Prevalence Of Cesarean Section Research Articles

Cephalad-caudad vs transverse blunt expansion of low transverse hysterotomy during caesarean section and risk of severe postpartum haemorrhage: A prospective comparative study

BackgroundThe global prevalence of caesarean section as a delivery method is increasing worldwide. However, there is notable divergence among countries in their national guidelines regarding the optimal technique for blunt expansion hysterotomy of the low transverse uterine incision during caesarean section (cephalad-caudad or transverse). AimTo compare the risk of severe postpartum haemorrhage (PPH) between cephalad-caudad and transverse blunt expansion hysterotomy during caesarean section. MethodsThis prospective comparative observational study was conducted in a university maternity hospital. All women who gave birth to one infant by caesarean section after 30 weeks of gestation between November 2020 and November 2021 were included in this study. The exclusion criteria were a coagulation disorder, the presence of placenta previa, multiple pregnancies, or enlargement of the hysterotomy with scissors. The choice between cephalad-caudad or transverse blunt expansion of the low transverse hysterotomy was left to the surgeon’s discretion. The primary outcome measure was severe PPH, defined as estimated blood loss ≥ 1000 ml. Univariate and multivariate analyses were employed to assess the risk of severe PPH associated with the two methods of enlarging the low transverse hysterotomy. ResultsThe study included 850 women, of whom 404 underwent transverse blunt expansion and 446 underwent cephalad-caudad blunt expansion. The overall incidence of severe PPH was 13.3 %. Univariate analysis revealed no significant difference in the frequency of severe PPH between the cephalad-caudad and transverse blunt expansion groups (13.9 % vs 12.6 %; p = 0.61). However, the use of additional surgical sutures (mainly additional haemostatic stitches) was less common with cephalad-caudad blunt expansion (26.7 % vs 36.9 %; p < 0.05). Multivariate analysis showed no significant difference in risk between the two techniques (odds ratio 1.17, 95 % confidence interval 0.77–1.78). ConclusionNo significant difference in the risk of severe PPH was found between cephalad-caudad and transverse blunt expansion of the low transverse hysterotomy during caesarean section.

Caesarean section delivery rates and associated factors in a faith-based referral hospital in Ghana: A retrospective analysis.

The global incidence of caesarean section (CS) deliveries has exceeded the recommended threshold set by the World Health Organization. This development is a matter of public health concern due to the cost involved and the potential health risk to the mother and the neonate. We sought to investigate the prevalence, indications, maternal and neonatal outcomes and determinants of CS in private health facilities in Ghana. A retrospective cross-sectional analysis was conducted using data from women who delivered at the Holy Family Hospital from January to February 2020 using descriptive and inferential statistics, with a significance level set at p<0.05. The prevalence of CS was 28.70%. The primary indications of C/S include previous C/S, foetal distress, breech presentation, pathological CTG and failed induction. Significant associations were found between CS and breech presentation (AOR = 4.60; 95%CI: 1.22-17.38) p<0.024, previous CS history (AOR = 51.72, 95% CI: 11.59-230.70) p<0.00, and neonates referred to NICU (AOR = 3.67, 95% CI: 2.10-6.42) p<0.00. The prevalence of caesarean section (CS) deliveries was higher than the WHO-recommended threshold. Major indications for CS included previous CS, fetal distress, and failed induction. Significant risk factors for CS were previous CS history, breech presentation, and neonates referred to NICU.

Prevalence of depression among pregnant women and its correlation with the choice of delivery method.

Caesarean section is usually limited to cases where natural vaginal delivery is not possible or poses a serious risk to the foetus and mother. Psychological health of mothers is likely to play an important role in the method of delivery. This study aims to investigate the prevalence of depression in pregnant women and its relationship with the choice of delivery method and other demographic parameters. In this descriptive cross-sectional study, 250 mothers referring to the hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran, were selected, and their demographic information and level of depression was collected using a questionnaire. Statistical analysis was conducted to evaluate the correlation between depression, method of delivery and other associated parameters. Among 250 pregnant women, 225 (90%) had no depression, 25 (10%) had mild depression and no moderate or severe depression was reported in any pregnant mother. Also, 146 (58.4%) were willing to have a caesarean section and 104 (41.6%) wanted to have a normal delivery. The choice of delivery method was not significantly associated with depression. Analyzes showed that increasing maternal age is associated with a greater tendency to caesarean delivery. The incidence and higher depression scores of mothers showed a significant association with the history of previous abortions. Although in this study no significant association was observed between depression in pregnant mothers and the choice delivery, due to the high prevalence of caesarean section in the country and its progression to higher percentages, it seems that the design and implementation of effective programs and interventions is required.

Identifies Current Trends in Vaginal Birth after Cesarean Section in IRAN: A Qualitative Study

Abstract Background: The growing prevalence of Cesarean Sections (CS), particularly repeated CS, is a major issue in contemporary midwifery. This study seeks to gain a comprehensive understanding of the experiences of pregnant women and specialists with vaginal delivery after CS, as well as the obstacles that may arise. Materials and Methods: From March 2020 to May 2021, 10 women, 12 midwives, and 8 obstetricians and obstetricians affiliated with Qom University of Medical Sciences were interviewed to investigate the experiences and challenges associated with Vaginal Birth After Cesarean section (VBAC). We used the content analysis method, and the sampling was purposive. Semi-structured interviews were conducted to collect data, which were then analyzed using qualitative content analysis based on conventional content analysis. Results: The results show that subcategories “individual aspects of VBAC” and “family-social aspects of VBAC” formed “positive aspects of VBAC.” Subcategories “self-efficacy” and “decision-making participation” formed the “empowerment for the woman.” Subcategories “technical team challenges” and “woman’s challenges” formed the main category of “upcoming challenges.” Conclusions: Positive relationships, choice-making ability, and self-confidence impact a woman’s decision to choose VBAC. Informing women of alternative delivery options after a CS and pursuing their dreams increases the likelihood of successful VBAC.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals

BackgroundBrazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project (“Projeto Parto Adequado”- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil.MethodEvaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA—“Participation of women” and “Reorganization of care” – among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group “Exposed to the PPA model of care” and the group “Standard of care model”.ResultsPPA had a low degree of implementation in both components “Reorganization of Care” (0.17 – 0.32) and “Participation of Women” (0.21 – 0.34). The combined implementation score was 0.39–0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA.ConclusionThe degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

Factors associated with breastfeeding at birth in maternity hospitals linked to the Rede Cegonha, Brazil, 2016-2017

Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour.

The Relationship between the Prevalence of Cesarean Sections and Progesterone (Duphaston) Usage during Pregnancy

Background: Progesterone plays a crucial part in ovulation, implantation, and pregnancy, among other reproductive processes.This is related to progesterone's role in controlling cyclical changes in decidualization and proliferation, which regulate uterine function during the menstrual cycle. Progesterone is necessary for the development of decidual tissues. In the event of fertilization, high levels of progesterone in the blood are crucial for maintaining pregnancy by promoting uterine growth and inhibiting the effects of factors that cause myometrial contraction. During a cesarean section, the fetus is delivered via a surgical incision made in the woman's abdomen (laparotomy) and in her uterus (hysterotomy). The likelihood of experiencing health issues following a cesarean birth is somewhat increased due to the high number of caesarean sections performed globally in comparison to spontaneous births. Method: 65 pregnant women participated in this cross-sectional study, which ran from October 1, 2022, to March 20, 2023, in the gynecological department of Salah Al Deen General Hospital in the Salah al Deen governorate and in Diyala. Result: As in result of questioners in pregnancies take the progesterone as stabilizer About 75.4% of participants were delivered by cesarean section and only 24.6% were delivered by normal vaginal delivery . Conclusion: The regular use of progestagens for the treatment of impending miscarriage may have contributed to the increased rate of cesarean sections among the participants.

Analysis of Cesarean section rates using Robson’s ten-group classification system in comparison with the MCS population reference

Abstract Background: The escalating global prevalence of Cesarean section (CS) deliveries raises concerns. To address this, the World Health Organization (WHO) suggests employing Robson’s ten-group classification system (RTGCS) for assessing and comparing CS rates among obstetric units. The aim of our study was to assess our hospital’s CS rate per group and juxtapose it with WHO Multi-Country Survey (MCS) population reference data. Furthermore, we delve into prevalent obstetric Indications for CS and examine potential strategies for mitigating the high CS rate. Materials and Methods: This observational cross-sectional study occurred at an Indian tertiary care teaching hospital from October 2018 to May 2020. Women delivering during this period were classified based on RTGCS, and Cesarean rates were computed across various groups. These rates were then compared with the WHO’s MCS population reference guidelines. Additionally, we investigated obstetric Indications for CS within these groups. Results: Of 2994 deliveries during the study period, 42.55% were CS. Notably, group 5 (29.75%) and group 1 (21.74%) had the highest CS rates. The CS rate of nulliparous women was 40.9%. Primary CS groups frequently cited fetal distress as the reason, while group 5 showed repeat CS due to previous CS with obstetric complications, on-demand CS, and scar integrity concerns. Conclusion: Despite our hospital’s overall high CS rate, group-specific contributions align with existing research. High-risk pregnancies, previous CS cases, and preterm CS for neonatal care notably contribute. Efforts should target in reducing CS in low-risk groups.

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

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

Breastfeeding success and perceived social support in lactating women with a history of COVID 19 infection: a prospective cohort study

BackgroundGiven the limited availability of research on the association between COVID-19 infection and breastfeeding success, the primary objective of this study is to conduct a comprehensive evaluation of this relationship.MethodsThis prospective cohort study included 260 women who were on the postnatal ward of an academic hospital affiliated with Tehran University of Medical Sciences during the COVID-19 pandemic (between March and August 2021). Among these women, 130 had tested positive for COVID-19 in pregnancy, while the remaining 130 were considered healthy. The study aimed to assess various factors, including sociodemographic characteristics and the results of four validated questionnaires: The Bristol Breastfeeding Questionnaire, The Multidimensional of Perceived Social Support (MPSS), The Breastfeeding Self-Efficacy Scale (BSES), and The Postpartum Partner Support Scale (PPSS). These questionnaires were administered to each participant to gather relevant data. After eight weeks, a telephone follow-up was carried out to assess the success of breastfeeding. The evaluation focused on determining if exclusive breastfeeding was maintained or not. Data was collected by questioning mothers about their infants’ feeding habits in the past 24 h. Exclusive breastfeeding refers to the exclusive use of breast milk without the introduction of other liquids or solid foods.ResultsWomen with a previous COVID-19 infection (case group) had a lower mean infant gestational age (P < 0.001) and a higher prevalence of cesarean section (P = 0.001) compared to the control group. The proportion of women who exclusively breastfed was higher in the control group (98.5%) than in women with a history of COVID-19 infection (89.2%) (P = 0.011). Furthermore, the case group reported lower scores in perceived social support and the Breastfeeding Self-Efficacy Scale, in contrast to the control group. Notably, there was a significant correlation between breastfeeding success and women’s breastfeeding self-efficacy score.ConclusionsThe findings of this study offer valuable insights for healthcare professionals, enabling them to promote early initiation of breastfeeding in mothers with a history of COVID-19 infection, while ensuring necessary precautions are taken.

Anxiety Disorders in Pregnant Women and its Effects on Choosing the Delivery Method

ObjectivesCesarean section is usually limited to cases where natural childbirth is not possible or is associated with serious risks to the fetus and mother. In the past few years, cesarean section has become a preferred method of delivery among women who are not medically indicated for the procedure. This study aimed to investigate the prevalence of anxiety in pregnant women and its relationship with choosing delivery methods and other demographic parameters. MethodsIn this study, 300 mothers referring to the hospitals of Shahid Beheshti University of Medical Sciences were selected by convenience sampling. The medical history of all patients was obtained, and the Beck questionnaire was used to determine the levels of anxiety. Results57% of mothers chose cesarean section as the method of delivery and the frequency of mild, moderate, and severe anxiety was estimated to be 36.33%, 19.33%, and 2.33%, respectively. It was seen that the preference for cesarean section was associated with higher levels of anxiety, higher education, older age, having a history of previous abortion, first pregnancy, and a gestation period of over 28 weeks. ConclusionsDue to the high prevalence of cesarean section in our country and its progress to higher percentages, it seems that the design and implementation of effective programs and interventions, including providing painless delivery, education, and psychological interventions.

Cesarean section prevalence based on prenatal care provider, location, and wealth index: A comparative analysis in peru's healthcare systems

BackgroundCesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems. AimTo evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system. MethodsA cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions. FindingsThe highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, “richest” wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the “poorest” or “poorer” wealth index category and when prenatal care was provided by a midwife in a private facility. ConclusionThe prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.

Relationship Between Pain Severity in Post-Caesarean Section and Its Preoperative Factors

Background: According to the World Health Organization (WHO), the global prevalence of cesarean section (C-section) reaches 21% of all deliveries and is expected to increase to 29% by 2030. This major surgery is associated with moderate to severe postoperative pain. Previous studies have shown that factors such as emergency cases, preoperative anxiety, previous C-sections, length of surgery, type of anesthesia, and pain medication are all important factors contributing to post-C-section pain.Objective: To identify preoperative factors that affect post-cesarean pain, including age, gravida, previous C-section, anthropometry, preeclampsia (PE), fetal malposition, premature rupture of the membranes (PROM), human immunodeficiency virus (HIV), malnutrition, preterm labor, hepatitis B, anemia, and emergency procedure.Methods: A cross-sectional study was conducted at dr. Soehadi Prijonegoro Hospital, Sragen, Indonesia. The inclusion criteria are: (1) willing to participate in this study, (2) age more than 18 years old, (3) cooperative and communicative, and (4) not in disability condition. We analyzed the data using Wilcoxon and Spearman's tests with Statistical Package for the Social Sciences (SPSS) version 25. This research has conducted ethical approval by the Ethics Committee.Results: From 30 subjects, the age spread between 22 to 44 years, with 20% being older than 35 years pregnant women. Most patients experienced moderate (Numeric Rating Scale [NRS] 4 to 6: 60%) and severe pain (NRS 7 to 10: 30%) 12 hours after surgery. While at 24 hours, the majority experienced mild (NRS 1 to 3: 36.7%) to moderate pain (NRS 4 to 6: 46.7%). Our analysis did not identify any preoperative factors significantly related to pain levels after 12- and 24-hours following C-section (p &gt; 0.05).Conclusion: There is no relationship between preoperative factors and postoperative pain. Nonetheless, pain management should be tailored to each patient’s clinical condition.

Association of Maternal Risk Factors with the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study.

In the last few years, there has been a gradually increasing rate of caesarean section deliveries worldwide that negatively affects both mothers' and children's health. The present survey intended to explore the relations of common maternal risk factors with the prevalence of caesarean sections. This is a cross-sectional study including 5182 healthy mothers from geographically diverse regions of Greece, which has applied relevant inclusion and exclusion criteria. An elevated 56.4% incidence of caesarean sections was noted. The prevalence of caesarean section deliveries was estimated to be 51.5% in private hospitals and 48.5% in public hospitals. Maternal age, pre-pregnancy overweight/obesity, excess gestational weight gain, preterm birth, financial status, smoking habits, and private type of birth hospital were considerably associated with a high probability of caesarean section, regardless of several confounders. In conclusion, caesarean section rates are constantly increasing, and various maternal risk factors additively elevate its incidence, which additionally enhances the likelihood of postpartum complications for both the mothers and their infants. Public health procedures and approaches are strongly recommended to notify future mothers of the potential risk factors that may result in adverse pregnancy outcomes of caesarean section delivery, highlighting its use only for emergency medical reasons and also promoting healthier nutritional and lifestyle habits that may reduce the increasing prevalence of caesarean section deliveries.

Prevalence and Risk Factors for Caesarean Section Delivery Following Labour Induction at Mbarara Regional Referral Hospital

Labour induction is one of the most common obstetric interventions. According to most current studies, the rate varies from 9-33% of all pregnancies annually. According to American Congress of Obstetricians and Gynecologists, one-fifth of all pregnancies are terminated with the induction method. The aim of induction is to prevent maternal and fetal disorders such as preeclampsia, premature rupture of membranes, intrauterine growth retardation and prolonged pregnancy. Since the purpose of induction is vaginal delivery, a number of authors consider successful induction as vaginal delivery without regarding to the time limits. Induction failure is defined as failure of induction leading to cesarean section. The aim of this study was to determine the relationship between induction and risk of cesarean section delivery for women with term pregnancies who were admitted to Mbarara Regional Referral Hospital. A hospital based retrospective cohort study was conducted using maternally-linked data from MRRH birth registry. The study was restricted to deliveries intervened by labor induction at Mbarara Regional Referral Hospital during the year 2019 to 2021. Study samples size were 180 cases using convenience sampling among eligible pregnant women admitted to MRRH for induction. Data analysis was performed using SPSS version 21. Chi-square and t-test were used to compare groups with significant levels of less than 0.05, and logistic regression test was used to determine odds ratio with 95% confidence level. The mean age of those who underwent induction were 26.7 ± 5.6 years. In terms of education, 63.3 % were at the elementary level, the majorities (94.6%) were housewives or unemployed prior to delivery, and 57.4% were nulliparous. The prevalence of cesarean section was 22.21%. The mean gestational age was 39.3 ± 2.6 weeks and post-term pregnancies (40.63%), and PROM (24.12%) were among the most common causes for induction. Dilatation and birth weight were factors predicting labour induction success. Furthermore, performing Induction in dilatation 3 cm or less was associated with an increased risk of cesarean delivery. The prevalence of caesarean section after induction of labour in this study was 22.1%. Cervical dilatation (3 cm or less) prior to induction and increasing birth weight could be the major factors leading to caesarean section, hence predicting labor induction success. More funding is necessary by the hospital to further give more light to the all-time prevalence of cesarean section following labor induction within MRRH. Keywords: Labour induction, vaginal delivery, Cesarean section, Maternal and fetal disorders, Premature rupture of membranes.

Prevalence and Factors Associated with Cesarean Section at UTH Women and Newborn Hospital Lusaka, Zambia

Background: Increase in cesarean section (CS) has been a source of public health concern globally. There is scanty updated information about cesarean section and associated factors in developing countries like Zambia. The aim of this study was to determine the prevalence of CS and associated factors at The University Teaching Hospital women and New-born in Lusaka Zambia. Methodology: The study design was cross sectional. It involved retrospective collection of data from birth registers of women who gave birth at the University Teaching Hospital-Women and Newborn from 1st January, 2018 to 31st December 2018. The total sample size was 6,965 women (15-49 years) after the inclusion and exclusion criteria were met. Statistical analysis was conducted using Binary Logistic Regression, level of significance was 0.05 and Confidence Interval of 95%. Goodness of fit was conducted using the likelihood ratio test. Data was analyzed using STATA version 14.2. Results: The Prevalence of Cesarean section was 44%. Factors significantly associated with Cesarean Section were maternal age (grouped), Birth weight (grouped), gestational age (grouped) and still birth (AOR=0.47 P&lt;0.0001). There was an increased odds of having Cesarean Section among multipara (AOR= 1.10 P=0.73) and Multigravida (AOR=1.04, P=0.73). Common maternal indicators identified were repeat caesarean section (18%), obstructed labor (11%) and failure to progress (10%). The common fetal indicators identified were fetal distress (18%), big baby (10%) and mal presentation (7%). Conclusion: Prevalence is higher than the recommended WHO limit. There is need to reinforce health education, reinforce fetal monitoring and promote vaginal birth after caesarean. Keywords: Cesarean Section, Prevalence, Factors, Women and newborn, Zambia.

Analysis of Mother's Pregnancy Knowledge at Az-Zahra Primary Clinic Tangerang

The prevalence of cesarean sections as much as 80% have exceeded the figure recommended by WHO, about 10-15%, supported by several factors. One of them is self-autonomy which is not owned by the mother causing a lack of knowledge about pregnancy. Knowledge has an effect of 1.8 times on readiness for pregnancy, childbirth, and postpartum. Antenatal education is a service requested by most pregnant women worldwide such as childbirth education programs or birth preparation classes. This research uses a qualitative research design. Data collection was done through in-depth interviews using a sample of 9 main informants (pregnant women). The primary and secondary qualitative data were collected through data processing and analysis techniques, imported into NVivo and classified according to the type of data to facilitate the processing and analysis of data in NVivo 12 Plus. Knowledge of the pregnancy process of pregnant women with low results; Knowledge of pregnancy signs of pregnant women with low results; Knowledge of the benefits of pregnancy examination with high results; Knowledge of the examination schedule of pregnant women is high; Knowledge of physical changes of pregnant women with low results; Knowledge of gestational age with high results; Knowledge of pregnancy danger signs with low results. Knowledge of pregnant women about pregnancy with results is still lacking, namely the knowledge of the pregnancy process, signs of pregnancy, physical changes, and signs of danger of pregna Therefore, it is necessary to provide educational services at Pratama Az-Zahra Tangerang Clinic.&#x0D; Keywords: section caesarea, knowledge, pregnant women, pregnancy

A retrospective study of neonatal and pregnancy outcomes in pregnant women suffering from inflammatory arthropathy treated with adalimumab

IntroductionAnti-tumor necrosis factor-alpha (TNF-α) treatments have been available for over two decades to treat inflammatory arthropathies (IA). Most of these disorders are common among women of reproductive age, which emphasizes the need to evaluate their safety in pregnancy. ObjectivesThis study aims to scrutinize neonatal and pregnancy outcomes in pregnant IA patients treated with adalimumab. Materials and methodsThe current cross-sectional work was conducted by reviewing the medical files of pregnant IA patients (n=30) receiving adalimumab referred to Golestan Hospital in Ahvaz (Iran) from 2014 to 2017, followed by extracting demographic profiles as well as neonatal and pregnancy outcomes. ResultsNoteworthy among the findings were PsA (n=13), RA (n=5), IBD (n=4), AS (n=3), uveitis (n=2), Behcet's disease (n=2), and panuveitis (n=1). The mean age of subjects, duration of illness, and duration of treatment were estimated at 29.53±5.88, 2.85±1.15, and 1.96±.90 years, respectively. No delivery outcome was found for 27 (90%) cases, and delivery outcomes observed in three (10%) patients were abortion (n=2) and preterm complications (n=1). No neonatal complication was found for 28 (93.3%) cases and neonatal IUGR outcome was reported in 2 (6.7%) cases. Cesarean section was a delivery method in 7 (23.3%) cases and natural method in 21 (70%) cases. There were no significant differences for the prevalence of cesarean section and neonatal outcomes based on the type of disease, but differences were observed for the outcome of delivery based on the type of disease. ConclusionsAccording to our findings, definitive conclusions on the safety of adalimumab during pregnancy were impossible and there is a need for further research with a larger sample size.

Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature.

Pregnancy after kidney transplantation (KTx) is considered to have a high risk of non-negligible complications for the mother, the allograft, and the offspring. With an increased incidence of these pregnancies over the past decades, transplant nephrologists and specialized obstetricians face increasing challenges, with scarce literature regarding long-term outcomes. We retrospectively collected data from all women with at least one live birth pregnancy after KTx who were followed at our tertiary hospital between 2000 and 2021 to study maternal, graft and fetal outcomes. Ten patients underwent 14 live birth pregnancies after KTx. Preponderant maternal complications were stage 1 acute kidney injury (43%), urinary tract infections (UTI, 43%), progression of proteinuria without diagnostic criteria for preeclampsia (29%), and preeclampsia (14%). Median baseline serum creatinine at conception was 126.5 µmol/L [median estimated glomerular filtration rate (eGFR) 49 mL/min/1.73m2], and eGFR tended to be lower than baseline at follow-ups. Overall, there was no increase in preexisting or occurrence of de novo donor-specific antibodies. No graft loss was documented within the 2-year follow-up. There were nine premature births (64%), with a median gestational age of 35.7 weeks. The median birth weight, height, and head circumference were 2,560 g, 45.5 cm, and 32.1 cm, respectively. These measurements tended to improve over time, reaching a higher percentile than at birth, especially in terms of height, but on average remained under the 50th percentile curve. Overall, pregnancies after KTx came with a range of risks for the mother, with a high prevalence of cesarean sections, emergency deliveries, UTI, and preeclampsia, and for the child, with a high proportion of prematurity, lower measurements at birth, and a tendency to stay under the 50th percentile in growth charts. The short- and long-term impact on the allograft seemed reassuring; however, there was a trend toward lower eGFR after pregnancy. With these data, we emphasize the need for a careful examination of individual risks via specialized pre-conception consultations and regular monitoring by a transplant nephrologist and a specialist in maternal-fetal medicine during pregnancy. More data about the long-term development of children are required to fully apprehend the impact of KTx on offspring.

The Demographic and Clinical History as Predictors Contributing to the Prevalence of Caesarean Sections in Ghana: A Facility-Based Study

Caesarean section is an essential clinical obstetric intervention used to reduce maternal and foetal death. Several indications contribute to the decision-making to use CS as a delivery in the clinical environment. This study sought to determine the prevalence of CS at LEKMA Hospital in Ghana and the demographic and clinical history of mothers as predictors for the prevalence. Using a retrospective study design, data for all mothers who had previously given birth at the hospital’s obstetric and gynaecological department was used. Multiple logistic regression was applied and a p-value&lt;0.05 with a 95% confidence interval (CI) for results using IBM-SPSS version 25. From the study, the prevalence of CS was 40.6% and the average age for SVD and CS were 28.3±5.94years and CS 29.6±5.50years respectively. The likelihood of those aged 36 years and above undergoing CS was notably higher (AOR; 2.84, 95%CI 1.41-5.3, p-value &lt;0.0001) compared to those aged 26-30 (AOR; 2.45, 95%CI 1.49-4.00, p-value: 0.004) years and 31-35 (AOR; 1.65, 95% CI 0.94-2.90, p-value: 0.080) years. The results further indicated that the risk of undergoing CS was greater among mothers with parity of 1-2 (AOR: 1.56, 95%CI 1.02-2.41, p-value: 0.040). The prevalence of CS in the study is greater than the recommended prevalence per 100 births by the World Health Organization. The sociodemographic and clinical history of a pregnant woman influenced the mode of delivery such that the increase in gestational age and parity decreased the risk of CS. Whiles the educational status and age of the mothers at the time of birth increased the risk of CS delivery. Keywords: Caesarean section, Prevalence, Maternal, Indications.