Multiparous Women Research Articles

Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women

BackgroundSupraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy with unclear clinical significance. ObjectivesThis study sought to report the prevalence, describe the management, and explore the association between SVT and adverse obstetric outcomes. MethodsCohort study of primiparous and multiparous women without history of Cesarean section (CS), and with structurally normal hearts admitted in labor. The study group consisted of women with at least 1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio. ResultsOf 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. A total of 76 (age 33.2 ± 4.8 years) had at least 1 symptomatic and documented episode during pregnancy. In women with a known SVT diagnosis before pregnancy, medical therapy was not associated with a lower risk of SVT recurrence (OR: 1.07; 95% CI: 0.41-2.80). However, catheter ablation before pregnancy was associated with significantly lower risk of SVT recurrence (OR: 0.09; 95% CI: 0.04-0.23). Women with SVT during pregnancy had higher incidence of CS (39.5% vs 27.0%; P = 0.03), and preterm labor (PTL) (30.3% vs 8.6%; P < 0.001). Adjusting for age and parity, SVT during pregnancy was an independent predictor of CS (OR: 1.80; 95% CI: 1.03-3.10), particularly planned CS (OR: 2.89; 95% CI: 1.06-7.89) and PTL (OR: 4.37; 95% CI: 2.30-8.31). ConclusionsSVT during pregnancy is associated with increased risk for CS and PTL in healthy women. History of SVT should be sought as early as preconception counseling, and a multidisciplinary approach is warranted for both prevention and management of SVT occurrence.

The impact of sesame oil on postpartum after-pain in multiparous women: a randomised, triple-blind, placebo-controlled clinical trial

IntroductionThis study aimed to evaluate the impact of sesame oil soft gels on postpartum pain in multiparous women. MethodsA total of 86 multiparous women participated in a randomised, triple-blind, placebo-controlled trial. The women received a 1.1-g capsule of sesame oil or placebo after vaginal delivery every 6 hours for 24 hours. After-pain was assessed using a pain-o-meter 1 hour after each dose of medication or placebo. ResultsAfter the intervention, the mean scores of pain intensity (P<0.001), emotional pain (P<0.001), physical pain (P<0.001) and total pain (P<0.001) in the group that received sesame oil soft gels were significantly lower than those in the placebo group. ConclusionSesame oil soft gels are affordable, easily available and they have been shown to decrease the severity of after-pains in multiparous women that would reduce the necessity of chemical drugs usage which have various side effects.

High first trimester ferritin levels differ according to parity and are independently related to preterm birth: A prospective cohort study.

A considerable amount of neonatal morbidity and mortality worldwide is caused by preterm birth. To date, the underlying etiology of preterm birth has not been fully clarified. Previous studies demonstrate that inflammation is one of the pathological factors that might cause preterm birth, and that there is a difference between primiparous and multiparous women in immune response to pregnancy. The objective of this prospective cohort study was to investigate the role of two inflammatory markers, ferritin and C-reactive protein (CRP) and preterm birth, in first trimester women, stratified for parity. In addition, a possible association between high ferritin and CRP, and a possible association between high ferritin and CRP and preterm birth were assessed. A total of 2044 healthy, low-risk pregnant women from primary obstetric care in the Netherlands participated in this study. Their ferritin and CRP levels were evaluated at 12 weeks' gestation. Levels above the parity specific 95th percentile were defined as high. The main outcome of this study was to assess the presence of a possible association between parity specific high ferritin and CRP, and preterm birth. The secondary outcomes were the ferritin and CRP levels of women, stratified for parity, and the possible association between high ferritin and CRP levels. Logistic regression analysis was performed with preterm birth as a dependent variable and parity specific high ferritin and CRP as an independent variable, adjusting for age and history of preterm birth. Ferritin levels decreased with increasing parity. Ferritin and CRP levels at 12 weeks' gestation were significantly higher in women with preterm birth. In primiparous women, high ferritin levels (OR: 2.5, CI: 1.14-5.38) and high CRP levels (OR: 5.0, CI: 2.61-9.94) were independently associated with preterm birth. In multiparous women, high ferritin levels (OR: 6.0, CI: 2.28-16.67) were independently associated with preterm birth while high CRP levels were not. First trimester parity specific ferritin and CRP levels could play a part in predictive models for preterm birth, and further research for their additive role in preterm birth is needed.

Decline in home births associated with faster increase in trend of postpartum haemorrhage and manual removal of the placenta

In this study we explored the relationship between home birth rates and increasing rates of postpartum haemorrhage (PPH) and manual removal of the placenta (MROP). Data were used from the Dutch national perinatal registry (2000–2014) of women in midwife-led care. Adjusting for place of birth flattened the increasing trends of PPH and MROP. By adjusting for place of birth, the rising trend of MROP among multiparous women disappeared. This suggests that if home birth rates had not declined, PPH and MROP rates might not have increased as much. This study supports policies of enabling women to choose home births.

Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study

Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) − 0.42; 95% confidence interval (CI) − 0.49 to − 0.33; p = 0.001), diaphragmatic excursion (MD − 2.75; 95% CI − 2.95 to − 2.55; p = 0.001), lumbar multifidus thickness (MD − 10.08; 95% CI − 14.32 to − 5.82; p = 0.02), and ArFSFI scores (MD − 9.2; 95% CI − 10.59 to − 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI − 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.

Effect of pelvic floor fascial mobilization on pelvic floor dysfunction in multiparous pregnant women - A randomized pilot study

BackgroundPelvic floor fascial mobilization (PFFM) is an innovative intravaginal and/or intrarectal manual therapy technique developed to treat pelvic distress by improving fascial gliding and muscle function. AimThe effect of PFFM on pelvic floor distress during pregnancy was compared to conventional pelvic floor muscle training. MethodsA pilot prospective randomized clinical trial. The primary outcome was the strength and function of the pelvic floor muscles measured via the Oxford grading scale, perineometry, and hip range of motion. Each subject was treated twice, one week apart. ResultsForty multiparous pregnant women at 24–30 weeks gestation, with pelvic distress, were allocated to PFFM (study group (n = 20)) vs. pelvic floor muscle training (control group (n = 20)). There was no difference in the severity of pelvic distress between the study and control groups before the interventions (PFDI-20: 27.1 ± 12.2 vs. 26.0 ± 13.5, respectively, p = 0.7). Twenty-six subjects completed the study protocol. PFDI-20 showed significant improvement: 42% improvement in the study group vs. 12% improvement in the controls (p = 0.001 for both groups). Group-by-time interaction (Cohen's d) was significant after the first treatment session for Oxford score, right hip internal rotation range of motion, and cervical length in the PFFM group and for perineometry and right hip internal rotation at the end of the study. ConclusionsBased on this pilot randomized trial, PFFM may potentially and partially 1. Alleviate symptoms, 2. Improve pelvic floor function and strength, and 3. Elongate the cervix after one or two treatment sessions. Further, a more extensive study is needed to confirm these results.

Factors associated with the absence of postpartum consultations in a high-risk population.

To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Geographical Attributes, Distribution, and Determinants of Pelvic Organ Prolapse in Midwestern Nepal

The study investigated the geographical attributes, distribution, and determinants of pelvic organ prolapse (POP) in Nepal to comprehend the underlying factors contributing to its high prevalence in the region. Conducted in the Panchapuri municipality of midwestern Nepal, this cross-sectional study surveyed 103 married women aged 20&amp;ndash;49 years using a semi-structured questionnaire. Participants were randomly selected from four health facility catchment areas in equal proportions. Descriptive statistics presented the data while binary logistic regression models assessed factors associated with POP. Participant allocations were mapped using ArcGIS, with shapefiles obtained from official sources. The study revealed a POP prevalence of 37.9%, with housewives exhibiting a significant association compared to businesswomen (AOR: 5.291; 95% CI: 1.046, 26.775). Constipation during pregnancy was significantly associated with POP (AOR: 9.104; 95% CI: 2.210, 37.501), while multipara women with a parity of four or more were 7.8 times more likely to have POP. Interestingly, geographical attributes like altitude, slope, and climate showed no association with POP. The findings underscore the significant association of POP with factors such as housewives, pregnancy-related constipation, and multiparity. Addressing these determinants through targeted research is vital in alleviating the burden of POP. This study emphasizes the urgent need for interventions, policies, and healthcare support, particularly focusing on maternal health and occupational well-being among rural housewives in Nepal.

Comparative Study of Fetomaternal Outcome in Abruptio Placenta and Placenta Previa

Background: Abruptio placenta and placenta previa are obstetric complications associated with significant risks for both the fetus and the mother, potentially leading to severe hemorrhage, preterm birth, and maternal shock. Early detection and prompt medical intervention are crucial for optimizing outcomes and reducing maternal and fetal morbidity and mortality.&#x0D; Objective: The study aims to analyze the maternal and perinatal outcomes of APH cases due to placenta previa and abruptio placenta.&#x0D; Methods: This prospective study conducted at Ad Din Akij Medical College, Boyra, Khulna July 1, 2021, to June 30, 2023, included 150 APH cases, with 109 meeting inclusion criteria for comparison between placenta previa and abruptio placenta. Data collection encompassed maternal demographics, obstetric history, severity of hemorrhage, and neonatal outcomes. Diagnosis was based on clinical evaluation and ultrasound. Statistical analysis was performed using MS Excel.&#x0D; Results: In our Study, the distribution of causes of placental issues reveals that Placenta Previa accounts for the majority, comprising 71.55% of cases, while Abruptio Placentae represents 28.44% of instances. Placenta Previa predominantly affects individuals aged 26-30 years and over 35 years, with the highest occurrence among those with 2 pregnancies. Conversely, Abruptio Placentae shows a varied distribution across age groups, with the highest incidence among those aged 31-35 years and with gravidity of 1 pregnancy. Gestationally, the majority of Abruptio Placentae cases present between 31-33 weeks, while Placenta Previa cases peak at 34-36.6 weeks. Preterm births are prevalent in both conditions, with Placenta Previa leading in preterm deliveries. Placenta Previa is associated with a history of abortion and dilation and curettage (D&amp;C), while hypertension is a significant risk factor for Abruptio Placentae. Maternal complications include anemia, postpartum hemorrhage (PPH), and shock, with Placenta Previa being associated with anemia and PPH, while Abruptio Placentae correlated with shock.&#x0D; Conclusion: Placenta previa emerged as the primary cause of APH, affecting multiparous women, while abruptio placenta correlated with hypertension and primigravida. Both conditions posed significant risks of maternal and perinatal morbidity and mortality, highlighting the importance of prompt diagnosis and intervention.

Concerns, Worries, and Fears During Pregnancy in Active-Duty United States Air Force Families.

There are no published studies on pregnancy-related concerns, worries, and fears (CWFs) in primiparous and multiparous women and men in U.S. Air Force (USAF) families. Reflecting a biopsychosocial model of behavioral health, women's and men's pregnancy-related CWF Questionnaires were developed. Usable data were obtained from 260 women and 243 men in USAF families. Similarities and differences in pregnancy-related CWFs were found when USAF and general population data were compared. The present findings can inform not only the general provision of pregnancy health-related services but also USAF secondary prevention pregnancy-related programs (e.g., USAF nurse home visiting programs for first-time parents). If CWF Questionnaires are individually administered, the information can be used to tailor services to individual client needs.

Comparative Study of Breast Cancer in Women Under 40 Compared to Older Women: The Experience of the Mohammed VI Center

Context: Breast cancer in young women is relatively rare worldwide, with patients under the age of 35 accounting for only 2% to 25% of all women diagnosed with this cancer. The objective of this study is to describe the epidemiological, clinical and histological profile of breast cancer in patients under 40 years of age. Methods: This is a comparative study between young and older patients at the Mohammed VI Center for Cancer Treatments. This study covered various aspects, including sociodemographic data and family history of cancer, gyneco-obstetrics, and circumstances of discovery of breast cancer, histopathological characteristics and molecular classification of breast cancer. Results: Among the 305 patients treated, 64 were aged 40 or younger, or 20.98% of the total. Breast cancer in our younger patients did not appear to differ significantly from that in older women, both in terms of sociodemographic factors and histopathological and molecular characteristics. The average age at first pregnancy was 23.85 years and the average parity was 1.58 children. 37.5% of young women were nulliparous. Among multiparous women, 95% breastfed their children. The average age of menarche was 13.34 years in young patients compared to 13.30 years in older patients (p = 0.85). Among the 6 postmenopausal patients (9.3% young women), the average age of onset of menopause was 39.17 years. 59.4% of young women used oral contraceptives, compared to 60.2% of older women. A family history of breast cancer was noted in 21.9% of young patients. The circumstances of discovery of breast cancer, most cases in both groups were identified by self-palpation or during a screening mammogram. The most common tumors were stage T2, involving lymph node invasion, and high-grade SBR II and III in 73.7% and 22.8% of cases, respectively. These were mainly invasive ductal carcinomas expressing hormonal receptors (ER and RP). About 30% were HER2+. No cases of bilateral cancer were observed in younger patients. Conclusion: Breast cancer in young women is a significant problem in our study population and its incidence is increasing worldwide. The absence of a systematic screening program before the age of 40 may explain the aggressive behavior of tumors in this age group.

IJCM_144A: Demographic Characteristics and Gender Preference Patterns among Postnatal Women at Tertiary Care Hospital in Mangalore

Background: Gender preference among women remains a significant phenomenon that reflects the imbalance in the sex ratio. Understanding the determinants of gender preference is crucial in addressing associated challenges and promoting gender equality. Objectives: To study the socio-demographic profile of post-natal women, gender preference among them and the factors affecting their preference. Methodology: A hospital-based Cross-Sectional Study was conducted in a tertiary hospital in Mangalore among 155 multiparous postnatal women. The data were collected using a pre-tested semi-structured questionnaire and was analysed using SPSS version 17.0. Results: Overall, 54.83 % of the study participants belonged to the age group of 18-27 years, 57.42% were unaware of any techniques for determining a person’s sex, and the most frequently mentioned method was ultrasound. The proportion of respondents with a preference for a male child was only 20.6%. The most common reason was the male gender carrying the family name. According to 73% of respondents, having two children is ideal for a family, while having an equal number of boys and girls was the most desired combination (60%). There is a significant preference (75%) for the second child to be male if the first child was female. Conclusion: It’s noteworthy that the preference for a male child was often tied to cultural and familial considerations, such as carrying on the family name. Interestingly, the study also highlights a prevalent preference for a second child to be male if the first child was female, signifying the persistence of gender-biased attitudes.

Confluence of newborn's sex and their mother's characteristics resulting in fetal macrosomia among Indian neonates

BackgroundA newborn's birth weight ≥4000 g is defined as fetal macrosomia, which is recognized as a reproductive and serious child health concern. ObjectivesOur study aims to reveal existence of any connection between maternal factors and newborn sex in giving birth to newborn ≥4000 g in an Indian context. MethodsData were drawn from the fifth round of National Family Health Survey (NFHS-5). A cross-sectional observational study was carried out with a total of 152,827 children born to women in reproductive age group (15–49) who had most recent live birth in the five years preceding the survey. Descriptive analyses, cross-tabulation, test of association and multivariate logistic regression analyses were performed. ResultsIn India, the prevalence of macrosomia was found in 3.8% of the total study participants. Considering newborn characteristics, fetal macrosomia was more prevalent among male neonates than female (AOR: 0.730; 95% CI: 0.687–0.775). Regarding maternal characteristics, overweight (AOR: 1.468; 95% CI: 2.042–2.559) and obese (AOR: 2.764; 95% CI: 2.394–3.192) motherswith gestational diabetes (AOR: 1.731, 95% CI: 1.385–2.164) and hypertension (AOR: 1.288, 95% CI: 1.116–1.488) were more likely to giving birth of macrosomic babies. Multiparous mothers (AOR: 1.207, 95% CI: 1.128–1.293) and women who did not undergo proper antenatal care (ANC) follow up had also greater risk of developing fetal macrosomia. Muslim women (AOR: 1.223, 95% CI: 1.119–1.338), and women belonging to a tribe (AOR: 1.476, 95% CI: 0.922–2.361) were significantly associated with the risk of having newborn ≥4000 g. ConclusionEmphasis should be given on counseling for mothers for desired weight management before and during pregnancy, gestational diabetes and hypertension screening, physical activity during pregnancy, adequate ANC follow up and balanced dietary intake among pregnant women.

IJCM_383A: Sociodemographic and fertility profile of post-natal women attending tertiary care hospitals in Mangaluru: A cross-sectional study

Background: The Indian census highlights persistent challenges in achieving balanced sex ratios, attributed to factors like female neglect, sex-selective abortion, and societal preferences for sons. These preferences stem from economic, religious, and social norms, perpetuating gender disparities. Despite national efforts, skewed sex ratios persist, particularly in regions like Haryana and Punjab. However, some areas, like Dakshina Kannada district in Karnataka, exhibit more favorable sex ratios, reflecting progress in gender equality. Overall, sex ratio improvement signifies societal health and equity in population distribution. This study aims to explore the socio demographic and fertility profile of post-natal women &amp; factors affecting to gender preference among the study population. Methodology: This cross-sectional study was conducted among 155 multiparous post-natal women, who were admitted in Lady Goshen Hospital and Kasturba Medical College, Attavar, Affiliated to Kasturba Medical college, Mangalore. Data was analyzed using SPSS version 25. Results were expressed using descriptive statistics and proportions. Results: In the study of postnatal women, the recent delivery of outcome was 84 females and 71 males and only 50.9% were aware of contraceptive methods, with condoms and IUCDs being most common among them. Despite this, 78.0% of respondents still perceive female feticide as prevalent. Son preference remains prominent, with 57.0% preferring a daughter as the second child if the first child is a son, and 75.0% desiring a son if the first child is a daughter, indicating a stronger bias towards sons. Conclusions: While most prefer two children, preferences for the second child vary based on the gender of the first child, reflecting societal gender biases. Superstitions regarding gender prediction were noted but deemed insignificant. The attitude of the mothers in study settings is comparative with the favorable sex ratios in the district.

Women’s preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project

BackgroundIn 2015, a quality improvement project called “Adequate Childbirth Project” (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women’s preference for vaginal birth (VB) at the end of pregnancy.MethodsEvaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women’s preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women’s preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram.ResultsFour thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99–3.24) and multiparous women (OR 1.44 95% CI 0.97–2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22–24.50) and in multiparous women (OR 53.11 95% CI 37.31–75.60).ConclusionsThe PPA had a positive effect on women’s preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.

Are migrants during the periconception period less likely to be supplementing with folic acid: An Australian cohort study

BackgroundFolic acid (FA) supplementation before and in early pregnancy is known to improve outcomes such as reducing neural tube defects; however, little is known about groups in Australia at risk of low FA use. AimTo determine whether differences exist in FA supplementation rates between Australian-born women and migrant women, with a secondary aim of examining the sociodemographic characteristics of women who are not supplementing with FA in early pregnancy. MethodsA retrospective cohort study from January 2018–July 2022 in a high-migrant population in Western Sydney, Australia. Multivariate logistic regression analysis was conducted adjusting for confounders including place of birth, age, ethnicity, parity, history of diabetes, and type of conception. FindingsThere were 48,045 women who met inclusion criteria; 65% of whom were migrants. We identified that 39.4% of the study population did not report FA supplementation by early pregnancy. Women who were migrants were more likely to report FA usage than those born in Australia (aOR 1.24; 95%CI 1.17–1.31). Women least likely to report use of FA were women < 20 years of age (aOR 0.54; 95%CI 0.44–0.67) and multiparous women (aOR 0.84; 95%CI 0.82–0.86). Women with type 1 or type 2 diabetes were more likely to report FA use (aOR 1.66; 95%CI 1.11–2.48, aOR 1.30; 95%CI 1.05–1.61). ConclusionA significant proportion of the population did not report FA supplementation before or during early pregnancy. To increase uptake of FA supplementation, clinicians and public health messaging should target at-risk groups.

A Simple Maneuver to Facilitate Delivery in Shoulder Dystocia

Shoulder dystocia is an unpredictable complication of vaginal delivery and it could lead serious adverse maternal and neonatal outcomes. Prompt intervention and appropriate management of this obstetric emergency is essential to reduce the risk of adverse outcome. The maneuvers that had various advantages and disadvantages to alleviate shoulder dystocia have been described previously. In this report, we defined a new, easy to perform and noninvasive maneuver which could be used to relieve shoulder dystocia. This maneuver was successfully implemented in two nulliparous and two multiparous women who had experienced shoulder dystocia during vaginal delivery. After the diagnosis of shoulder dystocia and unsuccessful McRoberts and suprapubic pressure maneuver, the gentle upward traction on the fetal head and neck was performed in the lithotomy position. The posterior shoulder slipped forward in the sacral hollow and brought closer to the introitus with this maneuver. Thus, the anterior and posterior shoulders were no longer in the same antero-posterior plane of the pelvis. Then the gentle downward traction on the fetal head was applied until the anterior shoulder protruded through the perineum and the impacted anterior shoulder dislodged from behind the symphysis pubis. No other maneuver was needed for the completion of the delivery in these four cases, and no maternal or neonatal complication was observed. In conclusion, the presented maneuver is an easy and noninvasive maneuver. It could be easily learned with simulation training and used in the management of shoulder dystocia.

Regulatory role of miR-125a expression with respect to its target genes LIFR, ERBB2 and STAT3 in the pathogenesis of recurrent pregnancy losses.

Studies have investigated miR-125a for its predictable role in recurrent pregnancy loss (RPL) cases to regulate many biological events required for the maintenance of pregnancy by regulating its confirmed target genes LIFR, ERBB2 and STAT3. The present study included 40 cases of women with at least two RPLs in ≤20 weeks of gestation against 40 healthy multiparous women without a previous history of abortion. Expression analysis of ERBB2, LIFR, STAT3 and miR-125a was conducted by quantitative real-time PCR (qPCR). The expression of miR-125a was significantly lower in the plasma of RPL cases (P = 0.0001) and showed a significantly increased mean expression level in product of conception (2.56-fold, P < 0.0001). Among the target gene of miR-125a, ERBB2 and STAT3 gene expression level was significantly increased (2.58-fold, P = 0.04; 1.87-fold, P = 0.025), respectively in RPL cases while the LIFR gene revealed comparable expression (P = 0.64). Furthermore, expression analysis of ERBB2 gene with respect to its regulatory miR-125a cases depicted a significant association (P = 0.0005). Kaplan-Meier survival analysis revealed cases with low miR-125a expression had significantly shorter time to miscarriages, (log-rank P = 0.02). Also, decreased expression of miR-125a significantly conferred >2-fold increased risk for RPL (HR = 2.34: P < 0.05). The overall conclusion of the study was that altered miR-125a expression may cause deregulation in target genes LIFR, ERBB2 and STAT3 resulting in adverse consequence in the outcome of pregnancy.

Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries

ObjectiveTo measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DesignA cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SettingThirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. ParticipantsA total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FindingsThe overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and “avoid pain in labour” was the most common perceived benefit of caesarean section. Key conclusionsOur results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. Clinical trial registryThe QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

Abstract MP71: Novel Association Between Parity and Skeletal Muscle Adiposity in Middle-Aged and Older African Caribbean Women

Objective: Pregnancy and parity (number of children born to a women) are associated with alterations in metabolism and lifestyle, which may affect women’s short- and long-term cardiometabolic health. Greater skeletal muscle adiposity (myosteatosis) is recognized as a major risk factor for cardiometabolic diseases, especially in African ancestry individuals. While lifetime parity has been previously associated with greater central obesity years after childbearing ceased, it remains unclear whether parity is associated with myosteatosis. Methods: We examined the association of parity (0, 1, 2, 3, 4+) with myosteatosis and general and central obesity among 1,119 African Caribbean women, aged 40-84 years, recruited from 2019 to 2023 without regard to health status. Calf myosteatosis area was measured by CT-derived intermuscular adipose tissue (IMAT, mm 2 ) and skeletal muscle density (mg/cm 3 , with a lower density indicating more adiposity). Multivariable linear regression models were used to estimate the adjusted means of IMAT, muscle density, BMI, and waist circumference for each parity group. Results: The mean age of women who reported ever being pregnant (N=969) was 55.8 (SD=9.0) years. They were obese on average (BMI=32.1 (SD=6.8) kg/m 2 ), and had given birth to an average of 3 (SD=2.3) children. In multivariable models, higher parity was significantly associated with higher IMAT and lower muscle density, after accounting for age, BMI, physical activity, and comorbidities (see Table). Parity showed no associations with BMI or waist circumference. Conclusions: Parity may be associated with greater accumulation of adiposity in skeletal muscle, despite no link with general or central adiposity among African Caribbean women. Our novel findings, if confirmed in prospective studies, might highlight the need for tailored strategies for maintaining healthy muscles in multiparous women of African ancestry. Table. Adjusted population marginal means (95% CI) for myosteatosis by parity groups in African Caribbean women a