Previous Cesarean Section Research Articles

Maternal near-miss and mortality associated with being referred: a case control study in Luanda

Abstract Background Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola. Methods A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value <0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI). Results Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89). Conclusions According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting. Key messages • Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola. • Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.

Misoprostol as Oral Solution or Oral Tablet for Induction of Labour (MISOBEST): A Randomised Controlled Non-Inferiority Trial.

To assess if off-label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non-inferiority design. Prospective, randomised, non-inferiority, open-label, blinded endpoint trial. Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023. In all, 874 women, without previous caesarean section, with an unripe cervix and a singleton, cephalic foetus at 37 + 0 to 42 + 0 gestational weeks, with a normal cardiotocography, planned for IOL were included. Women were randomised 1:1 to intervention (25 μg oral solution of misoprostol) or control (25 μg oral tablet of misoprostol) two-hourly for a maximum of eight doses. Subsequent methods of induction followed clinical practice. The primary outcome was vaginal delivery within 24 h tested using non-inferiority testing procedures at a non-inferiority margin of 5 percentage points. Secondary efficacy outcomes were tested for superiority of either treatment. Analyses were by intention-to-treat. There were 207 (47.4%) vaginal deliveries within 24 h for women receiving oral solution and 192 (43.9%) vaginal deliveries within 24 h for women receiving oral tablet, establishing non-inferiority with an absolute risk difference of 3.4% (95% CI -3.2% to 10.0%). Women receiving oral solution required fewer doses to reach active labour than women receiving oral tablet (5.7 vs. 6.1, p = 0.007). There were no significant differences for other secondary or safety outcomes. Off-label oral solution of misoprostol was non-inferior to the licensed oral tablet regarding efficacy of IOL defined as vaginal delivery within 24 h. Clinicaltrials.gov identifier: NCT05424445.

Risk Factor Associated with PAS Disorder and Observation its Management Modalities and Fetomaternal Outcome

Background: Diseases of the placenta accreta spectrum (PAS) have become recognized as a serious and potentially fatal condition due to their increasing prevalence, morbidity, and mortality. Determining the risk factors for PAS illnesses has been the subject of extensive investigation. Choosing the best management strategy for PAS diseases requires thought. Objective: The aim of this study is to assess the risk factor associated with PAS disorder and observation its management modalities and fetomaternal outcome. Methods: The cross-sectional observatinal study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka from18th January 2020 to 17th July 2020. This study comprised 84 people who had been diagnosed with PAS condition. Patients were divided into three groups based on the management strategy that was employed: Group B (n = 40) had a cesarean section (CS) with cervical inversion and ligation of both uterine arteries; group C (n = 16) had a cesarean hysterectomy with the placenta left in place. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, mean ± SD of age was calculated 32.1 ± 3.3 years for Group – A, 31.7 ± 2.2 years for Group – B and 31.4 ± 1.4 years for Group – C (p-value = 0.415) which explains that there was no significant statistical difference between the groups was observed. About 16 (57.1%), 18 (64.3%) and 3 (18.8%) of them had a parity ≥ 3 in Group-A, Group-B and Group-C respectively. 17 (60.7%) in Group-A and 15 (37.7%) in Group-B of them had ≥2 previous CSs. 9 (31.1%), 11 (27.5%) and 5 (31.3%) of them had previous history of placenta previa in Group-A, Group-B and Group-C respectively. About 8 (25.0%) patients in group-A, 12 (28.6%) in group-B and 6 (55.0%) in group-C had the history of previous ...

MRI and placenta accreta: Keys for its interpretation in images, regarding a case

Introduction: Placenta accreta spectrum (PAS) refers to the abnormal adherence of the placental trophoblast to the uterine myometrium. Several conditions are associated with its development. Ultrasound is the imaging modality of choice for antenatal diagnosis. In cases of doubt, magnetic resonance (MR) plays a leading role, due to its high performance, and contributes to surgical planning. The final diagnosis is made in the surgery, with subsequent confirmation by pathology. The objective of this article is to present a case of placenta increta, focused on the imaging findings in magnetic resonance imaging (MRI). Case Report: We present a case of a 35-year-old woman with a history of 2 previous cesarean sections and chronic hypertension, who presented a 23-week pregnancy with obstetric ultrasound showing placenta accreta. An MRI was performed, and it showed signs of placenta accreta, with no evidence of transmural extension to adjacent organs. At 34 weeks, a cesarean section and hysterectomy were performed, with no evidence of bladder invasion. Conclusion: The diagnosis of PAS is made antenatal with ultrasound, but MRI has been used in some cases, with some characteristic features that every radiologist should know.

PERINATAL OUTCOME IN SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN SECTION

Successful vaginal birth has been reported in 60%–80% of cases reported in published studies of women attempting vaginal birth after a previous Cesarean section. The recommended criteria for selecting candidates suitable for VBAC are potentially applicable in tertiary centers in developing countries, but there are many inadequacies in meeting them in our environment. VBAC avoids major abdominal surgery, lowers the women’s risk of postpartum morbidities like fever, blood transfusion, infections, and shorter hospital stay, and encourages earlier breastfeeding and better bonding between mother and neonate. Objectives: To determine the frequency of perinatal outcomes in successful vaginal birth after cesarean section (VBAC). Methods: Descriptive, case series study in the Department of Obstetrics & Gynecology, Lady Reading Hospital, Peshawar from August 2020 to February 2021. A total of 207 pregnant women with singleton pregnancy of cephalic presentation with successful vaginal birth after cesarean of gestational age 37-41 weeks were included. Patients with multiple pregnancies, ruptured uterus, placenta previa, and fetal malpresentation were excluded. After taking informed consent, all women were followed till delivery and perinatal outcome i.e. low birth weight, Apgar score<7 at 1 minute, and NICU admission was noted. Results: The age range in this study was from 18 to 40 years with a mean age of 29.32 ± 4.57 years. The majority of the patients 104 (50.24%) were between 31 to 40 years of age. The mean gestational age was 38.33 ± 1.17 weeks. The mean parity was 2.11 ± 0.82. In my study, the frequency of perinatal outcome in successful vaginal birth after the cesarean section was as follows; low birth weight in 15.94%, APGAR score<7 at 1 minute in 9.67%, and NICU admission in 14.01% neonates. Conclusion: This study concluded that the frequency of perinatal outcome in successful vaginal birth after cesarean section was as follows; low birth weight in 15.94%, APGAR score<7 at 1 minute is 9.67%, and NICU admission in 14.01% neonates.

ОСТРАЯ СПАЕЧНАЯ КИШЕЧНАЯ НЕПРОХОДИМОСТЬ У БЕРЕМЕННОЙ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Acute intestinal obstruction during pregnancy is a rare but extremely dangerous surgical pathology. Despite advances in medical technologies, preoperative diagnosis of acute surgical conditions of the abdominal organs during pregnancy is still imperfect. During pregnancy the clinical picture of the disease and laboratory parameters are nonspecific and variable which causes untimely provision of care and severe complications for both the mother and the fetus. The high incidence of acute intestinal obstruction during pregnancy is due to the adhesive process caused by surgical interventions including caesarean section the rates of which continue to rise steadily. The article presents a clinical case of a patient whose pregnancy was complicated by acute adhesive intestinal obstruction caused by the adhesive process after a previous caesarean section. The authors have noted the importance and necessity of multifield cooperation, timely decision-making both at the stage of diagnostic examination and during treatment, which made it possible to avoid severe complications from both the mother and the fetus.

Potential Risk Factors for Developing Cesarean Scar Pregnancy in Women With a History of Cesarean Section.

Cesarean scar pregnancy (CSP) occurs in 0.2%-0.5% of women with a previous cesarean section globally. Multiple factors influence the development of CSP; however, to date, the critical factors contributing to the development of CSP have not been fully explored due to its relatively low incidence. Moreover, CSP can be clinically categorized into type 1 and type 2 CSP. In this retrospective study with a large sample size, we investigated potential risk factors that could contribute to CSP development. Two hundred-one women diagnosed with CSP, either type 1 or type 2 CSP, and 1700 pregnant women with a history of cesarean section but without CSP diagnosis in subsequent pregnancy were included. Gravidity, previous live birth(s), consecutive cesarean section(s), surgical abortion(s), the interval between the pregnancies, and maternal age were compared between the 2 groups. Gravidity, the number of previous live births, the number of previous consecutive cesarean sections, and the number of surgical abortions were significantly associated with CSP development in women with a past cesarean section. This association was regardless of the subtypes of CSP. Notably, the interval between 2 pregnancies was also significantly associated with CSP development, but this association was only seen in type 2 CSP. However, maternal age was not an independent risk factor for CSP development. Additionally, a higher incidence of CSP was observed in China compared to that reported in the literature. In addition to a previous cesarean section, our study highlights at the number of surgical abortions also contributes to the development of CSP.

Assessment of Risk Factors Associated with Placenta Previa in a Tertiary Health Institution in Southeast Nigeria

Background: Placenta previa is a significant obstetric complication that can lead to adverse maternal and fetal outcomes. Understanding its risk factors is crucial for early diagnosis and management, particularly in healthcare settings in Nigeria. Objective: To assess the risk factors associated with placenta previa among pregnant women in a tertiary health institution in Southeast Nigeria. Materials and Methods: This prospective descriptive study was conducted over two years (January 2021 to December 2022) and included all pregnant women who delivered in the institution during this period. Data were collected using a structured, interviewer-administered questionnaire after obtaining informed consent from participants. Placenta previa was identified through abdominal ultrasonography, and all confirmed cases were managed according to the MacAfee regimen. Descriptive statistics and chi-square tests were used to analyze the data using SPSS version 26. Results: Out of the 8,766 deliveries recorded in the hospital during the period of this study, 94 (1.07%) were diagnosed with placenta previa. Significant associations were found between placenta previa and factors such as advanced maternal age (≥40 years, p=0.041), history of complications during previous pregnancies (p=0.039), previous cesarean section (p=0.009), history of placenta previa (p<0.001), multiple pregnancies (p=0.001), bleeding during pregnancy (p<0.001), and uterine surgeries apart from cesarean sections (p=0.001). Smoking history was also a significant risk factor (p<0.001). Conclusion: The study identified several risk factors for placenta previa, including advanced maternal age, previous cesarean section, history of placenta previa, multiple pregnancies, uterine surgeries, and smoking. These findings highlight the importance of targeted interventions and close monitoring of at-risk pregnant women to reduce complications.

Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

Background/Aims Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes. Methods This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically. Results A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years. Conclusions Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care. Implications for practice Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Current predictors for morbidity regarding choice of birth after a previous caesarean section, show poor predictive value in prediction modelling

IntroductionAfter a previous caesarean section, morbidity in the subsequent delivery in general is considered to depend on the probability of a vaginal birth after caesarean. However counselling could be improved by adding individualized probability of serious morbidity following either trial of labour or elective repeat caesarean section. The objective of this study was to develop prediction models for morbidity for both a repeat caesarean section and a trial of labor for a Dutch population. Material and methodsIn this cohort study, data were joined from three previous studies (SIMPLE 1, SIMPLE 2 and SIMPLE 2-implementation study). A cohort of 2592 women with one previous caesarean section and a singleton pregnancy who delivered ≥37 weeks, without a contraindication for vaginal delivery was formed. Maternal morbidity was defined as postpartum hemorrhage, blood transfusion, uterine rupture, ICU admittance or death. Neonatal morbidity was defined as asphyxia, NICU-admittance or death. Potential predictors for morbidity were chosen based on literature and expert opinion. Logistic regression was used to develop the models. Internal validation was intended using bootstrapping techniques. Main outcome measures were predictors for morbidity and for validation of the model we used the area under the receiver operating characteristic curve for discriminative capacity and calibration for accuracy. ResultsIn 324 out of the 2592 cases (12.7 %) maternal or fetal complications occurred. In general total morbidity was higher in women choosing TOL as compared to ERCS (p < 0.001). The performance of the several developed models was insufficient, the area under the receiver operating characteristic curve did not rise above 0.6. Due to poor model performance, before correction for overfitting, interval validation was not conducted. ConclusionIn this large cohort, developing a Dutch population based prediction model that aimed to improve counselling on the mode of delivery, by predicting individual chances of morbidity for different delivery modes was not possible, due to lack of performance. Further study could be directed to cut off on VBAC success rates to a more general advice regarding the safest mode of delivery.

A successful combined spinal-epidural anesthesia for cesarean section in a patient with neurofibromatosis type 1-associated dural ectasia.

Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking. A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery. Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia.

Reduced Misoprostol Regimen versus Standard Misoprostol Regimen for Induction of Second Trimester Abortion in Patients with Previous Cesarean Section Scar

Reduced Misoprostol Regimen versus Standard Misoprostol Regimen for Induction of Second Trimester Abortion in Patients with Previous Cesarean Section Scar

Effect of Interpregnancy Interval on Pregnancy Outcome in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Interpregnancy interval has a major impact on the maternal and fetal health worldwide. Women with short interpregnancy interval show higher rates of low birth weight and preterm babies. So this study aimed to study the effect of interpregnancy interval on pregnancy outcomes.Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care center after taking ethical approval from Institutional Review Committee (Reference number:229/080/081(6-11)E2). Data from September 1st, 2023 to January 30th, 2024 was collected. All multigravida women with singleton pregnancy after 28 weeks of gestation who delivered in our hospital with previous birth were enrolled in the study. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. The data was entered and analyzed using IBM SPSS Statistics version 26.0Results: Among the women , 31 (3.57%) women had short interpregnancy interval ≤18 months whereas 836 (96.43%) had interpregnancy interval of &gt;18 months. The mean age of the women was 28 years. Previous cesarean section was common indication of cesarean section 27 (87.09%) among women with short interpregnancy interval. These women had higher rates of preterm and low birth weight babies 11(35.58%) &amp; 15(48.38%).Conclusions: Women with short interpregnancy interval ≤18 months had higher preterm births and low birth weight babies. Pregnancy induced hypertension, hypothyroidism and gestational diabetes were increased in women with interpregnancy interval of &gt;18 months.

Factors Associated to the Presence of Isthmocele Diagnosed by Pelvic Ultrasound, Magnetic Resonance Imaging or Diagnostic Hysteroscopy: A Cross-Sectional Study.

We aimed to analyze the prevalence of isthmocele and factors associated with its onset within a cohort of women with previous history of cesarean section. A cross-sectional study with 90 women assessed from 2020 to 2022. Isthmocele was a composite variable diagnosed by transvaginal ultrasound (TVUS), magnetic resonance imaging (MRI) and/or diagnostic hysteroscopy (DxHys) and were asked about clinical symptoms, sociodemographic and obstetrical history and quality of life by the WHO-QOL questionnaire. Univariate and multivariate analysis (odds ratio (OR) plus 95% confidence intervals-CI) were performed to seek factors associated with the presence of isthmocele (5% significance level).The prevalence of isthmocele after combining MRI, TVUS and DxHys was 63.3% (n = 57). Women with isthmocele presented a higher body mass index (BMI) measured during delivery (32.70 ± 6.07 vs. 28.28 ± 9.86kg/m2;p < 0.05) than women without isthmocele. Other sociodemographic variables, obstetrical history and WHO-QOL subdomains did not differ between groups. Within women with isthmocele, the residual myometrial mantle had an average of 4.97 ± 1.57cm. Uterine volume was higher in the isthmocele group (103.95 vs. 81.34 cm3; p = 0.08), but with no statistical difference. Multivariate analysis (logistic regression) has reported that the factors associated with isthmocele were: higher BMI during delivery (aOR = 1.26[1.07-1.49];p < 0.05); longer interpartum interval (aOR = 1.22[1.03-1.46];p = 0.02) and presence of more than two cesarean sections (aOR = 2.16[1.16-4.01];p = 0.02). We concluded that a high prevalence of isthmocele was found. Women with previous cesarean section, with higher BMI during delivery and longer interdelivery interval were risk factors for the presence of isthmocele.

Low placenta at the mid trimester anomaly scan—A cause for concern?

AbstractObjectiveThis study was aimed to assess the predictive validity of internal os distance (IOD) in mid‐trimester scan for the prediction of third‐trimester low‐positioned placenta, and to define a cut‐off of IOD at which third‐trimester low‐positioned placenta could be identified, see the association of placental site (anterior/posterior), previous history of cesarean section with abnormal location of placenta in third trimester and see the maternal and neonatal outcomes.MethodsIt was a prospective cohort study of women with low‐positioned placenta (IOD &lt; 20 mm) at mid‐trimester anomaly scan followed up in third trimester till birth. Relative risks for a low‐positioned placenta in the third‐trimester were calculated for women with posterior versus anterior, low‐lying placenta versus placenta previa and positive versus negative history of cesarean section. Multilevel likelihood ratios and corresponding ROC curves for different ranges of IOD were calculated.ResultsWomen with posterior placenta had a high risk of low positioned placenta compared to anterior placenta (9.28% vs. 0.74%); RR 1.45, similarly women with placenta previa had high risk compared to low lying placenta (68.57% vs. 1.69%); RR 6.51, so did the women with previous cesarean section (9.41% vs. 5.87%); RR 1.47.Conclusions93.42% placenta which were low positioned in mid trimester were normally situated in third trimester. The cut‐off for IOD in anterior placenta was −40 mm and in posterior placenta was 14.3 mm. IOD measurement and interpretation seems promising.

Retrospective study on the outcomes and satisfaction with endometrial ablation by bipolar energy (NovaSure®) for the treatment of heavy menstrual bleeding.

To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes. Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain. A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; n = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, n = 131 out of 316). The majority of participants had no complications (95.5%; n = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (n = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (n = 221 out of 257) were satisfied with the procedure. Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CSmay slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.

Risk Factors for Failure of Second-Trimester Termination with Misoprostol as a Single Agent.

Background: Understanding the potential risk factors for failure of pregnancy termination is crucial for informed clinical decision making. Such insights can assist clinicians in adjusting the dosage or route of various regimens, as well as in counseling patients and predicting the likelihood of successful outcomes. However, research on these risk factors has been limited, and existing studies have yielded inconsistent results. To address this gap, we conducted a study with a large sample size, focusing on identifying the potential risk factors for failure of second-trimester termination using misoprostol as a single agent, specifically between 14 and 28 weeks of gestation. Methods: A secondary analysis based on a database of second-trimester terminations was conducted. The inclusion criteria were a singleton pregnancy, gestational age between 14 and 28 weeks, an unfavorable cervix, no spontaneous labor pain, intact membranes, and termination with misoprostol alone. Potential risk factors for failure of termination, defined as no abortion within 48 h, were analyzed using univariate and multivariate analyses. Results: A total of 1094 cases were included in the analysis, consisting of 991 successful cases and 103 (9.4%) cases of failure. The significant risk factors for failure of termination included early gestational age, live fetuses, sublingual regimen of 400 mcg every 6 h, and high maternal pre-pregnancy BMI. Previous cesarean sections and lower Bishop scores tended to increase the risk but did not reach a significant level. Conclusions: Second-trimester termination with misoprostol as a single agent was highly effective, with a failure rate of 9.4%. The risk factors for failure included gestational age, fetal viability, misoprostol regimen, and maternal pre-pregnancy BMI, suggesting that these factors should be taken into consideration for second-trimester terminations with misoprostol.

Prediction of Preoperative Cesarean Scar Dehiscence by Using 2D Ultrasound in Pregnant Women with Previous Cesarean Section

Prediction of Preoperative Cesarean Scar Dehiscence by Using 2D Ultrasound in Pregnant Women with Previous Cesarean Section

Bladder Endometriosis: Symptoms and Pregnancy Outcomes

ObjectiveTo investigate the clinical features of bladder endometriosis and factors associated with urinary symptoms, pregnancy outcomes, and long-term effects of symptom relief and recurrence. DesignA single-center retrospective cohort study. SettingA tertiary referral hospital. ParticipantsForty-seven patients who were surgically confirmed to have bladder endometriosis at Peking Union Medical College Hospital between January 2012 and December 2023 were included in this study. InterventionsA retrospective study of the clinical and pathological features and reproductive outcomes in patients with bladder endometriosis. Measurements and Main ResultsAmong 47 patients with bladder endometriosis, 27 (57.4%) presented with urinary symptoms, including urinary frequency, urgency, dysuria, and hematuria. Patients with urinary symptoms were more likely to have previous cesarean sections (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.1–19.2, p = .032) and experience dysmenorrhea compared to those without (p = .008, OR 5.3, 95% CI 1.5–18.8). Anterior compartment obliteration was another factor associated with urinary symptoms (OR 7.2, 95% CI 1.3–40.4, p = .016). Bladder lesions located within 1 cm of the ureteral orifice (OR 7.2, 95% CI 1.3–40.4, p = .020) and the deeper invasive layer of lesions (mucosal layer, OR 6.1, 95% CI 1.4–25.8, p = .009) were also found to be associated with symptoms. Regarding reproductive outcomes, 12 patients desired to conceive. Of the patients who desired pregnancy, 66.7% achieved pregnancy; 5 spontaneously and 3 after IVF treatment. The miscarriage rate among patients with bladder endometriosis was 25.0% in the age range of 27–40 years. Additionally, all patients experienced symptom relief after one year of follow-up. Only two patients experienced bladder endometriosis recurrence. ConclusionsPrevious cesarean section, dysmenorrhea, anterior compartment obliteration, lesion in the trigone, and mucosal layer invasion were identified as factors associated with urinary symptoms. Although some patients conceived successfully after surgery, disentangling the independent effect of bladder endometriosis on fertility remains challenging.

Cook’s balloon versus dinoprostone for Labour induction of term pregnancies with fetal GROWth restriction: study protocol for a randomised controlled trial in tertiary maternity hospitals in Spain (COLIGROW study)

IntroductionFetal growth restriction (FGR) affects about 3%–5% of term pregnancies. If prenatally detected and anterograde umbilical artery flow is preserved (stage I), it is recommended to deliver at term (≥...