Caesarean section (CS) rates are increasing worldwide. CS and repeat caesarean alter the risk profile for next pregnancy. Interpregnancy interval (IPI) has been shown to modify maternal and neonatal risk in subsequent pregnancies. There is limited research in the Australian context addressing outcomes relative to interpregnancy interval. The lack of pregnancy spacing information adds to confusion and conflicting recommendations for maternity care providers and women. We developed a protocol using data linkage of routinely collected hospital data from 1994 to 2023 in New South Wales, Australia to investigate both maternal and neonatal outcomes relative to interpregnancy intervals.•Large scale study of interpregnancy interval after CS in an Australian multiethnic cohort not previously explored•Quantify the risks associated with differing interpregnancy intervals compared to contemporaneous controls in this cohort•Results presented as absolute risk facilitating access to evidence-based information.

Background: Low birth weight (LBW), defined as a birth weight of less than 2,500 grams, remains a significant public health concern due to its considerable impact on infant mortality and long-term growth dan development outcomes. This study aims to examine the relationship between maternal dietary patterns (non-vegetarian and vegetarian) and other maternal factors on the incidence of LBW in selected areas in Indonesia. Methods: This research uses a cross-sectional design involving 122 respondents, data were collected through structured questionnaires and a Food Frequency Questionnaire (FFQ). The study was conducted from March to May 2025 using purposive sampling. Results: A LBW prevalence of 5.7% in Indonesia, with prevalence rates of 8.3% among vegetarian mothers and 5.1% among non-vegetarian mothers. Bivariate analysis revealed no statistically significant associations between LBW incidence and dietary type (p = 0.623), frequency of staple food consumption (p = 0.272), frequency of animal protein consumption (p = 0.751), frequency of plant protein consumption (p = 0.113), pre-pregnancy nutritional status (p = 0.941), gestational weight gain (p = 0.707), interpregnancy interval (p = 1), parity (p = 0.709), ANC visit frequency (p = 1), maternal education level (p = 0.650), and supplement consumption (p = 0.555). Conclusions: There is no significant relationship between all independent variables with the incidence of low birth weight

Short birth interval is an important reproductive health concern in low- and middle-income countries, including Bangladesh, as it may have adverse consequences for both perinatal and maternal health. According to the International Classification of Diseases, Tenth Revision (ICD-10) codes O09.891, O09.892 and O09.893, pregnancies occurring after a short interpregnancy interval are classified as high-risk pregnancies that require appropriate medical supervision. Understanding the risk factors associated with short birth intervals is crucial for designing effective interventions and achieving the maternal and child health targets outlined in the Sustainable Development Goals. Therefore, this study aimed to investigate the prevalence and identify the potential risk factors of short birth interval using a two-level logistic regression (LR) model and the Boruta machine learning (ML) based feature selection method. This was a cross-sectional study. The study used secondary data from the nationally representative Bangladesh Demographic and Health Survey (BDHS) 2022. The study included 11 872 married women of reproductive age (15-49 years) in Bangladesh who reported at least one previous live birth. The demographic, socioeconomic, reproductive and media exposure-related characteristics of the study participants were obtained from the BDHS 2022 dataset. A two-level LR model was used to identify the risk factors associated with short birth interval, and the results were presented as adjusted ORs (aORs) with 95% CIs and p values <0.05. Additionally, the Boruta ML method was applied to determine the important predictors of short birth intervals. The overlapping risk factors identified by both the LR model and the Boruta method were considered potential risk factors of short birth intervals among reproductive-aged women in Bangladesh. Subsequently, three widely used ML models were implemented in the study. The performance of each model was evaluated on the test dataset using five evaluation metrics, namely accuracy, precision, recall, F1-score and the area under the receiver operating characteristic curve. In Bangladesh, the prevalence of short birth intervals was 34%. Both the two-level LR model and the Boruta method identified women aged ≤19 years (aOR=6.496, 95% CI 2.900 to 14.551; p<0.001); residence in Sylhet (aOR=2.457, 95% CI 1.956 to 3.086; p<0.001), Chattogram (aOR=1.554, 95% CI 1.279 to 1.887; p<0.001), Dhaka (aOR=1.287, 95% CI 1.059 to 1.565; p=0.011), Mymensingh (aOR=1.394, 95% CI 1.118 to 1.738; p=0.003) and Rangpur (aOR=1.248, 95% CI 1.009 to 1.543; p=0.041) divisions; no education (aOR=1.399, 95% CI 1.078 to 1.816; p=0.011); poorest (aOR=1.364, 95% CI 1.146 to 1.624; p<0.001), poorer (aOR=1.230, 95% CI 1.042 to 1.452; p=0.014) and middle wealth quintile (aOR=1.196, 95% CI 1.022 to 1.399; p=0.025); use of traditional contraceptive methods (aOR=1.615, 95% CI 1.305 to 1.998; p<0.001) and no intention to use contraception (aOR=1.506, 95% CI 1.237 to 1.833; p<0.001); birth order ≥4 (aOR=1.467, 95% CI 1.243 to 1.730; p<0.001); and having more than two children ever born (aOR=2.777, 95% CI 2.455 to 3.141; p<0.001) as potential risk factors for short birth interval among reproductive-aged women in Bangladesh. Among the ML-based models, the extreme gradient boosting model achieved the highest performance, with an accuracy of 66.356% in predicting short birth intervals. The findings highlight that women aged ≤19 years, those residing in the Eastern and Central divisions, women with no formal education, lower household wealth quintile, traditional or no intention to use contraceptive methods, higher birth order and having more than two children were potential risk factors for short birth interval. The extreme gradient boosting classifier showed the best performance in predicting short birth intervals among reproductive-aged women in Bangladesh.

ABSTRACT Although the widespread adoption of tubectomies has contributed to reducing fertility rates in India, it has also resulted in significant reproductive health challenges. This paper investigates two such interrelated issues: inadequate birth spacing and the decreasing age at which women undergo tubectomies. Using qualitative research techniques, the paper shows how Indian women are reluctant to use reversible modern contraceptives as they disrupt regular menstruation, which further causes them to feel anxious about their fertility status. Coupled with a lack of willingness among men to use condoms, women instead opt for natural contraceptive methods, often leading to unplanned pregnancies and low inter-pregnancy intervals. As a final reprieve from frequent birthing, women who have their first child in their adolescence decide to undergo a tubectomy in their early 20s. Ultimately, this paper argues for reorienting reproductive health policy in India away from fertility control and toward prioritizing reproductive health and rights-based issues.

Impact of interpregnancy interval after pregnancy loss on clinical pregnancy and neonatal outcomes of subsequent frozen-thawed embryo transfer cycles: a retrospective cohort study.

Objective: To explore the impact of interpregnancy interval (IPI) after a singleton live birth on preterm birth based on natural IPI data. Methods: Data were obtained from the Guangxi Population Health Information Business Application Platform. The analysis included women with two consecutive singleton deliveries between 2018 and 2023 from 81 medical institutions in Nanning City, Guangxi Zhuang Autonomous Region. Maternal demographic characteristics and delivery outcome data were collected. The association between IPI and preterm birth was assessed using logistic regression model, with subgroup analyses stratified by maternal age, mode of delivery, and preterm birth (all in the previous pregnancy). Additionally, a restricted cubic spline model was applied to examine the dose-response relationship between IPI and the risk of preterm birth. Results: A total of 39 434 women with two consecutive singleton pregnancies and deliveries were included in this study. Of these, 2 055 (5.2%) experienced a preterm birth in the subsequent delivery. Compared with an IPI of 18-23 months, the risk of preterm birth was significantly increased by 90% (OR=1.90, 95%CI: 1.53-2.33) for IPI <6 months and by 21% (OR=1.21, 95%CI: 1.04-1.41) for IPI of 6-11 months. This significantly elevated risk associated with short IPIs was observed across most subgroups. Among women with an IPI of ≥36 months, those who delivered vaginally had a 30% (OR=1.30, 95%CI: 1.04-1.63) increased risk of preterm birth. Restricted cubic spline analysis revealed an L-shaped dose-response relationship between IPI and the risk of preterm birth. The lowest risk was observed with IPIs ranging from 16 to 27 months. Conclusions: A short IPI is a risk factor for preterm birth. When providing preconception medical services across different populations, greater emphasis should be placed on assessing maternal age, prior pregnancy, and delivery history. Additionally, postpartum care should include personalized guidance to maintain an optimal IPI, thereby reducing the risk of preterm birth and improving maternal and infant health outcomes.

Primary healthcare practitioners play a pivotal role in postpartum care. Many countries encourage women to attend a postnatal check after birth, providing an ideal opportunity for contraceptive care. However, contraception is often not discussed, increasing the risk of unintended pregnancy and short interpregnancy intervals. To explore primary healthcare practitioners' views and experiences of providing postpartum contraceptive counselling and care to better understand the gaps, needs, and opportunities. A rapid review was conducted of English language peer-reviewed primary research studies from high-income countries focussing on primary healthcare practitioners' views and experiences of providing postpartum contraceptive counselling and care. Studies were retrieved from five databases, supplemented by Google Scholar and citation searching. Key characteristics were extracted, and thematic analysis identified key themes. Altogether, 2255 references were identified, with eight studies included. Four themes were constructed: (1) varied knowledge and attitudes regarding postpartum contraception, including views on of long-acting reversible contraception (LARC), safety concerns, and optimal counselling timing; (2) structural and logistical barriers to contraception provision in primary healthcare, including lack of LARC availability, time constraints, and funding issues; (3) limited contraception education and training for practitioners in LARC provision, with practitioners lacking skills or motivation to upskill; and (4) gaps in postpartum contraception resources and guidelines needed to promote postpartum contraceptive care. Improving postpartum contraceptive counselling requires embedding comprehensive contraceptive training in healthcare education, developing standardized guidelines for postpartum appointments, and addressing barriers such as time constraints, lack of resources and funding to support effective contraception care for postpartum women.

To examine the association between interpregnancy interval (IPI) and the risk of worsening cystocele between two consecutive vaginal deliveries. In this retrospective cohort study, 314 women who underwent transperineal ultrasound (TPUS) within six months postpartum after each of two consecutive vaginal deliveries were included. Multivariable linear regression was used to assess the association between first-delivery cystocele severity and second-delivery outcomes, with IPI categorized as ≤24, >24-≤36, and >36 months to evaluate its potential modifying effect. Cystocele severity after the first delivery strongly predicted worsening at the second delivery (β = 0.5; 95% CI: 0.4-0.6; p < 0.001). Longer IPI was associated with less progression of cystocele, showing a significant linear trend across IPI categories (p for trend = 0.04). After adjusting for obstetric factors, the position of the most dependent point of the posterior bladder wall after the first delivery was independently associated with cystocele severity after the second delivery (β = 0.5; 95% CI: 0.4-0.6; p < 0.001). IPI was negatively associated with cystocele severity. Although the formal test for interaction was not statistically significant (p for interaction = 0.11), the test for linear trend across IPI strata was significant (p for trend = 0.04). Cystocele severity after the first vaginal delivery strongly predicts that after the second, and this association weakens with longer IPI. TPUS enables early identification of high-risk women, supporting individualized birth spacing counseling with potential public health implications for the prevention of pelvic floor disorders.

There is limited research on women's perception of risk regarding pregnancy after caesarean. Interpregnancy interval alters risk in the next pregnancy and birth following a caesarean. Interpregnancy interval is a potentially modifiable risk that health care providers need to consider when counselling women about future pregnancy plans. What is women's experience of decision making regarding interpregnancy interval after caesarean birth? Twelve women participated in in-depth interviews; these were analysed thematically assisted by the use of NViVO software. The overarching theme identified was "Finding my way through the confusion to make informed decisions". Women are receiving confusing biased information delivered at varying time points. This is not meeting women's information needs leading them to seek knowledge through other sources, including online peers, to make sense of the confusion. They gather their own knowledge in order to advocate for themselves, make pregnancy spacing decisions that fit with their expectations and maximise the chances of having the birth they want. Consistent evidence based information is lacking in the current maternity care environment regarding interpregnancy interval. This creates barriers to making informed decisions for next pregnancy and birth planning. Women are looking for evidence based information to make individualised decisions. This requires women to seek knowledge outside of the maternity care system to empower themselves to navigate the system and make decisions rather than following prescriptive directives. There is a need to provide evidence based pregnancy planning resources to women that facilitate informed shared decision making.

Pregnancy induces profound cardiovascular adaptations that may have cumulative effects with repeated pregnancies. However, the relationship between parity and subclinical myocardial dysfunction in healthy women remains unclear. This prospective cross-sectional study enrolled 605 healthy pregnant women without cardiovascular disease or risk factors. All participants underwent comprehensive echocardiographic assessment including speckle-tracking-derived global longitudinal strain (GLS) analysis during the third trimester (28-32 weeks gestation). The relationship between parity and GLS was described using multivariable linear regression analysis, adjusting for age, body mass index and blood pressure. Participants were stratified into two groups (≥ 4 vs. < 4 pregnancies) for comparative analysis. Mean age was 30.9 ± 7.2 years with mean parity of 3.8 ± 2.4 pregnancies. Despite preserved ejection fraction across all women (63.2% ± 4.7%), each additional pregnancy was associated with a 0.21-unit worsening in GLS independent of age (β = 0.21, 95% CI: 0.13-0.29, p < 0.001). Women with ≥ 4 pregnancies had significantly worse GLS compared to those with fewer pregnancies (-19.1% ± 2.5% vs. -20.5% ± 4.1%, p < 0.001). In multivariable linear regression, high parity remained independently associated with reduced GLS (β = 1.18, 95% CI: 0.52-1.84, p < 0.001) after adjusting for confounders. The effect was more pronounced in older women and those with shorter interpregnancy intervals (< 18 months). Higher parity is independently associated with reduced myocardial strain detected by GLS despite preserved ejection fraction, demonstrating a continuous relationship with each additional pregnancy. While GLS values remain within physiological ranges for pregnancy, the shift toward lower values suggests cumulative haemodynamic effects that warrant further investigation.

Objective To identify risk factors for cesarean scar pregnancy (CSP) in women with cesarean scar diverticulum (CSD) and develop a prediction model with risk stratification. Methods This retrospective study included 398 women with CSD and subsequent intrauterine pregnancy (82 CSP; 316 non-CSP). Clinical and sonographic variables were compared. Independent predictors from multivariable logistic regression were used to construct a nomogram. Model performance was assessed using ROC, calibration, decision curve analysis, and bootstrap validation. Risk groups were defined by tertiles of predicted probability. Results Compared with controls, the CSP group had larger niche length and depth, thinner residual myometrium, shorter cesarean interval, and lower early log(hCG) and progesterone (all p < 0.05). Independent predictors were cesarean interval (OR = 0.812), niche length (OR = 1.235), niche depth (OR = 2.129), residual myometrium thickness (OR = 0.326), log(hCG) (OR = 0.445), and progesterone (OR = 0.830). The model showed excellent discrimination (AUC = 0.970, 95% CI: 0.954–0.983). CSP incidences were 0.0%, 0.8%, and 60.9% in the low-, medium-, and high-risk groups, respectively. Conclusions Morphological defect severity, short interpregnancy interval, and low early-pregnancy hormone levels were associated with CSP risk in women with CSD. The model may support early risk stratification and clinical management.

Despite numerous studies on the optimal timing for planning a safe pregnancy, the impact of the interval between pregnancies on birth outcomes remains debatable. The aim of this study was to determine the association between early interpregnancy intervals (IPIs) ranging from 0 to 35 months and maternal and neonatal outcomes. We conducted a retrospective cohort study involving 6764 multiparous women who gave birth between January and December 2022 at two secondary-level maternity hospitals under the Ministry of Health of the Kyrgyz Republic. We investigated IPIs (0-5, 6-11, 12-17, 18-23 [control group], and 24-35 months) in relation to maternal, perinatal, and neonatal outcomes. Maternal morbidity affected 14.9% of all women. The highest risk of maternal morbidity was observed at IPIs of 6-11 months (adjusted odds ratio [aOR] 2.634; 95% confidence interval [CI] 1.887-3.002) and 24-35 months (aOR 2.562; 95% CI 2.129-3.459). Mothers with short IPIs had higher odds of severe anemia (0-5 months: aOR 5.615, 95% CI 1.386-22.752; 6-11 months: aOR 2.812, 95% CI 1.007-5.891). Short IPIs were associated with higher odds of preterm birth (PTB), particularly extremely PTB (0-5 months: aOR 4.968, 95% CI 2.075-15.892; 6-11 months: aOR 4.024, 95% CI 2.361-8.452). In contrast, for an IPI of 24-35 months, the risk of extreme PTB was not statistically significant (aOR 1.110; 95% CI 0.714-2.463). Short IPIs are significantly associated with increased risks of adverse maternal and neonatal outcomes. These findings emphasize the importance of optimal birth spacing and the need for enhanced postpartum family planning services to mitigate risks such as severe anemia and PTB.

BackgroundTrial of labour after caesarean section (TOLAC) is an important strategy for reducing repeat caesarean deliveries among appropriately selected women. However, failed TOLAC, resulting in emergency repeat caesarean section, is associated with increased maternal and neonatal risks. Evidence on the outcomes and determinants of failed TOLAC remains limited in Somalia. This study assessed maternal and neonatal outcomes and identified factors associated with failed TOLAC among women with one previous caesarean section in selected private hospitals in Mogadishu, Somalia.MethodsA hospital-based unmatched case-control study was conducted between October 2024 and May 2025 in selected private hospitals in Mogadishu, Somalia. A total of 228 women with one previous caesarean section who were eligible for TOLAC were included, comprising 114 cases with failed TOLAC resulting in emergency repeat caesarean section and 114 controls who achieved successful vaginal birth after caesarean (VBAC). Data were collected through structured interviews and medical record review. Multivariable logistic regression analysis was performed to identify independent predictors of failed TOLAC, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.ResultsIn the study sample, 114 women experienced failed TOLAC and 114 achieved successful VBAC. Maternal complications were more frequent among women with failed TOLAC, including blood transfusion in 14 (12.3%), wound dehiscence in 4 (3.5%), and uterine rupture in 1 (0.9%). After adjustment, failed TOLAC was independently associated with ruptured membranes at admission (AOR = 2.25; 95% CI: 1.13–4.51), attending only two antenatal care visits (AOR = 2.99; 95% CI: 1.49–6.02), an inter-pregnancy interval of less than two years (AOR = 2.84; 95% CI: 1.40–5.79), referral from another health facility (AOR = 4.46; 95% CI: 2.17–9.16), and a history of stillbirth (AOR = 2.37; 95% CI: 1.12–5.01). Neonatal outcomes differed between the two groups and were reviewed carefully during revision to ensure consistency with the corrected tables.ConclusionFailed TOLAC among women with one previous caesarean section in Mogadishu was associated with both obstetric and health-system factors. Strengthening antenatal care, promoting optimal birth spacing, improving referral pathways, ensuring close intrapartum monitoring, and developing context-appropriate standardized TOLAC protocols may help improve maternal and neonatal outcomes.

Introduction: Interpregnancy interval (IPI) plays a critical role in neonatal health, yet optimal spacing remains controversial. This study assessed neonatal outcomes across short and long IPI using three complementary classification approaches to identify consistent patterns of risk. Materials and Methods: In this retrospective cohort study, medical records of 1194 women with a prior live birth who delivered singleton pregnancies in 2024 at a tertiary referral center were analyzed. IPI was calculated as the delivery-to-conception interval (LMP + 14 days). Three IPI classification systems were applied: (1) classical cut-offs (<6, 6-11, 12-23, 24-59, and ≥60 months), (2) quartiles, and (3) tertiles. Primary outcomes included preterm birth, low birth weight (LBW), and NICU admission. Multivariable logistic regression models adjusted for maternal age, gravidity, and previous cesarean delivery. Results: Short IPI (6-11 months) demonstrated the highest NICU admission rates (29.4%). Very long IPI (≥60 months) showed the highest prevalence of LBW (16.6%). Multivariable regression analysis revealed that intervals ≥ 24 months were independently protective against preterm birth (24-59 months: aOR 0.48, p = 0.002; ≥60 months: aOR 0.58, p = 0.042), while maternal age increased preterm birth risk by 7% per year. Short IPI (6-11 months) and very long IPI (≥60 months) independently increased NICU admission risk (aOR 2.29, p = 0.002 and aOR 1.61, p = 0.036, respectively). Previous cesarean delivery was an independent predictor of NICU admission (aOR 1.35; p = 0.048). Conclusions: Short and very long IPIs are associated with increased neonatal morbidity, particularly NICU admission, while the apparent preterm risk in long intervals is largely mediated by maternal age. Once adjusted, IPIs exceeding 24 months demonstrate protective effects against preterm birth. However, the rising trend toward LBW and NICU admission in intervals beyond 5 years suggests that birth-spacing counseling targeting an optimal window of 18-24 months provides the best balance in minimizing competing neonatal risks.

Universal access to family planning (FP) services is essential for safeguarding sexual and reproductive health and rights. Integration of FP and routine maternal and child health (MCH) services has been associated with increased uptake of long-acting reversible contraceptives and contributes to reduced unintended pregnancies, unsafe abortions and complications associated with short interpregnancy intervals. In the DRC, FP use remains limited despite national efforts to expand services, and rapidly growing cities such as Lubumbashi face additional challenges due to health system fragmentation and reliance on private-sector care. This study examined spatial distribution, MCH-integration and determinants of FP service provision in Lubumbashi. We analysed data from a 2023 census of 1,267 health facilities in Lubumbashi. Descriptive analyses summarized the availability of FP services in facilities by health zone, sector, type, routine-data integration, MCH services, -integration, monthly birth volume, medicine stock and mean cost of vaginal birth. Multilevel logistic regression models with random intercepts at the health zone level identified facility-level determinants of FP service provision. Geospatial analyses mapped service availability with 1 km coverage buffers, population-adjusted facility density, and FP-MCH integration levels by health zone. Overall, 731 facilities reported offering FP services (57.7% of total), with significant variation across health zones (31.0–70.5%). FP provision was strongly associated with high monthly birth volumes (aOR = 8.14, 95% CI 2.81–23.58), public ownership (aOR 4.09, 95% CI 1.62–9.99), and integration with all types of MCH services. Geospatial mapping showed that 94.3% of women live within a 1 km radius of a facility offering FP, but FP services and FP-MCH integration were less dense in peripheral health zones. Despite near universal geographic access to FP in Lubumbashi, service integration with MCH-services remains suboptimal, and coverage gaps persist in peripheral areas. The city should prioritise under-served health zones for both health facility based and outreach FP interventions to guarantee universal FP access, and efforts should be made to expand subsidized or free services in areas dominated by private for-profit facilities. Additional barriers such as stockouts, costs, fear of side effects, misinformation or partner-related constraints warrant further investigation. Family planning (FP) services are an essential part of reproductive health, helping women and couples decide if and when to have children. Yet despite their importance, little is known about where these services are offered and how they are integrated with other maternal and child health care (MCH) services in Lubumbashi, the second largest city of the DRC. We collected information from all 1,267 health facilities in the city in 2023. We wanted to know three things: where FP services are located, whether they are offered together with maternal and child health services, and what factors make a facility more or less likely to provide FP. We found that just over half of all facilities offered FP services, and most provided this alongside MCH care, meaning women could access multiple services at the same place. Mapping the facilities showed that FP services are clustered in the centre of the city, but nearly all women still live within one kilometre of a FP-providing facility. But access is not equal. Larger, public and private non-profit facilities, and those charging higher fees were more likely to provide FP. Smaller and less well-resources facilities were less likely to do so. This means that even if FP services are close, some women may still face barriers. While FP services in Lubumbashi are broadly available, health system and financial factors still limit equitable access. Policies to strengthen facilities and reduce cost barriers could help ensure that every woman can access FP services when she needs them.

BackgroundAfter early pregnancy loss (EPL), couples often seek counselling on how long to wait before attempting to conceive again. However, the optimal interpregnancy interval (IPI) between EPL and the next pregnancy is controversial. Additionally, studies on the impact of the IPI following a previous EPL on the population with infertility are rare. Here, we explore the relationship between the IPI after EPL and pregnancy outcomes after subsequent frozen embryo transfer (FET).MethodsIn total, 859 patients were included in this retrospective study. Among these, 87 women (10.1%) had an IPI of less than 3 months, 402 (46.8%) had an IPI of 3 to 6 months, 279 (32.5%) had an IPI of 6 to 12 months, and 91 (10.6%) had an IPI of more than 12 months. The baseline characteristics of the four groups were compared and analyzed. Binary logistic regression analyses were subsequently conducted to investigate the association between the IPIs after EPL and pregnancy outcomes after subsequent FET.ResultsThe live birth rates of the four groups were 41.4%, 41.5%, 36.9% and 28.6%, respectively. There were no significant differences in live birth, biochemical pregnancy, clinical pregnancy, clinical pregnancy loss, or preterm birth among the four groups (P > 0.05). The results of the logistic regression analyses revealed that compared with an IPI of 3 to 6 months, a shorter IPI (1∼3 months) was not associated with decreased odds of live birth (adjusted OR, 1.001 [0.61–1.63]), biochemical pregnancy (adjusted OR, 0.95 [0.58–1.54]), or clinical pregnancy (adjusted OR, 0.96 [0.59–1.55]), and was not associated with an increased risk of clinical pregnancy loss (adjusted OR, 0.90 [0.41–1.97]) or preterm birth (adjusted OR, 0.87 [0.28–2.67]). However, compared with an IPI of 3 to 6 months, a longer IPI (≥ 12 months) was associated with reduced odds of a live birth (adjusted OR, 0.55 [0.32–0.93]).ConclusionsThe results of this study suggest that a short IPI following the return of menstruation did not appear to be significantly associated with adverse pregnancy outcomes. However, prolonging the IPI beyond 12 months might correlate with a reduced likelihood of achieving a live birth, although further research is needed to confirm this observation.

Risk factors for the recurrence of severe maternal morbidity in first and second births in California, 1997 to 2020.

The effect of a short interpregnancy interval (IPI) on pelvic floor disorders is unknown. We investigated the relationship between a short IPI and the development of stress incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence (AI) in the decade after the first delivery. We performed a secondary analysis of the Mothers' Outcomes After Delivery study-a prospective cohort of women recruited 5-10 years following their first delivery and followed annually between 2008 and 2018. A short IPI was defined as ≤18 months, calculated as the number of months between deliveries minus the length of the second pregnancy. SUI, POP, and AI were identified by annual validated questionnaires, examination, or history of treatment. Data were analyzed in SAS. Variables significant on bivariate analysis were entered into multivariable logistic regression models predicting each outcome using the generalized estimating equations approach for repeated measures. Of 1,127 women, the majority (671, 59%) never had a short IPI, 395 (35%) had 1 short IPI, and 61 (6%) had 2 or more. Within 10-15 years, 219 women (19%) reported SUI, 156 (14%) reported POP, and 251 (22%) reported AI. We found that a short IPI was not associated with SUI ( P =0.69), POP ( P =0.71), or AI ( P =0.95). When restricting the cohort to women with only nonoperative vaginal deliveries (n=440), there remained no difference in the presence of SUI, POP, or AI ( P = 0.88, 0.84, 0.78, respectively). A short IPI is not associated with pelvic floor disorders in the decade following the first delivery. This should be reassuring to women at risk of PFDs who elect to become pregnant within 18 months of childbirth.

In the postpartum period, fertility and sexual activity can return rapidly, placing women at risk of unintended pregnancy within the first 12 months following delivery. Unintended pregnancies during this period, particularly with short interpregnancy intervals, are associated with adverse maternal and neonatal outcomes. Postnatal contraception (PNC) counselling is often inconsistent, and gaps exist in both patient and provider knowledge and practices. The objective of this study is to assess knowledge, attitudes, and practices of healthcare professionals and postnatal women regarding PNC and to evaluate the termination of pregnancy (TOP) clinic to review women seeking termination within 12 months of delivery in a UK district general hospital. A cross-sectional, questionnaire-based survey of healthcare professionals and postnatal women was conducted between September 2024 and December 2024. In parallel, a retrospective study of women undergoing TOP between December 2023 and November 2024 was performed using electronic medical records. Quantitative survey data were analysed descriptively, and free-text responses were thematically analysed. Fifty-sevenhealthcare professionals (73.7% midwives (n= 42/57), 26.3% (n= 15/57) doctors) and 60 postnatal women participated. All staff acknowledged the importance of PNCcounselling, but midwives were more likely than doctors to view it as part of their role (83.3% (n= 35/42) vs 40% (n= 6/15)). Knowledge of early return of fertility was limited (26.6% (n= 4/15) of doctors; 7.1% (n= 3/42) of midwives). Common barriers included time constraints and workload, and most staff expressed interest in further training (92.8% (n= 39/42) of midwives; 80% (n= 12/15) of doctors), preferring online modules 58% (n= 33/57) or face-to-face sessions 28% (n= 16/57). Among women, 53.4% (n= 32/60) were multiparous, 43.3% (n= 26/60) reported the recent pregnancy as unplanned, only 26.6% discussed PNCpostnatally, mostly verbally, and awareness of fertility returning as early as three weeks postpartum was low (13.3%; n= 8/60). The audit showed that 15.4% (n= 29 of 188) womenunderwent TOPwithin 12 months of delivery,indicating that approximately one in five women experienced unintended pregnancies shortly after childbirth. Significant gaps exist in knowledge and counselling practices regarding PNC among both healthcare professionals and women. The findings underscore the need for systematic staff training and structured counselling pathways to improve timely uptake of contraception, reduce short interpregnancy intervals, and prevent unintended postpartum pregnancies.

Cesarean deliveries are one of the most common obstetric interventions globally. It is important all risks are fully understood. This study aimed to investigate the impact of first birth by cesarean delivery on subsequent reproductive outcomes. We conducted a retrospective cohort study of all women who gave birth to their first spontaneously conceived, singleton infant in Victoria, Australia from January 2005 to December 2015, with follow-up for second births until December 2017. The exposure was first birth by cesarean delivery, compared with vaginal birth. Primary outcomes included (1) a second live birth occurring within the study time frame and (2) conception via in vitro fertilization or other assisted reproductive technologies among those for whom a second birth was reported. Secondary outcomes included interpregnancy interval and miscarriage rates. Statistical analyses included Cox proportional hazards regression, Poisson regression, or quantile regression depending on the outcome. Outcomes were adjusted for maternal age (at both first and second pregnancy), Socio-Economic Indexes for Areas quintile at the time of pregnancy, preexisting hypertension, and preexisting diabetes. There were 298,241 women who met the inclusion criteria, of whom 184,061 (61.7%) had both their first and second birth during the 12-year study period. A total of 205,164 had a vaginal birth and 93,077 gave birth by cesarean delivery. Having a first birth by cesarean delivery was associated with an 11% reduction in the likelihood of having a second live birth (adjusted hazard ratio, 0.89; 95% confidence interval, 0.88-0.90). Among the cohort reporting a second live birth, there was a 28% increase in the use of in vitro fertilization for conception among those who had a prior cesarean delivery (adjusted risk ratio, 1.28; 95% confidence interval, 1.15-1.43) and a 28% increase in the probability of any assisted reproductive technology use (adjusted risk ratio, 1.28; 95% confidence interval, 1.18-1.40). No difference in miscarriage rates was observed (adjusted risk ratio, 1.01; 95% confidence interval, 0.98-1.03). First birth by cesarean delivery was associated with an 11% reduced likelihood of a second live birth within the 12-year study period and a 28% increase in the use of assisted reproductive technologies to achieve a second birth. Factors leading to a cesarean delivery may also be associated with subsequent reproductive outcomes and warrant further study.