High Caesarean Section Rate Research Articles

The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea

BackgroundPhysiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery.MethodsResearch data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression.ResultsAmong a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension.ConclusionThis population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.

Risk of Adverse Pregnancy Outcomes for Women with IBD in an Expert IBD Antenatal Clinic.

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of adverse outcomes from pregnancy. It is unclear whether IBD indications account for the higher rate of Caesarean section (CS) in IBD patients. Methods: A retrospective cohort study of 179 IBD patients cared for in a dedicated combined IBD antenatal clinic and 31,528 non-IBD patients was performed. The outcomes were method of delivery, preterm birth, birthweight, admission to neonatal intensive care unit (NICU), and stillbirth. We analysed the associations between disease activity, medication with method of delivery, and neonatal outcomes. Results: Delivery by CS was more common in IBD patients (RR 1.45, CI 1.16–1.81, p = 0.0021); emergency CS delivery was equally likely (RR 1.26, CI 0.78–2.07, p = 0.3). Forty percent of elective CS were performed for IBD indications. Stillbirth was five-fold higher in IBD patients (RR 5.14, CI 1.92–13.75, p < 0.001). Preterm delivery, low birthweight, and admission to NICU were not more common in patients with IBD, and IBD medications did not increase these risks. Active disease during pregnancy was not associated with adverse outcomes. Conclusions: Delivery by CS was more frequent in the IBD cohort, and most elective CSs were obstetrically indicated. A dedicated IBD antenatal clinic providing closer monitoring and early detection of potential issues may help improve outcomes.

Risk of adverse fetal outcomes following nonobstetric surgery during gestation: a nationwide population-based analysis

BackgroundLiterature suggests that nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion, prematurity, and a higher cesarean section rate, but the direct impact on fetal outcomes is still unclear. In this study, we aimed to investigate whether nonobstetric surgery during pregnancy is associated with negative fetal outcomes by analysing a nation-wide database in Taiwan.MethodsThis population-based retrospective observational case–control study was based on the linkage of Taiwan’s National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database between 2004 and 2014. For every pregnancy with nonobstetric surgery during gestation, four controls were randomly matched according to maternal age and delivery year. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of adverse fetal outcomes with the non-surgery group as the reference. The primary outcomes involved stillbirth, prematurity, low birth weight, low Apgar scores, and neonatal and infant death.ResultsAmong 23,721 identified pregnancies, 4,747 underwent nonobstetric surgery. Pregnancies with nonobstetric surgery had significantly higher risks of prematurity (aOR: 1.46; 95% CI: 1.31–1.62), lower birth weight (aOR: 1.49; 95% CI: 1.33–1.67), Apgar scores < 7 (1 min, aOR: 1.58; 95% CI: 1.33–1.86; 5 min, aOR: 1.34; 95% CI: 1.03–1.74), neonatal death (aOR: 2.01; 95% CI: 1.18–3.42), and infant death (aOR: 1.69; 95% CI: 1.12–2.54) than those without nonobstetric surgery after adjustment for socioeconomic deprivation, hospital level, and other comorbidities. Surgery performed in the third trimester was associated with a significantly increased rate of prematurity (aOR: 1.38; 95% CI: 1.03–1.85), but lower rates of stillbirth (aOR: 0.1; 95% CI: 0.01–0.75) and Apgar score < 7 at the 5th minute (aOR: 0.2; 95% CI: 0.05–0.82), than surgery performed in the first trimester.ConclusionsPregnancies with nonobstetric surgery during gestation were associated with increased risks of prematurity, low birth weight, low Apgar scores, neonatal and infant death, longer admission, and higher medical expenses than those without surgery. Furthermore, surgery in the third trimester was associated with a higher rate of prematurity than surgery performed in the first trimester.Trial registrationNot applicable.

Super-Utilizers of Inpatient Care in an Obstetrical Population: A Cross-Sectional Study.

The aim of the study is to estimate hospital charges (HC) and length of stay (LOS) for pregnancy and 6 weeks postpartum and to characterize the outliers who utilize a disproportionate share of health care resources. We performed a cross-sectional study of 500 subjects at a tertiary center between 2012 and 2014. Subjects were included who had inpatient status and an ICD-9 code for pregnancy; those with an ICD-9 code for ectopic pregnancy were excluded. Data were collected 266 days prior to the estimated date of delivery (EDD) and up to 42 days post-delivery. Medical diagnoses, obstetrical details, demographics, HC, and LOS were collected. Super-utilizers (SUs) were selected as patients with total HC exceeding $75,000, those who incurred $75,000 or less were assigned to the typical utilizer (TU) group. HC was positively skewed, with median's (interquartile range) of $151,143 (97,707-198,732) and $28,186 (19,292-38,943) among SUs and TUs, respectively. Despite the low proportion of SU patients (7%, n = 36), they accounted for 30% of charges. Similarly, SUs had longer LOS (16 vs. 3 days, p <0.05). They had earlier deliveries (34.5 vs. 38.5 weeks, p <0.05), higher cesarean section rates (69 vs. 35%, p <0.05), and more hysterectomies (8.3 vs. 0%, p <0.05). The most common complications in SUs were preterm labor (33.3 vs. 5.4%, p <0.05) and preterm premature rupture of membranes (25 vs. 3.9%, p< 0.05). The most common pre-existing condition in SUs was chronic hypertension (11.1 vs. 3%, p< 0.05). Although SUs comprise only 7% of the obstetrical population, they account for almost a third of the total HCs; in turn, SUs are at risk of adverse outcomes. Targeting this population can guide efforts to improve maternal health through prevention, research, and personalized care. SUs may have clustering at hospitals with higher levels of care and this topic warrants further investigation with state and national level data. · Just 7% of pregnant patients accounted for 30% of hospital charges.. · Super-utilizers had higher rates of preterm delivery, cesarean section, and hysterectomy.. · The most common pre-existing medical condition in super-utilizers was chronic hypertension..

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.

Racial disparities in caesarean delivery among nulliparous women that delivered at term: cross-sectional decomposition analysis of Nebraska birth records from 2005-2014

BackgroundPrevious studies suggest higher rates of caesarean section among women who identify as racial/ethnic minorities. The objective of this study was to understand factors contributing to differences in caesarean rates across racial and ethnic groups.MethodsData was collected from 2005 to 2014 Nebraska birth records on nulliparous, singleton births occurring on or after 37 weeks gestation (n = 87,908). Risk ratios (RR) and 95% confidence intervals (CI) for caesarean were calculated for different racial and ethnic categories, adjusting for maternal age, marital status, county of residence, education, insurance status, pre-pregnancy BMI, and smoking status. Fairlie decomposition technique was utilized to quantify the contribution of individual variables to the observed differences in caesarean.ResultsIn the adjusted analysis, relative to non-Hispanic (NH) White race, both Asian-NH (RR 1.21, 95% CI 1.14, 1.28) and Black-NH races (RR 1.13, 95% CI 1.08, 1.19) were associated with a significantly higher risk for caesarean. The decomposition analysis showed that among the variables assessed, maternal age, education, and pre-pregnancy BMI contributed the most to the observed differences in caesarean rates across racial/ethnic groups.ConclusionThis analysis quantified the effect of social and demographic factors on racial differences in caesarean delivery, which may guide public health interventions aimed towards reducing racial disparities in caesarean rates. Interventions targeted towards modifying maternal characteristics, such as reducing pre-pregnancy BMI or increasing maternal education, may narrow the gap in caesarean rates across racial and ethnic groups. Future studies should determine the contribution of physician characteristics, hospital characteristics, and structural determinants of health towards racial disparities in caesarean rates.

Birth rate after major trauma in fertile-aged women: a nationwide population-based cohort study in Finland

BackgroundTo date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman.MethodsIn this retrospective register-based nationwide cohort study, data on all fertile-aged (15–44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care. A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, and 1769 in hip or thigh fracture group. The data were subsequently combined with data from the National Medical Birth Register. We used Cox regression model to analyze the hazard for a woman to give birth during 5-year follow-up starting from a major trauma. Women with wrist fractures (4957 women) formed a reference group. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI).ResultsDuring 5-year follow-up after major trauma, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth. The cumulative birth rate was lower in the hip or thigh fracture group in women aged 15–24 years (HR 0.72, CI 0.58–0.88) and 15–34 years (HR 0.65, CI 0.52–0.82). Women with pelvic fracture aged 25–34 years also had a lower cumulative birth rate (HR 0.79, CI 0.64–0.97). For spine fractures and TBIs, no reduction in cumulative birth rate was observed. Vaginal delivery was the primary mode of delivery in each trauma group. However, women with pelvic fractures had higher rate of cesarean section (23.9%), when compared to other trauma groups.ConclusionsOur results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.

Pregnancy outcomes after stoma surgery for inflammatory bowel disease: The results of a retrospective multicentre audit.

AimThere is a paucity of data on pregnancies in women with stomas due to inflammatory bowel disease (IBD). The aim of this study was to assess stoma, IBD, obstetric and neonatal outcomes in pregnant patients with IBD and a stoma.MethodMulticentre retrospective audit in 15 UK hospitals. Pregnancy, stoma and neonatal outcomes were elicited from routinely collected hospital records.ResultsData on 82 pregnancies from 77 patients (mean age 31.4 years, 60.9% Crohn's disease, 35.4% ulcerative colitis, 3.6% IBD‐U) were included. Stoma types included ileostomy in 72 (88%) and colostomy in 10 (12%) women. There was one reported miscarriage, one still birth and 80 live births. Delivery occurred in 58 cases by caesarean section (CS), of which 44 were performed electively and 14 as emergency CS. The overall CS rate was 73%. Premature delivery before week 37 occurred in 19% and birth weight <2,500 g in 17%. Significant stoma related complications occurred during 20 (24%) pregnancies and included stoma prolapse in nine cases (2 required surgery), parastomal hernias in three cases (2 required surgery) and small bowel obstructions in seven cases (3 required surgery).ConclusionsPregnancy for women who previously had stoma formation for IBD is associated with higher rates of caesarean section and stoma complications. Future prospective studies should capture data, including patient reported outcomes, to gather a full picture on the impact of pregnancy after stoma surgery for IBD.

Effect of Depressive Disorders and Their Pharmacological Treatment during Pregnancy on Maternal and Neonatal Outcome.

Purpose: Depressive disorders are related to obstetrical and neonatal complications. The purpose of this study is to evaluate the outcomes of pregnancy in women suffering from depressive disorders, who are treated or not treated with pharmacotherapy during pregnancy. Methods: The maternal and neonatal outcomes of 281 pregnant women with depressive disorders (D group—DG), who delivered their babies at Sant’Anna Hospital of Turin, were compared with those of a control group of 200 depression-free, healthy, pregnant women, who were matched for maternal age (C group—CG). Of the depressed patients, those who received pharmacotherapy during pregnancy (DG-Tr, n = 199, 70.8%) were compared with those who did not (DG-Untr, n = 82, 29.2%). The comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. A linear regression analysis was run to examine the association between APGAR scores at 5 min and certain clinical variables. Results: The women in DG showed higher rates of cesarean section, preterm delivery, induction of labor and SGA babies, and low neonatal weights and 5-min APGAR scores, compared to the untreated patients. Those treated with psychotropic drugs showed lower rates of cesarean section, but lower 5-min APGAR scores, compared to those who were untreated. However, after controlling for confounding variables, the 5-min APGAR scores were linearly associated with neonatal weight and not with the use of psychotropic treatment. No significant differences were observed between the treated and untreated women, regarding the rates of preterm delivery, induction of labor, SGA and low neonatal weight. Conclusion: In pregnant patients with depressive disorders, poorer outcomes are expected vs. healthy controls. Pharmacological treatment is associated with a reduced rate of cesarean section, without inducing other complications for the mother and the newborn.

Hematological Changes and Pregnancy Outcome in COVID-19 Pregnant Patients: A Case–Control Study

Background: Viral infections during pregnancy are associated with adverse maternal as well as fetal outcomes such as higher rates of miscarriage, perinatal mortality, restriction of fetal growth and preterm delivery. Aim of the study: to explore maternal outcomes and hematological alterations in a sample of Iraqi pregnant women. Patients and methods: The current cross sectional study was carried out in Obstetric department in Al Imamain Al-Kadhimain Medical City, Baghdad, Iraq, including a total of 55 full term pregnant women who were grouped into 25 women with SARS-Cov-2 and 30 control pregnant women, starting from January 2021 through December 2021. Results: Fever was the most common symptom, which was reported in 12 cases (48.0 %), and it was followed by cough that was seen in 9 cases (36.0 %). Gastrointestinal symptoms in the form of nausea, vomiting and diarrhea were seen in 2 cases (8.0 %). Leaking liquor was seen in a single case of COVID-19 women. Pregnancy induced hypertension, antepartum hemorrhage and diabetes mellitus were seen in 2 cases of COVID-19 women for each event; with no significant difference between groups. The rate of cesarean section was higher in COVID-19 group in comparison with control group, 19 (76.0 %) versus 13 (43.3 %), respectively and the difference was significant (p = 0.014). Conclusion: COVID-19 at time of pregnancy is accompanied by higher rate of cesarean section because of fetal distress with no significant increase in fetal or maternal mortality rates and the main hematological changes are leukopenia and lymphopenia.

191 Giving birth with COVID-19

Introduction and aims: COVID-19 infection during pregnancy has been associated with preterm birth, higher rates of cesarean section (c-section), fetal compromise, vertical transmission and fetal and maternal mortality. This study aimed to analyze delivery outcomes in pregnant women with COVID-19 during labor. Methods: A cohort study was conducted, which included confirmed cases of COVID-19 during delivery (defined as a positive nasopharyngeal swab for SARS-CoV-2 upon admission to the delivery ward) at a tertiary hospital in northern Portugal between March 2020 and March 2021.

Secondary postpartum hemorrhage: Incidence, etiologies, and clinical courses in the setting of a high cesarean delivery rate.

To evaluate the incidence, etiologies, and clinical outcomes of secondary postpartum hemorrhage in a hospital with a high cesarean section rate and to compare the etiologies of secondary postpartum hemorrhage following cesarean delivery versus vaginal delivery. This retrospective study included 123 women with secondary postpartum hemorrhage who were treated at a tertiary-level hospital between January 2004 and June 2018. Descriptive statistics and the chi-square test were used for data analysis. The incidence of secondary postpartum hemorrhage was 0.21%. The median onset of bleeding was 12 days after delivery. Fifty-two percent of the deliveries were by cesarean section. The most common etiology of secondary postpartum hemorrhage was endometritis (67.5%), followed by retained placental tissue (21.1%). Women who delivered by cesarean section had a higher rate of endometritis (80.0% vs 53.4%) and a lower rate of retained placental tissue (10.8% vs. 32.8%) than those who delivered vaginally. Surgical intervention included uterine evacuation in 29.3% and hysterectomy in 8.1% of the patients. Five percent of women were treated by embolization. Endometritis was the most common cause of secondary postpartum hemorrhage. Women who delivered by cesarean section were less likely to have retained placental tissue but were at higher risk for endometritis and uterine pseudoaneurysm than those who delivered vaginally.

Endometriosis and Isthmocele: Common or Rare?

Higher cesarean section rates and better ultrasound diagnostics have led to a more frequent diagnosis of isthmocele, a cesarean scar defect. Sometimes, endometriosis is found in the isthmocele, but simultaneous extrauterine endometriosis and endometriosis in the isthmocele have not yet been reported. Additionally, the surgical technique to repair the isthmocele is the subject of ongoing controversy. The aim of this study is to analyze a possible correlation between uterine scar (isthmocele) endometriosis and extrauterine endometriosis and to investigate the outcome of laparoscopic isthmocele resection in the rendezvous technique. In this single-center retrospective study, we included 83 women of reproductive age with symptomatic isthmocele undergoing laparoscopic isthmocele repair in rendezvous technique from 2004 to 2020 at the University of Bern. We collected data on patient and surgical characteristics as well as on postoperative outcomes (symptoms, further pregnancy, and pregnancy outcomes) retrospectively. We analyzed and compared these data for patients with and without endometriosis. Endometriosis was diagnosed during surgery in 22 out of 83 operated patients (26.5%). Diagnosis of isthmocele endometriosis (n = 9, 11%) was significantly higher in patients with extrauterine endometriosis (n = 6, p = 0.004). While the duration of surgery was significantly longer for patients with endometriosis (p = 0.006), the groups did not differ with regard to blood loss or complications. In addition, both groups showed similar indications for isthmocele repair (infertility, abnormal uterine bleeding, or dysmenorrhea). Surgery significantly improved abnormal uterine bleeding (χ2 p < 0.001), dysmenorrhea (χ2, p = 0.03), and infertility (χ2, p < 0.001). Regardless of the presence of endometriosis, 25 of 40 (63%) infertile patients became pregnant after surgery. In one out of eight pregnancies, however, we observed scar complications during pregnancy such as uterine scar pregnancy (n = 3), uterine scar dehiscence (n = 3), and placenta previa (n = 1). Endometriosis is a non-negligible intraoperative finding in patients with symptomatic isthmocele. The laparoscopic approach in the rendezvous technique is safe and effective. Therefore, this method should be recommended, especially in women with secondary infertility, and preoperatively simultaneous endometriosis resection should be discussed with the patient. In follow-up, postoperative pregnancies have to be monitored with care.

Maternal and neonatal outcome in COVID-19 infection - A tertiary care centre study

With exponential increase in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2/COVID-19) worldwide Pregnant women and their fetuses are more susceptible to infection and poor outcomes. The risks to the mother appear to increase during the last trimester. The aim of this study was to summarize the maternal and neonatal outcomes of pregnant women infected with COVID-19 during labour.Eligibility criteria includes pregnant women positive for COVID-19 during the time of labour as detected by real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection.A total of 30 pregnant women positive for COVID-19 as confirmed by RT-PCR, were included in the study. 14 cases (46.6%) had preterm deliveries and LSCS was the preferred mode of delivery in 12 of 30 i.e., 40% cases. There was a tendency for low Apgar score at birth, higher rates of IUD, fetal distress, NICU admissions. There was 5 IUD and one neonatal death. This study confirms that COVID-19 infection during pregnancy increases the risk of several adverse outcomes, including slightly higher rates of caesarean section, low birth weight, Preterm birth, IUGR, fetal distress, NICU admissions. Proper antenatal care, vaccination against COVID-19 for pregnant and lactating mothers should be encouraged to Prevent further spread of infection. Early diagnosis, referral and emergency management should be done to safeguard both mother and fetus.

Distribution of cesarean delivery by Robson classification and predictors of postspinal anesthesia hypotension in Windhoek referral hospitals: A cross-sectional study.

There are concerns that high cesarean section (CS) rates are driven by nonmedical indications and unmitigated maternal hypotension following spinal anesthesia (SA) has materno fetal effects. Our objective was to investigate CS rates using Robson classification, identify patient groups for focused intervention as well as assess the incidence and predictors of maternal hypotension following SA for cesarean delivery. A cross sectional design was employed over 3 months (February-April, 2019). Data about total deliveries (vaginal and operative) were obtained from the hospital medical records. For parturients who had CS, variables which covered maternal characteristics, conduct of anesthesia, and the index pregnancy according to Robson classification system were entered into a proforma designed for the study. The total deliveries were 3031, of which 556 were CSs, giving a CS rate of 18.3%. Twenty one nonconsenting parturients were excluded, so 535 responded. Robson groups 5, 10, and 1 combined contributed 75% [401/535] to the overall CS. Two or more previous CS, 29.7% [159/535], was the main indication for performing CS, followed by maternal request 12.9% [69/535]. The incidence of maternal hypotension was 62.6% (293/468); the independent predictors were elective CS and having comorbidities. We found a low CS rate and Robson groups 5, 10, and 1 were the major contributors - previous CS (≥2) and maternal request were the predominant indications for performing CS. The independent predictors of SA induced hypotension were presence of comorbidities and elective CS.

Leiomyomas in pregnancy

Uterine fibroids are the most common benign tumors affecting female genital tract, responsible for a high morbidity across fertile age women, with a prevalence of 0,1-11% among pregnant women. Although generally asymptomatic, they can lead to a series of symptoms and complications such as pain, infertility, miscarriages, antenatal bleeding, postpartum hemorrhage, preterm labor, fetal malpresentation, placental abruptio and high cesarean section rates. The purpose of review is to update information regarding fibroids specifications and their correlation with pregnancy outcomes as well as fibroids management during pregnancy. Because of uterine fibroids heterogeneity and lack of large, randomized trials there are encountered discrepancies among studies, but it was observed that uterine fibroids increase the risks of negative obstetrical outcomes, especially when it goes to large, multiple, submucous and retroplacental myomas. Conservative management during pregnancy is advised, but in special situations myomectomy could be recommended and possible. Trial of labor should be offered to pregnant women even if they have large uterine fibroids, or previous myomectomy excepting fibroids obstructing the birth canal or patients who underwent extensive surgery for fibroids removal.

From coercion to respectful care: women\u2019s interactions with health care providers when planning a VBAC

BackgroundIn many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective.MethodsA national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions.ResultsTwo main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care.ConclusionsIn this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.

Pregnancy and delivery after pelvic fracture in fertile-aged women: A nationwide population-based cohort study in Finland

ObjectiveOnly a few small studies have assessed the effects of pelvic fractures on pregnancies, deliveries, and rates of cesarean sections. We aimed to evaluate the effect of pelvic fractures on subsequent pregnancy and delivery in Finland. Study designIn this retrospective register-based nationwide cohort study, data on all fertile-aged (aged 15–49) women with a pelvic fracture during our study period (1998–2018) were retrieved from the Care Register for Health Care. The data were subsequently combined with data from the National Medical Birth Register. Women with pelvic fracture before pregnancy were compared with a no-fracture group consisting of 621 141 women who had had 1 156 723 singleton deliveries without a preceding pelvic fracture. We used logistic regression to analyze preterm deliveries, cesarean sections, and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). ResultsA total of 2 878 women with a previous pelvic fracture were identified. Of these, 596 women had 1024 singleton deliveries after pelvic fracture. In the no-fracture group, 621 141 women had 1 156 378 singleton deliveries. Compared to the no-fracture group, women with a previous pelvic fracture had higher rates of cesarean sections (22.6% vs 15.9%) (AOR 1.55 CI 1.32–1.80), higher rate of preterm deliveries (6.2% vs 4.6%) (1.32 CI 1.01–1.69), and a higher rate of neonates requiring intensive care unit treatment (13.5% vs 10.0%) (AOR 1.35 CI 1.13–1.62). ConclusionVaginal delivery was the primary mode of delivery despite the higher rate of cesarean section among women with a previous fracture of the pelvis. The rate for preterm deliveries and need for neonatal intensive care was also higher, but the clinical importance of these findings is unclear. Our results suggest that vaginal delivery after fractures of the pelvic circle is generally safe for both mother and neonate.

Live births of immigrant mothers in Brazil: A population-based study

IntroductionMigration has become a major challenge for many countries, and women constitute half of the migrants in the world. Few studies have been conducted on migrant mothers in Brazil. We aim to identify differences in the pregnancies, childbirths, and live birth (LB) indicators of immigrant women, compared with those of Brazilian women living in the municipality of São Paulo (MSP), Brazil. MethodsThe LB characteristics of immigrant mothers from Bolivia (15,886), China (3861), Paraguay (1370), and Peru (1039) were compared with those of Brazilian mothers (967,921) living in the MSP between 2012 and 2017. Pearson's chi-square test was used to compare proportions with a significance level of 5%. ResultsTeenage pregnancy and low education were more frequent among Bolivian (13.1 and 31.7%, respectively) and Paraguayan mothers (13.1 and 36.2%). Bolivian women exhibited a high percentage of late-onset prenatal care (8.7%), few prenatal visits (14.3%), vaginal birth (77.0%), home delivery (1.6%), and postterm (3.6%). Bolivian (13.6%), Peruvian (10.6%), and Paraguayan (7.9%) women exhibited a higher prevalence of macrosomia than Chinese (4.3%) and Brazilian (4.0%) women. There was a high prevalence of preterm and low birth weights among Paraguayan (12.5 and 7.7%, respectively) and Brazilian mothers (11.0 and 9.7%) and a high rate of cesarean sections among Chinese (42.1%) and Brazilian (53.5%). ConclusionDifferences were observed in the sociodemographic profiles for the pregnancies, childbirths, and LBs of immigrant mothers, in view of their increase and diversity in the MSP. There was greater vulnerability among immigrant mothers, compared with Brazilian mothers, particularly regarding access to prenatal care.

A study of antepartum haemorrhage and its maternal and perinatal outcome at tertiary care hospital in western Rajasthan

It is an obstetric emergency contributing to a significant amount of perinatal morbidity and mortality. In developed countries maternal mortality has decreased due to better emergency obstetrical facilities. In India it is still high due to associated problems like anemia, difficulty in transport facilities, lack of awareness, lack of blood transfusion facilities in Rural India. A hospital based retrospective analysis is done Obstetric haemorrage is leading cause of maternal mortality in the world [3]. The prevalence of APH varies from hospital to hosopital i.e.0.5% to 5% [1]. There are many complications which are associated with APH like malpresentation, premature labor, PPH, shock, higher rate of caesarean sections, peripartum hysterectomy and maternal death, perinatal complication include premature delivery, low birth weight, intrauterine death, congenital malformation and birth asphyxia [4, 5]. After studying of Demographic profile of the cases, it was found that better provision of antenatal services is very much essential for prompt management and to reduce APH related complications. To avoid maternal and perinatal complications of APH following measures can be taken. All cases of APH should be considered under high risk pregnancy and proper management plan should be followed.