Previous Cesarean Section Delivery Research Articles

Maternal Risk Factors Associated with Preterm Birth: A Case Control Study.

Preterm birth is the child birth before 37 completed weeks .Prematurity is one of the leading causes of neonatal morbidity and mortality due to the complications associated with it. The objective of the study was to determine the maternal risk factors associated with all preterm birth in singleton pregnancy at National hospital. Hospital based unmatched case control study was conducted between March 2021 to December 2021 at National hospital, Thimphu, Bhutan. Case to control ratio was 1:2.Data were collected using interviewer -administered structured questionnaires. The collected data were entered into Epi-data and exported into SPSS for analysis. Independent variables with p-valves<0.05 in the univariate analysis were entered to multi variable logistic model to estimate the strength of association .P-valve <0.05 was considered significant. Total of 107 cases and 201 controls participated with a response rate of 95.95%.Multiple logistic regression showed that mothers with ANC follow ≤ four[aOR 9.58(7.36-28.86) ], previous history of preterm delivery [aOR 2.99(1.5-15.77) ], previous caesarean section [aOR 5.72(2.19-14.92)], prelabour rupture of membrane [aOR 8.67(3.78-19.73)], fetal growth restriction [aOR 7.28(2.11-25.11)] , and pre-eclampsia [aOR 10.99(6.75-85.29) were the risk factors positively associated with preterm birth . This study highlights that preeclampsia, number of antenatal care visits ≤ four, prelabour rupture of membrane, fetal growth restriction, previous caesarean section and previous preterm delivery were the risk factors for preterm birth. This show the need of early screening and prevention of preeclampsia, strengthening of antenatal care follow-up, and treatment of infection to prevent prelabour rupture of membrane, reducing primary caesarean section and more attention and care with previous preterm birth .

Successful Management of Uterocutaneous Fistula After Cesarean Delivery: A Case Report

Background: We have, herein, presented a case of an uterocutaneous fistula after cesarian delivery. Case Presentation: A 24-years old female, gravida 3 para 3 with 2 living children, who underwent an emergency cesarean section about one month before the term due to preterm labor at Hamedan, was diagnosed with uterocutaneous fistula. Her medical history included 2 previous term cesarean section deliveries. She reported having fever and chills three weeks after the cesarian delivery. She also developed nausea, vomiting, and epigastric pain. Abdominal examination revealed a 30×40mm, firm, and tender mass on the right side of the cesarian section suture without any discharge. She was admitted with metritis as a primary diagnosis at N.H.F hospital. The performed transvaginal ultrasonography reported a hetero-echo mass with a diameter of 38×30×37mm with several echogenic foci and cystic components in the right ovary. After that, an abdominopelvic CT scan was done, and a 30×40mm mass in the right ovary with non-homogeneous due to collection and abnormal density with local hematoma at the site of the previous cesarian section was reported. Due to suspicion of lesion, the surgery was performed with the diagnosis of fascia opening and right Tubo-ovarian abscess and the infectious discharge of the right ovary. Right salpingo-oophorectomy surgery was performed. She was admitted again with the complaint of infectious discharge from the right side of the suture and erythema for one month. She also developed generalized abdominal pain. The patient was, thus, diagnosed with a uterocutaneous fistula and was admitted to the center. She became a trans-abdominal hysterectomy candidate and underwent surgery. Conclusion: One of the important risk factors for the fistula to be formed is an abscess. A few cases have been reported of post-cesarean uterocutaneous fistula in the literature. Surgical treatment associated with medical therapy can be effective in women with multiple cesarian sections. Any infected dehiscence must be radically operated.

Reproductive outcomes after in vitro fertilization in women with cesarean section scar diverticulum: A retrospective study.

Some studies have suggested that cesarean section diverticulum may affect the pregnancy outcomes of assisted reproductive technology through a variety of mechanisms. This study aims to explore whether previous cesarean section and uterine scar diverticulum affect pregnancy outcomes after in vitro fertilization. This retrospective study included 954 infertile women with only one previous delivery who had in vitro fertilization treatment and underwent fresh embryo transplantation for the first time at our center between 2015 and 2019. We first divided the women into two groups by previous vaginal delivery (n = 557) or cesarean section delivery (n = 397), and the latter group included 88 women with cesarean diverticulum and 309 women without cesarean diverticulum. Baseline characteristics were compared and analyzed, and logistic regression analyses were performed to explore the different pregnancy outcomes among the above groups. Although the live birth rate, clinical pregnancy rate, and mean embryo implantation rate after in vitro fertilization were significantly reduced in patients with previous cesarean section (live birth rate: 26.45% vs. 43.99%, adjusted OR: 0.602, CI: 0.447-0.810; clinical pregnancy rate: 35.26% vs. 49.91%, adjusted OR: 0.724, CI: 0.544-0.962; mean embryo implantation rate: 0.227 ± 0.378 vs. 0.243 ± 0.397, adjusted OR: 0.860, CI: 0.514-1.439), there were no significant differences in pregnancy outcomes between the women with cesarean diverticulum and without cesarean diverticulum (p > 0.05) or between the two groups at different ages. The live birth and clinical pregnancy rates in the women with residual muscle thickness ≤2.2 mm or prolonged menstruation were reduced, but the difference was not statistically significant (p > 0.05). This study showed reduced pregnancy and live birth rates after in vitro fertilization in patients with previous cesarean section, while uterine scarring did not adversely affect pregnancy and delivery outcomes after in vitro fertiliazation.

Late registration for ante natal care by pregnant women with previous caesarean section

BackgroundDespite good access to antenatal care services for most women in Botswana, and regular training of health care workers in obstetrics and gynaecology, many pregnant women with previous caesarean section still presented late for antennal care at Letsholathebe II Memorial Hospital (LIIMH), in Maun, Botswana. Presenting late for antenatal care may lead to morbidity and mortality among pregnant women with previous caesarean section, and the babies they are carrying. Knowing the reasons why women with previous caesarean section present late for antenatal care may help in the formulation of interventions that decrease late presentation. Decreasing late presentation for ante natal care among pregnant women with previous caesarean section may decrease morbidity and mortality among these women and their babies.Aim The aim of the study was to explore the reasons why pregnant women with previous caesarean section registered late for ante natal care.SettingThis study was done at Letsholathebe II Memorial Hospital (LIIMH); a district a hospital situated in Maun Botswana.MethodsThis was a descriptive qualitative study. Consenting pregnant women who had a previous caesarean section delivery, were interviewed in the local language, until data saturation. These women presented at LIIMH, Maun, after the 20th week of pregnancy. The interviews were audio recorded, transcribed, translated into English and analysed thematically, using ATLAS-ti software.ResultsThe reasons that were raised by participants for late registration for antenatal care were lack of information, misconception on the appropriate booking time, and not knowing the place for their antenatal care. Participants’ dissatisfaction with the quality of clinic antenatal care, use of alternative antenatal care providers, delayed referral from local clinics, and experience from previous pregnancies were also mentioned as reasons for late registration.Discussion and ConclusionInadequate knowledge of antenatal care, and not knowing the planned place of delivery contributed to delays in registering for antenatal care at LIIMH. Dissatisfaction with antenatal care, and use of alternative antenatal care providers was another important factor. There is a need to keep pregnant women with previous caesarean section well informed about plans for their delivery, and for enlisting the help of alternative ante natal care providers, so as to improve management of pregnant women with previous caesarean section.

Successful Vaginal Delivery after Caesarean Section and its Associated Factors among Women Delivered in the University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia, 2022

Institutional based cross-sectional study was conducted among 409 women who were randomly selected and had one previous cesarean section delivery and underwent trial of labor. Data was analyzed and computed using Stata version 14 Software. Multivariable logistic regression analysis was performed to identify the factors associated with successful vaginal birth after caesarean section. A crude and adjusted odds ratio with a 95% confidence interval was used to interpret the results. A P value of < 0.05 indicated statistically significant results.

Prediction of vaginal birth after cesarean in China.

This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low-transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non-ultrasonographic factors from five hospitals between 2018 and 2019. A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non-ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674-0.764) and 0.774 (95% confident interval 0.712-0.837), respectively. Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.

Clinical Comparison of Anterior or Posterior Placental Location with Placenta Previa and History of Previous Cesarean Section Delivery.

BACKGROUND Placenta previa is defined as a placenta that grows from the anterior or posterior wall of the uterus and covers the cervix. The incidence of placenta previa has been increasing in recent years. It is thought that bleeding is more common during surgery in cases with anterior placenta that is closing the cervix. This study investigated the importance of placental location in pregnant women with placenta previa who had a previous cesarean section. MATERIAL AND METHODS This study covered the period from July 2017 to June 2020. The 116 patients included in the study were divided into 2 groups according to placental location: anterior (group 1) and posterior (group 2). All patients had previously delivered via cesarean section. Operation time, presence of invasion, estimated blood loss during surgery, and transfused erythrocyte volume were evaluated. Medical records were used to access the relevant data. RESULTS The patients in group 1 and group 2 had an average of 2.71 and 2.01 previous cesarean sections, respectively (P=0.002). The placental invasion (percreta) rate was significantly higher in group 1 than in group 2 (65.4 vs 5.3%, P<0.001), as was the estimated blood loss during surgery (790 vs 527 mL, P=0.014). The total erythrocyte suspension was considerably higher in group 1 than in group 2 patients (0.8 vs 0.2, P=0.014), both during and after surgery. CONCLUSIONS In patients with placenta previa, the location of the placenta should always be examined with ultrasonography to allow better preoperative planning.

The effectiveness of preoperative diagnostic methods in predicting intra-abdominal adhesions before repeat cesarean section delivery

This study aimed to evaluate the effectiveness of skin appearance, striae gravidarum severity, and ultrasonographic "sliding sign" in predicting preoperative adhesions before repeat cesarean section delivery on the same patient and find the most useful one. This was a prospective cohort study conducted on pregnant women with a history of cesarean section delivery. Davey's scoring system was used for stria evaluation. The scar was assessed using their visual appearance, and transabdominal ultrasonography was applied to detect sliding sign existence. Surgeons blinded to preoperative assessment graded the severity of intra-abdominal adhesions intraoperatively using Nair's scoring system. Of the 164 pregnant women with at least one previous cesarean section delivery, 73 (44.5%) had filmy or dense intra-abdominal adhesions. Statistically significant association was found between three groups regarding parity, previous cesarean number, scar appearance, total stria score, and sliding sign existence. Negative sliding sign had a likelihood ratio of 4.198 (95%CI 1.178-14.964) for the detection of intra-abdominal adhesions. Stria score and scar appearance were also valuable for detection adhesions with likelihood ratios of 1.518 (95%CI 1.045-2.205) and 2.405 (95%CI 0.851-6.796), respectively. After receiver operator characteristics curve analysis, striae score cutoff value in adhesion prediction was determined as 3.5. Stria score, scar appearance, and sliding sign are all significant predictors for intraperitoneal adhesions, and sliding sign, as an easy-to-apply, inexpensive, useful sonographic marker, is the most effective adhesion predictor before repeat cesarean section delivery compared to other known adhesion markers.

Retrospective analysis of maternal near miss and the applicability of previous caesarean section delivery as a predictor of risk at a tertiary level hospital of India

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Does a Caesarean Section Scar Affect Placental Volume, Vascularity and Localization?

Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age.

ART outcome after euploid frozen embryo transfer is not affected by previous Cesarean section delivery in the absence of intracavitary fluid.

To evaluate the impact of a cesarean section (CS) on the chance of clinical pregnancy and live birth (LB) in frozen embryo transfer (FET) cycles in the setting of euploid embryos and the absence of intracavitary fluid (ICF) as causes of implantation failure were excluded. Retrospective study, including patients with at least one previous CS or at least one previous vaginal delivery, who underwent a euploid FET cycle. A total of 412 euploid embryo transfer cycles had been included. Patients' mean age was 34.5years and 42.48% of patients have had at least one previous CS. A clinical pregnancy was seen in 69.42% and 60.19% of the patients had a LB. Positive pregnancy test, clinical pregnancy, and LB rate were not significantly different between the groups without/with a history of a previous CS (p = 0.6/0.45/0.94, respectively). LB rate was significantly reduced by the presence of mucus on the ET catheter (OR: 0.413; p = 0.010), the BMI (OR: 0.946; p = 0.006), the combined embryo quality (embryo quality fair: OR: 0.444; p = 0.001; embryo quality low: OR: 0.062; p < 0.001), and by the HRT endometrial preparation approach (OR: 0.609; p = 0.023). The possible negative impact of a CS can be overcome when a euploid FET after exclusion of ICF is performed.

The synergistic effects of short inter-pregnancy interval and micronutrients deficiency on third-trimester depression.

ObjectiveTo explore the effect of inter-pregnancy interval (IPI) and micronutrients on depression in the third trimester of pregnancy.Materials and methodsA total of 5,951 eligible pregnant women were included in this single-center retrospective cohort study. Variables with potential effects on third-trimester depression were collected. These variables included: maternal factors [age, pregnancy interval, body mass index (BMI), BMI change, gravidity, native place, education, smoking, and alcohol consumption], previous delivery outcomes [preterm birth, preeclampsia, intrahepatic cholestasis of pregnancy (ICP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), and delivery mode], and micronutrients in early pregnancy (folic acid, 25-hydroxy vitamin D, vitamin B12, calcium, and ferritin). Univariate and multivariate analyses were used to screen the factors affecting the occurrence of depression. Based on these factors, the nomogram model was established. At the same time, the interaction between IPI and micronutrients was verified.ResultsThe incidence of depression in the third trimester of pregnancy was 4.3%. Univariate and multivariate analysis showed that there were five independent risk factors for third-trimester depression: gravidity, previous cesarean section delivery, folic acid, and vitamin D levels in early pregnancy and IPI. According to the multivariate logistic regression analysis, the prediction model and nomogram were established. The prediction cut-offs of the corresponding factors were calculated according to the Youden index. Finally, the synergistic effect of short IPI and micronutrient deficiency was verified.ConclusionThere is a synergistic effect between short IPI and micronutrient deficiency in early pregnancy, which can aggravate the occurrence of depression in late pregnancy.

Maternal and neonatal outcomes among pregnant women with cardiovascular disease in the Philippines: a retrospective cross-sectional study from 2015–2019

Purpose Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy.

Preterm birth and its associated factors among reproductive aged women in sub-Saharan Africa: evidence from the recent demographic and health surveys of sub-Sharan African countries

BackgroundGlobally, preterm birth is the leading cause of neonatal and under-five children mortality. Sub-Saharan African (SSA) accounts for the majority of preterm birth and death following its complications. Despite this, there is limited evidence about the pooled prevalence and associated factors of preterm birth at SSA level using nation-wide representative large dataset. Therefore, this study aimed to determine the pooled prevalence and associated factors of preterm birth among reproductive aged women.MethodsThe recent Demographic and Health Surveys (DHSs) data of 36 SSA countries were used. We included a total weighted sample of 172,774 reproductive-aged women who were giving birth within five years preceding the most recent survey of SSA countries were included in the analysis. We used a multilevel logistic regression model to identify the associated factors of preterm birth in SSA. We considered a statistical significance at a p-value less than 0.05.ResultsIn this study, 5.33% (95% CI: 5.23, 5.44%) of respondents in SSA had delivered preterm baby. Being form eastern Africa, southern Africa, rural area, being educated, substance use, having multiple pregnancy, currently working history, having history of terminated pregnancy, and previous cesarean section delivery, primi-parity, and short birth interval were associated with higher odds of preterm birth among reproductive aged women. However, having better wealth index, being married, wanted pregnancy, and having four or more antenatal care visit were associated with lower odds for a preterm birth among reproductive aged women.ConclusionThe prevalence of preterm birth among reproductive-aged women remains a major public health problem in SSA. Preterm birth was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during intervention to prevent the short-term and long-term consequences of preterm birth.

Case Report of an Undisturbed Ectopic Pregnancy with Very High Human Chorionic Gonadotrophin (β-hCG)

This is a case report of a patient with an undisturbed ectopic pregnancy and very high levels of human chorionic gonadotrophin (β-HCG). The patient presented to the emergency room at 9+1 weeks of gestation with mild abdominal pain and vaginal bleeding. She had an obstetric history of two previous cesarean section deliveries. On presentation, her human chorionic gonadotropin (β-HCG) was measured to be 26,530 mIU/ml, and after 18 hours, the β-HCG level was 25,660 mIU/ml. An ultrasound scan revealed no evidence of intrauterine pregnancy, a left ovarian cyst measuring 2.86 cm x 2.17 cm, and the presence of a mixed mass near the ovary measuring 3.92 cm x3.62 cm. The patient was diagnosed with a left tubal ectopic pregnancy and was taken for an immediate laparoscopy. Intraoperatively, the left tubal ectopic pregnancy was undisturbed and measured about 4-5 cm involving more than half of the fallopian tube. The mixed mass, along with the left fallopian tube, was removed as a whole. Keywords: Abdominal pain, Cesarean Section, Ectopic-pregnancy, Laparoscopy, Tubal pregnancy, Ultrasonography

EFFECT OF ASPIRATION WITH POLICRESULEN COAGULATION OF ISTHMOCELE ON IVF OUTCOME IN INFERTILE PATIENTS UNDERGOING IVF TREATMENT

This study was performed to investigate the effect of aspiration with policresulen coagulation (APOC) of the large isthmocele after previous cesarean section delivery on IVF outcome in infertile women undergoing IVF-ET treatment. A total of 87 consecutive IVF-ET cycles in 87 infertile patients with large isthmocele with residual myometrial thickness (RMT) less than 3mm who underwent IVF-ET between May 2018 and March 2021 was included in this retrospective cohort study. In 45 patients of 87, APOC was performed immediately after oocyte pick-up (OPU) in IVF-ET cycles. Forty-two patients who did not receive APOC were served as controls. In all subjects, GnRH antagonist protocol was used for COS. IVF results and pregnancy outcome were compared between the APOC and control groups. Mean values were expressed as mean±standard deviation (SD). Student’s t-test was used to compare mean values. Chi-square test and Fisher’s exact test were used to compare fraction. Statistical significance was defined as P<0.05. All analyses were performed by using SPSS statistical package for Windows, version 11.0 (SPSS Inc, Chicago, IL). The demographic characteristics of subjects were comparable between the APOC and control groups. Incidence of intracavitary fluid (ICF) on the day of OPU was also similar in the two groups. There were no differences in the two groups with respect to total dose and days of gonadotropins used for COS, and the numbers of oocytes retrieved, mature oocytes retrieved, fertilized oocytes and grade 1 or 2 embryos. Clinical pregnancy rate (CPR) seemed to be higher in the study, but the difference did not achieve the statistical significance (P = .077). However, embryo implantation rate was significantly higher in the APOC group of 28.4% (23/81) compared with 15.0% (12/80) in the control group (P = .040). Miscarriage rate was similar in the two groups. APOC treatment performed immediately after OPU is an effective and safe procedure to increase embryo implantation rates in infertile patients with large isthmocele undergoing IVF-ET.

Association between the Length of Interpregnancy Interval and Pregnancy Outcomes in Women with One Previous Caeserian Section Undergoing a Repeat Caeserian Delivery at Term at Pumwani Maternity Hospital between 2014 and 2018 a Cross-Sectional Study

Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) recommends an Inter-pregnancy Interval (IPI) of at least 24 months to lower the risk of adverse maternal and perinatal outcomes in the subsequent pregnancy. However, whether the recommendation confers obstetric benefits is unclear as there’s paucity of data in low- and medium-income countries (LMIC). The objective was to determine the association between IPI length and maternal and neonatal outcomes in women with one previous caesarian section undergoing a repeat caesarian delivery at term in Pumwani Maternity Hospital between 1st January 2014 and 31st December 2018. A cross-sectional study was done where patients who had delivered via repeat caesarean section at term between 1st January 2014 and 31st December 2018 were evaluated. The files of 625 patients were retrieved and IPI was determined from the time interval between a previous caesarean section delivery and the beginning of the subsequent pregnancy, established from the date of the last normal menstrual period as recorded or extrapolated from an early trimester obstetric scan. The files were allotted to study groups as follows: = 170), 24 - 29 months/intermediate IPI (n = 384), and 60+ months/long IPI (n = 121) and data on sociodemographic/reproductive characteristics and maternal and neonatal outcomes abstracted and uploaded to SPSS (version 21) worksheet. Descriptive, bivariate, and multivariate logistic regression analyses were done and a p-value of 0.05 was considered statistically significant. The demographic and reproductive characteristics were comparable across the three IPI groups. Maternal outcomes such as uterine rupture, post-partum haemorrhage (PPH), blood transfusions, preeclampsia, and maternal mortality were comparable across short, intermediate, and long IPI. Some neonatal outcomes, however, showed evidence of an association with IPI. These were prematurity (p = 0.03) and developing congenital malformations (p = 0.01). Other neonatal outcomes (birth outcomes, birth weight, Apgar at 5, and NBU admission) were similar. In conclusion, maternal outcomes are comparable when the IPI after a repeat caesarean section at term is short, intermediate, and long. Congenital anomalies and premature births should be anticipated when the IPI is long (more than 59 months).

Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study.

Background: The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women’s knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. Methods: Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba’ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into “adequate (total score 6–10)” or “lack of adequate (total score 0–5)” knowledge. Crude and multivariable models were used to identify factors associated with “lack of adequate” knowledge on the mode of delivery and factors associated with CS preference. Results: A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18–24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07–8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06–3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02–1.14), employment (aOR, 1.96, 95% CI, 1.13–3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71–55.73) were associated with a preference towards CS delivery. Conclusion: This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.

Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters.

Purpose Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods Ninety-three patients with an average age of 32.7 years (range, 24–43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.

EFFECT OF AN ISTHMOCELE ON IVF OUTCOME IN INFERTILE PATIENTS UNDERGOING STIMULATED IVF TREATMENT

This study was performed to investigate the effect of an isthmocele after previous cesarean section delivery on IVF outcome in infertile women undergoing IVF in stimulated cycles. Retrospective cohort study. A total of 104 infertile patinets who underwent IVF in controlled ovarian stimulation (COS) cycles between May 2018 and April 2020 was included in this study. Of 104, sixty-one patients had no isthmocele, a cesarean scar (group 1) but forty-three had an existing isthmocele. Twenty-three patients of 43 had a small isthmocele with residual myometrial thickness (RMT) of 3mm or more (group 2) and 20 had a large isthmocele with RMT less than 3mm (group 3). COS results and IVF outcome were compared among the three groups. Analysis of variance (ANOVA) was used to compare the mean values among three groups. Chi-square test and Fisher's exact test were used for the comparisons of fraction. Statistical significance was defined as P<.05. The demographic characteristics of subjects were comparable among the three groups. There were also no differences in the three groups with respect to the number of oocytes retrieved, mature oocytes retrieved, fertilized oocytes and grade 1 or 2 embryos. However, intracavitary fluid (ICF) in the day of oocyte retrieval was more frequently developed in group 3 (large isthmocele group), compared with group 1 or 2 (P = .005 vs group 2, and P < .001 vs group 1). Clinical pregnancy rate (CPR) in group 3 was significantly lower than in group 1 (P = .028) and also lower than in group 2 with a borderline significance (P = .080). Miscarriage rate was similar in three groups. CPR was significantly lower in IVF treatment group with developing ICF than in group without development of ICF (P < .001). Large isthmocele was associated with developing ICF and had an adverse effect on the IVF outcome in infertile patients undergoing IVF in COS cycles.