Natural Childbirth Research Articles

The Impact of Health Transformation Plan on Bed Occupancy Rate, Average Length of Stay, and Bed Turnover Interval in a Deprived Region of Iran: An Interrupted Time Series

Background: The health transformation plan (HTP) in Iran started in May 2013 with 3 financial support approaches for people, creating justice in access to health services and improving the quality of services in hospitals in 2 health and treatment sectors. In the first phase, this program was divided into 8 separate packages in the treatment section, reducing the amount of payment for hospitalized patients, supporting the longevity of doctors in disadvantaged areas, the presence of resident specialist doctors in hospitals, improving the quality of visiting services in hospitals, improving the quality of hoteling in hospitals, and financial support of incurable, special and low-income patients. It refers to promoting natural childbirth and launching an air emergency service. Objectives: This study aims to investigate the effect of HTP on bed occupancy rate, average length of stay, and bed rotation distance in one of the most deprived areas. Methods: This study was a semi-experimental and retrospective descriptive-analytical study before and after the health system transformation plan based on the information collected from March 2012 to March 2019 in all Sistan and Baluchistan province hospitals. The data of indicators of monthly bed occupancy rate, average length of stay, and bed rotation interval in 83 months in the years before and after the implementation of the transformation plan were collected from the Vice-Chancellor of Treatment of Universities or the statistical units of hospitals and compared. The data were analyzed by Stata software using the interrupted time series (ITS) model, and split regression analysis was used to evaluate the short-term and long-term effects of HTP on the studied indicators. Results: This study showed that the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased immediately after HTP in Sistan and Baluchistan province hospitals. Also, the reform had a long effect on these indicators. Conclusions: Possibly due to underdeveloped hospitalization services in the past, the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased in the hospitals after this province's major health system reform.

Effectiveness of Self-Instructional Module on Knowledge Regarding Natural Birthing Methods among Antenatal Mothers

Background:This study aims to assess the effectiveness of self -instructional - module on knowledge regarding natural birthing methods among antenatal mothers of selected hospitals. It is quasi experimental research. Purpose of the study was to know the pre assessment knowledge regarding natural birthing methods followed by the intervention, which included administration of self-instruction-module, which was based on the content related to natural birthing methods. After administration post evaluation of the knowledge score was done to compare the effectiveness of the intervention.
 Material and method: A quasi experimental research design was used while the approach utilized was quantitative. Pre-test- post-test control group research design was used for the study. The study was done at tertiary hospital of a cosmopolitan city, while the samples were antenatal mothers who were attending the OPD’s. Data collection tool used was a structured questionnaire on natural birthing methods which included demographic questions and knowledge based questions. Analysis was done by using descriptive inferential statistics.
 Result:Results revealed that experimental group knowledge score in pre-test was 9.2 as compared to 11.2 in the post-test for the p-value of 0.05. In control group, knowledge score in pre-test was 8 as compared to 8.5 in the post-test. Association was found with the demographic variable of education
 Conclusion: Average mean difference in knowledge score in antenatal mothers in experimental group was significantly higher than that in control group hence It is evident that the self-instructional module is significantly effective in improving the knowledge among antenatal mothers regarding natural birthing methods.

Monoclonal antibody therapy for COVID-19 during pregnancy

Aim. Pregnancy worsens COVID-19 and has been listed by the US Food and Drug Administration as a high risk factor for complicating COVID-19. The severe course of a new coronavirus infection in some pregnant patients has created the prerequisites for the search for treatment methods that can reduce the likelihood of adverse outcomes. One of these therapy options is treatment with virus-neutralizing antibodies monoclonal antibodies. Experience with the use of monoclonal antibodies for the treatment of pregnant women is very limited, but in 2021 pregnancy was recognized as a high risk factor for the course of a new coronavirus infection, making it possible to use this group of drugs.
 Materials and methods. We described the experience of COVID-19 monoclonal antibody therapy during pregnancy in the Republic of Tatarstan. A retrospective analysis of 18 case histories of pregnant patients with mild and moderate course of confirmed coronavirus infection, treated with monoclonal antibodies (casirivimab/imdevimab) from March 2022 to June 2022, was carried out on the basis of the Perinatal Center of the Republican Clinical Hospital, Kazan, Republic of Tatarstan.
 Results. All patients tolerated the administration of casirivimab/imdevimab satisfactorily; no adverse drug reactions were identified. Subjective improvement was observed on the 3rd day of MCA treatment. Delivery through the natural birth canal was carried out on time in 11 women; by caesarean section on time in 5 patients. A follow-up study of children born to 18 patients who had COVID-19 was collected. The age of the children at the time of information collection ranged from 10 months 1 year 1 month. Currently, all children are healthy and developing according to their age.
 Conclusion. In all pregnant patients with a new coronavirus infection with mild to moderate course, the administration of casirivimab/imdevimab was an effective method of treating the new coronavirus infection. The follow-up of children born from 18 patients was followed: the childrens condition was satisfactory, their development corresponded to their age.

Probability of second live birth after first natural and medically assisted reproduction-mediated live birth: A historical cohort study.

Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one. This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan-Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right-censored if they moved out of the region, died, or did not have a second live birth by the end of follow-up. We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66-0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR-mediated live birth. In our cohort, one woman out of 10 having a first MAR-mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children.

Lysinuric Protein Intolerance and Its Nutritional and Multisystemic Challenges in Pregnancy: A Case Report and Literature Review.

Lysinuric protein intolerance (LPI) is a rare inborn error of metabolism (IEM), classified as an inherited aminoaciduria, caused by mutations in the SLC7A7 gene, leading to a defective cationic amino acid transport. The metabolic adaptations to the demands of pregnancy and delivery cause significant physiological stress, so those patients affected by IEM are at greater risk of decompensation. A 28-year-old woman with LPI had experienced 3 early miscarriages. While pregnancy was finally achieved, diverse nutritional and medical challenges emerged (food aversion, intrauterine growth restriction, bleeding risk, and preeclampsia suspicion), which put both the mother and the fetus at risk. Moreover, the patient requested a natural childbirth (epidural-free, delayed cord clamping). Although the existence of multiple safety concerns rejected this approach at first, the application of novel strategies made a successful delivery possible. This case reinforces that the woman's wish for a non-medicated, low-intervention natural birth should not be automatically discouraged because of an underlying complex metabolic condition. Achieving a successful pregnancy is conceivable thanks to the cooperation of interdisciplinary teams, but it is still important to consider the risks beforehand in order to be prepared for possible additional complications.

Antenatal perineal massage - risk of perineal injuries, pain, urinary incontinence and dyspereunia - a systematic review.

Natural childbirth is associated with the risk of damage to the perineum - a tears or a episiotomy. Adequate preparation of the woman for childbirth is essential to minimize the occurrence of perinatal injuries. The aim of the review is to assess and analyze the impact of APM (antental perineal massage) on perinatal perineal injuries and the development of pelvic pain and other complications in postpartum women, such as dyspareunia, urinary (UI), gas (GI), and fecal incontinence (FI). PubMed, Web of Science, Scopus and Embase were searched. Three authors independently searched databases and selected articles for inclusion and exclusion criteria. Next one author did Risk of Bias 2 and ROBINS 1 analyze. Of 711 articles, 18 publications were left for the review. All 18 studies examined the risk of perineal injuries (tearing and episiotomy), 7 pain in postpartum period, 6 postpartum urinary, gas/fecal incontinence and 2 described dyspareunia. Most authors described APM from 34 weeks of pregnancy until delivery. There were different techniques and times for doing APM procedures. APM has many benefits for women during labor and the postpartum period (e.g. lower rate of perineal injuries and pain). However, it can be observed that individual publications differ from each other in the time of massage, the period and frequency of its performance, the form of obtaining instruction and control of patients. These components may affect the results obtained. APM can protects the perineum from injuries during labor. It also reduces risk of fecal and gas incontinence in postpartum period.

Obstetric Anesthesia

Patient safety and reduction of possible complications are the top priorities for anesthesiologists in everyday clinical practice. Thus, interdisciplinary early assessment and optimization of patient specific medical conditions and risk factors are crucial. In obstetrics, regional anesthesia and general anesthesia are routinely being performed. To ensure maternal and fetal safety, knowledge regarding physiological changes during pregnancy is highly important. Regional anesthesia, particularly epidural analgesia, has its main field of application in the context of natural birth in the delivery room. Spinal anesthesia, as well as epidural and combined spinal-epidural anesthesia (CSE) are widely used for caesarean section. In this context, special attention should be paid to possible bleeding disorders. The combination of risk stratification and strategies to improve the patient's preoperative medical status is capable to reduce maternal and fetal complications.

Impact of Demographic and Migration Processes on the Settlement System in the Tyumen Region

The article analyzes the transformation of the settlement system of Tyumen Region between censuses in the context of demographic processes and population migration. The paper reveals trends in the natural movement of population in the region, including natural increase, birth rate and mortality in the context of urban and rural settlements. The growth of population in large and medium-sized cities in the region and rural municipalities has been analyzed. We have also analyzed the absolute volumes of migration, as well as various forms of migration that are represented in the region. Their contribution to demographic and socio-economic processes has been determined. The results of the sociological survey have been used to analyze the migration patterns of the Tyumen Region population with regard to their departure from the region. It has been established that migration not only replenishes the population of the region, but also forms the structure of population with a high proportion of migrants. This is a prerequisite for a high level of migratory attitudes among the population of the region with a view to moving to other regions of the country or abroad. Highlighted features of the settlement network development in the Tyumen Region, characterized trends in the transformation of the settlement system and the framework of settlement pattern of the territory.

A broad-based probe-free qPCR assay for detection and discrimination of three human herpes viruses

Primary infection or reactivation of latent human cytomegalovirus (HCMV) or herpes simplex viruses (HSV) 1 or 2 during pregnancy can transmit the virus in utero or during natural childbirth to the fetus. The majority of these infections are asymptomatic at birth but may present later with potentially lethal disseminated infection or meningitis (HSV), or long-term neurodevelopmental sequelae including sensorineural hearing loss or neurodevelopmental impairments (HCMV). Unfortunately, early signs and symptoms of disseminated viral infections may be misdiagnosed as bacterial sepsis. Therefore, immediate testing for viral etiologies may not be ordered or even considered by skilled clinicians. In asymptomatic HCMV infections, early detection is necessary to monitor for and treat future neurologic sequelae. In acutely ill-appearing infants, specific detection of viruses against other disease-causing agents is vital to inform correct patient management, including early administration of the correct antimicrobial(s). An ideal test should be rapid, inexpensive, require low sample volumes, and demonstrate efficacy in multiple tissue matrices to aid in timely clinical decision-making for neonatal infections. This work discusses the development of a rapid probe-free qPCR assay for HSV and HCMV that enables early and specific detection of these viruses in neonates. The assay’s probe free chemistry would allow easier extension to a broad-based multiplexed pathogenic panel as compared to assays utilizing sequence-specific probes or nested PCR.

Clinical Research on Aromatherapy Combined with Acupoint Massage on Promoting Natural Childbirth of Primipara

Objective: To discuss and analyze the clinical research of aromatherapy combined with acupoint massage onpromoting natural childbirth of primipara. Methods: A total of 100 primiparas who gave birth in the obstetrics department of our hospital from May 2022 to May 2023 were recruited and divided into the experiment group (n = 50) and the reference group (n = 50). The experiment group received a nursing that includes aromatherapy and acupoint massage, and the reference group received routine midwifery nursing. Bad mood, pain degree, sleep quality, labor time, and satisfaction were compared between the two groups. Results: Before nursing, there was no statistically significant difference in all the observation indicators between the two groups (P > 0.05). After nursing, the anxiety, depression, and other negative emotions, pain degrees, sleep quality, and satisfaction degree of the experiment group were significantly better than those in the reference group (P < 0.05). The duration of labor in the experiment group was shorter than that of the reference group (P<0.05). Conclusion: Aromatherapy combined with acupoint massage can promote the natural delivery of primipara, and it is worthy of wide application and promotion.

Ribosomal, Telomere, and Mitochondrial Repeat Copy Number Variations in Female Genomes during Ovarian Stimulation and the Prediction of In Vitro Fertilization Outcome: A Pilot Study.

Individual risk assessment of assisted reproductive technologies is essential for personalized treatment strategies. Genetic and genomic indicators of the response to stress by cells could provide individual prognostic indicators for in vitro fertilization (IVF) success. Such indicators include the copy number of ribosomal genes (rDNA), which modulates the level of protein synthesis, and the abundance of mitochondrial DNA (mtDNA), which provides the cell with energy, while the content of telomere repeats (TRs) indicate the biological age. The contents of the three repeats in DNA isolated from blood leukocytes of 40 women before and after ovarian stimulation were assayed prior to IVF. Then, we divided the women into a successful IVF group, IVF+ (N = 17, 7 cases of twins), and a group of failed cases, IVF- (N = 23). The control group included 17 non-pregnant women with natural childbirth in the past. The nonradioactive quantitative hybridization (NQH) method was applied to assay the genome repeat contents. The number of rDNA copies in the IVF+ group was significantly higher than in the IVF- group (p < 10-8). The number of mtDNA copies in the IVF+ group also exceeded those in the IVF- group (p < 0.001), whereas the TR content in the two groups differed, albeit, non-significantly (p < 0.03). Following the ovarian stimulation, the rDNA copy numbers did not change, while the contents of the mtDNA and TR varied significantly. This pilot study has shown that rDNA abundance in blood leukocytes can be considered a stable and effective predictor. Very low numbers of ribosomal repeat copies (<330) entail a high risk of IVF failure. However, a combination of numerous mtDNA and TRs, provided that rDNA content is not very low, increases the probability of multiple pregnancies.

NT-proBNP-Possible Prognostic Marker in Pregnant Patients with Associated Cardiovascular Risk Factors and SARS-CoV-2 Infection.

N-terminal pro brain-type natriuretic peptide (NT-proBNP) is a practical biomarker in the clinical pathologies where the ventricle is under stress and particularly stretched in the general population. The study aims to compare the value of NT-proBNP and its importance in the prognosis and severity of the cases involving pregnant patients with SARS-CoV-2 infection and cardiovascular risk factors to those of low-risk pregnant patients, mainly by analysing their symptoms, administered medication, days of hospitalization and severity of the viral disease. The study included a total of eighty-three pregnant patients who underwent natural birth or caesarean section at out hospital. NT-proBNP levels were analyzed at hospital admission as a potential cardiovascular marker. A comparative analysis was performed between pregnant patients with cardiovascular risk factors and pregnant patients without cardiovascular risk factors regarding NT-proBNP values. Pregnant patients with SARS-CoV-2 infection and cardiovascular risk factors had higher values of NT-proBNP in comparison to pregnant patients without cardiovascular risk factors. NT-proBNP testing in pregnant patients with SARS-CoV-2 infection can be a relatively important marker to be taken into consideration when it comes to the management, treatment and outcome of the cases, especially when it comes to women with associated cardiovascular risk factors.

Long-term outcomes of offspring from multiple gestations: a two-sample Mendelian randomization study on multi-system diseases using UK Biobank and FinnGen databases

BackgroundAssisted reproductive technologies (ART) have increased the incidence of multiple births, which can have a negative impact on maternal and offspring health. The study aimed to investigate the association between genetically predicted multiple birth and the risk of 42 common diseases of the nervous, psychiatric, cardiovascular, respiratory, digestive, and endocrine systems.MethodsThe study utilized two-sample Mendelian randomization (MR) analysis to explore the potential causal relationship between genetically predicted multiple birth and the genetically predicted risk of diseases. The study used the FinnGen and UK Biobank datasets for analysis.ResultsThe study found no significant causal relationship between multiple birth and psychiatric disorders. However, the lower limits of the 95% confidence intervals for bipolar affective disorder and anxiety disorders were not robust, indicating a need for further investigation. The study found that multiple birth may be a strong risk factor for infantile cerebral palsy, and caution is necessary in both natural and ART multiple births. The study revealed a potential causal relationship between multiple birth and coronary heart disease, ischemic heart disease, and deep vein thrombosis, which may be related to abnormal intrauterine environments in multiple pregnancies. Surprisingly, multiple birth appears to have a protective effect against some respiratory diseases, such as chronic obstructive pulmonary disease and asthma.ConclusionsThe study highlights the need for caution regarding the risk of infantile cerebral palsy, cardiovascular diseases, and psychiatric disorders in multiple birth. Our study can lead to the development of preventive strategies and improved clinical management for affected infants.

Efficacy of Massage on Pain Intensity in Post-Cesarean Women: a Systematic Review and Meta-Analysis.

Cesarean section is a common surgical procedure that may be considered a safe alternative to natural birth and helps to resolve numerous obstetric conditions. Still, the Cesarean section is painful; relieving pain after a Cesarean section is crucial, therefore analgesia is necessary for the postoperative period. However, analgesia is not free of complications and contraindications, so massage may be a cost-effective method for decreasing pain post-Cesarean. Our study aims to determine the massage role in pain intensity after Cesarean sections. We searched five electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. We calculated the pooled mean difference (MD) and standardized mean difference (SMD) for our continuous outcomes, using random or fixed-effect meta-analysis according to heterogenicity status. Interventional studies were assessed for methodological quality using the Cochrane risk-of-bias assessment tool, while observational studies were assessed using the National Institutes of Health's tools. Our study included 10 RCTs and five observational studies conducted with over 1,595 post-Cesarean women. The pooled MDs for pain intensity considering baseline values either immediately or post 60-90 minutes were favoring the massagegroup over the control group as follows:(stand. MD = -2.64, 95% CI [-3.80, -1.48], p >.00001; MD = -2.64, 95% CI [-3.80, -1.48], p >.00001, respectively). While pooled MDsregarding post-intervention only eitherimmediately or post 60-90 minutes were:(stand. MD = -2.04, 95% CI [-3.26, -0.82], p =.001; stand. MD = -2.62, 95% CI [-3.52, -1.72],p > .00001, respectively). Our study found that using massage was superior to the control groups in decreasing pain intensity either when the pain was assessed immediately after or 60-90 minutes post-massage application.

On epidemic spreading in metapopulation networks with time-varying contact patterns.

Considering that people may change their face-to-face communication patterns with others depending on the season, we propose an epidemic model that incorporates a time-varying contact rate on a metapopulation network and its second-neighbor network. To describe the time-varying contact mode, we utilize a switched system and define two forms of the basic reproduction number corresponding to two different restrictions. We provide the theoretical proof for the stability of the disease-free equilibrium and confirm periodic stability conditions using simulations. The simulation results reveal that as the period of the switched system lengthens, the amplitude of the final infected density increases; however, the peak infected density within a specific period remains relatively unchanged. Interestingly, as the basic reproduction number grows, the amplitude of the final infected density within a period gradually rises to its maximum and then declines. Moreover, the contact rate that occupies a longer duration within a single period has a more significant influence on epidemic spreading. As the values of different contact rates progressively increase, the recovery rate, natural birth rate, and natural death rate all decrease, leading to a larger final infection density.

Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study

BackgroundThe two-child policy implemented in China resulted in a surge of high-risk pregnancies among advanced maternal aged women and presented a window of opportunity to identify a large number of placenta accreta spectrum (PAS) cases, which often invoke severe blood loss and hysterectomy. We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning.MethodsCross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL + CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018.ResultsFrom a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL + CST had a significant reduction in intraoperative blood loss (β=-312 ml, P < .001), RBC transfusion (β=-1.08 unit, P = .001), but required more surgery time (β = 16.43 min, P = .01). MRI-measured placenta thickness, when above 50 mm, can increase blood loss (β = 315 ml, P = .01), RBC transfusion (β = 1.28 unit, P = .01), surgery time (β = 48.84 min, P < .001) and hospital stay (β = 2.58 day, P < .001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation.ConclusionsA conservative surgical management approach of UAL + CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery.Clinical trial registration number: ChiCTR2000035202.

The effect of date fruit consumption on early postpartum hemorrhage: a randomized clinical trial

BackgroundPostpartum hemorrhage, anemia, and iron deficiency are important health problems. Using safe, cheap, and available methods to reduce the amount of hemorrhage after childbirth can be effective for the mother's health during this period. Therefore, this study was conducted to determine the effect of date fruit consumption on the amount of hemorrhage after natural childbirth.MethodsThis randomized clinical trial was conducted on 98 women referred to the maternity ward of Al-Zahra Hospital in Rasht using the available sampling method. The primary outcome was postpartum hemorrhage, measured using the Pictorial Blood Loss Assessment Chart (PBLAC). Two hours after delivery, 100 g of date fruits were given to the intervention group, and the amount of hemorrhage was recorded during the first 24 h. Comparison between the two groups was done with the Mann–Whitney test with the Hodges–Lehmann estimator and corresponding exact conditional nonparametric confidence interval (CI) as effect estimate. A P < 0.05 was considered significant.ResultsThe median of postpartum hemorrhage after normal delivery in the date and control groups was 35.0 [interquartile range (IQR): 22.0 to 39.8] and 39.0 [IQR: 27.5 to 64.5], respectively. Using the Hodges–Lehmann estimator, on average, the median postpartum hemorrhage in the date group was 9.0 (95% CI: 2.00–18.0) units lower than the control group (P = 0.009).ConclusionConsumption of dates effectively reduces the amount of hemorrhage after natural childbirth; thus, consuming this fruit during postpartum period is recommended. Also to confirm the findings, it is recommended to conduct similar studies in this field.Trial registrationThis trial was registered with the Iranian Registry of Clinical Trials; https://www.irct.ir/trial/59197 (IRCT20210607051505N2) on 31/10/2021.

Contagious photons: Laser dynamics and the susceptible-infected-recovered model.

We explore a complete analogy between the classic susceptible-infected-recovered epidemiological model with natural birth and death rates, and class-B laser equations. As a result, recently derived asymptotic formulas in the former context can be used to describe the switch-on intensity pulse of a laser suddenly brought well above the lasing threshold, as in active Q-switching. Conversely, the well-studied laser relaxation oscillations find a companion behavior in epidemiology, emphasizing nontrivial timescales. Finally, we discuss the possible correspondence between multistrain outbreaks and multimode lasing.

Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia.

Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: In our study, more women delivered by caesarean section (n=35) than by vaginal birth (n=12). Women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section (OR 16.5; 95% CI 1.91-142.49; p=0.02). Similar to previous studies, we found that foetal malpresentation significantly increase the risk of caesarean delivery (OR 8.25; 95%CI 0.95-71.09; p=0.03), while labour augmentation decrease the likelihood of caesarean section (OR 0.20; 95% CI 0.49-0.81; p=0.03). There was also a significant older patients in the caesarean section groups (OR 1.26; 95% CI 1.09-1.45 ; p=0.00). Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Other larger cohort study are warranted, since many factors were involved in the decision of caesarean section.

The survey of factors associated with the development of immune tolerance in children with cow’s milk allergy; a cross-sectional study in Gorgan, Iran

Introduction: Cow’s milk allergy (CMA) is a common complication and one of the most common food allergies in infants, and it is estimated that this disease affects 2-3% of children under five years old. Objectives: This study investigated the factors associated with developing immune tolerance in children with CMA in Gorgan. Patients and Methods: In this cross-sectional study, 50 children with CMA referred to the asthma and allergy clinic of Taleghani Hospital in Gorgan during 2019-2020 were investigated. Multiple logistic regression was applied to measure odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between the selected factors and tolerance to cow’s milk. Results: The results suggested that factors including standard delivery (P=0.024, OR=4.03, 95% CI: 1.20-13.53) and breastfeeding in the first month of birth (P=0.003, OR=6.73, 95% CI:1.94-23.36), and gastrointestinal symptoms (P=0.026, OR=3.78, 95% CI: 1.17-12.19) were associated with immune tolerance to CMA. Younger age of starting complementary feeding (P&lt;0.001, OR=0.070, 95% CI:0.02- 0.30), younger age of starting cow’s milk feeding (P=0.003, OR=0.520, 95% CI: 0.32-0.83), skin symptoms (P=0.012, OR=0.211, 95% CI: 0.06-0.71) and respiratory symptoms (P=0.013, OR=0.219, 95% CI:0.07- 0.72) were associated with allergy persistence. Conclusion: The findings of our study demonstrated natural childbirth, breastfeeding, and gastrointestinal symptoms, including bloody stools, are factors related to immune tolerance in children with CMA. The findings showed that decreasing the onset of complementary feeding, reducing the age of cow’s milk feeding, and clinical manifestations of respiratory and skin are associated with persistent CMA in children.