Complication Of Cesarean Section Research Articles

Adhesion barriers in gynecologic surgeries and cesarean section: An Asia-Pacific expert panel consensus recommendation.

Adhesions arising from gynecologic surgeries and cesarean sections pose substantial clinical, social, and economic challenges, leading to issues like pelvic pain, infertility, bowel obstruction, and recurring surgeries. Preventing adhesions is a pressing unmet need, hindered by difficulties in assessing postoperative adhesions and understanding barriers. To bridge adhesion prevention gaps, statements on clinical practices were synthesized to present Asia-Pacific expert perspectives on gynecologic surgery and cesarean section adhesion prevention. An expert panel of eight physicians from various healthcare settings in the Asia-Pacific region was convened and a comprehensive literature search on topics related to adhesion prevention in gynecologic surgeries and cesarean sections was performed. Information from full-text publications was used to develop draft consensus statements, with each statement assigned the highest available evidence level based on a systematic literature review and graded using the Oxford Center for Evidence-based Medicine criteria. A modified Delphi process, involving two rounds of online voting and discussions with an extended group of 109 experts, was employed to reach a consensus on six topics related to adhesion barriers. A set of 15 consensus statements were synthesized. Key topics include adhesion incidence in Asia, cesarean section complications, barrier application status, adhesion formation and prevention, absorbable barriers' effectiveness, recommendations, and future considerations. The statements provide guidance for healthcare professionals, especially in the Asia-Pacific region, to tackle the challenges posed by postoperative adhesions and improve patient outcomes. Further research is needed to enhance understanding and prevention of adhesions in this region.

The risk of possible surgical complications in caesarean section

The risk of possible surgical complications in caesarean section

Norepinephrine versus phenylephrine affects prethrombotic response in patients undergoing cesarean section under spinal anesthesia: a randomized, double-blind, controlled study.

Venous thromboembolism (VTE) is one of the most common and serious complications of cesarean section in parturients. Norepinephrine (NE) has been shown to activate coagulation. The aim of this study was to compare the effect of a fixed-rate prophylactic norepinephrine infusion and a fixed-rate prophylactic phenylephrine（PHE） infusion under spinal anesthesia for caesarean section on the prethrombotic response. Sixty-six women undergoing cesarean section under spinal anesthesia were randomly assigned to the NE group or PHE group, starting simultaneously with the administration of the subarachnoid solution, a "study drug" solution containing either NE or PHE was pumped intravenously at a constant rate of 15 ml/h until the end of the operation. Plasma coagulation factor VIII activity (FVIII: C), Fibrinogen, and D-dimer levels were measured in blood samples obtained on admission to the operating theatre and at the end of the procedure. Compared with preoperative levels, there were no significant differences in postoperative fibrinogen and D-dimer levels in the NE group, except for a decrease in FVIII: C levels (P = 0.003). However, postoperative levels of FVIII: C (P = 0.009), fibrinogen (P = 0.035) and D-dimer (P = 0.025) were increased in the NE group compared with postoperative levels in the PHE group. NE does not affect the maternal prethrombotic response and can be safely used in cesarean sections. Compared with PHE infusion, NE infusion increased the level of coagulation molecules, suggesting that NE maybe more beneficial for women with high intraoperative bleeding requiring hemostasis.

Effect of Maternal Obesity on Operative and Post-Operative Complications of Elective Cesarean Section: An Observational Cross-Sectional Study

Effect of Maternal Obesity on Operative and Post-Operative Complications of Elective Cesarean Section: An Observational Cross-Sectional Study

Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi

BackgroundPhysicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor.MethodsThis retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity.ResultsAssociate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61–1.33).ConclusionsAssociate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.

The prevention of infectious complications of caesarean section in the context of the global rise of antibiotic resistance

In the context of the global rise of antibiotic resistance, optimising the prevention of infectious complications of caesarean section (CS) with a reassessment of the guidelines for ultra-short antibiotic (AB) regimens is becoming increasingly important. Given the current data on the negative consequences of the use of AB in pregnant women for the fetal microbiota, the role of antiseptics that are used locally, do not pass to the child, and are less likely to cause resistance, have a wider range of antimicrobial activity is increasing.The objective: to provide clinical evidence for the prevention of infectious complications of CS by topical application of an antiseptic with decamethoxin.Materials and methods. A comparative study of two homogeneous groups of women with low infectious risk delivered by elective CS was conducted. In the 1st group (55 women) an antiseptic with decamethoxin was used at all stages of abdominal delivery: preoperative treatment of the skin and vagina, intraoperative irrigation of the inner surface of the uterus, uterine sutures, and subcutaneous tissue. The 2nd group (55 patients) received conventional antibacterial prophylaxis. In the course of clinical and microbiological parallels, ultrasound monitoring of uterine involution, the results of the examination on the 42nd day after CS and information on the condition of the newborn child were used.Results. The absence of infectious complications of puerperium, infection of the surgical site, trends and signs of inflammatory reactions in both groups was revealed.In the 2nd group 5.5% of patients had partial skin suture separation due to seroma formation and transient infiltration of the subcutaneous tissue. The absence of such phenomena in the 1st group should be considered a consequence of the cytoprotective effect of decametoxin. The use of an antiseptic with decametoxin has pharmacoeconomic advantages over antibiotic prophylaxis regimens.Conclusions. The use of antiseptic with decametoxin in the perioperative care of caesarean section combines the possibility of safe reduction of antibiotics, effective antiinfective protection with guaranteed safety for the child.

Бактериофаги как альтернативный метод профилактики инфекционных осложнений кесарева сечения

Цель исследования. Доказать возможность применения бактериофагов наравне с антибиотиками в профилактике инфекционных осложнений кесарева сечения. Материалы и методы. В исследование вошли 240 пациенток, которые составили две группы: 1-я (основная) группа была представлена 108 женщинами, у которых в качестве профилактики использовался пиобактериофаг, а во 2-ю группу (группу сравнения) вошли остальные 132 пациентки, у которых в качестве профилактики применялся цефазолин. Микрофлору влагалища исследовали микроскопическим (с посевом на чувствительность к антибиотикам и бактериофагам, выполнялся дисково-диффузионным методом), бактериологическим методами и методом количественной полимеразной цепной реакции в реальном времени. Результаты. При анализе исходов кесарева сечения были получены следующие данные: нормальное течение послеоперационного периода отмечалось у 96% пациенток из основной группы и 87% пациенток группы сравнения, послеродовый эндометрит – у 5% пациенток основной группы и 13% – группы сравнения. Основными микроорганизмами у пациенток с послеродовым эндометритом оказались S. epidermidis, Streptococcus spp., Enterococcus spp., E. coli и Candida spp. В основной группе исследования у всех пациенток была обнаружена Candida spp., у 2 пациенток в количестве 104, а у 3 пациенток – 105. В группе сравнения ситуация оказалась следующей: S. epidermidis и Streptococcus spp. – у 2 пациенток в количестве 104 и 105, Enterococcus spp. – у 4 пациенток в количестве 106 и у одной пациентки в количестве 105, E. coli – у 5 пациенток в количестве 106 и у 3 пациенток в количестве 105. В основной группе 100% пациенток с послеродовым эндометритом оказались не чувствительны к проводимой ранее профилактике. В группе сравнения 52,94% пациенток оказались не чувствительны к проводимой профилактике. Заключение. На основании данных исследования была доказана возможность применения бактериофагов наравне с антибиотиками в профилактике инфекционных осложнений кесарева сечения. Нами была выяснена одна из проблем неэффективности профилактики осложнений кесарева сечения как бактериофагами, так и антибиотиками, заключающаяся в резистентности микроорганизмов к используемым препаратам. Purpose of the study. To demonstrate the feasibility of using bacteriophages alongside antibiotics in preventing infectious complications of cesarean section. Materials and methods. The study included 240 patients who were divided into two groups: the first group (the main group) consisted of 108 women who received pyobacteriofagum as prophylaxis. The second group (the comparison group) comprised the remaining 132 patients who received cefazolin for prophylaxis. Vaginal flora was examined using microscopic methods (with seeding for sensitivity to antibiotics and bacteriophages, performed by disc diffusion), bacteriological methods, and quantitative real-time polymerase chain reaction. Results. Upon analysis of the outcomes of cesarean section, the following data were obtained: normal postoperative course was observed in 96% of patients in the main group and 87% in the comparison group, while postpartum endometritis occurred in 5% of patients in the main group and 13% in the comparison group. The main microorganisms identified in patients with postpartum endometritis were S. epidermidis, Streptococcus spp., Enterococcus spp., E. coli, and Candida spp. In the main study group, Candida spp. was detected in all patients, with 2 patients having a count of 104 and 3 patients with a count of 105. In the comparison group, the situation was as follows: S. epidermidis and Streptococcus spp. were found in 2 patients with counts of 104 and 105, Enterococcus spp. was found in 4 patients with a count of 106 and in one patient with a count of 105, E. coli was found in 5 patients with a count of 106 and in 3 patients with a count of 105. In the main group, 100% of patients with postpartum endometritis were found to be resistant to the previously conducted prophylaxis. In the comparison group, 52.94% of patients were resistant to the prophylaxis being administered. Conclusion. Based on the study findings, the possibility of using bacteriophages alongside antibiotics in preventing infectious complications of cesarean section has been demonstrated. We have identified one of the problems of the ineffectiveness of cesarean section complication prophylaxis, both with bacteriophages and antibiotics, which lies in the resistance of microorganisms to the drugs used.

Acute and Chronic Complications of Caesarean Section: A Pictorial Review

Acute and Chronic Complications of Caesarean Section: A Pictorial Review

Long-Term Complications of Caesarean Section, the Niche in the Scar: A Prospective Cohort Study on Niche Prevalence and its Relation to Abnormal Uterine Bleeding

Long-Term Complications of Caesarean Section, the Niche in the Scar: A Prospective Cohort Study on Niche Prevalence and its Relation to Abnormal Uterine Bleeding

The effectiveness of hysteroscopy for the treatment of cesarean scar pregnancy: a retrospective cohort study

BackgroundCesarean scar pregnancy (CSP) is a long-term complication of cesarean section characterized by the localization of a subsequent gestational sac within the scar area or niche developed as a result of a previous cesarean section. Its incidence has increased substantially because of the high global cesarean section rate in recent decades. Several surgical and drug treatments exist for this condition; however, there is currently no optimal treatment. This study compared the effectiveness of direct hysteroscopic removal of the gestational tissue and hysteroscopy combined with vacuum suction for the treatment of CSP.MethodsFrom 2017 to 2023, 521 patients were diagnosed with CSP at our hospital. Of these patients, 45 underwent hysteroscopy. Among them, 28 underwent direct hysteroscopic removal (hysteroscopic removal group) and 17 underwent hysteroscopy combined with vacuum suction (hysteroscopic suction group). The clinical characteristics and outcomes of the hysteroscopic removal group and hysteroscopic suction group were analyzed.ResultsAmong the 45 patients, the amount of bleeding and hospitalization cost were significantly higher in the hysteroscopic removal group than in the hysteroscopic suction group (33.8 mL vs. 9.9 mL, P < 0.001; and 8744.0 yuan vs. 5473.8 yuan, P < 0.001; respectively). The operation time and duration of hospitalization were significantly longer in the hysteroscopic removal group than in the hysteroscopic suction group (61.4 min vs. 28.2 min, P < 0.001; and 3.8 days vs. 2.4 days, P = 0.026; respectively). Three patients in the hysteroscopic removal group had uterine perforation and received laparoscopic repair during operation. No complications occurred in the hysteroscopic suction group. One patient in the hysteroscopic removal group received ultrasound-guided suction curettage due to postoperative moderate vaginal bleeding, and one patient in the hysteroscopic suction group received ultrasound-guided suction curettage due to postoperative gestational residue and elevated serum beta-human chorionic gonadotropin levels. Reproductive function was preserved in all patients.ConclusionsHysteroscopy is an effective method for treating CSP. Compared with direct hysteroscopic removal, hysteroscopy combined with vacuum suction is more suitable for CSP. However, multicenter prospective studies with large sample sizes are required for verification of these findings.

Influence of Beliefs of Religious Leaders on the Acceptance of Caesarean Section as a Delivery Option among Women in Ogbomoso, South West Nigeria

Background: Lots of religious beliefs and doctrines among clergy in Christianity, Islam and traditional worshippers have determined the outcome of pregnancy and health of pregnant mothers in developing countries making them occasionally go through unnecessary risks of childbirth and postpartum conditions. Hence, a study to assess the influence of belief of religious leaders on the acceptance of Caesarean Section as a choice of child delivery is paramount. Methods: A cross-sectional study was conducted in April, 2023 among religious leaders and a total of 422 of them were selected randomly and interviewed using a structured interviewer-administered questionnaire. Results: About 164(38.9%) were below 40 years, 272(64.5%) were males, 150(35.5%) were females; majority 273(64.7%) practice Christianity, 138(32.7%) practice Islam; 354(83.9%) belong to the Yoruba ethnic group; more than half of the respondents 293(69.4%) were married; 314(74.4%) had a nuclear family structure; majority 302(71.6%) had tertiary education; 186(44.1%) were employed, 168(39.8%) were self-employed. 372(88.2%) believed that Caesarean sections a method of child delivery; less than half 144(34.1%) believed that Caesarean section is only used for emergency; 151(35.8%) believed that Complications of caesarean section are more than normal vaginal delivery; 198(46.9%) believed that Caesarean section is an easy way of delivery; 82(19.4%) believed that Caesarean section benefits only the mother; 80(19.0%) believed that Caesarean section affects the bonding between mother and child; amongst others. Conclusion: The study reveals that religious leaders in Ogbomoso will require more scientific information about caesarean section, and a significant proportion of them hold misconceptions about the procedure. Nevertheless, the majority of the religious leaders in the study were willing to accept caesarean section as a mode of delivery. Given their role in influencing their members' health-seeking behaviour, religious leaders could play a significant role in improving maternal and child health outcomes in the community by promoting accurate information about caesarean section and encouraging its acceptance.

Prospective Observational Study to Assess the Caesarean Section Complications in Second Stage of Labour in the Maternity Hospital

Prospective Observational Study to Assess the Caesarean Section Complications in Second Stage of Labour in the Maternity Hospital

Postoperative maternal complications of caesarean section: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo.

the maternal complications of caesarean section make it considered a riskier route of delivery than the vaginal route. The caesarean patient in fact combines the risks of giving birth and those of abdominal surgery. The objective of our study is to determine the epidemiological and therapeutic profile of postoperative maternal complications of caesarean section at the Provincial General Hospital of Kananga from January 1st, 2016 to December 31st, 2020. this is a cross-sectional study of cases of postoperative maternal complications of cesarean section, based on non-probability convenience sampling for case selection. multivariable logistic regression was used in statistical analyses. Our study sample was 302 cases. the hospital frequency of postoperative complications of cesarean section is 34.12% with the annual average of 60.40 (17.21) cases per year. The postoperative infections are the most frequent complication with more than 52.98% (n=160), treatment is surgical in 59.61% (n=180), the maternal mortality rate due to postoperative complications of cesareans is 5.63% (n=17). Five factors independently associated with postoperative complications of cesarean section were identifying: prolonged labor (aOR: 3.110, 95% CI: 1.040-9.250; p=0.001), defective hygiene of patients (aOR: 1.910, 95% CI: 1.090-10.930; p=0.001), uterine overdistension before caesarean section (aOR: 4.290, 95% CI: 3.320-5.550; p=0.000), multiparity (aOR: 2.070, 95% CI: 1.010-5.210; p=0.006) and emergency cesarean section (aOR: 1.510, 95% CI: 1.250-1.910; p=0.000) in our environment and during the period of our study. intraoperative complications of ceasarean section constitute a real health problem. These five factors independently associated with postoperative complications of cesarean section could be used for screening of high-risk women in obstetrical consultations during pregnancy monitoring.

Risk Factors for Perioperative Hypothermia in Pregnant Women undergoing Cesarean Section: A Systematic Review and Meta-Analysis.

Hypothermia is one of the common complications of cesarean section, which has a serious impact on intraoperative surgical safety and postoperative recovery of pregnant women. Mitigation of the risk factors of hypothermia in pregnant women undergoing cesarean section may reduce the probability of its occurrence and improve the perioperative comfort of pregnant women. Therefore, this study systematically evaluates the influencing factors of hypothermia in patients undergoing cesarean section, aiming to provide references for the prevention of hypothermia in pregnant women undergoing cesarean section. A systematic search was conducted across various databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature databases to gather observational studies on the factors affecting hypothermia in pregnant women undergoing cesarean section. The search deadline was January 30, 2024. Two researchers independently screened literature, extracted data, evaluated quality, and crosschecked the outcomes. Meta analysis was conducted using RevMan 5.3 and Stata17.0. Twelve studies were included in this review, all of which were case-control studies conducted from 2014 to 2022, encompassing a total of 5561 pregnant women. The quality of the studies included was average or above. The meta-analysis results showed that body mass index (mean difference (MD) = -1.47; 95% confidence interval (CI) [-2.84, -0.11]; p = 0.03), operating room temperature (odds ratio (OR) = 2.08; 95% CI [1.56, 2.76]; p < 0.00001), anesthesia method (OR = 1.84; 95% CI [1.40, 2.42]; p < 0.0001), fluid loss (MD = 160.09; 95% CI [77.31, 242.87]; p = 0.0002), flushing volume (MD = 66.43; 95% CI [8.46, 124.40]; p = 0.02), and hypothyroidism (OR = 2.29; 95% CI [1.61, 3.27]; p < 0.00001) were risk factors for perioperative hypothermia in pregnant women undergoing cesarean section (p < 0.05). The occurrence of hypothermia in pregnant women during the perioperative period is influenced by factors such as low body mass index, spinal anesthesia, low operating room temperature, intraoperative fluid loss, large flushing volume, and hypothyroidism.

Multidetector computed tomography evaluation of postcesarean section acute complications

Background: Cesarean delivery is the most commonly performed major abdominal operation in women. Its rate ranges from 3% to 5% in Africa to 33% in the United States and 43.9% in Brazil with a reported worldwide global estimation of 15%. Although it is a safe procedure, cesarean delivery has a variety of acute and chronic complications. The various acute complications of cesarean section are hematomas, infection, uterine dehiscence or rupture, and pelvic thrombophlebitis. The overall complication rate is around 14.5%. Aim and Objectives: The aim and objective of this study is to evaluate the imaging findings of acute complications of cesarean section. Materials and Methods: This prospective study was done in the Department of Radiodiagnosis Govt Medical College, Srinagar from June 2019 to February 2020 in collaboration with department of general surgery and gynecology and obstetrics. All patients with suspected complication in immediate postcesarean period were evaluated with contrast-enhanced multidetector computed tomography (MDCT). Results: Out of 25 patients evaluated for suspected immediate postcesarean complications, five patients had bladder flap hematoma only, 8 had uterine dehiscence, six patients had uterine rupture, 3 had ureteric injury, one had gossypiboma while as 2 had pelvic sepsis. Conclusion: MDCT plays an important role in the detection and confirmation of multiple postcesarean acute complication and can also help in guiding the management of complication as well.

Analysis of the maternal and fetal adverse outcomes of 154 pregnant women with cesarean section in the second stage of labor

Objective: To investigate the perinatal maternal and fetal adverse outcomes of cesarean section in the different duration of the second stage of labor. Methods: A retrospective cohort study was conducted on the clinical data of 154 pregnant women with singleton head pregnancy who underwent cesarean section at different times of the second stage of labor due to maternal and fetal factors in the First Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2021. According to the duration of the second stage of labor, they were divided into <2 h group (54 cases), 2-<3 h group (61 cases), and ≥3 h group (39 cases). The general data of pregnant women and neonates, preoperative maternal and neonatal conditions related to labor stages, surgical indications, surgical procedures, and perioperative maternal and neonatal adverse outcomes were compared among the three groups. Results: (1) General Information: there were no significant differences in maternal age, gravidity and parity, proportion of primipara, gestational age at delivery, body mass index before delivery, pregnancy complications, labor analgesia rate and the duration of the first stage of labor among the three groups (all P>0.05). The differences of the gender composition, birth weight and incidence of macrosomia of the three groups were also not statistically significant (all P>0.05). (2) Maternal and fetal status and surgical indications: the incidence of intrapartum fever and type Ⅱ and Ⅲ fetal heart rate monitoring in the <2 h group were higher than those in the 2-<3 h group and the ≥3 h group, and the preoperative fetal head position in the ≥3 h group was lower than that in the 2-<3 h group, with statistically significant differences (all P<0.05). The proportion of cesarean section due to "fetal distress" was 40.7% (22/54) in the <2 h group, which was higher than that in the 2-<3 h group (4.9%, 3/61) and the ≥3 h group (2.6%, 1/39). The proportions of surgical indication of "relative cephalo-pelvic disproportion" were 98.4% (60/61) and 94.9% (37/39) in the 2-<3 h group and ≥3 h group, respectively, and the surgical indication of "fetal head descent arrest" were 41.0% (25/61) and 59.0% (23/39), respectively. Compared with <2 h group [63.0% (34/54), 13.0% (7/54)], the differences were statistically significant (all P<0.05). There were no significant difference in surgical indications between 2-<3 h group and ≥3 h group (all P>0.05). (3) Intraoperative conditions and perioperative complications of cesarean section: the puerperal morbidity rate of <2 h group was 37.0% (20/54), which was higher than those of 2-<3 h group (18.0%, 11/61) and ≥3 h group (7.7%, 3/39), the difference was statistically significant (P<0.05). There were no significant differences in operation time, intraoperative blood loss, incidence of fetal head inlay, uterine incision tear, modified B-Lynch suture for uterine atony, postpartum hemorrhage, perioperative blood transfusion, preoperative hemoglobin (Hb) level, perioperative Hb change, and postoperative hospital stay among the three groups (all P>0.05). (4) Adverse neonatal outcomes: non-hemolytic neonatal hyperbilirubinemia in ≥3 h group was 35.9% (14/39), which was significantly higher than that in <2 h group (13.0%, 7/54; P<0.05). Among the neonates admitted to neonatal intensive care unit (NICU) within 1 week after birth, the proportion of neonates admitted to NICU due to neonatal hyperbilirubinemia in ≥3 h group (15/19) was significantly higher than that in <2 h group (9/17) and 2-<3 h group (10/19), and the differences were statistically significant (all P<0.05). However, there was no significant difference between the <2 h group and the 2-<3 h group (P>0.05). There was no perinatal death in the three groups. Conclusions: The rate of puerperal morbidity is higher in patients who were transferred to cesarean section within 2 hours of the second stage of labor. In the early stage of the second stage of labor, the monitoring of fetal heart rate and amniotic fluid characteristics should be strengthened, especially the presence or absence of prenatal fever. In good maternal and neonatal conditions, conversion to cesarean section after 2 hours of the second stage of labor does not significantly increase the incidence of serious adverse maternal and neonatal outcomes. For the second stage of labor more than 3 hours before cesarean section, it is necessary to strengthen the monitoring of neonatal bilirubin.

Intraoperative Fluid Management Correlates with Intraoperative Complications in Cesarean Section: A Prospective Clinical Trial

Background: This study focused on perioperative fluid administration in pregnant women undergoing a caesarean section (CS) by comparing liberal and non-liberal fluid administration in a multicentre setting across various Hospitals in the Bali province and its surrounding areas.&#x0D; Methods: Sampling was conducted using a total sampling method. All patients meeting the inclusion criteria were included in this study. A total of 310 samples of pregnant patients undergoing CS surgery in various operating rooms across hospitals in the Bali province and surrounding areas were obtained during the period of January to December 2022. The fluid administration strategy was divided into two types: liberal and non-liberal. Data analysis was performed using the Chi-square test with the correlation test of the contingency coefficient.&#x0D; Results: The results showed that liberal fluid administration significantly increased complications in the operating room for pregnant patients undergoing cesarean section (p&lt;0.001; r=0.305; OR 6.22) but not in the recovery room or postoperative hospital ward.&#x0D; Conclusion: Liberal fluid administration could significantly increase complications in the operating room for pregnant patients undergoing cesarean section but not in the postoperative period.

A comparative study of short-term post caesarean section complications in normal versus gestational diabetic mothers

Background: There are variegated complications following caesarean section that may compel the mothers to stay longer in hospital with sufferings or to carry a long period of morbidity at home. Unfortunately, these complications are more in gestational diabetes mellitus (GDM). This study was designed to compare post-operative complications following caesarean sections in normal and GDM Mothers. Methods: This study was conducted in the Department of Obstetrics and Gynecology, 250 bedded general hospital, Naogaon, Bangladesh, from January 2022 to June 2023. In this study 74 participants were included consecutively. Among these, 37 mothers had GDM and 37 had normal pregnancies as control. After caesarean section, data regarding sociodemographic, obstetric and surgical profile were recorded and analyzed. Results: The mean age of the participants in GDM group was 31.32±5.56 years and in normal pregnant group was 29.24±5.56 years. Post-operative pain were almost same in both groups. Mean time of PO mobilization was 25.2 hours in GDM group and 20.2 hours in normal group. 16 patients in GDM group had PO complications and 6 in normal mothers. Among the complications SSI and UTI were more common in GDM group. No mortality was recorded. Average hospital stay were 5.9 days and 4.9 days in GDM and normal patients. Conclusions: Some post-operative complications are more common in GDM mothers. So, good glycemic control, appropriate surgical technique and proper post-operative care are needed to reduce post-operative morbidity and hospital stay.

Prevalence and Risk Factors Associated with Maternal Near Miss Events in the Upper East Region of Ghana

A maternal near miss (MNM) event is a severe life-threatening maternal morbidity that reflects quality of obstetric care. It is considered a proxy of maternal mortality and predictor of quality obstetric care. The major underlying causes of MNM are hypertensive disorders, obstetric hemorrhage, sepsis and abortion complications. MNM is a more frequent event than maternal mortality and share several features together. Inquiries intodeficiencies andcritical assessment of health care quality, identify health system deficiencies, and help develop robust strategies for maternal care. We conducted a cross-sectional descriptive study to determine the prevalence and underlying causes of MNM. The study respondents were women aged 15 - 49 years with pregnancy experience in 2020 who had health facility care. Primary and secondary data were collected at households and health facilities respectively using electronic platform, KoBoCollect. STATA version 15.0 was used to analyze the data. The prevalence of MNM was 11.30%. The main underlying causes were complications of caesarean section, hypertensive disorders, anemia, obstructed labor, and antepartum hemorrhage. The main signal functions of emergency obstetric and newborn care (EmONC) employed to avert death were parenteral antibiotics, blood transfusion, caesarean section, and magnesium sulphate. The prevalence of MNM in the Upper East region was high. The region can reduce severe maternal morbidity and mortality by strengthening health systems, improving access to high-quality obstetric care and training healthcare providers to prevent and treat the major underlying causes of MNM identified in this study. Keywords: Ghana, MNM, Mortality, Prevalence, Antepartum, Hemorrhage, EmONC.

Post Vaginal Delivery with Impending Silent Abdominal Catastrophe: A Case of Vernix Caseosa Peritonitis

Vernix caseosa peritonitis (VCP) is a rare condition previously thought to be a complication of Caesarean section caused by the spillage of amniotic fluid and or meconium into the maternal peritoneal cavity during operation.1 This triggered an inflammatory reaction symptom such as an acute abdomen. A total of 34 cases has been reported since 1976.2 Nine of the 10 cases reported have been diagnosed in postpartum period after uneventful Caesarean section and only three reported cases of antenatal leakage since in 1998.3 VCP following vaginal delivery was first reported in 2013, involving a 28 year old with one previous scar who developed acute abdomen symptoms as early as 3 hours post vacuum delivery, with initial diagnosis of possible uterine scar rupture.4 Here we report a case of VCP in a post spontaneous vaginal delivery who presented with impending catastrophe and survived the ordeal.