rates of elective caesarean section (AOR 2.65; CI 2.12-3.30). Continuity of midwifery care models are associated with lower intervention rates and birth trauma compared to standard care. However, for women who seek, or are not concerned about increased obstetric intervention, private obstetric care also leads to lower rates of birth trauma when compared to standard care. Continuity of care models should be prioritised in future disaster events.

Pregnancy Outcomes in Women With Cardiovascular Disease:A Retrospective Cohort Study from Kaiser Permanente Northern California.

Descriptive cross-sectional analysis of nursing diagnoses, interventions, and outcomes in neonatal intensive care based on Roy's and Swanson's models.

In many countries, the consent for caesarean section (CS), when indicated, is made by the woman herself. However, in Somaliland, the family (husband, father, or other close male family member) are required to make the consent for CS to be performed, a process that can be time-consuming and result in adverse outcomes. This study aimed to investigate the barriers to and facilitators of timely family consent in caesarean sections at the national referral hospital in Somaliland. A convergent mixed-methods study with a parallel sampling method was conducted at the national referral hospital in Somaliland. Quantitative data was collected on timely vs. late family consent for CS, as well as sociodemographic and obstetric characteristics. Data were analysed using binary and multivariable logistic regression. In addition, in-depth interviews were conducted and analysed using thematic analysis. Of the 516 women included in the quantitative phase of the study, 16 participated in the in-depth interviews. The quantitative results showed that women with hypertensive disorders (aOR 8.491; 95% 1.076-66.991) and obstetric haemorrhage (aOR 3.209; 95% CI 1.159-8.887) had higher odds of late family consent compared to women without hypertensive disorders and obstetric haemorrhage respectively. The themes that emerged on barriers to timely family consent for CS were poor communication and understanding, delayed informed choice for CS, differences in understanding between family members on the indication for CS, and absence of the person providing formal consent. The themes that emerged on facilitators of timely family consent were the husband's autonomous decision making for CS and adequate disclosure of all relevant information about CS. A standard counselling package can be designed on educating family members on the importance of timely CS consent during the antenatal period with male involvement. A policy should be developed that gives women the autonomy to make health decisions and give consent in maternal health emergencies. Healthcare providers need training on effective communication when requesting CS consent, with a focus on the elements of informed consent.

There is a scarcity of literature documenting how women facing maternal morbidity issues deal with challenges to breastfeeding. This case study documents challenges faced by two women, one who underwent major abdominal surgery immediately after a Caesarean section at 32 weeks, and the other who had a primary and secondary postpartum hemorrhage with repeated hospital admissions. In the first case, the key issues for lactation were the mother-infant separation and difficulty in initiation and sustaining breastfeeding due to abdominal surgery after her Caesarean section. Early and frequent removal of milk are critical for establishing and sustaining supply and were challenging for the mother in the intensive care unit for 3 weeks. The second case involved a mother experiencing severe postpartum hemorrhage. Having lost over 3 L of blood, this mother faced a significant risk of a reduction in prolactin and activation of her milk supply. Her subsequent weakness and dyspnoea due to anaemia meant breastfeeding required extraordinary effort. Establishing lactation under these circumstances was challenging. Both mothers needed guidance and encouragement to build up and maintain their supply and the practical support of family to care for the infant. In Case Study 1, donor milk was used and alternated with artificial breastmilk substitutes until the mother re-established her supply after discharge. In Case Study 2, the mother required help to express, position, and hold the baby while she breastfed. Despite overwhelming medical and physiological odds, it is possible to establish exclusive breastfeeding with consistent personalized health-system support/training and relentless determination.

Objective — to analyze current data on anesthetic management techniques for abdominal delivery in pregnant women with morbid obesity. The review was conducted by searching PubMed, Google Scholar, and eLibrary databases from January 1, 2000, to August 31, 2024, using the keywords: pregnancy, obesity, body mass index, cesarean section, anesthesia, and complications. The search yielded 724 references. 655 references were excluded from the review due to their description of pregnancy management and spontaneous labor in obese patients. The literature review included 69 references. Inclusion criteria: design (clinical studies in all peer-reviewed journals without language or national restrictions); subjects (pregnant women with obesity grade II or higher). This review examines anesthesia techniques for cesarean section in pregnant women depending on the severity of obesity. The analysis revealed a wide range of neuraxial and general anesthesia techniques, each with its own advantages and disadvantages, and none is “perfect.” Anesthetic management of abdominal delivery in pregnant and postpartum women with morbid obesity requires a personalized, multidisciplinary approach. The review data suggest that further research is needed to personalize anesthesia for cesarean section in obese patients.

Short-course antimicrobial prophylaxis after emergency caesarean section.

Background Transversus abdominis plane (TAP) block with bupivacaine is commonly used for analgesia after cesarean deliveries. Liposomal bupivacaine has been incorporated into TAP blocks to potentially prolong analgesic effects and reduce opioid use. However, its effectiveness for elective cesarean section remains uncertain. Methods This review was registered on PROSPERO (CRD420251046460). We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies comparing TAP block with liposomal bupivacaine plus conventional bupivacaine vs. conventional bupivacaine alone in women undergoing elective cesarean delivery. Meta-analyses were performed using random-effects models. Heterogeneity was assessed with I 2 statistics and Cochran's Q test. Results Three randomized controlled trials (meta-analysis) and one retrospective study (qualitative synthesis) were included, comprising 695 patients. Of these, 357 (51.4%) received TAP block with liposomal bupivacaine. Its use was associated with significantly decreased opioid consumption at 24 h (mean difference −0.76 mg IV morphine equivalents; 95% CI −1.46 to −0.07; p = 0.03; I 2 = 20%). However, the absolute 24-hour reduction was small and well below the accepted minimal clinically important difference (MCID), suggesting no clinically meaningful opioid-sparing benefit. No significant differences were found in opioid consumption at 48 h, time to first rescue analgesia, or the incidence of nausea, dizziness, or serious adverse events. Conclusion In this meta-analysis, adding liposomal bupivacaine to TAP block resulted in a statistically significant but clinically trivial reduction in 24-hour opioid consumption (below accepted MCID thresholds), with no significant differences at 48 h. Time to first rescue analgesia and adverse events were similar between groups.

BACKGROUND: This study emphasis on effectiveness of various non-pharmacological methods and nursing interventional care and its evaluation among post-caesarean women in selected hospitals in India and other countries. Nursing intervention basically refers to standard post-operative care delivered to women undergone lower segment caesarean section to plummet post-surgery complications, reduce negative experience of the mother, and improve outcome of C-section post operation care and speedy healing of the women. OBJECTIVE: To identify studies regarding rate and incidence of C-sections and to identify studies which had included standard nursing interventional care and their effectiveness in the maternal outcome among post caesarean women at selected hospitals. METHODS: Online database browsed from PubMed, Google scholar, Sodhganga, Medline, research gate, Scopus, WoS by using keywords rate of caesarean section, post -operative care, nursing intervention, maternal outcome after C-section. RESULT: 12 articles were included in this review study reflecting maternal recovery regarding non-pharmacological interventions delivered to post- caesarean mothers. Difference in maternal and foetal outcome between routine nursing care and planned interventional nursing care. Significant recovery has been recorded in all therapeutic studies with positive maternal and foetal outcome. CONCLUSION: To summarise the review study that unveiled the positive maternal outcome which can be attained after caesarean section, by implementing various nursing interventional approaches among post-caesarean women that includes standardized post-operative outcome evaluation. Keywords: Rate and incidence of C-section, post-operative care, caesarean mother, nursing intervention, early ambulation

Vertical transmission of dengue virus (DENV) may produce a wide range of disease symptoms such as premature birth, low birth weight and miscarriages. We report and analyze 6 cases of vertical transmission of DENV type 2 in Salta Province, Argentina, during 2023. DENV infection in mothers and newborns was confirmed by the presence of NS1 antigen, viral nucleic acid and/or immunoglobulin M. Epidemiologic and clinical data were collected upon hospital admission, and laboratory parameters were determined during hospitalization. Most pregnant women exhibited dengue symptoms during the peripartum period, with fever, headache and thrombocytopenia each affecting 66.7% of cases. Three mothers experienced gynecorrhagia. One mother presented with severe dengue and developed pleural effusion. The median time from maternal symptom onset to childbirth was 4 days (interquartile range [IQR] 3-4 days). All neonates were full term with appropriate weight for gestational age, and 4 were females. Three newborns were delivered vaginally, and 3 were delivered by cesarean section. Five cases were symptomatic and presented varied clinical manifestations, including fever (83.3%) and respiratory distress (66.7%). Three neonates had thrombocytopenia, with a median minimum platelet count of 69,500/mm3 (IQR 38,000-81,500/mm3). One newborn with severe dengue experienced plasma leakage. All newborns progressed favorably with symptomatic and supportive care after a median hospitalization of 9 days (IQR 8-12 days). DENV infection should be considered in the differential diagnosis for nonspecific acute febrile syndrome in pregnant women and neonates during dengue outbreaks to provide adequate clinical management of both mothers and infants.

and uterus that often causes postoperative pain. Pain may inhibit early mobilization, lactation, and delay maternal recovery. Lavender aromatherapy is a non-pharmacological therapy with relaxation and analgesic effects through stimulation of the limbic system and endorphin release. Objective: To determine the implementation of lavender aromatherapy in reducing pain among postpartum mothers after cesarean section. Methods: This study used a descriptive method with a case study approach through the nursing process, including assessment, diagnosis, planning, implementation, and evaluation. Pain intensity was measured using the Numeric Rating Scale (NRS) before and after the intervention. Subjects were postpartum mothers on days 1–3 with stable conditions, experiencing moderate to severe pain (scale 6–8), conscious, able to communicate, and willing to participate. Patients with postoperative complications, lavender allergy, or severe respiratory or olfactory disorders were excluded. Results: Lavender aromatherapy administered for ±15–20 minutes reduced pain within the first 30 minutes and the effect lasted up to 8 hours. Pain scores decreased gradually from 6 to 3. Patients reported reduced pain, appeared calmer, and demonstrated improved light mobilization. Conclusion: Lavender aromatherapy can be a safe and practical non-pharmacological intervention to help reduce postoperative pain in postpartum mothers after cesarean section.

Aim: Caesarean section is one of the most frequently performed surgical procedures in obstetrics.Supporting early functional recovery in the postoperative period is of critical importance for maternalhealth and healthcare efficiency. This study aimed to investigate the short-term effects of parietalperitoneal closure on postoperative recovery following caesarean delivery.Materials and Methods: This prospective observational study included women aged 18–45 years whounderwent elective caesarean section under spinal anesthesia between January 15 and June 15, 2025.Emergency cases, procedures performed under general anesthesia, and high-risk pregnancies wereexcluded. Postoperative recovery was evaluated multidimensionally using the EQ-5D Quality of LifeScale, the Katz Index of Independence in Activities of Daily Living, and the Obstetric Quality of Recovery(ObsQoR) score. Additional outcomes included pain scores, return of gastrointestinal function,requirement for additional analgesics, and hematological parameters (NLR, PLR).Results: A total of 120 women were enrolled, with 60 in the peritoneal closure group and 60 in the nonclosuregroup. On postoperative day 5, EQ-5D scores were significantly higher in the closure group (p < 0.05). No statistically significant differences were observed between groups in terms of pain intensity,gastrointestinal recovery, additional analgesic requirement, or hematological parameters (NLR, PLR).Conclusion: The findings suggest that routine parietal peritoneal closure does not provide additionalbenefits for short-term postoperative recovery when considering early return to daily activities andinflammatory markers. Therefore, the decision to close the peritoneum may be better guided by surgicalpreference and intraoperative conditions rather than routine practice.

Background: Hemorrhage has been a leading cause of maternal deaths in Bangla desh over the past decade. Postpartum Haemorrhage (PPH) is one of the leading causes of maternal death worldwide. It is a life-threatening condition and a serious obstetric emergency. The aim of the study is to explore the predictors of secondary postpartum haemorrhage in a medical college hospital. Materials and methods: A hospital-based cross-sectional study was carried out with 40 purposively selected women aged 18 and older who were diagnosed with secondary postpartum hemorrhage and admitted more than 24 hours after childbirth or during the puerperal period. A pre-tested semi-structured questionnaire was used to interview these women in the Department of Obstetrics and Gynaecology at Sylhet MAG Osmani Medical College Hospital in Bangladesh. Results: Three-quarters of the participants (75.0%) were in the 18–30 age range, with an average age of 27.6±4.7 years.Among the patients, 20.0% reported issues during a previous pregnancy, and 65.0% experienced complications in their last delivery.Among the patients, 32.5% delivered in a hospital, while 67.5% gave birth at home. Of the total, 25.0% underwent a cesarean section, while 75.0% had a vaginal delivery. Additionally, 70.0% of the patients with secondary postpartum hemorrhage experienced varying degrees of anemia, ranging from mild to severe. Retained placental fragments were the primary cause of secondary PPH, accounting for 52.5% of cases, while endometritis and subinvolution each contributed to 15% of the cases. Conclusion: Enhancing awareness of the predictive factors for secondary PPH could significantly contribute to the recognition and management of postpartum morbidity and mortality Chatt Maa Shi Hosp Med Coll J; Vol.24 (2); July 2025; Page 3-7

Our objective was to evaluate the ultrasonography sliding sign with enhanced reliability using an inter-observer approach, with the aim of predicting standardized intra-abdominal adhesions before cesarean section. Between January 2022 and January 2024, this retrospective cross sectional study included 350 individuals who underwent cesarean section. Data from 198 participants who met the inclusion criteria were analyzed. Analyzes were made with SPSS 26.0. The Mann-Whitney U test was employed to assess variables that were not normally distributed. Chi-square test and Fisher precision test were employed in the categorical data analysis. These were presented as counts and percentages (%). An inter-rater reliability analysis was performed for ultrasonography sliding sign finding. For this purpose, the Cohen's Kappa was calculated. Receiver operating characteristic analysis was used to determine the area under the curve, which indicates the average sensitivity of ultrasonography sliding sign finding. There was a 95% confidence interval for the results. A p value of less than 0.05 was deemed statistically significant. To assess sliding signs, all pregnant participants received transabdominal ultrasonography. The study achieved triple masking: both sonographers were unaware of the surgical findings, the surgeon remained unaware of the ultrasound findings, and the data analyst was unaware of both sonographic and surgical findings. According to the Nair's modified scoring system, the cases were classified as Group 1 (adhesions present [Grade ≥ 1]; n = 107, 54%) and Group 2 (no adhesions [Grade 0]; n = 91, 46%). The diagnostic value of transabdominal ultrasonography sliding sign for detecting the presence of intra-abdominal adhesion (according to the modified Nair's scoring system) yielded 84.6% specificity and 58.9% sensitivity. A Nair's score ≥ 2 was identified as the cut-off point, with the sliding sign finding being statistically significant, resulting in 70% specificity and 54% sensitivity. This research validates the use of a sliding sign during transabdominal ultrasonography in pre-cesarean evaluation in patients with previous cesarean section. It has been shown that applying the adhesion scoring system categorically as well as using it numerically makes a difference by analyzing the cut-off point of Nair's score as 2. From this perspective, the reliability of the sliding sign finding in transabdominal ultrasound will be better demonstrated.

Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome. It is uncommon in the postpartum period and frequently under-recognised. Described here is a 31-year-old woman who developed HLH shortly after an uncomplicated emergency caesarean section. Initial postpartum pyrexia was attributed to Staphylococcus aureus bacteraemia and treated with intravenous antibiotics. Extensive investigations failed to identify an infectious source. An H-score of 216 indicated a high likelihood of HLH, and treatment with intravenous methylprednisolone followed by anakinra resulted in clinical stabilisation and full recovery. This case highlights HLH as an important differential diagnosis in postpartum patients presenting with unexplained fever and haematological abnormalities. Early recognition and prompt initiation of immunosuppressive therapy are critical to improving outcomes in this potentially fatal but treatable condition.

Objective: To investigate the key determinants of high CS rates in Peshawar’s resource-constrained healthcare system, exploring both demand-side (patient-related) and supply-side (healthcare provider and facility-related) factors. Study Design: Mixed-method approach. Setting: Three Major Hospitals from Peshawar Including Lady Reading Hospital, Hayatabad Medical Complex and Rehman Medical General Hospital. Period: January 2023 to December 2023. Methods: A hospital-based mixed-methods study was conducted across three major public and private facilities (N=221 CS cases). Quantitative data from medical records were analysed using multivariate logistic regression to identify independent predictors. Complementary in-depth interviews with providers (n=15) and mothers (n=15) explored decision-making processes. Results: The CS rate among study facilities was 48.6%, far exceeding WHO recommendations. Key independent predictors included: private hospital delivery (aOR=3.24, 95% CI:1.87-5.61), previous CS (aOR=4.83, 95% CI:2.42-9.65), low-income status (aOR=2.67, 95% CI:1.51-4.72), and primiparity (aOR=2.15, 95% CI:1.25-3.71). Qualitative data revealed three major themes: (1) defensive medical practices in private sectors, (2) inadequate labour monitoring leading to "failure to progress" diagnoses, and (3) socioeconomic perceptions of CS as superior care. Paradoxically, low-income women had higher CS rates despite typically facing access barriers. Conclusion: Multiple modifiable factors drive unnecessary CS in Pakistan's resource-constrained setting, particularly in private facilities and among disadvantaged populations. Targeted interventions should include: VBAC protocol implementation, provider training on labour management, and policy reforms addressing perverse financial incentives. The inverse socioeconomic gradient warrants particular attention in future research and programming.

Background: The integrity of the lower uterine segment scar following cesarean section (CS) is a critical determinant of safety in subsequent pregnancies. Sonographic measurement of the uterine scar niche and residual myometrial thickness provides a non-invasive means of stratifying risk for uterine rupture, scar dehiscence, and adverse perinatal outcomes. Despite a nationally elevated CS rate in Iraq, data from local populations remain scarce. Objective: To evaluate the relationship between lower uterine segment (LUS) scar thickness measured by transabdominal ultrasonography at 36–38 weeks of gestation and subsequent obstetric outcomes in women with a previous cesarean section attending Babylon Educational Hospital for Gynecology and Pediatrics, Iraq. Methods: A prospective cohort study was conducted between January 2023 and December 2024. A total of 215 pregnant women with one or more prior CS were enrolled and classified by LUS thickness: Group I (thin scar, <2.5 mm), Group II (adequate scar, 2.5–3.5 mm), and Group III (thick scar, >3.5 mm). Maternal and neonatal outcomes including mode of delivery, intraoperative uterine rupture or dehiscence, blood transfusion, neonatal Apgar scores, NICU admission, and birth weight were recorded and analyzed. Results: Of the 215 participants, 67 (31.2%) had a thin scar, 89 (41.4%) an adequate scar, and 59 (27.4%) a thick scar. Complete uterine rupture occurred exclusively in Group I (7.5%), and scar dehiscence was significantly more frequent in Group I (20.9%) compared with Groups II (2.2%) and III (0%) (p<0.001). Emergency CS, blood transfusion, and neonatal NICU admission were all significantly higher in Group I. Logistic regression identified LUS thickness as an independent predictor of uterine dehiscence (OR 0.34 per mm increase; 95% CI 0.18–0.63; p=0.001). Conclusion: Lower uterine segment scar thickness measured at 36–38 weeks of gestation is a reliable sonographic predictor of uterine scar complications and adverse perinatal outcomes in Iraqi women. Routine third-trimester LUS assessment should be incorporated into antenatal care protocols for women with previous cesarean delivery.

Physician adoption of new information about a medical procedure can affect patient outcomes. Medical malpractice law may influence physician use of such information. We analyze how physician reactions to information shocks regarding vaginal births after cesarean sections (VBACs) in the 1990s were mediated by tort reform and the standard used in malpractice claims to determine a physician's duty of care to patients. Differentiating states according to whether they capped non-economic damages in malpractice claims (Caps) and whether they defined the duty of care using a national or a local reference point, we analyze how physicians under the four legal regimes reacted to a series of adverse information shocks regarding VBACs over the period. Our results suggest that physicians whose duty of care is determined by standard practices nationwide are less likely to adopt innovations which have not yet been incorporated into those practices and more likely to adopt innovations once they are incorporated into those practices. Caps may moderate these effects. Our results also suggest intuitive heterogeneity in the effects of legal regime on physician decisions.

Health systems in low- and middle-income countries (LMICs) like Bangladesh face persistent challenges in delivering timely and equitable care, often exacerbated by poor planning and inefficient resource allocation. Forecasting service utilization using routine health data can support more responsive and data-driven health system planning, yet such approaches remain under utilized in Bangladesh. By analyzing service utilization trends and projecting future service volume at national and regional levels, we aim to improve region-specific health planning. This can promote more efficient and equitable service provision. We analyzed monthly routine health service data reported into the District Health Information Software 2 (DHIS2) platform between January 2021 and March 2025 in Bangladesh. We examined key indicators across maternal, newborn, child and hospital-based services. Bayesian log-linear Poisson regression models, adjusted for seasonality and autocorrelation, were applied to forecast service utilization for the final nine months of 2025 and all of 2026. Relative changes in 2025 and 2026 were calculated using 2024 as the reference year. The analysis revealed rising trends across most service areas relative to 2024 levels. Kangaroo Mother Care (KMC) has the highest projected expansion, with coverage forecast to rise by over 75% by 2026. Over the same time period, outpatient visits and pneumonia treatment are also expected to increase by about 30%. More moderate increases are seen in low birth weight (LBW) deliveries, cesarean sections, and normal deliveries. Notable regional disparities persist, with Dhaka and Chittagong showing the highest service utilization, while Barishal and Sylhet consistently report the lowest levels. Bangladesh's health system must prepare for increasing service utilization across all service categories. Forecasting using DHIS2 data supports for proactive planning and equitable resource allocation. Strategic investments in infrastructure, workforce, and data-driven planning are essential for building a resilient health system.