Primary Cesarean Research Articles

Comparing adverse maternal and perinatal outcomes in primary caesarean delivery during first versus second-stage of labour in Kenya: An institution-based cohort study.

As caesarean delivery rates continue to increase globally, so are the number of second-stage caesarean deliveries. Second-stage caesareans may carry additional risk of complications for both the mother and fetus owing to fetal head impaction into the maternal pelvis and manipulations required for delivery. So far, data on this procedure's outcomes from low resource countries are limited. To compare adverse maternal and perinatal outcomes between second-stage and first-stage of labour intrapartum primary caesarean deliveries over 12 months at a tertiary referral obstetric hospital in Kenya. In a hospital-based cohort study, 222 women with singleton, cephalic presenting fetuses at term gestation who had intrapartum primary caesarean delivery during active labour were recruited post-partum. Second-stage caesarean deliveries (73) were compared to 149 first-stage caesarean deliveries. The proportion of caesarean deliveries in the second-stage of labour was estimated and the adverse maternal and perinatal outcomes were compared. The study was conducted from August 2021 to July 2022 at the Moi Teaching and Referral Hospital, Eldoret. The proportion of second-stage caesarean deliveries among intrapartum primary caesarean deliveries was 4.3% [95% CI: 2.9% - 4.7%]. Compared to first-stage caesarean deliveries, second-stage caesarean deliveries had a significantly higher risk of adverse maternal outcomes (RR 3.272, 95% CI 2.28-4.71, P < 0.001), including intraoperative trauma, atony, blood transfusion, and a postoperative hospital stay of more than three days. Additionally, there was a higher risk of adverse perinatal outcomes (RR 2.748, 95% CI 2.45-4.50, P < 0.001), including increased risk of a 5-min APGAR ≤3, admission to NBU, and neonatal death. An increased risk of adverse maternal and perinatal outcomes is associated with primary second-stage caesarean deliveries compared to primary first-stage caesarean deliveries.

The Association of Prenatal Vitamin D Status With Pregnancy and Neonatal Outcomes.

Vitamin D inadequacy is globally prevalent among pregnant women; however, its impact on pregnancy remains inconclusive. This study aims to explore the associations of maternal and umbilical cord serum 25-hydroxyvitamin D (25(OH)D) levels with pregnancy and neonatal outcomes. We used archived serum samples from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study participants in the Hong Kong center and assayed maternal 25(OH)D levels at midgestation and umbilical cord 25(OH)D at birth using liquid chromatography-tandem mass spectroscopy. Data regarding pregnancy and perinatal outcomes were extracted from the HAPO study dataset and the hospital computerized medical system. Only 247 (16.4%) mothers and 66 (5.0%) neonates met the criteria for vitamin D sufficiency (ie, 25(OH)D ≥ 75 nmol/L). The ratio of umbilical cord to maternal vitamin D levels was positively associated with maternal age and ambient solar radiation at the month of delivery, while negatively associated with maternal serum total 25(OH)D at midgestation (all P < .001). Umbilical cord serum 25(OH)D was independently associated with a lower primary cesarean section rate (OR 0.990, 95% CI 0.982-0.999; P = .032). There were no associations of maternal and umbilical cord 25(OH)D levels with other adverse pregnancy and neonatal outcomes. Placental vitamin D transfer was found to be higher with a lower maternal vitamin D level, older maternal age, and higher ambient solar radiation at the time of the delivery. The protective effect of sufficient vitamin D in a cesarean section will require further studies.

Postpartum healthcare expenditures for commercially insured deliveries with and without severe maternal morbidity

Although severe maternal morbidity is associated with adverse health outcomes in the year after delivery, patterns of healthcare use beyond the 6-week postpartum period have not been well documented. This study aimed to estimate healthcare utilization and expenditures for deliveries with and without severe maternal morbidity in the 12 months following delivery among commercially insured patients. Using data from the 2016 to 2018 IBM Marketscan Commercial Claims and Encounters Research Databases, we identified deliveries to individuals 15 to 49 years of age who were continuously enrolled in noncapitated health plans for 12 months after delivery discharge. We used multivariable generalized linear models to estimate adjusted mean 12-month medical expenditures and 95% confidence intervals for deliveries with and without severe maternal morbidity, accounting for region, health plan type, delivery method, and obstetrical comorbidities. We estimated expenditures associated with inpatient admissions, nonemergency outpatient visits, outpatient emergency department visits, and outpatient pharmaceutical claims. We identified 366,282 deliveries without severe maternal morbidity and 3976 deliveries (10.7 per 1000) with severe maternal morbidity. Adjusted mean total medical expenditures for deliveries with severe maternal morbidity were 43% higher in the 12 months after discharge than deliveries without severe maternal morbidity ($5320 vs $3041; difference $2278; 95% confidence interval, $1591-$2965). Adjusted mean expenditures for readmissions and nonemergency outpatient visits during the 12-month postpartum period were 61% and 39% higher, respectively, for deliveries with severe maternal morbidity compared with deliveries without severe maternal morbidity. Among deliveries with severe maternal morbidity, adjusted mean total costs were highest for patients living in the western region ($7831; 95% confidence interval, $5518-$10,144) and those having a primary cesarean ($7647; 95% confidence interval, $6323-$8970). Severe maternal morbidity at delivery is associated with increased healthcare use and expenditures in the year after delivery. These estimates can inform planning of severe maternal morbidity prevention efforts.

Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry.

Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.

Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

Objective: To find the frequency and management outcome of bladder injuries in cesarean section operations. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Okara Pakistan, from Nov 2019 to Nov 2020. Methodology: After Ethical Review Committee, approval 1040 patients who underwent cesarean sections were included.Bladder injuries occurring during cesarean sections and their management outcomes were noticed. Results: The frequency of bladder injury was 214(20.6%), with the number of injuries as 482(48.3%) for primary cesareans and 345(33.2%) for repeat cesareans. The surgeon was called for help in 195(18.8%) cases, and 27(2.6%) cases were transferred to the tertiary care centre. No mortality was noticed during the study. Conclusion: The chances of bladder injuries can be minimized but will never be zero because of the anatomical development similarities of both tracts. It is pertinent to note that bladder injuries are the most common in obstetrics and gynecology surgeries.

Maternal outcomes of a cohort of pregnancies affected by non-immune hydrops fetalis.

To describe the maternal outcomes of a prospective cohort of non-immune hydrops fetalis (NIHF) pregnancies with negative standard-of-care evaluations. This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work-ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre-eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. Forty pregnancies were included. Four patients developed pre-eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5(13.5%) cases of postpartum hemorrhage and an additional 3(8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new-onset or exacerbated depression or anxiety symptoms. Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard-of-care evaluations, including a high rate of postpartum pre-eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.

Predicting cesarean delivery among gravidas with morbid obesity–a machine learning approach

Women with obesity have higher rates of complications following cesarean delivery, such as wound infection and endometritis, with risks being the highest if a cesarean delivery is performed after labor. Previous efforts at predicting whether a patient's labor course would ultimately result in cesarean delivery have been intermediate with area under the curve in the 0.75 to 78 range. This study aimed to assess whether machine learning algorithms would outperform traditional modeling in developing a cesarean delivery prediction model among gravidas with morbid obesity (body mass index of ≥40 kg/m2) to determine whether a primary cesarean delivery may be beneficial. This was a secondary analysis of a retrospective cohort of 1298 patients with morbid obesity presenting for vaginal delivery at ≥37 weeks of gestation between 2011 and 2016 at a single institution. Data available at the time of admission and delivery were modeled using logistic regression, decision tree, random forest, and support vector modeling with evaluation of area under the curve, accuracy, sensitivity, and specificity. Logistic regression demonstrated an area under the curve of 0.816 (95% confidence interval, 0.810-0.817), which was superior to machine learning models when evaluating data at the time of delivery (demographic data, initial cervical examinations, comorbidities, and obstetrical interventions) (P<.001). However, there was no significant difference between most machine learning models and logistic regression area under the curve of 0.799 (95% confidence interval, 0.795-0.804) when evaluating parameters available at the time of admission (demographic data, initial cervical examinations, and comorbidities). Race was noted to be a significant predictor in both models (P<.001). Machine learning and traditional modeling techniques are likely equivalent concerning cesarean delivery prediction in this population. The models developed showed good discrimination and may be used to guide clinical decision-making concerning the optimal mode of delivery.

“I was able to take it back”: Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean

In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.

Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women.

This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.

Fetal abdominal obesity and the ensuing adverse perinatal outcomes in older obese pregnant women with or without obesity and with normal glucose tolerance

To investigate whether the increased risk of fetal abdominal obesity (FAO) is present in the older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women with normal glucose tolerance, we reviewed medical record of 6721 singleton pregnancy. At 24–28 gestational weeks (GW), fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, estimated GA of biparietal diameter or femur length, respectively. FAO was defined as FAOR ≥ 90th percentile. Compared to young and non-obese women, older women showed significantly higher FAORs irrespective of obesity and the prevalence of FAO in older and non-obese women was significantly higher (11.8% vs. 8.6%, p < 0.05). The odds ratio for large for gestational age at birth were 3.06(1.96–4.77, p < 0.005), 1.47(1.16–1.86, p < 0.005) and 2.82(1.64–4.84, p < 0.005) in young and obese, older and non-obese, and older and obese women, respectively. The odds ratio for primary cesarean delivery in older and non-obese women was 1.33 (1.18–1.51, p < 0.005). An increased risk of FAO at 24–28 GW and subsequent adverse perinatal outcomes have been observed in the older women with or without obesity, compared to younger and non-obese women, despite normal glucose tolerance.

Can the Pfannenstiel skin incision length be adjusted according to the fetal head during elective cesarean delivery?

The study aims to determine whether the Pfannenstiel skin incision can be adjusted according to the fetal head's occipitofrontal diameter (OFD) during primary cesarean delivery. Eligible 114 nulliparous women delivered at term by cesarean section in which Pfannenstiel skin incision was performed according to the OFD of the fetal head between June 2017 and September 2021 were included. Excluded cases were non-vertex presentations, all emergency cesarean sections, severe preeclampsia, women in an active phase of the first stage of labor and second stage of labor, placenta previa and low-lying placenta, multiple pregnancies, and uncontrolled gestational diabetes mellitus. Among 114 eligible nulliparous women, the mean OFD was 116.1 ± 7.2 (99-138) mm, and the measurement of the Pfannenstiel skin incision length, which was performed according to the OFD was found to be 122.8 ± 9.2 (100-155) mm. The difference between OFD and Pfannenstiel incision kept remained within 10 mm in 90 (82.5.2%), 10-20 mm in 17 (15.5%), and more than 20 mm in two women (1.8%). This technique was successful in 109 (95.6%) out of 114 women without extending the skin incision. In five women, skin incision needed to be extended up to 38 mm. In 10 women (8.7%), the rectus abdominis muscle was cut partially to deliver the fetal head. The mean fetal umbilical artery pH was 7.33 ± 0.05. No neonatal hypoxia was encountered in the study. Pfannenstiel skin incision can be adjusted according to the OFD with minimal margins of error. This technique may provide better cosmetic results by avoiding unnecessarily prolonged incisions with similar newborn outcomes. Clinicaltrials.gov, identifier [NCT05632796].

Impact of Primary Cesarean Section on Grand Multiparous Women

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section. Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications. Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017. An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded. Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%. Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%. Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.

An Audit of Indication for Primary Caesarean Section Deliveries in Multigravida - A Descriptive Study

An Audit of Indication for Primary Caesarean Section Deliveries in Multigravida - A Descriptive Study

Uterine Leiomyomata as a Cause of Abdominal Compartment Syndrome in the Postpartum Period

Objective: To describe a case of uterine leiomyomata as a cause of abdominal compartment syndrome in the postpartum period. Study Design: Case report, short communication Results: n/a Conclusion: Uterine leiomyomas are common benign smooth muscle tumors that often occur during the reproductive years. Although many cases may not result in significant complications, negative pregnancy outcomes have been associated with the size and location of the fibroids. Degeneration of fibroids can occur as early as the late first trimester when they undergo significant volumetric growth, contributing to pain during pregnancy. While myomectomy is typically avoided during pregnancy, conservative management with anti-inflammatory medications may be effective. Surgical removal or preterm delivery may be necessary if symptoms persist. Abdominal compartment syndrome (ACS) is a rare condition characterized by sustained elevated intraabdominal pressure leading to organ failure. Although ACS resulting from large-volume leiomyomas in the postpartum period has not been previously described, we present a case of a 25-year-old patient with massive uterine fibroids who required indicated preterm delivery via primary Cesarean section at 25-weeks gestation. Her postpartum course was complicated by ACS, requiring emergent surgical decompression. When large fibroid burden is present during pregnancy or in the postpartum period, ACS should be considered.

Pregnancy Outcomes in Patients with Obstructed Hemivagina Ipsilateral Renal Agenesis

Study ObjectiveObstructed hemivagina with ipsilateral renal agenesis (OHVIRA) is a rare congenital Müllerian anomaly. We sought to explore the impact of OHVIRA on pregnancy outcomes. MethodsA retrospective chart review identified 8 patients with an OHVIRA diagnosis and at least 1 documented pregnancy. Data collected included demographic characteristics, age at diagnosis and repair, gynecologic history, and pregnancy outcomes. Descriptive analysis was performed. ResultsTwenty-three pregnancies were identified among the 8 patients (range 1-5 pregnancies per patient), resulting in 9 term births, 6 preterm births, and 8 first-trimester spontaneous abortions. The most common pregnancy complications were fetal growth restriction (2/15) and preeclampsia with severe features (2/15). The average gestational age at delivery was 37 2/7 weeks; however, 60% (9/15) of live births were at term. Two patients delivered after going into preterm labor, one of whom also had preterm premature rupture of membranes. Of the 15 live births, there were 10 cesarean deliveries, 4 vaginal deliveries, and 1 forceps-assisted vaginal delivery. Three patients (30%) underwent primary cesarean deliveries due to fetal malpresentation. Five live births were repeat cesarean deliveries, and 2 were unscheduled cesareans, at 34 and 36 weeks, due to preeclampsia with severe features. ConclusionThis study is among the first to examine pregnancy outcomes in patients with OHVIRA. Among these patients, there were 23 total pregnancies, with higher incidences of spontaneous abortion, preterm birth, breech presentation, and cesarean delivery compared with the general population. This descriptive data set addresses a knowledge gap to help clinicians more effectively advise patients with OHVIRA about pregnancy outcomes.

Contemporary Obstetric and Neonatal Outcomes in Sickle Cell Disease: A Retrospective Cohort Study.

Sickle cell disease is associated with adverse perinatal outcomes. Aspects of sickle cell disease in pregnancy, such as health care utilization and neonatal abstinence syndrome, are understudied. We aimed to describe contemporary sickle cell disease outcomes in a U.S. hospital system to improve perinatal counseling. We conducted a retrospective cohort study of patients with sickle cell disease who delivered at >20 weeks' gestation at two sites within the University of Pennsylvania Health System from May 1, 2017 to August 30, 2020. Descriptive statistics were utilized. Over the study period, 48 patients with sickle cell disease had 52 deliveries of 53 neonates. Sickle cell disease-related morbidity was prevalent prior to pregnancy; 27% had a history of avascular necrosis, and 58% had experienced acute chest syndrome. In the year prior to pregnancy, 52% used daily opioids. During pregnancy, more than half of patients were admitted at least once for sickle cell disease-related complications, spending a median 3 days admitted interquartile range (0-23); >10% spent >70 days of pregnancy admitted. New daily opioids were prescribed during pregnancy for 10% to manage pain crises. Acute chest syndrome was experienced by 23% of patients during pregnancy, and 8% required placement of long-term intravenous access. Preterm delivery <37 weeks occurred in 48%. The primary cesarean rate in nulliparas was 43%. Additionally, 50% experienced a hypertensive disorder of pregnancy, 35% underwent transfusion during delivery admission, and 10% had a perinatal venous thromboembolism. Finally, 53% of neonates were admitted to the intensive care unit. Low birth weight was noted in 34%, severe respiratory distress in 15% of infants, and neonatal abstinence syndrome in 21%. Sickle cell disease remains associated with significant perinatal morbidity and need for hospitalization. These data provide contemporary outcomes to target improvements in the care of patients with sickle cell disease. · SCD was associated with significant perinatal morbidity and healthcare utilization.. · Most patients with SCD required hospitalization during pregnancy.. · Neonates of patients with SCD experienced preterm birth, NICU admission, and neonatal abstinence syndrome..

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

BackgroundOne of the most challenging problems in developing countries including Ethiopia is improving maternal health. About 303,000 mothers die globally, and one in every 180 is at risk from maternal causes. Developing regions account for 99% of maternal deaths. Maternal near miss (MNM) resulted in long-term consequences. A systematic review and meta-analysis was performed to assess the prevalence and predictors of maternal near miss in Ethiopia from January 2015 to March 2023.MethodsA systematic review and meta-analysis cover both published and unpublished studies from different databases (PubMed, CINHAL, Scopus, Science Direct, and the Cochrane Library) to search for published studies whilst searches for unpublished studies were conducted using Google Scholar and Google searches. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Duplicated studies were removed using Endnote X8. The paper quality was also assessed based on the JBI checklist. Finally, 21 studies were included in the study. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Forest plots were used to present the pooled prevalence using the random effect model. Heterogeneity and publication bias was evaluated using Cochran’s Q test, (Q) and I squared test (I2). Subgroup analysis based on study region and year of publication was performed.ResultFrom a total of 705 obtained studies, twenty-one studies involving 701,997 pregnant or postpartum mothers were included in the final analysis. The national pooled prevalence of MNM in Ethiopia was 140/1000 [95% CI: 80, 190]. Lack of formal education [AOR = 2.10, 95% CI: 1.09, 3.10], Lack of antenatal care [AOR = 2.18, 95% CI: 1.33, 3.03], history of cesarean section [AOR = 4.07, 95% CI: 2.91, 5.24], anemia [AOR = 4.86, 95% CI: 3.24, 6.47], and having chronic medical disorder [AOR = 2.41, 95% CI: 1.53, 3.29] were among the predictors of maternal near misses from the pooled estimate.ConclusionThe national prevalence of maternal near miss was still substantial. Antenatal care is found to be protective against maternal near miss. Emphasizing antenatal care to prevent anemia and modifying other chronic medical conditions is recommended as prevention strategies. Avoiding primary cesarean section is recommended unless a clear indication is present. Finally, the country should place more emphasis on strategies for reducing MNM and its consequences, with the hope of improving women's health.

Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system

The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (p = 0.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71–0.80). In the NTSV population, the vaginal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, composite neonatal adverse outcome indicator, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.

Factors that Influence Women's Decision on the Mode of Birth After a Previous Caesarean Section: A Meta-ethnography.

Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women's decision-making to support informed choices for the mode of next birth after caesarean section (NBAC). A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare's seven-step meta-ethnography approach synthesised themes. Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control. This meta-ethnography highlights health professionals' influence on women's decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey.

To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32g vs. 3109.76 ± 540.89g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.