To evaluate national and international obstetric ultrasound guidelines regarding their recommendations for vasa previa (VP) screening, and to assess the consistency, scope and evidence base of the recommendations. We conducted a comprehensive review of accessible national obstetric imaging guidelines from 15 countries worldwide, as well as two international guidelines by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Guidelines were assessed for whether they explicitly mentioned VP, recommended screening for VP or incorporated VP detection strategies, such as placental cord insertion assessment, color flow Doppler assessment of the lower uterine segment or third-trimester transvaginal ultrasound with color flow Doppler in patients with second-trimester placenta previa or low-lying placenta. Additionally, we evaluated whether any national societies or international organizations had specific guidelines on VP, which were then assessed for whether they included recommendations for VP screening and outlined specific screening policies or strategies. Of 20 national and two international obstetric imaging guidelines reviewed, 12 mentioned VP and none explicitly recommended routine screening for VP in pregnant individuals. Nine national obstetric imaging guidelines recommended routine assessment of the placental cord insertion, while none endorsed routine color flow Doppler assessment of the lower uterine segment. Five national guidelines recommended third-trimester transvaginal ultrasound examination with color flow Doppler to rule out VP in pregnancies with a second-trimester low-lying placenta or placenta previa. In our search, only five national societies were found to have developed dedicated VP guidelines, although some of their recommendations were inconsistent with recent evidence. For example, the 2019 guideline from the Royal College of Obstetricians and Gynaecologists in the UK does not recommend routine VP screening, citing insufficient evidence and an uncertain balance of benefit vs harm. Despite the high mortality rate associated with undiagnosed VP and the mounting evidence supporting the feasibility of screening, many national and international obstetric imaging guidelines either omit mention of VP or fall short of recommending a structured screening approach. Given the demonstrated accuracy of VP screening, its remarkable impact in reducing the rate of VP-related stillbirth and the minimal additional resources required for VP detection strategies, current imaging guidelines should be updated to incorporate evidence-based VP screening strategies into routine obstetric imaging protocols to reduce preventable perinatal deaths. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Introduction: Induction of labor (IOL) may be recommended in the setting of pregnancy complications, gestational age, maternal comorbidities, or electively after 39 weeks gestational age. If IOL is indicated but the cervix is determined to be unfavorable, cervical ripening agents like mechanical dilators and synthetic prostaglandin E1 medications can be used to promote cervical dilation, softening, and thinning to mimic the physiologic processes of spontaneous labor. The objective of this study was to compare labor outcomes of women who underwent cervical ripening with a double-balloon catheter alone or with the addition of concurrent misoprostol. We hypothesized that concomitant use of misoprostol and cervical ripening balloon (CRB) was associated with increased vaginal delivery rates compared to CRB use alone. Methods: This study was a retrospective cohort analysis. The Epic medical record system was used to identify all patients who underwent IOL at Eskenazi Hospital during the study period (January 1, 2021- December 31, 2023). Patients were included if they underwent induction that included the use of a balloon catheter for cervical ripening, with or without additional medications. Exclusion criteria included placenta previa, history of prior cesarean delivery, gestational age less than 34 weeks, or contraindications to vaginal delivery. Data was extracted from the electronic medical record by study investigators and entered into the password-protected REDCap data collection system. Broadly, data collected included patient demographics (e.g., AMA, gestational age, ethnicity, nulliparity, indication for IOL), labor characteristics (e.g., cervical exam at time of balloon placement and removal, fetal presentation at admission, medication use in relation to balloon placement and removal), and maternal and fetal outcomes (e.g., terbutaline use, delivery mode, estimated blood loss, 5-minute Apgar score, NICU admission). Descriptive statistics were calculated using Chi-Square for categorical variables and t-test for continuous variables. Unadjusted and adjusted logistic regression models were used to calculate odds ratios with 95% confidence intervals. All statistics were performed using SAS V9.4 (SAS Institute, Cary, NC). Results: Of 1714 patients identified during the study period, 327 charts were reviewed with 323 meeting criteria for analysis. All 323 patients underwent IOL with a double-balloon catheter; 204 (63.2%) received concurrent misoprostol, while 119 (36.8%) received no additional pharmacologic agents. Baseline characteristics including mean maternal age, number of patients of advanced maternal age (AMA), ethnicity, and indication for induction were similar between groups. Individuals who received misoprostol in addition to the double-balloon catheter tended to have a greater mean gestational age (38.4±1.56 vs. 37.9±1.86 weeks; p = 0.009) and were less likely to be nulliparous (43.6 vs. 59.7%; p = 0.005) compared to those without additional pharmacologic intervention. Patients who received concurrent misoprostol were significantly more likely to achieve vaginal delivery compared to those who received balloon catheter alone (84.3% vs. 60.5%, p < 0.0001). An unadjusted logistic regression demonstrated that treatment with balloon catheter and concurrent misoprostol was associated with reduced odds of cesarean delivery (OR 0.29, 95% CI: 0.17–0.48). This association remained significant after adjusting for nulliparity, indication for induction, birth weight, and AMA status (adjusted OR 0.32, 95% CI: 0.18–0.56). Patients who underwent cesarean delivery were more likely to be nulliparous (OR 3.69, 95% CI: 1.95-7.02), be AMA (OR 2.96, 95% CI: 1.37-6.40), have gestational or chronic hypertension (OR 1.99, 95% CI: 1.00-3.95), and deliver infants with higher birth weights (OR 2.22, 95% CI: 1.25-3.97). These risk factors for cesarean delivery have also been demonstrated in prior research. When stratified by delivery mode, there were no significant differences in rates of tachysystole (p = 0.68 for vaginal, p = 0.16 for cesarean), maternal complications (p = 0.82, p = 0.07), estimated blood loss (p = 0.14, p = 0.54), NICU admission (p = 0.15, p = 0.64), or low 5-minute Apgar scores (p = 0.52, p = 0.35) between patients who received both misoprostol and balloon catheter and those who received a balloon catheter alone. Discussion: Concurrent use of misoprostol and CRB during IOL was associated with increased vaginal delivery rate without a significant difference in NICU admission or obstetric complication rates. Patients who underwent cesarean delivery were more likely to be nulliparous, be AMA, have infants with higher birth weights, and have gestational or chronic hypertension, regardless of ripening technique used. Potential impacts of this study include providing evidence-based recommendations on cervical ripening practices as well as informing best practices for future studies on induction of labor.

We aimed to evaluate the risk of perinatal complications in subsequent pregnancies after different types of myomectomy, viz. open, laparoscopic, or hysteroscopic. Moreover, we investigated whether the time interval from myomectomy to subsequent pregnancy (TIMP) is a risk factor for perinatal complications. This retrospective cohort study analyzed data from the vast Japanese health insurance JMDC database between January 2008 and July 2024. We identified primiparous women and excluded participants based on the following criteria: age < 20years at delivery, diagnosis of adenomyosis, multiple pregnancy, or history of repeated myomectomy using different approaches. The occurrence of placenta accreta spectrum (PAS), placenta previa, uterine rupture, gestational hypertension/preeclampsia, and placental abruption was compared among women who underwent open, laparoscopic, or hysteroscopic myomectomy and those in the control group. Subsequently, for each myomectomy procedure, we compared the TIMP between women with and without each perinatal complication. Fisher's exact test and multivariable logistic regression models were employed. Among the 27,129 eligible women, 140, 305, and 97 underwent open, laparoscopic, and hysteroscopic myomectomy, respectively. The proportion of PAS was the highest in the hysteroscopic group (5.2%), followed by the control (1.8%), open (1.4%), and laparoscopic (1.3%) groups. After adjustment, there was no association between PAS and hysteroscopic myomectomy (adjusted odds ratio, 1.86; 95% confidence interval, 0.75-4.63). Uterine rupture after myomectomy was observed only in the laparoscopic surgery group (1.0%); this difference among the four groups was statistically significant (Fisher's exact test, P = 0.001), although a robust adjusted analysis was not feasible due to the low incidence rate. The proportion of gestational hypertension/preeclampsia was the highest in the hysteroscopic group (17.5%); however, a similar trend was observed as for PAS (adjusted odds ratio, 1.30; 95% confidence interval, 0.74-2.27). The incidences of placenta previa and placental abruption did not differ significantly among the groups. The TIMP was the shortest after hysteroscopic myomectomy, followed by laparoscopic and open myomectomy. Although the number of outcomes was small, which constrained clinical interpretation, there were no perinatal complications associated with TIMP. Our study suggested the potential risk of uterine rupture after laparoscopic myomectomy. The optimal TIMP remains unclear. The risks of perinatal complications after myomectomy should be assessed and addressed at the individual level based on the specific myomectomy method, but further research on the optimal TIMP is warranted.

Cesarean delivery for placenta previa.

What is placenta accreta?

Uteroplacental detachment on transvaginal ultrasound is associated with substantial antepartum hemorrhage requiring early delivery in high-risk placenta accreta spectrum cases.

Neonatal indicators and obstetric complications associated with degree of prematurity: A retrospective cohort study in Cyprus.

The diagnosis of postcesarean delivery complications with imaging techniques (ultrasound, computed tomography, magnetic resonance imaging, X-ray, and angiography).

Placenta previa, a condition where the placenta obstructs the cervical birth path, is a major cause of late pregnancy bleeding. This study aims to address vaginal bleeding, support fetal development until term, and reposition the placenta using Master Tung and Traditional Chinese Medicine (TCM). A patient, G3P2 NSD, experiencing vaginal bleeding and pain for 15 days, was admitted at the 26th week of pregnancy. Abdominal ultrasound revealed a "low lying" placenta positioned 2 cm from the internal os. Treatment involved acupuncture, resulting in significant reduction of vaginal bleeding after the first session. Weekly monitoring showed complete cessation of bleeding and pain relief within a week. Treatment continued to manage persistent pain and achieve a placental distance surpassing 2.5 cm. Following nine acupuncture sessions, all symptoms resolved, with the placenta positioned 4.5 cm from the internal os. This case highlights the necessity of prompt intervention in placenta previa to ensure a safe full-term pregnancy, mitigating risks for both mother and baby.

Evolution of modern cesarean delivery: historic perspective and new challenges.

Uterine myomas afflict 2 10 of pregnant women. Myomas complicate the course in every ten patients, leading to poor pregnancy outcomes such as placental abruption, early rupture of membranes, placenta previa, preterm labor, fetal malpresentation.

Placental pathologies, particularly placenta accreta spectrum (PAS) disorders and placenta previa, are major causes of maternal morbidity and mortality, largely due to the high risk of massive obstetric hemorrhage. Anesthetic management is crucial in cesarean deliveries involving these conditions, yet limited data exist regarding how anesthesia type influences perioperative outcomes. This retrospective cohort study evaluated 70 pregnant women who underwent cesarean section for placenta previa or PAS disorders between June 2024 and April 2025. Patients were categorized into general anesthesia (GA) and regional anesthesia (RA) groups. Clinical, surgical, anesthetic, and neonatal data were collected and compared between groups. Inverse probability of treatment weighting (IPTW) based on the propensity score was applied to minimize baseline confounding, followed by weighted regression analyses to estimate adjusted associations. GA was used in 65.7% of cases, often in patients with placenta percreta and those requiring radical hysterectomy. In unadjusted analyses, GA was associated with higher estimated blood loss (1000 mL vs. 715 mL, p = 0.047), higher transfusion needs (87.0% vs. 54.2%, p = 0.004), increased maternal ICU admission (76.1% vs. 33.3%, p = 0.001), longer ICU (2 vs. 0 days, p = 0.002) and hospital stays (6 vs. 4 days, p = 0.008), and lower neonatal APGAR scores at 1 and 5min (p = 0.008 and p = 0.009, respectively). After adjustment using IPTW, GA remained significantly associated with a higher likelihood of maternal ICU admission and longer ICU length of stay. Associations between anesthesia type and transfusion requirement, neonatal ICU admission, hospital length of stay, postoperative complications, and maternal mortality were attenuated and did not reach statistical significance after weighting. In this retrospective cohort of cesarean deliveries complicated by placenta previa or PAS disorders, RA was associated with more favorable unadjusted maternal and neonatal outcomes. After accounting for baseline differences using IPTW, GA remained associated with increased maternal ICU utilization, reflecting its predominant use in clinically more complex and higher-risk cases. Not applicable.

Does extended embryo culture (EEC) associate with an increased risk of obstetrical, perinatal, or children's health complications? After thorough adjustment, EEC was not associated with widespread increased risks, although a moderate excess risk persisted for a few specific outcomes, notably cardiac anomalies, whereas reduced risks were observed for gestational diabetes, small birthweight, and musculoskeletal-limb anomalies. EEC is increasingly used in IVF cycles. While blastocyst transfer (day-5/6) often improves birth rates, concerns remain about its impact on maternal and child health. In this nationwide longitudinal cohort study, all live-born singletons conceived through IVF-with or without sperm microinjection-and following fresh embryo transfer between 2014 and 2019 in France were included and followed for up to 8 years. Data were obtained from the French National Health System and the National Biomedicine Agency registries. A comparative study was conducted between singletons conceived at either day-2/3 (cleavage-stage embryos group) or day-5/6 (EEC group). Data from both registries were cross-linked to identify obstetrical, perinatal, and health outcomes, including major congenital malformations, hospitalizations, and surgical interventions. Multivariable logistic and survival models were used to adjust for maternal, paternal, and treatment-related factors. A total of 41315 singletons were included (25816 and 15499 from day-2/3 and day-5/6 groups, respectively). Most outcomes were similar between groups, notably the incidence of global major congenital malformations. However, EEC was associated with increased risks of placenta praevia (aOR, 1.16; 95% CI, 1.02-1.30), admission in neonatal intensive care unit (aOR, 1.16; 95% CI, 1.05-1.29), and cardiac anomalies at age 3years (aHR, 1.78; 95% CI, 1.21-2.60). Conversely, the risk of gestational diabetes (aOR, 0.94; 95% CI, 0.88-1.00; P = 0.041) and small birthweight (aOR, 0.94; 95% CI, 0.88-1.00, P = 0.039) was lower, as was the risk of musculoskeletal-limb anomalies (aHR, 0.63; 95% CI, 0.42-0.97)-a finding that persisted up to age 7. Other health outcomes were largely comparable. One limitation of this study is that the data refer to live-born singletons, with stillbirths and medical terminations excluded from the analyses. Despite extensive adjustments, residual confounding cannot be excluded. Findings for specific pathologies/malformations should be interpreted with caution because the number of cases was small in some sub-groups. In this large and unique study, after adjusting for multiple maternal, paternal, and cycle-related variables, our findings provide some reassurance regarding the safety of prolonged in vitro embryo culture. A moderate risk remained for a few maternal and child health conditions following EEC-warranting further investigation-whereas the risk was notably lower compared to short embryo culture, particularly for musculoskeletal-limb anomalies. This work was supported by the AOI of University Hospital of Dijon. The authors have no competing interests to disclose. N/A.

Background: Placenta Accreta Spectrum (PAS) is a pregnancy-related disorder characterized by the abnormal adherence of trophoblastic tissue to the uterine myometrium, posing a significant risk of maternal mortality. Key risk factors for PAS include placenta previa and prior cesarean deliveries, which have been rising in frequency. Aim: to explore the risk factors of PAS, incidence, clinical outcomes of affected patients, and strategies to minimize maternal morbidity and mortality. Method: prospective cohort study conducted on 60 patients during the year 2022 in Benghazi Medical Centre including all patients labeled as PAS cases, Review of records for all patients using the structured data collection sheet. The total number of deliveries, caesarean deliveries, maternal and perinatal deaths had been registered; patients were followed up till delivery. Results: Mean age of the studied group was 35.37±5.70, 43.3 % of them were multipara , 56.7% with previous cesarean section three or more times, 71.7% of the studied group with grade III placenta previa, 95.0% experienced some complication, after multivariate analysis C.S 3 times and more is considered risk factor for hysterectomy (p value = 0.03) ( OR 6.12, 95% CI (1.15-32.59), there was statistical significant association between CS delivery and length of hospital stay (p value =0.005). Conclusion: Incidence of placenta accreta increases with advanced age, with multipara and with 3 times and more CS. Placenta previa was coexisting factor in 95% of the cases.

Background: The interpregnancy interval (IPI) is a significant factor influencing pregnancy outcomes, particularly in women with a prior cesarean section. Understanding how IPI influences maternal complications and pregnancy outcomes is crucial for guiding post-cesarean pregnancy management. Methods: A retrospective cohort study was conducted on 1803 women who underwent cesarean delivery at Guangzhou Women and Children’s Medical Center between January 1, 2011, and June 30, 2022. Those with a first cesarean delivery followed by one or more subsequent births were included. Participants were assigned into four IPI-based groups for comparison. Data of clinical characteristics (including age, marital status, mode of delivery, newborn weight, and medical history), maternal complications [including gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, polyhydramnios, oligohydramnios, placenta accreta, and placenta previa], and pregnancy outcomes [including fetal distress, macrosomia, postpartum hemorrhage, premature rupture of membranes (PROM), and preterm birth] were collected and analyzed using univariate and multivariate logistic regression. Results: Significant differences in clinical characteristics and maternal complications were observed across the IPI groups after cesarean section. Women with IPIs of ≥60 months had the highest mean age (34.09 ± 2.92, p &lt; 0.001) and increased risks of GDM (26.04%, p = 0.021) and placenta accreta (7.29%, p = 0.010). The IPI group of &lt;18 months exhibited the highest rates of gestational hypertension (15.15%) and oligohydramnios (4.55%). Significant associations between IPI and adverse pregnancy outcomes, such as fetal distress and PROM, were observed, particularly at the extremes of IPI (&lt;18 months and ≥60 months). After adjusting for potential confounding factors, including age and history of gestational hypertension, preeclampsia, postpartum hemorrhage, macrosomia, placenta previa, and fetal distress, multivariate logistic regression analysis revealed that the risk of GDM was significantly reduced in the 18–23 months IPI group compared to the 24–59 month group [adjusted odds ratio (OR) = 0.630; 95% confidence interval (CI): 0.431–0.920; p &lt; 0.017]. Gestational hypertension was strongly associated with shorter IPIs, whereas preeclampsia and placenta accreta were more common with longer IPIs. The risk of PROM increased with both very short and very long IPIs. Postpartum hemorrhage was more frequent in the 18–23 months group, and preterm birth risk increased significantly with IPIs of ≥60 months. Conclusion: Both short and long IPIs following a cesarean section are associated with specific adverse maternal complications and pregnancy outcomes. Individualized counseling and planning for subsequent pregnancies may benefit women with a history of cesarean delivery to minimize these risks.

Background: A hypoplastic uterus is a rare anomaly often considered incompatible with successful pregnancy due to inadequate uterine size, thin myometrium, and poor vascularization. Case: This case reports on a 29-year-old primigravida with a hypoplastic uterus who achieved a full-term pregnancy complicated by central placenta previa and placenta increta. At 37 + 4 weeks of gestation, a cesarean delivery yielded a healthy neonate; however, the patient required an emergent hysterectomy due to extensive uterine rupture and uncontrolled hemorrhage. Conclusions: This case highlights the importance of meticulous prenatal surveillance in patients with uterine anomalies and underscores the potential necessity for timely intervention to avert life-threatening complications.

Objective: To describe clinical and paraclinical characteristics and outcomes of managing pregnant women with placenta previa at A Thai Nguyen Hospital. Methods: A cross-sectional descriptive study of 84 pregnant women with placenta previa based on clinical and ultrasound findings, with a gestational age of 28 weeks or more, conducted from 01 June 2022 to 31 May 2025 at A Thai Nguyen Hospital. Results: Placenta previa is most common in pregnant women aged 25–34 years old, accounting for 56.0%, 72.6% were multigravida, 64.3% were previous cesarean. Clinical features included vaginal bleeding in 59.5% of all cases, 47.6% had complete placenta previa. The cesarean delivery rate was 95.2%. X-stitch sutures at the placental attachment site, accounting for 58.8%. The mean gestational age at delivery was 37.2 ± 1.9 weeks. Conclusion: Vaginal bleeding is a common symptom of placenta previa. The rate of successful hemostasis in the study was high (95.0%).

Background: Placenta Previa (PP) is a significant cause of management challenges for obstetricians, with a greater challenge and risk when a PP occurs in a pregnancy with a previous uterine scar. Evidence of the complications associated with the occurrence of these two risk factors together is scarce in Bangladesh. This study aimed to describe PP's clinical profile and fetomaternal outcome coexisting with a previous uterine scar in a public teaching tertiary-level hospital in Chattogram, Bangladesh. Materials and methods: A prospective observational study was conducted from January 2024 to June 2024 in Chittagong Medical College Hospital. Consecutively admitted 38 singleton pregnancies with PP with a history of Cesarean Section (CS) or myomectomy were included. Information was collected using a structured case record form and analyzed using MS Excel. Results: The mean age of the patients was 29.5±5.4 (Range: 18 to 42) years. The mean value of the parity and gestational age was 3.42±1.41 and 35.08±2.59 weeks, respectively. Thirty-seven (97.4%) had cesarean scar, and the mean number of CS was 1.95± 0.89. Placenta accreta spectrum was present in 25 (65.8%) patients, and in 23 (60.5%) patients, PP was covering the uterine scar. Twenty-eight (73.7%) patients developed haemorrhage, 15.8% developed shock, 44.7% required ³3 unit blood transfusion, 15.8% had bladder injury, 39.5% required a peripartum hysterectomy and the maternal mortality rate was 7.9%. According to the fetal outcome, NICU admission was 47.7%, perinatal death was 18.4%, and a low Apgar score at 5 minutes was observed in 71.1% of neonates. Conclusion: PP in the scared uterus is associated with diverse maternal and neonatal complications. Therefore, careful monitoring, planning, and resource allocation for delivery are crucial in such cases to manage potential risks effectively. JCMCTA 2025 ; 36 (1) : 14-17

Background: The increasing global prevalence of cesarean sections has led to growing concern about their long-term effects on maternal and fetal health. A previous cesarean section is a known risk factor for complications in subsequent pregnancies, such as uterine rupture, abnormal placentation, placenta previa, placenta accreta spectrum, preterm birthand adverse perinatal outcomes. These risks pose significant challenges for obstetric care and decision-making regarding the mode of delivery. Investigating the impact of prior cesarean deliveries is essential to guide clinical practices and improve maternal and fetal outcomes in future pregnancies.This study aims to evaluate the maternal and fetal outcomes in women with subsequent CS with a history of previous CS. Materials and methods: This was a prospective observational study of patients who had a previous caesarean section for either maternal or fetal indications. The study lasted for 6 months, from September 2024 to February 2025. A totalof 116 patients were included in this study based on predefined inclusion and exclusion criteria. The indications and maternal and neonatal outcomes were studied. Results: A total of 116 patients were included in this study. The most common age group of the studied cases was 25-29 years (38%). The mean age of the patients was found to be 27.50±4.40 years. One of the most important indications for C-sections was failure to progress (45%), followed by fetal distress 39%, 9% due to contracted pelvis, and 4% due to Cephalopelvic disproportion. with 3% due to malpresentation. The most common complications during subsequent pregnancy were preterm labour 15 (35.71%), following pre-eclampsia 12 (28.57%) and placenta previa 9 (21.43%). Current study showed 72% of babies following CS were admitted in the NICU due to birth asphyxia for low birth weight and 28% due to neonatal jaundice. 92% of fetuseswere found healthy in the cases studied, whereas only 8% suffered from developmental delay. Conclusions: The study highlights that previous cesarean sections significantly impact both maternal and fetal outcomes in subsequent pregnancies. Complications such as preterm labor, pre-eclampsia, and placenta previa were notably frequent. Neonatal outcomes also reflected increased risk, with a high NICU admission rate primarily due to birth asphyxia and low birth weight. Despite these challenges, the majority of fetuses (92%) remained healthy, underscoring the importance of vigilant prenatal care in pregnancies following a cesarean delivery. JCMCTA 2025 ; 36 (1) : 147-153

Background: This study aims to investigate the delivery modes, indications for cesarean section, and perinatal outcomes of infants with macrosomia in primiparous women, with a particular focus on those with gestational hyperglycemia who have achieved satisfactory glycemic control, as well as those with normal blood glucose levels. Methods: A retrospective cohort study was conducted in 269 primiparous women with infants affected with macrosomia at Haidian Maternal and Child Health Hospital in Beijing (2022–2024). These women had no prior history of uterine surgery, breech presentation, placenta previa, or any other conditions that would necessitate a cesarean section. The participants were categorized into two groups based on their blood glucose levels: a hyperglycemic group consisting of 107 cases (after excluding 2 cases due to inadequate blood glucose control) and a normal blood glucose group with 160 cases. This study compared various factors between the two groups, including basic demographic information, mode of delivery, reasons for the cesarean sections, and any complications that arose during delivery. Primary outcomes included cesarean section rates and perinatal outcomes. Results: The cesarean section rate was notably higher in the hyperglycemic group compared to those with normal blood glucose levels, while the rate of vaginal deliveries, including those assisted by forceps, was lower in the hyperglycemic group. This difference in delivery methods was statistically significant (χ2 = 4.132; p &lt; 0.05). Additionally, within the hyperglycemic group, babies born via cesarean section due to fetal macrosomia had a significantly greater birth weight than those delivered vaginally (Z = 3.500; p &lt; 0.05). A similar trend was observed in the normal blood glucose group, where cesarean section deliveries also resulted in higher birth weights compared to vaginal deliveries (Z = 3.750; p &lt; 0.05). Furthermore, the hyperglycemic group exhibited a higher incidence of shoulder dystocia and intrapartum fever compared to the normal blood glucose group, with these differences being statistically significant (p &lt; 0.05). Conclusions: For primiparous women with infants who possessed macrosomia, the cesarean section rate in the hyperglycemic group was higher than that in the normal blood glucose group, and the incidence of shoulder dystocia in the hyperglycemic group was higher than that in the normal blood glucose group. Therefore, using a fetal weight of ≥4150–4190 g as the cesarean section indication for macrosomia is recommended, whether for pregnant women with normal blood glucose levels or those with gestational hyperglycemia who have good blood glucose control.