Emergency Cesarean Section Group Research Articles

Emergency cesarean section in pregnant trauma patients presenting after motor vehicle collision

BackgroundMost pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for emergency cesarean section (ECS) during the index hospitalization for pregnant trauma patients (PTPs) are unknown. We sought to investigate the national rate of ECS in PTPs presenting after MVC, hypothesizing a higher risk of ECS among those with severe injuries or elevated shock index (SI). MethodsThe 2020–2021 TQIP was queried for PTPs presenting after MVC. PTPs that underwent ECS were compared to patients that did not undergo ECS. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale grade ≥3. Bivariate and multivariable logistic regression analyses were performed. ResultsFrom 1183 PTPs, 95 (8.0 %) underwent ECS. The median time to ECS was 115 min. The ECS group had higher rates of lung (27.4 % vs. 12.2 %, p < 0.001) injury, spleen (18.9 % vs. 5.5 %, p < 0.001) injury, and elevated SI (22.1 % vs. 9.8 %, p < 0.001). ECS patients had higher rates of complication (9.5 % vs. 2.1 %, p < 0.001) and death (4.2 % vs. 1.1 %, p = 0.012). Independently associated risk factors for ECS included severe head (OR 2.65, CI 1.14–6.17, p = 0.023) or abdominal (OR 2.07, CI 1.08–3.97, p = 0.028) injuries and elevated SI (OR 2.17 CI 1.25–3.79, p = 0.006). ConclusionThe national rate of ECS among PTPs presenting after MVC is 8 % with most occurring within the first 2 hours of arrival. Severe head and abdominal injuries as well as elevated SI are risk factors for ECS.

Study of the somatic, neurological and osteopathic status of full-term newborns born by cesarean section in a planned and emergency manner

Introduction. Currently, the frequency of cesarean section (CS) in the world is at least 25 %, in Russia — at least 30 %. It is known that newborns after CS are a special risk group for the development of somatic dysfunctions (SD), which should be considered comprehensively, taking into account their somatic and neurological status.The aim is to study the effect of emergency CS on the somatic, neurological and osteopathic status of newborns and on the course of the early neonatal period.Materials and methods. 60 patients of the Department of Neonatal Physiology, aged 3–5 days of life, without structural pathology or malformations, born by cesarean section, were examined. Children are divided into 2 groups of 30 people. Group 1 — children born by emergency caesarean section (ECS). Group 2 — children born by planned (elective) caesarean section (PCS). A complex of examination methods was used in both groups. The anamnestic method included an assessment of the main risk factors during pregnancy and features of the early neonatal period. The clinical method included assessment of the somatic status of newborns; neurological assessment. Assessment of osteopathic status according to clinical guidelines. Assessment of functional disorders — using neuro-sonography, ultrasound of the hip joints, ultrasound of the abdominal organs. Statistical data processing was carried out using Microsoft Excel and the Medstatistic statistical software package. To study the relationships between the characteristics, a comparison of the populations was carried out based on qualitative characteristics. Fisher′s exact test was used for statistical processing of data. The analysis used a significance level of p&lt;0,05, which reflects the strength of the dependence of the characteristics being compared. Pearson′s coefficient was used as a criterion for the strength of connection.Results. When analyzing risk factors in both groups, a predominance of women over 30 years of age with a complicated pregnancy was noted among mothers. Extragenital pathology (most often pathology of the endocrine system) was detected in 70 % of mothers. In the ECS group, early and more intense jaundice was observed significantly more often (p&lt;0,05) (12 out of 30 children versus 4 out of 30 children in the PCS group); muscular dystonia with a tendency to increase muscle tone in the upper extremities and decrease in the lower extremities (in 22 out of 30 children in this group versus 12 out of 30 children in the PCS group); SD of the head region (13 cases in this group versus 4 cases in the second group). In the PCS group, autonomic disorders were observed significantly more often (p&lt;0,05) (12 out of 30 children versus 2 out of 30 children in the ECS group); SD of the pelvic region (visceral component, 9 cases versus 2 in the ECS group). In children of the ECS group, a statistically significant (p&lt;0,05) relationship was revealed between breech presentation and SD of the pelvic region (somatic component) — contingency coefficient 0,44; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (visceral component) — 0,43; characteristics of the neurological status (hyperexcitability syndrome) and SD of the head region — 0,45. In children of the PCS group, a statistically significant (p&lt;0,05) relationship was revealed between morpho-functional immaturity and SD of the thoracic region (visceral component) — contingency coefficient 0.39; features of the skeletal system of the skull (Gothic palate, combination of Gothic palate and suture entry) and SD of the dura mater — 0,5; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (somatic component) — 0,6; characteristics of the hip joints (asymmetry of the gluteal folds, difficulty in abduction, hypermobility) and SD of the pelvic region (somatic component) — 0,45; postural disorders (flexion, extension, latero-flexion to the right, latero-flexion to the left) and SD of the pelvic region (somatic component) — 0,49; increased muscle tone of the arms and SD of the thoracic region (visceral component) — 0,41.Conclusion. A comparative assessment of the osteopathic status of children born by cesarean section in a planned manner and for emergency indications was carried out, and an analysis of the possible connection of the identified somatic dysfunctions with risk factors for pregnancy and features of the early neonatal period was carried out. Based on the identified relationships between the somatic, neurological and osteopathic statuses of newborns in the first day of life, in the future it is possible to develop optimal timing for consultation with an osteopath for the purpose of earlier diagnosis and correction of somatic dysfunctions.

Correlative analysis of different treatments of persistent occipitotransverse position on the outcome for mother and infant.

To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety-six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants.

Evaluation of maternal and neonatal outcomes of emergency cesarean deliveries in cases of placenta previa uncomplicated with placenta acreata spectrum

Objective: The management and surgery of placenta previa describe a challenging process that requires experience. It is important to decide on the timing of planned cesarean section in women with placenta previa, taking into account the balance between possible maternal severe bleeding and possible neonatal morbidities.&#x0D; Material and methods: In the present study, the data of 349 singleton pregnant women with a diagnosis of placenta previa uncomplicated by placenta accreta spectrum were analyzed. Patients who underwent planned (68%, n=236) or emergency cesarean section (32%, n=113) were divided into two groups. In this study, maternal demographic and clinical information, surgical procedures and maternal/neonatal outcomes were studied.&#x0D; Results: The proportion of patients who underwent uterine compression suture and Bakri balloon was found to be significantly higher in the emergency cesarean section group compared to the planned cesarean deliveries group (p&lt;0.001). The operation time, hospital stay, urinary tract infection rate, decrease in hemoglobin and need for blood transfusion were found to be significantly higher in the emergency cesarean section group compared to the planned cesarean section group (p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, respectively). In addition, a significant association was detected between emergency cesarean section and prematurity, low birth weight, low APGAR score, increased neonatal intensive care unit hospitalization and neonatal mortality.&#x0D; Conclusion: Cases of placenta previa are at risk of emergency cesarean delivery, which can be complicated by poor maternal and neonatal outcomes. Equipped centers and experienced teams are of great importance in reducing fetomaternal morbidity and mortality caused by placenta previa.

Prediction of Emergency Cesarean Section Using Detectable Maternal and Fetal Characteristics Among Saudi Women.

The worldwide rate of cesarean section (CS) is increasing. Development of prediction models for a specific population may improve the unmet need for CS as well as reduce the overuse of CS. To explore risk factors associated with emergency CS, and to determine the accuracy of predicting it. A retrospective analysis of the medical records of women who delivered between January 1, 2021-December 2022 was conducted, relevant maternal and neonatal data were retrieved. Out of 1793 deliveries, 447 (25.0%) had emergency CS. Compared to control, the risk of emergency CS was higher in primiparous women (OR 2.13, 95% CI 1.48 to 3.06), in women with higher Body mass index (BMI) (OR 1.77, 95% CI 1.27 to 2.47), in association with history of previous CS (OR 4.81, 95% CI 3.24 to 7.15) and in women with abnormal amniotic fluid (OR 2.30, 95% CI 1.55 to 3.41). Additionally, women with hypertensive disorders had a 176% increased risk of emergency CS (OR 2.76, 95% CI 1.35-5.63). Of note, the risk of emergency CS was more than three times higher in women who delivered a small for gestational age infant (OR 3.29, 95% CI 1.93-5.59). Based on the number of risk factors, a prediction model was developed, about 80% of pregnant women in the emergency CS group scored higher grades compared to control group. The area under the curve was 0.72, indicating a good discriminant ability of the model. This study identified several risk factors associated with emergency CS in pregnant Saudi women. A prediction model showed 72% accuracy in predicting the likelihood of emergency CS. This information can be useful to individualize the risk of emergency CS, and to implement appropriate measures to prevent unnecessary CS.

Comparison of Feto-Maternal Outcomes Between Emergency and Elective Cesarean Deliveries in Patients with Gestational Diabetes

Aim: To compare fetal and maternal outcomes between elective and emergency cesarean sections in patients with gestational diabetes&#x0D; mellitus (GDM).&#x0D; Material and Methods: Data from patients with GDM delivered by cesarean section between January 2015 and July 2020 were&#x0D; retrospectively reviewed. Patients were grouped according to whether the cesarean section was elective (n=129) or emergency (n=158).&#x0D; Results: The cesarean section rate was higher in patients with GDM (31.16%) than in patients without GDM. There were more patients&#x0D; with inadequate maternal care in the emergency cesarean section group than in the elective cesarean section group (p=0.003). One&#x0D; neonate in the elective group and six in the emergency C/S group died, but the rates of neonatal mortality were similar (p=0.198).&#x0D; Maternal morbidity (wound infection, fever, blood transfusion, and maternal intensive care) and fetal morbidity (birth asphyxia,&#x0D; respiratory morbidity, and neonatal intensive care) were higher in the emergency C/S group (p

Primiparous and Multiparous Women's Mode of Birth and Negative Emotions.

Negative childbirth experiences may result in negative emotions that may lead to negative outcomes, such as post-traumatic stress disorder. We aimed to examine the differences in emotions between primiparous and multiparous women and mode of birth. We used a retrospective cross-sectional study design with three hundred and fifty women. Primiparous women reported higher levels of fear, lack of control, and dissociation emotions compared to multiparous women. The EmCs (emergency cesarean section) group experienced the most fear, lack of control, anger, and conflict emotions. It is important to conduct follow up work with women who underwent unplanned birth procedures since negative childbirth experiences may lead to further negative effects on women’s psychosocial health and well-being.

Compliance with venous thromboembolism guideline after delivery at Maternity Teaching Hospital, Erbil city, Iraq

Background and objective: Venous thromboembolism is a leading cause of maternal morbidity and mortality. Few published articles have evaluated obstetricians' compliance with thromboprophylaxis guidelines, especially after vaginal delivery. This study aimed to assess obstetricians’ adherence to postpartum thromboprophylaxis guidelines and correlate adherence with the risk factors for venous thromboembolism after vaginal and cesarean delivery. Methods: A cross-sectional study involving 981 women delivered at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, was conducted. Obstetricians' compliance with the thromboprophylaxis guideline regarding dose, duration, and indications were recorded. We assessed the risk factors for thromboembolism using the 2015 Royal College of Obstetricians and Gynecologists guideline. Results: Medical thromboprophylaxis was required but not given to 93.2% of the women who delivered vaginally compared with 6.7% of the women who delivered by cesarean section. Women who delivered vaginally had a higher rate of age ˃ 36 years, parity of 3 and more, varicose vein, and current infection (P &lt;0.001). The rates of preeclampsia, preterm labor, and prolonged labor were highest in the emergency cesarean section group (P &lt;0.001). Factors associated with making a wrong decision were having no preeclampsia (odds ratio=15.4; 95% confidence interval=3.4–68.6), post-partum hemorrhage (odds ratio=15.3; 95% confidence interval=2.0–114.2), and vaginal delivery (odds ratio=250.2; 95% confidence interval=110.6–566.0). Conclusion: Obstetricians' compliance with postpartum thromboprophylaxis in the hospital was low, especially after vaginal delivery. Keywords: Thromboprophylaxis; Postpartum; Compliance; Venous thromboembolism; Guideline.

Gastric pH and volume change in emergency and elective cesarean section: A randomized trial

Context: Pregnancy is a condition when a woman suffers numerous changes in the body. These changes can be physical and physiological. There are numerous factors which affect the volume and gastric pH of a pregnant lady. A lady has to bear a number of changes during pregnancy, mainly in her first trimester and after pregnancy. Vomiting is a normal symptom of pregnancy which effects a lady in her first trimester. This badly affects the gastric content and increase in pH as well as volume. In cesarian cases also the digestion is badly affected and anesthesia also plays a major role in distortion of proper gastric functions. Aim: To compare the gastric pH of the fluid in elective cesarean v/s emergency sections. Setting and Design: This study is a cross-sectional survey performed in Lahore from September 2009 to June 2010. Material and Methods: A total number of 150(n= 150) patients were studied and divided into two groups. These patient were with elevated caesarian section and emergency caesarian section. Statical analysis: The results were statistically significant. (p-value < 0> Result: Patients in emergency cesarean section group had a lower value of gastric pH ranging from (2.16 + 0.64) and higher value of, the volume of gastric acidic (26.33 + 10.59) as compared to that in elective cesarean section group (4.56 + 1.28 and 11.65 + 4.37 respectively). Conclusion: The study concluded that in emergency and elective caesarian section the level of gastric volume was significantly high whereas the level of gastric pH was low. Keywords: Gastric pH, Emergency cesareans section gastric fluid volume, Elective cesarean section.

Comparison of maternal morbidity in Emergency and Elective Cesarean Section

Objective: We aimed to compare emergency and elective cesarean patients in our hospital in terms of epidemiological features and maternal morbidity.&#x0D; Material and Methods: We randomly retrospectively reviewed the records of 302 caesarean cases. Demographic features and indications for emergency (group 1) and elective caesarean section (C/S) (group 2) were recorded. The groups were compared in terms of indications and intraoperative and postoperative morbidity.&#x0D; Results: It was found that the mean hematocrit decrease in group 1 was not different from group 2 (5.70 ± 1.16 and 5.62 ± 0.67). When the groups are examined according to cesarean indications; In group 1 patients, fetal distress, cephalopelvic disproportion (CPD), non-progress of labor, abruptio placentae were significantly higher compared to group 2, whereas in group 2 patients the previous 1 C / S and previous 2 C / S indications were significantly higher. Intraoperative hemorrhage and bladder injury were more common in group 1 patients compared to group 2 patients. When the groups are examined according to postoperative maternal complications; In group 1 patients, transfusion, prolonged bladder catheterization, admission to intensive care unite (ICU), was significantly higher compared to group 2.&#x0D; Conclusion: It was found that many intraoperative and postoperative complications were more common in the emergency C/S group. it was also detected that all cases with bladder injuries had previous cesarean sections. Therefore, the presence of experienced personnel in these cases may be important for reducing morbidity due to the increased risk of complications.

Intrapartum prediction of emergency delivery due to non-reassuring fetal status at 40 weeks’ gestation in low-risk pregnancies: contribution of Doppler parameters, maternal history, and intrapartum clinical characteristics

Objective To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies. Methods This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks’ gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). Results From 403 included pregnancies, 18.6% (n = 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 versus 1.30; p < .001, and 1.61 versus 1.78; p = .001, respectively). There was a higher incidence of small-for-gestational-age neonates (20 versus 10.1%; p = .017), lower Apgar scores at the 5th minute (9.7 versus 9.9; p = .006), and NICU admissions (9 versus 3%; p = .016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p = .008). Conclusions In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.

Comparison of maternal and perinatal morbidity between elective and emergency caesarean section in singleton-term breech presentation

The objective of the study was to compare maternal and neonatal adverse outcomes between elective caesarean section (ElCS) and emergency caesarean section (EmCS) for singleton-term breech presentation. This study included women with singleton breech presentation who underwent ElCS or EmCS at term during 2007–2015 at Siriraj Hospital (Thailand). Complete data were collected for 2178 pregnant women. Of those, 1322 (60.7%) women underwent EmCS, and 856 (39.3%) delivered by ElCS. Maternal and perinatal morbidity were compared. There was no maternal or perinatal death in either group. Maternal morbidity was comparable between groups, except for longer hospital stay in the EmCS group (p = .047). One-minute Apgar score was significantly lower in the EmCS group (p = .040). There was no significant difference in 5-min Apgar score between groups. No significant difference was observed for serious maternal and neonatal morbidity between women who underwent ElCS versus those who underwent EmCS for singleton-term breech presentation.IMPACT STATEMENTWhat is already known on this subject? Emergency caesarean section (EmCS) is generally known to be associated with a higher risk of maternal and neonatal complications than elective caesarean section (ElCS).What do the results of this study add? In singleton-term breech presentation, EmCS in tertiary care setting was not associated with an increase in serious maternal and neonatal morbidity compared with EICS. Cord prolapse as an indication for emergency caesarean section was significantly associated with adverse outcomes while advanced cervical dilation ≥7 cm or low foetal station ≥+1 did not have an impact on maternal and neonatal complications.What are the implications of these findings for clinical practice and/or further research? Mean gestational age in both the ElCS and EmCS groups was approximately 38 weeks and 5 d; there were no neonatal cases with respiratory distress syndrome. Our findings suggest further prospective study in planned caesarean section scheduled for 38–39 weeks in patients with term breech presentation. The results of such a study could yield lower rates of both EmCS and potential adverse outcomes.

High mobility group box 1 and markers of oxidative stress in human cord blood.

Parturition induces considerable oxidative stress and many inflammatory mediators, such as high mobility group box 1 (HMGB1), are involved from the beginning of the pregnancy to birth. The aim of the present study was to evaluate serum cord blood concentration of diacron-reactive oxygen metabolites (d-ROM), biological antioxidant potential (BAP), and HMGB1 to investigate the perinatal oxidative status of neonates and correlation with mode of delivery, as well as the influence of labor. The subjects consisted of 214 neonates delivered at University Hospital "G. Martino", Messina, in a 6months period. Venous blood samples were collected from the umbilical cord after cord separation. Umbilical cord venous blood HMGB1 was significantly higher in the spontaneous vaginal delivery (SVD) group than in the elective or emergency cesarean section (CS) group (P = 0.018). Regarding labor, there was no significant difference in HMGB1 concentration in umbilical vein blood between the spontaneous and induced labor groups (P = 0.250). Furthermore, d-ROM was significantly different between the SVD group and the elective or emergency CS group (P = 0.044). BAP concentration, however, was not significantly different, not even with regard to mode of labor. Oxidation is higher in newborns delivered by SVD than in those delivered by CS, and HMGB1 may be involved in the mechanisms of birth, and responsible for decidual modifications that lead to birth.

Different concentration of human cord blood HMGB1 according to delivery and labour: A pilot study

ObjectiveOxidative stress is involved in several maternal conditions characterized both by an increase in free radicals synthesis and a parallel decrease in the antioxidant activity. Parturition induces considerable oxidative stress and many inflammatory mediators, among which HMGB1, are involved from the beginning of pregnancy to the birth of the infant. We evaluated serum cord blood HMGB1 levels in a population of neonates to investigate correlation with mode of delivery, as well as the influence of labour. Setting and patientsThe study subjects were 325 neonates delivered at University Hospital “G. Martino” of Messina over an 18-month period. Following cord separation, venous blood sampling was performed on umbelical cords. ResultsIn the cord venous blood, we found HMGB1 values significantly more elevated in spontaneous vaginal group when compared to elective or emergency caesarean section group. Regarding labour, umbilical cord venous blood HMGB1 levels were significantly higher in the spontaneous and induced labour group, compared to non-labouring women. ConclusionThese results could highlight a possible role of HMGB1 during birth time related to mode of delivery and labour.

Comparison Of Gastric PH In Emergency Versus Elective Caesarean Sections

Background: The volume of the gastric fluids and the gastric pH both are affected during pregnancy and surgery. The gastric fluid volume and pH are also affected by the mode of surgery (elective caesarean section and emergency caesarean). Objective: The predetermined aim of this study was to compare the gastric fluid pH in emergency with elective caesarean sections. Method: The study was conducted in Divisional Headquarters Teaching Hospital, Mirpur, Azad Kashmir and the sample population was consisted of 150 patients. The sample was divided into two groups, the patients with emergency caesarean section and elective caesarean section group. The gastric volume and gastric pH were detected in both groups of the study. Results: The group of the patients in the emergency caesarean section showed lower gastric pH value (2.16 ± 0.64) and the gastric acid volume was (26.33 ± 10.59). In comparison, the gastric pH value for elective caesarean section was (4.56 ± 1.28) and gastric acid volume was (11.65 ± 4.37) respectively. The results were found to be significant at p-value <0.05. Conclusion: The results of the study concluded that gastric volume was significantly higher and gastric pH was significantly lower in emergency caesarean section as compared to elective caesarean section.

Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain

Objective: To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain. Methods: A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1(st), 2014 to September 30(th), 2015 were recruited. They were divided into two groups, the vaginal delivery group (92.88%, 6 416/6 908) and the emergency cesarean section group (7.12%, 492/6 908). According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI, the 6 908 women were divided into three groups, the underweight group(BMI<18.5 kg/m(2); 17.39%, 1 201/6 908), the normal weight group(18.5-24.9 kg/m(2); 73.00%, 5 043/6 908), the overweight and obese group (≥ 25.0 kg/m(2); 9.61%, 664/6 908). According to the guidelines of Institute of Medicine (IOM) , they were divided into three groups, the inadequate gestational weight gain (GWG) group (16.72%, 1 155/6 908), the appropriate GWG group (43.11%, 2 978/6 908), the excessive GWG group (40.17%, 2 775/6 908). Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression. Results: (1) Comparing to the vaginal delivery group, women in the emergency cesarean section group were older, with a lower education level. Their prepregnancy BMI was higer and had more gestational weight gain. They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus. Comparing to the vaginal delivery group, the neonates in the emergency cesarean section group were elder in gestational week, with higher birth weight. More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P<0.05) . (2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara, with the unadjusted OR of 1.98 (95%CI: 1.54-2.54), adjusted OR (aOR) of 1.66 (95%CI: 1.27-2.16). In the inadequate GWG group and the excessive GWG group, overweight and obese women had increased risk of emergency cesarean section, with adjusted OR of 2.33 (95%CI: 1.06-5.14) and 1.62 (95%CI: 1.44-2.28), respectively. In the appropriate GWG group, there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women, with aOR of 1.54 (95%CI: 0.94-2.54). The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55, 95%CI: 0.40-0.74; aOR=0.66, 95%CI: 0.48-0.90). While no significant difference in the risk of emergency cesarean section was found between the underweight women, the overweight and obese women, with the aOR of 0.31 (95%CI: 0.07-1.32), 0.73 (95%CI: 0.48-1.10), 0.66 (95%CI: 0.38-1.12), respectively. (3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section, (aOR=1.03, 95%CI: 1.01-1.05). GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30, 95%CI: 1.07-1.58; aOR=1.01, 95%CI: 0.82-1.24). In the underweight group, the normal weight group and the overweight or obese group, the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03, 95%CI: 0.55-1.12; aOR=1.02, 95%CI: 0.80-1.30; aOR=1.03, 95%CI: 0.59-1.78) , respectively. GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62, 95%CI: 0.45-0.85; aOR=0.64, 95%CI: 0.46-0.88). In the underweight group and the overweight or obese group, there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR= 0.24, 95%CI: 0.06-1.01; aOR= 0.90, 95%CI: 0.40-2.04) . In the normal weight group, the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65, 95%CI: 0.45-0.95). Conclusions: Overweight and obese women have increased risk of emergency cesarean section. The prepregnancy BMI is supposed to be an appropriate level. Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section. There is no correlation between the excessive GWG and the risk of emergency cesarean section.

Effect of cesarean section on perinatal outcome: A case-control study

Background: Cesarean section is the surgical intervention which has been saving lives for a long period of time. Despite its importance, there are not many studies on maternal morbidity and mortality with perinatal outcome in patients undergoing elective or emergency cesarean section. Objective: To find out the effect of emergency and an elective cesarean section on maternal and neonatal outcome. Methods: This prospective unmatched case-control study was conducted from July 2012 to June 2013 in the Department of Obstetrics and Gynaecology and Pediatrics of a Medical College of Bengaluru. 300 patients (1:1) along with their babies were selected as per the inclusion and exclusion criteria by simple consecutive sampling after written informed consent. Examination of the patient was done, and all relevant data were obtained, and results were statistically analyzed by SPSS version 24 and Microsoft Office 2016. Results: Maternal complications (both intra- and post-operative) were more in the emergency cesarean section group than in elective cesarean section (p&lt;0.001). Neonatal complications were more common in emergency cesarean section group than in elective cesarean section (p&lt;0.05). Conclusion: Emergency cesarean section causes more morbidity among pregnant women and their babies, which can be reduced by combined efforts at all levels and by encouraging hospital vaginal deliveries of all the primigravida, grand multiparous pregnant women and those who had a previous cesarean section, provided adequate fetal monitoring and operative facilities are available.

On opportunity for emergency cesarean hysterectomy and pregnancy outcomes of patients with placenta accreta.

Effective diagnosis and clinical management of placenta accreta (PA) in China are not clear. The purpose of the study was to analyze the risk factors and diagnosis of PA, maternal and neonatal outcomes in patients with PA. It was a retrospective study of cases with PA, confirmed by histologically and/or clinically suspected during 3 years in 2 tertiary referral hospitals. The incidence rate of patients with PA, who had history of artificial abortion, cesarean section (CS), and placenta previa (PP) was 94%, 70%, and 72%, respectively. In 29 patients of scheduled CS group, 12 cases were performed with cesarean hysterectomy. Mean estimated blood loss (EBL) was 1.5 L, and 17 babies were admitted to neonatal intensive care unit (NICU). In the 18 cases of emergency CS group, 6 cases were performed cesarean hysterectomy. Mean EBL was 2.4 L, and 16 babies were admitted to NICU. The difference of mean EBL, cases of fetal admitted to intensive care unit in 2 groups was significant difference (P < .05).Women with history of uterine curettage, CS or PP are more likely to have PA. PA should be diagnosed early and accurately via ultrasound and magnetic resonance imaging. Maternal and neonatal outcomes in the scheduled CS are better than in emergency CS. Emergency peripartum hysterectomy is a feasible method under the circumstances of heave, fast bleeding, and the failure of conservative surgery.

Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network

BackgroundVery-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. ObjectivesTo assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). Study designA total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses. ResultsPrevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325–2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338–2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). ConclusionsOur observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.

Effect of intrapartum fetal stress associated with obstetrical interventions on viability and survivability of canine neonates.

Aim:This study was conducted with the objective of identifying and evaluating intrapartum fetal stress in connection with the type of delivery in bitches.Materials and Methods:A total of 26 bitches between 1 and 5 years, belonging to 10 different breeds were evaluated. Bitches were subjected to detailed clinico-gynecological examination based on history. Neonatal stress associated with spontaneous whelping (SW), assisted whelping (AW), and emergency cesarean section (EC) was evaluated using umbilical vein lactate (UL) estimation by collecting the blood from umbilical vein.Results:A high umbilical vein lactate value was associated with fetal distress. The mean umbilical lactate value was highest in EC (12.54±0.8 mmol/L) followed by AW (8.86±0.9 mmol/L) and the lowest value was found in SW (7.56±0.58 mmol/L). A significant increase (p<0.05) in umbilical lactate level was observed in EC group of canine neonates compared with AW and SW groups. Overall mean umbilical lactate values of neonates which died within 24 h (13.31±1.08 mmol/L) and the neonates which survived beyond 24 h (8.87±0.55 mmol/L) differed significantly at 5% level.Conclusion:Immediate identification of neonatal distress by use of umbilical vein lactate estimation is helpful for the clinician to undertake resuscitation or medical therapy to ensure better neonatal survivability.