High Caesarean Section Rate Research Articles

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson’s Ten Group Classification System

BackgroundLatin America has the highest Cesarean Section Rates (CSR) in the world. Robson’s Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS.MethodsSecondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity.ResultsAvailable data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%).ConclusionCesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

Characteristics of pregnancy with placenta previa in Prof. Dr. I. G. N. G. Ngoerah General Hospital, Bali, in 2017

Introduction: Cesarean sections (CS) are rising annually worldwide. Globally, based on data from 121 countries, from 1990-2014, the number of CS increased by 12.4%, with an average increase of 4.4% per year. The high rate of CS increases the risk of complications in subsequent pregnancies, including placenta previa. In a study conducted in England with nearly 400,000 women with a second pregnancy, the incidence rate of placenta previa was 8.7 in 1000 births in women with previous CS history and about 4.4 in 1000 births in women with previous vaginal delivery. This study aimed to determine pregnancy characteristics with placenta previa at Prof. Dr. I. G. N. G. Ngoerah General Hospital in 2017. Methods: This study is a cross-sectional study with a retrospective descriptive approach using medical records of patients admitted from 1st January-31st December 207. This research was conducted at Prof. I. G. N. G. Ngoerah General Hospital, Bali, from February 1 to April 1, 2018. All data from medical records were collected and processed to describe pregnancy characteristics with placenta previa. Results: There were 49 (4.89%) cases of placenta previa from 1001 deliveries in 2017. This number was higher than the placenta previa case in other countries, around 0.3-0.5%. There were 2 cases excluded, and 47 cases were processed for data presentation. Pregnancy characteristics that dominated placenta previa cases in this research were aged 30-34 years old, second to third pregnancy, age of gestation ≥ 37 weeks, no history of vaginal bleeding, no history of curettage, and no history of CS Conclusion: The characteristics of pregnancy in this study which dominated placenta previa cases were aged 30-34 years old, second to third pregnancy, age of gestation ≥ 37 weeks, no history of vaginal bleeding, no history of curettage, and no history of CS Further investigation is required.

Feto-maternal outcome among Anemic Women attending labor

The aim of this case-control comparative study is to analyze the risk of anemia during pregnancy on the health of both mother and fetus. Seven hundred-fifty pregnant women admitted in labor were included who were divided into three hundred fifty (350) as anemic group and four hundred (400) as non-anemic group. Among the anemic group 57.1% had iron deficiency type and 54% of anemic group had mild anemia. Low social class and lack of attendance to A.N.C. clinics were the major predisposing factors in anemic group as 48.6% were of low social class and 37.7% were not attended antenatal care clinics. This study revealed that anemic group was more risky to have pre-eclampsia 15.7%, post-partum hemorrhage 16.8% and ante-partum hemorrhage 11.7%. Anemic women had higher cesarean section rate 40.9% mainly due to fetal distress 26.7% and ante-partum hemorrhage 23.8%. Intra-uterine death 4.8%, preterm delivery 15.4% and intra-uterine growth retardation 2% were the frequent fetal complications among anemic group with highly significant difference. Newborn of anemic women tend to have lower birth weight, low Apgar score with more admission to Neonatal Intensive Care Unit 29.1%. In conclusion anemia was still the common medical health problem among pregnant women in Basra society which carry high risk to both maternal and fetal health.

CD34 immunostain increases the sensitivity of placental examination for distal fetal vascular malperfusion in liveborn infants

IntroductionPlacental fetal vascular malperfusion (FVM) is associated with increased perinatal morbidity and mortality. This retrospective observational analysis was performed to compare the impact of large proximal vessel (global) FVM, established/remote distal villous FVM, and recent (acute) FVM diagnosed by clustered endothelial fragmentation by CD34 immunostaining, on clinical and other placental phenotypes. MethodsClinical and placental phenotypes of 581 consecutive high-risk pregnancies with a live birth divided in five groups based on presence and type of FVM were analyzed. CD34 immunostaining was performed on all cases to refine the diagnosis of FVM. The statistical analysis was by ANOVA and Chi square. ResultsFVM was present in 88% of placentas from pregnancies dominated by congenital anomalies. 43% of those had global FVM (partial, large proximal vessel) without distal villous changes, either acute (endothelial fragmentation) or established (avascular villi). Acute distal villous FVM without avascular villi did not link with significant perinatal morbidity/mortality, likely because of its short duration. Established distal villous FVM with active endothelial fragmentation, labelled as FVM with temporal heterogeneity, is associated with preterm births, preeclampsia, abnormal Dopplers, fetal growth restriction, highest cesarean section rate, and high grade FVM, particularly the latter. DiscussionLesions of global FVM are common, featuring relatively low sensitivity for perinatal complications. Caution is indicated in assigning significance to isolated lesions such as fetal vascular ectasia, intramural fibrin deposition and stem vessel obliteration. Established and on-going FVM diagnosed by using CD34 immunostain, is much more significant and portends the most complicated perinatal outcomes.

An audit of caesarean section in a semi urban hospital in northern cross river state Nigeria utilizing the robson-10 criteria

Introduction: There has been rising rates of caesarean section across the globe and some of their indications are unjustified. This brings to the fore, the need to audit the caesarean section cases done in a resource poor setting like ours, utilizing the World Health Organization (W.H.O) endorsed Robson Ten Group Classification System (TGCS). Objective: To determine the rate of caesarean section and the major contributing groups to this overall rate using the Robson Ten Group Classification System. Materials and Method: This is a retrospective study of 430 women who had caesarean section over a 24 month period. Result: Out of 1402 women that delivered during the study period, 430 of them had caesarean section, giving a caesarean section rate of 30.7%. Using the Robson Ten Group Classification System, group 3 was the major contributor to the overall caesarean section rate with 25.81%. This was followed by groups 1 (18.84%) and 4 (13.95%) respectively. Conclusion: A high caesarean section rate of 30.7% was obtained from our study and group 3 was the major contributor to this caesarean section rate. Constant auditing is encouraged to lower the caesarean section rate.

Effect of Steroids on the Biophysical Profile and Doppler Indices of Umbilical and Middle Cerebral Arteries in Preterm Fetuses.

Introduction Preterm birth is a major cause of perinatal death and disability and emerges as an important global public health problem. The antenatal administration of corticosteroids for preventing neonatal death due to respiratory distress syndrome and the serious morbidities associated with preterm birth has become an accepted standard in worldwide obstetric practice since 1994.After administering corticosteroids, the biophysical score deteriorates transiently, leading to a high cesarean section rate. Thus, Doppler indices of the umbilical and middle cerebral arteries are taken into account before the termination of pregnancy in preterm labor. Materials and methods This is an interventional study conducted over a period of one year and six months among 59 eligible singleton pregnancies at risk for preterm delivery, i.e., at risk of preterm birth <34 weeks of gestation, having no contraindication to antenatal steroids, who were admitted to the labor room of the Srirama Chandra Bhanja (SCB) Medical College, Cuttack, India, from January 2014 to August 2015. The participants were prospectively recruited, after giving informed consent to participate in the study. The main indication for hospital admission and steroid use was preterm lower abdominal pain. Results Out of 59 eligible cases, 27 (45.8%) were <25 years of age, 26 (44.1%) were between 25 and 30 years of age, and six (10.2%) were >30 years of age. The range is 14 years (between 19 and 33 years). The mean age is 25.31 years, with a standard deviation of 3.74. The mean of the biophysical profile (BPP) score before steroid administration decreased from 9.19 ± 1.23 to 5.56 ± 1.05 after 48 hours of first dose of steroid. The p-value of this is <0.001, which is statistically significant. The results show that the administration of betamethasone decreased fetal movements by 78.6% and breathing by 71.8%. As a result, the BPP scores decreased significantly. However, the Doppler indices did not change significantly even after administering corticosteroids. Conclusion Doppler indices play an important role in differentiating between steroid-induced compromise in the fetus and real fetal distress. Thus, umbilical and middle cerebral artery (MCA) Doppler should always be done before the termination of pregnancy on the ground of fetal compromise after administering corticosteroids.

Non-obstetric Causes of Cesarean Section in Iranian Pregnant Women Referring to Medical Services Commission

Background: Despite the implementation of the Health Transformation Plan in recent years, the cesarean section (CS) rate has increased in private and public centers in Iran. Accordingly, Iran is the first among the four countries in the world with the highest CS rate. Objectives: The present study aimed to investigate the non-obstetric causes of CS in mothers who were referred to the Medical Services Commission of Alborz province, Iran, to review their requests for CS. Methods: In this cross-sectional study, 312 subjects were selected based on a census of all clients by the Midwifery Office of Alborz province, whose requests for CS for non-obstetric reasons were submitted to the Medical Services Commission in 2020. The information in this study was collected using a researcher-made questionnaire containing 26 items in two sociodemographic and medical sections. Results: The highest frequency of sociodemographic factors was observed for the age range of 20 - 30 years (n = 163, 52.2%), the educational level of diploma and higher (n = 236, 75.6%), urban residence (n = 274, 87.8%), and no complementary insurance (n = 258, 82.7%). The frequency distribution of the non-obstetric reasons of the participants was reported as 83 (26.6%), 60 (19.2%), 25 (8%), 24 (7.7%), 20 (6.4%), 14 (4.5%), and 86 (27.6%) for lumbar disc disease, eye diseases, repeat CS, genital warts, in vitro fertilization, fear of childbirth pain, and other causes, respectively. There was a significant association between the reason for requesting CS and the age group (P &lt; 0.001), the type of insurance (P = 0.043), and the mother’s educational level (P &lt; 0.001). Conclusions: In the present study, most of the women in the younger age group and non-employees requested a CS for non-obstetric reasons.

Bloody Amniotic Fluid and Neonatal Outcomes.

Information on the effect of bloody amniotic fluid during labor at term is scarce. This study assessed risk factors and adverse outcomes in labors with bloody amniotic fluid. During the six years of this study, all nulliparas in our institution, with a trial of labor, were included. Multiple pregnancies and preterm deliveries were excluded. Outcomes were compared between the bloody amniotic fluid group and the clear amniotic fluid group. Overall, 11,252 women were included. Among them, 364 (3.2%) had bloody amniotic fluid and 10,888 (96.7%) had clear amniotic fluid. Women in the bloody amniotic fluid group were characterized by shorter duration of the second stage and higher rate of cesarean section due to non-reassuring fetal heart rate. In addition, there were higher rates of low cord pH (<7.1) and NICU admissions in the bloody amniotic fluid group. In multivariate logistic regression analysis, cesarean delivery, cord blood pH < 7.1, and NICU admission were independently associated with increased odds ratio for bloody amniotic fluid. Bloody amniotic fluid at term is associated with adverse outcomes and must be considered during labor.

Adverse Perinatal Outcomes Associated with Increasing Maternal Obesity.

The aim of this study was to determine adverse perinatal outcomes related to maternal preconception body mass index (BMI). This is a retrospective observational cohort study at a single institution of 500 consecutive mothers of normal weight with a preconception BMI of 18.5 to less than 25 and 500 additional obese mothers with a preconception BMI more than or equal to 30. Maternal/newborn metrics were stratified by maternal preconception BMI and trend analysis was performed both by simple univariable and multivariable logistic regression analysis. The study included 858 mother/baby dyads after 142 were excluded. Trend analysis demonstrated higher preconception BMI was significantly associated with progressively higher rates of cesarean section (p < 0.001), preeclampsia p < 0.001), gestational diabetes (p < 0.001), preterm birth (p = 0.001), lower 1- and 5 minutes Apgar scores (p < 0.001), and neonatal intensive care unit admission (p = 0.002). These associations remained significant in both simple univariable and multivariable logistic regression models. We demonstrated obese women are more likely to have maternal complications and neonatal morbidity when compared with normal weight mothers. Maternal and fetal complications increase with increasing obesity with superobese mothers (BMI ≥ 50) having more perinatal adverse outcomes when compared with other classes of obesity. It is reasonable to counsel weight loss prior to conception of women with BMI more than or equal to 30 in an effort to reduce maternal complications and neonatal morbidity related to pregnancy. · Maternal obesity is associated with adverse outcomes.. · Complications increase with increasing obesity.. · Superobese mothers have the most adverse outcomes..

P-588 A comparison of obstetrical and neonatal outcomes in patients with the hyperandrogenic states, polycystic ovarian syndrome(PCOS) and congenital adrenal hyperplasia(CAH): a retrospective population-database study.

Abstract Study question PCOS and CAH are associated with increases in pregnancy complications. Therefore, we evaluated differences in pregnancy and neonatal outcomes between women with PCOS and CAH. Summary answer When comparing these conditions PCOS was associated with pregnancy-induced hypertension and gestational diabetes, whereas CAH had more cesarean sections and small for gestational age infants. What is known already PCOS and CAH are causes of hyperandrogenism among women of reproductive age. Apart from causing hyperandrogenism, they also share characteristics such as menstrual irregularity, polycystic ovaries and insulin resistance with central adiposity. Several meta-analyses have associated PCOS with adverse obstetrical and neonatal outcomes with most studies finding an increased frequency of pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes (GDM), cesarean section (CS) and preterm delivery. CAH on the other hand, is associated with higher rates of CS and inconsistent evidence about increases in GDM, chorioamnionitis and congenital anomalies. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of PCOS or CAH and pregnancy were identified. Each subject had a delivery or maternal death to be included once per pregnancy. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups, for which chi-squared tests were used. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI) and correct for any difference in baseline demographics (P &amp;lt; 0.05) between the groups. According to the Tri-Council Policy statement (2018), institutional review board (IRB) approval was not required, given that data was anonymous and publicly available. Main results and the role of chance A total of 15,179 women with either PCOS or CAH were included. Approximately 98% of those women (14,881) were diagnosed with PCOS, while the rest 2% (298) had CAH. The adjusted analysis for race, obesity, previous CS, multiple gestation and IVF yielded the following results. For pregnancy outcomes PIH (aOR=1.76; 95% CI: 1.12-2.77; p = 0.015) and GDM (aOR=1.68; 95% CI: 1.12-2.52; p = 0.012) were more common among women with PCOS, whereas no statistically significant results were detected for rates of placenta previa, preeclampsia or eclampsia superimposed on pre-existing hypertension or eclampsia. After additional adjusting for PIH and GDM, the delivery outcomes showed CS to be significantly less common in the PCOS group (aOR=0.59; 95% CI 0.44-0.80; p &amp;lt; 0.001), with no significant differences concerning preterm premature rupture of membranes, preterm delivery, abruptio placenta, chorioamnionitis, operative vaginal delivery, hysterectomy, postpartum hemorrhage, wound complications, maternal death and need for transfusion. In neonatal outcomes, women with CAH had higher percentages of SGA neonates (aOR=0.32; 95% CI 0.20-0.52; p &amp;lt; 0.001) and no difference in intrauterine fetal demise and congenital anomalies. Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. Furthermore, CAH type was not specified. Information on medication use and compliance was also lacking information about certain potential confounders such as parity, and duration of labor. Wider implications of the findings This is the first study to investigate the differences in obstetrical and neonatal outcomes between these two hyperandrogenic disorders and we noted that the majority of risks were similar, despite the difference in the pathophysiology of these conditions. Rates of certain complications differ and studies are needed to elucidate why. Trial registration number N/A

Review of socioeconomic risk factors for cesarean births: a population-based study.

The reasons for increased cesarean section (CS) rates are complex and multifactorial. The goal of this study was to look at different social and economic factors that might be causing more cases of CS in the population. A retrospective population-based cohort study. Data was taken from the Perinatal Neonatal Outcomes Research study in the Arabian Gulf (PEARL study) registry. Data from 60,728 live births ≥ 24 weeks of gestation were analyzed. In this study, various socioeconomic factors, such as maternal nationality, religion, educational level, employment status, parental income, consanguinity, housing, preterm birth, and tall stature, were examined for women undergoing cesarean section (CS) and their economic outcomes. Women who underwent vaginal delivery (VD) were compared. There are risks associated with pregnancy, smoking, assisted conception, and prenatal care. 60,728 births ≥ 24 weeks gestation were included in the analysis. 17,535 women delivered by CS (28.9%). Women with university-level -education and above were more likely to deliver by CS (61%), as compared to illiterate women or women with basic education at elementary or secondary levels (OR 0.73, CI 95%: P: <0.0001). Working women were more likely to deliver by CS (OR 1.40, CI 95%, P value <0.0001). Women living in rented houses were less likely to achieve a normal delivery (71.8%) (OR 1.40, CI 95%; P: <0.0001) as compared to women living in owned houses (74.7%). Women over 20 years old tended to achieve more VD compared to women less than 20 years old. P value <0.0001. Smoking was associated with lower chances of VD, with 42.4% of smokers delivered by CS compared to 28.3% of non-smokers (OR 1.87, CI 95%; P: <0.0001). Assisted conception was associated with higher CS rates as compared to spontaneous conceptions (OR 0.39; P: <0.0001). We found no statistically significant differences in how babies were born based on the mother's nationality, the father's job, or the mother's income. Higher education, employed mothers, smoking, and living in rented houses were socioeconomic factors associated with a higher rate of CS in our population. Furthermore, women who had regular antenatal care were more at risk for delivery by cesarean section, which could be related to other comorbidities increasing the likelihood of cesarean birth rather than antenatal care itself. In our population, assisted reproduction was associated with a higher probability of cesarean delivery.

Intertwin Membrane Perforation and Umbilical Cord Entanglement after Laser Surgery for Twin-Twin Transfusion Syndrome: Prevalence, Risk Factors, and Outcome

Introduction: Perforation of the intertwin membrane can occur as a complication of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS). Data on the occurrence and the risk of subsequent cord entanglement are limited. The objective of this study was to assess the prevalence, risk factors and outcome of intertwin membrane perforation, and cord entanglement after laser surgery for TTTS. Methods: In this multicenter retrospective study, we included all TTTS pregnancies treated with laser surgery in two fetal therapy centers, Shanghai (China) and Leiden (the Netherlands) between 2002 and 2020. We evaluated the occurrence of intertwin membrane perforation and cord entanglement after laser, based on routine fortnightly ultrasound examination and investigated the risk factors and the association with adverse short- and long-term outcomes. Results: Perforation of the intertwin membrane occurred in 118 (16%) of the 761 TTTS pregnancies treated with laser surgery and was followed by cord entanglement in 21% (25/118). Perforation of the intertwin membrane was associated with higher laser power settings, 45.8 Watt versus 42.2 Watt (p = 0.029) and a second fetal surgery procedure 17% versus 6% (p < 0.001). The group with intertwin membrane perforation had a higher rate of caesarean section (77% vs. 31%, p < 0.001) and a lower gestational age at birth (30.7 vs. 33.3 weeks of gestation, p < 0.001) compared to the group with an intact intertwin membrane. Severe cerebral injury occurred more often in the group with intertwin membrane perforation, 9% (17/185) versus 5% (42/930), respectively (p = 0.019). Neurodevelopmental outcome at 2 years of age was similar between the groups with and without perforation of the intertwin membrane and between the subgroups with and without cord entanglement. Conclusion: Perforation of the intertwin membrane after laser occurred in 16% of TTTS cases treated with laser and led to cord entanglement in at least 1 in 5 cases. Intertwin membrane perforation was associated with a lower gestational age at birth and a higher rate of severe cerebral injury in surviving neonates.

Association of duration of skin-to-skin contact after cesarean delivery in China: a superiority, multicentric randomized controlled trial

In China, rates of early initiation and exclusive breastfeeding are low. The high cesarean section rates further contribute to low breastfeeding outcomes. Skin-to-skin contact (SSC), a key component of Early Essential Newborn Care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to an RCT. To determine the association of duration of SSC after cesarean section on breastfeeding outcomes and maternal and neonatal health outcomes in China. A multi-centric RCT was conducted at four hospitals in China. 720 participants ≥37 gestational weeks with singleton pregnancy receiving elective cesarean section, using epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at the ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2) and 3 (G3) received 30, 60 and 90 minutes of SSC immediately after cesarean section, respectively. Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2 and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71% and 72%, compared to 22% in control group (p<0.001). The exclusive breastfeeding rate at discharge were 69%, 62% and 71%, compared to 57% in control group (p=0.003). EENC practices were associated with reduction in postpartum blood loss and NICU or neonatal ward admission (p< 0.001, p=0.022) . Our findings highlight that prolonged SSC after cesarean section was associated with higher initiation and exclusive breastfeeding at discharge. It also found associations with reduced postpartum blood loss and NICU or neonatal ward admission.

Maternal and fetal outputs in pregnant women with severe pre-eclampsy diagnosis

This study aims to evaluate maternal and perinatal outcomes among cases of planned and emergency cesarean section in PE with severe features. Retrospective cohort study with 202 women diagnosed with severe pre-eclampsia, with gestational age greater than 32 weeks. They were divided according to the mode of delivery: vaginal delivery, planned cesarean section and emergency cesarean section. Were analyzed the sociodemographic characteristics, obstetric history and clinical conditions at admission, post operatory maternal and perinatal outcomes and complications according to the type mode of delivery. A total 202 patients were included in the study, 78.7% of whom underwent planned cesarean section, 21.3% emergency cesarean sections and only 11.8% induced labor was performed and of the total. Only 2% of total progressed to vaginal delivery. Patients living in the interior (53.5%, P 0.040), primiparous (OR 1.4, P &lt;0.001), history of previous pre-eclampsia (OR 1.3, P = 0.020) and presence of signs of severity (OR 10.1, P &lt;0.001) had a higher risk of evolving to an emergency cesarean section. Postpartum hemorrhage was greater in the programmed cesarean section (OR 2.4, P 0.049). Regarding perinatal complications, the time of fetal hospitalization in days was longer in the programmed cesarean section (OR 6.7, P 0.035). These results demonstrate that there is a high rate of indication for cesarean sections (98%) in patients with severe preeclampsia. A high rate of cesarean section does not positively affect the indicators of maternal and neonatal morbidity and mortality. In addition, in women in whom delivery was induced, there was no increase in neonatal risks..

Eye-masks and earplugs compared to headband in nulliparas on increasing spontaneous vaginal delivery: a randomized trial

BackgroundA majority of pregnant women experience sleep disruption during pregnancy, especially in the third trimester. Lack of sleep is associated with preterm birth, prolonged labor and higher cesarean section rate. Six or less hours of night sleep in the last month of pregnancy is associated with a higher rate of caesarean births. Eye-masks and earplugs compared to headband improve night sleep by 30 or more minutes. We sought to evaluate eye-mask and earplugs compared to sham/placebo headbands on spontaneous vaginal delivery.MethodsThis randomized trial was conducted from December 2019-June 2020. 234 nulliparas, 34–36 weeks’ gestation with self-reported night sleep < 6 h were randomized to eye-mask and earplugs or sham/placebo headband (both characterized as sleep aids) to be worn each night to delivery. After two weeks, interim outcome data of the average night sleep duration and the trial sleep related questionnaire was answered through the telephone.ResultsSpontaneous vaginal delivery rates were 60/117(51.3%) vs. 52/117(44.4%) RR 1.15 95% CI 0.88–1.51 P = 0.30 for eye-mask and earplugs or headband respectively. At 2-weeks into the intervention period, the eye-mask and earplugs arm reported longer night sleep duration 7.0 ± 1.2 vs. 6.6 ± 1.5 h P = 0.04, expressed increased satisfaction with the allocated aid 7[6.0–8.0] vs. 6[5.0–7.5] P < 0.001, agreed they slept better 87/117(74.4%) vs. 48/117(41.0%) RR 1.81 95% CI 1.42–2.30 NNTb 4 (2.2–4.7) P < 0.001 and higher compliance median[interquartile range] 5[3–7] vs. 4[ 2–5] times per week of sleep aid use P = 0.002.ConclusionEye-mask and earplugs use at home in late third trimester do not increase the spontaneous vaginal delivery rate even though self-reported night sleep duration, sleep quality, satisfaction and compliance with allocated sleep aid were significantly better than for sham/placebo headband.Trial registrationThis trial was registered with ISRCTN on June 11, 2019 with trial identification number: ISRCTN99834087.

MATERNALAND FETAL OUTCOME IN TERM PREGNANCY IN OLIGOHYDRAMNIOS

Decrease in amniotic uid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aim of was present study was to study maternal and fetal outcome in term pregnancy in oligohydramnios in tertiary care center. A prospective observational Study was conducted on 100 patients with oligohydramnios with AFI &lt;= 5cm at Tertiary Care Center, studied between 2019-2021 to observe outcome of labour in form of perinatal morbidity and maternal outcome in form of induction and deliveries. It was observed that AFI measurement of less than 5 cm detected after 37 completed weeks of gestation with a low-risk pregnancy is found to be an indicator of adverse pregnancy outcome with higher cesarean section rate.

FETOMATERNAL OUTCOME IN SPONTANEOUS VERSUS INDUCED LABOR

Background and Objectives: The medical induction of labour at term gestation has always been controversial and is based on conicting evidences.The present study is an attempt to assess the feto-maternal outcome of induced labour compared to spontaneous onset labour. Type of study:It was a prospective comparative study conducted at a tertiary care hospital, Lalla Ded Hospital Srinagar. Materials and methods:Atotal of 200 patients participated in this study. 100 women who had indicated induction of labour (study group) were compared with 100 women with spontaneous onset labour in active phase with cervix atleast 4 cm dilated (control group). Results: Vaginal delivery was 66% in the study group compared to 88% in the control group. Induced labour was associated with a signicantly higher caesarean section rates (P&lt; 0.001 ). Maternal complications include primary postpartum haemorrhage, perineal lacerations and puerperal pyrexia. The study group had longer duration of hospital stay compared to the control (P &lt;0.001).The neonatal Apgar scores at 1 and 5 min were comparable between both groups and showed no statistically signicant difference. Conclusion:Induction of labour is associated with increased risk of caesarean delivery

Exclusive breastfeeding at 6 months after assisted and spontaneous conceiving: a prospective study in Northern Italy

Conceiving by assisted infertility treatments may influence breastfeeding duration. In one-year time, to evaluate the goal of 6 months breastfeeding, we recruited 55 consecutive mothers who conceived using assisted treatment compared to 45 mothers conceiving naturally, all giving birth to healthy, full-term, singleton infants, sharing the double-occupancy room. At birth, maternal/neonatal characteristics were obtained by medical records and interviews. Six months after, a telephonic interview was done about the exclusivity of breastfeeding, mood instability, and breastfeeding complications. All the women were supported by the same neonatal-pediatrician team, during the study period. The number of mothers who were exclusively breastfeeding at six months was not statistically different between the two groups, as well as, breastfeeding initiation, BMI, smoking habit, mood instability, co-morbidities. In the assisted group, the women were older, had fewer previous children, upper degree of education, higher rate of cesarean sections, their neonate’s birthweight was lower; they reported more breastfeeding complications, but the distribution was not different between groups. The control women had higher number of previously breastfed siblings. Our experience highlights that the mode of conception may not be the defining factor influencing the goal of 6 months lactation. The support of healthcare professional team has a crucial role in maintaining breastfeeding.

Perinatal Outcome following the Suspension of Intrapartum Oxygen Treatment.

This study aimed to evaluate whether the suspension of intrapartum maternal oxygen supplementation for nonreassuring fetal heart rate is associated with adverse perinatal outcomes. A retrospective cohort study, including all individuals that underwent labor in a single tertiary medical center. On April 16, 2020, the routine use of intrapartum oxygen for category II and III fetal heart rate tracings was suspended. The study group included individuals with singleton pregnancies that underwent labor during the 7 months between April 16, 2020, and November 14, 2020. The control group included individuals that underwent labor during the 7 months before April 16, 2020. Exclusion criteria included elective cesarean section, multifetal pregnancy, fetal death, and maternal oxygen saturation <95% during delivery. The primary outcome was defined as the rate of composite neonatal outcome, consisting of arterial cord pH <7.1, mechanical ventilation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage grade 3/4, and neonatal death. The secondary outcome was the rate of cesarean and operative delivery. The study group included 4,932 individuals, compared with 4,906 individuals in the control group. The suspension of intrapartum oxygen treatment was associated with a significant increase in the rate of composite neonatal outcome (187 [3.8%] vs. 120 [2.4%], p < 0.001), including the rate of abnormal cord arterial pH <7.1 (119 [2.4%] vs. 56 [1.1%], p < 0.01). A higher rate of cesarean section due to nonreassuring fetal heart rate was noted in the study group (320 [6.5%] vs. 268 [5.5%], p = 0.03).A logistic regression analysis revealed that the suspension of intrapartum oxygen treatment was independently associated with the composite neonatal outcome (adjusted odds ratio = 1.55 [95% confidence interval, 1.23-1.96]) while adjusting for suspected chorioamnionitis, intrauterine growth restriction, and recent coronavirus disease 2019 exposure. Suspension of intrapartum oxygen treatment for nonreassuring fetal heart rate was associated with higher rates of adverse neonatal outcomes and urgent cesarean section due to fetal heart rate. · The available data on intrapartum maternal oxygen supplementation are equivocal.. · Suspension of maternal oxygen for nonreassuring fetal heart rate during labor was associated with adverse neonatal outcomes.. · Oxygen treatment might still be important and relevant during labor..

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.