Number Of Cesarean Deliveries Research Articles

Comparison of Second-Trimester Uterine Artery Doppler Indices between Pregnant Women with and without Prior Cesarean Delivery and Effect on Perinatal Outcomes

Objective: To evaluate the effects of prior cesarean delivery on second-trimester Uterine Artery (UtA) Doppler and its effect on perinatal outcomes. Materials and Methods: This study was conducted at the Maternal Fetal Medicine unit of Bhumibol Adulyadej Hospital, Thailand between June 2023 and January 2024. Healthy pregnant women aged between 18 and 45 years old were recruited and divided into prior (PCD) and non-prior cesarean delivery (non-PCD) groups. Both groups underwent UtA Doppler study from 18 to 24 weeks of gestation. UtA Doppler indices consisted of pulsatility index (UtA-PI), resistance index (UtA-RI) and systolic/diastolic ratio (S/D). Demographics, maternal and neonatal outcomes were collected. Results: Total of 416 participants were recruited and divided equally. The mean age of participants was 30.5 years old. Diabetes mellitus in pregnancy and hypertensive disorder were reported as 18.9 (79/416) and 5.5 (23/416) percent, respectively. From univariate analysis, subjects in the PCD group had higher UtA-PI, UtA-RI and UtA S/D than the non-PCD group with statistical significance. After multiple logistic regressions, only UtA-RI was greater in the PCD group with any statistical significance. The mean gestational age at delivery was 38.41 weeks. Prevalence of small for gestational age deliveries, preeclampsia, and preterm birth were 4.4 (17/376), 3.1 (12/376) and 10 percent (38/376), respectively. Maternal and neonatal outcomes of both groups were comparable. Number of cesarean deliveries, parity, miscarriage, and anterior placentation were not associated with UtA Doppler indices. Conclusion: UtA-RI of prior cesarean delivery participants were higher than non-prior cesarean delivery participants and not associated with maternal and neonatal adverse outcomes.

USE OF PROPHYLACTIC ANTIBIOTICS IN PATIENTS UNDERGOING CAESAREAN SECTION AT CUT MEUTIA GENERAL HOSPITAL, NORTH ACEH 2021-2022

Caesarean section is a surgical procedure to remove the fetus through an incision in the lining of the abdomen and uterus. Cesarean delivery is performed by considering clinical signs of the mother and fetus, such as placenta previa, abnormal location of the fetus, as well as different signs that may endanger the existence of the mother or embryo. According to the World Health Organization (WHO), the number of cesarean deliveries has increased, which is directly relative to the increase in the contamination rate of surgical wound infection (ILO). Prophylactic antibiotics are one of the prevention of surgical wound infection. The research method used is retrospective descriptive. The sampling technique in this research uses non-probability sampling, namely total sampling. The aftereffects of this review show that the use of prophylactic antibiotics in caesarean section patients, namely ceftriaxone 51.2% and cefotaxime 48.8%, the use of prophylactic antibiotics at the Cut Meutia Aceh General Hospital based on ASHP, the use of antibiotics ceftriaxone, cefotaxime, and reponem is 100% inappropriate and based on PPRA RSU Cut Meutia which is 100% compliant. The aftereffects of this study presumed that the utilization of anti-toxins based on ASHP is not appropriate and based on PPRA Cut Meutia Hospital is appropriate.

Clinical factors associated with subsequent surgical intervention in women undergoing early medical termination of viable or non-viable pregnancies.

Mifepristone-misoprostol treatment for medical abortion and miscarriage are safe and effective. This study aimed to assess clinical factors associated with subsequent surgical intervention after medical termination of early viable or non-viable pregnancy. This retrospective, single-center study included women who underwent medical abortion at Taipei Medical University between January 2010 and December 2019. A total of 1,561 subjects, with 1,080 viable and 481 non-viable pregnancies, who were treated with oral mifepristone 600 mg followed by misoprostol 600 mg 48 h later were included. Data of all pregnancies and medical termination of pregnancy were evaluated using regression analysis. The main outcome was successful termination of pregnancy. The success rate of medical abortion was comparable in women with viable and non-viable (92.13% vs. 92.93%) pregnancies. Besides retained tissue, more existing pregnancies with ultrasonographic findings were found in the non-viable pregnancy group than in the viable pregnancy group (29.4% vs. 14.1%, p = 0.011). Multivariate analysis showed that previous delivery was an independent risk factor for failed medical abortion among all included cases. In women with viable pregnancy, longer gestational age [adjusted odds ratio (aOR): 1.483, 95% confidence interval (CI): 1.224-1.797, p < 0.001] and previous Cesarean delivery (aOR: 2.177, 95% CI: 1.167-40.62, p = 0.014) were independent risk factors for failed medical abortion. Number of Cesarean deliveries (aOR: 1.448, 95% CI: 1.029-2.039, p = 0.034) was an independent risk factor for failed medication abortion in women with non-viable pregnancies. This is the first cohort study to identify risk factors for subsequent surgical intervention in women with viable or non-viable pregnancies who had undergone early medically induced abortions. The success rate of medical abortion is comparable in women with viable and non-viable pregnancies. Previous delivery is an independent risk factor for failed medical abortion. Clinical follow-up may be necessary for women who are at risk of subsequent surgical intervention.

241 Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk

OBJECTIVES/GOALS: To evaluate the association of maternal delivery history with a brachial plexus birth injury (BPBI) risk in subsequent deliveries, and to estimate the effect of subsequent delivery method on BPBI risk. METHODS/STUDY POPULATION: We conducted a retrospective cohort study of all livebirth deliveries occurring in California-licensed hospitals from 1996-2012. The primary outcome was recurrent BPBI in a subsequent pregnancy. The exposure was prior delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering an infant with BPBI). Multiple logistic regression was used to model adjusted associations of prior delivery history with BPBI in a subsequent pregnancy. The adjusted risk (AR) and adjusted risk difference (ARD) for BPBI between vaginal and cesarean delivery in subsequent pregnancies were determined, stratified by prior delivery history, and the number of cesarean deliveries needed to prevent one BPBI was determined. RESULTS/ANTICIPATED RESULTS: Of 6,286,324 infants delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a BPBI. Higher parity was associated with a 5.7% decrease in BPBI risk with each subsequent delivery (aOR 0.94, 95%CI 0.92, 0.97). Previous shoulder dystocia or BPBI were associated with 5-fold (aOR=5.39, 95%CI 4.10, 7.08) and 17-fold increases (aOR=17.22, 95%CI 13.31, 22.27) in BPBI risk, respectively. Among individuals with a history of delivering an infant with a BPBI , cesarean delivery was associated with a 73.0% decrease in BPBI risk (aOR=0.27, 95%CI 0.13, 0.55), compared with an 87.9% decrease in BPBI risk (aOR=0.12, 95%CI 0.10, 0.15) in individuals without this history. Among individuals with a previous history of BPBI, 48.1 cesarean deliveries are needed to prevent one BPBI. DISCUSSION/SIGNIFICANCE: Parity, previous shoulder dystocia, and previously delivering a BPBI infant are associated with future BPBI risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding BPBI risk and planned mode of delivery.

A Rare Case Report of Caesarean Scar Ectopic Pregnancy

Caesarean scar pregnancy is rarest pregnancy, increasing incidence due to increasing in number of caesarean deliveries. It is defined as blastocyst implants on a previous caesarean scar Herman A. Early diagnosis can be done by using ultrasound with empty uterus and cervix, mass in the anterior wall of uterus in scar area. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility and decreases maternal morbidity and mortality, this is possible with ultrasound imaging. When ultrasound is inconclusive or equivocal then MRI has important role in diagnosis before therapy or intervention. Here we are presenting a case of G11P2+(1)L2A7 with previous two caesarean deliveries, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathology report, caesarean scar pregnancy was confirmed.

Scar Ectopic: Diagnostic and Management Challenge

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. Usually when a blastocyst implants on the fibrous tissue of the previous Caesarean scar is called scar ectopic. This type of abnormal implantation of embryo can occur following hysterotomy, dilatation and curettage ,abnormal placentation surgery on uterus like myomectomy ,hysteroscopy and manual removal of placenta. The incidence is increased due to increase in number of Caesarean deliveries. Trans vaginal Sonography helps in early diagnosis. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Excision of trophoblastic tissues using laparotomy or laparoscopy, systemically administered methotrexate, and more recently uterine artery embolization are the treatment options for scar ectopic. When TVS is inconclusive, MRI can be recommended. We are reporting here a case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done to preserve the future fertility. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 154-156

Subsequent pregnancy outcomes and risk factors following conservative treatment for placenta accreta spectrum: a retrospective cohort study

Placenta accreta spectrum can lead to uncontrollable massive hemorrhage in the perinatal period. Currently, the first-line treatment for placenta accreta spectrum recommended worldwide is hysterectomy. However, adverse outcomes after hysterectomy, including surgical complications, such as difficulty in performing the procedure, and sequelae, such as infertility and psychological issues, cannot be ignored. Several surgical approaches for conservative treatment have been proposed. There are few reports on the effectiveness, safety, and long-term complications of conservative treatments, especially subsequent pregnancy outcomes. This study aimed to investigate the clinical outcomes and identify risk factors of subsequent pregnancies among patients with placenta accreta spectrum who had undergone conservative surgery. This was a retrospective cohort study of subsequent pregnancy cases after cesarean delivery with conservative treatment for placenta accreta spectrum from 2011 to 2019 at The First Affiliated Hospital of Zhengzhou University to identify clinical outcomes of subsequent pregnancies and the risk factors of adverse pregnancy outcomes. A total of 883 patients undergoing conservative surgery were included in this study, among which 604 (68.4%) were successfully followed up. There were 75 successful pregnancies in 72 patients, including 22 full-term or near-term deliveries, 1 induced labor in the second trimester of pregnancy, 6 cesarean scar pregnancies (8.0%), 2 ectopic pregnancies, and 44 first-trimester pregnancies (3 miscarriages and 41 elective abortions and 12 medical abortions and 32 vacuum aspirations). All newborns survived in the 22 full-term or near-term deliveries. Moreover, 5 placenta accreta spectrum cases (22.7%) and 6 placenta previa cases were observed. Postpartum hemorrhage was observed in 2 cases, with an incidence rate of 9.1%. All parameters, including age at subsequent pregnancy, gravidity, number of cesarean deliveries, type of previous placenta accreta spectrum, gestational week of pregnancy termination, interpregnancy interval, and the use of vascular occlusion techniques, were not found to be associated with recurrent placenta accreta spectrum and cesarean scar pregnancy. Our findings show that treatment for placenta accreta spectrum does not automatically preclude a subsequent pregnancy. However, patients should be fully informed about the risk of recurrent placenta accreta spectrum, scar pregnancy, and postpartum hemorrhage.

Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk.

To evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk. We conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined. Of 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92-0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10-7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31-22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13-0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10-0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury. Parity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.

Cesarean Delivery Trends Among Patients at Low Risk for Cesarean Delivery in the US, 2000–2019

ABSTRACT Cesarean delivery is a method of improving outcomes for both mothers and neonates when there are medical complications to vaginal delivery. When used unnecessarily, however, it causes increased risks for adverse outcomes as a major surgery. Limited data and investigations have prevented some previous analyses of trends in cesarean deliveries, especially when classifying them as necessary or unnecessary. This study was designed to determine temporal trends in cesarean deliveries among low-risk patients over a 20-year period and to analyze trends in specific cesarean delivery indications. This study was designed as a repeated cross-sectional analysis among patients at low risk for cesarean delivery. The authors utilized the National Inpatient Sample data set, and then patients with conditions previously associated with an increased risk of cesarean delivery (eg, obesity) were excluded. Primary outcomes included temporal trends in the number of cesarean deliveries, as well as trends related to diagnoses of nonreassuring fetal status, labor arrest, or obstructed labor (including disproportion). Between 2000 and 2019, 40,517,867 eligible low-risk deliveries were identified. Of these, 4,885,716 were cesarean deliveries. The overall rate of cesarean delivery increased between 2000 and 2009 (from 9.7% to 13.9%) and then decreased between 2012 and 2019 (from 13% to 11.1%). The average annual percentage change (AAPC) from 2000 to 2005 was 6.4% (95% confidence interval [CI], 5.2%–7.6%), with a plateau from 2005 to 2009 (AAPC, 1.2%; 95% CI, −1.2% to 3.7%) and then a decrease from 2009 to 2019 (AAPC, −2.2%; 95% CI, −2.7% to −1.8%). Deliveries associated with the diagnosis of nonreassuring fetal status increased between 2000 and 2019 (AAPC, 2.1%; 95% CI, 1.7%–2.5%); those associated with labor arrest peaked in 2009 at 4.8% and then decreased to 2.7% in 2019 (AAPC 2009–2019, −5.6%; 95% CI, −6.6% to −4.6%). In contrast, cesarean deliveries due to obstructed labor continuously decreased from 2000 to 2019 (AAPC, −8.6%; 95% CI, −10.0% to −7.1%). After accounting for demographic and hospital characteristics, analysis showed that patients were at increased risk of cesarean delivery if they were between 35 and 39 years of age compared with the younger group of 25 to 29 years (adjusted odds ratio [aOR], 1.27; 95% CI, 1.25–1.28), if they delivered at a hospital in the South versus the Northeast (aOR, 1.11; 95% CI, 1.07–1.15), and if they were non-Hispanic Black versus non-Hispanic White (aOR, 1.23; 95% CI, 1.20–1.25). Overall trends showed increasing rates of cesarean delivery in the first 10 years of the study, but then decreasing rates for the final 10 years. Rates associated with diagnoses of nonreassuring fetal status increased over the study period, and those associated with labor arrest or obstruction decreased. The increase of cesarean delivery due to nonreassuring fetal status when compared with the overall trend of decreasing cesarean deliveries indicates a possible clinical oversight as the interpretation of nonreassuring fetal status can differ based on provider and facility. Some guidelines are in place for determining nonreassuring fetal status, but interpretation of the guidelines and sometimes the guidelines themselves have changed over the time period of this study. This increase is potentially attributable to the changes in requirements or the interpretation of them and should be more fully investigated. Future research should focus on more accurately identifying diagnoses of nonreassuring fetal status to reduce the number of unnecessary cesarean deliveries while improving the outcomes of those that truly need cesarean deliveries.

Karakteristik ibu hamil yang melakukan tindakan sectio caesarean di rumah sakit sitti khadijah makassar periode 2019 - 2021

All women want to give birth well and perfect parturition. There are two methods of parturition, namely vaginal parturition, which is better known as natural parturition, and caesarean section, in which the baby is removed through an incision in the abdominal wall and uterus. The number of caesarean deliveries in Indonesia continues to increase in 2018. Cesarean procedures account for 17.6% of all deliveries in Indonesia, exceeding the WHO standard of 15%. To find out the characteristics of pregnant women who perform caesarean sections at Sitti Khadijah Hospital Makassar for the period 2019 - 2021. An observational study with a descriptive approach, a cross-sectional study was used as the research design. There were 100 pregnant women who had Caesarean Sections at Sitti Khadijah Hospital Makassar for the period 2019-2021. The results showed that the characteristics of pregnant women who had Caesarean Sections based on the highest age was 20-35 years as much as 69% compared to other age groups, based on education the highest was undergraduate as much as 41% compared to other educational groups, based on work the highest were patients who did not work as much as 65% compared to patients who worked as much as 35%, based on medical indications the highest were Post SC patients as much as 38%, based on the highest type of SC is a patient with SSTP of 96% compared to Classic SC of 4%, based on parity, the highest were patients who were multiparous as much as 73% compared to primiparas as much as 27%. Pregnant women who did caesarean section based on the most age were aged 20-35 years, the most education was undergraduate, the most jobs were pregnant women not working, the most medical indications were pregnant women with a history of post SC, the most type of SC was SCTP, and the most parity was multiparous pregnant women

The Application Value of Contrast-Enhanced Ultrasonography in Assessing the Efficacy of Ultrasound-Guided Lauromacrogol Injections in Cesarean Scar Pregnancies.

To investigate the application value of contrast-enhanced ultrasonography (CEUS) in ultrasound-guided lauromacrogol injections in patients with cesarean scar pregnancies (CSP). A total of 31 patients diagnosed with CSP, who underwent an ultrasound-guided lauromacrogol injection + curettage in our hospital between February 2019 and December 2020 and had a complete recovery confirmed by a postoperative ultrasound review and serum β-human chorionic gonadotropin (β-hCG) assay, were enrolled as the study subjects. According to the volume of intraoperative blood loss and the duration of postoperative vaginal bleeding, the patients were divided into two groups, with 19 in the significantly effective group (Group A) and 12 in the effective group (Group B). The recorded clinical data, including age, duration of amenorrhea, number of pregnancies, number of deliveries, time since last cesarean delivery, number of cesarean deliveries, and preoperative serum β-hCG levels, were retrospectively analyzed. The morphological indicators in CEUS before the lauromacrogol injection, as well as immediately and 12-24 hours after the injection, were compared between the groups. In Group A, the post-injection CEUS showed no enhancement, single strip enhancement, and sparse punctate enhancement, while in Group B, it showed a more irregular ring and local patch enhancement. In addition, the number of cases where the CEUS showed no enhancement 12-24 hours after the injection was more than that of the immediate CEUS after the injection. In Group A, four (21.1%) cases showed a single strip-like blood flow on the immediate postoperative CEUS, four (21.1%) cases showed a sparsely dotted blood flow on the immediate postoperative CEUS, and three cases turned into no enhancement 12-24 hours after the injection. A total of four cases in Group B showed that the contrast enhancement range 12-24 hours after the injection was reduced compared with that of the immediate contrast after the injection. Contrast-enhanced ultrasonography can guide the location selection of the lauromacrogol injection in patients with CSP, and its postoperative morphological indicators can adequately predict the therapeutic effect after curettage and guide clinical management.

Role of Misoprostol in Induction of Labor: Sublingual versus Vaginal in Tikrit City

A successful induction of labor leads to vaginal delivery of a healthy baby, in an acceptable time frame with minimum maternal discomfort or side effects. To compare the efficacy and safety of sublingual and per vaginal 25µg misoprostol for labor induction. Primary outcome measures were the number of cases delivering vaginally, Secondary requirement, the incidence of meconium-stained liquor, number of cesarean deliveries, the incidence of hyperstimulation/tachysystole, maternal adverse effects and neonatal outcomes. A prospective study was conducted in Tikrit Teaching Hospital. Indications were reviewed; 416 women randomly received misoprostol 25 µg vaginally and sublingually every three hourly for maximum three doses. Outcomes were analyzed accordingly. The number of the cases who successfully delivered vaginally was greater in the sublingual group. The induction to vaginal delivery interval was significantly shorter in sublingual group. The incidence of tachysystole and meconium-stained liquor were more in the vaginal than in the sublingual group. The mean doses, mode of delivery, oxytocin augmentation and maternal outcomes were significantly favorable in sublingual group. No significant difference is seen in neonatal outcome. Sublingual misoprostol 25 µg administered three hourly for labor induction has better effficacy as compared to 25 µg of vaginal misoprostol.

Role of Parity and Age in Cesarean Section Rate among Women: A Retrospective Cohort Study in Hail, Saudi Arabia.

In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study's parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35-39.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.

Efficacy of suction curettage as the first-line treatment of cesarean scar pregnancy: A retrospective study

ObjectiveThere is still no consensus on a safe and efficient treatment modality for cesarean scar pregnancy (CSP), which is known to cause severe complications, such as life-threatening hemorrhage. Suction curettage (SC) has been used as the first-line treatment for CSP with controversial outcomes. In this context, the objective of this study is to analyze the efficacy of SC in the treatment of CSP. MethodsThe sample of this retrospective study consisted of 64 CSP patients treated using SC between 2012 and 2022. Patients’ demographic and clinical variables, including the thickness of the myometrium at the lower uterine segment between the urinary bladder and cesarean scar, were obtained from their medical records. The study's primary outcome was determined as the success rate of SC. Accordingly, the patients were categorized into two groups: successful SC (Group 1) and unsuccessful SC (Group 2). Results: The success rate of SC was determined as 78.1%. The number of previous cesarean deliveries, gestational age, baseline beta-human chorionic gonadotropin (β-hCG) values, and endometrial thickness was significantly higher in Group 2 (p<0.05 for all), whereas the fetal cardiac activity and absence of an embryonic pole were significantly higher in Group 2 (p = 0.001 and p = 0.004, respectively). There was no significant difference between the groups in the thickness of the myometrium at the lower uterine segment (p = 0.890). The hemoglobin levels decreased significantly after SC in both Groups 1 and 2 (p<0.001 and p = 0.009, respectively). There was no significant difference between the groups in preoperative and postoperative hemoglobin values and the decrease in hemoglobin levels (p>0.05). ConclusionThe study findings did not indicate any significant correlation between myometrial thickness at the lower uterine segment and the efficacy of SC in CSP patients. On the other hand, the number of cesarean deliveries, gestational age, baseline β-hCG values, endometrium thickness, fetal cardiac activity, and embryonic pole may be used to predict the outcome of SC in the treatment of CSP.

Experience of reconstructive plastic robot-assisted surgery in patients with isthmocele after cesarean section

BACKGROUND: According to several Russian researchers, the number of cesarean deliveries in different regions of Russia varies from 15.2% to 42%. The incidence of complications inconsistency of the uterine scar (isthmocele) after surgery is 10%15%.&#x0D; AIM: This study aimed to assess the efficiency and safety of robot-assisted surgery in the correction of isthmoceles after cesarean section in patients of reproductive age.&#x0D; MATERIALS AND METHODS: The study involved seven patients aged 2734 years with signs of isthmoceles after urgent or elective cesarean section 12 months to 6 years prior to hospitalization. A comprehensive dynamic examination (echography, magnetic resonance imaging, and office hysteroscopy), surgical treatment with the da Vinci Si robotic complex, and outpatient monitoring in the early and long-term period (1, 6, 12, 24, and 36 months) were performed.&#x0D; RESULTS: The patients were satisfied with the results of surgical treatment during outpatient monitoring due to the improved quality of life resulting from the reduction of pathological symptoms. The control echography (1, 6, and 12 months later) showed normal myometrial thickness (911 mm) and adequate blood flow in the metroplasty area in all patients. The niche was not visualized during office hysteroscopy 6-months after the metroplasty. Three patients became pregnant 1620 months after the reconstructive uteroplasty and ended with a timely operative delivery. Two patients were followed up for their pregnancies at 12 and 29 weeks of gestation, while two women continued taking oral contraceptives and planned their next pregnancy at least a year later.&#x0D; CONCLUSIONS: The use of the da Vinci Si robotic system for surgical correction of isthmoceles provides volumetric three-dimensional visualization of anatomical structures, reduces the duration of surgery and intraoperative blood loss, minimizes the number of intraoperative and postoperative complications, and contributes to accelerated postoperative rehabilitation of patients.

Association between Robson classification groups and cesarean delivery: a longitudinal analysis in Mongolia

BACKGROUNDThe number of cesarean deliveries has increased sharply worldwide over the last 3 decades. The World Health Organization recommends using the Robson classification as the best tool for monitoring and auditing cesarean delivery rates and to safely reduce the rate of avoidable cesarean deliveries.OBJECTIVEThis study aimed to identify the association between the Robson classification groups and cesarean delivery in 2008 and 2018 at the Urguu Maternity Hospital, Ulaanbaatar, Mongolia, and to examine the changes in this association over 10 years.STUDY DESIGNThis cross-sectional study was conducted using 21,225 participants’ electronic birth records (9544 in 2008 and 11,681 in 2018) from the Urguu Maternity Hospital. Birth records were categorized into 10 groups using the Robson classification report table. Multiple logistic regressions were conducted to examine the association between the Robson classification group and the cesarean delivery rate for 2008 and 2018. The same regression analysis was subsequently conducted using a pooled data set to capture the changes in the association among the Robson classification group, a birth-year dummy, and the cesarean delivery rate.RESULTSThe odds of having a cesarean delivery when classified in group 1 in 2018 (adjusted odds ratio, 3.02; 95% confidence interval, 1.85–4.94; P<.001) was 3 times greater than that in 2008. Moreover, the odds of having a cesarean delivery when classified in group 2 (adjusted odds ratio, 0.66; 95% confidence interval, 0.51–0.85; P=.001), group 3 (adjusted odds ratio, 0.21; 95% confidence interval, 0.16–0.29; P<.001), or group 4 (adjusted odds ratio, 0.33; 95% confidence interval, 0.25–0.45; P<.001) declined in 2018 when compared with 2008. The odds of having a cesarean delivery were the lowest among mothers classified in group 3 and the highest among mothers in group 5 in both study years.CONCLUSIONThe high percentage of mothers classified as group 5 who gave birth via cesarean delivery suggests that healthcare providers should work with mothers in group 5 to increase their willingness to give birth vaginally after a previous cesarean delivery in an attempt to reduce the overall cesarean delivery rates. Further research is needed to better understand the factors that may influence the increasing rates of birth through cesarean delivery.

Khuyết sẹo mổ lấy thai: Tổng quan về triệu chứng, chẩn đoán, thực trạng, một số yếu tố liên quan và điều trị

Abstract: The study aimed to review studies on cesarean scar defect incidence and its associated factors, diagnostic criteria, and treatments. The study reviewed 44 articles from PubMed in August 2022. Results showed that transvaginal ultrasound and contrast-enhanced hysterosalpingogram were the two most 17 common methods, often used together for diagnosing. The rate of cesarean scar defects ranged from 19% to 84%, depending on the diagnostic method. Common symptoms were irregular menstrual cycles, abnormal bleeding after menstruation, lower abdominal or lower abdominal pain, menstrual cramps, and infertility. Factors associated with cesarean section scar defects included individual factors (parity, number of cesarean deliveries, history of diabetes, uterus recline, maternal body mass index) and medical service factors (stitching technique at cesarean section, prolonged labor period). Treatment included both medical and surgical, but should only be done when there were symptoms affecting the mother's health. Given the high rate of C-section in Vietnam and very few studies on cesarean scar defects, it is necessary to conduct research on this topic in the future. Keywords: cesarean section scar defect, cesarean section, infertility, lower abdominal pain, abnormal bleeding between two menstrual cycles.

Intra-abdominal Adhesions among Patients Undergoing Repeat Caesarean Section in Department of Obstetrics and Gynaecology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Adhesions are one of the common complications encountered after caesarean section whose risk increases with the number of caesarean deliveries. This study aimed to find out the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section in a tertiary care centre. A descriptive cross-sectional study was conducted on 74 pregnant women undergoing repeat caesarean section in the Department of Obstetrics and Gynaecology of a tertiary care centre from July, 2021 to December, 2021 after receiving the ethical approval from the Institutional Review Committee (Reference number: 2107202103). Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. The severity of the adhesions was classified using the Tulandi and Lyell classification. Data were analysed using the Statistical Package for the Social Sciences version 26.0 software. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data. Out of 74 women undergoing repeat caesarean section, 55 (74.32%) (65.99-82.65 at 90% Confidence Interval) had developed intra-abdominal adhesions. Our study showed that the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section was higher when compared to similar studies conducted in similar settings. postoperative complications; repeat caesarean section; surgical adhesions.

Risk Factors for IUD Malposition [A36

INTRODUCTION: We aimed to identify the risk factors for intrauterine device (IUD) malposition and to develop a model to predict who is at risk for IUD malposition. METHODS: We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Our primary outcome was IUD malposition. The Fisher’s exact test and Wilcoxon rank sum test were used. We used logistic regression, least absolute shrinkage and selection operator (LASSO), and elastic net models to predict the likelihood of having a malpositioned IUD. Institutional review board (IRB) approval was obtained for this study. RESULTS: Of 1,759 ultrasound reports with an IUD present, 436 described a malpositioned IUD. Compared to participants with non-malpositioned IUDs, participants with malpositioned IUDs were more likely to be younger (30.7 and 31.9 years old, P=.02), have fibroids (21.6% and 15.9%, P&lt;.01), and have abnormal uterine bleeding (AUB) (19.7% and 14.9%, P=.02). There were no differences between groups in gravidity, parity, uterine surgeries, number of cesarean deliveries, IUD type, or timing of IUD placement relative to abortion or delivery. Reports describing malpositioned IUDs were more likely to have been authored by radiologists than gynecologists (85.1% and 13.5%, P&lt;.01). LASSO model, elastic net model, and logistic regression were unable to identify a meaningfully predictive model for IUD malposition CONCLUSION: Fibroids and AUB are associated with IUD malposition. No other risk factors were statistically or clinically significant. No linear combination of factors meaningfully predicted risk of IUD malposition. Radiologists were more likely to author reports describing malpositioned IUDs.

A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania.

To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand. Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities. Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status. Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.