Previous Delivery Research Articles

Complex umbilical cord entanglement: A case report

Background: Complex umbilical cord entanglement occurs less frequently and is associated with an increased risk of adverse perinatal outcomes. It is associated with umbilical artery pH and base excess levels that are significantly unfavorable, higher incidence of nonreassuring fetal heart rate, meconium-stained amniotic fluid, neonatal intensive care unit admissions, emergency cesarean section, and stillbirth. Case presentation: A 44-year-old para 2+0 gravida 3, with 2 previous cesarean delivery scars at 35 weeks presented with a history of reduced fetal movements for 24 hours. She had attended two antenatal care visits. Her blood group was A, rhesus negative, with hemoglobin levels of 11.2 g/dl, and normal platelets. Urinalysis and serology for HIV, hepatitis B, and Venereal Disease Research Laboratory test were nonreactive. She had received anti-D prophylaxis after her previous deliveries. An urgent obstetric ultrasound scan showed features consistent with intrauterine fetal death. Her coagulation profile was within the normal range. She was admitted for hysterotomy. Intraoperatively, a fresh stillborn baby boy was extracted with a cord around the neck tightly twice and entangled around the trunk. Conclusion: Complex umbilical cord entanglement occurs less frequently and associated with an increased risk of adverse perinatal outcomes. The risk of adverse perinatal outcomes increases with ≥3 loops of the umbilical cord. It is important to look out for cord entanglement antenatally by ultrasonography, particularly when assessing cases of decreased fetal movements.

Statement of Retraction [Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery

Statement of Retraction [Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery

Factors influencing the use of epidural labor analgesia: a cross-sectional survey analysis.

This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA). This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis. Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively. The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers. This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020.

Respectful maternity care at caesarean delivery: Experiences of mothers in a primary referral hospital in Ghana

AbstractBackgroundRespectful, dignified care is a human right for all women that impacts skilled birth attendance and outcomes. This study aimed to assess the prevalence of respectful maternity care (RMC) provided at caesarean deliveries in a Ghanaian referral hospital and determine associated factors influencing care provision. We sought to elucidate RMC prevalence and drivers specific to the caesarean experience, to promote rights‐based, patient‐centred caesarean delivery care.MethodsA cross‐sectional study was conducted from June to November 2022, among women who delivered via caesarean section at the hospital. Interviews of participants were conducted using structured questionnaires, capturing respondents' sociodemographic and obstetric features and perceptions of RMC. Quantitative data were summarised using means, medians, frequencies and proportions. Bivariable and multivariable logistic regression models were employed to determine factors associated with RMC at 95% confidence interval (CI) and a p &lt; 0.05.ResultsA total of 308 women were included in the study. The mean age of mothers was 29.9 (±6.8) years. Of the mothers, 67.9% (95% CI: 62.3, 73.0) received RMC and 32.1% reported disrespectful and abusive care. Several factors were associated with higher likelihood of receiving RMC at caesarean delivery, including being married, adjusted odds ratio (aOR) 2.45 (95% CI: 1.17, 5.12), having average monthly income between Ghana cedis 501 and 1500, aOR = 1.94 (95% CI: 1.07, 3.50), having a previous delivery history of spontaneous vaginal delivery only, aOR 2.04 (95% CI: 1.02, 4.08) and receiving anaesthesia from a male anaesthetist, aOR 2.04 (95% CI: 1.22, 3.42).ConclusionThough the majority of women at caesarean delivery received RMC, close to one‐third may attribute a negative caesarean birth experience to disrespectful care. Respectful and abusive‐free care at service delivery should thus be emphasised for healthcare givers and form part of antenatal education.

Study of Macrosomic Deliveries in the Gynaecology and Obstetrics Department of the "Major Moussa Diakite" Reference Health Center in Kati, Koulikoro, Republic of Mali

The delivery of a macrosomic baby remains a concern for obstetricians and neonatologists, especially when the delivery is vaginal, because of the risk of maternal and perinatal complications. The aim of this article is to study macrosomic deliveries in the gynaecology and obstetrics department of the Kati reference health center. Method: This was a prospective, cross-sectional study which ran from 1 November 2020 to 31 October 2022, a period of 24 months. It concerned all deliveries in which the birth weight of the newborn was greater than or equal to 4000 grams, excluding cases of foetal malformations. Results: Out of a total of 4676 deliveries, we recorded 127 cases of macrosomia, a frequency of 2.7%. The average age of the women was 28.5 years, ranging from 16 to 47 years. The main risk factors identified were high multiparity (29.1%), maternal obesity (28.4%), overdue delivery (19.7%), previous delivery with the presentation was cephalic in 93.7% of cases, and delivery was by vaginal route in 63.8% of cases, compared with caesarean section in 36.2%. Maternal complications were dominated by perineal tears in thirteen cases (10.2%), cervical tears in two cases (1.6%), endometritis in two cases (1.6%), vaginal tears in one case (0.8) and haemorrhage during delivery in one case (0.8%). However, no complications were found in 108 out of 127 deliveries (85%). The Apgar score was less than eight at 1 minute in 12.6% of newborns. We observed serosanguineous hump (8.7%), brachial plexus paralysis (4.7%), clavicle fracture (1.6%) and early neonatal death (2.4%) due to neonatal distress. Conclusion: Macrosomic delivery carries very real risks, and the indications for vaginal delivery must be restricted in order to improve maternal and foetal prognosis.

Effect of prior cesarean delivery on the outcomes of intracytoplasmic sperm injection.

This study was conducted to investigate the impact of previous delivery mode on pregnancy outcomes in patients with secondary infertility after frozen-thawed embryo transfer. This prospective observational study included 140 patients experiencing secondary infertility. Of these, 70 patients had a previous cesarean delivery (CD), while the remaining 70 patients had a previous normal vaginal delivery (NVD). The primary outcome was the implantation rate. The secondary outcomes included rates of clinical pregnancy, chemical pregnancy, miscarriage, and ectopic pregnancy. The comparison of all fertility outcomes between the two groups revealed no statistically significant differences. The implantation rate was 40.4% in the CD group and 41.7% in the NVD group (p=0.842). The clinical pregnancy rate was 50% in the CD group and 49.3% in the NVD group (p=0.932), while the chemical pregnancy rate was 14.6% in the CD group and 19% in the NVD group (p=0.591). The miscarriage rates in the CD and NVD groups were 20% and 17.6%, respectively (p=0.803). One case of tubal ectopic pregnancy occurred in the NVD group (1.4%). The mode of prior delivery did not significantly impact pregnancy outcomes following frozen-thawed embryo transfer.

Unplanned cesarean sections in advanced maternal age: Apredictive model.

As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40-44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72-0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.

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.

Pregnancy Outcomes in Diabetic Mothers with Controlled Glycemia: A Case-Control Study

Background: Overt Diabetes mellitus and Gestational diabetes mellitus (GDM) can complicate pregnancy. Early detection and management of the disease should be done to ensure better maternal and foetal outcomes. Our goal is to compare treatment-controlled diabetic women with non-diabetic women to evaluate the pregnancy-related unfavourable outcomes. Methods and Materials: This is a single-centre case-control study with women, from Nellore, Andhra Pradesh, who gave birth between September 2022 and February 2023. A total of 144 patients, including 72 women with diabetes and controlled glycemia (case group, n=72), were compared with non-diabetic women (control group, n=72). Various pregnancy-related outcomes were observed. The student t-test and SPSS were used for statistical analysis to compare Results: Average ages were 24±4.9 years and 27.83±6.24 years in controls and cases, respectively. Mean pregnancy duration was 268.15±7.1 days in controls and 257.1±31.2 days in cases. The cases had a mean HbA1C of 6.05%, indicating controlled levels. Caesarean births were observed in 75% of cases and 51.3% of controls. While macrosomia (&gt;4 kg) was not observed, 25% of cases had low birth weight (&lt;2.5 kg). Family history, gravidity, consanguinity, newborn sex, APGAR score, nuchal cord, asphyxia, and need for respiratory support did not significantly differ between the cases and controls. However, there was a significant difference (p&lt;0.05) in the gestation period, previous neonatal loss, type of previous deliveries, caesarean delivery, baby weight, hyperbilirubinemia, and present neonatal loss between diabetic mothers and non-diabetic mothers. Conclusion: A well-managed chronic hyperglycaemia was thought to prevent multiple pregnancy-related problems for both the mother and the baby. This study aimed to investigate this point. Though many complications were avoided with controlled glycemia in our study, complications such as caesarean deliveries, preterm births, low birth weight, hyperbilirubinemia, and neonatal loss were more prevalent in cases. This highlights the need for further research, especially in understanding and possibly intensifying glycaemic goals for diabetic mothers.

Prevalence and risk factors of detectable HIV viral load among pregnant women with HIV infection seeking antenatal care in Southern Malawi

ABSTRACT We evaluated detectable viral load (VL) in pregnant women established on antiretroviral therapy (ART) for at least 6 months before conception and those self-reported as ART naïve at first antenatal care (ANC) at two government clinics in Southern Malawi. We used logistic regression to identify the predictors of detectable viral load (VL), defined as any measure greater than 400 copies/ml. Of 816 women, 67.9% were established on ART and 32.1% self-reported as ART naïve. Among women established on ART, 10.8% had detectable VL and 9.9% had VL >1000 copies/ml (WHO criteria for virological failure). In adjusted analysis, among women established on ART, virological failure was associated with younger age (p = .02), “being single/widowed” (p = 0.001) and no previous deliveries (p = .05). One fifth of women who reported to be ART-naive were found to have an undetectable VL at first ANC. None of the demographic factors could significantly differentiate those with high versus low VL in the ART-naïve sub-sample. In this cohort, approximately 90% of women who had initiated ART prior to conception had an undetectable VL at first ANC. This demonstrates good success of the ART program but identifies high risk populations that require additional support.

Evaluation of the efficacy of labor induction with vaginal misoprostol in a low-risk pregnant women population.

The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10-0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13-10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.

Prevalence and Risk Factors of Postpartum Urinary Incontinence in Southern Saudi Arabia: A Cross-sectional Study

Abstract Background: Besides knowing the prevalence of urinary incontinence (UI), it is also vital to know its risk factors and how many patients will seek treatment. UI affects women’s quality of life considerably, but the severity and impact on quality of life differ significantly. Postpartum urinary incontinence (p-UI) reported a wide range ranging from 3% to 40%. It is essential to estimate the prevalence of postpartum incontinence accurately. Methods: We conducted a cross-sectional study of consented females of childbearing age with previous delivery and complaints of p-UI from August to December 2022. Experts developed a questionnaire form after a literature review of similar articles. Data have been collected from attendants of obstetrics and gynecology departments at three leading hospitals in the region after obtaining consent for direct interviews and answering the questionnaire. Results: One hundred and seventy-six females with UI agreed to be included in the study. Participants age ranged from 18 to 50 years old, with a mean of 32.1 ± 6.8 years. Of 103 (58.5%) had previous 1–3 deliveries and 33 (18.8%) had previous deliveries of 6 times or more. The most reported type of delivery was normal vaginal delivery (NVD) among 115 (65.3%), whereas 24 (13.6%) had both NVD and cesarean section. Exact 44.3% of the females complained of urinary frequency. Furthermore, 37.5% felt an urgent need to empty the bladder, and 35.2% had frequent lower abdomen pain. Urgency was reported by 34.1% of the females, and 26.7% complained of experiencing a minimal amount of urinary incontinence (urine drops). Conclusions: The prevalence of p-UI about one-third of the participants in southern Saudi Arabia with mixed UI was the most common type. Moreover, old age, multiparity, and high BMI were significant risk factors.

Factors associated with the intention to use maternity waiting homes among pregnant women in North Ethiopia.

Maternity waiting homes are residential facilities, located near a qualified healthcare facility, where pregnant women can await their delivery and be transferred to a nearby healthcare facility shortly before delivery, or earlier if complications arise. Although evidence has shown that maternity waiting homes reduce maternal and neonatal mortality, there is limited information about factors associated with the intention to use maternity waiting homes in the study area. Therefore, the aim of this study was to identify factors associated with intention to use maternity waiting homes among pregnant women. The study used a community-based cross-sectional study design. Simple random sampling was used to select 399 pregnant women. Data were collected using an interviewer-administered pre-tested structured questionnaire.A binary and multivariate logistic regression analysis was performed. Two hundred and eighty (70.2%) women indicated they intended to use a maternity waiting home during their current pregnancy. Participants' educational status, having experienced a previous institutional delivery, the affordability of food while staying at the maternity waiting home, placing a burden on their attendant, having children in the household who can be cared for by the community or family during the woman's absence, and having household chores covered by their family/community were the factors associated with the intention to use a maternity waiting home. Relatively few respondents intended to use maternity waiting homes. Empowering women and giving them agency by ensuring their needs are met are important measures necessary to increase the use of maternity waiting homes.

Істміко-цервікальна недостатність після вчасних пологів - що пішло не так?

Premature birth is a serious global medical problem. About 15 million premature babies are born annually in the world, of which 1 million dies. Spontaneous premature birth is a cause of 40-45% of all premature births. Cervical insufficiency (CI) is a significant risk factor for spontaneous premature birth. Purpose - to identify the risk factors for the development of CI in patients with a history of full-term pregnancies to draw attention to the problem of underdiagnosis of hidden obstetric injuries. Materials and methods. During 2021 – June 2023, a retrospective cohort study was conducted in the municipal non-profit enterprise “Kyiv Perinatal Center”, within which 140 patients were analyzed. The study group includes 70 patients who have a history of at least one full-term pregnancy, and who had a diagnosis of CI during the last pregnancy. The control group consisted of patients who had 2 or more pregnancies, during which they were not diagnosed with CI. Results. The odds of developing CI during the next pregnancy increased compared with the control group in the presence of the following: rapid delivery - up to ≈4:1; prolonged second stage of labour - up to ≈6.5:1; cervical surgery with cervical dilatation - up to ≈4.7:1; cervical surgery without cervical dilatation - up to ≈4.1:1. Previous spontaneous preterm delivery was not found to be a predictor of CI development at subsequent pregnancies. Conclusions. The results show that patients with precipitous delivery and surgical manipulations on the cervix in history have at least 4 times higher the risk of CI development after timely childbirth, and with a prolonged second period of childbirth - have 6.5 times higher risk. It should be noted that statistically significant differences were not found in patients who had spontaneous preterm delivery. We also postulate that such data indicate two possible phenotypes of the CI: one is of traumatic genesis, and the second is of congenital tendency of the cervix to weakness, which can first manifest in the form of precipitous childbirth, and subsequently manifest in the form of CI. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

Analysis of indications of caesarean section: A retrospective study in a tertiary care hospital, to curb the rising caesarean section rate

OBJECTIVE: To examine the indications leading to the overall escalation of Caesarean Section(CS) rate in our population and to put forward strategies/interventions where possible practically to curb the escalating rates of CS in a tertiary care hospital. MATERIAL AND METHODS: This Retrospective Cross-sectional study was conducted in obstetrics department of Lady Reading Hospital Peshawar, for a period of 1 year from January 2021 till December 2021. The data was collected from hospital’s clinical records of the women who had CS delivery during the study period. Required information was entered into a structured Proforma. Data was analyzed on SPSS version 21. RESULTS: During the study period n=7376 women delivered in the obstetrics unit A, of Lady Reading Hospital. Out of these n=1679(22.76%) were Caesarean Sections. The number of Primary CS were n=1021(60.81%) while n=658(39.18%) were repeat CS. It was found that most of the CS n=1066(63.49%) were Emergency CS while n=613(36.51%) were Elective CS. The most common indication for CS was Repeat CS in women with history of previous CS deliveries n=658 (39.19%).The 2nd most common indication was fetal distress n=302(18.04%) followed by Labour progress disorders n=235(13.99%). CONCLUSION: Majority of the women who underwent CS had the history of previous CS deliveries. It is the need of the day to educate the obstetricians and counsel/encourage women in antenatal period regarding the safety of procedures like externat cephalic version (ECV), trial of labour after caesarean section (TOLAC)and vaginal birth after caesarean section (VBAC), to reduce repeat CS in our setup.procedures like External Cephalic Version (ECV), Trail of Labour after previous Caesarean-Section (TOLAC) and Vaginal Birth after previous Caesarean Section (VBAC), if we want to reduce repeat CS in our setup. Moreover, CTG should be used only in high risk pregnancies/labours. Furthermore, adherence to WHO Labour Care Guide and skills and drills for reviving instrumental delivery in carefully selected cases may curb the escalating rate of CS.

Determinants of late initiation for Antenatal Care follow-up among pregnant mothers attending public health centers at Jimma Town, South West Ethiopia, 2021: unmatched case-control study

Background: The World Health Organization recommends that a woman without complications should have at least four antenatal care visits, the first of which should take place during the first trimester (not &gt; 16 weeks). But a high proportion of pregnant women in most developing countries attended the first antenatal care at a late time. In Ethiopia, the magnitude of late antenatal care follow-up initiation is 64%, and in the study area, it is 68.7%. However, the determinants of the problem were not identified, particularly in the study area. Objective: To identify determinants of late antenatal care initiation among pregnant women attending antenatal care in public health centers in Jimma Town, South West Ethiopia, 2021. Methods: A facility-based unmatched case control study was conducted from May 1–30. The cases (n = 177) were mothers who attended their first antenatal care visit at &gt;= 16 weeks of gestational age, and the controls (n = 177) were mothers who attended their first antenatal care visit at &lt;16 weeks of gestational age during the data collection period. Data was collected through face-to-face interviews using a pre-tested, structured questionnaire. Descriptive and summary statistics were done. Bivariate and multivariable logistic regression analysis was done using SPSS version 21.0 to identify candidate variables at P-value &lt;0.25 and determinants of late antenatal care initiation at P-value &lt;0.05, respectively. Results: The current study identified that age &gt; 25 years (AOR = 2.623, 95% CI 1.059– 6.496), poor knowledge about antenatal care (AOR = 3.856, 95% CI 1.266–11.750), lack of history of abortion (AOR = 3.326, 95% CI 1.082–10.224), place of previous delivery (AOR = 3.926, 95% CI 1.023–15.063), recognizing pregnancy through missed periods (AOR = 3.631, 95% CI 1.520–8.674), pregnancy-related pain (AOR = 3.499, 95% CI 1.423–8.603), and lack of family support (AOR = 2.647, 95% CI 1.092–6.415) were determinants of late antenatal care initiation. Conclusion: Age &gt; 25 years, poor knowledge about antenatal care, lack of history of abortion, place of previous delivery, recognizing pregnancy through missed period, pregnancy related pain, and lack of family support during antenatal care booking were determinants of late antenatal care initiation. Health facilities and respective health care providers should provide health education at the facility level regularly, with due attention to late antenatal care initiation

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

Homozygous missense variant F12 (Gly506Asp) associated with severe factor XII deficiency: a case report

BackgroundFactor XII deficiency can be related to either homozygous or compound heterozygous pathogenic variants in the F12 gene. The disease is commonly known as Hageman trait and is inherited in both autosomal recessive or dominant patterns. Clinically, factor XII deficiency is not associated with bleeding but conversely has been linked to thrombotic events, recurrent pregnancy loss, and hereditary angioedema. Molecular data of F12 deficiency are scarce and have revealed varying results between cases. However, most of the reported variants are missense mutations, gross deletions, or small insertion. Factor XII deficiency has been reported in the Saudi population in several studies, either as isolated case reports or included within the studies of rare bleeding factors deficiency. However, molecular data are lacking as no case report of genetic studies related to factor XII deficiency has been published in our local population, to the best of our knowledge.Case reportHerein we describe a homozygous missense variant involving exon 12 within F12 gene (5:176,830,269 G>A; p.Gly506Asp) in a 36-year-old Saudi multiparous female referred from the surgical clinic with significantly high activated partial thromboplastin time during preoperative assessment for sleeve gastrectomy. The patient had no history of bleeding episodes during the previous deliveries nor any tooth extractions. She had single event of spontaneous abortion during the 15th week of gestation without any bleeding complication. There was no history of thrombosis or skin manifestations, and she was not taking any medicines. There was no family history of bleeding or thrombosis. Family history revealed consanguinity as the parents are first-degree cousins. Physical examination was unremarkable. Upon investigation, the prolonged activated partial thromboplastin time was fully corrected by a 1:1 mixing study with normal pool plasma while lupus anticoagulant tests were negative. Factor assays and von Willebrand factor tests are all within normal ranges except for factor XII, which was severely deficient. A homozygous missense variant involving exon 12 within F12 gene (5:176,830,269 G>A; p.Gly506Asp) was identified.ConclusionF12 (5:176,830,269 G>A; p.Gly506Asp) variant is likely to be a pathogenic variant among homozygous factor XII-deficient patients. Genetic counseling and management of the patients and families should be based on clinical evaluation.

Chronic intermittent convection-enhanced delivery of vigabatrin to the bilateral subthalamic nucleus in an acute rat seizure model

Targeted intracerebral drug delivery is an attractive experimental approach for the treatment of drug-resistant epilepsies. In this regard, the subthalamic nucleus (STN) represents a focus-independent target involved in the remote modulation and propagation of seizure activity. Indeed, acute and chronic pharmacological inhibition of the STN with vigabatrin (VGB), an irreversible inhibitor of GABA transaminase, has been shown to produce antiseizure effects. This effect, however, is lost over time as tolerance develops with chronic, continuous intracerebral pharmacotherapy. Here we investigated the antiseizure effects of chronic intermittent intra-STN convection-enhanced delivery of VGB in an acute rat seizure model focusing on circumventing tolerance development and preventing adverse effects. Timed intravenous pentylenetetrazol (PTZ) seizure threshold testing was conducted before and after implantation of subcutaneous drug pumps and bilateral intra-STN cannulas. Drug pumps infused vehicle or VGB twice daily (0.4 µg) or once weekly (2.5 µg, 5 µg) over three weeks. Putative adverse effects were evaluated and found to be prevented by intermittent compared to previous continuous VGB delivery. Clonic seizure thresholds were more clearly raised by intra-STN VGB compared to myoclonic twitch. Both twice daily and once weekly intra-STN VGB significantly elevated clonic seizure thresholds depending on dose and time point, with responder rates of up to 100% observed at tolerable doses. However, tolerance could not be completely avoided, as tolerance rates of 40–75% were observed with chronic VGB treatment. Results indicate that the extent of tolerance development after intermittent intra-STN VGB delivery varies depending on infusion dose and regimen.

#276 : Impact of Previous Cesarean Delivery on Pregnancy and Neonatal Outcomes of Subsequent In Vitro Fertilization/Intracytoplasmic Sperm Microinjection and Single Frozen-Thawed Embryo Transfer

Background and Aims: Cesarean delivery (CD) rates continue to rise worldwide. Prior studies have indicated that CD is associated with not only various gynaecological symptoms and obstetric complications but also lower probability of subsequent fertility. However, the recognition about impact of CD on clinical outcomes in subsequent IVF/ICSI-FET is very limited. The purpose was to investigate the effects of previous CD on pregnancy and neonatal outcomes in single frozen-thawed embryo transfer (FET) cycles so that women with a previous cesarean delivery can be given detailed fertility counseling during the ART process. Methods: This is a large retrospective cohort study including a total of 5,750 patients who desired to transfer single vitrified-thawed blastocyst from the same oocyte retrieval cycle as their last live birth between January 2011 and January 2021 in a center for reproductive medicine in Shandong, China, comprising FET cycles of 3,853 previous single CD and 1,897 previous single vaginal delivery (VD). Results: Women with a previous CD had significantly lower rates of biochemical pregnancy (64.52% vs. 71.48% before propensity score matching (PSM), P&lt;0.001; and 65.58% vs. 71.49% after PSM, P&lt;0.001), clinical pregnancy (58.16% vs. 65.79% before PSM, P&lt;0.001; and 59.22% vs. 66.17% after PSM, P&lt;0.001) and live birth (48.17% vs. 55.82% before PSM, P&lt;0.001; and 49.29% vs. 56.10% after PSM, P&lt;0.001) than those with a previous VD. Meanwhile, the CD rate was significantly higher in the CD group (97.85% vs. 18.53% before PSM, P&lt;0.001; and 98.02% vs. 20.51% after PSM, P&lt;0.001). The rates of multiple pregnancy, miscarriage, ectopic pregnancy, multiple live birth, labor complications and preterm and neonatal outcomes were comparable between the two groups. Conclusion: Compared to VD, a previous CD is associated with a significant reduction in the rates of biochemical pregnancy, clinical pregnancy and live birth in patients undergoing subsequent single frozen-thawed blastocyst transfer.