Planned Caesarean Section Research Articles

Planned Cesarean Section Versus Planned Vaginal Delivery Among Women Without Formal Medical Indication for Planned Cesarean Section: A Retrospective Cohort Study of Maternal Short-term Complications

(Acta Obstet Gynecol Scand. 2022;101:1026–1032) The rates of cesarean delivery (CD) have climbed worldwide over the past 3 decades. While the increased risks of serious complications associated with CD compared with vaginal delivery (VD) have been well described, there is a lack of information on the risks and benefits of CD without medical indication, or “CD on maternal request.” This study compared the rates of short-term complications, including postpartum thromboembolism and infections, with planned, requested CD compared with planned VD.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030; RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012; RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

Monitoring of pregnancies with successful deliveries in a Niemann-Pick disease type B patient - case report and literature review

Introduction. Niemann?Pick disease type B is an autosomal recessive disease caused by sphingomyelinase deficiency resulting in sphingomyelin accumulation in macrophages of various organs. Visceral involvement includes spleen enlargement, thrombocytopenia, dyslipidemia, sphingomyelin deposition in lung and liver, and bleeding risk. This is a rare disease and literature data about pregnancy in this setting are scarce. We present two favorable pregnancy outcomes in a patient with Niemann?Pick disease type B along with the review of the literature. Case outline. At the time of the first intended pregnancy, the patient was 34 years old. She had an extremely enlarged spleen, mild restrictive pulmonary disorder, hyperlipoproteinemia type IIb, thrombocytopenia with impaired aggregation tests. Cesarean section was indicated. She was prepared for delivery with platelet concentrates and prophylactic use of antibiotics. In the 36th week of gestation, a Cesarean section without complications was performed. The newborn?s anthropometric parameters were BW 2490, BL 47 cm, HC 32 cm, and Apgar score was 7/8. The infant?s development was normal. Three years later, in the second wanted pregnancy, the same examinations were done. The planned Cesarean section was done without complication after the same procedures, including prophylactic use of antibiotics and platelet concentrates, and a healthy female child was born. Conclusion. A multidisciplinary approach in female patients who suffer from lysosomal storage disease such as Niemann?Pick disease type B is essential and a favorable course is possible despite all risks.

Traumel C In Optimizing Wound Healing in The Area of The Incision of The Uterus After a Planned Cesarean Section

The aim of the study was to determine the possibility and feasibility of using Traumel With no antibiotic prophylaxis to improve wound healing processes on the uterus after cesarean section. 46 maternity hospitals were examined. In 26 patients, Traumel was used in the postoperative period, and in 20 only antibiotic prophylaxis was used. The postoperative period in all women proceeded without complications. But the indices of the involution of the seam area (IIPSH) and neutrophil-lymphocytic index (NLI) indicated more optimal wound healing on the uterus in women who used only Traumel C.

The Value of Fetal Head Station as a Delivery Mode Predictor in Primiparous Women at Term before the Onset of Labor

Objective: Our objective was to demonstrate the role of the clinical determination of fetal head station (FHS) at term to predict the delivery mode in primiparous women before the onset of labor. Methods: This prospective study included unselected primiparous women at term who presented at our tertiary maternity. We excluded multiparous patients, pregnancies with a planned Cesarean section, non-cephalic presentations, and multiple pregnancies. The protocol included weekly clinical examinations to assess the FHS. The results were used to describe the clinical fetal head descent at term. We correlated the fetal head station determinations at each week with labor outcome, including the evaluations performed within the week before delivery. Results: The data show no significant differences between vaginal (VD) and Cesarean section delivery (CS) cases regarding FHS determined at each week at term. The median determinations at the gestational ages (GW) from 37 to 41 were −2 and −3, similar between the two groups, with a more consistent difference at 41 GW: station -1 for VD compared to −3 for CS. There were significant differences between the “week before delivery” evaluations of the two groups. The determinations showed for both groups similar minimum (−5), maximum (+1), and median (−2) FHS values. Most vaginal deliveries cases presented at weekly examinations with increasing rates toward more advanced stations: from 10% at station −4 to 35% at station −1. Although we investigated a low-risk group, we found significant differences between the vaginal and Cesarean groups in terms of age, weight, and BMI. We provided a multiple logistic regression equation that considered the predictive clinical variables at term: the fetal head situation, age, weight, height, and BMI. Conclusion: The clinical evaluation of fetal head station in primiparous before labor onset has a limited value regarding the prediction of the delivery mode. There is a potential benefit for the determinations performed within the week before delivery, but such a policy would require weekly assessments of the FHS at term, which is unlikely to be implemented. Another potential benefit would involve estimating labor outcomes in late-term or prolonged pregnancy. The fine tuning of the logistic prediction should be achieved by increasing the studied population and the number of centers involved before counseling primiparous women at term based on the clinical fetal engagement data.

Effect of Early Discharge After Planned Cesarean Section on Recovery and Parental Sense of Security: A Randomized Clinical Trial

(Acta Obstet Gynecol Scand. 2021;100:955–963) Enhanced recovery (ERAC) programs aim to decrease the length of hospital stay (LOS) for patients who underwent cesarean delivery (CD). While it can be positive for some parents to be discharged early, it is unclear whether others find it difficult in regard to their sense of security. The aim of this study was to assess patients’ sense of security in association with different hospital discharge times: the day following CD combined with a midwife home visit versus 2 days following CD.

Predictors of planned caesarean section births in a sample of Romanian women.

Romania has one of the highest incidences of births by caesarean section (CS) in the European Union (EU). The present study aims to identify the possible predictors of planned caesarean section (PCS) in a convenience sample of Romanian women. This is a secondary analysis of the cross-sectional data collected as part of the EU-level Babies Born Better online survey from 1908 Romanian women who gave birth between 2013 and 2018. Univariable and multivariable logistic regression models were performed to identify the potential individual and health system-level predictors of PCS. PCS was reported by 36.7% (n=657) of the women. In the multivariable regression model, older maternal age (aOR: 1.10, 95% CI: 1.07-1.14) and presence of medical or non-medical problems during pregnancy (adjusted odds ratio [aOR]: 1.67, 95% CI: 1.31-2.12) were significantly associated with PCS. Conversely, birth at a very high level of competence hospital was inversely associated with PCS (aOR: 0.48, 95% CI: 0.30-0.76). Our findings indicate that PCS may be associated with both individual and health system-level variables. Our results are significant because they could be used to inform decision-making processes aimed at lowering PCS incidence.

Case Report of a Rapidly Growing Sacrococcygeal Teratoma: A Planned Preterm Cesarean Delivery May Improve Fetal Outcome

Sacrococcygeal teratoma (SCT) is the most commonly diagnosed congenital tumor during the neonatal period. The outcome of SCT is dependent on the growth rate, the presence of solid components in cancer, and the presence or absence of high flow cardiac involvement of the fetus. This case report presents the management and outcome of a pregnant woman carrying a fetus with a rapidly growing SCT. Confirmation of diagnosis was based on the universal prenatal ultrasound examination standards. Eventually, the patient delivered a girl weighing 2.9 kg, including the neoplasm, by a planned Cesarean section. The newborn received one dose of surfactant and underwent complete resection of the teratoma on the second day with a favorable outcome. This case report aims to show that rapidly growing SCT requires frequent antenatal follow-up with serial prenatal ultrasound examinations, optimum timing, mode, and appropriate place of delivery for a better fetal outcome. Keywords: Prenatal diagnosis, Preterm delivery, Rapidly growing neoplasm, Sacrococcygeal teratoma, Surgical resection of teratoma

Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section

Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section

Why Do Pregnant Women Choose a Planned Caesarean Section in Burkina Faso? A Qualitative Study

Why Do Pregnant Women Choose a Planned Caesarean Section in Burkina Faso? A Qualitative Study

Safety and Efficacy of Intra Uterine Device Placement During a Planned Cesarean Section

About 70% of pregnancies in the first year after birth are unplanned and nearly 50% of women report having unprotected intercourse before the routine 6-week postpartum visit. Unplanned pregnancies are associated with delayed prenatal care initiation, poor pregnancy outcomes, deprived maternal mental health, lower breastfeeding rates, and typically related to higher costs. We aimed to examine the safety and efficacy of intrauterine device (IUD) placement during planned cesarean section (CS).

Women’s Experiences of Decision-making and Beliefs in Relation to Planned Cesarean Section: A Survey Study

(Aust N Z J Obstet Gynaecol. 2021;61:106–115) The decision for planned cesarean delivery (CD) is often based on the preferences and beliefs of the patient or clinician. When decision-making is shared, patient satisfaction improves. The extent to which shared decision-making (SDM) occurs in Australia is unclear. Moreover, no studies have directly compared the preferences and beliefs of women undergoing planned CD at the recommendation of the clinician or at their own request. This study aimed to assess the mode of birth preferences of women in Australia and their experiences with SDM for CD. It also aimed to compare the experiences of SDM depending on whether a woman requested a CD or it was recommended by a clinician.

The Anesthetic Modality but Not the Mode of Delivery Seem to Modulate the Methylation Status of Cyclooxygenase-2 Promoter of the Newborns.

Cesarean section (CS) rates are high. Epidemiological data supports increased risk of inflammatory conditions in the offspring born by CS. Epigenetic alterations occurring during the perinatal period may account for this risk. Cyclooxygenase-2 (COX2) has strong implications for inflammatory diseases. The methylation of COX2 of newborn infants was compared with respect to their mode of delivery. Ninety healthy term infants born by vaginal delivery (VD), planned cesarean section (PCS), or emergency CS (ECS) were recruited (30 infants in each group). For obstetric anesthesia, local (LA), regional (RA), or general (GA) anesthesia were used. Carefully selected exclusion criteria were implemented to eliminate any confounders with potential epigenetic effects. Umbilical artery blood samples were collected. Demographic and clinical characteristics, folate and CRP levels, and mean methylation levels of the COX2 gene promoter were determined. Except the birth weight and maternal age parameters, VD, PCS, and ECS were similar. The methylation percentage of COX2 was higher in ECS (16.9 ± 5.1) than VD (14.5 ± 4.1) and PCS (14.8 ± 2.9), albeit p was 0.064. Because of the dual anesthetic modality populations (RA and GA) in PCS and ECS and the recent literature on anesthetics and epigenetics, the anesthetic modality groups were also analyzed. The methylation percentage of COX2 was significantly different between LA, RA, and GA groups (14.5 ± 4.1, 13.9 ± 2.8, and 17.0 ± 4.6, respectively, p = 0.012). When the mode of delivery is the question of debate, the anesthetic modality should be remembered as an important epigenetic modulator. · Perinatal period is a vulnerable time period for epigenetic modulations.. · The mode of delivery is influential in any potential epigenetic alterations occurring perinatally.. · The obstetric anesthetic modality should be remembered as an important epigenetic modulator..

Programmed Labor in Gestational Diabetes Mellitus as a Reserve for Reducing the Frequency of Cesarean Section

The aim of this study was to investigate the perinatal outcomes of delivery by various methods in patients with gestational diabetes mellitus (GDM). Methods and Results: The study included 403 pregnant women (gestational age of 37.0–41.0 weeks) with GDM and 68 without disorders of carbohydrate metabolism, who gave birth from the second quarter of 2018 to the third quarter of 2020 in the maternity ward of the City Clinical Hospital No. 29 named after N.E. Bauman. All patients with GDM were divided into 2 groups. Group 1 included 187 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The main indicators of the health status of newborns in the early neonatal period were assessed taking into account the methods of delivery: programmed labor (PL), planned cesarean section (PCS), and spontaneous delivery. The 1-minute Apgar score in newborns from mothers of Groups 1 and 2 was higher at the PL, compared with PCS. The 5-minute Apgar score in newborns from mothers of Group 2 was also statistically significantly higher at the PL, compared with planned CS. The incidence of hypoglycemia in newborns from mothers of all groups was minimal at the PL, including a statistically significant low rate in newborns from mothers of Group 1. Symptoms of neonatal CNS depression were significantly more common in newborns born by abdominal delivery from mothers with GDM. Conclusion: PL in women with GDM reduces the incidence of the main complications of the early neonatal period: hypoglycemia and symptoms of neonatal CNS depression. PL may be considered more acceptable than abdominal delivery for women with GDM.

Comparison of Fetomaternal Outcome Between Planned Vaginal Delivery and Planned Cesarean Section in Women with Eclampsia: Observational Study.

The route of termination of pregnancy in eclampsia is not clearly established. This study aims to compare the fetomaternal outcome between planned vaginal delivery and planned cesarean section in women with eclampsia after 34weeks of gestation. This prospective observational study was conducted in the department of Obstetrics and Gynecology, Midnapore Medical College, West Bengal, India. 182 women with eclampsia carrying 34weeks or more gestation were allocated to either cesarean(CD) or vaginal delivery (VD) group. The primary measure of outcome was severe maternal outcome. Secondary measures of outcome were perinatal mortality and morbidity. Of the 62 women allocated in vaginal delivery (VD) group, 60 women (32.97%) had vaginal delivery and 122 (67.03%) had undergone cesarean delivery (CD). Severe maternal outcome was more common in VD group in comparison with CD group (72.5% vs 27.5%, P < 0.00001 RR 2.64 OR 6.98). Perinatal outcome in relation to Apgar score at 5min, still birth was better in CD group than VD group. Perinatal death was higher in VD group when compared with CD group (25.8%; vs. 8.33%; P = 0.002, RR 3.1 OR 3.83). There is increasing trend of delivering the eclampsia mother at > 34weeks of gestation by cesarean section instead of inducing labor and delivering vaginally. Cesarean section when chosen as method of delivery does not increase morbidity or mortality.

Early vs. Delayed Cord Clamping at Full-Term Planned Cesarean Section: A Randomized Study

Objective: In cesarean section (CS), which, early vs. delayed cord clamping is better for neonatal and maternal hematocrit/hemoglobin level is not yet completely determined. This randomized controlled study attempted to determine this issue. Methods: Study population consisted of 64 full-term pregnant women/neonates undergoing planned CS: 32 received early cord clamping (ECC: 15 seconds after birth) and 32 delayed cord clamping (DCC: 90 seconds). We measured and analyzed 1) neonatal hematocrit at the first 24 - 48 hours, and 2) maternal-hemoglobin-change before and after CS. Results: Infants with ECC and DCC showed hematocrit (24 - 48 hours) of 57.47 ± 8.65 vs. 59.54 ± 7.67, showing no significant difference. Also, no significant differences were observed in the change in maternal hemoglobin in two groups. Conclusions: Cord clamping at 15 vs. 90 seconds did not yield neonatal hematocrit change or maternal hemoglobin change. As far as the present data (neonatal and maternal anemia) was concerned, cord may be clamped at 15 seconds in planned term CS.

Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study.

Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. A cross-sectional survey of low-risk, nulliparous pregnant women (N = 416) and healthcare providers (N = 168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. Few women (< 15%) or professionals (33.3%) would participate in an RCT, though more would participate in PCTs (88% women; 65.9% professionals) or PRPPTs (44.4% public, 63.4% private sector women; 44.0% professionals). However, most women would choose vaginal delivery in the PCT and PRPPT (> 85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women's reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women's right to choose (RCT). Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.

Low Value of Apnea-test on Fetal Survival in Intrauterine Hypoxia is Universal Indicator for Planned Caesarean Section

Low Value of Apnea-test on Fetal Survival in Intrauterine Hypoxia is Universal Indicator for Planned Caesarean Section

Does Antenatal Dexamethasone before Full Term Planned Cesarean Section Affect the Incidence or Severity of neonatal Jaundice? A Randomized Controlled Trial

Objectives: Toevaluate the effectiveness of antenatal dexametha- sone before elective caesarean section at 37-39 weeks of gestation in reducing incidence and/or severity of neonatal jaundice.Patients and. Methods: A randomized controlled study was done in the Depart- ment of Obstetrics and Gynecology, Mansoura University Hospital. The study group received three doses of intramuscular dexameth- asone 8 mg ampoules at 8-hourly interval over 24 hours ended 48 hours before time of elective CS. Control group received the usual management without dexamethasone. Neonates were followed up and those who presented with neonatal jaundice within the first 72 hour of delivery (physiologic jaundice) the level of total bilirubin was measured. Results: The study included 200 cases. Hundred cases (50 %), re- ceived single course of antenatal dexamethasone and 100 control cases (50%). the incidence of neonatal jaundice (group 1 was 34% and group 2 was 38%) and the mean level of bilirubin in neonates who develop jaundice (group1 was 11.52±0.56 mg/dl) and (group 2 was 13.08±0.72 mg/dl). No significant difference were found between the intervention and the control groups regarding the inci- dence of jaundice (p=0.56) while there was a significant difference in bilirubin level in neonates who developed jaundice (P<0.001). Conclusion: Administration of antenatal dexamethasone before elective CS at 37-39 gestational weeks was associated with reduced incidence of neonatal jaundice and lower level of bilirubin in cases that developed jaundice.

A Retrospective Review of Neonatal Sepsis among GBS-Colonized Women Undergoing Planned Cesarean Section after Labor Onset or Rupture of Membranes.

Background Sepsis is a leading cause of mortality and morbidity in neonates, with group B streptococcus (GBS) remaining the most frequent pathogen isolated from term infants. Surveillance data showed that the majority of cases of early-onset GBS disease were neonates born to women who either received no or suboptimal intrapartum antibiotic prophylaxis with a notable portion of those women having a missed opportunity to receive ≥4 hours of chemoprophylaxis. Women planning delivery by cesarean section who present in labor or rupture of membranes prior to their scheduled surgery are unlikely to receive optimal GBS chemoprophylaxis and thus their neonates are at risk of having sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads was extracted from the Consortium on Safe Labor dataset. Women who had an unlabored cesarean section at ≥37 + 0 week gestation were selected and divided into four groups based on GBS status and timing of cesarean section with respect to onset of labor or rupture of membranes. The rate of neonatal sepsis and the patterns of intrapartum antibiotic chemoprophylaxis were determined. Results The sepsis rate (4.5%) among neonates of GBS-colonized women having their unlabored cesarean section after onset of labor or rupture of membranes was significantly higher than that in any other group in this study. In this group, 9.4% of women received chemoprophylaxis for ≥4 hours, while 31% had a missed opportunity to receive ≥4 hours of chemoprophylaxis. Conclusion This study suggests that neonates of GBS-colonized women having a planned cesarean section after onset of labor or rupture of membranes are at increased risk of having a sepsis diagnosis. This finding suggest the need for additional studies to assess the risk of sepsis among neonates of women in this group.