Fetal Presentation Research Articles

Analysis of Cesarean Section Causes Using Robson’s Ten Group Classification System in Selected Hospitals Affiliated to Shiraz University of Medical Sciences: A Cross-sectional Study

Background: Robson’s Ten Group Classification System (RTGCS) is widely used to evaluate, monitor, and compare cesarean delivery (CD) rates within and between delivery service centers. This study aimed to investigate the causes of CD in Shiraz teaching hospitals using RTGCS. Materials and Methods: A cross-sectional study on 1787 pregnant women who underwent CD in selected teaching hospitals in Shiraz, Iran, was selected via convenience sampling within 3 months. The data collection tool was a demographic, midwifery, and fertility information questionnaire completed through interviews and medical records. Subjects’ classification was performed based on midwifery concepts and parameters described in RTGCS. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation, and number of fetuses). Data were analyzed using SPSS software and descriptive tests were used to describe the data. Results: Of the 1787 subjects, 455 (25.5%) had planned CS and 1332 (74.5%) had emergency CS. The most common causes of CD were previous CD (58.6%) and fetal distress (27.6%). Overall, 823 (46.1%) had fetal and placental causes, 1268 (71%) had uterine causes, and 78 (4.4%) had maternal causes. Conclusion: The biggest factors that played a role in the CD rate in the present study were termed multipara women with a history of previous CD. The CD rate and the overall size of this group are still increasing, and as a result, women with a history of a previous CD must be motivated more effectively to have a vaginal birth after cesarean delivery (VBAC).

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand.

Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization(WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton,cephalic, term pregnancies. Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.

Short Communication - Possible aetiology of the posterior presentation in Perosomus elumbis

The aetiology of foetal presentation in cattle is still unresolved. The hind legs are the main source of propulsive movement in cattle, which provides changes in foetal presentation. The assumption is that in the absence of hind leg movements of the foetus, as in the case of the congenital malformation, Perosomus elumbis, the incidence of the anterior and posterior presentation will be the same. The Scopus database, the world wide web (www), and the list of article references were searched using the keyword, Perosomus elumbis. Manuscripts with data about the foetal presentation were included and 21 cases in 16 articles were identified. There were 11 cases of anterior presentation and 10 of posterior presentation. The Chi-square test didn't show a statistically significant difference between the incidence of anterior and posterior presentation. This finding supports the assumption that the posterior presentation is the result of the random occupying of the intrauterine space with the same probability of anterior and posterior presentation. To confirm or exclude at random the occupant of the intrauterine space with the same probability for anterior and posterior presentation as a general mechanism for posterior presentation in cattle foetuses, it is necessary to determine the incidence of foetal presentation at birth in various veterinary entities accompanied by an increased incidence of posterior presentation. The aim of the paper was to investigate the incidence of posterior and anterior presentation in Perosomus elumbis.

Faktor-Faktor yang Berhubungan dengan Lama Penyembuhan Laserasi Perineum Ibu Nifas Di Puskesmas Singotrunan-Banyuwangi

Perineal wound at the puerperium can be caused by episiotomy and lacerations during childbirth at the first labour or more. Factors that cause perineal lacerations are parity, birth spacing, breathing and pushing technique at giving birth, maternal age. fetal presentation and weight. The classification of wound healing perineum laceration is divided into 3 phases, firts is inflammatory phase (24 hours-48 hours), poliferation phase (48 hours-5 days), and the maturation phase (5 days and more). The purpose of this study was to analyze the factors associated with the healing time of perineal laceration wounds in puerperal mothers. This research method is quantitative with a cross sectional design of 34 respondents with total sampling techniques.This research was conducted at desember 2022-Januari 2023 at Singotrunuan Village, Subdistric Banyuwangi. Independent variables are patterns of nutritional fulfillment, personal hygiene, and early mobilization. The dependent variable is the healing of perineal laceration wounds. The collection data is using questionaire and analyzed using Chi Square statistical test. The results of the study found that there was a correlation between personal hyegiene, early mobilization, and nutritional fulfillment patterns with the duration of healing of perineal laceration wounds at the puerperal mother with p sig value of &lt;0.005.It is hoped that this study can add insight and knowledge to postpartum mothers with perineal laceration wounds about factors that affect the healing time of perineal laceration wounds.

Occurrence and risk factors for second-degree perineal tears: A prospective cohort study using a detailed classification system.

The amount of tissue trauma within second-degree perineal tears varies widely. Therefore, subcategorization of second-degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second-degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second-degree tear subcategories. This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second-degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second-degree tear subcategories were analyzed using a multinominal regression model. Perineal tears occurred as follows: first-degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third- or fourth-degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. The occurrence of second-degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second-degree tear in a more severe subcategory.

Fetal Diagnosis of Supravalvular Aortic Stenosis and Pulmonary Stenosis in a Family with Non-Syndromic Elastin Mutation.

Supravalvular aortic stenosis (SVAS) has been well described in Williams-Beuren Syndrome and non-syndromic elastin (ELN) mutations. Non-syndromic ELN mutations are inherited in an autosomal dominant pattern with incomplete penetrance and variable expressivity. ELN haploinsufficiency leads to progressive arteriopathy, typically affecting the aortic sinotubular junction. Multi-level pulmonary stenosis has also been reported and biventricular obstruction may portend a worse prognosis. Fetal presentation of ELN mutation with SVAS has not been previously reported in the literature. We present a case of fetal diagnosis of SVAS and multi-level pulmonary stenosis in a family with a known pathogenic ELN mutation (Exon 6, c.278del [p.Pro93Leufs*29]). On the fetus' initial fetal echo, there was only mild flow acceleration through the aortic outflow tract, however, she went on to develop progressive bilateral obstruction. In the early post-natal period, the child was clinically asymptomatic and showed similar mild SVAS and mild valvar and supravalvular pulmonary stenosis. Our case highlights the need for serial monitoring of fetuses with suspected or confirmed ELN arteriopathy.

Cesarean section prior to 28 weeks’ gestation: which type of uterine incision is optimal?

Objective The purpose of this study was to determine the factors that influence physician preference for type of hysterotomy incisions in gravidas with a singleton or twin pregnancy undergoing cesarean section under 28 weeks, and to assess factors that result in delivery complications, defined as either intraoperative dystocia or hysterotomy extension. We hypothesized that compared to those with non-cephalic presentations, gravidas with a presenting fetus in cephalic presentation would have higher rates of low-transverse cesarean section, and reduced rates of delivery complications with low-transverse hysterotomy. Methods This was a retrospective cohort chart analysis of 128 gravidas between 23 0/7 and 27 6/7 weeks undergoing cesarean section at a single academic institution between August 2010 and December 2022. Data was abstracted for factors that might influence the decision for hysterotomy incision type, as well as for documentation of difficulty with delivery of the fetus or need for hysterotomy extension to affect delivery. Results There was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), p = .03. No other significant associations were related to hysterotomy incision, including nulliparity, racially or ethnically minoritized status, plurality, indication for cesarean delivery, or pre-cesarean labor. Twenty (15.6%) subjects experienced either an intraoperative dystocia or hysterotomy extension. For the entire cohort, there was a greater median cervical dilatation in those with delivery complications (4.0 cm, IQR .5 - 10 cm) compared to those without complications (1.5, IQR 0 – 4.0), p = .03, but no significant association between delivery complications and fetal presentation, hysterotomy type, plurality, or other demographic/obstetrical factors. However, among gravidas undergoing low-transverse cesarean section, only 2/30 (6.7%) with cephalic presentations had a delivery complication, compared to 9/31 (29.0%) with breech presentations and 3/7 (42.9%) with a transverse/oblique lie, p = .03. Conclusion In pregnancies under 28 weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.

Maternal and fetal outcomes after planned cesarean or vaginal delivery in twin pregnancy: a comparison between 2 third level birth centers

Background Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). Methods This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. Results The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. Conclusion In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.

Sonographic evaluation of the commonest sites of placental localization in pregnant women in Umuahia, Abia State

Background: The Placenta is an organ of pregnancy that provides nutrition, excretory functions and oxygen to the fetus.&#x0D; Aim: The purpose of the study is to determine and provide information on the commonest sites of placental localization in pregnant women in their second and third trimesters in Umuahia, Abia state because there are few documented reports on the sonographic assessment of placental localization in Umuahia.&#x0D; Methodology: Prospective study of pregnant women in their second and third trimesters was carried out trans- abdominally using an ultrasound scan machine with a 3.5 MHz transducer. Placental localization was classified into anterior, posterior, fundal and low-lying, Ultrasonography was used because it is non-ionizing, cheap and readily available. Exclusion criteria; pregnant women with a history of Caesarian section, uterine fibroids and multiple gestation.&#x0D; Results: One hundred women between the ages of 20yrs and 42yrs with a mean age of 28.60±4.95 on their routine antenatal visit were used for the study. The women were in their second and third trimesters, and fetal gender distribution was 55 males and 45 females. Placental localization was classified into Anterior 44%, fundal 20%, posterior 30% and previa 3%.&#x0D; Conclusion: Anterior placentation was the commonest, followed by posterior, then fundal with placenta previa being the least site of placental localization. There was no statistical significance between placental localization and maternal age, gestational age, fetal weight, gender, fetal presentation and heart rate. Evaluation for placental localization in the second and third trimesters is important to rule out placenta previa.

Emergency cesarean sections in goats with abnormal fetal presentations: A case study

Emergency cesarean sections in goats with abnormal fetal presentations: A case study

Predictors of neonatal near-misses in Worabe Comprehensive Specialized Hospital, Southern Ethiopia.

Neonatal deaths are still a major leading cause of social and economic crises. Identifying neonatal near-miss events and identifying their predictors is crucial to developing comprehensive and pertinent strategies to alleviate neonatal morbidity and death. However, neither neonatal near-miss events nor their predictors were analyzed in the study area. Therefore, this study is aimed at assessing the predictors of neonatal near-misses among neonates born at Worabe Comprehensive Specialized Hospital, Southern Ethiopia, in 2021. A hospital-based unmatched case-control study was conducted from 10 November 2021 to 30 November 2021. A pre-tested, structured, and standard abstraction checklist was used to collect the data. After checking the data for completeness and consistency, it was coded and entered into Epi-Data 3.1 and then exported to Stata version 14 for analysis. All independent variables with a p-value ≤0.25 in bivariable binary logistic regression were entered into a multivariable analysis to control the confounding. Variables with p-values <0.05 were considered statistically significant. In this study, 134 neonatal near-miss cases and 268 controls were involved. The identified predictors of neonatal near-misses were rural residence [adjusted odds ratio (AOR): 2.01; 95% confidence interval (CI): 1.31-5.84], no antenatal care (ANC) follow-up visits (AOR: 2.98; 95% CI: 1.77-5.56), antepartum hemorrhage (AOR: 2.12; 95% CI: 1.18-4.07), premature rupture of the membrane (AOR: 2.55; 95% CI: 1.54-5.67), and non-vertex fetal presentation (AOR: 3.05; 95% CI: 1.93-5.42). The current study identified rural residents, no ANC visits, antepartum hemorrhage, premature rupture of membrane, and non-vertex fetal presentation as being significantly associated with neonatal near-miss cases. As a result, local health planners and healthcare practitioners must collaborate in enhancing maternal healthcare services, focusing specifically on the early identification of issues and appropriate treatment.

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births.

Bicornis unicollis uterus is a rare congenital uterine abnormality that occurs due to the failure of Mullerian duct fusion early in the development of the female internal genitalia system. In this case report, we present a woman with bicornis unicollis uterus who had preterm birth. A 30-year-old female patient with two caesarean sections history with premature babies was presented to the hospital with a complaint of regular contractions for twelve hours in her third preterm pregnancy. The patient has no particular symptoms besides acute abdominal pain. The ultrasonography examination indicated a uterus didelphys with breech presentation fetus. Due to the patient's caesarean history and the fetal presentation, an emergency caesarean section was decided and performed. It was found that the gravid uterus was on the left and the baby was subsequently delivered with a complete placenta. Postoperative condition of the patient was shown to be stable while the baby underwent an intensive care at the neonatal intensive care unit. This case report highlights that early diagnosis in this rare case is critical since bicornis unicollis uterus are mostly asymptomatic. Caesarean section was chosen in the present case based on consideration of the fetal and maternal clinical conditions.

Determinants of prelabor rupture of membrane among pregnant women attending governmental hospitals in Jimma zone, Oromia region, Ethiopia: A multi-center case-control study.

Prelabor rupture of membrane defined as the rupture of fetal membranes before the beginning of uterine contractions, is a common complication of pregnancy and the leading cause of preterm birth. In Ethiopia, the prevalence of prelabor rupture of membrane varied significantly between settings due to variations in risk factors. Besides, there was no study conducted using primary data, particularly in the Jimma zone, Ethiopia. Therefore, this study aimed to identify determinants of prelabor rupture of membrane among pregnant women attending governmental hospitals in the Jimma zone, Oromia region, Ethiopia. An institutional-based unmatched case-control study design was conducted from October 15 to December 15, 2021, at four governmental hospitals. A consecutive sampling technique was used to select 316 participants (79 cases and 237 controls). Women with prelabor rupture of the membrane were confirmed by history, sterile vaginal examination, and ultrasound as cases, and their counterparts as controls. An interviewer-administered questionnaire was used to collect data on maternal (obstetric, medical, behavioral) and fetal-related characteristics. The data were entered into Epi Data version 4.6 and analyzed using SPSS version 25. Descriptive statistics, bi-variable, and multivariable logistic regression were computed. The odds ratio with a 95% confidence level was used, and the significance level was declared at a p-value < 0.05. A total of 316 participants (79 cases and 237 controls) were included in this study. Pregnancy-induced hypertension (AOR = 3.06, 95% CI: 1.41-6.64), history of abortion (AOR = 3.67, 95% CI: 1.56-8.65), urinary tract infections (AOR = 2.61, 95% CI: 1.13-6.06), abnormal vaginal discharge (AOR = 2.65, 95% CI: 1.21-5.79), maternal khat chewing (AOR = 3.40, 95% CI: 1.70-6.80), mid-upper arm circumference less than 23 cm (AOR = 2.80, 95% CI: 1.51-5.19), and fetal presentation (breech) (AOR = 2.63, 95% CI: 1.10-6.28) were determinants of prelabor rupture of membrane among pregnant women. This study revealed that the aforementioned factors were found to be determinants of prelabor rupture of membrane among pregnant women. Therefore, hospitals should give focus to the early screening, diagnosis, and treatment of pregnancy-induced hypertension, urinary tract infection, and abnormal vaginal discharge to reduce the burden of prelabor rupture of membranes.

A cohort study to investigate the potential indicators for prenatal echocardiographic detection of suspected coarctation of the aorta.

Suspected coarctation of the aorta (CoA) is a common fetal echocardiographic presentation. However, the prenatal findings did not indicate a satisfied accuracy in determining the truly CoA after birth, which made the prenatal diagnosis of CoA still as a critical challenge with high false positive rate. Thus, this research is aimed to distinguish the potential prenatal parameters influencing the fetal echocardiographic images and enhance the true positive diagnostic rate of CoA fetuses which require early clinical intervention in postnatal life. A retrospective study had been designed and fetuses with suspected with CoA had been included from Jan 2016 to Dec 2021 in our center. The fetal echocardiography and related clinical information had been collected. And the postnatal diagnosis had been reached by echocardiography or CTA. Then, all the parameters had been analyzed by univariate analysis, and a multivariate logistic regression analysis was further involved to determine the independent parameters influencing the accuracy of diagnosis CoA fetuses. Moreover, such results had been validated by nomogram analysis and ROC curve. Among the included 44 liveborn infants who presented suspected CoA in fetal cardiac screening, 18 cases had been proved to be CoA postnatally (Group P). The true positive rate for this study was 40.9% (18/44). The abnormal atrial hemodynamic status (AAHs) and the gestational week of delivery (GWoD) were associated with the postnatal CoA confirmation among prenatal suspected fetuses. The ROC curve of predicting probability of the mode combined with two independent factors of absence of AAH and GWoD (AUC = 0.880, 95% CI 0.763-0.997) presented a satisfied efficacy in distinguishing postnatal positive CoA diagnosis. The nomogram plot had been be utilized in CoA prediction (model likelihood ratio test, p < 0.0001). AAH and GWoD had been identified as independent factors of predictive accuracy in detecting postnatal CoA among prenatal suspected fetuses. The prediction mode based on nomogram scores could be used to predict the risk of occurring CoA fetuses.

Asuhan Kebidanan Pada Kehamilan Trimester III Di TPMB Rupi’ah Suparman

The aim of the research is to provide midwifery care to pregnant women in the third trimester using a midwifery management approach. Data collection instrument method is a tool used to collect research data. The instruments used are in accordance with pregnancy care, namely using a mother's card, MCH book, scales, tensimeter, metelin, LILA tape, fundoscope or Doppler, Poedji Rochjati score card, instruments for simple laboratory examinations in the form of Hb, urine protein and urine reduction. Physiological pregnancy results, if calculated from the time of fertilization to the birth of the baby, a normal pregnancy will take place within 40 weeks or 9 months according to the international calendar. Pregnancy is divided into three trimesters, where the first trimester lasts 0-12 weeks, the second trimester 13-24 weeks, and the third trimester 25-41 weeks. Midwifery care in pregnancy given to Mrs "I" aged 28 years GIP0A0 has been carried out in accordance with Minimum 10 T Standard Care service program policies include weighing and measuring height, measuring blood pressure, measuring LILA, measuring uterine fundal height, TT immunization, administering iron tablets, determining fetal presentation and fetal heart rate, interviewing, laboratory tests, and management.

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

Neonatal factors associated with immediate low Apgar score in newborn babies in an intermediate hospital in Namibia: a case control study.

Apgar score is conducted to a baby immediately after birth checking how the baby tolerated the birth process and outside the uterus. To describe the neonatal factors associated with immediate low Apgar score and analysing the associations among factors associated with low Apgar score in new-born babies. A quantitative, case-control, descriptive research design was used. Study population were all maternal records of deliveries conducted between 01 January 2019 and 31 December 2019. Simple random sampling was used to select the sample size for 194 cases and 194 controls using a 1:1 case-control ratio. Records indicating low Apgar scores were the cases while normal Apgar scores were the controls. A total of 388 maternal files were reviewed. Data were collected using a document review checklist and analysed using SPSS version 26. The study found that, neonatal factors associated with immediate low Apgar score are; gestational age, foetal presentation, cord prolapse, cord around the neck and the importance of cardiotocography interpretation as they had a P-value > 0.005. Gestational age, birth weight, foetal presentation, cord around the neck and lack of cardiotocography assessment were found to be associated with immediate low Apgar score.

Adolescent Childbirth: Epidemiological and Clinic Aspects, Maternal and Perinatal Prognosis in Tengandogo Teaching Hospital, Burkina Faso

Background/Aim: Adolescent pregnancy is considered as a public health issue. This study aims at describing the epidemiological and clinical aspects, as well as the maternal and perinatal prognosis of adolescent childbirth. Materials and Methods: This was a descriptive and analytical study. Data were collected prospectively. The study population included all women admitted for delivery. Adolescents were sampled exhaustively. In order to identify factors associated with adolescent childbirth, we selected a control group of women aged between 20 and 39. Results: Adolescent deliveries accounted for 12.6% of all deliveries. The average age was estimated at 18.2 years. Patients aged 19 accounted for 55.1% of cases. Upon admission, 88.9% of adolescent girls were nulliparous. Adolescents were referred in 93.5% of cases. As for admission reasons, abdominopelvic pain with uterine contractions accounted for 39.81% of cases. In 21.3% of cases the gestational age as below 37 weeks of amenorrhea. Fetal breech presentation was observed in 8.3% of cases. Caesarean section was the mode of delivery in 60.2%. In our series, two adolescent girls presented a hemorrhage of deliverance. One case of maternal death was recorded. The prematurity birth rate was estimated at 20.4% and neonatal resuscitation concerned 24.9% of newborns. The perinatal mortality rate is estimated at 11.2% corresponding 112 deaths per thousand births. Conclusion: Adolescent childbirth, compared to that of adult women is still associated with a poor prognosis. There is the need to enhance appropriate measures in education, contraception, prenatal care and the fight against early marriage need to reduce the rates of early pregnancy and obstetric complications in this high-risk population.

Effect of mode of delivery on perinatal outcome in severe preterm birth: systematic review and meta-analysis.

To review the evidence on the effect of mode of delivery on perinatal outcome of fetuses born before 32 weeks' gestation. MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), the ClinicalTrials.gov registry and gray literature sources were searched, starting from the year 2000 to reflect contemporary practice in perinatal care. Non-randomized or randomized studies that included singleton fetuses without chromosomal abnormality or major congenital defect delivered vaginally or via Cesarean section were eligible for inclusion in the analysis. Primary outcomes were neonatal death, defined as death in the first 28 days of age, and survival to discharge. Secondary outcomes were other adverse perinatal events. The ROBINS-I tool was used to assess the risk of bias. The overall quality of evidence for the outcomes was assessed according to GRADE. Summary odds ratios (ORs) with 95% CIs were calculated, and random-effects models were used for data synthesis. Subgroup analysis was performed for delivery before 28 weeks, delivery between 28 and 32 weeks and according to fetal presentation at delivery. A total of 27 retrospective studies (22 887 neonates) were included in the systematic review and meta-analysis, all of which reported on singleton pregnancies. Among cases born before 28 weeks, vaginal delivery significantly increased the risk of neonatal death of fetuses with any type of presentation (n = 1496) (OR 1.87 (95% CI, 1.05-3.35); I2 = 65%, very low quality of evidence) and of fetuses with breech presentation (n = 733) (OR 3.55 (95% CI, 2.42-5.21); I2 = 21%, moderate quality of evidence). The odds of survival to discharge were significantly decreased among fetuses with breech presentation delivered before 28 weeks (n = 646) (OR 0.36 (95% CI, 0.24-0.54); I2 = 21%, low quality of evidence). Among breech fetuses born between 28 and 32 weeks, vaginal delivery increased the odds of perinatal death (intrapartum and neonatal) (n = 1581) (OR 3.06 (95% CI, 1.47-6.35); I2 = 0%, high quality of evidence). In non-cephalic fetuses born between 24 and 32 weeks, vaginal delivery decreased the odds of survival to discharge (n = 1030) (OR 0.28 (95% CI, 0.19-0.40); I2 = 0%, moderate quality of evidence). No significant effect on mortality of mode of delivery was observed in cephalic fetuses at any gestational age. This systematic review and meta-analysis suggests that vaginal delivery in severe preterm birth is associated with an increased risk of neonatal and perinatal death in breech fetuses, while no significant association was observed for cephalic fetuses. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Neonatal and Maternal Outcomes at 22-28 Weeks of Gestation by Mode of Delivery.

To compare neonatal and maternal outcomes after 22- to 28-week delivery between cesarean and vaginal delivery after stratification by gestational age and fetal presentation. This study was a repeated cross-sectional analysis using U.S. birth certificate data linked to infant death data from 2017 to 2020. We limited analyses to women with singleton pregnancies who gave birth at 22-28 weeks of gestation and whose neonates were admitted to the intensive care unit. Our primary outcome was neonatal death within 28 days. We also examined infant mortality within 1 year and severe maternal morbidity (SMM; any transfusion, unplanned hysterectomy, and intensive care unit admission). Outcomes were compared between cesarean and vaginal delivery after stratification by gestational age and fetal presentation. Multivariable logistic regression was performed to calculate adjusted odds ratios (vaginal delivery as a referent), controlling for potential confounders. Of 69,672 individuals with eligible deliveries, 1,740 (2.5%) delivered at 22 weeks of gestation, 6,155 (8.8%) delivered at 23 weeks, 9,341 (13.4%) delivered at 24 weeks, 10,516 (15.1%) delivered at 25 weeks, 11,994 (17.2%) delivered at 26 weeks, 13,662 (19.6%) delivered at 27 weeks, and 16,264 (23.3%) delivered at 28 weeks. In cephalic fetuses, cesarean delivery compared with vaginal delivery was associated with neonatal death and infant mortality at 24 weeks of gestation and greater (not significant at 22-23 weeks) and SMM in all gestational age groups. In contrast, in noncephalic fetuses, cesarean delivery compared with vaginal delivery was associated with decreased odds of neonatal death and infant mortality in all gestational age groups. Sample size for SMM in noncephalic fetuses precluded multivariable modeling. Cesarean delivery in cephalic fetuses was associated with increased odds of adverse neonatal outcomes (24 weeks of gestation or greater) and SMM (all gestational age groups). Cesarean delivery was associated with decreased odds of neonatal death compared with vaginal delivery for noncephalic fetuses in all gestational age groups.