Indication For Caesarean Section Research Articles

Outpatient Cervical Ripening With Misoprostol to Prevent Post-Term Pregnancy: A Double-Blind Randomized Clinical Trial

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of <8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P<0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P>0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

Auditing cesarean section indications in women of Groups 1 to 4 of Robson's Ten-Group Classification System: A descriptive study at a university hospital in Thailand

Aim: To determine the appropriateness of indication for cesarean section in women at term with a single fetus in cephalic presentation without previous CS irrespective of parity and how labor started (Robson's Ten-Group Classification System [RTGCS] groups 1-4). Methods: This was a descriptive study assessing medical records of 311 women in RTGCS groups 1- 4, between 1st January 2020 and 31st December 2020 who underwent a CS in Srinagarind Hospital, a university hospital, Khon Kaen, Thailand. Appropriateness of CS indications was assessed using criteria developed by our institute. Indications were classified into three categories: cephalopelvic disproportion (CPD), fetal indications, and other maternal indications. Results: The overall appropriate rate of CS indications in RTGCS groups 1-4 was 32.5% (95% CI 26.8% – 38.7%). The appropriate rates of CS indications in RTCGS group 1, 2a, 2b, 3, 4a, and 4b were 43.0% (95% CI 35.2% - 51.2%), 10.6% (95% CI 0.0% - 24.9%), 11.7% (95% CI 0.0% - 25.0%), 50.0% (95% CI 32.1% - 68.6%), 0% (95% CI 0.0% - 100%), and 40.0% (95% CI 20.0% - 74.8%) respectively. Conclusion: Low appropriateness in CS indications in RTGCS groups 1-4 leads to high CS rates. Increasing appropriateness of CS indications in this population will reduce unnecessary CS. Interventions focusing on increasing appropriateness in CS indications are urgently required to achieve appropriate use of CS.

Comparison of oral mifepristone with intracervical foleys catheterisation for induction of labour in term pregnancy: A randomized control trial

The purpose of this study is to compare the efficacy of oral Mifepristone with the efficacy of intracervical Foley catheterisation for induction of labour in term pregnancy. The primary outcome of this study is to compare both methods of induction of labour in terms of induction to delivery interval and the secondary outcome is to compare the two methods in terms of route of delivery, indications of caesarean section and the neonatal outcomes. This study is a randomized control trial conducted from May 2022 to December 2022 in Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College. 180 term pregnant patients were enrolled in this study based on a pre-established criteria. Patients were randomised into group A and B. Group A included patients who were given Tablet Mifepristone 200 mg PO followed by per vaginum Tablet Misoprostol and Group B included patients who underwent intracervical Foleys catheterisation followed by placement of per vaginum Tablet Misoprostol. The study concluded that there was significantly decreased induction-delivery interval in women induced with intracervical Foleys catheterisation (Group B) as compared to those given oral Tablet Mifepristone (Group A). There was no significant difference between the two groups in terms of the route of delivery, rate of C Sections and neonatal outcomes.Mifepristone is effective for inducing indicated term pregnancies, despite no decrease in induction delivery interval. Incidence of fetal distress with oral Mifepristone is comparable to intracervical foley's catheterization. Further research is needed to assess tachysystole/hyperstimulation and fetal distress caused by Mifepristone.

Risk of Cesarean Delivery after Vaginal Inserts with Prostaglandin Analogs and Single-Balloon Catheter Used for Cervical Ripening and Induction of Labor.

(1) Background: Induction of labor is currently the most frequently performed procedure in modern obstetrics, referring to more than one in five women, and it is postulated that the percentage of labor induction will increase. (2) Methods: In total, 2935 patients in uncomplicated full-term pregnancy fulfilled the study inclusion criteria and underwent induction of labor. Pregnant women were divided into three groups: IOL with Dinoprostone, Misoprostol vaginal suppositories, and Foley catheter. Outcomes, including cesarean section rates, time to delivery, and cesarean section indications, were analyzed. (3) Results: There was statistically significantly more cesarean sections within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p < 0.0001). The percentage of patients who had a cesarean section due to clinically diagnosed threatened fetal asphyxia was 63% in the Dinoprostone group, 81.3% in the Misoprostol group, and 55.3% in the Foley catheter group. There were statistically significantly more cesarean deliveries due to nonreassuring fetal heart rate patterns within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p = 0.0031 and p = 0.0363). (4) Conclusions: Misoprostol may cause a more turbulent and violent course of labor, with a higher rate of increased incidence of nonreassuring fetal heart rate patterns and cesarean deliveries. The use of a Dinoprostone vaginal insert or Foley catheter may provide longer labor, although still within 48 h, with a lower risk of cesarean section caused by nonreassuring fetal heart rate patterns.

Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Objective To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. Methods Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients’ demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. Results No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It’s worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). Conclusion EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.

Comparative evaluation of the caesarean section rate in term nulliparas with labour dystocia following augmentation with oxytocin alone versus with oxytocin and drotaverine

Background: Labour dystocia is the commonest indication for emergency caesarean section in nulliparas, and occurs when the progress of labour is abnormally slow. Labour dystocia may be caused by abnormalities in uterine contractions, slow cervical dilatation, or mechanical disproportion between the foetal presenting part and the maternal pelvis. Augmentation of labour with oxytocin is the traditional management for labour dystocia as it enhances uterine contractions. At times, despite good uterine contractions, dystocia persists due to cervical smooth muscle spasms or mechanical factors, thereby increasing the caesarean section rate. Drotaverine is a musculotropic antispasmodic and can relieve smooth muscle spasms. Aim/objective: This study compared the caesarean section rate in term nulliparas with labour dystocia that were augmented with oxytocin and placebo versus with oxytocin and drotaverine Methods: This study was a single-blinded randomized clinical trial conducted between January and August 2021. It involved 156 term nulliparous women with labour dystocia that were randomized into two groups for augmentation of labour. Each group had 78 parturients that were managed with either oxytocin with a placebo or oxytocin with drotaverine. They were monitored till delivery and the caesarean section rate in both groups was compared. Data obtained were analysed with SPSS version 23 software. The level of significance was set at 0.05, P&lt; 0.05 was statistically significant. Results: The two groups were similar in their sociodemographic characteristics. In this study 21(13.5%) women had emergency caesarean section while 135(86.5%) had vaginal delivery following augmentation. The caesarean section rate in the oxytocin-placebo was similar to the oxytocin-drotaverine group (10 (12.8%) vs 11 (14.1%), p=0.82). The majority, 14 (67%) of the caesarean sections were due to mechanical factors, 4 (19%) were due to functional dystocia and 3(14%) were due to foetal distress. Conclusion: The use of drotaverine with oxytocin in managing labour dystocia did not improve the caesarean section rate as the majority of the cases had mechanical dystocia.

The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices.

The purpose of the present study was to evaluate the effectiveness of a misoprostol vaginal insert as an induction-of-labor (IOL) agent in women with an unfavorable cervix (Bishop score < 2) in achieving vaginal delivery (VD) within 48 h, depending on the gestational week, with particular emphasis on the cesarean section (CS) percentage, intrapartum analgesia application and possible side effects, such as tachysystole ratio. In this retrospective observational study involving 6000 screened pregnant patients, 190 women (3%) fulfilled the study inclusion criteria and underwent vaginal misoprostol IOL. The pregnant women were collected into three groups: patients who delivered at up to 37 weeks of gestation (<37 Group)-42 patients; patients who delivered between 37 and 41 weeks of gestation (37-41 Group)-76 patients; and patients who delivered after 41 weeks of gestation (41+ Group)-72 patients. The outcomes included time to delivery and mode of delivery, rate of tachysystole, need for intrapartum analgesia, and need for oxytocin augmentation. Most of the patients delivered vaginally (54.8% in <37 Group vs. 57.9% in 37-41 Group vs. 61.1% in 41+ Group). A total of 89.5% (170/190) of patients delivered within 48 h (<37 Group-78.6% vs. 37-41 Group-89.5% vs. 41+ Group-95.8%). Statistical significance was demonstrated for the increased rate of vaginal deliveries and shortened time to delivery in the 41+ weeks group (p = 0.0026 and p = 0.0038). The indications for cesarean section were as follows: abnormal CTG pattern vs. lack of labor progression: 42.1% vs. 57.9% in <37 Group, 59.4% vs. 40.6% in 37-41 Group and 71.4% vs. 28.6% in 41+ Group. Statistical significance was demonstrated for the increased rate of abnormal CTG patterns as cesarean section indications in the 41+ Group (p = 0.0019). The need for oxytocin augmentation in each group was: 35.7% in <37 Group vs. 19.7% in 37-41 Group vs. 11.1% in 41+ Group. Statistical significance was shown for decreased need for oxytocin augmentation in +41 Group (p = 0.0016). The need for intrapartum anesthesia, depending on the group, was: 78.6% in <37 Group vs. 82.9% in 37-41 Group vs. 83.3% in 41+ Group. Statistical significance was demonstrated for increased need for intrapartum anesthesia application during labor in +41 Group (p = 0.0018). The prevalence of hyperstimulation was similar in all three groups (4.8% vs. 7.9% vs. 5.6% p > 0.05). The misoprostol vaginal regimen for IOL used in our study is effective in achieving vaginal delivery within 48 h. In post-term women, the use of this regimen is characterized by an increased rate of vaginal deliveries, a shorter time to delivery and a lower need for oxytocin.

Anaesthetic Management of Caesarean Sections at the Markala Reference Health Centre

Our work is a prospective study of 73 caesarean section cases (from 10 October to 10 December 2022), i.e. a period of 2 months at the Csréf in Markala. Our caesarean section success rate was 65.17%. The 20 to 40 age group was the most represented, with 73.97%, ranging from 16 to 42. In 83.56% of cases, caesarean sections were performed urgently. The indications for caesarean section were dominated by scar uterus (28.77%) and acute foetal distress (19.18%). General anaesthesia was the anaesthetic technique used in 89.04% of cases. Ketamine was the only narcotic used for induction and maintenance. Vomiting (8.22% of parturients) was the most common post-operative complication in the immediate post-partum period. Post-operative pain was managed with a combination of Paracetamol and Nefopam.

Retroplacental Hematoma with Non-Term Live Fetus; a Relevant Indication for Vaginal Caesarean Section

The objective is to report a clinical case of vaginal caesarean performed to save a fetus in distress by retroplacental hematoma. For this indication, the vaginal caesarean can be an alternative to the classic caesarean because of its short duration and the preservation of the possibility of future childbirth by natural means. However, this surgical technique described since the 19th century is still unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of fetal rescue performed by vaginal caesarean section at the Reference Health Center of the Sanitary District (District Hospital) of Bla in Mali in a 34-year-old patient, admitted for retroplacental hematoma with live fetal on a non-term pregnancy in latency phase of labor.

Epidemioclinical and Therapeutic Study of Caesarean Sections at the Markala Reference Health Centre

This was a retrospective study conducted at the Markala referral health centre from 2019 to 2022. The general objective was to study caesarean section at CS Réf in Markala. During our study period from 2019 to 2022, we recorded 1244 caesarean sections, i.e. a frequency of 28.29% of all deliveries. Parturients were evacuated in 51.6% of cases. Only 14.23% of our parturients were well monitored. The most frequent indication for caesarean section was SFA in 30.1%, i.e. 375 cases. The surgical procedure most frequently associated with caesarean section was LRT. Maternal mortality was 0.3%, mainly due to haemorrhage and pregnancy-related maternal pathologies. Maternal morbidity was dominated by infections, severe anaemia and haemorrhage. Fetal mortality was 11.9%, mainly due to severe fetal distress. Resuscitation was required for 23.5% of our caesarean section babies. Improving these results requires the support of all sectors of society.

Perinatal Outcome: A Comparative Study between Emergency and Elective Caesarean Section at A Tertiary Care Hospital

Introduction: Caesarean delivery is the most commonly performed lifesaving procedure in obstetrics. Caesarean section can be done in emergency and elective basis. There has been rising trend of caesarean section over the last few decades. Both the caesarean sections are associated with fetal risks than vaginal delivery.&#x0D; Objectives: To assess and compare the perinatal outcomes of emergency and elective caesarean sections.&#x0D; Methods: It was a cross-sectional comparative study done in Civil Service Hospital of Nepal over the period of one year starting from January 2021 to December 2021. All the patients who underwent caesarean section during the study period were taken into study. Data regarding perinatal outcomes were analysed by SPSS software.&#x0D; Results: During the study period, there were 1349 total deliveries. Caesarean sections accounted for 52.2% (n=705) of all deliveries. There were a total of 373 (52.9%) emergency CS and 332 (47.1%) elective CS. Most common indications of emergency and elective caesarean section were fetal distress and previous caesarean section respectively.Out of 713 new-born’s, 26 (6.9%) were preterm in emergency CS, 4 (2.1%) in elective group which was statistically significant (X2 &lt;0.001). Regarding APGAR score, need of resuscitation, nursery admission, respiratory distress syndrome, and neonatal intensive care unit transfer, neonates delivered by emergency basis had more number of babies than elective. However, there was no significant difference. There was one early neonatal death in the study period.&#x0D; Conclusion: Caesarean section is in rising trend of late. However, timely decision making skills can certainly lead to better perinatal outcome in caesarean sections.

Factors associated with successful vaginal birth after one lower uterine transverse cesarean section delivery

A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus. It has a higher success rate when the right women are selected for a trial of labor. This study aimed to assess factors associated with successful vaginal birth after one lower uterine transverse cesarean section and to validate the Flamm and Geiger score at the public hospitals of Bahir Dar City, Northwest, Ethiopia, 2021. A health facility-based retrospective cross-sectional study was conducted from March 1 to 15/2021. A medical record review of 408 women charts with a trial of labor after one lower uterine transverse cesarean section from January 1/2020 to December 31/2020 was done and 345 women charts with complete maternal and fetal information were included in the study with a response rate of 84.6%. The data were collected using a structured checklist, entered into Epi data 3.1, and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. This study identified that the trial of labor after cesarean section rate was 69.5%, and the success rate of vaginal birth after one lower uterine transverse cesarean section was 35.07%. Of the failed trial of labor, fetal distress (38.9%) and failed progress of labor (32.1%) were the main indications for an emergency cesarean section. The maternal age group of 21–30 years, prior vaginal birth after or before cesarean section, non-recurring indication (fetal distress and malpresentation), ruptured membrane, cervical dilatation ≥ 4 cm, cervical effacement ≥ 50%, and low station (≥ 0) at admission were associated with successful vaginal birth after one lower uterine transverse cesarean section. For the Flamm and Geiger score at a cut point of 5, the sensitivity and specificity were 73.6% and 86.6% respectively. In this study area, the trial of labor after cesarean section rate is encouraging, however, the success rate of vaginal birth after one lower uterine transverse caesarian section was lower. The maternal socio-demographic and obstetric-related factors were significantly associated with successful vaginal birth after one lower transverse caesarian section delivery. This study indicated that when the Flamm and Geiger score increases, the chance of successful vaginal birth after one lower uterine transverse caesarian section also increases. We suggest emphasizing counselling and encouraging the women, as their chance of successful vaginal delivery will be high in the subsequent pregnancy, especially if the indications of primary caesarian section delivery were non-recurring.

Indications of Induction and Caesarean Sections Performed Using the Robson Classification in a University Hospital in Spain from 2010 to 2021.

Background: The Robson Ten Group Classification System (RTGCS) enables the assessment, monitoring, and comparison of caesarean section rates both within healthcare facilities and between them, and the indications of caesarean sections (CS) performed in a maternity ward. The aims of the present study were to conduct an analysis to assess the levels and distribution of birth from a descriptive approach by CS in La Ribera University Hospital (Spain) between 2010-2021 using the Robson classification; to describe the indications for the induction of labour and the causes of caesarean sections performed; and to examine the association between the induction of labour and CS birth. Methods: A retrospective study between 1 January 2010 and 31 December 2021. All eligible women were classified according to the RTGCS to determine the absolute and relative contribution by each group to the overall CS rate. The odds ratio (OR) of the variables of interest was estimated by logistic regression. In an analysis of the subgroups, the level of significance was adjusted using the Bonferroni method. Results: 20,578 women gave birth during the study period, 19% of them by CS. In 33% of births, induction was performed, and the most common cause was the premature rupture of membranes. Group 2 (nulliparous with induced labour/elective CS before labour) accounted for the largest contribution to the overall rate of CS (31.5%) and showed an upward trend from 23.2% to 39.7% in the time series, increasing the CS rate by 6.7%. The leading cause of CS was suspected fetal distress, followed by induction failure. Conclusions: In our study, Robson Group 2 was identified as the main contributor to the hospital's overall CS rate. Determining the causes of induction and CS in a population sample classified using the RTGCS enables the identification of the groups with the greatest deviation from the optimal rate of CS and the establishment of improvement plans to reduce the overall rate of caesarean sections in the maternity unit.

Is mifepristone a game changer in induction of labour..?

: Induction of labor is defined as artificially stimulating the uterus to start labor. Mifepristone is a synthetic steroid hormone analog that has both anti-progesterone and anti-glucocorticoid activities. This study aimed to study the efficacy of mifepristone in the induction of labor and cervical ripening.: This study was conducted in Gandhi Hospital from August 2022 to November 2022. A total of 100 antenatal cases were admitted for safe confinement after 37 completed weeks and given oral mifepristone 200 mg and assessed for cervical ripening and need for further augmentation and the outcome was studied based on improvement in bishops score assessed after 24 hours of intake of oral mifepristone. It was observed that there was a significant improvement in the bishop’s score 24 hours after giving mifepristone. Out of 100 women who were given mifepristone, 79% delivered vaginally and 21% delivered through emergency cesarean section. The major indication for emergency cesarean section was fetal distress. The majority of patients had good neonatal outcomes and there were no serious maternal complications. Mifepristone is an effective and safe method of induction of labor with significant improvement in Bishop's score within 24 hours of administration.

The Assessment of Natural Vaginal Delivery in Relation to Pregnancy-Related Anxiety-A Single-Center Pilot Study.

Pregnancy-related anxiety (PrA) is a specific type of anxiety experienced during the perinatal period. It may concern a person's health and physical appearance, fetal development, hospital and health care experiences, impending childbirth, and early parenthood. PrA is considered to be a stronger predictor of adverse pregnancy outcomes than general anxiety and depression. The purpose of this research was to conduct a pilot study and evaluate the course of vaginal birth (VB) in relation to PrA levels in a population of pregnant women with low obstetrical risk. This cross-sectional exploratory study included 84 pregnant women (with a mean age of 28.61 ± 4.99) (without cesarean section (CS) indications and with a low risk of complications during VB). Research questionnaires were distributed and filled in in person during the course of hospitalization. Groups that varied at the level of PrA were compared using the Wilcoxon rank-sum test, Fisher's exact test, or chi-square test of independence, as appropriate. More than two-thirds of the respondents (72.6%) were medicated in labor. Women with high PrA, selected based on a cut-off point with a total PRAQ-R2 score of 60, experienced significantly longer first (start of established labor to fully dilated cervix) and second (lasts from when cervix is fully dilated until the birth) periods of labor, instrumental delivery, or emergency CS. In the group with high PrA levels, a episiotMmentation of evidence-based recommendations for the affected population to identify and further treat women with elevated levels of PrA.

Analysis of factors increasing the risk of prelabour rupture of membranes and its effect on fetomaternal outcome

Perinatal morbidity and mortality due to prelabour rupture of membranesPROM) is 18-20% and 21.4% respectively. Multiple risk factors are associated with the development of PROM. Limited data is available on the risk factors of term PROM and relation of its duration with adverse maternal and fetal outcomes from India. To assessfactors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Five hundred and ten patients presented with term PROM in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh (M.P.) from December 2018 to February 2019 were studied. After the detailed history, sociodemographic details, risk factors for PROM and neonatal outcomes were recorded. PROM was more common in women with age 21-25years (73.3%), who were housewife (92.5%), were underweight (21.37%), were from the rural area (58.4%), belong to lower SES (62.8%) and were primigravida (59.2%). Majority were leaking for 13-24 hours (70.2%). Majority (85.64%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 28(14.35%) went into spontaneous labour after 24 hours of PROM. Most common risk factor was malpresentation (46.52%) followed by history of PROM (30.04%), Polyhydramnios (13.19%), multiple pregnancy (10.99%) and febrile illness (6.96%). Out of 312 women who had vaginal delivery, labour was induced in 87.82% women. The most common indication for Caesarean section was previous 1 LSCS (13.1%), followed by fetal distress (8.6%), breech presentation (7.3%) and cephalopelvic disproportion (2.9%). Most of the women presenting with PROM were delivered vaginally (61.2%), while 38.8% women underwent caesarean section. Out of 529 babies, 6.24% were admitted in NICU. Majority of the neonates were admitted for 3 days (39.39%). PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

COVID-19 and Cesarean Section Rates: A Retrospective Observational Study at Our Rural Tertiary Center using Robson's Classification

Objective: This study aimed to evaluate the effect of COVID-19 infection on the rate and indications for cesarean section (CS) according to Robson's Ten-Group Classification system. Methodology: Our study was a 6-month retrospective observational study at the Maternal and Child Health Wing where every antenatal woman who was admitted irrespective of gestational age and whether in labor or not was customarily screened for COVID-19 infection. Based on the mode of delivery, all delivered women were classified into two groups: vaginal or cesarean, and the information was then further classified according to Robson's classification. Data collected were analyzed using Excel sheets, and Chi-square test was applied to evaluate if the difference in CS rates was statistically significant. Results: During COVID months, a total number of confinements were 877, among which the cesarean section were 381, contributing to a rate of 43.4%. The total COVID-19-positive confinements during the same period were 68. Group 2 formed the vast majority of CSs, followed by Group 1 and 5. During the post-COVID months, summation of confinements was 1443, among which the CS were 580, thereby contributing to a rate of 40.1%. In contrast to COVID time, Group 5 formed the greatest chunk contributing to CS rate, followed by Group 2 and 1. There was a statistically significant difference among confinements during COVID and post-COVID period and between CS rates among COVID-19 positive and negative women. Conclusion: During the COVID pandemic, there was a decrease in the number of confinement in our hospital. However, the CS rate increased and according to Robson's classification Group 1 and 2 made greatest contribution to CSs due to changed dynamics.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

Myome Praevia: A case report

Uterine fibroids are quite common, affecting 20% of women of childbearing age. Their association with pregnancy ranges from 0.5% to 4%, making it a high-risk pregnancy. They can interfere with the process of pregnancy, labor, delivery and even the postpartum period. Monitoring of the pregnancy should be cautious but not aggressive. Monitoring will be based on clinical examination and ultrasound. A fibroid praevia observed on ultrasound is an indication for cesarean section. We report a case of myoma previa, followed in our training since 14 WA.'

Knowledge, attitude and acceptability regarding antenatal perineal massage in Thai pregnant women.

Antenatal perineal massage for obstetric anal sphincter injury prevention is not routinely performed in Thailand. Due to the cultural conservatism in the country, attitudes and acceptability need to be evaluated before procedure implementation. This research was conducted to evaluate knowledge, attitudes, and acceptability of antenatal perineal massage and identify associated factors for acceptability in antenatal perineal massage among Thai pregnant women. A cross-sectional study was conducted in the antenatal clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand between July 2021 and June 2022. Thai women with singleton pregnancies at 22weeks or more of gestation without an indication for cesarean section were enrolled. Knowledge, attitudes, and acceptability of antenatal perineal massage were assessed using a self-administered questionnaire. In-depth interviews with pregnant women who were not interested in antenatal perineal massage were also completed. A total of 144 pregnant women were enrolled with 119 participants (83%) having an accepting attitude about antenatal perineal massage. Results on knowledge included 22 (15%) participants aware of this practice, 46 participants (31.9%) knew it should be practiced after GA 34weeks, 52 participants (36.1%) knew the massage should be maintained for 5-10min, and 37 participants (25.7%) knew it should be performed daily. Factors associated with acceptability of antenatal perineal massage were prior interest in perineal massage and trust in the benefit of the perineal massage in facilitating vaginal delivery. Reasons for disagreeing in antenatal perineal massage included never hearing of perineal massage, concern about pregnancy complications, fear of pain, believing it to be a useless procedure, and previous successful vaginal delivery. We found high acceptability for antenatal perineal massage. This program should be routinely explained and offered to Thai pregnant women to prevent severe perineal trauma and postpartum complications.