Cesarean Section Rate Research Articles

Increased Cesarean Section Rates during the COVID-19 Pandemic: Looking for Reasons through the Robson Ten Group Classification System.

To compare cesarean section (CS) rates according to the Robson Ten Group Classification System (RTGCS) and its indications in pregnant women admitted for childbirth during the first wave of the coronavirus disease 2019 (COVID-19) pandemic with those of the previous year. We conducted a cross-sectional study to compare women admitted for childbirth from April to October 2019 (before the pandemic) and from March to September 2020 (during the pandemic). The CSs and their indications were classified on admission according to the RTGCS, and we also collected data on the route of delivery (vaginal or CS). Both periods were compared using the Chi-squared (χ2) test or the Fisher exact test. In total, 2,493 women were included, 1,291 in the prepandemic and 1,202 in the pandemic period. There was a a significant increase in the CS rate (from 39.66% to 44.01%; p = 0.028), mostly due to maternal request (from 9.58% to 25.38%; p < 0.01). Overall, groups 5 and 2 contributed the most to the CS rates. The rates decreased among group 1 and increased among group 2 during the pandemic, with no changes in group 10. There was an apparent change in the RTGSC comparing both periods, with a significant increase in CS rates, mainly by maternal request, most likely because of changes during the pandemic and uncertainties and fear concerning COVID-19.

Factors that Influence Women's Decision on the Mode of Birth After a Previous Caesarean Section: A Meta-ethnography.

Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women's decision-making to support informed choices for the mode of next birth after caesarean section (NBAC). A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare's seven-step meta-ethnography approach synthesised themes. Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control. This meta-ethnography highlights health professionals' influence on women's decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

Incidence, Timing, and Possible Risk Factors for Post-Cesarean Wound Infection among Low-Risk Patients in Zaria, Nigeria: A Cross-Sectional Study

Context: Rising cesarean section rates worldwide have led to an increase in post-operative complications, especially wound infection, and endometritis. Low-risk cesarean sections are still at risk of these infections despite the absence of common risk factors. The burden and possible risk factors for these have not been widely documented in patients without major risk factors. Aim: To determine the incidence, timing of diagnosis, and possible risk factors for wound infection in low-risk cesarean sections. Settings and Design: A prospective cross-sectional study conducted among consenting women undergoing low-risk cesarean sections, defined as the absence of established risk factors for post-operative wound infection. Materials and Methods: Participants' sociodemographic and obstetric characteristics were documented in a structured proforma. The primary outcome measure was the incidence and timing of wound infection. Secondary outcome measures were the incidences of endometritis and febrile morbidity. The data were analyzed using SPSS version 21 and Windows WINPEPI. Results: The incidence of wound infection was 11.2% (19); endometritis—20.6% (35); febrile morbidity—4.1% (7). The mean timing of diagnosis of wound infection and endometritis were 10.22 ± 3.64 and 11.57 ± 3.34 days, respectively. Grandmultiparity (P = 0.007), low maternal educational levels (P = 0.014), endometritis (p = &lt;0.0001), and febrile morbidity (P = 0.017) were the demonstrated risk factors for wound infection. Conclusion: The incidence of wound infection in the study population was high and mostly diagnosed after discharge from the hospital. Risk factors for wound infection were grand multiparity, lower educational level, endometritis, and febrile morbidity.

The vagina question: Can maternal vaginal fluid impact the infant gut microbiome and neurodevelopment?

Cesarean section rates continue to rise globally, and C-sectioned infants are at a higher risk of adverse child outcomes. In this issue of Cell Host & Microbe, Zhou etal. report that vaginal microbial transfer (VMT) from birth mother to infant post-delivery may alter infant gut microbiota and improve neurodevelopment.

Comparative evaluation of the caesarean section rate in term nulliparas with labour dystocia following augmentation with oxytocin alone versus with oxytocin and drotaverine

Background: Labour dystocia is the commonest indication for emergency caesarean section in nulliparas, and occurs when the progress of labour is abnormally slow. Labour dystocia may be caused by abnormalities in uterine contractions, slow cervical dilatation, or mechanical disproportion between the foetal presenting part and the maternal pelvis. Augmentation of labour with oxytocin is the traditional management for labour dystocia as it enhances uterine contractions. At times, despite good uterine contractions, dystocia persists due to cervical smooth muscle spasms or mechanical factors, thereby increasing the caesarean section rate. Drotaverine is a musculotropic antispasmodic and can relieve smooth muscle spasms. Aim/objective: This study compared the caesarean section rate in term nulliparas with labour dystocia that were augmented with oxytocin and placebo versus with oxytocin and drotaverine Methods: This study was a single-blinded randomized clinical trial conducted between January and August 2021. It involved 156 term nulliparous women with labour dystocia that were randomized into two groups for augmentation of labour. Each group had 78 parturients that were managed with either oxytocin with a placebo or oxytocin with drotaverine. They were monitored till delivery and the caesarean section rate in both groups was compared. Data obtained were analysed with SPSS version 23 software. The level of significance was set at 0.05, P&lt; 0.05 was statistically significant. Results: The two groups were similar in their sociodemographic characteristics. In this study 21(13.5%) women had emergency caesarean section while 135(86.5%) had vaginal delivery following augmentation. The caesarean section rate in the oxytocin-placebo was similar to the oxytocin-drotaverine group (10 (12.8%) vs 11 (14.1%), p=0.82). The majority, 14 (67%) of the caesarean sections were due to mechanical factors, 4 (19%) were due to functional dystocia and 3(14%) were due to foetal distress. Conclusion: The use of drotaverine with oxytocin in managing labour dystocia did not improve the caesarean section rate as the majority of the cases had mechanical dystocia.

Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis.

The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran. This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software. Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation. The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Frequency of Caesarean Section Classified by Robson's Ten Group Classification System: A Scoping Review.

The prevalence of caesarean section (CS) is rising rapidly. However, it should be carried out only under valid obstetric indications due to the various complications associated with it. Therefore, to record CS incidences, Robson's Ten Group Classification System (TGCS) was implemented. This review focuses on the prevalence of CS rates found in various studies and identifies the clinically important groups that were most involved in CS deliveries. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelineswere followed in this review. "Caesarean delivery" OR "Robson's Ten Group" OR "Classification System" were keywords used tosearch literature. Twenty-one studieswere included in this review based on eligibilitycriteria. We concluded that group 5 was the major contributing factor for the increase in CS rates followed by group 10, group 4, group 2, and group 1. Previous CS was the most common factor responsible for increasing CS rates. We emphasize that Robson's TGCS is an essential parameter for recording CS ratesand is simple to use for CS rate comparison.

Comparison of Pregnancy Outcome between 4 and 6 cm Cervical os Dilatation to Demarcate Active Phase of Labour: A Cross-Sectional Study.

This is a cross-sectional study comparing pregnancy outcomes between participants with 4 and 6 cm of cervical os dilatation at the diagnosis of the active phase of labour. It was conducted in a single tertiary centre involving low-risk singleton pregnancies at or beyond 37 weeks with spontaneous onset of labour. A total of 155 participants were recruited, 101 in group 1 (4 cm) and 54 in group 2 (6 cm). Both groups were similar in mean maternal age, mean gestational age at delivery, ethnicity, median haemoglobin level at delivery, body mass index, and parity. There were significantly more participants in group 1 who needed oxytocin augmentation (p < 0.001) for the longer mean duration (p = 0.015), use of analgesia (p < 0.001), and caesarean section rate (p = 0.002). None of the women had a postpartum haemorrhage or a third- or fourth-degree perineal tear, and none of the neonates required admission to the neonatal intensive care unit. There were significantly more nulliparas who had a caesarean section as compared to multiparas. A cervical os dilatation of 6 cm reduces the risk of caesarean section by 11% (95% CI, 0.01-0.9) and increases three times more the need for analgesia (AOR = 3.44, 95% CI, 1.2-9.4). In conclusion, the demarcation of the active phase of labour at a cervical os dilatation of 6 cm is feasible without an increase in maternal or neonatal complications.

Placental Endocan Expression in Woman With Preeclampsia and its Relation With Maternal and Fetal Outcomes: A Cross-section Study

Objectives: This study aimed to determine placental endocan expression in women with preeclampsia (PE) and its relation to fetal and maternal outcomes. Materials and Methods: This cross-sectional study was carried out at the Obstetrics Department/Al-Yarmouk Teaching Hospital from January 2020 to October 2020. The study included 90 pregnant inpatient women with PE. The participants were divided into 3 groups including 30 patients with severe PE, 30 non-severe PE, and 30 normotensives. After delivery, placental endocan expression was determined immunohistochemically. Results: The study showed that endocan was expressed in 44 patients’ placenta, all of them were hypertensive vs. 46 negatives for endocan (P=0.001), this expression correlated with adverse maternal outcomes including HELLP (haemolysis, elevated liver enzymes, and low platelets count) syndrome (9.1%), Placental abruption (13.6%) and increase rate of CS (63.6%), as well as adverse fetal outcomes (P=0.001). included stillbirth (13.6%), birth weight &lt;2500 g (68.2%), Apgar score in 1 min &lt;7 (63.6%) and in 5 minutes &lt;7 (31.8), admission to neonatal intensive care unit (NICU) (31.8%), and (68.2%) delivered preterm. Conclusions: This study showed a higher expression of endocan in the placenta of women with PE, and it had a positive correlation with adverse maternal and fetal outcomes.

A Three-Year Review of Birth Weight Pattern Among Term Deliveries in Bowen University Teaching Hospital, Ogbomoso, Nigeria

Background: Birth weight is a commonly used indicator of newborn maturity and health and a reliable predictor of postnatal survival. There is a need to determine the birth weight pattern and maternal factors that influence the birth weight in babies delivered at term. Objective: To determine the birth weight pattern and maternal factors influencing the birth weight of babies delivered at term. Methods: In this retrospective, descriptive study, the hospital records of all pregnant women who had childbirth at term in Bowen University Teaching Hospital (BUTH), Ogbomoso, Nigeria, from 01 January 2018 to 31 December 2020, were retrieved. Data on birth weight and maternal obstetric factors were retrieved for analysis. Results: The mean age of the mothers was 30.52 ± 5.23 years. A total of 1072 deliveries were recorded during the study period. These consisted of 580 (54.1%) males and 492 (45.9%) females, with a male-to-female ratio of 1.18:1. The caesarean section rate was 37.7%. The mean birth weight was 3.15±0.56 kg, and male babies had a higher mean weight (3.186±0.535kg vs 3.14±0.493kg). Normal birth weight (NBW) was recorded among 90.3%, while low birth weight (LBW) and high birth weight (HBW) were 6.7% and 3.0%, respectively. Only maternal comorbidities (p = 0.0001) and number of gestation (p = 0.0001) were significantly associated with birth weight. Conclusion: Maternal and foetal factors influenced the birth weights of the babies. Implementing measures to minimise the risk of delivering babies with abnormal birth weights is essential to improve newborn survival.

O-054 Live Births following Laparoscopic Caesarean Scar Niche Repair in patients with Secondary Infertility: A Self-Controlled Case Series and Literature Review.

Abstract Study question Does laparoscopic repair of caesarean scar niches as a treatment for secondary infertility improve live birth rates? Summary answer In our self-controlled case series, the laparoscopic repair of caesarean section niches in patients with secondary infertility has improved pregnancy and live birth rates. What is known already A niche is an iatrogenic myometrial defect due to abnormal tissue healing at a previous caesarean section scar site. Patients with a niche present with symptoms of vaginal discharge, abnormal uterine bleeding, chronic pelvic pain, dyspareunia and secondary infertility. As a niche is secondary to caesarean sections, rising caesarean section rates will lead to an increase in the rate of niche presentation and diagnosis. Study design, size, duration A retrospective review was performed of all women undergoing a hysteroscopy assisted laparoscopic niche repair between 2016 and 2023 at Guy’s and St Thomas’ Hospital in London. The primary outcome measure was live births. A literature review was performed to interrogate the currently available evidence on live birth rate following niche repair. Ultrasound images of the niche prior to and post repair, as well as intra-operative laparoscopic and hysteroscopic images and videos, are also presented. Participants/materials, setting, methods The cases were identified from the Assisted Conception Unit database. Only women who presented with secondary infertility with a diagnosis and repair of a niche were reported. Niche diagnosis was made in patients presenting with abnormal discharge, bleeding and fluid in the uterine cavity. Any incidental myometrial defect found on transvaginal ultrasound was also a diagnostic characteristic. Main results and the role of chance There are some reports in the literature on pregnancy outcome following niche repair. A scarcity of studies reporting specifically on live birth rates following repair, suggests this case series as unique. Eleven patients underwent caesarean section niche repair by two surgeons at our unit. The mean age at repair of the patients was 36. All patients had two or more years of subfertility on presentation, with a proportion having several failed in-vitro fertilisation (IVF) cycles prior to repair. The pregnancy rate, clinical pregnancy rate and live birth rate were 73% (8/11), 64% (7/11) and 45% (5/11) respectively. One patient had an early miscarriage at age 48 following repair and has not conceived again since. One patient underwent a second repair and is awaiting further investigations. Two patients have not yet conceived following repair, one of which had sickle cell disease, age factor and endometriosis. Our findings suggest a positive correlation between surgical repair of the niche and live births. However, this could be due to a strict selection criteria in a small sample size. In the two patients that did not have live births following repair, other factors of subfertility such as age, male factor and comorbidities could also play a role. Limitations, reasons for caution The small sample size can lead to selection bias and impairs the external validity of our findings. The likelihood of random error is high. Lack of a control group prevents any comparisons. Furthermore, all repairs were performed by the two surgeons which introduces operator bias. Outcome assessors were not blinded. Wider implications of the findings Subfertility secondary to niches is likely to be a growing challenge as caesarean section rates continue to increase. Our study suggests that surgical repair may improve live birth rates. We present our findings to augment the current international data on live birth rates following niche repair. Trial registration number not applicable

P-778 Same mother-different Oocyte: Comparison of obstetric and perinatal outcomes between pregnancies achieved through oocyte donation versus those achieved through spontaneous conception for the same mother

Abstract Study question Is there a difference in obstetrical and perinatal outcomes between pregnancies achieved through oocyte donation versus those achieved through spontaneous conception for the same mother Summary answer OD pregnancies show higher incidences of preterm labor and pregnancy-induced hypertension, and lower incidences of small for gestational age, compared to spontaneous pregnancies What is known already Oocyte donation (OD) is an integral part of modern assisted reproductive care and has been used for over three decades. OD pregnancies have an increased rate of hypertension, cesarean section, and preterm labor. Yet most of these complications are attributed to the mothers going through OD, not to the biological effect of different oocyte sources (autologous Vs. donation). Study design, size, duration This study is a retrospective cohort study that utilizes electronic data from Maccabi Healthcare Services. This 2.5-million-patient integrated care organization represents 25% of the pregnant population in the country. The data used in this study were collected from 2000 through 2018. Participants/materials, setting, methods The study included mothers who experienced both a spontaneous conception (SP) pregnancy and later an oocyte donation (OD) pregnancy. The study compared obstetric and perinatal outcomes, including the incidence of preterm labor (PTL) and small for gestational age (SGA). Mother's obstetric outcomes such as pregnancy induced hypertension (PIH), gestational diabetes, malpresentation, and postpartum hemorrhage were also analyzed. A paired t-test was performed to compare each outcome for the same mother Main results and the role of chance The cohort included 194 mothers who had a first spontaneous pregnancy and a second pregnancy with oocyte donation. The mean age of the mother during her OD pregnancy was statistically older than the OD pregnancy (mean difference 2.2 years, p = 0.0028). No difference was found between pregnancies regarding the BMI (p = 0.216). A trend toward a higher prevalence of PIH was found in the OD pregnancy compared to the SP (mean difference 2.5, p = 0.058). No difference was found between pregnancies regarding gestational diabetes (p = 0.7), malpresentation (p = 1), retained placenta (p = 0.318), and Cesarean section (p = 0.565). Perinatal outcomes show a higher prevalence of premature labor before the 34th week and 32nd week in the OD pregnancies compared to SC pregnancies (mean difference 3.6, p = 0.034 and mean difference 3, p = 0.33 respectively). No difference was found between pregnancies regarding labor before the 37th week (p = 1). A statistically lower prevalence of SGA was found in the OD pregnancy compared to the SP (p = 0.0057). Limitations, reasons for caution Due to its retrospective character, some information is lacking. Information regarding indications leading to OD/AO are missing which might have elaborated our findings Wider implications of the findings OD pregnancies should be considered high-risk, primarily due to the increased risk of PTL and PIH. Adequate recommendations should be considered, including cervical length surveillance, frequent blood pressure measurements, and perhaps prophylactic low-dose aspirin to reduce the risk of preeclampsia. Trial registration number 0046-18-BBL

O-269 Reproductive and Neonatal Outcomes in Women with Adenomyosis: A Population-based Study

Abstract Study question Does adenomyosis impact reproductive and neonatal outcomes? Summary answer Adenomyosis increases risk of infertility and pregnancy/delivery complications. Increased surveillance may aid in prevention and/or decreasing risk of maternal and neonatal morbidity and mortality. What is known already Patients with adenomyosis experience greater adverse obstetric and gynecological events which include but are not limited to, infertility and preterm delivery, as well as other adverse gynecological conditions such as endometriosis. Currently, existing literature provides a limited guide regarding obstetric and gynecological surveillance and management of patients diagnosed with adenomyosis. The current study aims at providing an in-depth analysis of a population database to expand and provide evidence-based insight on maternal, pregnancy and neonatal outcomes in women with adenomyosis. Study design, size, duration Retrospective population-based study. Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database (HCUP-NIS) were extracted from 2004 through 2014 using the ICD-9 codes to create a delivery cohort. Code 617.0 was used to identify women with adenomyosis, and reproductive outcomes were then compared to pregnancies without adenomyosis. A multivariate logistic regression model was utilized to adjust for statistically significant variables (P-value &amp;lt;0.05) Participants/materials, setting, methods Data was obtained from HCUP-NIS databse. Delivery records for the study and control groups were extracted using international classification of diseases Clinical Modification diagnostic codes(ICD-9-CM). The study group consisted of patients with adenomyosis and the control was patients without a diagnosis of adenomyosis. Logistic-regression-analysss was conducted to explore associations between adenomyosis and maternal&amp;neonatal obstetrical outcomes through the estimation of odds ratio (OR) and 95%-confidence intervals(CI). The regression models were adjusted for the potential confounding factors. Main results and the role of chance Of the 9,096,788 deliveries in the study period, 2467 women had adenomyosis. Women with adenomyosis were more likely to be older (P &amp;lt; 0.0001), obese (P &amp;lt; 0.0001), have chronic hypertension (P &amp;lt; 0.0001), thyroid disease (P &amp;lt; 0.0001), pre-gestational diabetes mellitus (P &amp;lt; 0.0001), to have had previous caesarean section (P &amp;lt; 0.0001) and in-vitro fertilization (IVF) (P &amp;lt; 0.0001). Patients with adenomyosis had a statistically significant risk of developing pregnancy induced hypertension, preeclampsia, and placenta previa relative to the controls, after controlling for baseline risk factors; aOR 1.55 (95% CI 1.33-1.82), aOR 1.69 (95% CI 1.38-2.08), and aOR 5.86 (95% CI 4.62-7.43), respectively. Moreover, the rates of abruptio placenta, caesarean section, hysterectomy, post-partum hemorrhage, wound complications, blood transfusions and maternal infection were higher in the adenomyosis group relative to the controls, after controlling for confounding factors, aOR 2.17 (95% CI 1.60-2.95), aOR 21.63 (95% CI 17.99-26.02), aOR 6.39 (95% CI 4.22-9.68), aOR 1.97 (95% CI 1.60-2.42), aOR 2.37 (95% CI 1.52-3.69), aOR 2.25 (95% CI 1.71-2.95), and 1.82 (95% CI 1.39-2.39), respectively. At birth 1.5% of neonates born to adenomyosis patients had congenital anomalies, relative to 0.4% within the controls (aOR 2.94 (95% CI 2.02-4.28)). Limitations, reasons for caution Code were utilized to identify patients with adenomyosis. This may present as a limitation given the possibility that a number of adenomyosis patients were grouped within the controls. Inability to differentiate between severity and extent of adenomyosis, presents as a limitation within the HCUP-NIS database. Wider implications of the findings This is the first study of its kind to provide an in-depth analysis with substantial statistical power and over nine-million deliveries, in order to provide clinical guidance for patient surveillance and management. Trial registration number Not applicable

P-588 A comparison of obstetrical and neonatal outcomes in patients with the hyperandrogenic states, polycystic ovarian syndrome(PCOS) and congenital adrenal hyperplasia(CAH): a retrospective population-database study.

Abstract Study question PCOS and CAH are associated with increases in pregnancy complications. Therefore, we evaluated differences in pregnancy and neonatal outcomes between women with PCOS and CAH. Summary answer When comparing these conditions PCOS was associated with pregnancy-induced hypertension and gestational diabetes, whereas CAH had more cesarean sections and small for gestational age infants. What is known already PCOS and CAH are causes of hyperandrogenism among women of reproductive age. Apart from causing hyperandrogenism, they also share characteristics such as menstrual irregularity, polycystic ovaries and insulin resistance with central adiposity. Several meta-analyses have associated PCOS with adverse obstetrical and neonatal outcomes with most studies finding an increased frequency of pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes (GDM), cesarean section (CS) and preterm delivery. CAH on the other hand, is associated with higher rates of CS and inconsistent evidence about increases in GDM, chorioamnionitis and congenital anomalies. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of PCOS or CAH and pregnancy were identified. Each subject had a delivery or maternal death to be included once per pregnancy. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups, for which chi-squared tests were used. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI) and correct for any difference in baseline demographics (P &amp;lt; 0.05) between the groups. According to the Tri-Council Policy statement (2018), institutional review board (IRB) approval was not required, given that data was anonymous and publicly available. Main results and the role of chance A total of 15,179 women with either PCOS or CAH were included. Approximately 98% of those women (14,881) were diagnosed with PCOS, while the rest 2% (298) had CAH. The adjusted analysis for race, obesity, previous CS, multiple gestation and IVF yielded the following results. For pregnancy outcomes PIH (aOR=1.76; 95% CI: 1.12-2.77; p = 0.015) and GDM (aOR=1.68; 95% CI: 1.12-2.52; p = 0.012) were more common among women with PCOS, whereas no statistically significant results were detected for rates of placenta previa, preeclampsia or eclampsia superimposed on pre-existing hypertension or eclampsia. After additional adjusting for PIH and GDM, the delivery outcomes showed CS to be significantly less common in the PCOS group (aOR=0.59; 95% CI 0.44-0.80; p &amp;lt; 0.001), with no significant differences concerning preterm premature rupture of membranes, preterm delivery, abruptio placenta, chorioamnionitis, operative vaginal delivery, hysterectomy, postpartum hemorrhage, wound complications, maternal death and need for transfusion. In neonatal outcomes, women with CAH had higher percentages of SGA neonates (aOR=0.32; 95% CI 0.20-0.52; p &amp;lt; 0.001) and no difference in intrauterine fetal demise and congenital anomalies. Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. Furthermore, CAH type was not specified. Information on medication use and compliance was also lacking information about certain potential confounders such as parity, and duration of labor. Wider implications of the findings This is the first study to investigate the differences in obstetrical and neonatal outcomes between these two hyperandrogenic disorders and we noted that the majority of risks were similar, despite the difference in the pathophysiology of these conditions. Rates of certain complications differ and studies are needed to elucidate why. Trial registration number N/A

P-327 Intrauterine fluid in patients with cesarean section defects in association with ivf outcomes

Abstract Study question This study evaluate the effect of cesarean section scar defects associated with intrauterine fluid during endometrial preparation on pregnancy outcomes. Summary answer Patients with Cesarean section scar defect and intrauterine fluid during endometrial preparation had a substantially lower pregnancy outcome compared to those without uterine fluid. What is known already The Cesarean section rate in developed countries has increased continuously, leaving many short-term and long-term consequences. Intrauterine fluid, which reported incidence may reach 40% in patients who have had a previous caesarean section, may play an important role in reducing endometrial receptivity and further impair pregnancy outcomes. Study design, size, duration This is a retrospective cohort study performed on patients who had undergone frozen embryo transfer at an Assisted Reproductive Technology Center from January 2019 to December 2019. Participants/materials, setting, methods 2,350 patients without intrauterine fluid and 74 patients with Cesarean section scar defect who had intrauterine fluid during endometrial preparation but none at progesterone supplementation were analyzed. Multiple logistic regression was performed for the probability of the pregnancy outcome of embryo transfer and measured the association with the status of intrauterine fluid, age, endometrial thickness, number of previous transfer, number of embryos, type of infertility, and difficult embryo transfer at the alpha level of 0.05%. Main results and the role of chance The outcomes among 2,424 patients undergoing cryopreserved embryo transfer were 59.45% for pregnancy rate, 8.7% for biochemical pregnancy rate, 50.33% for clinical pregnancy rate, and 43.15% for ongoing pregnancy rate. The analysis of multiple logistic regression indicated that the presence of intrauterine fluid during endometrial preparation did not affect the pregnancy rate. However, in patients with intrauterine fluid, there was an increased rate of biochemical pregnancy (OR 2.46, 95%CI 1.35-4.50) and a reduced rate of ongoing pregnancy (OR 0.54, 95%CI 0.32-0.89). Limitations, reasons for caution The major limitations of the present study are the retrospective design and small number of patients with uterine fluid. Additionally, the composition of the uterine fluid (eg, blood, mucus, purulent, or transparent) cannot be classified by an ultrasound exam. Wider implications of the findings Intrauterine fluid may be an innovative and controllable factor that should be considered in patients who have a history of caesarean section in order to improve pregnancy outcomes. Trial registration number Not Applicable

O-109 Avoiding the C-section scar defect

Abstract The cesarean scar defect was first described in 1961 by Poidevin et al. Cesarean delivery is one of the most common surgeries today, and millions of women give birth this way every year. The prevalence of cesarean scar defect is increasing due to increasing cesarean section rates. The cesarean scar defect is called by different names in the literatüre, such as isthmocele, niche, diverticulum, dehiscence of the cesarean scar. It was discovered that the prevalence of isthmocele varied widely. Using contrast-enhanced sonohysterography, the prevalence in a random group of women with a history of CS was between 56% and 84%, whereas the incidence in pelvic ultrasonography fluctuates between 6% and 36%. The most common gynecological problems that may occur due to isthmocele are menstrual spotting, dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The likelihood of scar pregnancy, placentation abnormalities, and uterine rupture increases with subsequent pregnancies. Both hysteroscopic and laparoscopic isthmocele repair techniques are highly effective. Therefore, precautions against isthmocele during cesarean delivery should be made more transparent. The development of isthmocele is influenced by the timing of the cesarean section (during pre/early or advanced labor), the position of the uterine incision (its distance or proximity to the internal os of the cervix), and the opening and closing (suturation) method of the uterine incision. Once more, both gestational diabetes and being overweight might be viewed as independent risk factors. Understanding the risk factors for isthmocele development will aid in the development of preventative measures. The two most crucial elements in the formation of isthmocele, according to our knowledge of the literature, are the site of the uterine incision and the suture methods. In this presentation, we will discuss ways to prevent the development of isthmocele.

Evaluation of endometrioma size effect on ovarian reserve, embryo quality and pregnancy outcome after in vitro fertilization cycle; a cross-sectional study

IntroductionInvestigation of endometrioma size and its laterality on the quality of the embryo in patients with endometrioma compared to healthy subjects.Materials and methodsIn this retrospective and cross-sectional study, 70 patients with unilateral and bilateral endometrioma were recruited and compared with 70 age-matched infertile patients as the control group in terms of AMH before ovum pick-up, embryo quality as well as pregnancy outcome. Additionally, in the case group, we divided both unilateral (n = 32) and bilateral endometrioma patients (n = 38) into three groups based on the size of endometrioma. (1–3 cm, 3–6 cm, 6–10 cm)ResultsThere was no difference in terms of age, BMI, parity, and age of menarche between the case and control groups. Moreover, no significant difference was observed in the baseline level of AMH between the case 2.96 ± 2.72 ng/dl (0.21–11.3) and control 2.73 ± 2.39 (0.21–12.8) groups. (P = 0.59) There was also no significant difference concerning AMH level between unilateral 3.58 ± 3.20 ng/dl (0.21–12.8) and bilateral endometrioma 2.45 ± 2.14 (0.21 − 0.20) groups. In terms of the quality and number of embryos, there was no significant difference between the case and control groups. (P = 0.30) Although the AMH level decreased with the increase in endometrioma size, this difference was not statistically significant. (P = 0.07) There was no significant difference in terms of the embryo quality between the groups based on the size of endometrioma. (P = 0.77) In addition, no significant difference was observed between the case and control groups in the terms of birth weight and pregnancy complications, such as premature delivery, cesarean section rate, neonatal respiratory distress, jaundice, as well as hospitalization rate. Head circumference of the newborns was higher in the endometrioma group while their Apgar score was lower in the case compared to the control group.ConclusionThe presence of endometrioma by itself does not affect the main result of IVF procedures, including the number and quality of embryos and pregnancy outcome. Thus, IVF and embryo preservation and even pregnancy before surgery seem to be reasonable for endometriotic patients.

Cesarean section trends from 1992 to 2016 in Estonia and Finland: A registry-based study.

The number of cesarean sections (CSs) has grown steadily, but the underlying factors driving this increase remain unknown. Data from Medical Birth Registries were retrieved to analyze CS trends in Estonia and Finland during the period 1992-2016. All births in Estonia (n = 356 063) and Finland (n = 1 437 234) were included. The differences between Estonia and Finland in five-year time periods for the total CS rate, and rates in Robson 1, 2, and 5 groups (R1, R2, R5) were analyzed by logistic regression. Total CS rates were adjusted for birthweight, parity, previous CS, gestational age, singleton pregnancy, cephalic position, induction, mother's age. R1; R2; R5 rates were adjusted for birthweight and mother's age. In Estonia, the proportion of CSs increased from 6.5% to 21.0% and in Finland from 15.1% to 16.8% between 1992 and 2016. In 2016, Estonia and Finland remained within the target value with their R1 + 2 (Estonia 18%; Finland 16%) and R5 (Estonia 59%; Finland 42%) values. Comparing Robson groups in different countries can shed light on divergent CS rates and to improve the quality of perinatal and obstetric care.

Use of cigarettes and heated tobacco products during pregnancy and maternal–fetal outcomes: a retrospective, monocentric study

PurposeTo compare the effects of using heated tobacco products (HTP) or traditional cigarettes (C) on maternal and neonatal outcomes.MethodsThis is a retrospective, monocentric study conducted at San Marco Hospital from July 2021 to July 2022. We compared a cohort of pregnant patients who smoked HTP (HS), with pregnant women smoking cigarettes (CS), ex-smoker (ES) and non-smoker (NS) pregnant women. Biochemistry, ultrasound, and neonatal evaluations were performed.ResultsIn total, 642 women were enrolled, of which 270 were NS, 114 were ES, 120 were CS, and 138 were HS. CS had the greatest weight gain and had more difficulty getting pregnant. Smokers and ES experienced more frequently threats of preterm labor, miscarriages, temporary hypertensive spikes, and higher rates of cesarean sections. Preterm delivery was more associated with CS and HS groups. CS and HS had lower awareness of the risks to which the mother and the fetus are exposed. CS were more likely to be depressed and anxious. Biochemical parameters did not show significant differences between the groups. CS had the greatest difference in days between the gestational age calculated based on the last menstrual period and the one based on the actual ultrasound age. The average percentile newborn weight range of CS was lower, as well as the mean 1st minute and the 5th minute Apgar scores.ConclusionThe comparison of the data obtained between CS and HS underlines the greater danger of C. Nevertheless, we do not recommend HTP because the maternal–fetal outcomes are not superimposable to the NS outcomes.

185-LB: Examining the Association between Neighborhood Socioeconomic Deprivation and Cesarean Section Rates among Women Diagnosed with Gestational Diabetes Mellitus—A Retrospective Analysis of the Maryland State Inpatient Database

Introduction: The rising cesarean section (CS) rates in patients with Gestational Diabetes Mellitus (GDM) may be influenced by social determinants of health, including neighborhood socioeconomic deprivation. Recent research has highlighted the association between higher levels of neighborhood socioeconomic deprivation and increased rates of CS among women with GDM. Understanding this relationship is crucial for addressing health disparities and improving maternal and infant health outcomes in disadvantaged communities. Objective: To determine the association between neighborhood socioeconomic deprivation (DCI) and incidences of cesarean section among women with GDM in Maryland. Methodology: DCI and CS rates among women with GDM. We adjusted for potential confounding variables, including age, day of admission, insurance type, race/ethnicity, and income, in our final multivariate analysis. Results: In our study period, we identified 17,326 cases of GDM, with a CS rate of 44.3%. We found a significant correlation between the level of socioeconomic deprivation in the neighborhood and the rate of CS among women with GDM. Women with GDM residing in the poorest communities had the highest odds of CS. Prosperous, reference, Comfortable, (OR=1.08, 95% CI 0.98-1.20, p=0.13), Mid-tier, (OR=1.14, 95% CI 1.02-1.26, p=0.02), At-Risk, (OR= 1.17, 95% CI 1.02-1.34, p=0.03), and Distressed, (OR=1.29, 95% CI 1.11-1.50, p=0.001). Conclusion: Women with GDM residing in areas with the poorest communities have the highest incidence of CS, irrespective of other risk factors. Disclosure O. A. Akinyemi: None.