Previous C-section Research Articles

Prevalence and Risk Factors of Surgical Site Infection Following Cesarean Section

Background: Surgical site infection (SSI) following Cesarean section (C-section) is a common cause of morbidity and imposes a significant load on the healthcare system. Therefore, the prevalence of factors that make individuals more susceptible to SSI after a C-section should be accurately assessed. Objectives: This study aimed to determine the frequency and risk factors for infection following C-section in women referred to the maternity ward of Ali ibn Abi Talib Hospital in Zahedan, Iran, from 2020 to 2022. Methods: This descriptive cross-sectional study was performed on all women admitted to the maternity ward of Ali ibn Abi Talib Hospital in Zahedan, whether undergoing elective or emergency C-sections. The patients were entered into the study with informed consent and were followed up to one month after surgery. Results: This study showed that approximately 5300 cases of C-sections were performed in Ali ibn Abi Talib Hospital during the mentioned period, of which 120 patients were referred to this hospital again because of surgical site infections. The occurrence of SSI in the present study was 2.26%, and obesity and anemia were identified as the predominant risk factors. The findings showed that the incidence of patients with SSI following a C-section with obesity, anemia, skin scar of previous C-section, rupture of membranes before C-section (> 6 hours), and diabetes mellitus were 80, 76.8, 36.7, 33.3, and 24.2 %, respectively. Conclusions: The recorded incidence of SSI following C-section was comparatively lower than findings from prior studies conducted in developing countries. Although the frequency of these complications is desirable, there are the same number of irreparable complications to mothers and infants and high costs for families and society.

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit.

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.

Clinical assessment of ectopic pregnancy in a tertiary care hospital: An observational study

Background: Ectopic pregnancy is defined as pregnancy that occurs outside normal uterine cavity that occurs due to implantation of fertilized ovum in an aberrant site which is conducive to its growth and development. In developing countries like India, late presentations with tubal rupture and hemodynamic instability, late presentations with tubal rupture causes first trimester maternal morbidity and mortality. For early diagnosis, a clinician should be well aware about the various presentations of ectopic pregnancy. Aims and Objectives: (a) To estimate the incidence, risk factors, clinical manifestations and outcome following different management protocol. (b) To estimate the morbidity and mortality with respect to different types of presentation and management. (c) To understand the need for clinical assessment in order to diagnose early and provide urgent intervention and also to lean toward the possibility of conservative approach in order to preserve fertility. Materials and Methods: The current study was a time bound, Observational descriptive study with Longitudinal design. It was conducted in the Department of Obstetrics and Gynecology, R. G. Kar Medical College and Hospital, between March 2021 and August 2022. One hundred and thirty-eight participants, suspected to have ectopic pregnancy were enrolled for the study. Data collection was done by detailed history taking and physical examination. The basic investigations including hemoglobin, ABO and Rhesus typing, urine pregnancy test, and ultrasound (USG) examination were done. All data were collected on a structural data form and analyzed for descriptive statistics. Post-operative histopathological examination (HPE) reports were collected and final diagnosis was made. Results: About 63.8% of the study population belonged to 21–30 years of age. About 63.7% patients presented with >5–8 weeks of amenorrhea. About 18.1% of the study population were sterilized and the duration between the sterilization and the occurrence of ectopic was 4–10 years in 64% patients. The most common risk factor was h/o Previous C-section (31.8%). The most common clinical symptom was abdominal pain present in 131 (94.9%), 44 (31.9%) participants had all the three classical symptoms with 100% specificity. On examination, forniceal fullness/tenderness was the most specific finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. Five patients underwent medical treatment. Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality.

Exploring uterine contractility frequency in infertile population: A comparative study among different control groups with and without a C-section defect.

Women undergoing IVF who have had a previous c-section (CS) have a lower live birth rate than those with a previous vaginal delivery. However, the precise underlying mechanisms need clarification. Does a previous CS affect the pattern of uterine contractility?. Prospective evaluation in patients undergoing frozen blastocyst embryo transfer in medicated endometrial preparation cycles. Twenty patients were included in groups: A/nulliparous. B/previous vaginal delivery. C/ previous CS without a niche, whereas fifteen patients were recruited in group D (CS and a niche). Patients employed estradiol compounds and 800 mg vaginal progesterone. A 3D-scan was performed the transfer-day where uterine contractility/minute was recorded. Baseline characteristics (age, BMI, smoking, endometrial thickness) were similar. Mean frequency of uterine contractions/minute was similar between groups (1.15, 1.01, 0.92, and 1.21 for groups A, B, C, and D, respectively). There was a slight increase in the number of contractions in patients with a sonographic niche versus controls, not reaching statistical significance (p=0.48). No differences were observed when comparing patients with a previous C-section (regardless of the presence of a niche) to those without a C-section, either nulliparous (p=0.78) or with a previous vaginal delivery (p=0.80). The frequency of uterine contractions was similar between patients who achieved a clinical pregnancy and those who did not (1.19 vs. 1.02 UC/min, p=0.219, respectively). Our study found no significant difference in the frequency of uterine contractility between patients with or without a previous C-section or sonographic diagnosed niche. Further investigation is necessary to understand the physiological mechanisms affecting implantation in patients with isthmocele.

Comparison of the rate and indications of caesarean section in primigravida and multigravida in a maternity hospital of Pakistan.q

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value <0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

Robson Criteria to Determine the Risk of Cesarean Section in Females Presenting to Sir Ganga Ram Hospital (SGRH), Lahore

Rates of caesareans have increased, resulted in unfavourable outcomes in subsequent pregnancies. Robson categorization enhances standard of care by optimising the use of C-sections and evaluating methods to lower caesarean rates. Objective: To determine the frequency of caesarean section and to determine frequency of Robson 10 group classification system in patients who undergo caesarean. Methods: In this cross-sectional study, 140 pregnant selected via simple random sampling, were enlisted from Gyne department of SGRH, Lahore. According to Robson 10-group categorization those who underwent C-section were divided into ten groups and indication of C-section was studied. Data scrutiny was done using SPSS version 26.0. Mean and SD was used for quantitative variables and frequency for qualitative data. Data were stratified for effect modifiers, p-≤0.05 was taken as significant. Results: Mean age of patients calculated was 31.94 ± 2.14 years. Out of 140, 23.6% had C-section and 76.4% had vaginal delivery. According to class of modified Robson criteria, 12.1% had class 1, 12.1% had class, 2, 21.2% had class 3, 36.4% had class 5, and 3.0% each had class 4, 6, 7, 8, 9, and 10. Conclusions: According to our findings, considerable percentage of C-sections occur with previous C-sections serving as most common indicator. This pattern emphasizes how crucial it is to concentrate on primary preventive techniques in order to lower its rate. Large number of C-sections performed on nulliparous both those in spontaneous labour and those who were not indicates that labour management procedures and decision-making processes need to be closely examined.

Obstetric risk profiles and causes of death: Estimating their association with cesarean sections among maternal deaths in Mexico.

Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric risk profiles, cause of death, and mode of delivery. Utilizing a retrospective observational design, 4,561 maternal deaths in Mexico from 2010-2014 were analyzed. Data were sourced from the Deliberate Search and Reclassification of Maternal Deaths database, alongside other national databases. An algorithm was developed to extract the Robson Ten Group Classification System from clinical summaries text, facilitating a nuanced analysis of C-section rates. Information on the reasons for the performance of a C-section was also obtained. Logistic regression and multinomial logistic regression models were used to estimate the relation between obstetric risk factors, mode of delivery and causes of maternal death, adjusting for covariates. Among maternal deaths in Mexico from 2010-2014, 47.1% underwent a C-section, with a significant history of previous C-sections observed in 31.4% of these cases, compared to 17.4% for vaginal deliveries (p<0.001). Early prenatal care in the first trimester was more common in C-section cases (46.8%) than in vaginal deliveries (38.3%, p<0.001). A stark contrast was noted in the place of death, with 82.4% of post-C-section deaths occurring in public institutions versus 69.1% following vaginal births. According to Robson's classification, the highest C-section rates were in Group 4 (67.2%, p<0.001) and Group 8 (66.9%, p<0.001). Logistic regression analysis revealed no significant difference in the odds of receiving a C-section in private versus other settings after adjusting for Robson criteria (OR: 1.21; 95% CI: 0.92, 1.60). A prior C-section significantly increased the likelihood of another (OR: 2.38; CI 95%: 2.01, 2.81). The analysis also indicated C-sections were significantly tied to deaths from hypertensive disorders (RRR = 1.25, 95% CI [1.12, 1.40]). In terms of indications, 6.3% of C-sections were performed under inadequate indications, while the indication was not identifiable in 33.1% of all C-sections. This study highlights a significant overuse of C-sections among maternal deaths in Mexico (2010-2014), revealed through the Robson classification and ana analysis of the reported indications for the procedure. It underscores the need for revising clinical decision-making to promote evidence-based guidelines and favor vaginal deliveries when possible. High C-section rates, especially noted disparities between private and public sectors, suggest economic and non-clinical factors may be at play. The importance of accurate data systems and further research with control groups to understand C-section practices' impact on maternal health is emphasized.

Indications and determinants of caesarean section in Al Batool teaching hospital

Background: C-section (caesarean section) is a lifesaving procedure when certain complications arise during pregnancy and labor. however, it’s a major surgery and associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long term effects. Objective: To describe indications and determinants of caesarean section in Al Batool teaching hospital in Diyala during the study period. Patients and Methods: Across sectional study conducted among women admitted to Al Batool teaching hospital and delivered by C-section from first of October 2022 to 15th of march 2023. Results: A total of 150 women underwent C-section enrolled in this study during the study period, age of participants ranged from 19-35. out of them, 88(59%) sections were elective and 62(41%) sections were emergent. commonest indication for emergency C-section was fetal distress (62%) and commonest indication for elective C-section was previous cesarean (33%). Conclusion: Parity, residence, education, and antenatal care visits were significant determinants for C-section. previous C-section, maternal request and malpresentation were commonest indications for such procedure. Keywords: C-section, Al Batool teaching hospital, malpresentation.

Indications and determinants of caesarean section in Al Batool teaching hospital

Background: C-section (caesarean section) is a lifesaving procedure when certain complications arise during pregnancy and labor. however, it’s a major surgery and associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long term effects. Objective: To describe indications and determinants of caesarean section in Al Batool teaching hospital in Diyala during the study period. Patients and Methods: Across sectional study conducted among women admitted to Al Batool teaching hospital and delivered by C-section from first of October 2022 to 15th of march 2023. Results: A total of 150 women underwent C-section enrolled in this study during the study period, age of participants ranged from 19-35. out of them, 88(59%) sections were elective and 62(41%) sections were emergent. commonest indication for emergency C-section was fetal distress (62%) and commonest indication for elective C-section was previous cesarean (33%). Conclusion: Parity, residence, education, and antenatal care visits were significant determinants for C-section. previous C-section, maternal request and malpresentation were commonest indications for such procedure.

Emergent Bedside Cesarean Section for COVID-19 Patient on Veno-venous Extracorporeal Membrane Oxygenation: A Case Report

Background &amp; Case: A 38-year-old Spanish-speaking, pregnant woman at 26.1 weeks’ gestation with two previous Cesarean sections (C-section) presented with acute respiratory distress syndrome secondary to COVID-19 pneumonia. She was intubated and ventilated, complicated by bilateral pneumothoraces and emphysema requiring bilateral chest tubes and blow holes. She had worsening hypoxic respiratory failure ultimately requiring cannulation for venovenous extracorporeal membrane oxygenation (VV-ECMO). She was started on cefazolin for Methicillin-susceptible Staphylococcus aureus bacteremia. On day three of VV-ECMO, there was non-reassuring fetal heart tone necessitating emergent bedside non-sterile Cesarean section at 27.2 weeks’ gestational age in the surgical intensive care unit. Post-Cesarean section, her respiratory failure improved, and she was decannulated from VV-ECMO 13 days later. This case report highlights that VV-ECMO can be a life-saving treatment option for pregnant women with cardiopulmonary failure who are unresponsive to conventional therapy. Literature describing Caesarean section on VV-ECMO is limited. Specifically, there have been only a handful of case reports of C-sections on patients put on VV-ECMO due to respiratory failure. Results: The obvious benefit of proceeding with this emergent bedside C-section was to save the fetus. However, this had to be weighed against the risks of hemorrhage in this high-risk patient since she had two previous C-sections and was on a therapeutic heparin drip while on VV-ECMO. Additionally, there is the risk of infection due to having the C-section done in a non-sterile manner, especially in a patient who is bacteremic. This was mitigated by using additional prophylactic antibiotics post-operatively. The patient’s respiratory status improved significantly after the fetus was delivered, likely due to improvements in respiratory mechanics post-partum. The successful outcome of this patient and her baby required the timely coordination of a multidisciplinary team. Conclusions: Emergent C-section on a pregnant woman with respiratory failure on VV-ECMO can be life-saving for the fetus and the mother. However, the inherent risks associated with it requires close monitoring of the patient and the fetus in order to determine when this is truly necessary. Keywords: Acute respiratory distress syndrome, Cesarean-section, COVID-19, Pregnancy, Veno-venous extracorporeal membrane oxygenation

Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.

A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of "en bloc" excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien-Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.

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.

Single-use negative pressure wound therapy to prevent surgical site complications in high-risk patients undergoing caesarean sections: a real-world study

Abstract Surgical site complications (SSCs), including surgical site infection (SSI), are common following C-sections. Management of the post-operative incision with single-use negative pressure wound therapy (sNPWT) has been shown to reduce the risk of SSC in high-risk individuals. This study explored the outcomes of routine, real-world use of sNPWT in high-risk patients undergoing C-sections. An observational, retrospective in-service evaluation was conducted across eight obstetric centres in the Republic and Northern Ireland. Patients undergoing C-sections were stratified for their risk of developing SSC using commonly known risk factors, including BMI ≥30, smoking, diabetes, and whether the patients had undergone previous C-sections or had a previous history of wound dehiscence. Those at high-risk were treated with sNPWT post-operatively. Data relating to any SSC that developed post-operatively, for up to 30 days, were captured. Data were compared with original research previously published by Wloch et al. (2012). Of 1111 women considered high-risk, 106 (9.5%) went on to develop SSCs, predominantly superficial SSIs. SSCs were associated with extra visits with their general practitioner (GP), outpatient visits, or inpatient hospital stays in 5.7%, 2.4%, and 1.7% of the entire cohort, representing 59.4%, 25.5%, and 17.9% of the 106 patients with SSC. Patients needed on average 1.8 extra GP visits and 0.7 extra outpatient visits. Patients who needed to be readmitted to hospital had an average length of stay of 4 days. In comparison with a previously published cohort, in which sNPWT was not used, we observed a significant reduction in the incidence of SSCs across BMI groups 18.5–24.9 (P = 0.02), 25–29.9 (P = 0.003), and ≥35 kg/m2 (P = 0.04). In those patients who had undergone at least one previous C-section, the rates of complications also reduced (P = 0.006). This analysis provides further justification for using sNPWT to manage surgical incisions in patients considered at high risk of developing post-procedural SSCs, particularly those with a BMI ≥30 or a history of more than one C-section.

Mirroring Perinatal Outcomes in a Romanian Adolescent Cohort of Pregnant Women from 2015 to 2021.

Although the rates of adolescent pregnancies appear to have dropped according to the World Health Organization (WHO), the decrease in the age of the first menarche and better nutrition seems to contribute to the otherwise high rate of adolescent pregnancy worldwide, despite the efforts of different organizations to improve upon this trend. We conducted a population-based retrospective cohort study from January 2015 to December 2021 using our hospitals' database. We totaled 2.954 adolescent and 6.802 adult pregnancies. First, we compared younger adolescents' outcomes with those of older adolescents, as well as with adolescents aged between 18 and 19 years old; secondly, we compared adolescent pregnancies with adult ones. We detected higher percentages of cephalo-pelvic disproportion (43.2%), cervical dystocia (20.7%), and twin pregnancy (2.7%) in underage adolescents compared with 32%, 14.1%, and 1% in older underage adolescents, respectively, and 15.3%, 3.1%, and 0.6% in older ones. As teens became older, the likelihood of malpresentations and previous C-sections rose, whereas the likelihood of vaginal lacerations declined. When comparing adolescents with adult women, we found more cases that required episiotomy (48.1% compared with 34.6%), instrumental delivery (2.1% compared with 1%), and cervical laceration (10.7% compared with 8.4%) in the adolescent group, but the rates of malpresentation (11.4% compared with 13.5%), previous C-section (13.9% compared with 17.7%), and placenta and vasa praevia (4.5.6% compared with 14%) were higher in the adult women group. Adolescent pregnancy is prone to being associated with higher risks and complications and continues to represent a challenge for our medical system.

Factors associated with caesarean sections among pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia.

Caesarean section rates are increasing worldwide in both developed and developing countries becoming an issue of grave concern. The aim of the study was to determine the factors associated with caesarean sections performed on pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia. A retrospective data approach was conducted on 200 patients' files using a self-administered checklist at a private academic hospital. A total of 200 records of mothers who underwent caesarean sections were systematically reviewed from January 2020 to December 2020 at a private academic hospital in Ongwediva, Namibia. A pretested structured checklist was used to record the data. The study revealed that 95.5% of women who had caesarean sections (C-section) were performed. A previous C-section was the most frequent indication, while 0.5% were performed due to patient requests. The p-value for the chi-square statistic was smaller than the standard alpha value (P<0.05), i.e., there is a relationship between the demographic characteristics and factors associated with caesarean sections, as well as between socioeconomic factors and factors associated with caesarean sections. This study shows that 95.5% of C-sections are done as a necessity with clear indications, while only 0.5% are done due to patient requests. This study's findings can be used to develop strategies and targeted interventions geared towards reducing the increasing rates of cesarean section considering maternal age, the number of indications of primary cesarean delivery, and following standard operating procedures that might improve the quality of prenatal and delivery care.

Caesarean Delivery- a Pressured Choice for Women: A Meta-Analysis of 23 Cross-Sectional Studies

The aim of this study is to investigate the associated factors which influence women to choose caesarean delivery or C-Section (CS) and to quantify the contribution of these factors. This meta-analysis indicates that for maternal age at birth, age group 20-29 years is 1.45 times more likely to choose CS as compared to the age group ≤19 years [OR= 1.45; Overall effect Z=4.57, p&lt;0.01], for mother’s education level educated mothers are 8.86 times more likely to choose CS as compared to the uneducated mothers[OR= 8.86; Z=4.10, p&lt;0.01].For marital status OR=1.40;Z= 1.34, p=0.18, for residence OR= 1.02;Z=0.11, p= 0.91, for mother’s employment status OR= 0.97;Z=-0.12, p= 0.90 and for receiving Antenatal Care between 1-3 times versus 0 time OR= 2.11;Z=1.84, p= 0.07. Mother’s economic status [OR= 1.41;Z=3.43, p&lt;0.01], whether previous CS [OR=9.39; Z=2.24,p=0.03] and type of delivery facility [OR= 0.67; Z=-2.03, p= 0.04] are found to be significant factors for choosing CS over normal delivery. Dhaka Univ. J. Sci. 71(1): 1-5, 2023 (Jan)

Frequency of Obstetrical Hysterectomy in Morbidly Adherent Placenta in Women with Previous Cesarean Section in Tertiary Care Hospital

Objective: To determine the frequency of obstetrical hysterectomy in the morbidly adherent placenta in women with previous cesarean sections in tertiary care hospital. Study design: A cross-sectional study Place and Duration: Gynecology and obstetrics department of Liaquat university hospital Hyderabad from 5th November 2020 to 5th May 2021 Methodology: This study comprised 62 women who had placentas that were identified as morbidly adherent by Doppler ultrasound. Repeat ultrasound scans were used to monitor cases with grossly adherent placentas. The condition of the mother and fetus was routinely evaluated in the hospital, where blood was cross-matched for transfusion. All information was entered into a pre-made proforma. Results: The women were 30.68 ±4.70 years of age on average. When a placenta was morbidly adherent and in a woman who had previously had a caesarean section, 7.41% (17/62) of those women underwent an obstetrical hysterectomy. These women spent an average of 4.92 ±2.65 days in the hospital. Conclusion: - In 7.41% of cases, obstetrical hysterectomy was performed on women who had previously undergone caesarean section because of a morbidly attached placenta. These findings suggest that a morbidly adhered placenta can seriously interfere with a female's ability to procreate. It is crucial to make a well-informed decision about having a C-section in the first place, and following previous C-sections, vaginal birth should be given some thought. Keywords: caesarean section, morbidly adherent placenta, hysterectomy

An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report fromSomalia.

There has been an increase in worldwide cesarean section rates, although they remain low in most Sub-Saharan African countries, including Somalia. The present is the first hospital-based study that analyzes the rate, indications, and associated maternal mortality of cesarean deliveries reported from Somalia. This retrospective study reviewed data of all deliveries from 2015 to 2021 using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications and the type of cesarean section, and the documented maternal mortality during the study period. During seven years, there were 12,540 total deliveries. Among these, 2703 were cesarean sections giving an overall cesarean section rate of 21.6%. The mean age of the patients was 26.7±7.3 years [14-44 years]. Multiparous mothers constituted 67.7% during the study period. According to cesarean deliveries, nulliparous mothers (55.7%) underwent the maximum number of cesarean sections. Emergency cesarean section was the predominant intervention compared to elective C-sections (59.2% vs 40.8%). Primary CS was the most common predominant, while repeat CS increased timely, 77.7% vs 22.3%, respectively. Overall, previous C-sections and fetal distress were the two most common indications for cesarean delivery (22.3% and 22.1%), respectively. C-sections were predominant in women of younger age, Primiparity, having term deliveries, and did not receive regular antenatal care. The maternal mortality rate was 1.7%, and 61% was due to direct obstetric hemorrhage, including postpartum hemorrhage, Placenta abruption, and uterine rupture. The study findings showed a slight increase in cesarean delivery rates during the study period. This rate is higher than the 10-15% recommended by the WHO in developing countries. Policies and efforts to decrease unnecessary cesarean sections should be promoted and implemented at each health facility.

Fetomaternal Outcome in Morbidly Adherent Placenta

Aim: To determine the fetomaternal outcome in morbidly adherent placenta Study design: Cross-sectional study. Place and duration of study: Department of Obstetrics &amp; Gynecology, Liaquat University Hospital Hyderabad from 1st January 2022 to 30th June 2022. Methodology: Forty five females of adherent placenta were enrolled. The consent was taken from every relevant patient having low lying placenta with previous scar/surgery the following details were collected. The operative events were recorded. Results: The mean age was 30.77 years and mean gestational age was 34.15 weeks. Majority of the cases 53.3% had history of three previous C-sections, 64.4% cases had placenta accreta, 20% had placenta percreta and 15.6% had p Placenta increta. Antepartum haemorrhage was seen in 68.9% of the cases. 55.6% females underwent C-sections, 22.2% were admitted in ICU, rate of the hysterectomy was high, 46.7% one patient was died. Considering the fetal outcome, 22.2% of the cases had fetal growth retardation, pre-term birth rate was 66.7%, neonatal ICU admission rate was 31.1% of the cases, respiratory distress was seen in 6.7% of the cases, perinatal sepsis was in 11.1% of the cases and intra uterine death rate was 8.9% of the cases. Conclusion: Morbidly adherent placenta was found to be a significant cause of adverse fetal and maternal outcome. It was frequently more prevalent among females who had previous history of scar. Key words: Invasive placenta, Fetomaternal complications

Cesarean delivery in Zawia City, Libya prevalence and associated factors a cross-sectional study

Background; A caesarean section is a surgical procedure that can save the lives of mothers and babies when certain complications arise during pregnancy or labour. Objective; To investigate the prevalence and factors associated with caesarean delivery in Zawia city, Libya. Methods: A cross-sectional study with data from 175 postpartum women interviewed between June and August, 2022. Multivariate logistic regression analysis was used to identify those factors associated with the Caesarean section. Results: Caesarean section rates were 70.9%. Factors associated with Caesarean section were: Significant evidence of an association was observed between mode of delivery and previous c-section. Mothers who didn’t have previous c-section had lower odds of c-section than who had at least one c-section (OR =0.026, 95% CI 0.009, 0.073, p=0.000). Mothers who desired of c-section in early pregnancy had higher odds of c-section than mothers who didn’t (OR =4.9, 95% CI 3.03, 7.9, p=0.000). Also, mothers who delivered in private facility had higher odds of c-section than mothers who delivered in public facility (OR =3.8, 95% CI 1.94, 7.65, p=0.000). Conclusion: It is necessary to properly orientate all pregnant women who desire a Caesarean delivery, from both the private and public health system, about the inherent risks of the surgical procedure without indication. Guidelines should be focused on pregnant women with previous Caesarean delivery, with a per capita income higher than one minimum wage and those who are overweight or obese, as these women are more likely to have a Caesarean section