Incidence Of Cesarean Delivery Research Articles

Upper back, neck, and shoulder pain during labor epidural analgesia: a quality improvement initiative

BackgroundSevere upper back/interscapular, neck and shoulder pain during labor epidural analgesia (PLEA) is not uncommon. The objective of this quality initiative was to evaluate the incidence, demographic associations and management of PLEA. MethodsAn 8-month, single-center quality improvement initiative was performed for the detection and management of PLEA. After survey-based consensus among obstetric anesthesiology attendings and fellows, a 3-step PLEA treatment protocol with interventions and numeric rating scale (NRS, 0 – 10 scale) pain assessments was introduced. Demographic data and outcomes were compared among parturients with and without PLEA. ResultsAmong 2,888 women who received labor epidural analgesia from October 2022 through May 2023, 36 (1.2% [95% CI 0.9% to 1.7%]) reported PLEA. Women with PLEA were younger, more likely to be nulliparous, and had a higher body mass index (BMI) than women without PLEA (p < 0.05 for all). A total of 72.2% (26/36) of women with PLEA received at least one protocol treatment. Twenty-three women received first-line therapy, with pain relief in 91.3% (21/23). The median NRS score decreased from 9 [IQR 8–10] to 3 [1–4]. Women with PLEA had a higher incidence of cesarean delivery (CD) and a longer interval between epidural placement and delivery; 52.8 vs 17.5% (p < 0.001) and 16.5 vs 6.9 h (p < 0.001), respectively. ConclusionsThe incidence of PLEA was higher than previously reported. Patients with PLEA were younger, more commonly nulliparous, had higher BMI, longer epidural infusion times and higher CD rates. A 3-step treatment protocol was successful in managing PLEA.

Effect of anesthesia on the success rate of external cephalic version: GRADE- assessed systematic review and meta-analysis of randomized controlled trials

BackgroundExternal cephalic version (ECV) is a medical procedure in which an extracorporeal manipulation is performed to render the breech presentation (BP) fetus in the cephalic position. The use of anesthesia to facilitate repositioning has been evaluated in various randomized clinical trials (RCTs), but its potential effectiveness remains controversial.MethodsA systematic literature search was carried out in 8 electronic databases. In the meta-analysis, a random effects model was used to calculate the pooled relative risk (RR) and its 95% confidence interval (CI), and the pooled standardized mean difference (SMD) and its 95% CI, in order to systematically assess the effect of anesthesia on the success rates of ECV, vaginal delivery, cesarean delivery as well as other outcomes. Relevant subgroup analyses, publication bias test and sensitivity analyses were also conducted.ResultsThis review included 17 RCTs. Women who received anesthesia had a significantly higher incidence of successful ECV (RR: 1.37, 95% CIs: 1.19-1.58) and vaginal delivery (RR: 1.23, 95% CIs: 1.03-1.47), and a significantly lower incidence of cesarean delivery (RR: 0.69, 95% CIs: 0.53-0.91), compared with those who did not.ConclusionThe administration of anesthesia not only significantly reduces maternal pain but also significantly increases the success rate of ECV in women with malpresentation at term, leading to a significant rise in the incidence of vaginal delivery. However, it may increase the incidence of maternal hypotension.Systematic review registrationThe protocol was prospectively registered with PROSPERO, registration CRD42022381552.

Effects of epidural analgesia at 1 cm cervical dilatation on multiparae: A retrospective cohort study using propensity score-matching.

The aim of the present study was to investigate the effects of epidural analgesia (EA) administered at cervical dilatation of 1 cm on multiparae who underwent vaginal delivery. This propensity score-matched retrospective cohort research was conducted between 2021 and 2022. All the singleton multiparae who had previous successful vaginal deliveries and epidural analgesia during this delivery were screened for eligibility. The primary outcome was the effect of EA on the duration of labor. The main secondary outcomes included the incidence of cesarean delivery and umbilical arterial pH. This study incorporated 686 multiparae who were divided into two cohorts: EA 1 (cervical dilatation = 1 cm, n = 166) and EA 2 (cervical dilatation >1 cm, n = 520). In the propensity score-matched cohort (including 164 women in each group), there were no statistically significant differences in the incidence of cesarean delivery (4 [2.4%] vs 4 [2.4%], P = 1.000), umbilical arterial pH (7.28 ± 0.06 vs 7.28 ± 0.07, P = 0.550) and other secondary outcomes between the two groups. Based on a comparative assessment of the women who delivered vaginally to the Kaplan-Meier curves and propensity score-matching (including 160 women in each group), there was no statistical significance in the duration of the first, second and third stages of labor (log rank P, P = 0.811; P = 0.413; P = 0.773, respectively). Initiation of epidural analgesia at cervical dilatation of 1 cm in multiparae did not cause adverse effects with regard to the duration of labor, increased cesarean deliveries, and bad neonatal outcomes.

OBSERVATIONAL STUDY TO ASSESS THE EFFICACY OF POST-OPERATIVE PAIN MANAGEMENT IN CASES OF CAESAREAN SECTION

Context:The incidence of cesarean deliveries is on the rise now-a-days. Post-operative pain is a major problem and if untreated, can lead to chronic pain. Aims: To observe the effectiveness of the obstetrician led post-operative analgesia regime in patients operated for caesarean section. Settings and Design:The observational study was conducted at a rural based tertiary care centre, designed to include all the patients who fulfilled the selection criteria for caesarean section. Methods and Material:After approval from institutional ethics committee and patients informed consent, the multimodal analgesic regime was evaluated on Visual analogue scale (VAS) at rest for 24 hours. A questionnaire was also taken as feedback from the patients at end of 24hrs for qualitative assessment. Statistical analysis used: Descriptive analysis of the data collected was done. Results: 91.5% patients had VAS score &lt; four while 8.5% patients had VAS score &gt; four. The percentage of patients who were fully satisfied, partially satisfied, not at all satisfied and in severe pain was 18%, 68%, 13.5% and 0.5% respectively. The newborn care was not at all affected in 17.5%, somewhat affected in 76.5% and to a great extent in 6% patients. In 89% patients, sleep was not affected while in 11% it was affected. Majority of patients (99%) did not mind bearing mild pain in order to prevent side effects of drugs. Conclusions: Overall, the obstetrician led postoperative analgesic protocol followed was satisfactory. Discrepancy between patient satisfaction by VAS score assessment and patient perception by qualitative assessment suggests requirement of in-depth qualitative assessment for better pain control.

The Relationship Between Risk Factor Obesity in Pregnancy with the Incidence of Caesarean Delivery: Literature Review

The Relationship Between Risk Factor Obesity in Pregnancy with the Incidence of Caesarean Delivery: Literature Review

Timing of cesarean delivery for fetal heart rate abnormalities in hypertensive pregnancies induced with oral misoprostol or Foley catheter: Secondary analysis of a randomized clinical trial.

The study aims to assess how oral misoprostol for cervical ripening affects the time of cesarean delivery (CD) for fetal heart rate (FHR) abnormalities in pre-eclampsia patients. Secondary goals include determining the role of uterine hyperstimulation, comparing misoprostol with Foley catheter, and identifying risk factors for FHR abnormalities associated with CD. A previously published randomized clinical trial was subjected to a secondary analysis (NCT01801410). We conducted a time-dependent analysis, stratifying the population based on the final mode of induction used (low-dose oral misoprostol vs Foley catheter). There was no CD for FHR abnormalities within 2 h of starting misoprostol. At 5 h, the cumulative incidence of CD for FHR abnormalities in the misoprostol group was 2.10%, while it was 1.00% in the Foley group (P = 0.565). After 25 h, the CD risk for FHR abnormalities remained constant in both groups at 21.00% (95% confidence interval [CI] 15.00%-28.00%). Within 5 h of misoprostol induction, the risk of uterine hyperstimulation was similar in both groups (0.33% in misoprostol vs 0.34% in Foley group, P = 0.161). The risk of CD for FHR abnormalities was unaffected by newborn weight centiles. There was no significant difference in CD risk for FHR abnormalities between misoprostol and Foley catheter induction. Nonetheless, the cumulative incidence of CD for FHR abnormalities increased faster in the misoprostol group, indicating that FHR monitoring timing should be tailored to the induction method.

Thick endometrium is associated with hypertensive disorders of pregnancy in programmed frozen-thawed embryo transfers: a retrospective analysis of 2,275 singleton deliveries

To investigate whether endometrial thickness (EMT) acts as a contributing factor to adverse perinatal outcomes in programmed frozen-thawed embryo transfer (FET) cycles. Retrospective cohort study. University-based reproductive medical center. The study included singleton live births resulting from programmed FET cycles that took place between January 2017 and April 2022 (N = 2,275 cycles). The EMT measurement conducted on the day of progesterone initiation was utilized. Programmed FET cycles with EMT <7 mm were excluded from consideration. All included subjects were divided into 4 groups on the basis of the 10th, 50th, and 90th percentiles of EMT: group Ⅰ (EMT ≤8 mm, n = 193), group Ⅱ (EMT = 8.1-10 mm, n = 1,261), group Ⅲ (EMT = 10.1-12 mm, n = 615), and group Ⅳ (EMT >12 mm, n = 206). After adjusting for patient demographics and FET parameters, logistic regression analysis and restricted cubic spline were used to investigate the relationship between EMT and perinatal outcomes. The group Ⅱ (EMT = 8.1-10 mm) served as a reference. The primary outcome measure was the hypertensive disorders of pregnancy (HDP). Secondary outcomes included gestational diabetes mellitus, cesarean delivery, placenta previa, premature rupture of membrane, birthweight, preterm birth, low birthweight, macrosomia, small for gestational age, large for gestational age and neonatal morbidity. The incidence of HDP was substantially elevated in group Ⅳ when compared with the other groups (5.7% vs. 4.1% vs. 5.7% vs. 9.7% for groups Ⅰ-Ⅳ, respectively). In addition, group I displayed a higher incidence of cesarean deliveries, whereas both group I and group IV exhibited an elevated prevalence of placenta previa. After adjusting for confounding factors, patients in group IV exhibited a significantly increased risk of HDP (adjusted odds ratio [OR] = 2.03, 95% confidence interval [CI] 1.13-3.67) as compared with patients in the reference group. The restricted cubic spline model revealed a nonlinear association between EMT and the odds of HDP on continuous scales. In comparison to women with an EMT of 9.5 mm, there was no significant change in the risk of HDP in women with EMT between 7 and 11 mm, as indicated by adjusted ORs of 1.37 (95% CI 0.41-4.52), 1.34 (95% CI 0.73-2.47), 1.13 (95% CI 0.79-1.62), 1.04 (95% CI 0.87-1.25), and 1.46 (95% CI 0.81-2.65), respectively. However, the risk of HDP was significantly higher in women with EMT ranging from 12 to 15 mm, with adjusted ORs of 1.86 (95% CI 1.03-3.35), 2.33 (95% CI 1.32-4.12), 2.92 (95% CI 1.52-5.60), and 3.62 (95% CI 1.63-8.04), respectively. This study demonstrated a noteworthy association between EMT and adverse perinatal outcomes during the programmed FET cycles. Specifically, a thick endometrium (EMT >12 mm) was independently associated with an increased risk of developing HDP, whereas the optimal EMT for reducing the risk of HDP was at around 9-10 mm.

Comparison of Intracervical Foley's Catheter With Vaginal Misoprostol Versus Intravaginal Misoprostol Alone for Cervical Ripening and Induction of Labor.

Introduction Induction of labor implies stimulation of contractions before the spontaneous onset of labor, with or without membranes. Augmentation refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical and fetal descent. This study compared the effectiveness of intracervical Foley catheter insertion and vaginal misoprostol versus only vaginal misoprostol in the induction of labor and other outcomes relted to it. Methods The present study was a randomized controlled trial that included 148 women divided into two groups: (i) Group A, which received intracervical Foley catheter insertion and vaginal misoprostol (25 µg), and (ii) Group B, which received intravaginal administration of tablet misoprostol (25 µg) alone. We compared the median time from the time of induction to vaginal delivery, incidence of cesarean delivery, chorioamnionitis, puerperal infection, uterine tachysystole, neonatal information at delivery, and discharge status (i.e., birth weight, neonatal intensive care unit (NICU) admission, and neonatal death) between groups. Results We found that the rates of puerperal infection (n=36; 48.6%) and meconium-stained amniotic fluid (n=45; 60.8%) were higher in Group B than in Group A (n=20; 27.0% and n=25; 33.8%, respectively), which were statistically significant differences (p=0.0066 and p=0.0009, respectively). In addition, NICU admission was higher in Group B (n=47; 63.5%) than in Group A (n=30; 40.5%), which was a statistically significant difference (p=0.0051). Conclusion An intracervical Foley catheter with 25 µg of misoprostol was more effective for induction of labor than 25 µg of intravaginal misoprostol alone every six hours for a maximum of four doses in terms of induction to delivery interval, meconium-stained amniotic fluid, mode of delivery, intrapartum complications, and puerperal infection.

An Evaluation of the Second Trimester Thyroid Function Test in Gestational Diabetes Mellitus: A Case-Control Study.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance in a female with its onset or first recognition during pregnancy. Females with GDM are at higher risk of developing antenatal complications like preeclampsia during pregnancy and increased risk of type 2 diabetes as well as cardiovascular disorders later in their life. Maternal thyroid changes in the first and second trimesters of pregnancy have been widely related to the risk of GDM.Hypothyroidism during pregnancy is associated with early and late complications like abortions, anaemia, gestational hypertension, placental abruption and postpartum haemorrhage, impaired infant neurodevelopment, and low birth weight. This study aims to compare the thyroid function test (TFT) (serum fT3, fT4, TSH)and thyroid peroxidase antibody (anti TPO) between GDM and non GDM pregnant women in the second trimester and to correlate the adverse pregnancy outcomes with TFT in GDM and non GDM women. A nested case-control study was done in the Department of Obstetrics and Gynaecology, Department of Endocrinology, Department of Paediatrics, University College of Medical Sciences, and Guru Teg Bahadur (GTB) Hospital, Delhi. About 350 pregnant women from 13 weeks till 28 weeks period of gestation were screened out of which 40 GDM and 40 non GDM women were selected after performing an oral glucose tolerance test (OGTT). A TFT and anti TPO test were compared between GDM and non GDM participants. Furthermore, various parameters like sociodemographic profile, mode of delivery, pregnancy outcomes, and adverse maternal and adverse neonatal outcomes were compared. The mean age of GDM women is found to be more than non GDM women. The mean TFTvalues are significantly lower in women with GDM as compared to non GDM women. In addition, higher values of anti TPO antibody (thyroid autoantibody) were found in the GDM group which aidsin insulin resistance. Maternal complications like polyhydramnios, preterm labour, and pregnancy-induced hypertension were found to be more frequent in the GDM group compared to the non GDM group, but the results were statistically not significant. There was a higher incidence of caesarean delivery in the GDM group. Thus, we recommend the implementation of routine thyroid function profile testing in all antenatal females especially those who are at risk of developing GDM. Our study is one of the few Indian studies to evaluate the association of TFT in GDM, and we recommend similar research with a larger sample size and postnatal follow-up.

Validated Calculators Predicting Cesarean Delivery After Induction: Accuracy in an External Population.

To evaluate the performance of two previously published calculators in predicting cesarean delivery after induction of labor in an external population. This was a cohort study including all nulliparous pregnant patients with singleton, term, vertex fetuses; intact membranes; and unfavorable cervices who underwent induction of labor between 2015 and 2017 at an academic tertiary care institution. Individual predicted cesarean risk scores were calculated with two previously published calculators. For each calculator, patients were stratified into three risk groups (lower, middle, and upper thirds) of approximately equivalent size. Predicted and observed incidences of cesarean delivery were compared with two-tailed binomial tests of probability in the overall population and in each risk group. A total of 846 patients met inclusion criteria, and 262 (31.0%) had cesarean deliveries, which was significantly lower than overall predicted rates of 40.0% and 36.2% with the two calculators (both P <.01). Both calculators significantly overestimated risk of cesarean delivery in higher risk tertiles (all P <.05). The areas under the receiver operating characteristic for both calculators were 0.57 or less in the overall population and in each risk group, suggesting poor predictive value. Higher predicted risk tertile in both calculators was not associated with any maternal or neonatal outcomes except wound infection. Both previously published calculators had poor performance in this population, with neither calculator accurately predicting the incidence of cesarean delivery. Patients and health care professionals might be discouraged regarding trial of labor induction by falsely high predicted risk-of-cesarean scores. We caution against widespread implementation of these calculators without further population-specific refinement and adjustment.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Balloon Catheters Versus Vaginal Prostaglandins for Labour Induction (CPI Collaborative): An Individual Participant Data Meta-analysis of Randomised Controlled Trials

ABSTRACT Since 2010, the rates of induction have risen in Australia (from 25% to 35%) and the United Kingdom (from 20% to 32%). This may be an indication that induction has become more acceptable among women and health providers. In women with unripe cervices, mechanical methods, such as balloon catheters, and pharmacological methods, such as vaginal prostaglandins, are commonly used for cervical ripening to induce labor. Yet, induction poses the risks of cesarean delivery (CD), as well as maternal and neonatal morbidity and mortality. Finding the optimal method to induce labor is important to reduce these risks. The aim of this study was to compare the safety and effectiveness of balloon catheters and vaginal prostaglandins for the induction of labor. This was a meta-analysis using individual patient data from published and unpublished randomized controlled trials that had completed data collection between March 19, 2019, and May 1, 2021. A recent Cochrane review provided additional trials completed before March 19. Eligible trials were those that compared single- or double-balloon catheters with the vaginal prostaglandins, misoprostol, or dinoprostone. The analysis included only women with viable, singleton pregnancies with no exclusion for parity or membrane status. The primary outcomes were CD, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. A total of 12 trials, representing 5460 deliveries, were included in the analysis. Overall, the crude incidence of CD was 27%, the perinatal composite was 13.6%, and the maternal composite was 22.7%. No significant differences in the rate of CD were found between patients who received a balloon catheter and those given vaginal prostaglandin to induce labor (12 trials, 5414 women; adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.95–1.24). The adverse perinatal composite was lower among those who received balloon catheters (10 trials, 4452 neonates; aOR, 0.80 [95% CI, 0.70–0.92]; I 2 = 0%). There were no significant differences for the adverse maternal composite measure (10 trials, 4326 women; aOR, 1.02 [95% CI, 0.89–1.18]; I 2 = 0%). Balloon catheters were associated with fewer instrumental vaginal births than vaginal prostaglandins (10 trials, 4888 women; aOR, 0.82 [95% CI, 0.68–1.00]). In a subgroup analysis, there was a lower chance of the adverse perinatal composite with the use of a single-balloon catheter versus vaginal prostaglandins (9 trials, 2683 neonates; aOR, 0.84 [95% CI, 0.71–0.99]). This study found that labor induction with balloon catheters and vaginal prostaglandins was equally effective and had similar rates of CD and adverse composite maternal outcome. However, induction with a balloon catheter was observed to improve perinatal outcomes.

Association of Maternal Anemia and Cesarean Delivery: A Systematic Review and Meta-Analysis.

Anaemia during pregnancy is associated with an increased incidence of caesarean delivery (CD). This study was conducted to explore the association between CD and maternal anaemia. The PubMed/MEDLINE, Cochrane, Google, Google Scholar and ScienceDirect databases were searched for relevant studies on this topic. The assessment and review were conducted with the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. The studies were assessed using the modified Newcastle-Ottawa quality assessment scale. Data were collected in an Excel sheet, and the 'meta' package of the R 4.0.3 software was used for statistical analysis. Fourteen studies that enrolled 336,128 pregnant women were included in the meta-analysis. Women with anaemia were found to be at a higher risk for CD (OR = 1.63, 95% CI = 1.23-2.17). As heterogeneity was detected in the studies, the random-effects model was used for the pooled meta-analysis (Q = 96.7, p &lt; 0.001). In the subgroup analysis, anaemic women were found to be at higher risk for CD in studies from both low-middle-income (7) and high-income countries (7). In meta-regression analysis, none of the investigated covariates were associated with the pooled OR of CD. This evidence demonstrates with a moderate level of certainty that anaemic pregnant women are more likely to have CD than non-anaemic pregnant women.

STUDI KASUS: PENATALAKSANAAN TERAPI KOMPLEMENTER PADA IBU HAMIL TRIMESTER III DENGAN NYERI PUNGGUNG

Various problems that arise in the third trimester of pregnancy are problems that are often complained of by pregnant women, such as anxiety and pain. Among these complaints, low back pain is the most commonly reported, occurring in 60% -90% of pregnant women, and is one of the causes of the incidence of cesarean delivery. Back pain is caused by pain in the lumbosacral area. The increase in intensity as the gestational age increases is caused by a shift in the center of gravity and changes in body posture. Back pain from sacroiliac/lumbar can be a long term back problem if not treated immediately. One of the complementary therapies that can reduce or relieve pain, reduce or prevent muscle spasms, provide a sense of comfort, namely with warm compresses and prenatal massage. This case study describes the management of complementary therapy consisting of warm compresses and prenatal massage in third trimester pregnant women with complaints of back pain. After midwifery care was implemented, Mrs. F experienced a decrease in back pain so that the problem could be resolved.

Fetal Biometry and Doppler Assessment of Pregnant Women with COVID-19

Background: The world has changed radically because of the worldwide COVID-19 pandemic. SARS-CoV-2, a unique strain of large, enveloped single-stranded RNA viruses, that has spread around the world. The primary objective of this research was to assess the fetal growth velocity in pregnancies complicated by SARS-CoV-2 infection and those that were not. The secondary objective was to determine if SARS-CoV-2 infection may affect maternal and fetal Doppler readings. Methods and Results: A total of 250 pregnant women diagnosed with SARS-CoV-2 (Case group) were compared to 300 healthy pregnant women (Control group) in a prospective case-control study in Mosul from February 20 to October 20, 2021. Infections during pregnancy were detected and verified using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). All ultrasound exams were done from 24 to 40 weeks. Measuring parameters using Doppler ultrasonography included plasticity and resistive indices (PI, RI), as well as cerebroplacental ratio computed according to gestational age. Fetal development in utero was assessed by measuring biometric markers, such as parietal diameter, head size, belly circumference, leg length, and estimated fetal weight every four weeks. The US scans in the second and third trimester of pregnancy showed no evidence of congenital abnormalities (P=0.7047). There was a significant incidence of cesarean delivery (P=0.0000) and lower fetal activity at birth (P=0.0000) in the Case group, compared to the Control group. Anticoagulant treatment during pregnancy was not associated with an increased risk of postpartum hemorrhage in women of the Case group. Also, there were no significant differences in fetal biparietal diameter and femur length between groups in the second and third trimesters, and both fetal and maternal Doppler studies throughout the second and third (35-37 weeks) trimesters of pregnancy yielded no significant differences in the PI and RI indices.

The “Quiet Revolution” and the cesarean section in the United States

This paper estimates how changes in family structure and women’s labor market attachment during the last fifty years have affected the incidence of cesarean delivery in the United States. Both sets of factors are strongly related to cesarean utilization, and have generally changed so as to increase the rate of cesarean delivery over time. Altogether, changes in these factors, complemented by demographic changes, raised the U.S. cesarean section rate by eleven percentage points since the late 1970s, nearly two-thirds of the increase over that period. Today’s elevated cesarean section rate is in part a social phenomenon.

Outcome of Inducing Labor in Pregnancies with Suspected Fetal Growth Restriction: Oxytocin Discontinuation during the Active Phase of Labor versus Conventional Management.

Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is limited evidence to guide labor management. This study aimed to investigate the prognosis of induced labor in pregnancies with suspected FGR and whether oxytocin discontinuation during the active phase of labor affects maternal and neonatal outcomes. This retrospective cohort study investigated singleton pregnancies with vertex presentation and indications for labor induction owing to FGR after 34.0 weeks of gestation at Osaka University Hospital. From January 2010 to December 2013, women were conventionally managed, and oxytocin was continued until delivery unless there was an indication for discontinuation (conventional management group). From January 2013 to December 2020, oxytocin was routinely discontinued, or the dose was reduced at the beginning of the active phase of labor (oxytocin discontinuation group). A total of 161 women (conventional management group, n = 74; oxytocin discontinuation group, n = 87) were included. After the active phase of induced labor, the total incidence of cesarean delivery was very low (3.1%), and the duration was short (173 ± 145 minutes). Oxytocin discontinuation was associated with lower cesarean delivery (1.1 vs. 5.4%; p = 0.12) and uterine tachysystole (9.8 vs. 23.0%; p = 0.08) rates and longer duration of the second stage of labor (mean: 56.5 ± 90 vs. 34.2 ± 45 minutes; p = 0.08) than conventional management; however, the difference was not significant. The other maternal and neonatal outcomes, including postpartum hemorrhage, did not also significantly differ between them. After the active phase of induced labor for suspected FGR, the risk of cesarean delivery is low, and the high incidence of uterine tachysystole and rapid labor progression should be considered cautiously. Oxytocin can be safely discontinued during the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes. · The cesarean delivery rate was low after the active phase.. · The labor progress after the active phase was rapid.. · Oxytocin can be safely discontinued during the active phase..

Caesarean Scar Pregnancy: Surgical Obstacles

As a rare phenomenon, caesarean scar pregnancy has been found to be managed in many ways in literature. However, to date there lacks a general consensus on the management of caesarean scar pregnancy. In modern obstetrics nowadays, the incidence of caesarean deliveries has been rising. Due to the increase in caesarean section rates, the incidence of caesarean scar pregnancies is also on the rise. Even though the optimal management of caesarean scar pregnancy is unclear, the basic management is tailored according to the clinical presentation and fertility concerns of the individual. Herein, we report a case of a ruptured caesarean scar pregnancy which was managed surgically via emergency laparotomy and hysterectomy.

Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil.

IntroductionThe socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity.ObjectivesWe aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil.MethodsThis cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years.ResultsThe prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35–33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13–2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12–2.14; p <0.01).ConclusionThe PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.

Recognition of the Type of Cesarean Scar Pregnancy in First Trimester Sonography

This case series is presented to illustrate the clinical value of identifying, sonographically, the type of cesarean scar ectopic pregnancy that may present, as this has become more frequently encountered. The choice of surgical treatment appears to be dependent on the sonographic typing, of this specific type of ectopic pregnancy. This case study illustrates the importance of this topic, given the rising incidence of cesarean deliveries coupled with the increase in first trimester sonograms being more commonly performed. The value of proper diagnostic detection is important, given the contemporary management of this new type of ectopic pregnancy.