Frequency Of Cesarean Section Research Articles

Delivery and Delivery Frequency

Vaginal delivery is preferred given that morbidity and mortality associated with operative caesarean section have increased over time. Caesarean section is a unique measure of preserving the health and life of the mother or fetus, but the global rise in its frequency is alarming. Medical caesarean section is an effective method of reducing maternal and perinatal mortality. Any method of delivery for women with a history of caesarean section carries risks. Today, it is extremely necessary to assess the frequency of unreasonable delivery tactics, namely the frequency of unreasonable antenatal cesarean section, unsuccessful attempts at vaginal delivery, the frequency of delivery with severe complications for the mother and/or newborn. In general, 951 births occurred in the Kyrgyz Scientific Center for Human Reproduction in 2016, in 2017 (2193) the number of births increased by +130.6%, in 2018 (2638) by +20.3%, in 2019 the decline was −15.9%, in 2020 the number of births increased again (2808) by +26.5%, 2021 (3543) by +26.1% and 2022 (3231) cases of childbirth decreased by −8.8%. Analysis of delivery methods in women admitted to the Center for Human Reproduction in Bishkek showed in the years studied the predominance of vaginal deliveries over cesarean sections from 2.4 times to 3.0 times. Over time, cases of vaginal delivery tended to decrease against the background of an increase in cases of cesarean sections in 2018 and 2020-2022, with the exception of 2017 and 2019.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals

BackgroundBrazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project (“Projeto Parto Adequado”- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil.MethodEvaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA—“Participation of women” and “Reorganization of care” – among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group “Exposed to the PPA model of care” and the group “Standard of care model”.ResultsPPA had a low degree of implementation in both components “Reorganization of Care” (0.17 – 0.32) and “Participation of Women” (0.21 – 0.34). The combined implementation score was 0.39–0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA.ConclusionThe degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

Cesarean Sections and Family Planning Among Ultra-Orthodox Israeli Jews.

The elevated frequency of Cesarean sections (C-sections) in OECD countries not only burdens health systems financially but also heightens the risks for mothers and infants. This study explores the feasibility of reducing C-section rates by examining the Israeli ultra-Orthodox population, noted for its large families and low C-section rates. We analyze birth data from an Israeli hospital, focusing on ultra-Orthodox mothers with husbands who are yeshiva students compared to other mothers. Our findings reveal that all else being equal, mothers married to yeshiva students exhibit a lower likelihood of undergoing a C-section and a higher propensity to seek private medical services to avoid this procedure. This behavior is attributed to their preference for large families and the desire to minimize C-sections, which may restrict the number of possible future pregnancies. These insights underscore the potential effectiveness of initiatives encouraging mothers to opt for vaginal deliveries, thereby reducing healthcare costs and maternal-infant risks.

Tight versus less tight 1-hour postprandial glycemic target in women with gestational diabetes mellitus - a single-center cohort study.

We aimed to assess the impact of the change of 1-hour postprandial glycemic target from < 6.7 mmol/L (120 mg/dL) to < 7.8 mmol/L (140 mg/dL) on gestational diabetes mellitus (GDM) treatment and pregnancy outcomes. In a retrospective analysis of 1021 GDM patients from the Department of Metabolic Diseases, University Hospital in Cracow, Poland, we compared insulin therapy regimens and pregnancy outcomes between women admitted in 2014-2016 (before the change) and in 2018-2019 (after it). A total of 377 patients were admitted between 2014 and 2016 (TIGHT group) and 644 between 2018 and 2019 (LESS TIGHT group). Women from the LESS TIGHT group were older (32 vs 30 years, p < 0.001) and gained less weight during pregnancy (7.0 vs 9.0 kg, p < 0.001). There was no change in the frequency of any insulin therapy (51.6% vs 56.1%, p = 0.168). In the LESS TIGHT group, the basal insulin-only model was used more frequently (32.5% vs 10.2%, p < 0.001), while the prandial insulin and basal-bolus model less frequently (23.6% vs 42.6% and 21.4% vs 36.7%, p < 0.001, respectively) than in the TIGHT group. There were no differences in the frequency of cesarean sections, preterm births, Hbd of delivery, mean birth weight or prevalence of perinatal complications. Less tight glycemic targets in women with GDM, compared to tighter targets, were associated with less frequent use of prandial insulin, with insulin therapy often limited to basal administration. The change in glycemic targets did not affect the prevalence of adverse pregnancy outcomes, providing evidence supporting new recommendations.

The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.

Role of Chewing Gum in Enhancing Post-Operative Recovery 0f Bowel Function after Lower Segment Cesarean Section

Background: The frequency of cesarean sections globally exceeds the World Health Organization's recommended rates, leading to an increased focus on postoperative recovery, particularly the restoration of gastrointestinal (GIT) function. The delayed return of intestinal activity, known as postoperative ileus, can extend hospital stays and elevate healthcare costs. Chewing gum has been proposed as a simple, non-pharmacological intervention to stimulate the GIT and potentially expedite recovery. Objective: This study aimed to evaluate the efficacy of chewing gum in improving GIT activity and recovery in patients following a cesarean section, contributing to the evidence base for postoperative care practices in obstetrics and gynecology. Methods: A cross-sectional comparative analytical study was conducted at the Department of Obstetrics and Gynecology, KRL Hospital Islamabad, from May 2021 to November 2021. Two hundred patients undergoing elective cesarean sections were divided into two groups: Group A (n=100), who received chewing gum postoperatively, and Group B (n=100), who did not. The primary outcomes measured were the time to first bowel sound, time to first flatus, and time to first defecation. Data were analyzed using SPSS version 25, with a significance level set at p≤0.05. Results: Group A demonstrated a significantly faster time to first bowel sound (3.75 ± 1.31 hours vs. 7.01 ± 1.94 hours, p=0.001), first flatus (7.97 ± 1.96 hours vs. 14.75 ± 3.57 hours, p=0.001), and first defecation (32.37 ± 3.56 hours vs. 48.20 ± 6.06 hours, p=0.001) compared to Group B. These findings were consistent across age stratifications, with significant improvements in GIT recovery times in younger (18-25 years) and older (26-35 years) subsets of patients. Conclusion: Chewing gum post-cesarean section significantly accelerates the recovery of GIT functions, reducing the time to first bowel sound, flatus, and defecation. This study supports the inclusion of chewing gum as a low-cost, effective method in postoperative care protocols for cesarean section patients, potentially improving patient outcomes and reducing healthcare costs.

Management and Outcome of Pregnancy in Patients With Idiopathic Intracranial Hypertension: A Prospective Case Series Study.

Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without an identifiable cause that mostly affects obese persons of childbearing age. In this prospective case series, we have evaluated the overall outcome of pregnancy and birth in participants with IIH and their newborn children. We also provide a proposal for the management of pregnant persons with IIH. In this observational study, neuro-ophthalmological findings, the course of IIH-related symptoms, disease management, and pregnancy outcomes were evaluated. The participants were divided into 3 groups according to the course of the disease during pregnancy: stable, worsened, and new diagnosed. Furthermore, the type of delivery and outcome of newborn children such as gestational age, weight at birth, and the presence of asphyxia were compared between the groups. We observed 47 pregnancies in 42 participants; 2 had spontaneous abortions. There were 19 (47%) participants in the stable, 18 (45%) in the worsened, and 3 (8%) in the new diagnosed groups, respectively. A relapse of IIH occurred in 2 (5%). Worsening of IIH-related symptoms was experienced by 18/37 (49%) participants: headache by 17/18 (94%), tinnitus by 11/18 (61%), and vision by 7/18 (39%) (mostly in the first and second trimester). In 8/18 (44%), the symptoms were transient or alleviated in the second and third trimester. Body mass index before and after pregnancy did not significantly differ among the groups. A total of 8 participants were treated with acetazolamide. The frequency of cesarean section was 17/40 (43%). Preterm delivery occurred in 22%. No increased risk of asphyxia was observed, and all infants, but one, were healthy. Worsening of headache, tinnitus, and/or vision were experienced by half of pregnant participants with IIH, mostly transient in the first and second trimester, rarely required specific treatment, and were not identified as a relapse of IIH. There was no difference in gestational age and weight at birth in children among the groups, and no perinatal asphyxia was noted. Weight gain in the participants was not identified as a risk factor for relapse of IIH in pregnancy. The rate of cesarean and preterm delivery was higher than in the non-IIH population. A proposal for the management of IIH in pregnancy is provided.

FETAL MACROSOMIA. OBSTETRIC AND PERINATAL OUTCOMES

One of the significant medical and social problems is pregnancy and childbirth in the presence of a large fetus. Macrosomia in most literature is defined as birth weight &gt;4000 g and occurs in 10% of pregnancies. This condition is associated with risks for both the mother and the fetus: the frequen-cy of cesarean section, trauma to the birth canal, shoulder dystocia and perinatal asphyxia increas-es.

Gestational diabetes mellitus in patients undergoing assisted reproductive techniques or conceiving spontaneously: an analysis on maternal and foetal outcomes.

With the rise of medically assisted reproductive techniques (ART) the number of pregnanciescomplicated by gestational diabetes mellitus (GDM) has increased. The aim of this study was to evaluateretrospectively the outcomes of pregnancies complicated by GDM who conceive trough ART (cases) compared tothose who conceived spontaneously (controls). In 670 women with GDM, 229 cases and 441 controls, followed by the Diabetology of Padua, between2010-2022, clinical-metabolic maternal characteristics and maternal-foetal outcomes were evaluated. As for the maternal clinical-metabolic characteristics, plasma glucose levels at 60' and 120' under oralglucose tolerance test (OGTT) at time of diagnosis were significantly higher in cases (177.4 ± 31.1 vs 170.9 ± 34.1 mg/dl, p = 0.016; 151.5 ± 32.2 vs 144.0 ± 33.4 mg/dl, p = 0.005 respectively). Furthermore, at diagnosis, cases showhigher levels of total cholesterol (257 ± 53 mg/dl vs 246 ± 52 mg/dl; p = 0.012) and triglycerides (199.8 ± 83.2 mg/dl vs 184.9 ± 71.3 mg/dl; p = 0.02) compared to controls. As for maternal outcomes, thyroid disfunction, was recorded in ahigher percentage in case (21.4% vs 14.3%; p = 0.008), as well as, the frequency of cesarean section (50.3% vs41.2%; p = 0.038) and twin pregnancies (16.2% vs 2.5%; p < 0.001). As for neonatal outcomes, there were nostatistically significant differences, except for the birth weight of the second twin, which was significantly lower incases (2268 ± 536 vs 2822 ± 297 g; p = 0.002). No other significant differences were found. This study showed no meaningful differences in the outcomes of GDM pregnancies who were conceived with ART compared to that arose spontaneously as the patients were promptly diagnosed and treated.

Changes in coagulogram parameters and acid-base composition of blood in pregnant women with moderate and severe preeclampsia

Objective: to conduct a comparative analysis of coagulogram and acid-base composition of blood in pregnant women with moderate and severe preeclampsia (PE) and to assess the impact of the detected disorders on pregnancy outcomes. Material and methods. Group 1 consisted of patients with moderate PE (n=33), group 2 — with severe PE (n=34), and group 3 —women with physiological gestation (n=39). Parameters of coagulogram, acid-base composition of capillary blood of pregnant women (pH, pC02, p02, HC03-act) were determined on the RAPIDLAB 1265 device. Results. An increase in the level of fibrinogen was revealed in group 1 — by 9.9% relative to the indicator of group 3 (p=0.10), in group 2 — by 28.2% (p=0.002) against the background of a shortening of the APTT, respectively by 6.8% (p=0.003) and 9.9% (p&lt;0.001) and a decrease in the number of platelets — by 11.9% (p=0.03) and 27.3% (p&lt;0.001). Changes in the acid-base composition of capillary blood in PE were established: a decrease in HC03-act and p02 with an increase in pC02, which reflect the tendency to develop metabolic acidosis and respiratory alkalosis, more pronounced in group 2. Conclusions. PE is associated with disorders of blood coagulation potential and changes in blood gas composition, more pronounced in severe PE, which contributes to an increase in the frequency of premature birth (with moderate PE — up to 75.8%, severe — up to 100%) and cesarean section (respectively, by 7.7 and 18 times). The measurement of pC02 and p02 levels should be classified as informative and promising tests in terms of differential diagnosis of the severity of PE.

Аналіз інтегральної ефективності медичної допомоги матерям і дітям

Effective formation and support of the health of mothers and children, which determine the fundamental basis of the formation of the health of the future society and humanity, defense capability, labor reserve and intellectual potential of the country, possible only in the presence of effective health care systems. Purpose - to conduct an analysis of the integral efficiency of medical care for mothers and children based on the definition of the list and the weighted contribution of individual indicators of structural efficiency to the integral coefficient. Materials and methods. Based on the data of general and medical statistics of Ukraine, a structured assessment of the integrated effectiveness of medical care for mothers and children was carried out by individual components. The methods of systematic approach, structural-logical, epidemiological analysis, mathematical, and modeling are used. Results. The data of the analysis of the activities of the maternal and child health service of Ukraine in 2021 indicate a sufficient, above average level of achievement of the planned results - the comprehensive assessment ratio (CAR) is 0.79, with fluctuations by component from high (0.89 for the structure results) to above average (0.76 for the process indicators and 0.78 for the performance indicators). According to the geospatial analysis, the leaders in integrated maternal and child health service performance with high level of CAR (≥0.80), indicating sufficient effectiveness of maternal and child health care, are Ternopil, Chernivtsi, Lviv, Ivano-Frankivsk, Sumy Oblasts and the city of Kyiv. Donetsk and Kherson Oblasts became outsiders in terms of integrated effectiveness of medical care for mothers and children with an average level of CAR (0.61-0.69), requiring management decisions on their more efficient operation. The most problematic indicative indicators of maternal and child health services with a low and below-average level of the coefficient of achievement of results are the level of maternal mortality CAR (ratio of achievement of the standard value - RASV) = 0.00), the frequency of cesarean section (RASV=0.37), the frequency of low birth weight newborns (RASV=0.50), neonatal transfer index (RASV=0.60). Conclusions. The developed toolkit for integral assessment of the effectiveness of medical care for mothers and children allows for objective assessment and monitoring of the overall system, by region and by individual components on a unified basis, with the development of measures to address the identified problems and their implementation in the activities of the maternal and child health service. No conflict of interests was declared by the authors.

The effect of hormone-modulating therapy during pregravid preparation on the course of pregnancy and childbirth in patients with a history of endometriosis

BACKGROUND: Endometriosis is a benign proliferation of tissue similar in morphological and functional characteristics with endometrium outside the uterine. In the structure of gynecological diseases, it ranks on the third place and its prevalence is growing steadily every year.&#x0D; AIM: The aim of this study was to analyze the features of pregnancy and childbirth in patients with endometriosis who received hormone-modulating therapy during pregravid preparation.&#x0D; MATERIALS AND METHODS: This retrospective analysis of the course of pregnancy and childbirth in patients with a surgically confirmed diagnosis of varying severity endometriosis (n = 140) in history was carried out at the Center for Diagnosis and Treatment of Endometriosis, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The control group consisted of pregnant women without endometriosis (n = 50).&#x0D; RESULTS: Before pregnancy, 82.1% (n = 115) of patients with endometriosis used hormone-modulating therapy, while 17.9% (n = 15) of patients did not comply with the given therapy. During therapy, 70% (n = 98) of patients mentioned decreasing in the severity of pain. In patients with a history of endometriosis, threatened miscarriage took the leading place and was identified in 24.3% of cases in the first and second trimesters and in 33.6% of cases in the third trimester of pregnancy, which was consistently higher than in the control group. Miscarriage was observed in 38.5% of patients and recurrent pregnancy loss in 18.6% of women. Preeclampsia was diagnosed in 23.8% (n = 33) of patients with endometriosis. The use of hormone-modulating therapy during pregravid preparation was shown to reduce the risk of developing preeclampsia among patients with endometriosis by 4.1 times, and the use of dienogest 2 mg as the therapy of endometriosis to reduce the frequency of preeclampsia by ten times in comparison with patients who did not receive any treatment. Fetal growth restriction was observed in 18.6% (n = 26) of patients with endometriosis. The presence of endometriosis increased the likelihood of developing fetal growth restriction by 3.6 times and reduced the likelihood of having a large fetus by 2.7 times. Preterm birth was observed in 20% (n = 28) of patients with endometriosis, which is four times higher than in the control group (p = 0.019). Most pregnant women with a history of endometriosis – 64.3 % (n = 90) of patients – were delivered by cesarean section, while 35.7% (n = 50) of women had vaginal birth, which was 3.34 times higher than the frequency of cesarean section in the control group.&#x0D; CONCLUSIONS: Patients with a history of endometriosis are at high risk for the development of obstetric complications associated with the pathogenesis of the disease. An integrated approach to the treatment of endometriosis with the use of hormone-modulating therapy during pregravid preparation and personalized management of patients in different trimesters of pregnancy can reduce the risk of complications of pregnancy and childbirth.

Ways to reduce the incidence of cesarean sections according to the Robson classification

Introduction and Aim: Cesarean sections (CS) are a medically indicated and effective method for reducing maternal and perinatal mortality. The incidence of CS has increased in developed as well as developing countries over the past few decades. The objective of this study is to analyze the distribution of births according to the Robson classification and to assess ways to reduce the frequency of CS. Methods: This is a retrospective study based on records of the delivery histories of 18,125 female patients in the maternity department of the Kyrgyz Research Center for Human Reproduction, conducted using Robson classification. Results: However, the parameters also showed a statistically significant decrease in the highest number of patients in group 3 by -18.9% (from 40.6% to 32.9%) and group 1 by -9.9% (from 29.2% to 26.3%) in 2022 compared to 2016, p&lt;0.001. Despite their low specific weights, the 6, 7, 8, 9, and 10 groups showed a significant increase despite their small numbers. Conclusion: Despite their low proportion but massive increase in indicators, the small number of groups 6, 7, 8, 9, and 10 may contribute to perinatal mortality and morbidity, highlighting the need for rigorous monitoring and control of pregnant women in these groups.

Maternal and Perinatal Outcomes Amongst Nulliparous Singleton Pregnancies Electively Induced at 39Weeks: A Prospective Observational Study.

Given the uncertainty of inducing beyond 39weeks, we intended to study the maternal and neonatal mortality and morbidity associated with planned elective induction of labour (eIOL) at 390/7 to 396/7weeks. To study the maternal and perinatal outcomes, after eIOL, at 390/7 to 396/7weeks, amongst nulliparous singleton pregnancies, followed up for the duration of their hospital stay. All consecutive nulliparous, singleton gestations, undergoing eIOL, at 390/7 to 396/7weeks, with no plan for caesarean section (CS) or contraindication for vaginal delivery were prospectively recruited. The primary outcome studied was the incidence of CS and neonatal intensive care requirement, and the secondary outcomes studied were induction-delivery interval, incidence of chorioamnionitis, postpartum haemorrhage, meconium aspiration syndrome (MAS), APGAR ≤ 7 at 1min and neonatal mortality. Amongst the total 304 mothers electively induced at 390/7 to 396/7weeks, 80 (26.3%) mothers underwent CS and 48 (15.8%) neonates required intensive care. Fifteen (4.9%) babies required respiratory support at birth. The mean induction-delivery interval was 19h 42min ± 10h. There were 9(3%) cases of PPH and no reported cases of chorioamnionitis. Eleven (3.6%) babies had an APGAR < / = 7 at 1min and 9 (2.9%) had MAS, but there was no maternal or neonatal mortality. Induction of labour at 39weeks in low-risk nulliparous women did not result in a lower frequency of CS or adverse perinatal outcomes.

Indications of caesarean section in pregnant women attending a public maternity teaching hospital and private hospitals in Sulaimani city Iraq

Objective: To determine the frequency and indications of caesarean sections among pregnant women in an urbansetting.Method: The cross-sectional study was conducted from October 1, 2021, to February 1, 2022, at public-sectorMaternity Teaching Hospital and private-sector Baxshin and Harem hospitals in Sulaimani, Iraq, after approval fromthe ethics review committee of the College of Health and Medical Technology, Sulaimani. The sample comprisedpregnant women who were admitted to the maternity wards and who underwent caesarean section. Data wascollected using a predesigned questionnaire filled through face-to-face interviews individually. Data was analysedusing SPSS 25.Results: There were 474 pregnant women with mean age 28±6.87 years. Of the total, elective caesarean section caseswere 384(81%) and emergency cases were 90(19%). The main indications of caesarean section were mother’s request266(56.2%), fear of pain in natural vaginal delivery 375(79.1%), history of previous caesarean section 38(8%),cephalopelvic disproportion 26(5.5%), history of diabetes 21(4.4%), pre-eclampsia 19(4%) and bad obstetrichistory/infertility 10(2.1%). Age, parity, previous history of caesarean section and mother’s occupation weresignificantly associated with the type of caesarean section (p&lt;0.05).Conclusion: Caesarean section rates were found to be much higher than recommended.Keywords: Prevalence, Caesarean section, Indications, Suliamani city, Iraq.

EP34.11: Frequency of Caesarean section according to the mother's wishes in obstetrics and gynecology specialist mothers

EP34.11: Frequency of Caesarean section according to the mother's wishes in obstetrics and gynecology specialist mothers

Акушерська та перинатальна патологія в жінок з великими акушерськими синдромами в анамнезі

Purpose - to determine the features of obstetric and perinatal pathology in women who had complications from the group of major obstetric syndromes (MOS) in the anamnesis during previous pregnancies. Materials and methods. A prospective analysis of the course of pregnancy, childbirth and the condition of newborns was conducted in 120 pregnant women who had complications from the group of MOS in the anamnesis during previous pregnancies and received generally accepted diagnostic and treatment-prophylactic measures during this pregnancy (during 2019-2022). Statistical processing of research results was performed using the standard programs Microsoft Excel 5.0 and Statistica 6.0. Results. Peculiarities of the course of pregnancy and childbirth in women with a history of MOS are characterized by a high frequency of the threat of premature birth - 32.5% of cases, which determines the high frequency of perinatal pathology. In addition, it is possible to note the high frequency of premature births - 10.8% of cases. Attention is drawn to the stable high rates of the following complications of the III trimester of pregnancy: gestational anemia in 29.2% of cases; preeclampsia 13.3% of cases; placental insufficiency with growth retardation syndrome in 14.2% of cases; and violation of microbiocinosis of the genital tract in 24.2% of cases; without a tendency to decrease the frequency of these complications over the years. The consequence of these complications is an increase in the frequency of cesarean sections to 30.1% of cases. Conclusions. The identified features of obstetric and perinatal pathology in pregnant women who had complications from the MOS group during previous pregnancies can serve as markers for predicting the risk of developing complications from the mother and the fetus in these pregnant women. In our opinion, further analysis of functional, instrumental and laboratory indicators in these women can provide an opportunity to identify the most informative prognostic criteria regarding the development of MOS, and will allow the development of an effective method of predicting obstetric and perinatal complications in these women. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Women's informed consent was obtained for the study. No conflict of interests was declared by the author.

Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study

BackgroundTrial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section.MethodsWe collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions.ResultsOf the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman’ rho = 0.50 and 0.42, p value < 0.001).ConclusionsOrganizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.

Relationship between traditional Chinese medicine constitution and pregnancy outcome in elderly primiparae

Purpose: To investigate the correlation between traditional Chinese medicine (TCM) constitution and pregnancy outcomes in elderly primiparae.Methods: A cross-sectional case-control study was conducted on 113 elderly primiparae who were delivered in Jinshan Hospital of Fudan University, Shanghai, China from January 2019 to December 2019. The elderly primiparae was the study group. Using a random ratio of 1:3, 393 primiparous women of suitable age who were delivered in the hospital at the same period were selected as the control group. A traditional Chinese medicine (TCM) questionnaire was used to collect clinical data, and differences between the two groups were compared.Results: The incidence of gestational diabetes mellitus was significantly higher in the study group (elderl y primiparae) with phlegm dampness constitution and qi stagnation constitution than in control group (appropriate-age primiparae) (p &lt; 0.05). The incidence of hypertension was significantly higher in the study group with yin deficiency constitution and special constitution than in control group (p &lt; 0.05). The frequency of selective cesarean section in study group with a biased qi-deficiency constitution, yang-deficiency constitution, and yin-deficiency constitution were significantly higher than control group (p &lt; 0.05).Conclusion: There is a correlation between pregnancy outcomes in old age and TCM constitution. Individualized diet and exercise programs may be formulated in early pregnancy (based on the type of physique) to improve pregnancy outcomes in elderly primiparae.

The Prevalence of Maternal and Newborn Morbidity Following a Repeat Cesarean Section: Data From Zagazig University Hospital

Background and Objective: Cesarean section (CS) is one of the most common obstetric procedures performed worldwide, and new research indicates that the frequency of CS is increasing. Maternal-fetal morbidity and death due to CS is a serious public health problem worldwide. Our study aimed to assess the impact of multiple cesarean sections (CSs) on mother-fetal morbidity. Methods: This cross-sectional study was performed on 165 women who underwent multiple repeated CSs in our clinic and met the criteria of inclusion by evaluating their records. All women were divided into 3 groups according to the number of CSs: 2nd (n = 111), 3rd (n = 44), and 4th/5th (n = 10). Maternal-neonatal outcomes; blood transfusion needs, adhesions, APGAR scores, and respiratory difficulties were investigated retrospectively. Results: Our results revealed that adhesion (60.6 %) was the most frequent maternal complication. The prevalence of thick adhesions decreased with the number of cesarean sections performed (70, 25, and 5 cases for the previous 2nd, 3rd, and 4 or more CS, respectively). There was no statistically significant difference between the groups in terms of adhesions, uterine rupture, bladder injury, endometritis, and wound infection. NICU admission (14.5 %), Low birth weight (3.6 %), and IUGR (3.03 %) were among the unfavorable fetal outcomes. There was a significant difference among the three studied groups regarding APGAR score, maternal age, and hospital stay, while a non-significance was found in birth weight and maternal adhesion. Conclusion: Our findings support our hypothesis that the likelihood of maternal complications rises as the number of CSs rises. The manner and time of delivery have a greater impact on infant outcome than the number of CSs. There is no clear absolute barrier for the number of CSs, however, 4 or more cesarean births were recognized as the essential level for the majority of outcomes. The number of CSs must be decreased to reduce the associated issues.