Cesarean Section Research Articles

Pregnancy care and perinatal outcomes in pregnant women with a shunt for hydrocephalus.

The number of patients with an implanted shunt reaching reproductive age and planning pregnancy is increasing thanks to advances in the treatment of hydrocephalus. Changes in the mother's organism, which are mainly related to the accumulation of water in the organism and the elevation of intra-abdominal pressure, contribute to the increased incidence of complications during pregnancy and childbirth. Therefore, it is necessary to make a preconception exam and specify pregnancy management, a suitable method of childbirth dealing with potential complications. Possible malfunction of the shunt is solved individually according to the current neurological findings and taking into account the patient's overall condition and gestational age. Vaginal delivery is considered safe and preferred by most authors. Primary caesarean section is indicated only in patients with a history of rapidly progressing deterioration of the neurological condition due to shunt malfunction or serious complications related to its impaired shunt function. In an uncomplicated pregnancy with normal values of intracranial pressure, both general and epidural or spinal anesthesia can be used when choosing anesthesia.

Extra-Hepatic Portal Venous Obstruction in Pregnant Women of South-Asian Descent: A Case Series

Liver diseases complicate approximately 3% of pregnancies worldwide, and require specialized care to ensure optimal pregnancy outcomes. Extra-hepatic portal venous obstruction (EHPVO), even though asymptomatic in a majority of the cases, has a higher risk of variceal bleeding in pregnancy and adverse pregnancy outcomes. In this series, we describe five cases of EHPVO presenting during pregnancy at our tertiary care hospital, their antenatal management, and delivery outcomes. In our case series on EHPVO in pregnancy, a majority of the women were diagnosed during childhood and adequately asymptomatic before pregnancy. Two women underwent Endoscopic band ligation for esophageal varices and one woman underwent splenectomy before pregnancy for disease control. One woman was Anti-nuclear antibody (ANA) positive and another was Anti-phospholipid antibody (APLA) positive, while the other three did not have pre-existing thrombotic tendencies. One patient required Endoscopic band ligation during pregnancy. Pregnancy complicated by hypertension was noted in two of the five women (40%). Four of the five women (80%) had thrombocytopenia requiring blood products during delivery. Two women underwent preterm vaginal delivery, and one woman underwent preterm Caesarean section because of placental abruption. Three women had a post-partum hemorrhage, which was effectively managed with uterotonics and blood products. All five women and their neonates were discharged in good health. Multi-disciplinary approach with standardized antenatal care can give positive pregnancy outcomes in women with EHPVO.

Association of Placenta Previa with Previously Scarred and Non Scarred Uterus: A Descriptive Cross-Sectional Study

Introduction: Placenta previa, where the placenta is partially or completely placed in the lower uterine segment, is a major contributor to vaginal bleeding during pregnancy and affects 0.4-0.5% of all labors. Its exact cause is uncertain but is believed to be linked to aberrant endometrial vascularization caused by scarring or atrophy from prior trauma, surgery, or infection. Objective: The objective of this study was to establish an association between the placenta previa and the scarring of uterus. Methods: A cross-sectional study was conducted on pregnant women at Nobel Medical College Teaching Hospital, Biratnagar, from November 2021 to October, 2023. Ethical approval and written consent were obtained from all participants. Using convenient sampling technique, the study involved 57 participants out of 3576 patients who were admitted for Lower Segment Cesarian Section. Results: A study of 3576 patients admitted for Lower Segment Cesarian Section at Nobel Medical College Teaching Hospital, we found 57 cases of placenta previa over 24 months. The incidence was 1.59%, with 1.82% in patients with a previous history of LSCS and 1.51% without any history of scarring. The results showed no association between placenta previa and uterine scarring. Conclusion: The study found no association between the incidence of placenta previa and scarred/non-scarred uterus, but a slightly higher likelihood of having placenta previa in those with a history of uterine scarring.

Outcome differences of emergency cesarean delivery in the delivery room versus the operating room: A study based on propensity score matching.

This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room. The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters. The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates. The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.

Diagnostic value of prenatal ultrasound screening and analysis of pregnancy outcomes in velamentous umbilical cord insertion

Objective: To explore diagnostic value of prenatal ultrasound screening in velamentous umbilical cord insertion (VCI) and its influence on perinatal outcomes, and to provide theoretical basis for clinical practice. Methods: Fifty-eight pregnant women diagnosed with VCI before or after delivery admitted to the First Affiliated Hospital of Xi'an Jiaotong University were selected from January 2012 to December 2022. The clinical features and perinatal outcomes of 45 women finally with VCI after delivery (VCI group) were retrospectively analyzed, and 225 women with normal umbilical cord attachment were selected as the control group during the same period. Results: (1) Among 58 women, 54 (93.1%, 54/58) were diagnosed with VCI by prenatal ultrasound screening, 4 patients (6.9%, 4/58) were missed; and 13 (22.4%, 13/58) were misdiagnosed. Finally, a total of 45 women were confirmed by postpartum placental examination, and 11 (24.4%,11/45) were combined with vasa previa. (2) There were no differences in age, number of pregnancies, and number of induced abortions between the two groups (all P>0.05). Compared with the control group, the rate of assisted reproductive technology [13.3% (6/45) vs 0.4% (1/225); P<0.01], and twin pregnancy rate [8.9% (4/45) vs 0.4% (1/225); P<0.01] in the VCI group were significant higher. (3) Compared with the control group, the rate of placenta previa, succenturiate placenta, vasa previa, postpartum hemorrhage, prenatal hemorrhage and postpartum intrauterine remainder in the VCI group were significant higher (all P<0.05); there was no significant difference in the incidence of placental abruption, premature rupture of membranes, fetal distress and single umbilical artery between the two groups (all P>0.05). The incidence of fetal structural abnormalities in the VCI group (4.4%, 2/45) was higher than that in the control group (1.3%, 3/225), but there was no significant difference between the two groups (P=0.195). (4) The cesarean section rate [75.0% (33/44) vs 45.1% (101/224); P<0.01], preterm birth rate [29.5% (13/44) vs 5.4% (12/224); P<0.01], rate of small for gestational age [20.5% (9/44) vs 5.4% (12/224); P<0.01] in the VCI group were significant higher. However, neonatal birth weight [(2 928±552) vs (3 353±498) g; P<0.01], and 1-minute Apgar score (median: 10 vs 10; P<0.01) in the VCI group were lower than those in the control group. Conclusions: Prenatal ultrasound screening is an important method to diagnose VCI. VCI is more prone to adverse pregnancy outcomes, such as postpartum hemorrhage, premature delivery, small for gestational age, et al. Its risk factors include twin pregnancy, assisted reproductive technology, placenta previa, and para-placenta.

The effects of footbath on postpartum pain after caesarean section: A case report

Background: Caesarean section delivery is carried out not only based on medical indications but also non-medical ones. Caesarean section delivery has an impact on both the mother and fetus. The risk of delivery with caesarean section is three times greater than with normal delivery. Purpose: To determine the effect of a footbath on postpartum pain after cesarean section. Method: Descriptive case study with a nursing process approach which includes assessment, nursing diagnosis, planning, implementation and evaluation. Results: Footbath for 20 minutes at a time can make the patient more relaxed and calm the patient. This therapy can lower the postpartum pain scale from 5 to 3. Conclusion: Footbath or soaking the feet in warm water can reduce postpartum pain after a cesarean section. This therapy is recommended as an additional intervention to reduce pain in post-cesarean section mothers.

Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study

BackgroundPostpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.MethodsWe conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.ResultsA total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10–1.48], anemia (aOR 1.66; 95% CI 1.34–2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39–5.05), coagulopathy (aOR 25.92; 95% CI 8.59–69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86–4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04–2.47), uterine scar (aOR 1.39; 95% CI 1.15–1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74–4.38), polyhydramnios (aOR 2.52; 95% CI 1.19–4.68) and placenta previa (aOR 25.03; 95% CI 21.04–29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.ConclusionsTen risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.

Contemporary issues of the birth trauma

Background. Birth trauma is a group of diseases caused by mechanical factors during childbirth. Birth trauma is an interdisciplinary problem, affecting various fields of medicine, such as obstetrics, pediatrics, child neurology and other sciences. Birth trauma occupies an important place in the structure of perinatal morbidity and mortality. Birth injuries of newborns during vaginal birth occur in 3.6% of cases, during cesarean section — in 1.2%. However, at present, despite a comprehensive study of the problem, the incidence of birth trauma in newborns remains high. Along with obstetric birth trauma, spontaneous birth trauma also occurs — not associated with any obstetric care.Purpose of review. To summarize and analyze the available data on the causes of birth trauma in newborns depending on the type of birth injury.Materials and methods. The review includes published data over the past 10 years regarding the study of the causes of the main types of birth injuries in newborns. The literature search was conducted in Web of Science, Google Scholar, PubMed, and ELibrary databases.Results. The problem of fetal-pelvic disproportion in the genesis of the development of risk factors for maternal-fetal trauma remains relevant. Fetal macrosomia is one of the most significant factors in birth trauma. The most common skull injury in newborns is cephalohematoma. According to the mechanism of occurrence, birth trauma is divided into spontaneous — occurring during physiological childbirth — and obstetric — associated with any obstetric benefits. The degree of configuration of the fetal head plays a significant role in the pathogenesis of birth trauma. Birth trauma is considered as a systemic reaction on the part of the newborn’s body, which leads to a breakdown of compensatory and adaptive mechanisms and the development of critical damage to the central nervous system and is differentiated from birth damage, which includes only local changes.Conclusion. To search for preventive measures aimed at preventing birth injuries in newborns, it is necessary to systematize the groups of causes that influence the increased risk of birth injury. Timely assessment of the pathological configuration of the fetal head is extremely important when deciding on the advisability of using obstetric aids during vaginal operative delivery, since it is an early predictor of the formation of fetal-pelvic disproportion — a significant factor in birth trauma in the newborn. In recent years, taking into account the active study of molecular genetic mechanisms in the genesis of the formation of various pathological conditions, the search for various genetic and epigenetic factors that influence the risk of developing birth traumatic injuries in a newborn against the background of individual susceptibility to the effects of any physical factors during childbirth.

Nomogram Predictive Model for Vaginal Birth after One Prior Cesarean Section: A Retrospective Study

Background: Repeat cesareans pose significant maternal risks, whereas vaginal birth after cesarean (VBAC) offers better outcomes, with a complication rate of 2.4% compared with 3.6% for elective repeat cesareans and 14.1% for failed trial of labor after cesarean (TOLAC). TOLAC rates are low in China, and success rates vary between 60% and 80%. This study aims to develop a nomogram-based predictive model for VBAC in China and improve existing, less rigorous scoring models. Methods: This retrospective cohort study was conducted at Hangzhou Women's Hospital from February 2015 to March 2020, and included 159 parturient attempts at labor after one prior low transverse cesarean section. The participants were divided into two groups based on their mode of delivery for comparison: the VBAC and the TOLAC failure group. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors for VBAC and develop a nomogram predictive model to estimate the success rate of TOLAC. The bootstrap method was used for internal validation of the models. Three different VBAC prediction models were evaluated by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision curves. Results: A total of 127 women had VBAC and 32 women failed TOLAC, with a success rate of 79.9%. Three independent factors affecting the VBAC were identified: gestational age at delivery, Bishop score and newborn birth weight. A predictive nomogram model for the VBAC was constructed that incorporates these three factors. The model showed a good fit (χ2 = 11.94, p = 0.154) with an overall prediction accuracy of 81.1%. The area under the ROC curve was 0.83 (95% CI (confidence interval), 0.76–0.90) (p &lt; 0.001) and the optimal cut-off value was 83.4%. The bootstrap internal validation showed that our predictive model maintained high overall accuracy and specificity, but exhibited low sensitivity and a low Kappa coefficient. Compared to the Grobman model and Jiaming Rao et al. model, our developed prediction model possesses the strongest discriminatory ability and the highest net benefit, followed by the model by Jiaming Rao et al. All three models demonstrate a high degree of fit. Conclusions: Shorter gestational age at delivery, lower newborn birth weight and higher cervical Bishop score are favorable factors for VBAC. The predictive nomogram model for the VBAC after a single cesarean section, constructed with these three factors, has good predictive efficacy. The model is simple to calculate and has practical value in the clinical selection of suitable candidates for TOLAC after a single cesarean section.

Paragangliome et grossesse : une histoire mictionnelle palpitante

Objectives: Carrying out a pregnancy to term in a patient with a paraganglioma or pheochromocytoma (PPGL) results from a multidisciplinary challenge. The objective was to compare our therapeutic attitude with the existing literature and to identify optimal treatment.Methods: Description of a case of paraganglioma treated during pregnancy at the University Hospital Center of Caen (France) in 2024 and comparison with the literature.Results: We describe a patient with a family history of paraganglioma, in whom paravesical PPGL was discovered at 18 weeks of gestation. The symptoms were marked by episodes of palpitations and headaches during urination. The diagnosis was confirmed by a measurement of urinary metanephrines associated with magnetic resonance imaging. After initiation of alpha-blocker treatment, delivery was performed by cesarean section at 36 weeks of gestation. An excision was carried out by laparoscopy 2 months postpartum without intra- and post-operative complications.Conclusions: The absence of antenatal diagnosis of PPGL is the main risk factor increasing maternal and fetal mortality. Certain criteria such as a family history, the appearance of early or malignant arterial hypertension should suggest the diagnosis of PPGL. The initiation of alpha-blocker treatment upon diagnosis is essential. The curative therapy remains surgical excision. Its timing depends on its size, location, term of pregnancy and route of delivery. It is preferable to postpone it until postpartum in order to reduce the risk of complications.

Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants

BackgroundThe objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).MethodThe data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.ConclusionMaternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.

A double‐blind, randomized, placebo‐controlled trial of melatonin as an adjuvant agent for induction of labor: The MILO trial

AbstractIntroductionMelatonin has been suggested to have a biological role in the onset and progress of labor. We tested the hypothesis that the addition of melatonin during an induction of labor will reduce the need for a cesarean birth.Material and MethodsThis trial underwent protocol amendments that are detailed in the main text of the article. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12616000311459). At a multi‐center health service including secondary and tertiary obstetric hospitals, we performed a randomized, double‐blind, placebo‐controlled trial in women with a singleton cephalic pregnancy, free of significant maternal or perinatal complications who were undergoing induction of labor (with or without cervical ripening). Women were randomized to 10 mg melatonin vs placebo, with cervical ripening as required, and then 6‐h during their induction of labor to a maximum of four doses or until birth. The primary outcome was cesarean birth. Secondary outcomes included labor, maternal, and neonatal outcomes. Data were analyzed using intention to treat. Sub‐group analyses based on mode of ripening and parity were also performed.ResultsBetween 2019 and 2021 we randomized 189 women (103 to melatonin and 86 to placebo). The study was prematurely terminated due to logistical complications resulting from the COVID‐19 pandemic. Cesarean rates were 28/103 (27.2%) in the melatonin group versus 20/84 (23.3%) in the placebo group (RR 1.17 95% CI 0.71–1.92). There were no significant differences in rate of cesarean birth between the melatonin and placebo groups for failure to progress (13.4% and 9.3%, respectively, RR 1.46; 95% CI 0.64–3.32) or suspected fetal distress (10.7% and 10.5%, respectively, RR 1.02; 95% CI 0.44–2.34). The melatonin group had significantly lower rates of spontaneous vaginal birth within 24 h (35.0% vs. 50.0%; RR 0.70 95% CI 0.50–0.98). The rates of secondary outcomes such as total length of labor, rate of postpartum hemorrhage, and instrumental birth were comparable. Babies born in the melatonin group were more likely to need admission to the special care nursery, namely for hypoglycemic monitoring (18.5% vs. 8.1% RR 2.26; 95% CI 1.00–5.10).ConclusionsIn women undergoing induction of labor, melatonin does not reduce the cesarean section rate. Melatonin use intrapartum may also be associated with neonatal hypoglycemia.

Early pregnancy hyperglycaemia among pregnant women with risk factors for gestational diabetes increases the risk of pregnancy complications

The current diagnostic criteria for gestational diabetes (GDM) were based on data from women after 24 weeks of gestation, but this may not be equally applicable for earlier gestation. There is insufficient data regarding early pregnancy glycaemia and the associated complications. We retrospectively reviewed 39,483 deliveries and 12,918 with risk factors for GDM underwent oral glucose tolerance test (OGTT) before 24 weeks of gestation. A strong and progressively positive association was observed with any pregnancy complications in both fasting glucose (FG) and 2 h glucose (2hG). The increased risk of developing any pregnancy complications started from FG 4.5–4.7 mmol/L and 2hG of 6.2–6.9mmol/L. Every increase by 1 mmol/L in FG or 2 hG levels increased the risk of developing any complications (aOR 1.614 for FG and 1.131 for 2hG), pre-eclampsia (aOR 1.472 for FG and 1.143 for 2hG), maternal insulin use (aOR 12.821 for FG and 2.366 for 2hG), primary Caesarean section(aOR 1.274 for FG and 1.099 for 2hG), shoulder dystocia (aOR 1.941 for FG and 1.282 for 2hG), macrosomia(aOR 2.203 for FG and 1.072 for 2hG), and large for gestation age(aOR 2.157 for FG and 1.074 for 2hG). Therefore, glycaemic levels in early pregnancy among high-risk women positively associated with pregnancy complications, even at levels below the current recommended diagnostic criteria for GDM.

Mode of delivery in chorioamnionitis: impact on neonatal and maternal outcomes

BackgroundThe impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.MethodsSingleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.ResultsAfter chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5–13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1–18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.ConclusionsThe rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.

Robson Classification in Cesarean Section in Chhattisgarh, India

Robson Classification in Cesarean Section in Chhattisgarh, India

Complications among assisted reproductive technique (ART) twin gestations versus spontaneously conceived twin gestations (SC): A retrospective outcome analysis among an Afro-Caribbean population at a university-based hospital in Jamaica

Aim: The aim of the study is to compare the frequency of maternal and neonatal complications among pregnant women with twin pregnancies conceived spontaneously versus conceived by assisted reproductive technique (ART). Methods: Univariate and bivariate analyses of maternal characteristics and neonatal outcomes were performed in this retrospective cohort study at a university-based hospital between 2006 and 2016 in Jamaica, a middle-income Caribbean country. Neonatal data were the primary outcomes: APGAR scores, gestational age, birth weight, admission to the neonatal intensive care unit (NICU), and the level of ventilatory support required. Maternal characteristics, comorbidities, and pregnancy complications were other outcomes studied. Results: There were 157 SC and 27 ART twin gestations. Women conceiving via ART were more likely to be advanced maternal age (p greater 0.001), have uterine fibroids (p greater 0.001), previous myomectomy (p=0.001), and incompetent cervix (p=0.003), delivery by cesarean section (p=0.007), and experience hemorrhage (p=0.017) than SC. There were no statistically significant differences in rates of preterm births, birth weight, APGAR scores, or NICU admissions. Assisted reproductive technique twins were more likely to require continuous positive airway pressure (CPAP) (p=0.025), with no differences observed between the two groups for neonatal respiratory distress. Conclusion: In our predominantly Afro-Caribbean population, ART mothers were observed to have more poor maternal outcomes than mothers who conceived spontaneously. Assisted reproductive technique and SC twins had similar neonatal outcomes; however, ART twins were more likely to require CPAP.

A nomogram for predicting postpartum post-traumatic stress disorder: a prospective cohort study

BackgroundPostpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.MethodsRecruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.ResultsA total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.ConclusionsWith its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

Gossypiboma with enterocutaneous fistula after cesarean section: a case report and review of the literature

IntroductionAlthough precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01–0.001%, of which gossypibomas make up 80% of cases.Case presentationA 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively.ConclusionRetained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery.

Epidermolytic Hyperkeratosis Type 1 with a New Heterozygous Mutation in KRT1 Gene: A Case Report

Background: Epidermolytic hyperkeratosis (EHK) formerly known as bullous ichthyosiform erythroderma, is a rare autosomal dominant inheritance condition with a prevalence ranging from 1:200,000 to 1:300,000. The underlying etiology of which is a mutation in the genes responsible for keratin proteins synthesis, primarily in KRT1 and KRT10 genes, cataloged under OMIM number 113800. Clinicopathological presentations include blistering in the neonatal period followed by ichthyotic hyperkeratosis in childhood and adolescence, characterized by the hallmark features of generalized dry skin, scaling, hyperkeratosis, and frequently associated with erythroderma. EHK may present with or without palmoplantar keratoderma involvement, depending on the keratin gene variant. Case report: A 24-year-old male of Arab descent was born with diffuse skin hyperkeratotic plates featuring erythematous fissures, covering his entire body, resembling a collodion baby. His birth was full-term via cesarean section without complications, although he later developed developmental dysplasia of the hip. By the time he started primary school, he began experiencing severe thickening of the skin around his joints, reducing flexibility and leading to contractures and significant disfigurement. He is undergoing treatment with acitretin. Genetic testing using Next-Generation Sequencing (NGS) was performed to identify the responsible gene, revealing a novel heterozygous variant in the KRT1 gene (OMIM 139350), while no variant was detected in the KRT10 gene. Conclusion: EHK type 1 manifests with a new heterozygous variant in the KRT1 gene. This rare disorder, associated with variant in genes related to keratin production such as KRT1 and KRT10, results in distinctive skin features present from birth, as well as joint problems and fungal foot infections. Genetic testing has confirmed the presence of a variant in the KRT1 gene.

Association between preoperative shock index and hypotension after spinal anesthesia for non-elective cesarean section: a prospective cohort study

BackgroundShock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section.MethodsIn this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves.ResultsThree hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15–6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14–4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72–10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06–1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49–0.57) and 0.56 (95%CI 0.51–0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively.ConclusionIn parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability.Trial registrationRegistration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov.