Non-progressive Labor Research Articles

Analyzing trends in Cesarean Section by Action Oriented Classification (Robson Criteria) at Creek General Hospital, Karachi

Objectives: The objective of this study is to analyze Cesarean section trends using the Robson classification system and identify the cause of cesarean section in each group, in a tertiary care hospital Karachi. Study Design and Settings: This cross-sectional study was conducted in the obstetric department of Creek General Hospital Karachi, from 1 Jan 2021 to 31 Dec 2022. Methodology: Data collection utilized a non-probability consecutive sampling method. This study examined the sociodemographic characteristics, indications for cesarean section, and the Robson classification system in the women who underwent cesarean section in the hospital during specified duration. Inclusion criteria of study were all women who underwent for C-section procedure during the study timeline. Data was analyzed using IBM SPSS Statistics version 26. The study adhered to the Helsinki Declaration and ethical approval. Results: The Robson classification system was analyzed in this study, and group 5 was shown to be the primary contributor followed by group 2 and then group 1. Most frequently noted indication was previous CS (43.2%), followed by non-progress of labor (15.1%), and fetal distress (11.6%). Conclusion: Cesarean section rate can be reduced by encouraging vaginal birth after cesarean section in multiparous women who had one cesarean section, under supervision of senior obstetrician. Meanwhile, the Non-progress of labor can be targeted by improving antenatal and intrapartum care, birth preparation classes and presence of companion during labor. Through CTG interpretation and their standardized management protocols will be effective in preventing and curbing the rising cesarean rate due to fetal distress

Analysis of Birth Statistics, Examination of Caesarean Rates and Caesarean Indications; Retrospective Study

Aim: This study investigated cesarean delivery rates and indications for cesarean delivery among patients who gave birth in our clinic between 2019 and 2022. Material and Method: For the study, the data of 16,559 patients who gave birth between 2019 and 2022 in the Obstetrics and Gynecology clinic of a Training and Research Hospital were retrospectively analyzed. The mode of delivery, gender information, fetal birth weight, vaginal delivery, and cesarean section rates and indications for cesarean section were analyzed. Results: Among the patients who gave birth in our clinic between January 01, 2019, and December 31, 2022, 58.1% delivered vaginally, and 41.9% delivered by cesarean section. According to the four-year average, 48.5% of the babies born were girls, and 51.5% were boys. The most common indication for cesarean section was previous uterine surgery. The rate of primary cesarean section among cesarean deliveries was 47%. The most common indications for primary cesarean section were fetal distress, breech presentation, and non-progressive labor. Conclusion: In our clinic, the four-year average cesarean delivery rate was 41.9%. Although this rate is below the national average of 53%, it is above the Ministry of Health's target rate of 35% in Turkey. When evaluated specifically for our province, we think this is mainly due to the lack of obstetrician-gynecologists in the districts and the high number of referrals to our hospital. Nevertheless, considering these results, it is clear that more comprehensive studies are needed to reduce cesarean section rates.

Impact of maternal muscle strength on cesarean delivery outcomes: a comparative study of nulliparous women.

This study explored the correlation between maternal muscle mass and strength and the mode of delivery in childbirth. Specifically, it focused on full-term nulliparous pregnant women, analyzing ultrasonographic measurements of the quadriceps femoris muscle together with serum myostatin levels and muscle strength as determined by a handgrip test. The aim was to discern whether these factors could influence the likelihood of delivering vaginally or via cesarean section. This study included 86 healthy nulliparous women at term, categorizing them into two groups based on their mode of delivery: vaginal delivery (58 women, Group 1) and cesarean section (28 women, Group 2). Comparative analyses of demographic information, delivery characteristics, ultrasonographic measurements of the quadriceps femoris, limb circumferences, handgrip strength, and serum myostatin concentrations were conducted. The findings revealed that women in Group 1 had less gestational weight gain but greater handgrip strength compared to Group 2. Additionally, women who underwent cesarean section due to nonprogressive labor had greater arm and calf circumferences relative to those who had vaginal deliveries. The data of this study suggest a trend whereby lower maternal muscle strength and mass are associated with a decreased likelihood of vaginal delivery in pregnant women.

Anatomical and physiological aspects of the mutual influence of circulatory hypoxia of the myometrium and non-progressive labour

Non-progressive labour occurs in almost 10% of deliveries and is a main reason for unplanned cesarean sections and operative vaginal births using obstetric forceps or vacuum extraction. This article describes the morphological transformation of the myometrium and uterine blood vessels that occurs during pregnancy. It is shown that the myometrium inevitably experiences hypoxia at the microstructural level during each normal or pathological labour. We analyzed recent studies of the mutual influence of myometrial hypoxia and labour dystocia. Experimental and clinical studies showed relationship between the pH values and lactate levels determined in the myometrium on its contractility. Further research is justified, including the study of the pH and lactate values in amniotic fluid in patients with non-progressive labor. Finally, that will allow for clarifying the conditions and timing of labour stimulation with oxytocin and identifying a group of patients for whom oxytocin administration is contraindicated or hopeless.

Safety and Efficacy of Oral Mifepristone for Cervical Ripening and Induction of Labor.

Background Labor induction, a common practice to prevent maternal and fetal complications from prolonged labor, involves stimulating contractions before they begin naturally. This can be achieved through medications, mechanical methods, or surgical interventions. Cervical ripening is crucial for successful delivery. When the cervix is not sufficiently ripe, drugs are often used to augment this process chemically. Objective To evaluate the safety and efficacy of mifepristone for cervical ripening and induction of labor. Method A sample size of 200 was used in this single-blind randomized control trial. Primarily, pregnant women with term pregnancies, Bishop scores <6, and cephalic fetal presentation were included in the study. The study population was randomly divided into test and control groups. The test group (n=100) was administered 200 mg of mifepristone orally, while the control group (n=100) received a placebo. The Bishop score was reassessed 24 hours after mifepristone administration. Patients were taken for labor induction if their Bishop score was >6. For individuals with a Bishop score of <6, 1 mg of dinoprostone gel was administered intracervically once every six hours. Safety and efficacy were assessed by analyzing several parameters associated with labor progression, maternal outcomes, and fetal outcomes. Results The mean age of patients in the test group was 26±4.5 years, while in the control group, it was 26±5 years. The induction-to-delivery interval was notably shorter in the test group (18.8±2.3 hours) than in the control group (19.24±1.8 hours, p<0.0001). After the administration of 200 mg mifepristone, the mean Bishop score in the test group was 5.74±0.8, compared to 5.13±0.76 in the control group. The increase in the Bishop score after mifepristone treatment was significantly higher in the test group than in the control group (p-value=0.013). In the study, 73 (73%) patients in the test group had a normal vaginal delivery (NVD), whereas NVD accounted for 64 (64%) patients in the control group. Instrumental deliveries were less frequent in the test group, accounting for 14 (14%) patients, compared to 16 (16%) patients in the control group. The frequency of lower segment cesarean section (LSCS) was also lower in the mifepristone-treated group at 13 (13%) compared to the control group at 20 (20%). Fetal distress in five (38%) patients and non-progression of labor in 11 (55%) patients were the most frequent indications for LSCS in the test and control groups, respectively. There was no significant difference in neonatal outcomes between the test and control groups. Meconium-stained liquor was the most frequent complication in both the test group(10, 10%) and the control group (5, or 5%). Conclusion Administration of mifepristone effectively increased the Bishopscores and reduced the induction-to-delivery interval compared to controls, highlighting its potential as a cervical ripening agent.

Comprehensive analysis of jaundice in pregnancy: Evaluating maternal and fetal outcomes – A 3-year retrospective study in a tertiary care center

Background: Jaundice during pregnancy poses significant risks to both maternal and fetal health. This retrospective study aimed to assess the incidence, causes, and outcomes of jaundice among pregnant women admitted to a tertiary care center over a 3-year period. Aims and Objectives: The primary objectives were to identify the incidence of jaundice, analyze its causes, and evaluate the maternal and fetal outcomes in cases of jaundice during pregnancy. Materials and Methods: Conducted as a case series with clinical correlation, the study spanned 3 years (2021–2023) at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Science, Bangalore. Data from parturition books and case sheets were collected after institutional ethical committee approval. Investigations included a complete blood count, liver function tests, coagulation profile, and serology. Fetal and maternal outcomes were recorded. Results: Out of 9 cases, 7 were diagnosed with intrahepatic cholestasis of pregnancy (IHCP), while 1 case each involved hemolysis, elevated liver enzymes, low platelet syndrome, and unconjugated hyperbilirubinemia specific to pregnancy. IHCP is correlated with adverse perinatal outcomes, including meconium-stained amniotic fluid and fetal distress. Cesarean sections were prevalent (58%), often indicated by previous lower segment cesarean sections and non-progression of labor. Conclusion: The study underscores the substantial association between IHCP and adverse perinatal outcomes, emphasizing the heightened prevalence of cesarean sections in pregnancies complicated by jaundice. It highlights the necessity for vigilant monitoring and tailored management strategies to mitigate risks and ensure favorable maternal and fetal outcomes in cases of jaundice during pregnancy.

Fetomaternal Outcome of Obstructed Labor in a Tertiary Care Centre

INTRODUCTION Obstructed labor is the leading cause of hospitalization. It is a preventable obstetric complcation. However, it is a major cause of maternal and perinatal morbidity and mortality. The main objective of the study was to find feto-maternal outcome in obstructed labor at tertiary care hospital UCMS-TH, Bhairahawa. MATERIAL AND METHODS Eighty seven women admitted with features of obstructed labor at our hospital were studied. By clinical examination, diagnosis of cephalopelvic disproportion, malpresentation, malposition, obstruction in birth canal, overdistended bladder, hematuria, rupture uterus and supermoulding of fetal head was detected. Demographic profile of patients, mode of delivery, time interval between referral and admission, intervention done, intrapartum and postpartum complications, maternal and fetal outcome were evaluated. RESULTS There were 87 cases of obstructed labor among 1655 total deliveries. Most common cause for obstructed labor was cephalopelvic disproportion (34.4%) followed by malpresentation (19.5%) and non progress of labor (17.2%). Majority of the patients were primigravida (43.6%) followed by multiparous (35.6%) and grand multipara (20.6%). Most of cases were unbooked and referral from primary health centers (80.4%). PPH (41.2%), extension of uterine incision (17.4%), followed by sepsis, pyrexia and uterine rupture were common complications. Perinatal morbidity due to obstructed labour requiring NICU admission was (33.9%) and perinatal mortality was (21.7%) mainly due to meconium aspiration, respiratory distress and septicemia. CONCLUSION Cephalopelvic disproportion and primigravida were the commonest cause of obstructed labour and associated with PPH, extension of uterine incision, uterine rupture, sepsis and neonatal ICU admission and even neonatal death.

Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery

ObjectivesComparison of the rate of obstetric anal sphincter injury (OASI) between women having their first vaginal birth after caesarean section (CS) and true nulliparous women with a vaginal delivery. Assessment of risk indicators for OASI in women with vaginal birth after one CS (VBAC). Study design28 535 women with their first VBAC and a cohort of 275 439 nulliparous women with a vaginal delivery of a liveborn infant in a cephalic position from the Dutch perinatal registry were analyzed. We compared the OASI rate with univariate and multivariate analysis. In women with VBAC possible risk indicators for OASI were assessed using univariate and multivariate logistic regression analysis. ResultsThe rate of OASI was 5.2% in women with vaginal birth after CS and 4.0% in women with a first vaginal delivery. The adjusted OR (aOR) for vaginal birth after an elective CS was higher (aOR 1.34, 95% CI 1.23–1.47) compared to vaginal birth after an emergency CS (aOR 1.16, 95% CI 1.08–1.25). In women with vaginal birth after emergency CS, the aOR for the indication non-progressive labor was 1.18 (95% CI 1.08–1.29), whereas CS for suspected fetal distress was not significantly associated with obstetric anal sphincter injury in VBAC.In the 28 535 women with a VBAC, mediolateral episiotomy (MLE), birth weight < 3000 g and maternal age < 25 years were associated with a significantly lower rate of OASI. A gestational age of 42 weeks, birth weight ≥ 3500 g, operative vaginal delivery and duration of the 2nd stage of labour of ≥ 60 min were associated with a significantly higher rate of OASI. ConclusionsWomen with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.

Prevalence and risk factors for serious birth concerns in unselected population of mothers.

The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.

The REDUCED trial: a cluster randomized trial for REDucing the Utilization of CEsarean delivery for Dystocia

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.

Analysis of predictive variables of success of the mechanical cervical ripening with Foley catheter in patients with a prior cesarean section and a postterm pregnancy

Objectives: Analysis of success variables of cervical ripening with the Foley catheter in patients with prior cesarean section (PCD), post-term pregnancy (PP), and a Bishop score £6. Evaluation of technique’s safety. Study design: Prospective cohort trial in which 120 patients were enrolled, from April 2014 to May 2018. PCD was codified in four groups: 1) failed Induction (FI); 2) non-progressive labor (NPL) or cephalopelvic disproportion (CPD); 3) abruptio placentae (AP), risk of fetal distress (RFD) or placenta previa; or 4) other causes. Inclusion criteria: singleton pregnancy; &gt;40+6 weeks’ gestation; cephalic presentation; Bishop Score £6; PCD &gt;18 months; signed consent of vaginal delivery (VD). Exclusion criteria: myomectomy with entry into the endometrial cavity; &gt;1 PCDs or uterine rupture; other presentations; macrosomia; multiple pregnancy; placenta or vasa previa; premature rupture of membranes (PROM); inferior genital tract infection. Used material and protocol: Foley catheter insertion at 9 am, followed by 2 hours of fetal cardiotocograph register (CR). This was repeated 6 hours later. Catheter removal 12 hours after the insertion. Intravenous oxytocin was started at 8 am the following day. Statistical analysis: multivariable logistic regression to assess the similarity of populations. Assessment of the relation between VD and APL with the PCD indication and the CL through logistic regressions. The analysis were performed using R (3.5.1), clickR packages (0.3.64), and Boot Validation (0.1.6). Results: A total of 86/109 (78.9%) achieved APL. Whereas 52/86 (60.47%) finished by VD, 34/86 (39.53%) had a cesarean delivery (CD). No significant differences were found between populations. PCD indications for AP, RFD or placenta previa (OR = 7.85 IC95% [1.87, 39], p=0.007) have a higher likelihood of VD. The PCD indication for NPL or CPD; and AP, RFD and placenta previa, have a higher likelihood of achieving APL (OR 14,55 [IC 95% 2.01, 308.5], p=0.023; OR 15,81 [IC 95% 2.03, 359.78], p=0.024; respectively). As CL was higher, the likelihood of APL was lower (OR=0.92 IC95% [0.84, 0.99], p=0.034). No uterine rupture registered. Conclusions: Cervical ripening with the Foley catheter was satisfactory in 78.9% (86/109). PCD indications that are different from FI associate a higher likelihood of VD. CL has a decreasing effect on the likelihood of APL. The Foley catheter is a safe method for cervical ripening.

Neonatal Facial Subcutaneous Abscess: A Case Report

Skin and soft-tissue infections (SSTIs) are a relatively common diagnosis in both the pediatric and adult populations and include abscesses and cellulitis. An abscess is a focal, contained, purulent infection with a clearly defined “cavity” and surrounding inflammation involving the deep subcutaneous tissues. Cellulitis is an infection of the skin, without an organized cavity, presenting with erythema, warmth, induration, and tenderness [1]. There has been a recent rise in the incidence of SSTIs, with up to 95% of this increase attributed to abscesses and cellulitis, with the largest change occurring in the pediatric (&lt;18 years) population [2]. In addition to an overall increase in SSTIs, there has been a concomitant rise in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) [3]. A 20 days old male full term baby born to a G2P1D1 mother via lower segment cesarean section in view of non progression of labor with birth weight of 2.8 kgs presented in our hospital with subcutaneous abscess diffusly present on the left side of the scalp &amp; face. Informant was father with good reliability. Patient presented with complaints of fever since 2 days and distension of abdomen since 2 days. Swelling over the scalp since birth. All relevant investigations sent &amp; IV antiobiotics like meropenem &amp; vancomycin started. Incision &amp; drainage done by pediatric surgeon &amp; 100 ml pus removed. IV antibiotics given for 14 days. Regular dressing done &amp; patient discharged on day 16 of admission. The gold standard treatment for subcutaneous abscesses remains incision and drainage (I&amp;D). The use of antibiotics for SSTIs after drainage is an area of great debate and variance. As a general guideline, the Infectious Disease Society of America (IDSA) recommends the use of antibiotics after I&amp;D only in the presence of systemic signs of infection. In summary, abscesses are a very common presentation in the pediatric ED. MRSA is the most common isolate of these abscesses, regardless of risk factors. History and physical exam combined with ultrasound should be used to diagnose abscesses. As upper &amp; lower limb skin abscess are more common, we here report facial abscess in neonate which was diffuse &amp; successfully treated.

Using Pen-Side Measurable Blood Parameters to Predict or Identify Dystocic Lambing Events.

Simple SummaryProlonged or non-progressive labour is the greatest risk factor for loss of newborn lambs in Australia and poses significant welfare and economic concerns worldwide. In this study, we set out to investigate whether pen-side technology could be used to predict which ewes would be at risk of prolonged labour. In our pilot trial, we found potentially useful markers. We next developed a sampling protocol by looking at changes in candidate markers over time in normal lambing events. Finally, we searched for blood markers that could distinguish between normal and difficult lambing events, sampling pre-birth (estimated one week before birth), at birth (within 3 h) and post-birth (16–26 h). Possible predictors of lambing difficulty were chloride, haematocrit and haemoglobin, sampled one week before birth; creatinine, sampled at birth; and acid–base related parameters after birth. In conclusion, we found that pen-side analysis of blood markers showed promise in identifying dystocic lambing events. More information is required to decide whether pen-side diagnostics could be useful to identify and predict dystocic lambing in the future.Dystocia is the greatest contributor to neonatal lamb mortality in Australia and poses significant welfare and economic concerns worldwide. In this study, we set out to investigate whether pen-side analysis technology could be employed to detect blood parameters predictive of dystocic labour events in sheep. In a pilot trial, we collected and analysed blood samples in pen-side assays for glucose, lactate, pH, pCO2, pO2, base excess, HCO3, TCO2, sO2, lactate, sodium, potassium, chloride, calcium, urea nitrogen, creatinine, haematocrit, haemoglobin and anion gap. From the pilot data, we identified creatinine, TCO2, chloride and calcium as potentially useful markers. To develop a time course and to establish variability of the selected blood parameters, a time series of samples was collected from 12 ewes, from mid-gestation to 48 h after birth. For the main trial, blood samples were collected at mid- and late gestation for glucose determination and for the full set of blood parameters at three time points before, at and after birth. Possible predictors of lambing difficulty were chloride, haematocrit and haemoglobin, sampled one week before birth; creatinine, sampled at birth; and blood pH and base excess after birth. In conclusion, we found that pen-side analysis of blood markers showed promise in identifying dystocic lambing events.

A study on analysis of cesarean section rate using Robson ten group criteria in a rural tertiary centre Karnataka

Introduction: Cesarean delivery is one of the most widely performed surgical procedures in obstetrics worldwide. There is a progressive increase in cesarean deliveries across the world, both in developed as well as in developing countries1. There was an upward trend in the cesarean delivery rate as there were no reliable and internationally standardized data enabling a global comparison for the indications of cesarean deliveries. Hence, in 2014, the WHO proposes the Robson Ten Group Classification system as a global standard for assessing, monitoring, and comparing cesarean delivery rates within healthcare facilities over time and between facilities.4 Methodology: This was a retrospective study on 196 patients undergoing cesarean delivery over a period of 6 months and were classified according to Robson&rsquo;s 10 group classification in a rural tertiary care hospital in Dakshina Kannada., to see which clinically relevant groups contributed most to the cesarean deliveries. Results: In the present study, the age distribution was between 19 years and 41 years with a maximum of 120 patients in the age group was 21-30 years accounting for 61.2%. Most of them belonged to the lower class and were unemployed. 85.71 % of the CS was done between 37 and 40 weeks of gestation, many of them were done electively (60.2%). 59.7% of the study population were multiparous women with the most common indication of repeat CS (40.3%).40.3% of the study population were nulliparous with the most common indication for CS among them being fetal distress (17.3%) followed by non-progression of labor (16.3%). The maximum contribution of cesarean was through Robson&rsquo;s group 5. Conclusion: Caesarean section rate can be reduced by combined efforts at all levels and by encouraging hospital vaginal deliveries of all the primigravida, grand multiparous pregnant women, and those who had previous cesarean section by providing adequate maternal and fetal monitoring during labor and round the clock operative facilities and blood bank facilities in all public and private health institutions.

Intrapartum fetal heart rate monitoring and offspring long-term neurological health

Although some evidence suggests that intrapartum fetal heart rate (FHR) monitoring is associated with a reduction in intrapartum death, a reduction in long-term neurological impairment or cerebral palsy (CP) has not been proven. However, continuous intrapartum FHR monitoring resulted in more cesarean deliveries (CDs) for abnormal FHR patterns. In this study, we sought to evaluate offspring long-term neurological morbidity of children born via CD for non-reassuring FHR (NRFHR) indication as compared with non-progressive labor (NPL)

Analysis of Cesarean Section Using Robson's Ten Group Classification System in a Tertiary Care Center from Southern India

Background: The rising cesarean section (CS) rate is a global concern and World Health Organization in 2015 has proposed the use of Robson-10 group classification system as a standard for assessing and monitoring CS both within and across the healthcare facilities. Objective: The objective is to analyze the CSs performed in a teaching hospital using Robson 10-group classification system. Methodology: The present cross-sectional study was done over a period of 1 year from May 2017 to April 2018. All eligible women delivered in JIPMER, a tertiary care referral center during the study period were classified as per Robson Ten-Group classification system. Caesarean delivery rates were reported. The relative and absolute contribution to CS rates in each groups were calculated. Epi data V.3.1 was used for data analysis. Results: Among 16,863 women delivered during the study, the CS rate was 21.4%. The three common indications for CS overall were fetal distress, nonprogress of labor, and cephalopelvic disproportion. Group 1 (nulliparous, singleton, term cephalic, spontaneous labor) was the largest size followed by group 2 (nulliparous, singleton, term cephalic, induced labor) with 25% and 16.9%, respectively. The maximum contribution of CS was by group 5 (multiparous women, singleton, term cephalic, previous uterine scar) followed by group 2 with 34.9% and 18.9%, respectively. Conclusion: Robson group 5, 2, and 1 were the major contributions to CS in our hospital. Further studies are needed to study the appropriateness of indications for CS especially in groups 2 and 1 as they are the future group 5.

Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study

Introduction: Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.Methods: A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and &gt;24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.Results: Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.Conclusion: Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.

The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

AimTo examine the characteristics of pregnancies at a very advanced age and the effect of parity on adverse obstetric outcomes.MethodsWe retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).ResultsSignificantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher.ConclusionSince primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

Risk for complications in the subsequent pregnancy following first versus second-stage cesarean delivery: 25 years follow-up in a large cohort

Background Cesarean delivery is a prevalent procedure worldwide, and an established risk factor for subsequent pregnancies. Aims To examine if a prior cesarean delivery due to first vs. second stage non-progressive labor carries different risk profiles for adverse outcomes in the subsequent pregnancy. Materials and methods A retrospective cohort study, based on data accumulated over the years 1988–2013 at the Soroka University Medical Center. We compared pregnancy complications and adverse perinatal outcomes in subsequent delivery following a cesarean delivery due to first vs. second stage non-progressive labor. Multiple logistic regression models were constructed. Results There were 3828 subsequent deliveries of patients who underwent prior cesarean delivery due to first vs. second stage non-progressive labor, 2791 (72.91%) and 1037 (27.09%), respectively. Patients with a prior cesarean delivery due to first stage non-progressive labor were more likely to have hypertensive disorders of pregnancy (7.4% vs 3.8% in first vs. second stage non-progressive labor, respectively, p = .002), and repeated cesarean delivery at the subsequent pregnancy (70% vs 62% in first vs. second stage non-progressive labor, respectively, p < .001). Patients with prior cesarean delivery due to second stage non-progressive labor were more likely to have preterm birth (10% vs 6.8% in second vs. first stage non-progressive labor, respectively, p = .001). Prior cesarean delivery due to first stage non-progressive labor was independently associated with a recurrent cesarean delivery in the subsequent pregnancy. In addition, prior cesarean delivery due to second stage non-progressive labor was independently associated with preterm birth. Conclusions Cesarean delivery due to first stage non-progressive labor carries higher rates of hypertensive disorders of pregnancy and recurrent cesarean delivery in the subsequent pregnancy. Prior cesarean delivery due to second stage non-progressive labor carries higher rates of subsequent preterm birth.

English

BACKGROUND In current and subsequent births, Caesarean sections bear their own risks for maternal and perinatal morbidity and mortality. In contrast with vaginal delivery, Caesarean section has increased risk of blood transfusion, hysterectomy and death and the risk of uterine rupture, placenta accreta and placenta previa in future pregnancies is also increased. We wanted to analyse the Caesarean section rate using Robson ten group classification system &amp; identify the leading groups contributing to high caesarean section rates using Robson ten group classification system. METHODS This observational descriptive study enrolled 11,090 women who underwent delivery, of whom 5117 (46.14 %) women delivered vaginally and 5973 (53.86 %) women delivered through Caesarean section. RESULTS Overall caesarean section percentage was 53.86 %. Major contributors for the CSR were Group 5, 2 and 1 in that order. CS rate in Group 5 and 1 is relatively increased. Ratio of relative size of Group 1 and 2 is 1:2 indicating a greater number of prelabour caesarean sections in nulliparous women. Caesarean section rate in Group 1 and 2 was 15.7 % and 20.1 % respectively. The main indications for caesarean sections being fetal distress, non-progressive labour and severe oligohydramnios / anamnios. Relative size of Group 1 and 5 was 47.3 % stating that most of the obstetric population was in Group 1 and 5. Caesarean section rate in Group 3 and Group 4 was relatively higher than expected; this may be due to our institute being a referral center. Group 5 contributed 45.7 % to overall caesarean section rate. CONCLUSIONS Standardisation of indication of Caesarean deliveries, regular audits and definite protocols in hospital will aid in decreasing the Caesarean section rate in hospital. KEYWORDS Kidney Size, Ultrasound Assessment, Age Groups