Emergency Caesarean Section Research Articles

Risk-Prioritised Versus Universal Medical Nutrition Therapy for Gestational Diabetes: A Retrospective Observational Study

Background: The optimal application of medical nutrition therapy (MNT) in treating gestational diabetes remains uncertain. MNT involves individualised nutrition assessment and counselling, which is labour-intensive and is not the sole type of intervention offered by clinical dietitians. Objective: To determine whether pregnancy outcomes differed for individuals with gestational diabetes who were offered MNT on a risk-prioritised (RP) versus universal basis. Methods: Observational data from two cohorts of individuals who were offered MNT only if they met the high-risk criteria following general group-based dietary education (RP1, n = 369; RP2, n = 446) were compared with a baseline cohort who were universally offered at least one MNT consultation (UM, n = 649). The RP1 cohort were seen during community-wide COVID-19 restrictions in 2021, while RP2 were seen after restrictions had lifted in 2022. Furthermore, the RP approach primarily utilised telemedicine, while the UM approach was delivered in person. Results: MNT consultations halved under the RP approach (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and saved more than 20 h of dietitian time per 100 diagnoses (95 vs. 73 h for RP2 vs. UM). No significant increases were observed (p < 0.05) for any pregnancy outcomes in the RP cohorts compared with the UM cohort, including usage of diabetes medications, maternal weight gain below and above target, early deliveries, induced deliveries, emergency caesarean sections, large- and small-for-gestational-age (SGA) infants, infant macrosomia, neonatal hypoglycaemia and neonatal intensive care admissions. The use of both basal insulin (27% vs. 33%, OR 0.62, 95% CI 0.46 to 0.84) and metformin (6% vs. 10%, OR 0.52, 95% CI 0.31 to 0.88) was lower in the RP1 cohort during pandemic restrictions compared with the UM cohort; however, these differences were not retained in the RP2 cohort. Additionally, there were fewer SGA infants under the RP approach, particularly for the RP2 cohort (6% vs. 11% for RP2 vs. UM, OR 0.55, 95% CI 0.34 to 0.89). Conclusions: Risk-prioritised MNT was a more efficient dietetic service approach to gestational diabetes than the universal MNT model, with comparable pregnancy outcomes. Similar approaches may represent a strategic way to address sustainable health service planning amidst the rising global prevalence of this condition. However, further research is needed to investigate consumer perspectives, wider service impacts and post-partum maternal and child health outcomes.

Implications of mechanical circulatory support devices in a pregnant woman with cardiogenic shock

Data on the use of mechanical circulatory support devices in pregnant women are limited. A 27-year-old woman at 27 weeks and 6 days of gestation was supported by three different mechanical circulatory support devices due to cardiogenic shock. She came into spontaneous labor, which was complicated by major hemorrhage at the cannulation site, fetal distress, and transverse position, requiring emergency cesarean section. The postpartum period was complicated by intra-abdominal bleeding and arterial occlusion of lower extremity. When using mechanical circulatory support devices in pregnant women, a multidisciplinary approach is recommended.

Successful Anesthetic Management of a Cesarean Section in a Patient with Cardiomyopathy and Cardiogenic Shock: A Case Report

Background: Cardiomyopathy in pregnancy is a rare but serious condition that can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of these patients is challenging due to the complex interplay of physiological changes and the potential for hemodynamic instability. This case report describes the successful anesthetic management of a cesarean section in a patient with cardiomyopathy and cardiogenic shock. Case presentation: A 29-year-old woman with cardiomyopathy and cardiogenic shock presented for emergency cesarean section at 36-37 weeks gestation. She had a history of global hypokinetic, left ventricular and atrial dilatation, and an ejection fraction (EF) of 32%. She was also in atrial fibrillation. Epidural anesthesia was selected due to its lower risk of complications compared to general anesthesia. The patient was carefully monitored throughout the procedure, and her hemodynamics were maintained with a combination of fluids and inotropes. The surgery was successful, and the patient delivered a healthy baby boy. Conclusion: This case report demonstrates that successful anesthetic management of cesarean section is possible in patients with cardiomyopathy and cardiogenic shock. Careful planning, close monitoring, and a multidisciplinary approach are essential for a positive outcome.

Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study

ObjectiveIn the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision...

A randomized controlled trial of povidone-iodine application after skin closure for prevention of surgical site infection in emergency cesarean section.

To determine the effectiveness of povidone-iodine application after skin closure to prevent surgical site infection after an emergency cesarean section and to assess risk factors associated with surgical site infection. A randomized controlled trial enrolled 352 pregnant women who required emergency cesarean delivery at King Chulalongkorn Memorial Hospital, from August 2018 to March 2019. Participants were randomly assigned to receive the povidone-iodine application at the incision after skin closure (n = 176) or without application (n = 176). Thirty-day surveillance of complications and adverse effects was performed. The primary outcome was the incidence of surgical site infection, which was compared between groups using the chi-squared test. The adjusted odds ratios (ORs) of the factors associated with surgical site infection were determined by logistic regression analysis. There were no significant differences in the incidence of surgical site infection and adverse effects between the povidone-iodine and control groups (9.5% vs 7.1%, P = 0.430). The significant factor associated with surgical site infection was a long interval (≥60 min) from the administration of prophylactic antibiotics to the incision (adjusted OR 4.06, 95% CI 1.49-11.03). The application of povidone-iodine after skin closure in an emergency cesarean section did not have the advantage of reducing the incidence of surgical site infection. This study was registered in TCTR registry on March 10, 2018 with trial identification number: TCTR20180310002 (https://www.thaiclinicaltrials.org/show/TCTR20180310002). The first participant was recruited on August 2, 2018.

Factor structure and psychometric characteristics of the City birth Trauma Scale- Slovak version.

The City Birth Trauma Scale (City BiTS) is a questionnaire designed to assess the posttraumatic symptoms after birth. This study aimed to explore the factors structure, internal consistency, known-groups validity, and convergent validity of the City Birth Trauma Scale in Slovakia. Cross-sectional Slovak national data from the INTERSECT study were analyzed in this study. The research was set in four public hospital sites in central and eastern Slovakia. A 28-item City BiTS online questionnaire was administered to 437 women 6-8weeks postpartum study (mean age 30.5±4,8; range18-45), along with the Edinburgh Postnatal Depression Scale (EPDS) and the Post-Traumatic Stress Diagnostic Scale indicating previous trauma. The stressor criterion of PTSD based on DSM 5 classification was met by 11.5% of postpartum women in the Slovak sample, and all criteria for PTSD were met by 2.8% of participants. Significantly higher City BiTS scores were found among primiparas (p≤0.01), women who experienced previous trauma (p≤0.001), with positive psychiatric anamnesis (p≤0.001), and women after assisted vaginal birth or emergency caesarian section (p≤0.001). The Slovak version of City BiTS has been shown to have good reliability and good divergent and known-groups validity. The results of confirmatory factor analysis showed that the two-factor model of the BSS-R offers a good fit to the Slovak data (χ2(df = 169)=574, p<0.001, CFI=0.90 and RMSEA = 0.08). The Slovak version of the City Birth Trauma scale has been found to have good psychometric properties comparable with other validation studies of this measure.

Consent for interventions during childbirth: A national population-based study.

To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.

Systematic Review of Interventions in Early Pregnancy Among Pregnant Individuals at Risk for Hyperglycemia.

The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section). We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 - 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial." Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English. We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type. 21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes. Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations.

Prolonged second stage of labor and risk of postpartum hemorrhage in nullipara with epidural anesthesia and vaginal delivery: A cohort study with propensity score analysis.

To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (>3 h) and the risk of postpartum hemorrhage (PPH) in a diverse population. We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged ≥18 years, presenting cephalically, and with a gestational age (GA) of ≥24 weeks at a tertiary maternity hospital in China (chictr.org.cn identifier: ChiCTR2200063094). Women undergoing emergency cesarean section in labor were excluded. The primary outcome was PPH, with secondary outcomes including severe postpartum hemorrhage and blood transfusion. We employed propensity score overlap weighting to analyze the association between prolonged second stage labor and PPH. The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor >3 h and 3566 with a second stage ≤3 h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in >3 h group vs 17.64% in ≤3 h group; weighted odds ratio 1.01; 95% CI: 0.51-2.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third-/fourth-degree perineal laceration, GA >41 weeks, twin pregnancies, episiotomy and GA >37 weeks. Sensitivity analysis did not reveal significant differences. This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting >3 h in our population, providing additional evidence for clinical practice.

Differentiation between Hypovolemic Shock and Septic Shock in Patients with Unstable Vital Signs after Cesarean Section: A Case Report

Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Determinant of adverse early neonatal outcomes following emergency cesarean section in North West, Ethiopia: institutional-based case-control study

BackgroundThe World Health Organization recommends a cesarean delivery rate of 5–15%, which is thought to be within the range that can reduce infant morbidity and mortality. Various investigations have shown that those poor newborn outcomes are influenced by a variety of maternal and fetal factors and are more prevalent in emergencies than planned cesarean deliveries. Ethiopia is one of the five nations that account for 50% of all neonatal fatalities worldwide. Sub-Saharan African countries account for 38% of all infant deaths worldwide.AimTo know the determinants of adverse early neonatal outcomes after emergency cesarean delivery.Method and materialA multicenter case-control study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 318 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. The measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.ResultsMaternal age over 35, the presence of danger signs during pregnancy, and non-reassuring fetal heart rate were significantly associated with increased risk of adverse fetal outcomes following emergency cesarean section. Women aged over 35 were 3.6 times more likely to experience adverse fetal outcomes compared to younger women (AOR: 3.6, 95% CI: 1.1, 9.7). Women with danger signs during pregnancy were 3.5 times more likely to have adverse fetal outcomes compared to those without (AOR = 3.5, 95% CI: 2.4, 36). Similarly, cases with non-reassuring fetal heart rate were associated with a 5.2 times higher risk of adverse newborn outcomes (AOR = 5.2, 95% CI: 1.1, 26).ConclusionThis study identified advanced maternal age (over 35 years old), pregnancy complications, and non-reassuring fetal heart rate as significant risk factors for adverse neonatal outcomes following emergency cesarean section.

FETOMATERNAL OUTCOME AMONG PREGNANT WOMEN PRESENTED WITH OBSTETRIC CHOLESTASIS

Obstetric cholestasis is a significant condition in pregnancy, associated with adverse fetomaternal outcomes, particularly at term. Timely diagnosis and management are crucial to mitigate complications. Objective: The aim of this study was to evaluate the fetomaternal outcomes among pregnant women diagnosed with obstetric cholestasis at term. Methods: This cross-sectional study was conducted from January 1, 2024, to July 1, 2024, in the Department of Obstetrics and Gynecology. Consecutive non-probability sampling was used to recruit women aged 18-40 years diagnosed with obstetric cholestasis at term. Patients with acute hepatitis, chronic kidney disease, or drug-induced hepatitis were excluded. Demographic data such as age, BMI, educational status, occupation, socioeconomic status, and residence area were recorded. Fetomaternal outcomes, including emergency cesarean section, sleep disturbances, postpartum hemorrhage, low birth weight (&lt;2.5 kg), APGAR score &lt;7, NICU admission, and meconium-stained liquor, were assessed. Results: A total of 120 patients were included in the study. The mean age of participants was 28.56 ± 6.40 years, and the majority were within the 18-30 years age group. Fetomaternal outcomes showed that 35% of the women required an emergency cesarean section. Sleep disturbances were observed in 54.2%, and postpartum hemorrhage occurred in 11.7% of cases. Low birth weight was recorded in 20.8% of neonates, while 10% had an APGAR score &lt;7. NICU admission was required for 23.3% of the neonates, and meconium-stained liquor was present in 35.8% of deliveries. Conclusion: The study demonstrated significant fetomaternal outcomes in obstetric cholestasis, emphasizing the need for early detection and careful management to reduce complications such as higher rates of emergency cesarean sections, sleep disturbances, postpartum hemorrhage, low birth weight, and NICU admissions.

Abnormal Venous Flow in Pregnant Women with Mild Right Ventricular Dysfunction in Repaired Tetralogy of Fallot: A Clinical Model for Organ Dysfunction in Preeclampsia.

Background: Pregnant women with congenital heart disease carry a high risk of complications, especially when cardiac function is suboptimal. Increasing evidence suggests that impaired right ventricular (RV) function has a negative effect on placental function, possibly through venous congestion. We report a case series of hepatic and renal venous flow patterns in pregnant women with right ventricular dysfunction after repaired Tetralogy of Fallot (ToF), relative to those observed in normal pregnancy and preeclampsia. Methods: At 20-24 weeks pregnancy, RV function was measured by echocardiography and by cardiovascular magnetic resonance in women with repaired ToF. Combined Doppler-ECG of the hepatic and renal interlobular veins were performed in three women with asymptomatic right ventricular dysfunction. Venous impedance index and pulse transit time were measured and classified as abnormal at >75th and <25th reference percentile, respectively. Results: All three women showed dilated RV and mildly impaired RV function. Both hepatic and intrarenal Doppler flow waves were abnormal and very much resembled the patterns seen in preeclampsia. One of the three women had complications including ventricular tachycardia, intrauterine growth restriction, antenatal bleeding, emergency cesarean section and acute heart failure 2 days postpartum. Conclusions: Pregnant women with mild right ventricular dysfunction after repaired ToF show abnormal venous Doppler flow waves in the liver and kidneys, similar to those observed in preeclampsia. These findings are in line with reported observations on the association between impaired RV function, abnormal return of venous blood, venous congestion and organ dysfunction. The parallel with venous Doppler flow observations in preeclampsia suggest that the venous compartment might play an important role in the etiology of preeclampsia-induced organ dysfunction. Whether this phenomenon directly affects the uteroplacental circulation is to be assessed in future research.

Maternal and Perinatal Outcomes of Induced Labor for Breech Presentations

Background: Inducing labor for breech presentation is a relatively harmless and effective approach when carefully chosen for the right cases regarding both maternal and perinatal outcomes. Objective: To determine safety of induction of labor in women with breech presentation with respect to maternal and perinatal outcomes. Material and Methods: This descriptive case series included Para 1-5 with single alive fetus, frank or complete breech with flexed head after 37 weeks. Labor induced with prostaglandin E2 vaginal pessary either alone or with balloon catheter combination. Maternal outcomes (postpartum hemorrhage, postoperative fever, perinatal trauma and hospital stay of &gt; 24 hrs) and neonatal morbidity APGAR scores (A/S) of &lt;7, Neonatal Intensive Care Unit admission, any trauma and mortality were recorded. Results: The study showed about 43 (86%) of women between age group of 18-35 years and 37(74%) with parity 1-3. Emergency cesarean section observed in 7 (14%) while vaginal delivery in 43(86%) cases. Maternal adverse outcomes observed were PPH in 4(8%) (P= 0.50), postoperative fever3 (6%) (P =0.68), perinatal trauma 2(4%) (P =0.68), and hospital stay 9(18%) cases (P =0.84).Observed neonatal outcomes were A/S of &lt; 7 in 5(10%) (P =0.07), Neonatal Intensive Care Unit admission in4( 8%) (P =0.59), injury to humorous in 1(2 %)P =0.64)case. Conclusion: Induction of labor for term breech showed no statistically significant change in feto-maternal outcomes with regard to mode of delivery

Peritoneal Closure at Caesarean Section; A Comparative Cross-Sectional Study

Background: Cesarean section rates have been growing consistently on a worldwide scale. Peritoneal closure is important because it can help provide the best possible surgical results and recuperation after surgery. The surgical incision site could not receive enough support and protection if the peritoneal layer is not closed. Objective: To compared the mean pain score following peritoneal closure with non-closure during Caesarean procedure. Materials and Methods: Comparative cross-sectional study, conducted at department of obstetrics and gynecology of Hayatabad Medical Complex Peshawar. The research comprised 276 pregnant women with primigravida, who were having an elective caesarian section, categorized into two groups (Closure &amp; Non-closure) of 138 participants in each. To prevent surgical skill bias, senior obstetricians with over three years of experience conducted Caesarean sections on both groups. SPSS (version 22) was used to enter and analyze all the data. Results: A total of 138 with closure patients were observed in which 38(60%), 48(35%), and 7(5%) patients had mild, moderate, and sever pain respectively. While in closure group, a total 138 patients were observed in which 64(46%) had mild, 62(45%) moderate, and 12(9%) patients had severe pain. The p-values for mild, moderate, and severe pain across age groups were 0.571 and 0.681 for the non-closure and closure groups, respectively. Conclusion: Our study highlights that peritoneum non-closure discomfort is less severe than peritoneum closure during a cesarean section. It is advised that during an emergency cesarean section, both visceral and parietal peritoneal closure can be safely skipped because the surgical result is better.

Foetal paraspinal neuroblastoma: A case report of autopsy findings

Neuroblastoma is a rare tumour originating from neural crest cells, primarily occurring in the adrenal glands and sympathetic ganglia, with prenatal diagnosis often complicated by the difficulty in distinguishing it from other foetal abdominal or paraspinal masses. We present a case of foetal neuroblastoma in a 26-year old woman who, at 36 weeks of gestation, experienced absent foetal movements, leading to ultrasound confirmation of foetal demise with associated effusions. An emergency caesarean section revealed a stillborn male foetus with a previously undetected encapsulated mass in the posterior mediastinum, which was confirmed as neuroblastoma through histopathological analysis. This case highlights the challenges in prenatal diagnosis, as the tumour went unnoticed despite routine imaging. It contributes to the limited literature on foetal neuroblastoma, underscoring the need for further research on effective management strategies.

Prevalence of meconium-stained amniotic fluid and factors associated with emergency cesarean section: multicenter cross-sectional study in south central Ethiopia

BackgroundMeconium is thick black-green fetal intestinal content starting from the early first trimester of gestation. Unfortunately, if it is released into the amniotic cavity due to any cause, it can be associated with neonatal mortality and morbidity.ObjectiveTo identify the factors associated with meconium-stained amniotic fluid among mothers undergoing emergency cesarean section in specialized hospitals cross-sectional study in south central Ethiopia from August 1, 2022, to 30, October 2022MethodInstitution based multicenter cross-sectional study was done prospectively through meticulous chart review and interview on 875 mothers who gave birth with emergency cesarean section. Data were entered using Epi data 7 and analyzed with SPSS 26. The association between independent variables and meconium-stained amniotic fluid was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at P-value &amp;lt; 0.05ResultThe prevalence of meconium-stained amniotic fluid is 31.4%. Gravidity (AOR 3.643; 95% CI:1.215,10.921), time interval between decision to delivery (AOR 1.361; 95% CI: 0.424,4.365),eclampsia(AOR 8.022; 95% CI: 1.634,39.372), time taken from referring institution to managing institution (AOR 15.258; 95% CI: 1.591,146.328), obstructed labor (AOR 24.614; 95% CI: 6.073,99.766), cephalopelvic disproportion (AOR 2.640; 95% CI:1.002,6.950), fetal heart beat abnormality (fetal bradycardia AOR 2.068; 95%CI 0.997,4.292) (fetal tachycardia AOR 3.513; 95% CI:1.633,7.556) duration of labor(AOR 5.44; 95% CI: 1.355,9.782) and referral from health center(AOR 5.41; 95% CI: 2.053,14.272) are associated with MSAF whereas obstetric complications(AOR 6.820; 95% CI: 2.870,16.202), cesarean section scar (AOR 3.010; 95% CI: 1.344,6.740) are negatively associated.ConclusionPrevalence of meconium-stained amniotic fluid is relatively high for which intrapartum, obstetric and institution related factors are incriminated. Therefore, an improvement in the quality of antenatal and intrapartum care is strongly recommended; professional development at the health center, building the infrastructure, and strengthening the referral system is also suggested.

Takayasu's arteritis in pregnancy: A case report and literature review.

Takayasu's arteritis (TA) is a rare, chronic inflammatory disease of unknown cause, primarily affecting young women in their reproductive years. It can result in the narrowing and occlusion of arteries and the formation of aneurysms in arteries, especially those related to the aorta, creating significant risks during pregnancy. Women with TA are more susceptible to cardiovascular complications, including hypertension and heart failure, which can negatively affect both maternal and fetal health. This case report details a 23-year-old pregnant woman diagnosed with TA during the first trimester, presenting with symptoms of fainting and pulselessness in her right upperlimb. Doppler imaging of the right upper limb confirmed the diagnosis. Treatment for TA was initiated alongside comprehensive antenatal care. In the third trimester, she also developed gestational hypertension. And at 36 weeks of gestation, due to placenta previa and preterm premature rupture of membranes, an emergency cesarean section was performed. Timely medical intervention resulted in a favorable outcome, with an uneventful postpartum recovery. This case highlights the need for early diagnosis and collaborative care in pregnant women with TA to ensure better outcomes for both mother and child. Understanding the clinical aspects of TA is essential for effective management and improved prognosis.

Effects of the COVID-19 pandemic on maternal, newborn, and child health service coverage in Burkina Faso.

While countries' coronavirus disease 2019 (COVID-19) emergency contingency and response plans aimed to prevent and control the spread of the virus, they also caused major disruptions to health services. We assessed the effects of COVID-19 on coverage and inequalities in select maternal, newborn, and child health services in Burkina Faso. We analysed data from two cross-sectional household surveys conducted in two provinces, one rural and one urban. The first survey of 3375 households was conducted immediately before the pandemic (February to March 2020) and the second survey in the same areas two years after the pandemic (May to June 2022) using a similar methodology. We compared the coverage of maternal, newborn, and child health interventions and care-seeking between the two surveys to assess the effects of the pandemic on maternal, newborn, and child health services. Our findings did not show significant disruptions in coverage of antenatal service, postnatal care for mothers and babies, child routine vaccination, and care-seeking for sick children during the pandemic. However, there was a dramatic drop of the number of women (23 percentage points) accompanied by their partners for delivery as well as the number of caesarean-section deliveries in urban areas. The shortage of health staff, facility congestion, fear of getting COVID-19 after a caesarean-section admission, and prioritisation of critical health services such as emergency caesarean-section to the detriment of elective cases may explain the decline of caesarean-section rates. COVID-19 did not cause major reversals in the coverage of maternal, newborn, and child health services in Burkina Faso, except for caesarean sections. We also saw no substantial increases in service coverage. In the absence of a counterfactual, we could not attribute the stagnation to the pandemic. However, the very low proportion of women reporting disruption in care-seeking suggests some resilience of the health systems to mitigate the negative impacts of the pandemic.

Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Early gestational diabetes mellitus (eGDM) refers to elevated blood glucose levels not meeting the criteria for overt diabetes before 20 weeks gestation. Observational studies link eGDM to adverse outcomes, but randomized controlled trial (RCT) evidence on early intervention benefits remains inconclusive. To address this, we performed a systematic review and meta-analysis (SRM) of RCTs on this subject. We searched electronic databases to identify RCTs comparing early treatment versus observation for eGDM. The primary neonatal outcomes analyzed were large-for-gestational-age (LGA) and macrosomia. The primary maternal outcome was pregnancy-related hypertension. Secondary neonatal outcomes included neonatal respiratory distress (NRD), neonatal intensive-care unit (NICU) admission, small-for-gestational-age (SGA), cord-blood C-peptide ≥90th percentile, and neonatal hypoglycemia. Secondary maternal outcomes were cesarean section (CS), emergency CS, labor induction, preeclampsia, and preterm birth. Seven RCTs involving 4,427 pregnancies were analyzed. The studies differed in their timing and methods of inclusion. Six studies used a combination of lifestyle and pharmaceutical interventions, while one relied solely on lifestyle modifications. Early treatment did not reduce LGA [OR 0.84 (95%CI: 0.53-1.32); P=0.44], macrosomia [OR 0.68 (95%CI: 0.43-1.06); P=0.09], or pregnancy-related hypertension [OR 1.04 (95%CI: 0.68-1.57); P=0.87]. Among the secondary outcomes, only NRD was significantly reduced in the treatment arm [OR 0.52 (95%CI: 0.34-0.80); P=0.003]. However, sensitivity analysis, omitting the lifestyle-only study, demonstrated a lower risk of macrosomia with early intervention [OR 0.55 (95%CI: 0.34-0.91); P=0.02]. The SRM demonstrates early intervention does not improve most pregnancy outcomes, except NRD. Sensitivity analysis, excluding the lifestyle-only study, additionally revealed a reduction in macrosomia. The findings must be interpreted cautiously due to the variability in study designs. Replication in well-designed multicenter trials is required before clinical application.