High Caesarean Section Rate Research Articles

A prospective cohort study of the association between mode of delivery and postpartum posttraumatic stress disorder

Previous studies investigating the correlation between mode of delivery and posttraumatic stress disorder (PTSD) have yielded inconsistent results. This study aims to investigate the association between mode of delivery and PTSD in a cohort of Chinese women with a high rate of cesarean section (CS). We conducted a prospective cohort study in China between October 2019 and June 2021. Women aged 20–45 years who give birth at The Seventh Hospital of the Southern Medical University during the study period were enrolled. PTSD was assessed by the Posttraumatic Stress Disorder Checklist-Civilian Version at 42 days postpartum. We examined the independent association between mode of birth and PTSD by log-binomial regression analysis. A total of 759/800 (94.88%) women completed questionnaire. The prevalence of postpartum PTSD was 12.12% in included women, 8.18% in women with vaginal delivery (VD), 17.55% in women with CS. After adjusting for confounding factors, it was found that women with elective CS (RR = 1.70, 95%CI, 1.03 to 2.87) and emergency CS (RR = 1.95, 95%CI, 1.08 to 3.83) had an increased risk of developing postpartum PTSD compared with women with VD. CS is identified as an independent risk factor for PTSD in a cohort of Chinese women with a high prevalence of CS.

High Cesarean Section Rates during Labor Induction in Low Risk, Late-Term Cephalic Pregnancies in a Tertiary Centre

Background: The cesarean section rate is high in countries such as Türkiye, Egypt, and Brazil. The aims of this study were to determine whether the cesarean section rate during labor induction is high in late-term cephalic pregnancies and to evaluate the related factors. Methods: This retrospective descriptive study was conducted with 254 patients with a cephalic fetal presentation who were admitted in the labor unit of a tertiary center for induction of labor (IOL) at ≥41 0/7 weeks of gestation. The patients were evaluated in terms of demographic characteristics, Bishop score, labor induction method (dinoprostone or oxytocin administration), IOL duration, vaginal delivery rate, cesarean section rate, indication for cesarean delivery, 5-min Apgar score, fetal requirement for neonatal resuscitation, oxygen treatment, and neonatal intensive care unit admission. Results: The study population comprised 254 patients, of whom 181 (71.3%) had a vaginal delivery and 73 (28.7%) had a cesarean delivery. To evaluate the factors that affect labor induction failure and cesarean indication, the patients were divided into two groups: the nulliparous (n: 122) and multiparous (n: 132). The cesarean section rates in the nulliparous and multiparous groups were 44.3% (n: 54/122) and 14.4% (n: 19/132), respectively. According to the multivariate logistic regression, being nulliparous, having a male fetus were found to be the associated risk factors for cesarean delivery (p < 0.05). Conclusions: The study results suggest that the cesarean section rate during labor induction is higher in low-risk, late-term cephalic pregnancies. Nulliparity, male fetal sex were risk factors for cesarean delivery.

Maternal and neonatal outcomes after metabolic and bariatric surgery among women with severe obesity.

Earlier evidence indicated that metabolic and bariatric surgery (MBS) may adversely affect neonatal outcomes among patients conceiving soon after MBS, but recent studies demonstrated conflicting results, especially for new surgical techniques. The aim of this study was to assess the effects of MBS types and surgery to birth interval on maternal, birth, and nonbirth outcomes in women with severe obesity. New York State's all-payer hospital discharge database (2008-2019). We identified women with severe obesity who underwent MBS (Post-MBS, n = 5001) or did not undergo MBS (No-MBS, n = 74,515), and examined maternal, neonatal, and nonbirth outcomes by MBS type and time since surgery in a propensity score-matched sample. Compared with No-MBS mothers, Post-MBS mothers had a lower incidence of stillbirths, ectopic pregnancies, and miscarriages (nonoverlapping confidence intervals). Post-MBS mothers were also significantly less likely to have pregnancy hypertension, gestational diabetes, and cesarean deliveries, but were more likely to experience vaginal bleeding during early pregnancy and deliver low birthweight newborns compared with No-MBS mothers (P < .05). Among Post-MBS mothers, deliveries within 18 months after surgery were associated with higher rate of cesarean sections and neonatal deaths compared with deliveries 18+ months after MBS (P < .05). Pregnancies after gastric bypass (RYGB) were more likely to result in cesarean deliveries compared with pregnancies after sleeve gastrectomy (P < .01). Although weight loss surgery in women with obesity may reduce the rates of adverse maternal nonbirth outcomes and pregnancy complications, neonates born to women who conceived during the first year after MBS, especially RYGB, may be at higher risk for adverse outcomes.

Factors contributing to visual intrapartum cardiotocograph interpretation variation among healthcare professionals: An integrative review.

The reliability of cardiotocographs as diagnostic tools for fetal well-being is hampered by interpretational variations among healthcare professionals, contributing to high rates of cesarean sections and instrumental deliveries. While adjunct technologies may be used to confirm cases of fetal distress, those in resource constrained areas continue to rely on visual cardiotocograph interpretation to come up with the diagnosis of fetal hypoxia. This study investigated the factors contributing to variations in the visual interpretation of intrapartum cardiotocograph among healthcare professionals in the absence of adjunctive technologies. In this integrative literature review, we conducted a literature search of the following electronic databases: EBScohost, PubMed, Web of Science, and Scopus. The following search terms and Boolean operators were used: (Intrapartum OR Labor OR Labour OR Childbirth OR Birth OR Delivery) AND (Cardiotocography OR CTG OR "Electronic Fetal Monitoring" OR EFM) AND (Interpretation OR Analysis) AND (Variations OR Differences) AND ("Healthcare Workers" OR Nurses OR "Medical Workers" OR "Healthcare Professionals" OR Midwives OR Obstetricians). After removal of duplicates, a total of 1481 articles and titles were screened, 60 full-text articles were examined to verify whether they addressed the scope of the literature review. Nine articles addressed the factors contributing to variations in the visual interpretation of intrapartum cardiotocographs among healthcare professionals. The quality of the studies was appraised using the Quality Appraisal Tool for Studies of Diagnostic Reliability. Thematic analysis identified the following themes: 1) Interpretational variations in cardiotocograph characteristics among health professionals, and 2) factors leading to increased interpretational variation among healthcare professionals. Our results highlight the need for increased cardiotocograph training to improve consistency among health professionals, especially for suspicious and pathological traces, which often lead to cesarean section.

Magnitude of cesarean section and its associated factors among mothers who gave birth in public hospitals in East Wollega Zone, Oromia, Ethiopia

BackgroundGlobally, there has been an explosive rise in the cesarean section rate that exceeds the World Health Organization rate of 10–15% and in the past fifteen years the rates was doubled in some countries including Ethiopia. Therefore, it is essential to recognize the current magnitude and the factors that contribute to increasing cesarean section rates beyond the World Health Organization recommendations and specifically in the study areas.ObjectiveThis study aimed to assess the magnitude of cesarean sections and its associated factors among mothers who gave birth in public hospitals in East Wollega Zone, Oromia Ethiopia 2022.MethodsA Facility-based cross-sectional study design supplemented by the qualitative study was conducted among 403 mothers, and an in-depth interview was held with purposefully selected 18 post-cesarean section mothers who gave birth at public hospitals. The study subject for quantitative data was selected by a systematic random sampling method. Face-to-face interviews and a chart review checklist were used for data collection. Data were entered into EPI Data Version 3.1 and analyzed by SPSS version 25 for quantitative data and thematic analysis for qualitative data. Bivariate and multivariable logistic regression was used to assess the association between dependent and independent variables. Variables that were statistically significant at bivariate logistic regression with a p-value < 0.25 were entered into the multivariable logistic regression. Statistical significance was declared at a p-value less than 0.005ResultThe finding of this study revealed that the magnitude of the cesarean section was 31.5% (95% CI: 27.4%-36.5%). Factors such as living in an urban area (AOR = 2.87, 95%CI (1.63,5.05)), a mother who attained college and above (AOR = 3.48, 95% CI (1.72, 7.06)), being a referred mother (AO R = 2.27, 95% CI (1.31, 3.94)), being induced labor (AOR = 4.83, 95% CI (1.93,12.06)) and lack of antenatal care follow up (AOR=7.84, 95% CI (4.26, 14.44)) were significantly associated with an increased likelihood of cesarean section.Conclusionand RecommendationThe study indicates a high cesarean section rate that exceeds the World Health Organization recommendation 10-15%. Therefore, improving antenatal care, referral systems, and labor induction management needs concern to mitigate unnecessary cesarean deliveries.

Current concepts on the use of the partogram to monitor labor progression.

The partogram is a graphic tool used to monitor labor progression. This article reviews the recent literature on the use of the partogram, aiming to evaluate whether its implementation reduces cesarean section rates and to determine which model is more appropriate. Studies that compared using the partogram with not using it were analyzed, as well as studies that contrasted different partogram models. The results indicate that partogram use is not associated with a significant reduction in cesarean section rate, particularly in countries with low cesarean section rates. However, the modified World Health Organization partogram, which eliminates the latent phase, appears to have advantages over the classic 1994 model, with significantly lower cesarean section rates. Although the partogram has not shown significant benefits in reducing cesarean sections, it is still a useful tool for graphically documenting the progress of labor, which could improve clinical decision-making. In Chile, the high cesarean section rates, close to 45%, suggest that implementing the WHO 2000 partogram could be beneficial. However, local studies are needed to confirm the potential benefits of reducing cesarean sections.

Maternal, Fetal, and Kidney Outcomes of Viable Pregnancies in Women with Underlying Kidney Disease: Experience from a Single Tertiary Care Center in India

Background There is a dearth of data from resource-limited settings on pregnancy outcomes in women with kidney disease. We investigated the maternal, fetal, and renal outcomes of pregnancies amongst women with kidney disease and compared these outcomes with normal pregnancy outcomes. Materials and Methods This was a single-center retrospective observational study. The maternal, fetal, and renal outcomes of women with kidney dysfunction who delivered at the study center after at least 22 weeks of gestation (viable pregnancy) between January 2012 and December 2021 were analyzed. The study results were also compared with the outcomes of normal pregnancy. Results Two hundred and one deliveries were included in the study, constituting 0.14% of all deliveries during the study period. Lupus nephritis (39.3%) and Immunoglobulin A nephropathy (11.4%) were the most common underlying kidney diseases. The mean (±SD) gestational age at delivery was 34.9 (±3.7) weeks. A higher cesarean section rates (45.3%) were observed in these high-risk pregnancies. Low birth weight was observed in 51.7% of all deliveries. Renal outcome regarding proteinuria and estimated glomerular filtration rate was excellent. Renal transplant patients had unfavorable outcomes. More than 45% of patients had term deliveries with normal birth weight. Conclusion Satisfactory maternal, fetal, and renal outcomes can be achieved with proper pre-pregnancy counseling and multidisciplinary care in women with kidney diseases, even in resource-limited settings.

Labor and Delivery Outcomes in Australian Mothers after Kidney Transplantation.

Background: Factors influencing high cesarean section rates among mothers with a kidney transplant remain unclear. Methods: Using linked Australia and New Zealand Dialysis and Transplant Registry (1970-2016) and perinatal datasets (1991-2013), we compared deliveries of women with a functioning kidney transplant to those without kidney replacement therapy (non-KRT). Results: Of 2,946,851 babies (1,627,408 mothers), 211 were born to 137 mothers with a kidney transplant. Overall cesarean sections rates were doubled in transplant cohort (63% versus 26% non-KRT, p&lt;0.001) across all gestational periods compared to non-KRT cohort, and highest in preterm births (≥37 weeks: 48% versus 25%, p&lt;0.001, 33-36 weeks: 77% versus 40%, p&lt;0.001, and &lt;33 weeks: 75% versus 41%, p&lt;0.001). Cesarean section rates remained higher after adjusting for maternal factors (incidence rate ratio: 1.5; 95% CI: 1.3-1.7). In post-transplant women with past pregnancy, 53% with no previous cesarean sections had a cesarean section in the current pregnancy (versus 19% non-KRT, p&lt;0.001). Mothers with a kidney transplant had less spontaneous labor than non-KRT mothers (30% versus 63%, p&lt;0.001) and more planned deliveries (induced or elective cesarean sections) (70% versus 36%, p&lt;0.001). Nearly half of the women with transplantation (45%) delivered by non-labor cesarean sections, mostly occurring preterm (&lt;37 weeks: 70% versus ≥37 weeks: 30%, p=0.002). In the transplant cohort, the main indications for non-labor cesarean sections were hypertensive disorders of pregnancy and breech presentation (&gt;50% versus 18% non-KRT cohort, p&lt;0.001) and were linked to gestational age. Non-labor cesarean sections for fetal distress were higher in women with transplantation (10% versus 4% non-KRT, p=0.029). In the non-KRT cohort, previous cesarean sections were the main indication for non-labor cesarean sections (40% versus 24% transplant; p=0.055). Post-partum hemorrhage (13% vs 7% non-KRT, p=0.003) and fetal distress (18% versus 10% non-KRT, p=0.001) were higher among the transplant cohort. Conclusions: Women with a kidney transplant have higher rates of cesarean sections delivery even after accounting for maternal factors, preterm delivery and past cesarean sections compared to non-KRT cohorts.

Individual- and system-level determinants of breastfeeding in a low-resource setting.

The benefits of breastfeeding are widely established and therefore the World Health Organization recommends that every child be exclusively breastfed for the first 6 months of life and continue breastfeeding up to 2 years of age or beyond. However, the rate of exclusive breastfeeding is low globally and has declined in Bangladesh in recent years. In this review, Bangladesh is used as an example to demonstrate the complex individual- and system-level determinants of breastfeeding in a low-resource setting. Mothers face barriers to breastfeeding within the context of marketing by commercial milk formula companies, limited safe alternatives to breastfeeding directly from the breast, and insufficient resources to support breastfeeding in the hospital, community, and workplace setting. Future research and implementation science is required to investigate the overlapping effects between breastfeeding and the high antibiotic use and Caesarean section rates in Bangladesh, along with public health efforts to promote breastfeeding based on robust evidence.

Risk of Bleed During Pregnancy in Women with Epilepsy Due to Cerebral Vascular Malformations.

Cerebral vascular malformations are rare but important causes of epilepsy in young women. The risk of bleed during pregnancy and delivery as well as the fetal outcomes are important concerns for women with epilepsy (WWE) due to cerebral vascular malformations (EVM). We compared the maternal and fetal outcomes of a cohort of EVM with women with focal epilepsy due to other causes (ENVM). We identified all EVMs in the Kerala Registry of Epilepsy and Pregnancy and compared their characteristics with that of a set of randomly selected ENVM in the same registry. The clinical characteristics, pregnancy outcome, and seizure risk during pregnancy from the vascular malformations were compared between the two groups with Chi-square test and multivariate logistic regression after adjustment for age, epilepsy classification, and AED usage. There were 45 women with EVM (arteriovenous malformations: 25, cavernoma: 20) in this registry between 1998 and 2018. The EVM and ENVM groups (n = 96) had similar rates of seizure relapse during pregnancy (37.1% vs. 55.1%), fetal loss (11.4% vs. 13.5%), and fetal malformations (9.4% vs. 9%). The rate of delivery by cesarean section, adjusted for maternal age, was higher for the EVM group (61.2% vs. 39%, odds ratio = 2.79, 95% CI: 0.99-7.9, P = 0.05). AVM bled during pregnancy for three women (none of the cavernoma had bled during pregnancy). Maternal and fetal outcomes were comparable for the EVM and ENVM groups, but the former had a higher rate of cesarean section. AVM bled during pregnancy for 15% of women.

Maternal and Neonatal Perinatal Outcomes of Singleton Pregnancies in Advanced-Age Women Undergoing IVF/ICSI-ET Compared with Spontaneous Conception: A Retrospective Propensity Score Matched Cohort Study.

To assess the safety and efficiency of in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on maternal and neonatal perinatal outcomes in women (≥40y) with singleton pregnancies. This multi-center retrospective cohort study, carried out from January 2018 to June 2023, enrolled 1762 women (≥40y) with singleton pregnancies of at least 28weeks. Participants were divided into two groups: the IVF/ICSI-ET group (204 cases) and the spontaneous conception (SC) group (1558 cases). After 1:2 propensity score matching (PSM), the two groups were compared for maternal and neonatal outcomes. The SC group (1558 cases) was further divided by age into the <43 years group (1195 cases) and the ≥43 years group (363 cases) for subgroup analysis. Adverse maternal and neonatal outcomes were comparable between the IVF/ICSI-ET group and the SC group, with a higher cesarean section rate (78% vs 67.5%, P =0.013), an increased maternal ICU admissions rate (5.5% vs 1.3%, P =0.008), and a lower birth defects rate (1.1% vs 4.6%, P =0.037) in the IVF/ICSI-ET group. Subgroup analysis showed that women aged ≥43 years had higher incidences of gestational diabetes, gestational hypertension, cesarean section, and neonatal asphyxia compared to women aged <43 years. This study indicated IVF/ICSI-ET is relatively safe for women ≥40 years with singleton pregnancies. However, advanced maternal age deteriorated maternal and neonatal outcomes, and IVF/ICSI-ET further heightened the risk of cesarean section and maternal ICU admissions. Therefore, enhanced care and vigilance are crucial for women over 40 undergoing IVF/ICSI-ET.

Low Antenatal Care Number of Consultations Is Associated with Gestational Weight Gain and Birth Weight of Offspring of Teenage Mothers: A Study Based on Colombian and Mexican Cohorts.

More than 70% of pregnant adolescents in developing countries experience inappropriate gestational weight gain (GWG). To determine the association of the number of antenatal care visits (ANC) with GWG, birth weight, and their differences between two countries. A prospective study was conducted in two cohorts of adolescents, one from Mexico and one from Colombia. The study calculated pregestational body mass index (BMI), obtained GWG and birth weight, and collected socioeconomic characteristics. Birth weight was categorized according to gestational age. A total of 690 mother-child pairs were included, of which 42.6% were Colombian and 57.4% Mexican. The study found no association between socioeconomic characteristics and GWG or birth weight. Colombian adolescents were more likely to experience insufficient GWG (68%), compared with 36% of Mexican adolescents. Colombian adolescents who attended fewer than eight ANC visits were at increased risk of insufficient GWG, whereas Mexican adolescents were at increased risk of excessive GWG. Mexican adolescents who began their pregnancies overweight or obese were at increased risk of excessive GWG. Fewer than eight ANC visits were associated with small for gestational age (SGA) in the Mexican cohort. Inadequate numbers of ANC visits were associated with excessive and insufficient GWG, and SGA. Promoting ANC in adolescent pregnancy is essential to prevent suboptimal GWG and SGA. This study highlights the need for interventions targeting pregnant adolescents from low socioeconomic backgrounds, prioritizing early initiation of prenatal care (first trimester) and a drastic reduction in the high rates of cesarean sections in this group.

Impact of vaginism on mode of delivery and obstetrical outcomes

IntroductionAccording to ICD 10, vaginism is defined as the presence of spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening. Intromission is impossible or painful. Vaginism, whose prevalence is estimated at 1%, is often diagnosed during pregnancy follow-up, when clinical examination is difficult or impossible. However, few studies report obstetrical complications and pregnancy outcomes associated with this pathology. ObjectiveEvaluate the impact of vaginism on mode of delivery and obstetrical complications. Materials and methodsComparative, monocentric, retrospective study at the Montreuil maternity hospital between January 2019 and January 2024 that included all singleton deliveries in cephalic presentation at term. Vaginism was defined as an involuntary contraction of the pelvic muscles that made clinical examination during pregnancy impossible. Mode of delivery (caesarean section during labour, operative delivery, spontaneous vaginal delivery) and obstetric complications (episiotomy, OASIS, complex tear, Postpartum haemorrhage (PPH) due to tear) were compared between patients with vaginism and a control group, in univariate analysis and multivariate logistic regression with adjustment for maternal age, BMI, maternal origin, gestational age, high obstetrical and medical risk level, diabetes with or without insulin use, pregnancy complications, Robson group and birthweight. A propensity score adjustment with matching 1 case to 3 controls was conducted. ResultsDuring the study period, 13,469 patients were included, among which 440 patients had vaginism. In univariate analysis, patients with vaginism had a higher rate of caesarean section (16,8% versus 9,4%, p < 0.001), operative delivery (29,3% versus 13,3%, p < 0.001), episiotomy (12,5% versus 5.3 %, p < 0.001), OASIS (3.4 % versus 1.0 %, p < 0.001), complex tear (17,5% versus 7,7%) and PPH due to tear (2,5% versus 1,1%, p = 0,009).After adjustment, vaginism appeared to be an independant risk factor for cesarean section with a psaOR of 1.38 [1.02–1.85], operative delivery psaOR 2.39 [1.83–3,10], OASIS psaOR 2,19 [1.10–4,27], and complex tear psaOR 1,39 [1,02–1,87] ConclusionVaginism appears to be an independent risk factor for cesarean section, operative delivery, OASIS, and complex tear. Further studies should evaluate the impact of early and appropriate follow-up during pregnancy on adverse obstetrical outcomes.

Rising Cesarean Section Rates in Pakistan: Analyzing Frequency and Key Risk Factors in a Tertiary-Care Hospital.

The increasing frequency of cesarean sections (CS) has emerged as a significant public health concern, particularly in Pakistan. This cross-sectional study aimed to assess the prevalence of CS and its contributing factors among mothers in an underdeveloped region of the country. Data were collected from 250 delivery cases using a self-developed questionnaire. Among the participants, 110 (44%) had undergone CS, with 67 (60.9%) being emergency procedures and 43 (39.1%) elective. Statistical analysis revealed that younger maternal age (p = 0.04), type of CS (p = 0.05), and education level (p = 0.04) were significantly associated with higher rates of CS. Major medical risk factors contributing to CS included preeclampsia/eclampsia, vaginal hemorrhage, gestational diabetes, and hypertension (p < 0.001). Furthermore, urban residence, younger maternal age (20-24 years), and preterm gestational age were also identified as significant contributors. The findings suggest that the high rate of CS (44%) in the study population is influenced not only by physiological and medical factors but also by demographic elements such as education, income, and type of delivery. To mitigate unnecessary CS, community-focused educational interventions targeting at-risk populations should be implemented during pregnancy. Effective measures are essential to reduce the rising CS rates in Pakistan.

Obstetricians and midwives perspective of the alarming high cesarean section rates in Greece and worldwide

IntroductionThis study aimed to outline the perspectives of obstetricians/gynecologists (physicians) and midwives regarding the alarmingly high rates of cesarean sections (CSs) to identify areas for improvement and describe the role of a regional obstetric quality initiative. Material and methodsA cross-sectional study was performed utilizing real-world data from questionaries provided to Greek midwives and obstetricians. Primary outcomes included the attitudes of Greek physicians and midwives toward the CS rates in Greece and around the world, as well as identifying potential solutions for lowering these rates. The secondary outcome was the potential correlation between the answers of the participants and their demographic parameters. ResultsA total of 456 physicians and 234 midwives participated in the survey. Greek CS rates (>50 %) were considered “acceptable” and inevitable by 29.7 % and 32 % of the participants, respectively. Stratified analysis based on profession showed that significantly fewer midwives compared to obstetricians would agree with current CS rates. Participants who had obtained their degrees abroad were more likely to consider all CS rates more justified than physicians and midwives who had graduated from Greek medical schools. For all questions, the younger age subgroups responded in a way toward the non-acceptability of CS rates and favored the implementation of rules and practice control according to guidelines. The responses did not differ significantly between male and female physicians. ConclusionsGreek midwives, to a greater degree than obstetricians/gynecologists, consider the current CS rates unjustified and agree on the importance of implementing appropriate interventions to reduce them.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Caesarean sections, indications and outcomes: a cross-sectional study using the Robson classification in a tertiary hospital in Sierra Leone

ObjectiveWHO recommends the use of the Robson’s ‘Ten Groups Classification’ for monitoring and assessing caesarean section (CS) rates. The aim of this study was to investigate the rates, indications and...

A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes.

Background Hypertensive complications during pregnancy play a significant role in the increased rates of maternal and perinatal morbidity and mortality on a global scale. Preeclampsia is characterized by elevated blood pressure levels and the presence of protein in the urine and is associated with diverse hematological alterations, particularly impacting the coagulation cascade. The primary objective of this research was to conduct a comparative analysis of the coagulation profiles and pregnancy outcomes in women with preeclampsia versus those with normal blood pressure during pregnancy. Methods This was a prospective case-control study with 74 participants across two groups, conducted from September 2022 to May 2024. The participants were enrolled and divided into two groups, with 37 in the clinically diagnosed preeclampsia group and 37 in the normotensive group. Coagulation parameters including platelet count, bleeding time, clotting time, international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen levels, alkaline phosphatase (ALP) levels, D-dimer levels, and fibrin degradation products (FDP) levels were assessed. Maternal and neonatal outcomes were also compared. In our study, we comprehensively examined both maternal and neonatal outcomes in preeclampsia and normotensive groups. Maternal complications analyzed included mode of delivery, incidence of eclampsia, placental abruption, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, postpartum hemorrhage (PPH), and peripartum cardiomyopathy (PPCM). For neonatal outcomes, we assessed birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, and the duration of neonatal intensive care unit (NICU) stays. Results The results showed that mean platelet count was significantly lower in the preeclampsia group (151,503 ± 59,875/µL) compared to the normotensive group (245,405 ± 69,021/µL) (p < 0.0001). Bleeding time, INR, APTT, and PT showed significant elevation in the preeclampsia group, indicating a slower coagulation process. Fibrinogen levels, ALP levels, and D-dimer levels were significantly higher in the preeclampsia group (p < 0.0001). The preeclampsia group had a higher rate of cesarean sections (65% vs. 24%) and lower neonatal birth weights (mean 2.3 kg vs. 2.5 kg). APGAR scores were comparable between groups, but a higher number of neonates went to the NICU in the preeclampsia group (64.9% vs. 10.8%). The preeclampsia group also showed higher rates of low birth weight (27%), intrauterine growth restriction (27%), respiratory distress syndrome (10.8%), and asphyxia (5.4%). Conclusion Preeclampsia is associated with significant hematological changes, particularly in coagulation parameters, and adverse fetomaternal outcomes. Early identification and monitoring of these changes are crucial for timely intervention and improving maternal and neonatal health outcomes.

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case-Control Study.

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

BackgroundThere is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).MethodsTwenty-two selected maternity units in Greece will participate in a multicenter stepped-wedge randomized prospective trial involving 20,000 to 25,000 births, with two of them entering the intervention period of the study each month (stepped randomization). The maternity care units entering the study will apply the suggested interventions for a period of 8–18 months depending on the time they enter the intervention stage of the study. There will also be an initial phase of the study lasting from 8 to 18 months including observation and recording of the routine practice (cesarean section, vaginal birth, and maternal and perinatal morbidity and mortality) in the participating units. The second phase, the intervention period, will include such interventions as the application of the HSOG (the Hellenic Society of Obstetrics and Gynecology) Guidelines on labor management, training on the correct interpretation of cardiotocography, and dealing with emergencies in vaginal deliveries, while the steering committee members will be available to discuss and implement organizational and behavioral changes, answer questions, clarify relevant issues, and provide practical instructions to the participating healthcare professionals during regular visits or video conferences. Furthermore, during the study, the results will be available for the participating units in order for them to monitor their own performance while also receiving feedback regarding their rates. Τhe final 2-month phase of the study will be devoted to completing follow-up questionnaires with data concerning maternal and neonatal morbidities that occurred after the completion of the intervention period. The total duration of the study is estimated at 28 months. The primary outcome assessed will be the cesarean section rate change and the secondary outcomes will be maternal and neonatal morbidity and mortality.DiscussionThe study is expected to yield new information on the effects, advantages, possibilities, and challenges of consistent clinical engagement and implementation of behavioral, educational, and organizational interventions described in detail in the protocol on cesarean section practice in Greece. The results may lead to new insights into means of improving the quality of maternal and neonatal care, particularly since this represents a shared effort to reduce the high cesarean section rates in Greece and, moreover, points the way to their reduction in other countries.Trial registrationNCT 04504500 (ClinicalTrials.gov). The trial was prospectively registered.Ethics Reference No: 320/23.6.2020, Bioethics and Conduct Committee, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece