Indication For Caesarean Section Research Articles

Evaluation of Factors Affecting Intrapartum Cesarean Section Rates by Comparing the Data of Patients with Vaginal Delivery: A Retrospective Case-Control Study

Objective: This study aimed to determine intrapartum cesarean section rates of our clinic as well as risk factors for intrapartum cesarean section. We also aimed to identify patients with risk factors beforehand and to reduce the intrapartum cesarean section rates and the complications that might occur due to intrapartum cesarean sections. Material and Methods: A total of 150 patients admitted to our clinic for vaginal delivery that ended up having intrapartum cesarean sections (case group) and 200 patients who had a vaginal delivery (control group) were included in our study retrospectively. Demographic, clinical, and neonatal results of the patients were compared. Results: Intrapartum cesarean section rate was determined to be 23% (150/654). The most common indication for intrapartum cesarean section was fetal distress (48%). We found that low gestational week at delivery, nulliparity, and polyhydramnios were independent risk factors for intrapartum cesarean section. We determined that gravidity and parity were not risk factors for intrapartum cesarean section. It was found that 1st minute APGAR scores of babies of patients with intrapartum cesarean section were significantly lower and that intrapartum cesarean section was an independent risk factor for this particular finding. Conclusion: The possibility of the intrapartum cesarean section should be considered in the labor follow-ups of patients with risk factors. We recommend hospital deliveries where the necessary conditions for the mother and fetus are met.

Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study.

Background and Aims:There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients.Material and Methods:This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed.Results:A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2.Conclusion:COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.

Management of Arterial Hypotension Induced by Spinal Anesthesia during Cesarean Section at the Parakou University Hospital in Benin in 2020: Ephedrine versus Noradrenaline

Background: Spinal anesthesia (SA) is a preferred anesthetic technique for childbirth through caesarean section. It causes a sympathetic block responsible for low blood pressure which can be prevented or treated with vasopressors. Aim: This research aims to compare the effect of Noradrenaline with that of Ephedrine in the management of arterial hypotension caused by SA during Caesarean act. Study method: It was a cross-sectional study with two comparative settings which took place at the Teaching hospital of Parakou from April 15th to August 15th 2020. It included all parturients who underwent a caesarian act and received spinal anesthesia. To prevent hypotension two groups were formed. The first group parturient received Noradrenaline (10 γ) as prophylactic and the second group received Ephedrine (10 mg) before anesthesia. The main evaluation criteria were the time before the hypotension occurs and, the secondary endpoint was the number of hypotension episode. The two groups were compared using the usual statistical tests. The study received the approval of the Local Ethical committee of University of Parakou. Results: Two hundred and four parturients were compiled with 102 in each group. The mean age was 28.37 ± 6.15 years with extremes of 16 and 45 years. The main indications for Caesarean section were respectively iterative Caesarean section (46.57%) for scheduled Caesarean section and acute fetal distress (15.69%) for emergency Caesarean section. The incidence of hypotension was 38.24%. The mean delay of occurrence of hypotension was significantly longer in adrenaline group (19.90 min) than ephedrine group (12.53 min) with P = 0.001. According to the secondary endpoint the number of episodes of hypotension, number of tachycardia, and the total doses of each vasopressor were significantly lower in adrenaline group than in the ephedrine group. Conclusion: The use of Noradrenaline according to the established protocol demonstrated its efficiency compared with Ephedrine in the management of hypotension after spinal anesthesia.

A comparison of cesarean section indications and characteristics in 2009 and 2020 in a Saudi tertiary hospital

Background: Cesarean section (CS) has been increasing in recent years with a wide range of etiologies. This study aimed to assess the indications, outcomes, and complications of CS in a hospital in Riyadh, Saudi Arabia. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. The study included two cohorts including G1 (2009) and G2 (2020). Variables including CS indication, neonatal and maternal complications, CS type, age of the mother, body mass index, parity, gestational age, and neonatal data were assessed. Results: A total of 399 women were recruited and divided into two groups, G1 (n = 199) and G2 (n = 200) with a mean age of 32 ± 6 years. G1 and G2 had significant differences in mean age with 30 ± 6 and 34 ± 5 years, respectively (p ≤ 0.001), which indicated delayed fertility between the groups by 4 years. Moreover, the breech presentation was less likely to occur in G2. Maternal causes, such as repeated c-sections and maternal medical conditions were more likely to happen in G2. Furthermore, postpartum hemorrhage showed an increase of 12% in G2. G2 patients were more likely to be admitted to the neonatal intensive care unit and to the special care baby (p ≤ 0.001), compared to regular nursery admission. Conclusion: Multiple factors contributed to the increase in the CS rate in a Saudi tertiary hospital. The factors were suggested to be previous CS, abnormal fetal heart rate, malpresentation, and maternal or fetal medical condition.

A brief history and indications for cesarean section

Cesarean section (CS) is one of the oldest surgical operations. Originally, this surgery was performed post-mortem by cutting open the woman’s abdomen to remove a dead or alive fetus. It was therefore not intended for saving the mother in ancient times. Roman law and religious rituals shaped the procedure until the Middle Ages. At that time, the indication of CS was only post-mortem. Although CS became a medical procedure in the Renaissance, maternal mortality was extremely high, mainly due to hemorrhage and puerperal infection. The reason for performing CS was to rescue the mother and fetus from protracted labor as a last resort. Since the late 19th century, with the introduction of chloroform and the developments of surgical techniques, and the availability of blood transfusion in the early twentieth century, CS became a relatively safe procedure, further helped by the introduction of antibiotics after World War II. Then, CS was increasingly an intervention to preserve the health and safety of both mother and fetus. During the 21st century, CS has been performed even without medical indication, such as maternal choice. Advancement of obstetric practice technologically and professionally during the period as well as changing attitudes of both obstetricians and childbearing women meant indications for CS are no longer limited to medical/obstetric indications. CS is perceived as a safer mode of childbirth. Therefore, the indications of CS have been changed drastically from ancient times (rescuing a baby from dying or dead mother) to the 21st century (maternal choice/reproductive rights).

Puerperal Complications in a Tertiary Hospital

Postnatal period is considered as an important part in reproductive life of women. Even though the antenatal phase and labour are utmost important, puerperal phase of pregnancy cannot be overlooked. Puerperal complication can sometime lead to diabilities for lifelong of women. For the prevention of postnatal complication, antenatal prepadareness is needed. The objective of this study was to find out the incidence of puerperal complications and associated risk factors. This is a retrospective, descriptive study conducted at Tribhuvan University Teaching Hospital, Department of Obstetrics and Gynaecology from April 2019 to March 2020. The cases of puerperal complications were noted from the record book from ward. The individual files were collected from record section. Data was collected from record files and analysed. Total number of deliveries were 4932 in one year. Out of which, 84 cases (1.7%) were admitted due to various puerperal complications. Majority of the women admitted with puerperal complications were between 21-29 years, 59.5%. Sixty-four percent (n=54) were primipara and 35.7%(n=30) were multipara. Seventy-six (90.5%) were term deliveries, 6(7%) were preterm and 2(2.4%) were post term deliveries. Sixty-two (74%) had emergency cesarean section as mode of delivery. Major indication of emergency cesarean section was fetal distress (29.8%, n=25). Surgical site infection (53/84,63%) was the commonest puerperal complication followed by puerperal sepsis (8/84,9.5%). Fifty- three cases of surgical site infection (SSI) were observed in patients who had undergone emergency cesarean section. Associated medical condition like hypertension, diabeties, anemia, obesity was seen in 33.5% (n=33) of the cases. Surgical Site Infection is the most common puerperal complication and commonly seen in women who had undergone emergency cesarean section.

Assessment the Indication for Caesarean Section among Women's attending AL -Dewaniya Maternity and Pediatric Hospital

Background: Knowing the indications for a cesarean section will help to have a better understanding of this common obstetrical procedure and prepare for the high level of care management that it entails. Aims of the study: The goal of this study was to determine the factors that influence caesarean section indications among women who visited AL-Dewaniya Maternity and Pediatric Hospital, as well as the relationship between caesarean section women's indications and socio-demographic data. Methodology: A descriptive cross-sectional study design is conducted for the period of December 26th 2020 to June 1st 2021 at Al Dewaniya Maternity and Pediatric Hospital. The validity of the questionnaire is determined through a panel of experts and reliability is achieved through a pilot study. By a purposive sample is selected among those who are undergo caesarean section, data was collected through the use questionnaire and interview techniques; and analyzed through the descriptive and inferential statistic. Results: the mean age was 29±7.723, most of the patient were in the age 20-29 years old (n=217; 43.4%), about (n=149; 29.8%) not read and write, more than half of study participants are housewife (n=339; 67.8%), most of study participants are overweight (n=248; 49.6%). Failure of labor progress were predominated were most common indications for cesarean section, the Oligohydramnios were the most factors indicated for cesarean section, as well as, there were no-significant relationship between women demographic data and their indications for caesarean section at p-value >0.05. Conclusion: failure of progress of labor was the most indication for cesarean section. Oligohydramnios was the most fetal factors indicated for cesarean section. Recommendations: Avoiding unjustified cesarean section delivery should be encouraged and detailed medical justification for performing caesareans by doctors should be provided

Efficacité et tolérance du misoprostol oral 25 μg vs dinoprostone vaginale dans le déclenchement du travail à terme

ObjectiveTo compare the efficacy and safety of oral misoprostol 25μg compared to vaginal dinoprostone in the induction of labor at term. MethodsAnalytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. ResultsOur study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). ConclusionNo difference in efficacy was found between the two induction techniques. Oral misoprostol 25μg seems to be better tolerated from a maternal and fetal point of view.

Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women.

ABSTRACTObjectiveSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother‐to‐child transmission of SARS‐CoV‐2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS‐CoV‐2‐positive women.MethodsPregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS‐CoV‐2‐positive nasopharyngeal swab 24–48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS‐CoV‐2 detection was carried out using real‐time reverse‐transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother‐to‐child transmission of SARS‐CoV‐2 were applied to the study population.ResultsForty‐two SARS‐CoV‐2‐positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty‐five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS‐CoV‐2 test at birth and none had coronavirus disease 2019‐related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS‐CoV‐2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS‐CoV‐2. Our results also showed that 40–60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested.ConclusionThis study contributes evidence to reinforce the potential for vertical transmission of SARS‐CoV‐2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS‐CoV‐2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Maternal amylase, lipase, lactate dehydrogenase, creatine kinase levels at preterm delivery, and the effect of tocolysis

Background/Aim: Preterm labor is one of the main obstetric problems and the leading cause of neonatal mortality and morbidity. Some pregnant women at risk of preterm labor receive tocolytic therapy, but the agents used can affect maternal blood parameters and enzyme levels. Physiological changes that occur during pregnancy may cause changes in enzymatic activities. Maternal amylase, lipase, lactate dehydrogenase (LDH), and creatine kinase (CK) levels should be followed throughout pregnancy to assess any increase. This study aimed to examine maternal amylase, lipase, creatine kinase, and lactate dehydrogenase levels in pregnant women who gave term and preterm birth and determine the physiological changes that may occur with gestational age and tocolysis. Methods: The records of patients over their 24th gestational week who gave birth at the Gynecology and Obstetrics Department of Okmeydani Training and Research Hospital between July-December 2018 were reviewed in this retrospective cohort study. Their clinical findings, maternal and obstetric outcomes were noted. A total of 548 pregnant women were included in the study, who were divided into three groups: Group 1- Preterm delivery without tocolysis, Group 2- Preterm delivery with tocolysis, Group 3- Term delivery Results: The maternal age, gravidity, history of abortion, fetal gender, amylase, and lipase values were similar between the groups (p>0.05 for all), while delivery types and cesarean section indications significantly differed (p=0.009, and p

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury.

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

Examining prescribing practices with respect to oral iron supplementation for post-partum anemia: a retrospective review

Purpose Treatment for post-partum anemia frequently entails oral iron supplementation, but questions remain regarding optimal dosing, frequency, and efficacy. The objective of this study was to describe oral iron prescribing practices in post-partum women delivered via Cesarean section, and identify factors associated with iron supplementation. Methods A retrospective review of Cesarean section deliveries at a single tertiary center between May 2019 and April 2020 was undertaken. Patient demographics, hematological indices, indication for Cesarean section and discharge prescriptions were collected. Univariate and multivariable analyses were performed to identify factors associated with oral iron prescription at discharge. Results During the study period, 1470 women were eligible for inclusion. The mean age at delivery was 34.4 ± 4.9 years and mean gestational age was 37.2 ± 3.6 weeks. Most pregnancies (92%) were singleton. Ninety-six total patients (6.5%) received intravenous iron post-partum. Fourteen percent of women (210/1470) received prescriptions for oral iron at discharge, most commonly ferrous fumarate (61.9%, 130/210). The most common dose provided was 300 mg (145/210). Ante-partum ferritin was available for most patients (64.3%, 945/1470), but only for 17 post-partum patients (1.2%). Factors significantly associated with oral iron prescription were earlier gestational age at birth (aOR 0.93, 95% CI 0.89–0.97), history of complications during pregnancy or labor (aOR 1.92, 95% CI 1.26–2.98), higher blood loss (aOR 2.66, 95% CI 1.36–5.44), post-partum anemia (aOR 6.28, 95%-CI 4.41–8.96), blood transfusion (aOR 5.43, 95%-CI 1.81–18.19) and antenatal iron supplementation (aOR 5.70, 95%-CI 4.02–8.17). Conclusions In summary, a relatively small proportion of women following Cesarean section were prescribed oral iron at discharge. We identified several factors associated with post-partum iron supplementation. This information will inform future prospective studies investigating the efficacy of iron supplementation in the treatment of post-partum anemia.

Pregnancy management in patients with uterine fibroids. Case report

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

Caesarean Section in Preventing Stillbirths in Pregnancy Complicated with COVID-19: a Narrative Review.

COVID-19 is a complex syndrome caused by SARS-Cov-2. It mainly affects the respiratory system, but it could cause serious harm during pregnancy. An increase in stillbirths and preterm births has been highlighted by many authors. Although WHO and Royal College of Obstetrics and Gynecology don't recommend elective cesarean section in women with confirmed infection, cesarean sections were performed by many clinicians. This short narrative review aims to analyze pieces of evidence found in literature about the effectiveness of cesarean section in preventing stillbirths in COVID-19 positive mothers. Studies included in the present review were retrieved searching MEDLINE (last access August 5th, 2021) with the following keywords: "pregnant woman with covid-19", "Caesarean section", "Ab-dominal Delivery" and "Stillbirth". Studies regarding the mode of delive-ry in pregnant women infected with COVID-19 and neonatal outcomes were included. Studies about biology, anesthesiology and necroscopy were excluded. Filters for "human" and "English" were applied. Searching MEDLINE, 24 references were found. Other 103 articles were found searching bibliography. Two references were excluded after duplicate removal, 77 references after the title screen and 27 after the abstract screen. The final number of references included was 23. Most of the included studies were case reports. Most of them were from China. Many authors highlighted the increased risk of fetal death in pregnancies complicated with SARS-Cov-2 infection, but it is not clear if Caesarean Section could reduce this risk. Pieces of evidence show that most clinicians choose to perform an elective cesarean section mostly because of maternal conditions or the fear of possible vertical transmission. Data show that mode of delivery doesn't affect the neonatal outcome and Caesarean Section doesn't reduce the positivity rate among neonates. Different opinions were found about the possible infection of amniotic fluid, cord blood and placenta. The risk of vertical transmission is considered moderate or low by most of the authors. Positivity to SARS-Cov-2 isn't an indication of elective cesarean section by itself, but this mode of delivery should be optioned in patients with other obstetrical indications or with severe conditions due to COVID. The recent increase in stillbirths could be related to the overall deterioration of maternal conditions.

Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum.

Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum. This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine "Safe Prevention of the Primary Cesarean Delivery" recommendations. Fisher's exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant. Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM "Safe Prevention of the Primary Cesarean Delivery" publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004). Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level. · Many patients with placenta accreta spectrum have potentially preventable primary cesarean sections.. · Privately insured patients are more likely to have potentially preventable primary cesarean sections.. · Our findings suggest that at least a subset of placenta accreta spectrum cases may be preventable..

Knowledge and Attitudes of Pregnant Thai Women Regarding Modes of Birth: A Hospital-Based Study in Southern Thailand

Objective: This study aimed to determine the knowledge and attitudes of pregnant Thai women regarding modes of birth. Methods: A cross-sectional study was conducted at Songklanagarind Hospital. A total of 605 women with a singleton pregnancy and gestational age &gt;20 weeks who attended an antenatal clinic from September 2018 to June 2019 were recruited. Women having a history of cesarean section, or any condition associated with indications for cesarean section, having a fetus with an obvious anomaly, could not read or write in the Thai language, or could not complete the questionnaire were excluded. Their knowledge and attitudes regarding modes of birth were evaluated through self-administered questionnaires. Results: Most women (69.4%) had poor knowledge scores (&lt;5), with a median score of 3 (range, 0-9). Only 14.5% of women knew about serious complications of cesarean section in future pregnancies(placental adherence). Multivariate logistic regression analysis showed that factors associated with adequate knowledge scores (&gt;5) were high educational levels (OR 2.06; 95% CI 1.23-3.47), high incomes (OR 1.96; 95%CI 1.32-2.90), and multiparity(OR 1.73; 95%CI 1.18-2.52). Most women had positive attitudes towards vaginal birth. Only 10.2% of women had a preference for cesarean birth. Factors associated with the preference for cesarean birth were advanced maternal age (OR 3.10; 95%CI 1.72-5.60), having an underlying disease (OR 3.61; 95% CI 1.79-7.25), and poor knowledge scores (OR 2.43; 95% CI 1.21-4.91). Conclusion: Most pregnant Thai women had poor knowledge of the modes of birth. However, the majority of women had positive attitudes towards vaginal birth.

MATERNAL FACTORS ON LABOR WITH CESAREAN SECTION HISTORY

AbstractBackground : Cesarean section without medical indications can have negativity in developing or developed countries. Cesarean section is a medical intervention in certain circumstance but must be recognized as a major surgical procedure with potential risks to the mother and baby. This research aim to analyze maternal factors in labor with a history of cesarean esction. Method : this research was a cross sectional method with collected 72 medical records in RSUD Dr. M. Soewandhie Surabaya. Result : Maternal age, interpregnancy interval, indication of past Cesarean section, and BMI during pregnancy, did not correlate with method of delivery. Factors which correlated to method of delivery after Cesarean section were prior vaginal delivery (p=0,044) and length of stay (p=0,000). Conclusion : There is a relationship between the factors of vaginal birth history and length of stay with delivery method.

Predictors of immediate neonatal outcome after cesarean section in Uganda.

To identify predictors of low Apgar score, immediate neonatal death, and stillbirth after cesarean section in Uganda. Records of cesarean sections performed at all 14 regional referral hospitals and also 14 first-level (district) hospitals in Uganda were reviewed. Both elective and emergency cases were included. Data comprised mother's age, indication, type of anesthesia, and immediate outcome of the newborn. To evaluate the relation of the predictor variables to outcome, regression analysis was performed. A total of 37585 cesarean sections were recorded. The indications for cesarean section that led to the highest neonatal mortality and stillbirth rates and lowest mean Apgar scores were uterine rupture and hemorrhage. Emergency surgery and general anesthesia had worse neonatal outcomes than elective surgery and spinal anesthesia. Compared with general anesthesia, spinal anesthesia was favorable for neonatal outcomes. Elective surgical planning and scale-up of the use of spinal anesthesia may potentially reduce stillbirths and immediate neonatal deaths.

The management of very early preterm birth

The objective: a determination of the management for very early preterm birth, depending on the gestational age, and an assessment of perinatal outcomes. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation. The patients were divided into two groups depending on the criteria of live birth: the 1st group – 79 women whose labor was as a late miscarriage (retrospective study); the 2nd group – 87 women with very early preterm birth (prospective study). Exclusion criteria: congenital malformations of the fetus. All women were examined using clinical, instrumental and laboratory research methods.Results. The main complications of gestation in pregnant women of both groups in the II trimester were the threat of pregnancy interruption and placental dysfunction (PD), which led to the development of fetal growth retardation in both groups (66% – in the 1st group, 63% – the 2nd group). The presence of PD by VEPB was confirmed histologically in 68% and 72% of cases in each group, respectively. 55 (69.6%) patients of the 1st group and in 26 (29.9%) women of the 2nd group had vaginal delivery. Indications for cesarean section (CR) in the 1st group were mainly from the mother (75%), in the 2d group 27.8% persons had indications from the mother, 4.9% (PD) – from the fetus, combined indications were determined in 65.6% (deep prematurity). The expansion of indications for CS by VEPD in 41% led to a 1.5-fold decrease in perinatal mortality (p&lt;0.05). In the postpartum period, patients of both groups had a decrease frequency of purulent-septic complications after the preventive treatment from 13.9% (the 1st group) to 4.6% (the 2d group) (p&lt;0.05). The analysis of perinatal mortality demonstrated a high rate at 22–24 weeks of gestation, while this indicator was in 1.5 times lower at 25 weeks and 3.5 times lower at 26–27 weeks. We found that the method of delivery did not affect perinatal results at 22–25 weeks, but at 26–27 weeks the survival rate of newborns born by CS is on 10% higher than by spontaneous delivery (p&lt;0.05). The expansion of indications for the prevention of respiratory distress syndrome of the fetus from 22 weeks in the 2nd group (in the 1st group was not performed) by 10.7% led to an increase in the survival rate of children with extremely low body weight by 11% (p&lt;0.05).Conclusions. In cases of threat of VTPB, the management is determined by the gestational age, the state of health of the mother and the fetus, the degree of readiness of the birth canal for delivery. Premature delivery is not an indication for CS, except for the presence of specific obstetric indications, but abdominal delivery is possible in early pregnancy (22–25 weeks). The questions about the operated vaginal delivery, the determination of the gestational age for the prevention of respiratory distress syndrome with glucocorticoids, the need to use tocolysis are controversial. The correct determination of the management of women with preterm birth will allow to apply timely measures to be taken to improve the results for the mother and the newborn and may have a prognostic character.

External cephalic version in the outpatient clinic

The continuous increase in the rates of cesarean section worldwide is concerning. Breech presentation is one of the major indications for cesarean section in most countries. External cephalic version (ECV) can reduce cesarean rates by approximately two-thirds in term breech pregnancies. After introduction of ultrasonography and cardiotocography before and after the procedure, ECV has become much safer. As a result, over-night fasting, intravenous access, and preoperative laboratory tests are no longer recommended as the patient's risk of requiring emergency cesarean section is very low. We have been running the largest ECV clinic in South Korea since 2008, and ECV trials in the outpatient clinic were started in 2015. We want to share our experiences running the ECV clinic for 15 years managing more than 2000 patients.