History Of Cesarean Section Research Articles

Spontaneous uterine rupture in pregnancy after treatment of Asherman syndrome

Study objectiveWomen with Asherman syndrome are at high risk of recurrent adhesions and pregnancy complications. Spontaneous uterine rupture is a rare but life-threatening complication, associated with severe maternal and fetal morbidity and mortality. Uterine ruptures can occur after extended induction of labor or a history of cesarean section, whereas spontaneous uterine rupture in an unscarred uterus is rare. Aim of this study is to evaluate the incidence of spontaneous uterine rupture among women with Asherman syndrome treated by hysteroscopy and without a history of cesarean section. DesignProspective cohort study. SettingAsherman Expertise Center of the Spaarne Gasthuis, the Netherlands. PatientsWomen were defined by as patients with Asherman syndrome when they had one or more clinical features and the presence of hysteroscopically confirmed intrauterine adhesions. InterventionsHysteroscopic adhesiolysis and a second-look hysteroscopy two months after the initial procedure. Measurements and resultsData on the severity of adhesions and ongoing pregnancy after treatment were collected prospectively. A total of 428 women with Asherman syndrome were included, 4 women (0.9%) experienced spontaneous uterine rupture. The timing varied, none of the affected women were in active labor and the occurrence of uterine rupture was not related to the severity of adhesions. Ruptures were all found in the fundus. One woman had a history of perforation of the uterine wall located in the fundus. Neonatal outcomes were poor, two cases had intrauterine neonatal death and two cases had long-term lifelong disability. One woman had a second uterine rupture. ConclusionWomen with Asherman syndrome are at risk of uterine rupture, a pregnancy complication with significant consequences that is challenging to predict and may also be associated with history of uterine perforation. Clinicians should be aware of this risk in women treated with hysteroscopic adhesiolysis and consider counseling these patients accordingly prior to treatment.

DETERMINANT FACTORS AFFECTING THE INCIDENCE OF PLACENTA ACCRETA

Background: Placenta accreta is a rare condition during pregnancy characterized by abnormal placentation that can increase maternal morbidity and mortality. The increase in the incidence of placenta accreta is directly related to the increase in section caesarean rates. The maternal mortality rate in NTB in 2021 was 15% due to hemorrhage, in 2022 there was an increase in the incidence of placenta accreta at the NTB Provincial Hospital. The aim of the research is to identify the determinant factors affecting the incidence of placenta accreta at the NTB Provincial Hospital in 2022. Methods: This was a descriptive observational study. The population in this study were all mothers who delivered at the NTB Provincial Hospital from January to December 2022. The sample number was 50 patients diagnosed with placenta accreta. The sampling technique used was total sampling with the research variable of maternal characteristics. Data were collected from the medical records of mothers with placenta accreta from January to December 2022, and the results were analyzed using descriptive analysis. Results: Placenta accreta patients were more common in mothers with age ≤ 35 years with a median of 34.34 ± 4.28, multiparous parity (76%), overweight BMI (54%), 3-9 years labour spacing (82%), history of SC ˂ 2 times (52%) and ≥ 2 times (48%), and with a history of uterine surgery 24%. Conclusion: Determinant factors that affect the incidence of placenta accreta in NTB Provincial Hospital in 2022 are mothers with age < 35 years, multigravida, overweight body mass index, mostly with a parity of 3-9 years, without degenerative diseases, all have a history of cesarean section and almost a quarter have a history of other operations on the uterus.

Trend, prevalence, and associated factors of uterine rupture at Nekemte Specialized Hospital, Oromia Regional State, Western Ethiopia

Maternal morbidity and mortality have long been among the world’s most challenging health issues. Uterine rupture is one of the peripartum complications that kills almost one in every thirteen mothers. However, there is limited evidence on uterine rupture trends, proportions, and determinants. Thus, this study assessed the trend, prevalence, and associated factors of uterine rupture at Nekemte Specialized Hospital, Oromia Regional State, Western Ethiopia. An institution-based cross-sectional study was conducted among 2661 clients selected using a systematic random selection technique among the data collected for the project between January 2014 and December 2022 at Nekemte Specialized Hospital. Data were collected through an interview-administered questionnaire and card review from March 2023 to August 2023. The collected data were checked, coded, and entered into Epi info version 7.2 and then exported to SPSS Version 27 for analysis. Logistic regression models were fitted to identify the factors of uterine rupture. Adjusted odds ratio with 95% Confidence Interval was estimated to measure the strength of the association, and statistical significance was declared at a p-value less than 0.05. The trend of uterine rupture declined from 1.54% in 2014 to 0.93% in 2022. The overall prevalence was 3.53% (95%CI: 2.7%, 4.3%). Low household income (Adjusted OR = 3.75, 95%CI: 1.97, 7.13), grandmultiparity (Adjusted OR = 7.78, 95%CI: 4.70, 12.88), having a history of obstetrics complications such as prolonged labor (Adjusted OR = 3.78, 95%CI:2.11, 6.75), a history of cesarean section (Adjusted OR = 2.49, 95%CI:1.42, 4.35), and history of uterine repair (Adjusted OR = 18.01, 95%CI: 6.81, 47.64) were significantly associated with uterine rupture. This finding showed that the trend is declining, and the proportion of uterine rupture is still higher. A more vigilant approach to increase access to lower-income mothers, prevent prolonged and obstructed labor, and maintain antenatal care with complete packages and a referral system are issues to be addressed to minimize the chance of uterine rupture among women.

Is domestic violence during COVID-19 in lactating women related to infantile colic? An important question

BackgroundPsychosocial factors such as maternal stress in lactating women were shown to be related to an increased risk of infantile colic because the infants can be affected through breast milk. Therefore, domestic violence against lactating mothers can be effective on the infants’ health. It is also demonstrated that domestic violence against women has increased following the COVID-19 pandemic and quarantine. Therefore, this study aims to assess the relationship between domestic violence against breastfeeding women during COVID-19 and the incidence of infantile colic.MethodsThis was a case-control study that was conducted on 356 lactating mothers who attended Bentolhoda Hospital in Bojnoord-Iran from November 2021 to August 2022. The participants were exclusively breastfeeding mothers who were under 6 months infants. Mothers with and without infantile colic infants were considered the case and control groups, respectively. Two questionnaires were used for data collection including a demographic questionnaire, and a questionnaire to assess domestic violence against women during the quarantine period of Corona pandemic. The data was analyzed using SPSS-V22 and Pearson Spearman correlation and linear regression tests.ResultsThe results showed that women in the case group had a significantly higher score for “sexual violence and restraint” than women in the control group [0.59 ± 0.34 versus 0.62 ± 0.25 (Mean ± SD), respectively] (P < 0.05). The chance of infantile colic was higher among the infants of mothers who experienced domestic violence, but it was not statistically significant (OR = 1.236, P = 0.573). Significant relationships were found between the infantile colic and the history of abortion (OR = 1.430, P = 0.028) and cesarean section (OR = 1.723, P = 0.044).ConclusionDomestic violence during pregnancy can potentially increase infant colic through breast milk. Although our findings need more investigation, it can be recommended to plan the direction of screening for domestic violence and providing the necessary care and counseling to the parents in perinatal care services to prevent infantile colic and improve the infant’s health.

Gitelman Syndrome in a 37-Years Old Woman with Urinary Tract Syndrome and History of Caesarean Section: A Case Report

Gitelman Syndrome (GS) is a rare genetic disorder often underdiagnosed due to its non-specific symptoms that can appear from neonatal stages to adulthood. It is more frequently observed in Asians, with a prevalence of approximately 1 in 40,000 people. Accurate diagnosis requires a comprehensive clinical interview and laboratory examinations. This report presents the case of a 37-year-old woman with GS who also experienced a urinary tract infection and had a history of cesarean section. Upon admission, she reported feeling fatigued and weak in all extremities. She had undergone a cesarean section a month prior due to pre-eclampsia. Initial laboratory tests revealed hypokalaemia, hyponatremia, and hypochloraemia. Further evaluation during hospitalization detected a urinary tract infection, hypocalciuria, and hypomagnesemia. The patient also suffered from carpopedal spasms and muscle cramps. Treatment included magnesium sulfate, calcium gluconate, potassium chloride, and sodium chloride infusions to restore electrolyte balance. The patient was discharged after six days, with a diagnosis of Gitelman Syndrome, which was unusual given her late onset of symptoms, as most cases are identified in childhood. The clinical presentation was largely driven by the patient’s electrolyte imbalances, especially hypokalaemia and hypomagnesemia, with hypomagnesemia further contributing to hypocalcemia and vitamin D deficiency. The patient’s symptoms improved after appropriate electrolyte supplementation. This case emphasizes the importance of a detailed clinical history and laboratory assessments in diagnosing GS, along with timely correction of electrolyte disturbances to improve the patient’s condition and prevent complications.

Potential Risk Factors for Developing Cesarean Scar Pregnancy in Women With a History of Cesarean Section.

Cesarean scar pregnancy (CSP) occurs in 0.2%-0.5% of women with a previous cesarean section globally. Multiple factors influence the development of CSP; however, to date, the critical factors contributing to the development of CSP have not been fully explored due to its relatively low incidence. Moreover, CSP can be clinically categorized into type 1 and type 2 CSP. In this retrospective study with a large sample size, we investigated potential risk factors that could contribute to CSP development. Two hundred-one women diagnosed with CSP, either type 1 or type 2 CSP, and 1700 pregnant women with a history of cesarean section but without CSP diagnosis in subsequent pregnancy were included. Gravidity, previous live birth(s), consecutive cesarean section(s), surgical abortion(s), the interval between the pregnancies, and maternal age were compared between the 2 groups. Gravidity, the number of previous live births, the number of previous consecutive cesarean sections, and the number of surgical abortions were significantly associated with CSP development in women with a past cesarean section. This association was regardless of the subtypes of CSP. Notably, the interval between 2 pregnancies was also significantly associated with CSP development, but this association was only seen in type 2 CSP. However, maternal age was not an independent risk factor for CSP development. Additionally, a higher incidence of CSP was observed in China compared to that reported in the literature. In addition to a previous cesarean section, our study highlights at the number of surgical abortions also contributes to the development of CSP.

Childbirth at advanced reproductive age: the impact of biopsychosocial factors on the mode of delivery

Introduction Contemporary society reflects a clear trend towards delayed motherhood, raising significant concerns in the management of pregnancy and childbirth in women of advanced reproductive age. In this context, the mode of delivery and associated risks for this age category require increased attention. Birth methods have been thoroughly examined to identify risks and influencing factors within this specific cohort. Material and methods A descriptive cross-sectional study was conducted on a sample of 528 women. Data were collected using a pre-tested semi-structured questionnaire, and respondents were divided into three groups based on the mode of delivery: vaginal delivery, planned cesarean section, and emergency cesarean section. Sociodemographic, anthropometric, medical, and obstetric characteristics were analyzed using linear regression. Statistical analyses included descriptive and inferential statistics (Chi-square), with a 95.0% confidence interval. Results The analysis revealed statistically significant variations in the mode of delivery based on maternal age (p=0.013) and paternal age (p=0.001), with an increased rate of cesarean sections at more advanced ages. Significant variations were also found in relation to area of residence (p=0.003), education level (p=0.001), nature of work (p=0.028), GP appointments (p=0.020), number of GP appointments(p&lt;0.001), number of obstetrician appointments (p=0.032), time of informing on risk factors (p=0.005), parity (p&lt;0.001), multiple pregnancies (p=0.016), mode of first delivery (p&lt;0.001), pregnancy complications (p=0.003), delivery complications (p&lt;0.001), gestational age at birth (p=0.017), Apgar scores at 1 and 5 minutes (p&lt;0.001). Conclusions Advanced reproductive age has been associated with a higher risk of cesarean section compared to vaginal delivery. The influence of age is modulated by various sociodemographic, medical, and obstetric characteristics, including area of residence, education level, history of cesarean section, parity, pregnancy and delivery complications, pre-existing chronic conditions, antenatal care and provision of information on risk factors.

Low placenta at the mid trimester anomaly scan—A cause for concern?

AbstractObjectiveThis study was aimed to assess the predictive validity of internal os distance (IOD) in mid‐trimester scan for the prediction of third‐trimester low‐positioned placenta, and to define a cut‐off of IOD at which third‐trimester low‐positioned placenta could be identified, see the association of placental site (anterior/posterior), previous history of cesarean section with abnormal location of placenta in third trimester and see the maternal and neonatal outcomes.MethodsIt was a prospective cohort study of women with low‐positioned placenta (IOD &lt; 20 mm) at mid‐trimester anomaly scan followed up in third trimester till birth. Relative risks for a low‐positioned placenta in the third‐trimester were calculated for women with posterior versus anterior, low‐lying placenta versus placenta previa and positive versus negative history of cesarean section. Multilevel likelihood ratios and corresponding ROC curves for different ranges of IOD were calculated.ResultsWomen with posterior placenta had a high risk of low positioned placenta compared to anterior placenta (9.28% vs. 0.74%); RR 1.45, similarly women with placenta previa had high risk compared to low lying placenta (68.57% vs. 1.69%); RR 6.51, so did the women with previous cesarean section (9.41% vs. 5.87%); RR 1.47.Conclusions93.42% placenta which were low positioned in mid trimester were normally situated in third trimester. The cut‐off for IOD in anterior placenta was −40 mm and in posterior placenta was 14.3 mm. IOD measurement and interpretation seems promising.

Post-Caesarean Surgical Site Infections at the Reference Health Center of Commune V (Mali)

During this study period, we recorded 10187 deliveries, including 2763 caesarean sections. Surgical site infections were found in 102 caesarean sections, i.e. 3.69%. We found that age over 35 years, history of diabetes, asthma, sickle cell anemia, obesity (BMI &gt; 30 kg/m2) and history of caesarean section were risk factors for the occurrence of an infection at the surgical site. The bacteriological profile was dominated by Staphylococcus Aureus (21%) followed by Klebsiella Pneumoniae (20%) and Escherichia Coli (16%). Superficial infection was the most common at 65%. Most of the germs were sensitive to imipenems; to the ertapenems; amikacin; gentamycin; colistin and ciprofloxacin. Klebsiella was the germ most resistant to common antibiotics.

Diagnostic value and efficacy evaluation value of transvaginal color doppler ultrasound parameters for uterine scar pregnancy and sub-type after cesarean section

ObjectiveWe aimed to probe the diagnostic value of transvaginal color Doppler ultrasound (TV-CDU) parameters in cesarean scar pregnancy (CSP) and CSP sub-types, and the relevant factors affecting patients’ surgical effects.MethodsSeventy-five CSP patients (all requested termination of pregnancy) were selected as the observation group, and 75 normal pregnant women with a history of cesarean section were selected as the control group. All the study subjects underwent TV-CDU and their cesarean scar muscle (CSM) thickness, minimum sagittal muscle thickness and resistance index (RI) of blood flow in the anterior wall of the lower uterine segment were calculated. The diagnostic value of CSM, minimum sagittal muscle thickness, and RI for CSP and CSP sub-types was analyzed. The patients in the observation group were grouped into the effective group and the ineffective group according to whether the surgical treatment was effective or not, and the independent factors affecting CSP efficacy were analyzed.ResultsThe observation group had lower CSM, minimum sagittal muscle thickness and RI than the control group. CSM, RI, and minimum sagittal thickness in patients with type II CSP were lower than those in patients with type I, and these indicators in patients with type III were lower than those in patients with type II. The area under the curve (AUC) of CSM, RI and minimum sagittal muscle thickness in combination for CSP diagnosis and the AUC for CSP sub-types were higher than those of each indicator alone. Gestational sac size and CSM were independent factors affecting CSP treatment.ConclusionChanges in TV-CDU parameters facilitates CSP diagnosis after cesarean section. CSM, minimum sagittal muscle thickness changes, and RI in combination possesses high value for CSP diagnosis and CSP sub-types. Gestational sac size and CSM are independent factors affecting CSP treatment.

Analysis of Risk Factors Associated with the Incidence of Placenta Accreta at an Indonesian Tertiary Hospital

Highlights:1. The increased incidence of placenta accreta is contributed significantly by parity classification, a history of cesarean section, body mass index, and interbirth interval.2. The findings of this study can be used as an additional reference in determining the risk of placenta accreta in pregnant women, specifically as an input in screening and antenatal care programs for pregnant women to provide early detection and appropriate management. Abstract The incidence of placenta accreta during pregnancy constitutes a serious problem in reproductive health. This complication has increased significantly over the last few decades, especially in developed countries where cesarean deliveries have also risen. Placenta accreta spectrum can cause very severe bleeding and potentially lead to other serious complications. The purpose of this study was to analyze the risk factors associated with the incidence of placenta accreta in women giving birth at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This quantitative study used an analytical observational research design, specifically the case-control approach. The study sample was all mothers who gave birth at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, between 2019 and 2023. In addition to a univariate analysis, the data were subjected to bivariate analysis using a two-sample independent t-test or Mann-Whitney test for ordinal data and for nominal data using the Chi-square test as well as multivariate analysis using logistic regression (p&lt;0.05). The results showed that parity, a history of cesarean section, body mass index, and interbirth interval were the variables identified as significantly associated with placenta accreta. According to the logistic regression analysis, parity, a history of cesarean section, and a history of curettage were identified as the primary determinants of placenta accreta incidence. The classification of parity was found to have the most significant relationship to the incidence of placenta accreta. This study concluded that parity classification, a history of cesarean section, body mass index, and interbirth interval are the significant risk factors contributing to the increased incidence of placenta accreta at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Analysis of Risk Factors Associated with Gestational Diabetes Mellitus: A Retrospective Case-Control Study.

Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM. A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed. The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥30 years old, body mass index (BMI) in early pregnancy≥24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥30 years old (≥30 vs <30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183-3.878, p=0.012), BMI≥24.0 kg/m2 (≥24.0 kg/m2 vs 18.5-23.9 kg/m2, OR: 1.887, 95% CI: 1.041-3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022-3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046-7.863, p=0.041) were associated with GDM. Age of pregnant woman ≥30 years old, BMI≥24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.

Forceps-assisted delivery leads to the formation of a giant uterine isthmus diverticulum: A case report

The formation of uterine diverticula following forceps-assisted delivery is a rare complication characterized by irregular and prolonged postpartum menstruation. While ultrasound and MRI can assist in diagnosis, the identification of this condition often suffers from delayed recognition due to an absence of cesarean section history. Case Report: We present a case involving a 31-year-old woman who developed a uterine diverticulum as a result of forceps delivery and was misdiagnosed for four years. Conclusions: This case report highlights an uncommon complication associated with forceps-assisted delivery—uterine diverticula—and proposes strategies for the early identification and prevention of such conditions following these types of deliveries.

Frequency of Placenta Previa among Women with Previous Cesarean-Section

Placenta Previa was defined as when the placenta was attached to the lower uterine segment, poses significant risks, including antepartum hemorrhage and maternal mortality. The incidence was rising, attributed partly to increased cesarean sections and advanced maternal age. Objective: To determine the frequency of placenta Previa among women with previous cesarean-sections. Methods: This cross sectional study was carried out at a Teaching Hospital of Sialkot, from June to December 2021. The sample size was 147 pregnant females. These pregnant females have a history of cesarean section. The non-probability Consecutive sampling technique was used, and data were analyzed by using SPSS version 25.0. Results: Among those, 16.3% had placenta Previa, which increased significantly in women with &gt;2 previous cesarean sections to 26.4% (p = 0.003). Regarding parity, the increase in the risk of placenta Previa was not significant: 12.8% for parity &lt; 3 and 20.3% for parity ≥ 3 (p = 0.087). However, in the stratified analysis by BMI, this became significant: 11.0% for normal-weight, 18.6% for overweight, and 66.7% for obese women (p = 0.001). There was no significant difference concerning age groups, p = 0.177. Such findings of the significant associations of placenta Previa with such factors as BMI and number of cesarean sections indicate that great attention to monitoring should be paid. Conclusion: Hence concluded that previous cesarean sections strongly correlate with placenta previa in subsequent pregnancies. Such findings underscore the need for rigorous monitoring and proactive measures, especially in cases of multiple cesarean deliveries, in the management of associated complications.

Maternal Outcome of Pregnancy with Previous History of Caesarean Section with Central Placenta Previa Admitted into DMCH Gynae Department (6 months study)

Background: Placenta previa, a condition where the placenta is abnormally positioned in the lower uterine segment, poses significant risks to both maternal and neonatal health. It has become more prevalent with increasing cesarean deliveries, advanced maternal age, high parity, and assisted reproductive technologies. The impact of placenta previa on subsequent pregnancies, especially in women with a history of cesarean sections, remains an area of concern due to potential complications such as hemorrhage, transfusion needs, and adverse outcomes like peripartum hysterectomy. Objective: This study aimed to assess the maternal and neonatal outcomes in pregnancies with a history of cesarean sections complicated by central placenta previa, admitted to the Department of Obstetrics and Gynecology at DMCH from January 2023 to June 2023. Methodology: A Descriptive Cross sectional study was conducted using medical records from the Department of Obstetrics and Gynecology at DMCH. We analyzed data from 104 women with central placenta previa and previous cesarean sections. Diagnostic criteria were based on trans-abdominal or transvaginal ultrasound. Statistical analysis was performed using SPSS v21.0, employing chi-square and Mann–Whitney U tests for categorical and continuous variables, respectively. Multivariate analysis assessed the association between a history of placenta previa and adverse maternal and neonatal outcomes, with significance set at P &lt; 0.05. Results: The majority of patients were aged between 29-39 years (58.7%). Most had a parity of 1 or 2 (75.0%) and were in their 3rd or 4th gravida category (64.4%). A predominant number were between 35-38 weeks gestation (68.3%). APH was present in 65.4% of patients, and the average number of transfusions required was 4. The uterus was preserved in 63.5% of cases. 36.5% cases peripartum hysterectomy was performed. Maternal outcomes showed a 93.3% improvement rate, with 6.7% mortality. Neonatal outcomes included 86.5% .....

Navigating the unexpected: Insights into bladder injuries during emergency cesarean deliveries

Bladder injury is a recognized complication of emergency cesarean sections, yet comprehensive studies elucidating its incidence and associated risk factors are limited. This retrospective study analyzed data from emergency cesarean deliveries performed over a three-year period at a tertiary care center. Cases with documented bladder injury were identified, and relevant clinical variables including patient demographics, surgical details, various risk factors, and obstetric history were collected and analyzed.Among the emergency cesarean cases reviewed (n= 12218), bladder injury was identified in 22 cases making a incidence rate of 0.18%. The majority of injuries occurred during the initial phase of uterine incision. Significant risk factors associated with bladder injury included a history of previous cesarean sections, presence of adherent placenta, and intraoperative adhesions. Distribution analysis revealed varying prevalence rates across different clinical variables.Bladder injury represents a notable complication of emergency cesarean deliveries, necessitating a comprehensive understanding of associated risk factors and preventive measures. This study contributes valuable insights into the epidemiology and clinical correlates of bladder trauma in urgent obstetric interventions, emphasizing the importance of tailored interventions to enhance patient safety and reduce maternal morbidity.

Malignant Transformation of Abdominal Wall Endometriosis: A Case Report

Background: The carcinogenic potential of parietal endometriosis is poorly understood, making it difficult to diagnose and uncertain how to treat it. The prognosis for this complication of an abdominal scar is rather poor. In the literature, the survival rate only reaches 57% with a short follow-up of 20 months. The most common histological form is clear cell carcinoma, followed by endometrioid carcinoma. Radical surgery is the main treatment. Good operating technique with appropriate care during cesarean sections can prevent this complication of endometriosis. The starting point is usually a caesarean section scar. We report the case of a 44-year-old woman with a history of caesarean section who presented with recurrent parietal endometriosis, which transformed into clear cell adenocarcinoma.

Predictive model for postpartum hemorrhage requiring hysterectomy in a minority ethnic region.

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, and hysterectomy is an important intervention for managing intractable PPH. Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates. To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan, China, to help guide clinical decision-making. The study included 23490 patients, with 1050 having experienced PPH and 74 who underwent hysterectomies. The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model, and its predictive efficacy was subsequently evaluated. The proportion of hysterectomies among the included patients was 0.32% (74/23490), representing 7.05% (74/1050) of PPH cases. The number of deliveries, history of cesarean section, placenta previa, uterine atony, and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy. Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953 (95% confidence interval: 0.928-0.978) with a sensitivity of 90.50% and a specificity of 90.70%. The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan, China.

Risk factors of chronic endometritis in women who have undergone hysteroscopy: a prospective nested case–control study

There is limited research on risk factors for chronic endometritis regarding reproductive history and clinical symptoms. Thus, this nested case–control study identified risk factors for chronic endometritis in women who have undergone hysteroscopy. Endometrial tissue sections were obtained from 502 women with intrauterine disorders who underwent hysteroscopy. Chronic endometritis was diagnosed via CD138 immunostaining. The women were divided into two groups: 271 women without chronic endometritis and 231 women with chronic endometritis. The prevalence of chronic endometritis was 46%. Univariate logistic regression revealed that prolonged menstruation and intermenstrual bleeding were associated with chronic endometritis, and subsequent multivariate logistic regression analyses showed that these were further independently associated. With univariable logistic regression, the gravidity and abortion history were correlated with chronic endometritis; however, no significant correlation was found with the adjusted odds ratio (OR) of 0.74 (95% confidence interval [CI] 0.46–1.19) or 0.76 (95% CI 0.58–1.11), respectively. No significant correlation was found between caesarean section history and the rates of chronic endometritis. No significant difference was found in all other variables between the three groups with > 5, ≤ 5 plasma cells and in a unknown group. Prolonged menstruation and intermenstrual bleeding were risk factors associated with chronic endometritis. Chronic endometritis should be considered and CD138 immunohistochemical examination should be recommended in women with these symptoms.

Study on the value of MRI in locating the internal OS of the cervix and influencing factors

The position of the internal os of the cervix reported in the literature was inconsistent on MRI images. Additionally, the practical impactful data influencing the internal os located by MRI is limited. We aimed to confirm the position of the internal os of the cervix on MRI images, and the influencing factors locating the the internal os by MRI. A single-center retrospective study was conducted. Data from 175 patients who underwent total hysterectomy for stage I endometrial cancer were collected. The internal os of the cervix is positioned as the starting point for measuring the length of the cervix on MRI images. On dynamic contrast-enhanced MRI (DCE-MRI), the section formed by the enhancement difference between the uterus and cervix, and on T2-weighted imaging(T2WI), the section formed by the physiological curvature of the uterus and the low signal intensity of the cervical stroma were used as starting points. The results showed no statistically significant difference compared with the removed uterus specimens (p = 0.208, p = 0.571, p = 0.804). A history of cesarean section(p < 0.001), irregular vaginal bleeding for more than three months(p < 0.001), cervical adenomyosis(p = 0.043), and premenopause(p = 0.001) were not conducive to locating the internal os of the cervix by MRI. Our findings provide valuable information and confirm the position of the internal os of the cervix on MRI images, and the several important infuencing factors. We hope that some patients will benefit from our study.