Multiparous Women Research Articles

The effect of cesarean section on the dimensions and ratios of mons pubis

BackgroundPregnancy and labor can impact women’s body contours. After a cesarean section, some women may experience aesthetic issues such as the formation of a panniculus and a bulging mons pubis. This study aimed to investigate the impact of cesarean sections on the dimensions of the mons pubis and their ratios.MethodsThe study included 194 multiparous Caucasian women. Participants’ ages ranged from 18 to 40 years, and their BMI ranged from 18 to 30. They were divided into two BMI groups. Each group was further subdivided based on the mode of delivery into vaginal delivery (VD) and cesarean section (CS) groups. Manual measurements of the three dimensions of the mons pubis (monal height, monal width, and monal length) were conducted. Measurements were recorded in centimeters in the lithotomy position using iGaging 8-inch digital outside calipers. Monal height is the distance between the anterior surface of the symphysis pubis and the maximum height of the mons pubis (calculated by measuring the distance between the anterior wall of the vagina and the maximum height of the mons pubis minus the distance between the anterior wall of the vagina and the anterior surface of the symphysis pubis). Monal width is the maximum transverse distance between the merging borders of the mons pubis and the fat of the lower abdominal wall. Monal length is the maximum longitudinal distance between the merging upper border of the mons pubis and the fat of the lower abdominal wall and the upper end of the pudendal cleft.ResultsNo significant statistical difference was observed between the three dimensions of the mons pubis in vaginal delivery and cesarean section populations in the two groups. The changes in the ratios between the two groups’ different monal dimensions in the cesarean section population are minimal and do not follow a consistent pattern. There were no significant differences between the dimensions of single and repeated CS populations, with non-trendy changes in the different ratios in the repeated CS group.ConclusionEven when repeated, cesarean section minimally affects the dimensions and ratios of the mons pubis. However, more studies with standardized fascial and subcutaneous fat closure are needed.

Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands

BackgroundInformed consent for medical interventions is ethically and legally required; an important aspect of quality and safety in healthcare; and essential to person-centred care. During labour and birth, respecting consent...

CLASSİFİCATİON OF CLİNİCAL SYMPTOMS DEPENDİNG ON THE SEVERİTY OF ANEMİA İN PREGNANT WOMEN

The article provides information on the results of research conducted to study the changes in clinical signs during pregnancy in women with different degrees of iron deficiency anemia (IDA). Hemogram parameters were studied using the “ Mythic 18” (Switzerland) hematological analyzer. For this purpose, the mutual relationships between the main indicators of iron metabolism and the main symptoms of anemia were analyzed using clinical-biochemical methods in the blood of 110 women of reproductive age at various stages of pregnancy. The main contingent of the study consisted of 80 pregnant women with IDA (main group). 30 pregnant women without anemia were included in the comparison group, and 21 healthy women without pregnancy were included in the control group. It has been determined that in multiparous pregnant women, the hemoglobin level in mild anemia is Me = 10.4 (10.0-10.5), in moderate anemia Me = 8.9 (8.3-9.5), in severe anemia Me = 6.9 (6.3-6.9) p<0.001; the level of iron in mild anemia is Me = 9.0 (8.0-9.4), in moderate anemia Me = 6.7 (6.1-7.7), in severe anemia Me = 5.3 (3.5-5.8) p<0.001; the level of ferritin in mild anemia is Me = 19.3 (12.0-28.0), in moderate anemia Me = 9.9 (9.1-12.0), in severe anemia Me = 3.0 (2.0-8.0) p<0.001. During pregnancy, significant changes occur in iron metabolism in iron deficiency anemia. Pregnancy anemia is a significant risk factor for fetal and maternal morbidity. Thus, depending on the severity of anemia, complications such as intrauterine growth retardation, chronic fetal hypoxia, preeclampsia, preterm birth, and primary birth weakness during delivery have been predominant. This allows us to carry out corrective treatment.

Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study

ObjectiveTo assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. MethodsA multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5–10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2–4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. ResultsDuring the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2–4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten.GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06–1.34) for parity 8, 1.17 (95 % CI: 1.01–1.36) for parity 9, and 1.39 (95 % CI: 1.18–1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. ConclusionOur study demonstrates that parity 8–10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.

Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach

BackgroundEffective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.MethodsWe conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed.ResultsThe median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.ConclusionsSublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

Maternal excessive weight gain as a potential risk factor for prolonged labor in Japanese pregnant women: The Japan Environment and Children's Study.

This study aimed to determine whether excessive maternal weight gain during pregnancy was associated with a higher risk of prolonged labor. We analyzed the data regarding maternal weight gain during pregnancy for the participants of Japan Environment and Children's Study (JECS), which is an ongoing nationwide prospective birth cohort study in Japan. After excluding participants with multiple pregnancies, with deliveries before 37 or beyond 42 weeks of gestation, or who had undergone cesarean section, 71,154 (nulliparous, n = 28,442) Japanese women were included. Prolonged labor was defined by a cutoff ranking at the 95th percentile and consequently defined as labor duration exceeding 12.7 h in multiparous women and exceeding 23.2 h in nulliparous women. These classifications were made according to labor curves established by the Japanese Society of Obstetrics and Gynecology Perinatal Committee developed in June 2021. Considering that no studies have conducted an investigation based on this new guideline, we analyzed the association between excessive maternal weight gain during pregnancy and prolonged labor by parity. The overall incidence of prolonged labor was 10.2% (2,907/28,442) in nulliparous women and 6.1% (2,597/42,712) in multiparous women. Multivariable analysis indicated that excessive maternal weight gain was significantly associated with prolonged labor in nulliparous (adjusted odds ratio, 1.21; 95% confidence interval, 1.10-1.32) and multiparous women (adjusted odds ratio, 1.15; 95% confidence interval, 1.05-1.27). Kaplan-Meier survival analysis showed that as labor progressed, the percentage of women who had not yet delivered was higher among those with excessive maternal weight gain than among those with normal maternal weight gain in both the nulliparous (median labor duration 12.9 h vs 12.2 h, p<0.001) and multiparous (median labor duration 6.2 h vs 5.8 h, p<0.001) groups. Excessive maternal weight gain was significantly associated with prolonged labor in Japanese women.

P-711 Female age at embryo creation and embryo transfer do not impact the ongoing pregnancy rates in single euploid frozen embryo transfers

Abstract Study question Which factors influence the ongoing pregnancy rate in single euploid frozen embryo transfer (seFET) cycles? Summary answer Ongoing pregnancy rates in seFET cycles are significantly influenced by parity, BMI, embryo quality, trophectoderm biopsy day and endometrial preparation, but not by female age. What is known already The probability of a pregnancy is influenced by several factors and female age is the major determinant as the ovarian reserve decreases and embryo aneuploidy increases with age. Preimplantation genetic testing for aneuploidy and embryo selection was considered to mitigate the effect of female age on ART treatment outcomes by selecting euploid embryo(s) for embryo transfer (ET). Previously published data point to a decline in pregnancy rates with increased maternal age even when a euploid embryo is transferred. However, other factors besides embryo ploidy might play a role in the chance of achieving an ongoing pregnancy. Study design, size, duration Retrospective study, including 1923 women who underwent a seFET between 04/2017 and 08/2023. Patients’ (age at oocyte-pick-up and seFET, BMI, parity, endometrial preparation type) and embryo characteristics (Day of biopsy, embryo quality (EQ)) were considered for the analysis. Ongoing pregnancy was defined as viable pregnancy beyond 12 weeks of gestation. Participants/materials, setting, methods Women, undergoing a seFET either in a true natural cycle (NC) t or in a hormonal replacement cycle (HRT). Only cycles with embryos being biopsied on day 5 or day 6 and a known outcome of the cycle were included. Main results and the role of chance There were 990 (51.48%) ongoing pregnancies among 1923 included transfers. The ongoing pregnancy rates were 51.8%, 47.4%, 52.3% and 52.8% for women aged ≤35, &amp;gt;35 to ≤ 37, &amp;gt;37 to ≤ 40, and &amp;gt;40 years-old at seFET, respectively. Cochrane Armitage test did not show a significant trend for decreasing pregnancy rates with increasing female age at OPU (P = 0.679) or at transfer (P = 0.609). Multivariable regression analyses showed primiparous, and multiparous women were more likely to have an ongoing pregnancy compared to nulliparous women (OR: 2.96, 95%CI:2.22-3.94 and 2.73, 95%CI:2.10-3.55, respectively, P &amp;lt; 0.001 for both) and those who had a natural endometrial preparation (OR: 1.53, 95%CI: 1.24-1.88, P &amp;lt; 0.001). Transfers with good quality embryo had higher ongoing pregnancy rates compared to those who had a fair quality embryo (OR: 2.0, 95%CI: 1.37-2.91, P &amp;lt; 0.001). Being overweight or obese at the time of transfer were associated with lower ongoing pregnancy rates compared to normal weight (OR: 0.71, 95%CI: 0.56-0.89, and 0.68, 95%CI: 0.52-0.88, respectively, P = 0.003 for both). Age categories at the time of transfer did not show a significant effect on ongoing pregnancy rates in multivariable analyses (P &amp;gt; 0.05 for all) and there was no significant interaction between age at OPU and embryo quality categories either (P = 0.881 and 0.601). Limitations, reasons for caution The retrospective design of the study is a limitation. Wider implications of the findings This analysis did not confirm the otherwise reported negative impact of female age on the outcome of seFET cycles. Outcomes are significantly influenced by BMI, parity, EQ-related factors as well as the endometrial preparation. As BMI and endometrial preparation can be influenced, the adequate choice might improve seFET outcomes. Trial registration number not applicable

Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes.

Friedman's standards, developed almost 50 years ago, may no longer align with the needs of today's obstetric population and current pregnancy management practices. This study aims to analyze contemporary labor patterns and estimate labor duration in China, focusing on first-stage labor data from Chinese parturients with a spontaneous onset of labor. This retrospective observational study utilized data from electronic medical records of a tertiary hospital in Changsha, Hunan. Out of a total of 2,689 parturients, exclusions were made for multiple gestations, preterm, post-term, or stillbirth, cesarean delivery, non-vertex presentation, and neonatal intensive care unit admission. Average labor curves were constructed by parity using repeated-measure analysis, and labor duration was estimated through interval-censored regression, stratified by cervical dilation at admission. We performed an analysis to assess the impact of oxytocin augmentation and amniotomy on labor progression and conducted a sensitivity analysis using women with complicated outcomes. Nulliparous women take over 180 minutes for cervical dilation from 3 to 4 cm, and the duration from 5 to 6 cm exceeds 145 minutes. Multiparous women experience shorter labor durations than nulliparous. Labor acceleration is observed after 5 cm in nulliparous, but no distinct inflection point is evident in the average labor curve. In the second stage of labor, the 95th percentile for nulliparous, with and without epidural analgesia, is 142 minutes and 127 minutes, respectively. These findings provide valuable insights for the reassessment of labor and delivery processes in contemporary obstetric populations, including current Chinese obstetric practice.

Neonatal Outcome following External Cephalic Version (ECV)-Comparison between Vaginal Birth after Successful ECV and Elective Caesarean Section after Unsuccessful ECV.

Introduction: In 3-6% of pregnancies, foetuses can be expected to be in a breech presentation near term. Consultation concerning further management of the pregnancy, including the option of an external cephalic version (ECV), is recommended by international guidelines (RCOG, ACOG, and DGGG). With regards to an ECV, there need to be two assumptions. Firstly, the procedure is safe, which has been shown adequately. Secondly, a vaginal birth after a successful ECV needs to prove to be non-inferior to the alternative of an elective caesarean section. The aim of this study is to assess the non-inferiority assumption. Methods: Overall, 142 singleton pregnancies were analysed that presented a foetus in a non-cephalic presentation and underwent an ECV near term between 2011 and 2020. The ECV was performed at 36 weeks of gestation for primiparous women and at 37/38 weeks of gestation for multiparous women. To assess neonatal outcome, the following parameters were recorded: arterial and venous umbilical cord blood pH, APGAR scores and admission to the neonatal intensive care unit (NICU). Data were analysed under the assumption that neonatal outcome does not differ between elective caesarean sections with or without an ECV in advance. Results: The success rate of an ECV was 56.3% (80/142). In the case of a successful ECV, there was a 77.5% (62/80) chance for a vaginal delivery. The mean arterial pH for neonates born vaginally after successful ECV was 7.262 (SD 0.089), compared to 7.316 (SD 0.051) for those born via elective caesarean section (p < 0.001). APGAR scores at 1, 5, and 10 min were similar between the groups, with a slightly higher proportion of neonates scoring below the median in the caesarean section group. Specifically, 13.7% (7/51) at 1 min, 15.7% (8/51) at 5 min, and 9.8% (5/51) at 10 min in the caesarean section group were below the median, compared to 4.92% (3/61), 4.92% (3/61), and 3.28% (2/61) in the vaginal birth group. NICU admission rates were 3.28% for vaginal births and 3.92% for elective caesarean sections (p > 0.05). Conclusions: Women with a successful ECV can expect a neonatal birth outcome after a vaginal birth that is non-inferior to an alternative elective caesarean section.

The Development and Evaluation of Alternative Communication Strategies to Facilitate Interactions with Refugees in Obstetric Triage: A Preliminary Study

Purpose: In this pilot study, we investigate the potential of pictographs to facilitate communication and accelerate care for non-English speaking birthing people in triage. The immigrant and refugee populations have been steadily increasing in the United States; reproductive age women are a large percentage of those who seek medical care. Barriers to care include timely access to interpreters, which can delay treatment. Pictographs have been used successfully in medicine in various situations such as pharmaceutical instruction and symptom description. We searched extensively for obstetric triage pictographs with little success. To address this, we created a pictograph sheet specifically for common obstetrical complaints. Methods: The most common reasons for visiting triage were ascertained. From these, key topics were identified for drawings. For each topic, the authors drafted scripts for a list of relevant actions. The actions for each topic were then represented by a professional illustrator in pictographs. Pictographs were developed using the following guidelines: focus on actions people should take, include prompts within pictures such as labels or arrows and exclude nonessential details such as room background and elaborate borders. After the pictographs were developed, its appropriateness, accuracy and relevance were reviewed and validated by two experts with experience in women’ care. The experts perceived that the drawings represented the actions well in a simple and clean manner. The following concerns were depicted: decreased fetal movement, abnormal vaginal discharge, rupture of membranes, vaginal bleeding, vision changes, shortness of breath, nausea, contractions, headaches, and overall assessment of wellbeing. Focus groups were developed collaboratively with Della Lamb, a resettlement agency. Inclusion criteria included women of reproductive age who are non-English speaking and currently pregnant. These focus groups were held at the University Health. Two focus groups were created: one with refugees from Afghanistan and one with refugees from the Congo. Each focus group was guided by a licensed medical interpreter of their native language: Dari and Swahili, respectively, and ranged from 3 to 4 participants. One by one the pictograms were introduced to the group. Each participant was asked what they think the illustration represents. For participants’ comfort, groups were not recorded; instead, notes were taken by observers during and after the discussion. The participants read the text and pictographs and were asked to identify if pictographs were clear, understandable, and acceptable. Results: Congolese Focus Group: Participants’ ages varied in their 30s. All had recently immigrated to the United States and lived in Missouri for less than 6 months. They were in the second trimester of their pregnancy and had at least one prenatal visit in the United States. They were all multiparous women with previous uncomplicated vaginal deliveries in their native country. All could read and write in Swahili but spoke no English. They all had no previous experience with the medical health system in the United States. Afghani Focus Group: Participants’ ages varied in their 20-30s. All had recently immigrated to the United States and lived in Missouri for less than 3 months. 3 women were in their second trimester, 1 was in her third trimester. Aside from 1, the rest (3) were multiparous women with previous uncomplicated vaginal deliveries in their native country. 3 of them could read and write in Dari but spoke no English. They all had no previous experience with the medical health system in the United States. Comprehension was significantly different between the two groups. Overall, the Congolese group of women misunderstood the purpose of the pictographs. No picture was understandable to the patients. It was also apparent that the patients did not realize these were issues for which to come to triage. There was also ambiguity regarding the color, i.e. they did not correlate green with nausea. The general prohibition sign was also absent in meaning for them. However, all of the patients expressed interest in learning what each picture meant and would like to have that option there if they came to triage and could not get an interpreter. The Dari group did not understand shortness of breath or nausea. However, they were familiar with the other symptoms and able to identify those as reasons to come to triage. The patients were also familiar with colors and scales. Conclusion: The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. However, research is needed regarding limitations due to cultural backgrounds. Future research is also needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Trial and error − Outcome of breech presentation depending on birth mode and root cause analysis of severe adverse events

ObjectivesThe debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management.Study design: We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. ResultsOf 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). ConclusionThe failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.

Differing intensities of a midwife-led antenatal healthy lifestyle service on maternal and neonatal outcomes: A retrospective cohort study

IntroductionMaternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes. MethodThis retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain. ResultsThere were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40–0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64–1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93–2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31–0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences. DiscussionUncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.

Association Between Gestational Weeks, Initial Maternal Perception of Fetal Movement, and Individual Interoceptive Differences in Pregnant Women: Cross-Sectional Study.

Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity. The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women. A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores. A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=-0.43, P=.01) and among primiparous women (r=-0.53, P=.03) but not among multiparous women. Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement.

Factors infl uencing delivery in women with multiple fetus pregnancy.

This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022. Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

A Retrospective Cohort Study of Patient Risk Factors and Pelvic Venous Reflux Patterns on Treatment Outcomes With Pelvic Vein Embolisation.

To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Venous Disorder (PeVD). We performed a retrospective cohort review assessing population, intervention, comparison, and outcomes (PICO) for women undergoing PVE for PVR January 2017-January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52). The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data. 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal, 25.3% (48/190) postmenopausal and menopausal status not documented 1% (2/190). 10.1% (19/188) were nulliparous (average age 34 years; range 20-55 years). There was a statistically significant improvement in all symptoms and in the appearance of varicosities on TVDUS post-PVE (P < 0.05) of the ovarian vein plexus, uterus plexus, arcuate veins, vaginal wall, peri-urethral, peri-anal, haemorrhoids, labial and proximal thigh. The locations of veins requiring embolisation having demonstrated reflux were analysed; 82.8% (154/186) underwent embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (P > 0.05). No significant complications such as coil migration were observed. PVE is an effective treatment for pelvic pain due to PeVD and its diagnosis should not be limited to multiparous women of childbearing age, as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal.

Interpregnancy Interval After Healthy Live Birth and Subsequent Spontaneous Abortion

Many studies have reported that the interpregnancy interval (IPI) is a potential modifiable risk factor for adverse perinatal outcomes. However, the association between IPI after live birth and subsequent spontaneous abortion (SA) is unclear. To investigate the association of IPI after a healthy live birth and subsequent SA. This prospective cohort study used data from 180 921 women aged 20 to 49 years who had a single healthy live birth and planned for another pregnancy and who participated in the Chinese National Free Prepregnancy Checkups Project from January 1, 2010, to December 31, 2020. Statistical analysis was conducted from June 20 to October 5, 2023. Interpregnancy interval, defined as the interval between the delivery date and conception of the subsequent pregnancy, was categorized as follows: less than 18 months, 18 to 23 months, 24 to 35 months, 36 to 59 months, and 60 months or longer. The main outcome was SA. Multivariable-adjusted odds ratios (ORs) were calculated by logistic regression models to examine the association between IPI and the risk of SA. Dose-response associations were evaluated by restricted cubic splines. The analyses included 180 921 multiparous women (mean [SD] age at current pregnancy, 26.3 [2.8] years); 4380 SA events (2.4% of all participants) were recorded. A J-shaped association between IPI levels and SA was identified. In the fully adjusted model, compared with IPIs of 18 to 23 months, both short (<18 months) and long (≥36 months) IPIs showed an increased risk of SA (IPIs of <18 months: OR, 1.15 [95% CI, 1.04-1.27]; IPIs of 36-59 months: OR, 1.28 [95% CI, 1.15-1.43]; IPIs of ≥60 months: OR, 2.13 [95% CI, 1.78-2.56]). Results of the subgroup analysis by mode of previous delivery were consistent with the main analysis. This cohort study of multiparous women suggests that an IPI of shorter than 18 months or an IPI of 36 months or longer after a healthy live birth was associated with an increased risk of subsequent SA. The findings are valuable to make a rational prepregnancy plan and may facilitate the prevention of SA and improvement in neonatal outcomes.

(122) RIGHTS-BASED REPRODUCTIVE SERVICES IN THE MEDICAL SCHOOLS IN THREE STATES IN INDIA: BASELINE FINDINGS OF A MIXED METHODS IMPLEMENTATION RESEARCH

Abstract Introduction Women’s sexual and reproductive health depends on their autonomy to decide, freedom to choose free from coercion, right to education and information, right to dignity, and equity in access to sexual and reproductive health services. These services, especially regarding family planning and abortion services, must be strengthened in the Indian medical schools. Hence, implementation research with baseline and endline comparison was conducted to strengthen reproductive rights and evidence-based practices related to family planning and abortion care services in these schools. This study presents the findings of baseline assessment. Objective To determine the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools Methods A concurrent mixed methods study design was used to conduct the baseline assessment in nine medical schools in Rajasthan, Gujarat, and Union territory in India from October 2018 to June 2019. Reproductive health services provided to 104 women during counseling for family planning (N=85) and abortion (N=19) were observed quantitatively using a predesigned, pre-tested checklist. In-depth interviews of 33 faculty members from the Department of Obstetrics and Gynecology were conducted to qualitatively explore their beliefs and practices regarding a rights-based approach to providing reproductive healthcare services. The Capability, Opportunity, and Motivation model of behaviors (COM-B) was used to qualitatively identify barriers and facilitators of reproductive rights while providing family planning and abortion services in medical schools. Results Family planning counseling services with a cafeteria approach were observed in 69.4% of cases. Among these, 7.1% were provided with couple counseling services. Auditory privacy could be provided to 22.2% of the family planning counseling sessions. The choice of three or more contraceptives was offered to 76.5% nullipara, 54.2% para one, and 75.6% multipara women. The average duration of counseling was 7.4 minutes. Counseling on family planning and abortion was provided to 31.6% of clients. For 36.8% of clients, sterilization/IUD insertion was kept as a pre-condition for abortion. Medical schools lacked space, staffing, and logistics to provide rights-based reproductive health services. Social barriers like the poor socio-economic status of the clients, lack of education and awareness of women's rights, less autonomy in decision-making, and social and gender bias compromised women's reproductive rights. As per the COM-B model, the reproductive rights-based approach facilitators included well-informed faculty regarding dignified and respectful care, ensuring total privacy and confidentiality. However, infrastructure gaps, limited space, high workload, insufficient human resources, and lack of standard operating procedures often compromise privacy and confidentiality during counseling. Conclusions Right-based reproductive services around family planning counseling and abortion services were delivered partially despite the medical schools' trained faculty. This was mainly due to limited workspace, high workload, less autonomy, and lower awareness of reproductive rights among women. Disclosure No.

Programmed Intermittent Epidural Bolus Reduces Workloads in Labor Analgesia: A Single Center's Experience.

Background and Objectives: Labor epidural analgesia can be maintained through programmed intermittent epidural bolus (PIEB), continuous epidural infusion (CEI), or patient-controlled epidural analgesia (PCEA). Our department changed from CEI+PCEA to PIEB+PCEA as the maintenance method. The higher hourly dose setting in the current regimen brought to our concern that side effects would increase with proportional staff workloads. This study aimed to investigate the validity of our proposal that PIEB+PCEA may function as a feasible tool in reducing the amount of work in the obstetrics anesthesia units. Materials and methods: This 2-year retrospective review included parturients with vaginal deliveries under epidural analgesia. We compared the staff burden before and after the switch from CEI (6 mL/h, PCEA 6 mL lockout 15 min, group A) to PIEB (8 mL/h, PCEA 8 mL lockout 10 min, group B). The primary outcome was the difference of proportion of parturients requiring unscheduled visits between groups. Side effects and labor and neonatal outcomes were compared. Results: Of the 694 parturients analyzed, the proportion of those requiring unscheduled visits were significantly reduced in group B (20.8% vs. 27.7%, chi-square test, p = 0.033). The multivariate logistic regression showed that PIEB was associated with fewer unscheduled visits than CEI (OR = 0.53, 95% CI [0.36-0.80], p < 0.01). Group B exhibited a significantly lower incidence of asymmetric blockade, as well as motor blockade. In nulliparous subjects, obstetric anal sphincter injury occurred less frequently when PIEB+PCEA was used. Significantly more multiparous women experienced vacuum extraction delivery in group B than in group A, and they had a longer second stage of labor. Conclusions: The PIEB+PCEA protocol in our study reduced workloads in labor epidural analgesia as compared to CEI+PCEA, despite that a higher dose of analgesics was administered. Future studies are warranted to investigate the effect of manipulating the PIEB settings on the labor outcomes.

PROLAPSUS GENITAUX : ASPECTS EPIDEMIOLOGIQUES DIAGNOSTIQUES ET THERAPEUTIQUES A PROPOS DE 58 CAS.

Genital prolapse is a permanent or stressful exit through the vagina of one or more components of the pelvic viscera. It is frequent in elder, multiparous and menopausal women. Its diagnosis is clinical and the treatment essentially surgical. The recurrent rate is significant. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and prognostic aspects of genital prolapse in the general surgery department of Aristide Le Dantec Teaching Hospital in Dakar. Materials and method. It was a retrospective study interesting genital prolapse operated in the period of 10 years 6 months from January 1, 2008 to July 31, 2019. The studied parameters were epidemiological data, clinical data, classification, paraclinical data, surgical treatment and results. Results. We collected 58 cases of genital prolapse represented 0.55% of the surgical activity during the study period. The mean age was 59 years with extremes of 25 and 89 years. The most represented age group was 61 and 75 years of age with 25 cases (43.1%). Patients over the age of 60 represented 50.1%. We had 46 cases of multiparous (79.3%) and 11 cases of pauciparous (19%). Postmenopausal patients represented 44 cases (75.8%). The majority of our patients, 67.2%, were housewives with the notion of carrying a heavy charge. All of our patients delivered vaginally with 13.3% obstructed labor. Eight patients (13.7%) had a history of pelvic surgery. The mean duration of symptom was 8 months with extremes of 10 days and 40 years. The functional signs were dominated by the sensation of a vaginal mass in 53 cases (91.3%). We had 13 cases of urinary incontinence (22.4%) and all associated with a cystocel. The three-stage genital prolapse was the most frequent (43.1%). The grade III was the most frequent (43.3%). Pelvic ultrasound was performed in 74.1%. The vaginal route was performed in 56 cases (96%). The triple perineal intervention with hysterectomy was the most performed procedure in 23 cases or 41%. Two cases (4%) of uterine promontofixation by laparotomy was done. The mean of hospital stay was 4 days. Morbidity was 4 cases (6.8%) and was dominated by urinary tract infection. Six cases of recurrence were noted (0.3%). Conclusion:Although the clinical diagnosis is easy, management is uncodified and would require the establishment of a well questionnary. Keywords: genital prolapse, urinary incontinence, vaginal surgery

Vaginal matrix metalloproteinase-9 (MMP-9) as a potential early predictor of preterm birth.

To evaluate the differences in vaginal matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMPs) in pregnant patients with a history of prior preterm birth compared with controls. A prospective cohort pilot study recruited patients during prenatal care with history of prior spontaneous preterm birth (high-risk group) or no history of preterm birth(low-risk/controls). Inclusion criteria were singleton gestation at 11-16weeks and between 18 and 55 years of age. Exclusion criteria were diabetes mellitus, hypertension, diseases affecting the immune response or acute vaginitis. A vaginal wash was performed at time of enrollment, and patients were followed through delivery. Samples were analyzed using semi-quantitative analysis of MMPS and TIMPS. The study was approved by the IRB and a p-value <0.05 was considered significant. A total of 48 pregnant patients were recruited: 16 with a history of preterm birth (high-risk group) and 32 with no history of preterm birth (low-risk group/controls). Groupswere similar in age, race, BMI, and delivery mode. The high-risk group had more multiparous women (100 vs. 68.8 %; p=0.02), a greater preterm birth rate (31.2 vs. 6.3 %; p=0.02), and a lower birth weight (2,885±898 g vs. 3,480±473 g; p=0.02). Levels of vaginal MMP-9 were greater in high-risk patients than low-risk patients (74.9 %±27.0 vs. 49.4 %±31.1; p=0.01). When dividing the cohort into patients that had a spontaneous preterm birth (7/48, 14.6 %) vs. those with a term delivery (41/48, 85.4 %), the vaginal MMP-9 remained elevated in the cohort that experienced a preterm birth (85.46 %+19.79 vs. 53.20 %+31.47; p=0.01). There were no differences in the other MMPS and in TIMPs between highand low-risk groups. There was an increase in vaginal MMP-9 during early pregnancy in those at high risk for preterm birth and in those who delivered preterm, regardless of prior pregnancy outcome. Vaginal MMP-9 may have potential as a marker of increased risk of preterm birth.