Birth Research Articles

PERINATAL OUTCOME IN SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN SECTION

Successful vaginal birth has been reported in 60%–80% of cases reported in published studies of women attempting vaginal birth after a previous Cesarean section. The recommended criteria for selecting candidates suitable for VBAC are potentially applicable in tertiary centers in developing countries, but there are many inadequacies in meeting them in our environment. VBAC avoids major abdominal surgery, lowers the women’s risk of postpartum morbidities like fever, blood transfusion, infections, and shorter hospital stay, and encourages earlier breastfeeding and better bonding between mother and neonate. Objectives: To determine the frequency of perinatal outcomes in successful vaginal birth after cesarean section (VBAC). Methods: Descriptive, case series study in the Department of Obstetrics & Gynecology, Lady Reading Hospital, Peshawar from August 2020 to February 2021. A total of 207 pregnant women with singleton pregnancy of cephalic presentation with successful vaginal birth after cesarean of gestational age 37-41 weeks were included. Patients with multiple pregnancies, ruptured uterus, placenta previa, and fetal malpresentation were excluded. After taking informed consent, all women were followed till delivery and perinatal outcome i.e. low birth weight, Apgar score<7 at 1 minute, and NICU admission was noted. Results: The age range in this study was from 18 to 40 years with a mean age of 29.32 ± 4.57 years. The majority of the patients 104 (50.24%) were between 31 to 40 years of age. The mean gestational age was 38.33 ± 1.17 weeks. The mean parity was 2.11 ± 0.82. In my study, the frequency of perinatal outcome in successful vaginal birth after the cesarean section was as follows; low birth weight in 15.94%, APGAR score<7 at 1 minute in 9.67%, and NICU admission in 14.01% neonates. Conclusion: This study concluded that the frequency of perinatal outcome in successful vaginal birth after cesarean section was as follows; low birth weight in 15.94%, APGAR score<7 at 1 minute is 9.67%, and NICU admission in 14.01% neonates.

Ancient Practice of Garbh Sanskar and its Importance in Modern Scenario

Garbh Sanskar is ancient practice of nurturing mental, physical and emotional environment of mother during her pregnancy stage to promote overall well-being of both mother as well as her unborn child. This ancient practice combines holistic habits that include balanced nutrition, Yoga, recitation of Mantra, prayer and meditation, etc. This process inculcates positive values in the subconscious mind of Garbh (fetus) and also nourish mother in all means to manifest optimal strength in all dimensions. The practices of Garbh Sanskar maintain well being of mother and child, these effects subsequently reflects in the later stages of pregnancy and after the child birth. The current scenario witnessed hampered pattern of life style which significantly deteriorate health of women carrying fetus, this may cause problem in normal child birth or disrupt health of new born. Therefore practices of Garbh Sanskar become crucial in modern’s day life style to prevent mother and child from the harmful effects of stressful pattern of current scenario. This article highlights ancient practice of Garbh Sanskar and its importance in modern scenario.

Molar Incisor Hypomineralization and Related Risk Factors among Primary School Children in Jeddah: A Cross-Sectional Study.

Molar Incisor Hypomineralization (MIH) is a prevalent multifactorial developmental dental defect with unclear etiology. This study aimed to identify potential risk factors for MIH among primary school children in Jeddah, Saudi Arabia. A cross-sectional study including children aged 7 to 10 years old, recruited from twelve randomly selected schools located in three regions of Jeddah city, was carried out. The children were examined for MIH and dental caries using the European Academy of Pediatric Dentistry Criteria (2003) and the DMFT/dmft WHO index. Parents were asked to provide medical and socio-demographic information on their children from their first two years of life. A total of 2010 children were examined, with 888 parents responding to the survey (a 44.2% response rate). Lower maternal education was found to be significantly associated with a decreased adjusted odds ratio (AOR) of MIH (Model 1: p = 0.014, AOR = 0.646, and 95% CI = 0.456 to 0.915; Model 2: p = 0.019, AOR = 0.658, and 95% CI = 0.465 to 0.933). Being an only child, a child's birth order, type of delivery, breastfeeding, and medical conditions were not associated with MIH. The significant association between MIH and maternal education suggests that further research is needed to explore the underlying mechanisms and identify other potential confounding variables.

Anatomical and physiological aspects of the mutual influence of circulatory hypoxia of the myometrium and non-progressive labour

Non-progressive labour occurs in almost 10% of deliveries and is a main reason for unplanned cesarean sections and operative vaginal births using obstetric forceps or vacuum extraction. This article describes the morphological transformation of the myometrium and uterine blood vessels that occurs during pregnancy. It is shown that the myometrium inevitably experiences hypoxia at the microstructural level during each normal or pathological labour. We analyzed recent studies of the mutual influence of myometrial hypoxia and labour dystocia. Experimental and clinical studies showed relationship between the pH values and lactate levels determined in the myometrium on its contractility. Further research is justified, including the study of the pH and lactate values in amniotic fluid in patients with non-progressive labor. Finally, that will allow for clarifying the conditions and timing of labour stimulation with oxytocin and identifying a group of patients for whom oxytocin administration is contraindicated or hopeless.

Modern ideas about the predictions of postpartum hemorrhage

Postpartum hemorrhage is currently a pressing problem. Its increasing incidence over time is observed not only in developing countries but also in countries with high levels of income and resources that significantly contribute to the development and functioning of the health system, which is the cause of scientific debate worldwide. The risk factors of postpartum hemorrhage include low hemoglobin level before birth, older maternal age, first birth, prolonged duration of the first and second stages of labor, high birth weight of the newborn, abnormal placentation, surgical vaginal birth, cesarean section, episiotomy, and placental defects. This review outlines the main risk factors of postpartum hemorrhage, displays new data on the relationship between types of assisted reproductive technologies and postpartum hemorrhage, and discusses prospects for research regarding the problem. A link between assisted reproductive technologies and postpartum hemorrhage elucidates the increase in the incidence of postpartum hemorrhage in developed countries. It is crucial to further research on obstetric risks following the use of assisted reproductive technologies and identify additional risk categories for complications to provide quality medical care and reduce maternal and perinatal losses.

Dietary amino acids, macronutrients, vaginal birth, and breastfeeding are associated with the vaginal microbiome in early pregnancy.

This secondary analysis of the MicrobeMom randomized controlled trial reveals that dietary amino acids, macronutrients, previous vaginal birth, and breastfeeding have the strongest associations with vaginal taxonomy in early pregnancy. Function of the vaginal niche is associated mainly by species composition, but smoking, vitamin K, and phenylalanine also play a role. These associations provide an intriguing and novel insight into the association between host factors and diet on the vaginal microbiome in pregnancy and highlight the need for further investigation into the complex interactions between the diet, human gut, and vaginal microbiome.

Prevalence of postpartum complications and associated factors among postpartum women in Uganda, a cross-sectional study

BackgroundPostnatal care exhibits the lowest coverage levels in the obstetric continuum of care. The highest rates of maternal and newborn morbidity and mortality occur within 24 h of birth. Assessment of women in this time period could improve the detection of postpartum complications and maternal outcomes. This study determined the patterns of maternal assessment and the factors associated with postpartum complications.MethodsThis was a cross-sectional study involving observations of immediate postpartum care provided to women following uncomplicated vaginal births at three health facilities in Mpigi and Butambala districts (Uganda) from November 2020 to January 2021. Data were collected using an observation checklist and a data abstraction form for maternal and newborn social demographic data. The collected data were analyzed using Stata version 14.0. Maternal assessment patterns were summarized as frequencies, and the prevalence of postpartum complications was calculated. Logistic regression analysis was performed at both bivariate and multivariate levels to identify factors associated with developing postpartum complications among these women.ResultsWe observed 263 women receiving care at three health facilities in the immediate postpartum period. The level of maternal assessments was very low at 9/263 (3.4%), 29/263(11%) and 10(3.8%) within the first two hours, at three hours and at the fourth hour, respectively. The prevalence of postpartum complications was 37/263 (14.1%), with 67.6% experiencing postpartum hemorrhage (PPH), 13.5% having perineal tears, and 10.8% having cervical tears. Mothers who did not undergo a postpartum check in the first three hours (p = 0.001), those who were discharged after 24 h (p = 0.038), and those who were transferred to the postpartum ward after two hours (p = 0.001) were more likely to have developed postpartum complications.ConclusionThe maternal assessment patterns observed in the population were suboptimal. Women who were not assessed at the third hour and those transferred after two hours to the postnatal ward were more likely to have developed postpartum complications.

Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

Background/Aims Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes. Methods This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically. Results A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years. Conclusions Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care. Implications for practice Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Paternal Incarceration and Adolescent Delinquency: Role of Father Engagement and Early Child Behavior Problems.

Paternal incarceration is an important predictor of teen delinquency, but the factors that may explain this relationship-such as early child problem behaviors and level of father engagement-have not been adequately explored. The current longitudinal study examined paternal history of incarceration as a predictor of teen self-reported delinquency over a 15-year gap, considering early child problem behaviors and father engagement as mediators. Sex differences in these relationships were also evaluated. This four-wave longitudinal study included an analytic sample of 4897 teens who participated in the birth-cohort Future of Families and Child Well-Being Study. Mothers and fathers were interviewed shortly after the focal child's birth and were then reassessed in follow-up interviews at child ages 1, 3, 5, 9, and 15. The focal children were interviewed at ages 9 and 15. Results showed that paternal prior incarceration at year 1 was associated with greater child behavior problems and father engagement at year 5; however, those relationships disappeared by age 9. Paternal history of incarceration was not related to teen delinquency, but child behavior problems at age 9 were directly related to subsequent engagement in delinquent behaviors. Paternal current incarceration was related to subsequent father engagement but was not associated with later child behaviors. No significant indirect pathways emerged, indicating a lack of support for mediation. No sex differences in these relationships were observed. Overall, the findings underscore the complexity of the relationships between paternal incarceration, child behavior, and father engagement in the emergence of delinquent behaviors.

Association of Socioeconomic Variables with Primary Cesarean Section.

Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth. Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, P = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, P = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, P = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, P < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, P = 0.02). No significant association occurred for women receiving public assistance. Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.

Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Centre for Childbirth in Québec, Canada: A Chart Review 2015–2019

ObjectivesChildbirth evacuation, the transfer of patients from rural and remote communities to urban centres for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Québec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, Northern Québec transferred to a southern tertiary care centre. MethodsA 5-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care centre between 2015 and 2019. ResultsThe most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of the 534 (78.9%) Inuit who gave birth at the tertiary centre, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to the neonatal intensive care unit. Approximately 3.4% (18/534) had complications within the postpartum period, with the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%). ConclusionsA relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n=8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p=0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

Current predictors for morbidity regarding choice of birth after a previous caesarean section, show poor predictive value in prediction modelling

IntroductionAfter a previous caesarean section, morbidity in the subsequent delivery in general is considered to depend on the probability of a vaginal birth after caesarean. However counselling could be improved by adding individualized probability of serious morbidity following either trial of labour or elective repeat caesarean section. The objective of this study was to develop prediction models for morbidity for both a repeat caesarean section and a trial of labor for a Dutch population. Material and methodsIn this cohort study, data were joined from three previous studies (SIMPLE 1, SIMPLE 2 and SIMPLE 2-implementation study). A cohort of 2592 women with one previous caesarean section and a singleton pregnancy who delivered ≥37 weeks, without a contraindication for vaginal delivery was formed. Maternal morbidity was defined as postpartum hemorrhage, blood transfusion, uterine rupture, ICU admittance or death. Neonatal morbidity was defined as asphyxia, NICU-admittance or death. Potential predictors for morbidity were chosen based on literature and expert opinion. Logistic regression was used to develop the models. Internal validation was intended using bootstrapping techniques. Main outcome measures were predictors for morbidity and for validation of the model we used the area under the receiver operating characteristic curve for discriminative capacity and calibration for accuracy. ResultsIn 324 out of the 2592 cases (12.7 %) maternal or fetal complications occurred. In general total morbidity was higher in women choosing TOL as compared to ERCS (p < 0.001). The performance of the several developed models was insufficient, the area under the receiver operating characteristic curve did not rise above 0.6. Due to poor model performance, before correction for overfitting, interval validation was not conducted. ConclusionIn this large cohort, developing a Dutch population based prediction model that aimed to improve counselling on the mode of delivery, by predicting individual chances of morbidity for different delivery modes was not possible, due to lack of performance. Further study could be directed to cut off on VBAC success rates to a more general advice regarding the safest mode of delivery.

Human milk feeding practices and serum immune profiles of one-year-old infants in the CHILD birth cohort study

Breastfeeding and human milk consumption are associated with immune system development; however, the underlying mechanisms and the impact of different infant feeding practices are unclear. This study aimed to investigate how current human milk feeding (HMF) status is related to infant immune biomarker profiles, and explore relationships with HMF history (i.e., duration, exclusivity, and method: directly from the breast, or pumped and bottled). This observational birth cohort study involved 605 infants from the Canadian CHILD Cohort Study. Infant feeding was captured from hospital birth records and parent questionnaires. Ninety-two biomarkers reflecting immune system activity and development were measured in serum collected at one year (12.6±1.4 months) using the Olink Target 96 Inflammation panel. Associations were determined using multivariable regression (adjusted for sex, time until blood sample centrifugation, and study site). Nearly half (42.6%) of infants were still HMF at the time of blood sampling. Compared to non-HMF infants, HMF infants had higher levels of serum Fibroblast Growth Factor 21 (FGF-21, adjusted standardized β-coefficient=0.56; 95%CI=0.41,0.72), Cluster of Differentiation 244 (CD244, β=0.35; 0.19,0.50), Chemokine Ligand 6 (CXCL6, β=0.34; 0.18,0.50), and Chemokine Ligand 20 (CCL20, β=0.26; 0.09,0.42), and lower Extracellular Newly Identified Receptor for Advanced Glycation End-Products Binding Protein (EN-RAGE, β=-0.16; -0.29,-0.03). Among non-HMF infants, serum Interleukin 7 (IL-7) had a marginally positive association with past HMF duration (β=0.05; 0.02,0.08) that persisted for up to five months post-HMF cessation. Exclusive HMF duration and HMF method (at three months of age) were not associated with any biomarkers. Current HMF status and (to a lesser extent) HMF history are associated with several inflammation-associated biomarkers in one-year-old infants. These results provide new evidence that HMF impacts immune activity and development and suggest hypotheses about the underlying mechanisms. They also highlight the importance of including current HMF status in immune-system-focused infant serum proteomic studies.

Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women.

To develop prediction models for intrapartum caesarean section in vaginal breech birth. This single-center cohort-study included 262 nulliparous and 230 multiparous women attempting vaginalbreech birth. For both groups, we developed and (internally) validated three models for the prediction of intrapartum cesarean section. The prediction model for nulliparous women (AUC:0.67) included epidural analgesia (aOR 2.14; p=0.01), maternal height (aOR 0.64 per 10 cm; p=0.08), birthweight≥3.8 kg (aOR 2.45; p=0.03) and an interaction term describing the effect of OC if birthweight is≥3.8 kg (aOR0.24; p=0.04). An alternative model for nulliparous women which, instead of birthweight, included fetal abdominal circumference with a cut-off at 34 cm (aOR 1.93; p=0.04), showed similar performance (AUC: 0.68). The prediction model for multiparous women (AUC: 0.77) included prelabor rupture of membranes (aOR 0.31; p=0.03), epidural analgesia (aOR 2.42; p=0.07), maternal BMI (aOR 2.92 per 10 kg/m2; p=0.01) and maternal age (aOR 3.17 per decade; p=0.06). Our prediction models show the most relevant risk factors associated with intrapartum cesarean section in vaginal breech birth for both nulliparous and multiparous women. Importantly, this study clarifies the role of the OC byshowing that this parameter is only associated with intrapartum cesarean section if birthweight is above 3.8 kg (or abdominal circumference is above 34 cm). Conversely, knowing the OC when the birthweight is less than 3.8 kg (orabdominal circumference is less than 34 cm) did not improve prediction of this surgical outcome.

Determinants of Success and Complications in Vaginal Birth After Cesarean Section: A Systematic Literature Review

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2–0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby.

Profile of women with retained placenta at a tertiary care hospital

Abstract The placenta is said to be retained when it is not expelled from the uterus even 30 min after the delivery of the baby. The occurrence of retained placenta following vaginal birth is estimated to be 1%–3% of deliveries. It can lead to severe bleeding, infection, and other adverse outcomes, making it a significant concern in obstetric care. Hence, the present study was carried out to study the profile of women with retained placenta. This was a descriptive study among 97 women with retained placenta. The incidence of retained placenta was 97 (1.8%). The most common characteristic feature was postdated pregnancy in 29.8%. Eighty women responded to medical management alone, whereas 17 women required manual removal. The most common complication was postpartum hemorrhage in 33.3%. We conclude that a retained placenta can be a source of significant hemorrhagic and surgical morbidity to the mother. In considering ways to lessen morbidity, the clinician should have a knowledge of the clinical profile of retained placenta.

Treatment of Spastic quadriplegia resulting from hypoxia in newborn through body engineering technique-hand therapy Case Report Described by Parents: Qualitative study

Objectives: Summary of Case Report on Spastic quadriplegia accompanied by several disabilities. Treatment with Body Engineering/Hand Therapy. This case report describes the successful treatment of a 4 years old girl who was diagnosed with Spastic quadriplegia and global developmental delay accompanied with relapse, slurred speech, and cognitive delay resulting from hypoxia during child birth. To report a case of a girl who suffered Spastic quadriplegia, seizures, and delay in speech and perception due to hypoxia and to highlights the critical role of body engineering techniques for the rehabilitation of children with similar cases. Methods: An informed case report was given by from the child's parents. Functional recovery was achieved through a customized rehabilitation plan according to the body engineering / hand therapy techniques We highlight: -Medical Management for such cases. -A rehabilitation plan based on body engineering/ hand therapy techniques that led to complete recovery. -Satisfaction of the patient's parents after treatment. Results: Treating the patient through body engineering (hand therapy) and rehabilitating him for a full year led to the appearance of signs of clinical and radiographic improvement. Conclusions: Hypoxia-induced spastic quadriplegia often results in multiple disabilities, as seen in this case. Early intervention using body engineering techniques can lead to significant improvements in physical and cognitive functions. Continuous monitoring and rehabilitation are recommended to sustain progress and prevent relapses (Odding et al., 2006). Based on the provided information, body engineering and hand therapy have proven to be highly effective in rehabilitating a girl with hypoxia-induced cerebral palsy. Through a comprehensive rehabilitation program, the patient's physical, cognitive, and communication abilities have significantly improved. This case report underscores the importance of early intervention in maximizing outcomes for children with spastic quadriplegia. By providing ongoing support and tailoring rehabilitation programs to individual needs, it is possible to help these children reach their full potential, aligning with the World Health Organization's definition of rehabilitation as a process to improve performance and reduce disability.

Risk Factors and Predictive Models for Postpartum Hemorrhage after Vaginal Delivery

Background: Postpartum hemorrhage (PPH) remains one of the biggest reasons of maternal morbidity and mortality. Clinical prediction of PPH remains challenging, particularly in the case of a vaginal birth. The purpose of this research is identifying patients at risk for PPH in vaginal delivery by using risk factors and predictive models. Methods: 1840 cases who underwent vaginal deliveries at Beijing Ditan Hospital, Capital Medical University between December 2020 to December 2022, which were divided into two groups based on the amount of blood loss (PPH and non-PPH groups). Fourteen risk factors could cause increased risk of PPH, including demographic characteristics and placental anomalies factors. Logistic regression analysis was used to influence the risk factors of PPH in vaginal delivery. According to the results of multivariate logistic regression analysis, a risk prediction model was established, the Hosmer-Lemeshow test was used to assess the model fit. Results: A total of 94 cases presented with PPH in this study, and the incidence of PPH was 5.10% (94/1840). Two items including macrosomia (odds ratio (OR): 2.229, 95% confidence interval (95% CI): 1.062–4.679) and placental anomalies (OR: 4.095, 95% CI: 2.488–6.742) were independent risk factors affecting the occurrence of PPH with vaginal delivery (p &lt; 0.05). Conclusion: The construction of a logistic regression-based model can be used to predict the risk of PPH after vaginal delivery, predictability to be studied further. Clinically, more attention should be paid to vaginal delivery, early identification and screening of high-risk factors for PPH, as well as timely preventive interventions for high-risk groups so as to reduce the risk of PPH.