Emergency Caesarean Section Delivery Research Articles

Comparison of efficacy and safety of the Dinoprostone Vaginal tape and Dinoprostone vaginal tablet for the induction of labor in para three and more women: A retrospective cohort Study

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p>0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p>0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

Establishment method and significance of birthweight curve and reference in single center

Objective: To establish neonatal birthweight percentile curves based on single-center cohort database using different methods, compare them with the current national birthweight curves and discuss the appropriateness and significance of single-center birthweight standard. Methods: Based on a prospective first-trimester screening cohort at Nanjing Drum Tower Hospital from January 2017 to February 2022, the generalized additive models for location, scale and shape (GAMLSS) and semi-customized method were applied to generate local birthweight percentile curves (hereinafter referred to as the local GAMLSS curves, semi-customized curves) for 3 894 cases who were at low risk of small for gestation age (SGA) and large for gestation age (LGA). Infants were categorized as SGA (birth weight<10th centile) by both semi-customized and local GAMLSS curves, semi-customized curves only, or not SGA (met neither criteria). The incidence of adverse perinatal outcome between different groups was compared. The same method was used to compare the semi-customized curves with the Chinese national birthweight curves (established by GAMLSS method as well, hereinafter referred to as the national GAMLSS curves). Results: (1) Among the 7 044 live births, 404 (5.74%, 404/7 044), 774 (10.99%, 774/7 044) and 868 (12.32%, 868/7 044) cases were diagnosed as SGA according to the national GAMLSS curves, the local GAMLSS curves and the semi-customized curves respectively. The birth weight of the 10th percentile of the semi-customized curves was higher than that of the local GAMLSS curves and the national GAMLSS curves at all gestational age. (2) When comparing semi-customized curves and the local GAMLSS curves, the incidence of admission to neonatal intensive care unit (NICU) for more than 24 hours of infants identified as SGA by semi-customized curves only (94 cases) and both semi-customized and local GAMLSS curves (774 cases) was 10.64% (10/94) and 5.68% (44/774) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks of infants identified as SGA by the semi-customized curves only and both semi-customized and local GAMLSS curves was 12.77% (12/94) and 9.43% (73/774), 9.57% (9/94) and 2.71% (21/774), 24.47% (23/94) and 7.24% (56/774) respectively, which were significantly higher than those of the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. (3) When comparing semi-customized curves and the national GAMLSS curves, the incidence of admission to NICU for more than 24 hours of infants identified as SGA by semi-customized curves only (464 cases) and both semi-customized and national GAMLSS curves (404 cases) was 5.60% (26/464) and 6.93% (28/404) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); all P<0.001]. The incidence of emergency cesarean section or forceps delivery for non-reassuring fetal status (NRFS) in infants identified as SGA by semi-customized curves only and both semi-customized and national GAMLSS curves was 4.96% (23/464) and 12.38% (50/404), both significantly higher than that in the non SGA group [2.57% (159/6 176); all P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks in the semi-customized curves only group and both semi-customized and national GAMLSS curves group was 8.84% (41/464) and 10.89% (44/404), 4.31% (20/464) and 2.48% (10/404), 10.56% (49/464) and 7.43% (30/404) respectively, all significantly higher than those in the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. Conclusion: Compared with the national GAMLSS birthweight curves and the local GAMLSS curves, the birth weight curves established by semi-customized method based on our single center database is in line with our center' SGA screening, which is helpful to identify and strengthen the management of high-risk infants.

Evaluation of decision to delivery interval and its effect on feto-maternal outcomes in Category-I emergency cesarean section deliveries in Phuentsholing General Hospital, 2020: A retrospective cross-sectional study.

When there is an immediate threat to maternal or fetal life, it is recommended to deliver within 30 min of the decision to have favorable perinatal outcomes. However, there is no data on the delivery intervals for Category-I emergency cesarean section in Bhutan. The study evaluated the decision todelivery interval (DDI)and its effect on perinatal and maternal outcomes in Category-I emergency cesarean section. A retrospective cross-sectional study was conducted at the Phuentsholing General Hospital, Bhutan, from January 1, 2020to December 31, 2020. Mothers who underwent Category-I emergency cesarean section were included. The demographic variables, patient transfer time, anesthesia time, operation time, DDI, and maternal and perinatal outcomes were recorded in a standard proforma. The data were analyzed using SPSS version 23. Of 78 Category-I emergency cesarean sections, only 23 (29.5%) of the cases were able to perform within 30 min of the DDI. The median (interquartile range) DDIwas 37 (30-44) min. More time was taken by anesthetists to administer anesthesia (20 [15-8] min). Fetal distress (40, 51.3%) was the commonest indication. The longest DDI was around 39 min for prolonged labor, and the shortest was 26 min for failed instrumental delivery. Over half of the newborns delivered more than 30 min of DDI had low APGAR scores (25, 32.1%) at 1 min and meconium was present (23, 29.5%). Intensive care was required in 11 (14.1%), of which there was 1 (1.3%) neonatal death. The Category-I emergency cesarean sections performed within recommended DDI of 30 min were much less. The main delay was due to the longer time taken for the patient transfer and time taken by the anesthetists to administer anesthesia. Perinatal outcomes were favorable when the deliveries were conducted within 30 min of DDI.

Prenatal differential diagnosis of placental mesenchymal dysplasia and molar disease with coexistent live twin fetuses

Background: Numerous hypoechoic cysts in the placenta on prenatal ultrasonography with a live fetus may indicate twin pregnancy with a complete hydatidiform mole with a coexistent fetus, partial mole, confined placental mosaicism, or placental mesenchymal dysplasia (PMD). Ultrasonographic appearances of these are similar; however, the differential diagnosis should be made because maternal and fetal prognoses differ. Cases: We present two cases of twin pregnancies with numerous placental cystic lesions. The first case was a partial hydatidiform mole in monochorionic diamniotic twins with a diploid karyotype that underwent a spontaneous abortion at 20 gestational weeks. The second case was PMD in dichorionic diamniotic twins; live twin neonates were delivered at 34 gestational weeks. Emergency cesarean section delivery was performed due to severe preeclampsia and fetal growth restriction in twin A at 34 weeks of gestation. Conclusions: Numerous hypoechoic cysts in the placenta on prenatal ultrasonography with a normal live fetus warrants chromosomal analysis and serial ultrasonographic examination to differentiate between PMD and molar pregnancy with a coexisting normal fetus to avoid unnecessary termination.

Maternal Anemia and BMI as Determinants of Pregnancy Outcomes: A Hospital-Based Study.

Malnutrition is a serious underlying cause of child and maternal deaths around the world. The objective of this study evaluates maternal anemia and body mass index as determinants of pregnancy outcomes. Undernourishment during pregnancy can occurs Intra Uterine Growth Retardation. Contributing to about 80,0000 new-borns, 40,0000 infant deaths and 20% under 2 years children have stunted, 20% of maternal deaths during labor and early postpartum. This study Hospital-based cross-sectional study. The study comprised laboring women admitted for delivery in selected tertiary care hospital in South India from 10th November 2021 to 20th January 2022. Structured interview schedule for demographic information, patient's case sheet for information about the 'Body Mass Index as a determinants of pregnancy outcomes' and anthropometric measurement for body mass index (weight and height). All registered deliveries in the study period have been included, comprising of 101 sample size Bivariate logistic regressions were used to determine the factors associated with outcome variables. A significant level of 5% was used to decide the significance of statistical tests. Body Mass Index in the 1st antenatal visit of the women who came for delivery in tertiary care hospital, underweight 36.6%, normal body mass index 52.5%, and overweight 10.9%. During 1st antenatal visit 58.4% had anemia, while 53.5% had mild anemia during the last antenatal visit. Respectively 39.6% of antenatal women had normal Hb% during 1st antenatal care visit, whereas 46.5% had normal Hb%, during their last antenatal visit. The mode of delivery; spontaneous vaginal delivery 45.5%, vacuum delivery 3.0%, emergency caesarean section delivery 50.5%. Preterm delivery was statistically significant among whose first antenatal care visit was after 11th weeks of gestation. Whereas, emergency caesarean section delivery was statistically significant among underweight. Increasing maternal weight body mass index was associated with maternal and neonatal health outcomes. Which was risk of pregnancy induced hypertension, preeclampsia, eclampsia, gestational diabetes mellitus and caesarean section delivery. Every 2nd women was anemic, every 3rd pregnant women was underweight (BMI >18.5), every 2nd baby was born with caesarean section delivery. Preterm delivery was statically significant of weeks of gestation during first antenatal care visit with more than 11th weeks of gestation. Whereas, emergency cesarean section was significant with low body mass index.

Risk of Adverse Pregnancy Outcomes for Women with IBD in an Expert IBD Antenatal Clinic.

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of adverse outcomes from pregnancy. It is unclear whether IBD indications account for the higher rate of Caesarean section (CS) in IBD patients. Methods: A retrospective cohort study of 179 IBD patients cared for in a dedicated combined IBD antenatal clinic and 31,528 non-IBD patients was performed. The outcomes were method of delivery, preterm birth, birthweight, admission to neonatal intensive care unit (NICU), and stillbirth. We analysed the associations between disease activity, medication with method of delivery, and neonatal outcomes. Results: Delivery by CS was more common in IBD patients (RR 1.45, CI 1.16–1.81, p = 0.0021); emergency CS delivery was equally likely (RR 1.26, CI 0.78–2.07, p = 0.3). Forty percent of elective CS were performed for IBD indications. Stillbirth was five-fold higher in IBD patients (RR 5.14, CI 1.92–13.75, p < 0.001). Preterm delivery, low birthweight, and admission to NICU were not more common in patients with IBD, and IBD medications did not increase these risks. Active disease during pregnancy was not associated with adverse outcomes. Conclusions: Delivery by CS was more frequent in the IBD cohort, and most elective CSs were obstetrically indicated. A dedicated IBD antenatal clinic providing closer monitoring and early detection of potential issues may help improve outcomes.

Sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria

Background&#x0D; Stillbirths are reported as one of the most neglected tragedies in global health, with around 2m stillbirths occurring annually and the majority occurring in low- and middle income countries (LMICs). Many antenatal stillbirths are due to preventable conditions such as maternal infections and non-communicable diseases. Almost half of all stillbirths occur during the intrapartum period, with many linked to obstetric complications. Known risk factors for stillbirths overall include young or advancing maternal age, fetal infection, maternal hypertensive conditions, perinatal asphyxia, history of previous stillbirth, obstetric complications, intrauterine growth restriction and abruptio placenta/placenta praevia. Common non-clinical risk factors include lack of education, socioeconomic deprivation and substandard antenatal care.&#x0D; Methods&#x0D; A single site prospective observational study conducted over three-months was conducted in a tertiary referral hospital in Kano, Nigeria. Eligible participants were mothers presenting at the site in labour and their babies.&#x0D; Demographic and clinical data were collected by paper-based questionnaires. Data were collected on living environment, health and medical history, pregnancy history and pregnancy/birth factors. Each mother answered pre-delivery questions, with potential follow-on questions dependent on birth outcome. Further data points were collected from clinical observations. Photographs were taken of stillborn babies to support data collected and to aid the UK team on classifying degrees of maceration in an attempt to identify antenatal and intrapartum fetal death.&#x0D; Findings&#x0D; Higher odds of stillbirth were associated with low levels of education, a further distance to travel from home to the hospital, living in a shack, maternal hypertension and having had a previous stillbirth after adjusting for all sociodemographic and health features. Higher odds of intrapartum stillbirth included; shoulder presentation, compound presentation and breech presentation compared to cephalic presentation. Other birth related factors associated with higher odds of stillbirth included reported birthing complications, duration of labour being &gt;=18 hours), antepartum haemorrhage, prolonged/obstructed labour, vaginal breech delivery, emergency Caesarean-section delivery, and signs of trauma to the neonate.&#x0D; ConclusionsIdentified risk factors associated with stillbirths are relatively amenable to intervention and a lot of work has been conducted globally, so the development of intervention with sufficient funding should be a relatively rapid process.&#x0D; For collaborations please contact: Email: miltonrl1@cardiff.ac.uk

Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p < 0.001), and 99.8% of the women received antibiotic(s). The antibiotic combination of benzylpenicillin, gentamicin, and metronidazole was the most commonly prescribed (n = 39, 146.7%), followed by ceftriaxone (n = 349, 41.6%). Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.

Umbilical artery thrombosis diagnosed at different gestational ages and fetal outcomes: a case series

BackgroundUmbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes.MethodsOur Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems.ResultsThree patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive.ConclusionsUmbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.

Migration, Gestational Diabetes, and Adverse Pregnancy Outcomes: A Nationwide Study of Singleton Deliveries in Denmark.

It remains unclear if migrants have different odds for adverse outcomes associated with gestational diabetes mellitus (GDM). We investigated if the associations between GDM and adverse pregnancy outcomes are modified by country of origin and examined the odds of these outcomes according to GDM status and country of origin. Data were extracted from a nationwide register-based study of singleton deliveries in Denmark, 2004-2015. We used logistic regression models and tested for interaction. Among the 710 413 singleton deliveries, 2.6% had GDM and 14.4% were immigrants. Country of origin modified the association between GDM and pre-eclampsia, large for gestational age (LGA), and small for gestational age (SGA) but not between GDM and planned or emergency cesarean section and preterm delivery. GDM increased the risk of pre-eclampsia among women from Denmark (OR 1.28; 95% CI, 1.18-1.39), Lebanon (OR 3.34; 95% CI, 1.35-8.26), and Morocco (OR 2.28; 95% CI, 1.16-6.88). GDM was associated with increased odds of LGA among women from most countries, particularly women from Sri Lanka (OR 4.20; 95% CI, 2.67-6.61), and was associated with reduced odds of SGA in some countries. Compared with Danish-born women with GDM, the odds of LGA were significantly lower and the odds of SGA higher among women with GDM from India, Lebanon, Pakistan, Iraq, and Somalia. Our study documents that different immigrant groups have higher odds of different GDM-associated adverse pregnancy outcomes and also among countries of origin often grouped together. This highlights the importance of increased awareness to both immigrant background and GDM status in the clinical assessment.

Maternal, pregnancy and neonatal outcomes of twin gestations in women with rheumatic diseases: A single-center, case-control study

ObjectiveTo assess maternal, pregnancy and neonatal outcomes of twin pregnancy (TP) in women with rheumatic diseases (RD) (Group A) as compared to those of singleton pregnancy (SP) in women with RD (Group B) and TP in the general obstetric population (GOP) (Group C). MethodsCase-control study including TP in RD during the period 2009–2020 at single institution. Women in Group A were matched with women of the same age at conception and affected by the same RD (Group B). Women in Group A and C were also matched. ResultsFifty-three women with RD (13 in Group A and 40 in Group B) and 39 healthy controls were included. RD was quiescent in 85% of patients in both Groups A and B. Spontaneous conception was more frequent in Group B (98%), as compared to A (62%) (p = 0.002). Emergency cesarean section and premature delivery were more frequent in Group A as compared to B and C (54% vs 15% vs 23%, p = 0.008, 69% vs 13% vs 39%, p < 0.000 and p = 0.054, respectively). Five babies (21%) in Group A required admission to the neonatal intensive care unit (NICU), but none in Group B (p = 0.007). ConclusionThis is the first case-control study assessing the outcomes of TP in women with RD. An increased risk of preterm delivery, emergency cesarean section and admission to NICU as compared to both SP in RD and TP in the GOP was observed. Multidisciplinary management is warranted to minimize these risks.

Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020.

PurposeAlthough its fetal outcomes and practicality are unclear time interval between decision-to-delivery ≤30 minutes in emergency caesarean section (CS) is the internationally accepted standard of practice. This study aimed to determine whether a decision to delivery interval (DDI) of approximately 30 minutes was achieved in daily practice, its fetal outcomes, and associated factors among emergency caesarean section delivery at South Gondar Zone Hospitals, Northwest Ethiopia.Patients and MethodsRetrospective cross-sectional study was carried out from August 1–30/2020 among emergency caesarean sections. Information was collected from the birth register book and individual files of standardized facility booking forms. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. A bivariable and multivariable logistic regression analysis was conducted and a significant association was recorded at p<0.05.ResultsOnly 17.5% of parturients attained a decision-to-delivery interval ≤30 minutes. The average median of decision to delivery interval was 54 minutes with interquartile range (IQR) of 48–80 minutes. Time taken to collect material with Adjusted odds ratio (AOR=10.3, 95% CI 5.87–45.7), time of decision (AOR=0.32, 95% CI, 0.15–0.67), and time taken from decision to delivery to delivery of anesthesia (AOR=4.74, 95% CI, 1.30–17.3) were the predictors of prolonged delivery time interval. Significant fetal adverse outcomes were not observed in a decision to delivery interval higher than 30 minutes.ConclusionIn most cases, delivery was not completed within the prescribed ≤30-minutes interval, particularly in developing countries with infrastructural challenges, however, fetal outcomes were not directly correlated. Despite lack of substantial linkage between the delivery time declaration and fetal events, an unreasonable gap from the decision-making to birth of the child is not appropriate and should be discouraged.

Helping asthmatic children through bonding therapy

Abstract: Disruptions in maternal-infant bonding are shown to be the mediating variable between maternal distress and the subsequent expression of childhood asthma. When bonding is repaired, it seems that children's asthmatic symptoms diminish or remit. This study evaluated 16 asthmatic children before and after their mothers were treated with bonding therapy. Fourteen improved on 11 measures, including reduction in STEP classification system and medication use. Thirteen children were able to stop all medications. The links between bonding disruptions, stress, and airway inflammation are discussed. Keywords iBonding Therapy, Childhood Asthma, Bonding Disruption, Asthma Treatment Introduction Asthma affects more children's lives than any other chronic illness (Lara et al., 2002). In 2008, just over 10 million children within the U. S were reported as ever having had a diagnosis of asthma (Akinbami, Moorman, Garbe, & Sondik, 2009). It is the third-ranking cause of hospital admissions in children under 15 (DeFrances, Cullen, & Kozak, 2007). The financial cost in America in 2007 was $56 billion in health costs, lost school and work days, and early deaths (Center for Disease Control and Prevention, 2011). Asthma is responsible for 14 million missed school days annually (Martin, 2004) - more than any other chronic illness. Since childhood asthma has reached epidemic proportions and has major public health and financial impacts, researchers have been attempting to identify risk factors for the development of this disease. For several years a significant focus of attention has revolved around the connection between maternal distress and the subsequent development of asthma children. Mrazek, Klinnert, Mrazek, and Macey (1991), at the National Jewish Center for Immunology and Respiratory Medicine in Denver, studied 150 children whose mothers were asthmatic. They found a link between early problems in coping/parenting and the subsequent expression of asthma. Klinnert et al. (2001), surprised by this finding, noted that this link between parental stress in care-giving and the subsequent development of asthma was the first documented report of such a connection. Maternal stress is known to be caused by many factors: Cesarean section deliveries, maternal health issues, psychological problems, maternal despondency, to list a few. Cesarean section deliveries and emergency cesarean sections have been linked to childhood asthma. A Finnish study of 60,000 births found that mothers who delivered by cesarean sections were 50% more likely to have a child who later developed asthma (Kero et al., 2002). Emergency cesarean section deliveries (even more stressful) predictably raised the asthma rate up to 60%. This finding was replicated by Roduit et al. (2009) who studied 2,917 children. Annesi-Maesano, Moreau, and Strachan (2001), using a British cohort of 2,583 mothers, investigated whether in utero and perinatal influences contribute to the development and severity of asthma in childhood. Childhood asthma was more frequently reported by mothers when there had been health complications during pregnancy, labor, or delivery, or when the child was ill during the first week of life. She concluded that there is evidence that in utero and perinatal factors may increase the risk of developing asthma. Similarly, a Norwegian study of over 1.5 million mothers and 5,938 asthmatic children found that many types of pregnancy complications represented a risk factor for the development of asthma in the offspring (Nafstad, Samuelsen, Irgens, & Bjerkedal, 2003). Kozyrskyj et al. (2008) studied healthcare records of 13,907 children and their mothers from Manitoba databases. Healthcare or prescription medication for depression or anxiety was used to define maternal distress, and asthma status was determined from the children's asthma prescription records. They found that risk for childhood asthma was increased among children who were exposed to continued maternal distress from birth until age 7 years. …

Possible Vertical Transmission of COVID-19 to the Newborn;a Case Report

Vertical transmission of the novel coronavirus 2019 (COVID-19), has been reported in case reports and series, while the data regarding its transmission is still not enough. Thus, presenting different experiences form various regions could help better understand the virus behavior in pregnancy. We herein report a possible vertical transmission of COVID-19 from a mother to the neonate. A 41-year-old mother with signs and symptoms of acute respiratory illness presented with labor pain and vaginal leak at 37 weeks of gestation. She tested positive for COVID-19 using RT-PCR and underwent emergency cesarean section delivery and gave birth to a girl neonate. The baby tested positive for the COVID-19. Although vertical transmission of COVID-19 has not been proved yet, but there are several lines of evidences suggesting it. Paying close attention to the mother and newborn with COVID-19 and long-term follow-up are needed for better understanding of the virus in pregnancy.

Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway

BackgroundProlonged labor might contribute to a negative birth experience and influence first-time mothers’ attitudes towards future pregnancies. Previous studies have not adjusted for possible confounding factors, such as operative delivery, induction and postpartum hemorrhage. We aimed to determine the impact of prolonged labor on birth experience and a wish for cesarean section in subsequent pregnancies.MethodsA survey including the validated “Childbirth Experience Questionnaire”. First-time mothers giving birth between 2012 and 2014 at a Norwegian university hospital participated. Data from deliveries were collected. Regression analysis and thematic content analysis were performed.Results459 (71%) women responded. Women with labor duration > 12 h had significantly lower scores on two out of four sub-items of the questionnaire: own capacity (p = 0.040) and perceived safety (p = 0.023).Other factors contributing to a negative experience were:Cesarean section vs vaginal birth: own capacity (p = 0.001) and perceived safety (p = 0.007). Operative vaginal vs spontaneous birth: own capacity (p = 0.001), perceived safety (p < 0.001) and participation (p = 0.047).Induced vs spontaneous start: own capacity (p = 0.039) and participation (p = 0.050). Postpartum hemorrhage ≥500 ml vs < 500 ml: perceived safety (p = 0.002) and participation (p = 0.031).In the unadjusted analysis, prolonged labor more than doubled the risk (odds ratio (OR) 2.66, 95%CI 1.42–4.99) of a subsequent wish for cesarean delivery. However, when adjustments were made for mode of delivery and induction, emergency cesarean section (OR 8.86,95%CI 3.85–20.41) and operative vaginal delivery (OR 3.05, 95%CI 1.46–6.38) remained the only factors significantly increasing the probability of wanting a cesarean section in subsequent pregnancies.The written comments on prolonged labor (n = 46) indicated four main themes:Difficulties gaining access to the labor ward.Being left alone during the unexpectedly long, painful early stage of labor.Stressful operative deliveries and worse pain than imagined.Lack of support and too little or contradictory information from the staff.ConclusionsWomen with prolonged labors are at risk of a negative birth experience. Prolonged labor per se did not predict a wish for a cesarean section in a subsequent pregnancy. However, women with long labors more often experience operative delivery, which is a risk factor of a later wish for a cesarean section.

Cesarean Section or Instrumental Delivery: The Best Choice for Mode of Delivery during Second Stage of Labor

Introduction Managing second stage of labour is very crucial. Emergency Cesarean Section (CS) or Instrumental Delivery (ID) is the only choices although complications might occur in both modes of deliveries. The rate of CS is at rise and the fear of failed ID followed by emergency CS with added complications makes the choice more difficult amongst the obstetricians.&#x0D; MethodsA retrospective study done to assess the maternal and fetal outcome in second stage of labour following ID and emergency CS from April 2018 to March 2019 among the pregnant women having completed 34 weeks of gestations and beyond.&#x0D; ResultsOf 4761 deliveries, 2537 (53.2%) were vaginal and 2224 (46.7%) CS, and amongst all, 133 (2.7%) were second stage interventions. Out of 133, 78 had ID, 76 were successful and 2 failed. Fifty seven (2.6%) were second stage CS. Nulliparas (65.8%) needed more ID, teenage pregnancy (6.5%) (p=0.04) and heart disease (18.4%) (p=0.002) were high risk for ID. Complications were more in CS, uterine extensions, (29.8%) (p&lt;0.001), urinary complications, (43.9%) (p&lt;0.001) and blood loss (p&lt;0.001). Neonatal admission too was higher in CS (n=29) and more so due to respiratory distress (16/29).&#x0D; ConclusionDespite of few failed attempted ID, it still proved to be better choice for delivery during second stage, as both maternal and neonatal complications were higher following the second stage CS. Hence, the correct and timely decision for ID addressing the associated risk factors could lead to favorable outcome.

The risk of adverse maternal outcomes in cases of placenta praevia in an Australian population between 2007 and 2017.

Placenta praevia is characterised by an inferior placental margin that overlies or falls within 20mm of the endocervical os. It remains a common cause of antepartum haemorrhage and is associated with adverse maternal and neonatal outcomes. We aimed to determine the association between antepartum and postpartum haemorrhage and adverse outcomes in cases of placenta praevia. The study population included women diagnosed with placenta praevia, who delivered between 1 April 2007 and 30 April 2017. The endpoints of interest included blood transfusion, emergency caesarean section, peripartum hysterectomy and admission to intensive care. There were 513 cases of placenta praevia, of which 67.3% delivered at term. Antepartum haemorrhage was associated with an increased risk of blood transfusion (relative risk (RR) 3.29; 95% CI 2.04-5.32), emergency caesarean section (RR 1.38; 95% CI 1.18-1.62) and preterm delivery, after 32weeks gestation (RR 4.21; 95% CI 2.77-6.38). Postpartum haemorrhage more than doubled the risk of blood transfusion (RR 9.08 95% CI 5-16.44) and admission to the intensive care unit (RR 10.44; 95% CI 2.34-46.59), as well as increased the risk of peripartum hysterectomy (1.4%). We also described the management of 12 cases of placenta praevia (2.3% of the study population) delivered vaginally. Antepartum and postpartum haemorrhage in cases of placenta praevia are predictors of several adverse outcomes. However, the high rate of term deliveries reaffirms the current practice of expectant management.

Factors associated with emergency caesarean section delivery during term induction of labour: A case-control study

Factors associated with emergency caesarean section delivery during term induction of labour: A case-control study

Evaluation of decision to delivery time interval and its effect on feto-maternal outcomes and associated factors in category-1 emergency caesarean section deliveries: prospective cohort study

BackgroundCategory-1 emergency caesarean section delivery is the commonly performed surgical procedure in pregnant women associated with significant mortality and morbidity both in the mother and fetus. The decision to delivery time interval is recommended to be less than 30 min by the Royal College of Obstetricians and Gynecologists as well as the American College of Obstetricians and Gynecologists. This study was designed to evaluate the decision to delivery time interval and its effect on feto-maternal outcomes and the associated factors during category-1 emergency caesarean section deliveries.MethodA prospective observational cohort study was conducted from March to May 2018 at the University of Gondar Comprehensive Specialized Hospital obstetrics Operation Theater and postnatal ward. A total of 163 clients who were undergone category-1 emergency caesarean section were included in this study. Statistical analysis was performed using SPSS version 20 (IBM Corporate). Bivariate and multivariate logistic regression with a 95% confidence interval was used to determine the association of decision to delivery time interval with predictor variables and feto-maternal outcomes.ResultsOnly 19.6% of women had a decision to delivery time interval below 30 min. The average decision to delivery time interval was 42 ± 21.4 min, the average time from the decision of category-1 emergency caesarean section arrival to the operation theater was 21.58 ± 19.76 min and from theater to delivery of anesthesia was 11.5 ± 3.6 min. Factors that were associated with prolonged decision to delivery time interval were: time taken to collect surgical materials (AOR = 13.76, CI = 1.12–168.7), time taken from decision and arrival to the operation theater (AOR = 0.75, CI = 0.17–3.25) and time taken from arrival at the operation theater to the immediate start of skin incision (AOR = 0.43, CI = 0.28–0.65).ConclusionDelivery was not achieved within the recommended time interval in the majority of category-1 emergency caesarean sections. The average decision to delivery time interval was longer than the recommended time but it did not affect feto-maternal outcomes.

A244 MATERNAL THIOPURINE AND ANTI-TUMOR NECROSIS FACTOR THERAPY DURING PREGNANCY IS ASSOCIATED WITH AN INCREASED RISK OF PLACENTAL-RELATED DISEASES

Abstract Background Though previous studies have suggested that most therapies for inflammatory bowel disease (IBD) are safe during pregnancy, the effect of these medications on placental-related diseases remain unknown. Aims To determine the effect of gestational medication exposure on pregnancy-related outcomes in patients with IBD. Methods We retrospectively reviewed the University of Alberta and University of Toronto pregnancy databases to identify patients (age &amp;gt; 18) who underwent routine assessment by a gastroenterologist at least once during pregnancy (first trimester (T1), second trimester (T2), and third trimester (T3). Pregnancy-related outcomes (maternal, obstetrical, and neonatal) were recorded from obstetrical records. Low-birth weight (LBW) was defined as an infant weight &amp;lt; 2500g at birth. Pre-term delivery was defined as birth &amp;lt; 37 weeks gestation. Medication exposure, such as 5-aminosalicylates (5-ASA), thiopurines, steroids, and anti-tumor necrosis factor (TNF) therapy was recorded for each trimester. Categorical variables were statistically compared using the Chi-square (x2) test through the SPSS software. Results A total of 84 patients were included. Compared to those not exposed to thiopurines, patients exposed to thiopurine therapy during T2 had an increased risk of pre-term birth (26.7% vs. 7.7%, p=0.046) and pre-eclampsia (13.3% vs. 0%, p=0.008) and a trend towards an increased risk of placental abruption (6.7% vs, 0%, p=0.061). Furthermore, compared to those not treated with corticosteroids, those prescribed corticosteroid therapy during any trimester had an increased risk of pre-term birth (T1 exposure: 50% vs. 10.2%, p=0.024; T2 exposure: 37.5% vs. 8.5%. p=0.018; T3 exposure: 42.9% vs. 8.8%, p=0.008) and infants born with LBW (T1 exposure: 50.0% vs. 7.8%, p=0.009; T2 exposure: 37.5% vs. 8.2%, p=0.015; T3 exposure: 57.1% vs. 8.6%, p=0.0005). Those exposed to corticosteroids in T3 only had an increased risk of PPROM (60.0% vs. 7.5%, p=0.0003) and chorioamnionitis (14.3% vs. 0%, p=0.002). Finally, anti-TNF therapy in T2 was associated with an increased risk of pre-eclampsia (9.1% vs. 0%, p=0.040. 5-ASA therapy was not associated with an increased risk of any adverse pregnancy-related outcome. No medication increased the risk of other maternal (i.e. gestational diabetes, emergency Cesarean-section delivery) and neonatal (intensive care unit admission, congenital anomalies) outcomes. Conclusions Placental related diseases, such as pre-eclampsia, appear to be increased with maternal exposure to thiopurine and anti-TNF therapy during pregnancy. Larger studies are required to confirm these associations. Funding Agencies None