History Of Prior Cesarean Section Research Articles

Prior Caesarean Section Delivery Increases the Risk for Seroma Development in Abdominoplasty Patients: Our Experience With 746 Patients.

Complications after body-contouring surgery is a field of great interest. Recognition of patient-related characteristics contributing to a greater risk for complication is of the utmost importance in improving the quality of care and safety profile of aesthetic procedures. Prior history of cesarean section and its impact on adverse events after abdominoplasty has yet to be investigated and defined. Evaluate the effect of prior cesarean section on the risk for adverse events in abdominoplasty. The medical records of 746 eligible patients were reviewed and relevant information was extracted. Stratification of patients based on prior history of CS was followed by statistical analysis of differences between the groups. Relevant regression models were implemented to further understand the data. Seven-hundred and forty-six patients were included in the study, of which 308 (43.1%) had history of CS delivery. the group did not differ in terms of baseline demographic and surgical details, except for greater hemoglobin level (P value= 0.007).analysis of complication rates found a statistically significant increase in the risk for seroma development in the group of patients with history of CS delivery (P value= 0.031) which correlates to a 65% increase in the risk for complications (OR= 1.65, 95% CI 1.07-2.56). Medical history of CS increased the risk for seroma development in the postoperative period following abdominoplasty. Several potential pathogenic mechanisms exist, and further prospective research to further characterize the association.

10612 Laparoscopic Resection of Uterine Niche in a Patient with a History of Prior Cesarean Section

10612 Laparoscopic Resection of Uterine Niche in a Patient with a History of Prior Cesarean Section

Term Delivery Complicated by Uterine Rupture with No Prior History of Cesarean Section or Uterine Curettage Following Oxytocin Use and Arrest in Second Stage of Labor: A Case Report.

BACKGROUND Uterine rupture during delivery in an unscarred uterus may be associated with oxytocin dose during second stage arrest and with underlying maternal factors. This report is of a 34-year-old woman, gravida 5, para 3, with no previous history of cesarean section (CS), who had a uterine rupture at term delivery following the use of oxytocin for second-stage arrest. CASE REPORT A 34-year-old Afghani woman, gravida 5, para 3 was admitted at term for delivery. The current pregnancy had been normal and the estimated birth weight was approximately 4000 g. There was no history of steroid treatment or any underlying connective tissue disease, and no history of dilation and curettage. Oxytocin was given as per protocol, starting at 20 ml/h of a dilution of 10 IU/1 L natrium chloride (NaCl). Subsequent labor progress was complicated by arrest of descent in the second stage of labor, necessitating cesarean section delivery. After opening the abdominal wall, a uterine rupture with several large blood clots was discovered, freely floating in the peritoneal space, about 500 ml in volume. The rupture stretched from the left side of the uterine body and down into the thin lower segment. The tissue in this area had diffuse hematoma. CONCLUSIONS Although uterine rupture mostly occurs in women with previous CS, this report has shown that uterine rupture can occur in pregnancy complicated by arrest in the second stage of labor.

Young Birthing Age and Delivery and Neonatal Outcomes [ID: 1356517

INTRODUCTION: The objective of this study is to examine differences in obstetric delivery and neonatal outcomes between young birthing patients (age 18 years or younger) and a standard risk birthing population (age 25–30 years). METHODS: This is a retrospective cohort study of patients delivering between 2012 and 2017 in a single urban academic health system. Outcomes were examined for a young birthing cohort (n=528) and compared with a standard risk cohort age 25–30 years (n=937). This study was identified as exempt by the local IRB. RESULTS: When examining delivery outcomes, young birthing age was associated with a lower risk of cesarean section, even after adjusting for a history of prior cesarean section (13.4% versus 30.7%, adjusted odds ratio [aOR] 0.41), and a lower risk of postpartum hemorrhage (8.5% versus 12.85, aOR 0.48), all with P<.05. However, young age was also associated with an increased risk of delivery at less than 37 weeks of gestation (15.2% versus 9.5%, OR 1.96). When examining neonatal outcomes, young birthing age was associated with a lower rate of congenital anomalies at birth (6.6% versus 14.4%, aOR 0.42). After adjusting for covariates, there was no difference in low birth weight or neonatal intensive care unit (NICU) admission. CONCLUSION: Young birthing patients have delivery outcomes that vary from those of a standard birthing cohort, with a lower risk of cesarean delivery and postpartum hemorrhage but an increased risk of preterm birth. In addition, younger birthing patients have a lower risk of anomalies identified at birth but no increased risk of lower birth weight or NICU admission. These data may help tailor birthing programs for younger patients to better address their specific delivery risks.

Uterine Surgery and Risk of Adenomyosis: A Retrospective Study

<h3>Study Objective</h3> To determine an association between adenomyosis and history of uterine surgery, including cesarean section, dilation & curettage (D&C), and myomectomy. Also, if repeat uterine surgery increases the risk of adenomyosis development. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Large academic center, Parkland Hospital in Dallas, TX. <h3>Patients or Participants</h3> Data was collected from electronic medical records of women who underwent hysterectomy for benign indications at Parkland Hospital between January 2014-December 2018. A total of 2911 women were included, 1184 with adenomyosis and 1727 without adenomyosis. <h3>Interventions</h3> Variables included gravidity/parity, number of vaginal deliveries, number of cesarean sections, number of D&C procedures, and number of myomectomies. Pathology of uterine specimens were noted for presence of adenomyosis, leiomyomata, and endometriosis. Non-parametric rank sum test compared medians of continuous variables, Chi-square or Fisher exact tests compared categorical variables. Logistic regression was used to generate odds ratios for adenomyosis and clinical factors. <h3>Measurements and Main Results</h3> History of any uterine surgery was associated with an increased risk of adenomyosis (OR 1.28, 95% CI 1.11-1.49). Patients with a history of D&C were significantly more likely to have adenomyosis on pathology (OR 1.57, 95% CI 1.30-1.90). Repeat D&C was also associated with increased risk of adenomyosis (OR 1.31, 95% CI 1.01-1.72). The association between history of prior cesarean section and adenomyosis was not statistically significant (OR 1.12, 95% CI 1.00-1.37). A history of myomectomy was not significantly associated with adenomyosis (OR 0.95, 95% CI 0.59-1.54). <h3>Conclusion</h3> Of the risk factors explored, history of any uterine surgery, D&C and repeat D&C were associated with an increased risk of adenomyosis. However, there was not a significant association between history of cesarean section or increasing numbers of repeat cesarean delivery with the development of adenomyosis. This is the largest known retrospective study thus far investigating this association and we concluded that cesarean sections do not individually increase the risk of adenomyosis.

"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section.

It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section. This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging. A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage. It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher.

Timing of initiation of cervical ripening and its effect on time of delivery

Increasing staff shortages despite a rise in patient numbers has led to congestion on our L&D unit resulting in delays in scheduled inductions. Our staffing model differs from day to night with regard to number of nurses, residents, attending physicians, and ancillary staff present. While staffing is more limited during nighttime hours, our patients undergoing daytime cervical ripening are more likely to deliver during the night. We sought to examine if shift of admission for cervical ripening impacted the time of delivery. We completed a retrospective cohort study of singleton pregnancies at our institution delivered January-December 2018. We included viable pregnancies with cephalic presentation requiring cervical ripening. Bishop score ≥6 was excluded. Cervical ripening was completed with misoprostol or foley balloon. We excluded history of prior cesarean section, gestational age < 37 weeks, multiple gestations, and contraindication to vaginal delivery. Primary outcome was shift of delivery. Multiple logistic regression was performed to evaluate the relative impact of BMI, parity, and cervical exam on time to delivery. Significance defined as P< .05. 450 patients met inclusion criteria. Patients were divided into those with day (7am-7pm) and night (7pm-7am) deliveries. The majority of our population was nulliparous (59%) with admission dilation of 1cm (44%). We found no statistically significant difference in time of delivery based on shift of admission for cervical ripening. We did find statistically significant differences in time from admission to delivery based on parity, cervical exam on admission, and BMI. Our data show shift of admission for cervical ripening does not impact shift of delivery. BMI, parity, and cervical exam on admission do influence length of induction to delivery. These patient characteristics may be used to predict the length of time a patient will be on L&D and help time inductions to optimize delivery to match staffing and improve L&D flow. Development of a predictive model for induction to delivery timing is currently being studied.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Examining pre-term birth and cesarean section rates in gestational carrier pregnancies.

This study sought to report on the route and gestational age at delivery of gestational carrier (GC) pregnancies with respect to the GCs' prior obstetric history. A retrospective analysis of all GC pregnancies from one of the largest surrogacy agencies in California between 2008 and 2018 was performed. Available demographic data and obstetric history, including a history of prior cesarean section (CS) and preterm birth (PTB), were collected for each GC and correlated to outcomes of the index GC pregnancy. Primary outcomes for the index GC pregnancies included delivery route and gestational age at delivery. Eight-hundred-thirty-six GCs were included in our analysis. 319 (38.2%) delivered via CS, and 517 (61.8%) delivered vaginally. 60 (18.8%) of the CS deliveries were due to multifetal gestation. Primary CS rate in singleton GC pregnancies was 38.5%. In women without a history of CS, neither age, BMI, interpregnancy interval, prior parity, nor year of delivery impacted the primary singleton CS rate (all, P > 0.05). Of GCs with a history of a prior CS (n = 350, 41.9%), 218 (62.3%) had a vaginal delivery after CS (VBAC) and 132 (37.7%) had a repeat CS. Women who had successful VBACs were significantly younger than those who had repeat CS (mean 33.7 vs. 35.2years, P = .003). BMI was lower in patients who had a VBAC compared to those that had a repeat CS (mean BMI 24.6 vs. 25.5, P = 0.074), although this did not reach statistical significance. In GCs with a history of CS, interpregnancy interval, year of delivery, prior parity, and multiple gestation in the index GC pregnancy did not impact mode of delivery. VBAC rates did not change over the study period (P = 0.757). Overall PTB rate was 15.1%. Most PTB in GC pregnancies were in those with a history of PTB, and PTB was more likely in singletons rather than multifetal gestations (76.7% in singletons vs. 30% in multiples) in patients with history of PTB (P < 0.001). Those with no history of PTB and who carried multiples had a low rate of PTB; in fact, in this group, only 1 out of 35 patients had a PTB with multiples. Both primary CS and PTB rates in singleton GC pregnancies are higher than national averages. CS rates are independent of age, BMI, and interpregnancy interval. In GCs with a history of a CS, VBAC rates well exceed national averages and are higher in younger GCs with a lower BMI. PTB rates are impacted primarily by the GCs obstetric history. In those GCs without a history of PTB, rates of PTB are low, even in those with a multifetal gestation.

Clinical factors associated with a placenta accreta spectrum

IntroductionPlacenta accreta spectrum (PAS) is a life-threating obstetric complication, and prenatal prediction of PAS can decrease maternal morbidity and mortality. The aim of this prospective cohort study was to determine the clinical factors associated with PAS. MethodsPregnant women who delivered at a university hospital were enrolled. Clinical data were collected from medical records, and logistic regression analyses were performed to determine which clinical factors were associated with PAS. ResultsEighty-seven (2.1%) of the 4146 pregnant women experienced PAS. Multivariable analyses revealed that a prior history of cesarean section (CS) (OR 3.3; 95% CI 1.9–5.7; p < 0.01), dilation and curettage (D&C) (OR 2.8; 95% CI 1.7–4.6; p < 0.01), hysteroscopic surgery (OR 5.7; 95% CI 2.3–14.4; p < 0.01), uterine artery embolization (UAE) (OR 44.1; 95% CI 13.8–141.0; p < 0.01), current pregnancy via assisted reproductive technology (ART) (OR 4.1; 95% CI 2.4–7.1; p < 0.01), and the presence of placenta previa in the current pregnancy (OR 13.1; 95% CI 7.9–21.8; p < 0.01) were independently associated with the occurrence of PAS. ConclusionPregnant women who have a prior history of CS, D&C, hysteroscopic surgery, UAE, current pregnancy via ART, and the presence of placenta previa in the current pregnancy are high risk for PAS.

Determinants of maternal near miss among women admitted to maternity wards of tertiary hospitals in Southern Ethiopia, 2020: A hospital-based case-control study.

A maternal near-miss (MNM) refers to when a gravely ill woman survives a complication as a result of the standard of care she receives or by chance during gestation, childbirth, or within 42 days of the termination of pregnancy. Rescuers of near-miss events share several features with mothers who have died and identifying MNM determinants will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Ethiopia is one of the countries in sub-Saharan Africa with high maternal mortality and morbidity, but there is little evidence on determinants of a MNM based on a WHO criteria. Hence, this study aimed at identifying determinants of MNM among women admitted to tertiary hospitals in southern Ethiopia, 2020. A facilities-based unmatched case-control study was conducted in five selected tertiary hospitals found in central southern Ethiopia from February 1 to June 1, 2020. A total of 322 (81 cases and 241 controls) study participants were included in the study. At the time of their discharge, cases were recruited consecutively, while controls were selected using a systematic sampling method. The cases were women admitted to hospitals during pregnancy, childbirth, or 42 days following termination of pregnancy who met at least one of the WHO near-miss criteria. Whereas the controls comprised of women who were admitted during pregnancy, childbirth, or 42 days following termination of pregnancy and discharged without severe obstetric complications. Data collection was conducted using the interviewer-administered structured questionnaire and data abstraction tool. The data was coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis was conducted and determinants of MNM were established at p-value<0.05. Severe postpartum hemorrhage (50.6%) and sepsis (23.4%) were the most common reasons for admission of cases. Lack of ANC [AOR = 3.25; 95%CI: 2.21,7.69], prior history of Cesarean section [AOR = 3.53; 95%CI:1.79,6.98], delaying more than 60 minute to access final place of care [AOR = 3.21; 95%CI:1.61,6.39], poor practice of Birth preparedness and complication readiness (BPCR) [AOR = 3.31; 95%CI:1.50,7.29], and history of preexisting medical disorders [AOR = 2.79; 95%CI:1.45,5.37] were identified as significantly determinants of maternal near miss. Stakeholders need to enhance their efforts for improving access to roads and transportations. Besides, women who have a prior history of Caesarean section, chronic medical conditions, and no ANC need special attention from their families and health care providers to proactively mitigate the occurrence of serious obstetric complications. More attention has to be paid to birth preparedness and complication readiness activities.

977 Outcomes of intrahepatic cholestasis of pregnancy in women with a prior cholecystectomy

Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus in the setting of elevated serum bile acids (BA). While some studies have identified cholecystectomy (CCY) as a risk factor for developing ICP, little is known about the effects of prior CCY on the severity or outcomes of the disease. Our objective was to compare the maternal outcomes of women with and without prior CCY who developed ICP. This was a retrospective cohort study of patients diagnosed with ICP between 2012 and 2019 at a tertiary referral center. ICP was defined as symptomatic pruritus combined with serum BA ≥10 μmol/L. Maternal characteristics and outcomes were abstracted from electronic medical records and compared between those with and without prior CCY. Student’s t-test, Mann-Whitney U, Chi-squared or Fisher’s exact tests were used as appropriate. A p-value < 0.05 was considered statistically significant. 438 patients were included in the analysis. Women with diagnosed ICP shared similar baseline characteristics including age, race, and gestational age at diagnosis. Women with prior CCY were more likely to have severe disease (BA ≥100 μmol/L, 12% vs 2%, p<0.01) and despite no difference in history of prior cesarean section, were more likely to have a cesarean delivery (43% vs 28%, p=0.04). There was a trend of elevated AST in patients with prior CCY, though this was not statistically significant (45% vs 31%, p=0.05). There was no difference in the incidence of gestational diabetes, hypertensive disorders of pregnancies, fetal growth restriction, or preterm labor between the two groups. There was also no difference in a composite of adverse neonatal outcomes between those with and without a prior CCY (33 vs 29%, p=0.48). Women with ICP with prior CCY are more likely to have severe disease and a cesarean delivery. Serial bile acid measurements to evaluate for development of severe disease may be warranted in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

646 Characterizing placenta accreta spectrum in patients without prior cesarean delivery

Placenta accreta spectrum (PAS) is a disease of abnormal placentation that often necessitates hysterectomy at the time of delivery. Suspicion for PAS is informed by a combination of sonographic markers and patient history, most notably a prior cesarean section (CS). The a priori risk of PAS in a patient without prior CS is extremely low and not well described in the literature. Our aim is to evaluate differences in patient risk factors, ultrasound findings and outcomes in those with confirmed PAS with and without a prior CS. This retrospective cohort study included all subjects who underwent a cesarean hysterectomy for histologically confirmed PAS at a single academic institution between 2011 and 2020. Antenatal ultrasound images were reviewed in a blinded fashion for 8 placental findings. Perinatal and delivery outcomes were abstracted. Subjects with a prior CS were compared to those without prior CS. Our primary outcome was 3 or more placental findings concerning for PAS on antenatal ultrasound. Outcomes were compared using univariate and bivariate analyses. Of the 91 subjects who underwent a cesarean hysterectomy for PAS, 9 had no history of prior CS. Those without a prior CS had fewer ultrasound findings compared to those with a prior CS (3 or more ultrasound findings: 22% vs 81%, p=0.001). Those without a prior CS had less depth of invasion on pathology, delivered at a later gestational age, had shorter hospital stays and were less likely to require Gyn Oncology or Urology involvement (all p<0.05). Transfusion rates were similar, however the amount of blood products required was significantly lower for those without a prior CS (p<0.05 for pRBC, FFP and platelets). PAS without prior CS is characterized by fewer ultrasound findings making it a challenging diagnosis antenatally. Despite this, outcomes for this group of patients tend to be more favorable, possibly due to the lesser degree of placental invasion. Further research comparing differences between those with and without prior CS may help to describe different subtypes of PAS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa.

To evaluate the association of placental thickness with placenta accreta spectrum disorder in placenta previa. In this IRB-approved, retrospective study, ultrasound (US) reports were retrospectively queried for keyword previa. US performed closest to mid-gestation were included. Three measurements were performed at the thickest portion of the placenta on longitudinal transabdominal images. Operative reports and surgical pathology were used as the reference standard. Statistical analysis was performed using unpaired T-tests and receiver operating curve (ROC) analysis. Sixty-five patients with placenta previa were included: 38 with PAS disorder and 27 without PAS disorder, clinically or pathologically. 38/38 (100%) patients of PAS group and 16/27 (59.3%) patients of non-PAS group had history of prior cesarean section. The average placental thickness was 4.3cm (range 1.8cm to 7.8cm) for PAS group and 3.0cm (range 0.6cm to 5.3cm) for non-PAS group (p<0.001). Placental thickness in patients without PAS disorder and history of prior cesarean section was 3.1 (±1.1) cm. This was statistically different from patients who had history of prior cesarean section with PAS diagnosis (4.3cm, P<0.01). Using ROC analysis, a threshold measurement of 4.5cm leads to sensitivity of 50% and specificity of 96%. Our results demonstrate that among women with placenta previa, increased placental thickness at lower uterine segment correlates with placenta accreta spectrum disorder. A threshold of 4.5cm can be useful for screening patients with placenta previa and risks factors for PAS.

Determinants of maternal near-miss in private hospitals in eastern Ethiopia: A nested case-control study.

Objective:Maternal near-miss refers to a woman who nearly died but survived complications in pregnancy, childbirth, or within 42 days of termination of pregnancy. The study of maternal near-miss has become essential for improving the quality of obstetric care. The objective of this study was to identify the determinants of maternal near-miss among women admitted to major private hospitals in eastern Ethiopia.Method:An unmatched nested case–control study was conducted in major private hospitals in eastern Ethiopia from 5 March to 31 March 2020. Cases were women who fulfilled the sub-Saharan African maternal near-miss criteria and those admitted to the same hospitals but discharged without any complications under the sub-Saharan African maternal near-miss tool were controls. For each case, three corresponding women were randomly selected as controls. Factors associated with maternal near-misses were analyzed using binary and multiple logistic regressions with an adjusted odds ratio along with a 95% confidence interval. Finally, p-value < 0.05 was considered as a cut-off point for the significant association.Results:A total of 432 women (108 cases and 324 controls) participated in the study. History of prior cesarean section (AOR = 4.33; 95% CI = 2.36–7.94), anemia in index pregnancy (AOR = 4.38; 95% CI = 2.43–7.91), being ⩾ 35 years of age (AOR = 2.94; 95% CI = 1.37–6.24), not attending antenatal care (AOR = 3.11; 95% CI = 1.43–6.78), and history of chronic medical disorders (AOR = 2.18; 95% CI = 1.03–4.59) were independently associated with maternal near-miss.Conclusion:Maternal age ⩾ 35 years, had no antenatal care, had prior cesarean section, being anemic in index pregnancy, and have history of chronic medical disorders were the determinants of maternal near-miss. Improving maternal near-misses requires strengthening antenatal care (including supplementation of iron and folic acid to reduce anemia) and prioritizing women with a history of chronic medical illnesses. Interventions for preventing primary cesarean sections are crucial in this era of the cesarean epidemic to minimize its effect on maternal near-miss.

Comparison of maternal-neonatal results of vaginal birth after cesarean and elective repeat cesarean delivery.

To evaluate maternal-neonatal results in women who underwent vaginal birth after cesarean (VBAC) and elec-tive repeat cesarean delivery (ERCD). In a two-year retrospective cohort analysis, 423 patients with a history of prior cesarean section, singleton pregnancy with cephalic presentation and gestational age of 37-41 weeks were investigated. The maternal and perinatal outcomes of 195 patients desiring VBAC and undergoing a trial of labor after cesarean (TOLAC) attempt and 228 patients undergoing an ERCD were compared. While the TOLAC attempt was successful in 141 patients (72.3%), it was unsuccessful in 54 patients. No statistically significant difference was determined between VBAC and ERCD patients regarding uterine rupture, dehiscence, post-partum hemorrhage, the need for a blood transfusion and wound site infection (p > 0.05). When the post-partum neonatal outcomes were compared, there was no statistically significant difference between VBAC and ERCD groups regarding the prevalence of admission to the neonatal intensive care unit (NICU), respiratory distress, sepsis and birth injury (p > 0.05). The maternal and perinatal outcomes of our study may be encouraging in favor of VBAC particularly in countries with higher cesarean rates. We think that the option of VBAC should be offered more frequently for selected appropriate patients in created safe environments.

Outcomes of labor induction at 39 weeks in pregnancies with a prior cesarean delivery

Background The optimal timing of induction for those undergoing a trial of labor after cesarean section has not been established. The little data which supports the consideration of induction at 39 weeks gestation excludes those with a history of prior cesarean section. Objective To determine the risks and benefits of elective induction of labor (IOL) at 39 weeks compared with expectant management (EM) until 42 weeks in pregnancies complicated by one previous cesarean delivery. Study design This is a retrospective cohort analysis of singleton non-anomalous pregnancies in the United States between January 2015 and December 2017. Data was provided by the CDC National Center for Health Statistics, Division of Vital Statistics. Analyses included only pregnancies with a history of one previous cesarean delivery (CD). Perinatal outcomes of pregnancies electively induced at 39 weeks (IOL) were compared to pregnancies that were induced, augmented or underwent spontaneous labor between 40 and 42 weeks (EM). Unlabored cesarean deliveries were excluded. Outcomes of interest included: cesarean delivery, intra-amniotic infection, blood transfusion, adult intensive care unit (ICU) admission, uterine rupture, hysterectomy, 5-minute Apgar score 3, prolonged neonatal ventilation, neonatal ICU (NICU) admission, neonatal seizure, perinatal/neonatal death. Log-binomial regression analysis was performed to calculate the relative risk (RR) for each outcome of interest, adjusting for confounding variables. Results There were 50,136 pregnancies included for analysis with 9,381 women in the IOL group. Compared with EM, IOL at 39 weeks decreased the risk of intra-amniotic infection (1.7% vs 3.0%, p < .001; aRR: 0.58, 95% CI: [0.49–0.68]), blood transfusion (0.3% vs. 0.5%, p = .03; aRR: 0.66, 95% CI: [0.45–0.98]), and low 5-minute Apgar score (0.31% vs 0.47%, p = .031; aRR: 0.66, 95% CI: [0.44–0.97]). Conversely, IOL increased the risk of cesarean delivery (49.0% vs 27.6%, p < .001; aRR: 1.72, 95% CI: [1.68–1.77]). Furthermore, in the EM group, 919 pregnancies developed preeclampsia and 42 progressed to eclampsia. There were no differences in other perinatal outcomes. Conclusion In pregnancies complicated by one previous cesarean delivery, elective induction of labor at 39 weeks reduced the risk of intra-amniotic infection, blood transfusion, and low 5-minute Apgar score while increased the risk of repeat cesarean delivery.

Factors Associated with Maternal Near Miss among Women Admitted in West Arsi Zone Public Hospitals, Ethiopia: Unmatched Case-Control Study.

Background Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just “tip of the iceberg,” whereas maternal near-miss as the “base.” Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.

Labor Induction at 39 Weeks Versus Expectant Management in Women With Prior Cesarean Delivery [22P

INTRODUCTION: To compare maternal and neonatal outcomes between elective induction (EIOL) and expectant management (EM) in low risk women with a prior cesarean delivery. METHODS: Records of women with a prior cesarean and whose plan of delivery was a trial of labor (TOLAC) were reviewed. Patients who reached 39 weeks and were low risk were included and divided into 2 groups. Those who were induced electively between 39 weeks 0 days and 39 weeks 6 days (EIOL) versus those who were not (EM). Low risk was defined as absence of a maternal or fetal indication for delivery prior to 41 weeks 6 days. The primary outcome was a composite of adverse neonatal outcomes. Secondary outcomes included repeat cesarean delivery (CD) and maternal morbidities. RESULTS: From July 2014–July 2019, 552 low risk women underwent TOLAC: 317 women in the EM and 235 in the EIOL group. The primary outcome occurred in 5.38% in the EM group and 3.40% in the EIOL group (OR 0.62, 95% CI 0.23–1.55). The frequency of CD was 31.86% in the EM group and 26.38% in the EIOL group (OR 0.766, 95% CI 0.52–1.13). CONCLUSION: Elective induction of labor at 39 weeks among low risk women with a history of prior cesarean section was not associated with an increase in perinatal morbidity, and was associated with lower rates of hysterotomy-associated complications and medically-indicated delivery. It is reasonable to offer elective induction of labor at 39 weeks to women who are candidate for TOLAC.

Association between Preoperative Adenomyosis Detection Rate during Pelvic Ultrasonography and the Specialty of the Reading Physician

To compare the detection rate of adenomyosis when ultrasound is performed by a radiologist compared with a gynecologic expert sonologist. A retrospective, single-center study. A university teaching hospital. All women above 18 years of age with a positive histopathology diagnosis of adenomyosis obtained in a hysterectomy specimen from October 1, 2011, to October 1, 2017, were screened for inclusion. Cases without a preoperative pelvic ultrasound report, those with coexisting premalignant/malignant conditions, and patients presenting to the clinic with symptoms other than abnormal uterine bleeding, dysmenorrhea, or abdominal pain were excluded. A total of 412 cases were included in the final analysis. The preoperative ultrasound was performed by a radiologist in 241 patients (59%) and by an expert gynecologic sonologist in 171 patients (42%). Patients' age, body mass index, race, ethnicity, parity, and history of prior cesarean section were comparable between the 2 groups. The adenomyosis detection rate was significantly higher in the expert gynecologic sonologist group compared with radiologists (95 [56%] vs 29 [12%], p <.01). After controlling for patients' race, body mass index, prior cesarean sections, and presence of myomas using multivariable logistic regression, gynecologic expert sonologists were 7.8 times more likely to detect adenomyosis than radiologists (odds ratio = 7.84; 95% confidence interval, 4.58-13.44). Regardless of medical specialty, the presence of myomas significantly decreased the detection of adenomyosis compared with the absence of myomas (odds ratio = 0.23; 95% confidence interval, 0.13-0.39). The detection rate of adenomyosis was significantly higher when ultrasound was performed by expert gynecologic sonologists compared with radiologists. The presence of myomas significantly decreased detection rates regardless of specialty. Ultrasound evaluation for detecting adenomyosis should be preferentially performed by gynecologic expert sonologists.

Predictors of maternal near miss among women admitted in Gurage zone hospitals, South Ethiopia, 2017: a case control study

BackgroundMaternal mortality and morbidity remain unacceptably high in developing countries. Behind every maternal death, many other women suffered from acute and chronic obstetric complications. Women who survive severe acute maternal morbidities/near miss have many characteristics in common with maternal death events particularly on risk factors. Ethiopia is among countries with high maternal mortality and morbidities in sub-Saharan Africa. However there is scarce evidence on risk factors of severe acute maternal morbidities in Ethiopia. Therefore this study aimed to identify predictors of maternal near miss among women admitted in Gurage zone hospitals, south Ethiopia, 2017.MethodsHospital based case control study was conducted to assess predictors of maternal near miss among women admitted in five hospitals of Gurage zone, South Ethiopia. Data of 229 (77 cases and 152 controls) women were included in the analysis. Cases were women admitted due to severe acute maternal morbidity while controls were women admitted for normal labor or women admitted due to mild to moderate obstetric complications. Cases were identified by validated-disease specific criteria. Then, two controls were selected for each verified case using lottery method among eligible women.Data were collected using interviewer administered questionnaire and reviewing patients’ records. Data were entered using Epi Info 7 and analyzed by SPSS 21. Multivariable logistic regression analysis was done to identify independent predictors of maternal near miss.ResultMajority of cases were admitted due to dystocia (57.1%) and obstetric hemorrhage (26%). The median first delay (delay to seek health care) among cases and controls was six and 4 h respectively. Prior history of cesarean section {AOR 7.68, 95%CI, 3.11–18.96}, first delay {AOR 2.79, 95%CI, 1.42–5.50}, and being referred from other health facilities {AOR 7.47, 95% CI, 2.27–24.51} were independent predictors of maternal near miss.ConclusionsPrior history of cesarean section, being referred from other health facilities and first delay were factors associated with maternal near miss. Timely health care seeking behavior of women is uncommon in the study area. Therefore primary health care programs need to enhance the existing efforts to improve timely health care seeking behavior of women.