Vaginal Birth After Cesarean Research Articles

Incidence and Predictors of Successful Vaginal Birth Among Women With a History of Cesarean Section in Public Health Facilities of Southern Ethiopia in 2021

BACKGROUND:Even though a cesarean section (CS) performed greater than 15% has no significant association with a reduction in maternal and neonatal mortality, repeat elective CS continues to play a major role in unnecessary CS worldwide. Trial of labor after cesarean (TOLAC) is one of the strategies to reduce the rate of unnecessary CS. However, the selection of candidates for a TOLAC is not an easy task without evidence. This study was conducted to determine the incidence of successful vaginal birth after one CS and the associated factors in public health facilities in southern Ethiopia.METHODS:An institutional-based cross-sectional study was conducted from June 10, 2020, to December 10, 2021, on laboring women, and the data were collected using a pretested interviewer-administered questionnaire and a data extraction sheet. A binary logistic regression model was used to assess the factors associated with successful vaginal birth after cesarean (VBAC) section using SPSS version 25. Bivariate and multivariate analyses were performed, and independent variables withp< .05 along with an odd ratio and 95% confidence interval (CI) declare the associated factors.RESULTS:A total of 417 women participated in this study making a response rate of 98.8%. The incidence of vaginal births after cesarean was 51.1% (CI, 46%–56%). The likelihood of successful VBAC was observed in women with a history of vaginal delivery before CS (AOR, 3.7, CI = 1.06, 13.19), favorable Bishop score at admission (AOR, 19.1, CI = 2.69, 134.98), greater than 4-cm cervical dilation at admission (AOR, 171.3, CI = 1.8, 16,722), and clear color of amniotic fluid (AOR, .096, CI = .02, .38).CONCLUSION:The incidence of VBAC in this study is promising and should be practiced. In choosing a woman for the TOLAC, health professionals might need to pay attention to intrapartum variables, such as cervical dilation, Bishop score, and color of the amniotic fluid.

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study.

To investigate the risk of stillbirth in relation to (1) a previous caesarean delivery (CD) compared with those following a vaginal birth (VB); and (2) vaginal birth after caesarean (VBAC) compared with a repeat CD. Population-based cohort study. The Swedish Medical Birth registry. Women with their first and second singletons between 1982 and 2012. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Stillbirth (antepartum and intrapartum fetal death). Of the 1 771 700 singleton births from 885 850 women, 117 114 (13.2%) women had a CD in the first pregnancy, and 51 755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR 1.37; 95% CI 1.23-1.52) in women with a previous CD compared with VB. The odds of intrapartum stillbirth were higher in the previous pre-labour CD group (aOR 2.72; 95% CI 1.51-4.91) and in the previous in-labour CD group (aOR 1.35; 95% CI 0.76-2.40), although not statistically significant in the latter case. No increased odds were found for intrapartum stillbirth in women who had VBAC (aOR 0.99; 95% CI 0.48-2.06) compared with women who had a repeat CD. This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help healthcare providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

Repeat Cesarean Sections: Maternal and Neonatal Outcomes and Complications

Repeat Cesarean Sections: Maternal and Neonatal Outcomes and Complications

Outcomes of Trial of Labor after a Cesarean Section in Bomet County, Kenya

Trial of labor after cesarean section (TOLAC) is recommended for women with one prior cesarean section. However, TOLAC positive outcomes depend on selecting candidates to achieve higher success rates. Most available TOLAC data to inform patient selection originates from developed countries, which limits a patient-centered TOLAC practice in low-resource settings. Thus, we used a prospective observational cross-sectional approach to assess the success rate of TOLAC and establish the maternal and fetal factors associated with successful TOLAC in 170 women with one previous scar at two referral hospitals in Bomet County, a low-resource setting in Kenya. The primary maternal and neonatal outcomes were compared between those who had a vaginal birth after a cesarean section (VBAC) and those who had an emergency repeat cesarean section (ERCS) following a failed TOLAC between October 2022 and June 2023. The TOLAC success rate was 48.2% with the most common indication for emergency repeat cesarean section being failure to progress (34.1%). Factors associated with successful TOLAC included inter-delivery interval >60 months (p-0.044), and parity 2-4 (p- <0.001). Breech presentation and non-reassuring fetal status (NRFS) as indications for previous cesarean section, were associated with a successful VBAC (p-< 0.001, 0.033). In contrast, a birth weight of >3500 g was associated with an increased risk of ERCS. Moreover, a failed TOLAC was associated with a prolonged (>4 days) hospital stay (p-0.012). Our findings suggest that with proper patient selection, TOLAC remains a viable option with better outcomes if successful. However, TOLAC candidates should be evaluated based on the contextual factors of a given setting, hence careful patient selection is recommended to improve outcomes associated with TOLAC.

Continuity obstetric care demonstrates greater vaginal birth after caesarean success.

Australia's caesarean rate is higher than Organisation for Economic Co-operation and Development (OECD) average, and is rising. Vaginal birth after caesarean (VBAC) is safe for selected women. Midwifery continuity of care (CoC) is associated with higher rates of vaginal birth compared to other models; however, impacts on VBAC attempts and success are unknown. The primary aim was to determine if there is a difference in achieving VBAC between CoC and non-CoC (NCoC) models. The secondary aim was to determine if there is a difference in the proportion of women attempting VBAC between these models. Retrospective review of antenatal records and birthing data of all women who birthed in 2021 with one or more previous caesareans. Women were included if they had two or fewer caesareans. Women were excluded if contraindications to VBAC existed. There were 142/1109 (12.8%) women who had previous caesareans and were eligible to attempt VBAC. There were 47/109 (43.1%) women who attempted vaginal birth after one caesarean with 78.7% success. After one caesarean, women in CoC were more likely to achieve VBAC than NCoC (45.2% vs 26.1%; relative risk (RR) 1.76, 95% CI 1.04-3.00), although when stratified by private and midwifery CoC models, women in midwifery CoC models were more likely to be successful (private RR 0.69, 95% CI 0.23-2.07 vs midwifery RR 2.48, 95% CI 1.50-4.11). Women in CoC were more likely to attempt VBAC (54.7% vs 34.8%; RR 1.57, 95% CI 1.02-2.41), and receive counselling about VBAC (92.5% vs 62%; RR 1.48, 95% CI 1.41-3.11). CoC improves the rate of attempted and successful VBAC through several factors, including increased counselling and greater provision of birth choices.

Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China.

There have been limited reports on the duration of labor progression in pregnant women undergoing vaginal birth after cesarean (VBAC). This study aimed to investigate the duration of labor progression during VBAC in Hubei, China. A total of 359 pregnant women undergoing VBAC were enrolled as the VBAC group, meeting the following criteria: singleton pregnancy, gestational age ≥ 37weeks, live birth, history of cesarean delivery, and a willingness to attempt a vaginal delivery. At the same time, 359 primiparas successfully undergoing vaginal delivery were randomly enrolled in the control group at a 1:1 ratio. Subsequently, the durations of the first, second, and third stages of labor were comparatively analyzed between the two groups. The duration of the first, second, and total stages of labor in the VBAC group was significantly shorter than that in the control group (p < 0.05). There was no significant difference in the duration of the third stage of labor between the two groups (p > 0.05). The amount of blood loss, the rate of postpartum hemorrhage (PPH), and episiotomy were higher in the VBAC group than in the control group (p < 0.05). The rate of labor analgesia and intrapartum fever in the VBAC group was significantly lower than that in the control group (p < 0.05). The duration of labor progression of the first, second, and total stages of VBAC is shorter than that in primiparous women in our observation in China.

Comparison of maternal and neonatal outcomes between vaginal birth after cesarean section and normal vaginal birth

Objective This study aimed to compare the outcomes of vaginal birth after cesarean (VBAC) with those of normal vaginal birth (NVB) in a tertiary hospital in China. Methods This retrospective cohort study analyzed 1,024 women who birthed vaginally between January 2019 and December 2020. The VBAC group (n = 512) included women with one previous cesarean, while the NVB group (n = 512) had no previous caesareans. All women used epidural analgesia. We assessed maternal and neonatal complications using descriptive statistics, chi-square tests, and logistic regression. Statistical analysis was performed using SPSS version 25.0. Results The VBAC group had an 87.5% success rate for vaginal birth under epidural analgesia, whereas the NVB group had a 100% success rate. A primary focus of the study was uterine rupture. Vaginal birth after cesarean was associated with a higher incidence of uterine rupture (0.8% vs 0%, p = 0.031), postpartum hemorrhage (6.6% vs 3.5%, p = 0.021) and the need for blood transfusions (2.7% vs 0.8%, p = 0.012) compared with NVB. There were no substantial differences in maternal infections, wound infections or perineal lacerations between the groups. Although neonatal outcomes were generally similar, the VBAC group experienced higher rates of 5-minute Apgar scores <7 (2.3% vs 0.6%, p = 0.009) and admissions to neonatal intensive care units (3.1% vs 1.2%, p = 0.016 Even after adjusting for confounders, VBAC remained an independent risk factor for several complications. Conclusion Although VBAC is feasible and mostly safe, it is associated with a higher risk of specific complications compared with NVB. Careful selection of candidates and close monitoring are essential for optimizing outcomes in VBAC cases.

A randomized controlled trial reducing cesarean delivery rates in China by introducing trial of labor after cesarean and electrohysterography

Objective A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. Methods In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. Results After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p = .48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p = .21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. Conclusion This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. Trial registration The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199).

Maternal and Fetal Outcome in Patients with Vaginal Birth After Caesarean Delivery Comparison to and Elective Caesarean Section with Previous One LSCS

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS.&#x0D; Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery.&#x0D; Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p&lt;0.05). Blood Transfusion and Premature rupture of membrane were not associated with any of the two groups. (p&gt;0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p&lt;0.01). Mean stay of hospitalization was significantly higher in LSCS group (p&lt;0.01).&#x0D; Conclusion: Better Bisho’s score has significantly more chances of successful VBAC. VBAC has better APGAR score at 1 min and at 5 min compared to LSCS group. Birth weight is not affected by the type of delivery after first caesarian delivery.

Evaluating the performance of an AI-powered VBAC prediction system within a decision-aid birth choice platform for shared decision-making.

Vaginal birth after cesarean (VBAC) is generally regarded as a safe and viable birthing option for most women with prior cesarean delivery. Nonetheless, concerns about heightened risks of adverse maternal and perinatal outcomes have often dissuaded women from considering VBAC. This study aimed to assess the performance of an artificial intelligence (AI)-powered VBAC prediction system integrated into a decision-aid birth choice platform for shared decision-making (SDM). Employing a retrospective design, we collected medical records from a regional hospital in northern Taiwan from January 2019 to May 2023. To explore a suitable model for tabular data, we compared two prevailing modeling approaches: tree-based models and logistic regression models. We subjected the tree-based algorithm, CatBoost, to binary classification. Forty pregnant women with 347 records were included. The CatBoost model demonstrated a robust performance, boasting an accuracy rate of 0.91 (95% confidence interval (CI): 0.86-0.94) and an area under the curve of 0.89 (95% CI: 0.86-0.93), surpassing both regression models and other boosting techniques. CatBoost captured the data characteristics on the significant impact of gravidity and the positive influence of previous vaginal birth, reinforcing established clinical guidelines, as substantiated by the SHapley Additive exPlanations analysis. Using AI techniques offers a more accurate assessment of VBAC risks, boosting women's confidence in selecting VBAC as a viable birthing option. The seamless integration of AI prediction systems with SDM platforms holds a promising potential for enhancing the effectiveness of clinical applications in the domain of women's healthcare.

130 Vaginal birth after cesarean (VBAC) success and uterine rupture among twin compared to singleton gestation

130 Vaginal birth after cesarean (VBAC) success and uterine rupture among twin compared to singleton gestation

Analysis of Cesarean section rates using Robson’s ten-group classification system in comparison with the MCS population reference

Abstract Background: The escalating global prevalence of Cesarean section (CS) deliveries raises concerns. To address this, the World Health Organization (WHO) suggests employing Robson’s ten-group classification system (RTGCS) for assessing and comparing CS rates among obstetric units. The aim of our study was to assess our hospital’s CS rate per group and juxtapose it with WHO Multi-Country Survey (MCS) population reference data. Furthermore, we delve into prevalent obstetric Indications for CS and examine potential strategies for mitigating the high CS rate. Materials and Methods: This observational cross-sectional study occurred at an Indian tertiary care teaching hospital from October 2018 to May 2020. Women delivering during this period were classified based on RTGCS, and Cesarean rates were computed across various groups. These rates were then compared with the WHO’s MCS population reference guidelines. Additionally, we investigated obstetric Indications for CS within these groups. Results: Of 2994 deliveries during the study period, 42.55% were CS. Notably, group 5 (29.75%) and group 1 (21.74%) had the highest CS rates. The CS rate of nulliparous women was 40.9%. Primary CS groups frequently cited fetal distress as the reason, while group 5 showed repeat CS due to previous CS with obstetric complications, on-demand CS, and scar integrity concerns. Conclusion: Despite our hospital’s overall high CS rate, group-specific contributions align with existing research. High-risk pregnancies, previous CS cases, and preterm CS for neonatal care notably contribute. Efforts should target in reducing CS in low-risk groups.

Neonatal outcomes of patients with vaginal delivery after a Caesarean section

Purpose: The rates of caesarean section (CS) have been increasing in recent years in Türkiye and throughout the world. A previous CS is known to not be an absolute indication for repeat CS, and vaginal delivery (VD) (trial of labor after caesarean (TOLAC)) can occur after a CS. The aim of this study was to investigate the neonatal outcomes of TOLAC patients in Konya City Hospital.&#x0D; Materials and Methods: A retrospective analysis was made of the records of all the births in Konya City Hospital between 10 August 2020 and 10 June 2022. The study included all patients with full or nearly complete cervical dilation-effacement and who had a previous CS. These patients were compared with patients who had elective CS and VD. A total of 119 patients were included in the study in 3 groups; TOLAC n:32, CS n:42, VD n:45.&#x0D; Results: TOLAC patients gave birth earlier and the infant birth weight (2991.25gr), length (50.66cm) and head circumference (34.09cm) measurements were found to be significantly lower than those of the other groups. The development of any problem (icterus, respiratory distress syndrome (RDS), oxygen requirement, hypoglycemia, hypothermia) was determined at a significantly higher rate in the TOLAC (21.9%).&#x0D; Conclusion: Patients with a history of CS do not have to have a repeat CS. TOLAC can be performed in appropriate cases, but care should be taken against uterine rupture, the need for emergency CS, and adverse neonatal outcomes.

Prevalence and Outcome of Repeat Caesarean Delivery: A Retrospective Review in Rasheed Shekoni Federal University Teaching Hospital Dutse, North-west Nigeria

Background: Caesarean section is the most common Obstetric surgical procedure. Repeat CS has been a significant contributor to the overall increase in CS rate and accounts for about one- third of all caesarean deliveries worldwide. Objective: This study aimed to determine the prevalence and outcome of repeat Caesarean section. Materials and methods: The study was a 3-year retrospective review of Caesarean sections, carried out between 1st July 2020 and 31st June 2023 in the department of Obstetrics and Gynecology of Rasheed Shekoni Federal University Teaching hospital. The case files of the participants were retrieved from the record department. Data analysis was carried out using IBM statistical package for social sciences (SPSS) version 26. Measured variables were expressed in frequencies and percentage. Test for association was done using chi-square non-parametric test, setting P-value at &lt;0.05. Results: A total of 144 were repeat caesarean deliveries were performed out of 344 Caesarean sections done during the review period, giving an incidence rate of 41.9%. The mean age of the patients was 30.42 ± 50 years and the mean parity was 4.47±2.62. Most (51.39%) of the repeat CS were elective. Majority (93.06) of the patients had EBL ≤1000ml and most (82.6%) of the babies delivered had 5th minute Apgar score of ≥7. Conclusion: The repeat Caesarean section rate in this study is high. Similarly, the emergency Caesarean section rate at first and second order repeat Caesarean deliveries is high. Additionally maternal and fetal complications are higher among women lower order Caesarean deliveries.

Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study.

Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years. We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h). Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth. In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.

A jump into the deep end - Women's strategies on the way to VBAC in Poland

ProblemIn Poland, as in other high-income countries, the rate of caesarean sections (CS) is alarmingly high. Promoting vaginal birth after caesarean section (VBAC) is one of the ways that may help to decrease CS rate. Despite the recommendations by the Polish Association of Gynaecologists and Obstetricians that one previous CS should not be an indication for a subsequent one and VBAC should be promoted, the rate of VBAC in Poland remains low. BackgroundResearch shows that in countries with high VBAC rates women felt supported by healthcare personnel to have VBAC. AimThis study aims to explore the elements of Polish maternity services that contribute to or hinder women’s chances of having a VBAC. MethodsThe study used qualitative methods of research based on semi-structured interviews.We interviewed 22 women. Each woman was interviewed twice, once during pregnancy and then between 6 and 12 weeks after she had given birth. FindingWomen who planned vaginal birth after one previous CS engaged in various strategies such as seeking supportive personnel, opting for fee-for-service dedicated midwifery care or traveled long distances to give birth in facilities supporting VBAC. ConclusionsPolish maternity services do not support women on the way to vaginal birth after surgery. Access to VBAC in Poland is highly unequal and dependent on women’s social and financial resources such as access to private care, place of residence, or social relationships. Efforts should be made to make access to VBAC more universal.

Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil.

To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil. The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression. Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences. The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.

Elective Repeated Cesarean Section (ERCS)

Elective Repeated Cesarean Section (ERCS)

Shared decision making on mode of delivery following a prior cesarean delivery in Dar es Salaam, Tanzania.

Shared decision-making between clinicians and pregnant women with prior cesarean on the subsequent mode of delivery improves trial of labor rates, and reduces the number of repeat cesarean sections and their related complications. However, this practice is insufficient worldwide and the factors influencing it are still unknown. The study aimed at determining the proportion of pregnant women involved in shared decision-making and its associated factors in Dar es Salaam. A cross-sectional analytical study among 350 pregnant women with one prior cesarean section. Data was collected using a structured questionnaire and SPSS 23 was used for analysis. A score of 80 or higher on the nine-item Shared Decision-Making Questionnaire (SDM-Q9) was used to calculate the proportion of women, and the associated factors were obtained using a logistic regression model. P value of < 0.05 was considered significant. The proportion of pregnant women involved in shared decision making was 38%. Factors that were significantly associated with sharing decision making were; having low level of education (AOR 0.55 95% CI 0.33-0.91), being married/having partner (AOR 2.58 95% CI 1.43-4.63), having a companion who had active participation (AOR 3.31 95% CI 1.03-10.6) and being familiar with the clinician (AOR 5.01 95% CI 1.30-19.2). To promote practice of shared decision making in our setting, encouragement of socially vulnerable pregnant women's participation in decision-making by health care professionals, encouragement of companion participation during antenatal care and promotion of personal continuity of care to improve familiarity to clinicians are needed.

Multiple Cesarean Section Outcomes and Complications: A Retrospective Study in Jazan, Saudi Arabia.

Given the increase in the rate of cesarean sections (CSs) globally and in Saudi Arabia, this study was conducted to assess the maternal and perinatal complications after repeat cesarean sections in the studied population. This retrospective study was conducted by reviewing the records of all women who underwent CSs between January and July 2023 in three hospitals in the Jazan region of Saudi Arabia. Of the 268 women studied, 195 (72.7%) had a CS for the first or second time and 73 (27.3%) had two, three, or four previous CSs (repeat CS). The most common maternal intra-operative complications reported by the repeat CS group were intra-peritoneal adhesions (7.5%) and fused abdominal layers (7.1%) while the most common postoperative complications were the need for blood transfusion (22%) and UTIs (3%). The most common neonatal complications were a low Apgar score (19%), needing neonatal resuscitation (2.6%), and intensive care admission. In addition, 3.7% of mothers failed to initiate breastfeeding in the first 24 h. The frequent complications were intra-peritoneal adhesions, fused abdominal wall layers, blood transfusion, and postoperative infections which were overcome by the optimal hospital care. However, the frequent neonatal complications were a low Apgar score, needing neonatal resuscitation, and intensive care admission.