Caesarean Section Delivery Rates Research Articles

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study.

We aimed to explore the association between epidural-related maternal fever (ERMF) and prognosis of parturients. 159 parturients who underwent vaginal delivery under labor epidural analgesia (LEA) received noninvasive continuous core body temperature monitoring. 122 of them completed the 42-day postpartum follow-up. Parturients with body temperature ≥38°C during labor were categorized as the Fever group, while the others were categorized as the No-Fever group. Compared to No-Fever group, Fever group had a greater proportion of primiparas, greater gestational age of parturients, and longer third stage of labor. The cesarean section and forceps delivery rates, and the amount of intrapartum hemorrhage in Fever group were significantly higher. There were no significant between-group differences with respect to puerperal infection, and amniotic fluid turbidity degree, neither significant between-group difference at 42-days postpartum. We found that ERMF was associated with some short-term outcomes. However, it showed no relation with long-term prognosis of the parturients at 42-days postpartum.

Pregnancy incidence, outcomes and associated factors in a cohort of women living with HIV/AIDS in Rio de Janeiro, Brazil, 1996-2016.

The aim of this research was to analyze pregnancy incidence and associated factors in a cohort of 753 women living with HIV/AIDS (WLWHA) in Rio de Janeiro, Brazil, from 1996 to 2016. Women aged 18-49 years who were not on menopause (surgical or natural) and did not have a tubal ligation were eligible for the study. Data were collected by medical professionals during initial and follow-up visits. Person-time pregnancy incidence rates were calculated throughout the follow-up period. Pregnancy incidence-associated factors were investigated by univariate and multiple analyzes, using an extension of the Cox survival model. Follow-up visits recorded 194 pregnancies, with an incidence rate of 4.01/100 person-years (95% CI: 3.47; 4.60). A higher pregnancy incidence was associated with CD4 nadir ≥ 350 cells/mm³, use of an antiretroviral regimen not containing Efavirenz, and prior teenage pregnancy. In turn, women with a viral load ≥ 50 copies/mL, age ≥ 35 years old, with two or more children and using a highly effective contraceptive method showed a lower incidence. Results showed a significant reduction in pregnancy incidence after 2006, a significant reduction in female sterilization from 1996 to 2016, and a high rate of cesarean sections. The association found between pregnancy incidence and the use of contraceptive methods and virological control markers suggests a good integration between HIV/AIDS and reproductive health services. The high rate of cesarean section delivery indicates the need to improve childbirth care.

Maternal and Foetal Outcome among Pregnant Women Infected with COVID-19 in Three Referral Hospitals in Cameroon

Introduction: Pregnancy is generally known to be an immune compromised state, thus placing pregnant women at risk of SARS-COV-2 infection. We therefore carried out this study to assess the maternal and foetal outcomes among pregnant women infected with COVID-19 in three referral hospitals in Cameroon. Methodology: This was a hospital-based retrospective case control study covering a two-year period. Data collection was done over a duration of four months at the Yaoundé Central Hospital, Douala Gynaeco-Obstetric and Paediatric Hospital and the Bamenda Regional Hospital. Cases were pregnant women who gave birth after a confirmed COVID-19 infection, matched 1:2 by age (±1 year) and parity (±1) to pregnant women not infected by COVID-19, who gave birth at the three hospitals within the same period. Results: The rate of caesarean section delivery among our cases was 52.4% as compared to 44.3% among controls (OR, 1.38, 95% CI, 0.74 - 2.60, P = 0.296). Maternal mortality rate in our cases was at 8.2% as compared to 6.6% in controls (OR, 1.60, 95% CI, 0.50 - 5.12, P = 0.422). The rate of preterm delivery in our cases was 24.6% as compared to 11.5% in the control group (OR, 2.39, 95% CI, 1.05 - 5.42, P = 0.025). Perinatal death rate in our study was recorded at 8.2% as compared to 3.4% in the controls (OR, 2.63, 95% CI, 0.68 - 10.18, PS = 0.162) Conclusion: Pregnant women infected with COVID-19 were found to have higher risks of preterm delivery and acute foetal distress as compared to pregnant women who were not infected. Caesarean section deliveries, maternal and foetal mortality were higher in COVID-19 infected pregnant women as compared to those not though these findings were not statistically significant.

Labor induction in term gravidas with prelabor rupture of membranes and unfavorable cervixes: Oxytocin versus vaginal misoprostol.

To compare maternal and neonatal outcomes between oxytocin and vaginal misoprostol induction in women with term prelabor rupture of membranes (PROM) and unfavorable cervixes. In this retrospective study, 589 pregnant women with term singleton fetuses in cephalic presentation, reactive nonstress tests, PROM of 2-24 h duration, Bishop score <6, and no previous uterine surgery were reviewed and divided into oxytocin (n= 301) and misoprostol (n= 288) groups. The primary outcomes were the rate of vaginal delivery and delivery within 24 h. After 24 h of induction, the misoprostol group showed a significantly higher proportion of vaginal delivery (64.6% vs. 49.5%, P< 0.001) and a lower cesarean section delivery rate (11.5% vs. 25.2%, P< 0.001) than the oxytocin group. More primiparas in the misoprostol group achieved vaginal delivery within 24 h than in the oxytocin group (60.5% vs. 45.4%, P= 0.001). Among primiparas, the misoprostol group had a significantly lower cesarean delivery rate (12.6% vs. 27.5%, P< 0.001). Vaginal misoprostol induction in term PROM gravidas with unfavorable cervixes was associated with lower cesarean section and higher vaginal delivery rates within 24 h than oxytocin infusion. Vaginal misoprostol and oxytocin infusion had similar maternal and neonatal outcomes.

Relationship between the mode of delivery, morbidity and mortality in preterm infants.

The aim of the study, to evaluate the relationship between mode of delivery and preterm morbidities and mortality, who born ≤34 weeks of gestation within 1 year. Babies were divided into two groups as who were born by cesarean section (CS) and vaginal delivery (VD) between March 2019 and March 2020. Infants born at ≤28 weeks were also analyzed. The rate of CS delivery was 76% (378) in the whole group and 73% (115) in the babies of ≤28 gestational weeks. The most common maternal factor causing CS was preeclampsia (25%). The antenatal corticosteroid (ACS) application rate was 30% (152) in the whole group and 30% (45) in infants of ≤28 weeks. Rate of babies with an Apgar score of <5 at 5th min, asphyxia, multiple organ failure, development of severe respiratory distress syndrome, severe intraventricular hemorrhage (IVH) and mortality were significantly increased in infants born VD (for all p < 0.05). Mortality was significantly higher when gestational age was ≤28 weeks, birth weight was ≤1500 g and ACS was not administered (p < 0.001 for all). Mortality, severe IVH, neonatal asphyxia and multiple organ failure were found to be higher in those who were born by VD. These findings suggest that these results were due to inadequate prenatal care and follow-up and lack of ACS.

Frequency of Cesarean Section in Premature Rupture of Membranes

Background: Premature rupture of membranes (PROM) is always of clinical significance either it occurs before onset of labour at term or preterm. It is defined as spontaneous rupture of fetal membranes which results in leakage of amniotic fluid. PROM is related with maternal and perinatal morbidity and mortality if not treated sensibly on time, due not only to conditions causing it but also likelihood of emergency cesarean delivery. Aim: To ascertain frequency of C- section in women presented with premature rupture of membranes at tertiary care hospital. Study Design: Cross-sectional descriptive study Place and Duration of Study: Department of Obstetrics and Gynaecology Unit 1, Sheikh Zayed Women Hospital, Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st October 2020 to 30th April 2021 Methodology: One hundred and eighty six pregnant women having gestation from 28 weeks till 40 weeks and diagnosed as premature rupture of membranes were included. Results: The average age 27.97±5.66 years. 29.57% of caesarean section presented PROM was observed. Conclusion: PROM remains an imperative cause of maternal and fetal morbidity and increased rate of cesarean section delivery to focus upon. Timely evaluation of reasons leading to PROM can help us in reducing the soaring rate of cesarean section in developing countries. Keywords: Premature rupture of membranes, Caesarean section, complications.

Socio-demographic, obstetric and non-obstetric factors influencing the incidence of cesarean section (C-section)

Cesarean sections (CS) and regular vaginal births are two processes for childbirth. Cesarean section is an intricate surgery involving numerous risks such as blood loss, organ damage, allergic reaction to anesthesia, infections and blood clots. Now a days rate of CS is increasing in developed countries. The increased rate of caesarean section can be described by socio-economic status (SES), medical and non-medical factors. Socioeconomic status (SES) is linked to a wide range of maternity services including Cesarean section (CS), whereas the most common medical and non-medical factors are labor dystocia, fetal mal-presentation, multiple gestations, suspected fetal macrosomia, placenta previa, placenta abruption, prolonged labor, fetal distress, birth defects, repeated cesareans, chronic health condition, cord prolapse, cephalopelvic dis-proportion (CPD), preeclampsia, bleeding, IUGR (Intrauterine growth restriction), uterine rupture, gestational diabetes, pelvic tumors, vesico-vaginal fistula repair, AP (anterior and posterior) repair and IUD (intrauterine devices).The aim of this study was to determine the rate of CS and socio-demographic, obstetric and non-obstetric factors influencing the incidence of cesarean section (C-section). This study was conducted at Combined Military Hospital (CMH), Peshawar for a period of 8 months. A standardized questionnaire was made by investigator to evaluate social and physiological status, obstetric factors, and non-obstetric- factors. 400 CS patients participated in this study. The findings of this study showed different socio-economic factors (ethnic variances, age occupation, income status) affecting cesarean section (C- section) delivery rates. The highest CS rate (39.25%) was in the age group of 26-30 years and in non-working women (61.5%). Moreover the high education of pregnant females is greatly associated with C-section rates because of the frequent visits for antenatal care during their pregnancy. Frequency of CS in overweight and obese women were found 139 (34.75%) and 198 (49.5%) of the total cases. As far as obstetric code was concerned, nulliparous women (62.5%) are more likely to be delivered by caesarean section as compared to Multipara 36.8% and Grand Multipara 0.8% when labor is induced.

Unnecessary caesarean section delivery in rural China: exploration of relationships with full-term gestational age and early childhood development.

Gestational age at delivery is reportedly associated with cognitive and non-cognitive development in early childhood. Delivery at an earlier full-term gestational age has been associated with an increased rate of caesarean section (C-section) delivery; the high rate of C-section delivery in China implies that the rate of medically unnecessary C-section delivery is also high. This study investigated the relationships of medically unnecessary C-section delivery with full-term gestational age and early childhood development in rural China. We conducted a survey of 2765 children (aged 5-24 months) who resided in 22 national designated poverty counties. Primary caregivers were interviewed to collect information regarding child and household characteristics (including the child's gestational age), each child's delivery method, and reasons for C-section delivery (if applicable). The children were assessed using the Bayley Scales of Infant Development. Developmental outcomes were compared among gestational age-groups; regression analyses were used to assess relationships among medically unnecessary C-section delivery, gestational age, and developmental outcomes. Overall, 56.2% of children were born at ≤39 weeks of gestation. Among C-section deliveries, 13.1% were medically necessary and >40% could clearly be classified as medically unnecessary. Repeat C-section was the most common reason given for medically unnecessary C-section delivery. For each 1-week increase in full-term gestational age, cognition scale scores increased by 0.62 points (P<0.01), language scale scores increased by 0.84 points (P<0.01), and motor scale scores increased by 0.55 points (P<0.05). Medically unnecessary Csection delivery was significantly associated with lower full-term gestational age. Higher full-term gestational age was significantly associated with better childhood developmental outcomes, indicating that medically unnecessary C-section delivery may negatively influence early childhood development.

Adrenal insufficiency and pregnancy.

Adrenal insufficiency is a disorder characterized by the failure of adrenocortical function because of distorted function of hypothalamic-pituitary- adrenal (HPA) axis. Pregnancy is a state of a physiological glucocorticoid excess as the HPA axis is functioning at a higher level. The aim of the present review was to shed light on current evidence of adrenal insufficiency management during pregnancy, along with maternal and neonatal outcomes. A recent multicenter study under the auspices of the European Network for the Study of Adrenal Tumours (ENSAT) presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone (or mineralocorticoids when needed according to the level of disorder) replacement treatment, increased rates of caesarean section, preterm delivery and adrenal crises along with peripartum and postpartum complications but no maternal or neonatal fatality. These data were in agreement with those obtained from previously published studies. The limited published evidence is in line with the present guidelines as real-life data did not document any increased fatality among pregnant women or newborns. Prospective data with prolonged follow-up are needed to shed more light on appropriate dose adjustments to avoid the risks of under-replacement or over-replacement of glucocorticoid and/or mineralocorticoid drugs and their sequelae. A recent multicenter study by ENSAT presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone as replacement treatment during pregnancy, along with an increased rate of caesarean section and preterm delivery, adrenal crises, peripartum and postpartum complications but no maternal or neonatal fatality. These data are in agreement with those of a previously published study and also confirm the statements made by the recent guidelines. Prospective data are needed aiming to develop precise therapeutic protocols during each trimester of pregnancy according to the different causes of adrenal insufficiency.

Evaluation of obstetric and neonatal outcomes and cesarean section rates of Syrian and Turkish adolescent pregnant women according to the Robson ten group classification system.

Aim: Our research has two purposes. To begin with, we sought to determine whether there were any differences in maternal and newborn outcomes between Syrian adolescent and adult pregnant women living in Turkey after the Syrian civil war and Turkish adolescent and adult pregnant women. Second, we wanted to examine and compare the rates of cesarean section (CS) and spontaneous vaginal delivery (SVD) in adolescent and adult pregnant women using the Robson ten group classification system (RTGCS). Material and Method: Our study investigated data from a retrospective cross-sectional study of 1823 Turkish and Syrian pregnant women who gave birth between September 2020 and August 2021 in a tertiary reference hospital in Turkey's Mediterranean area. Our study enrolled 838 pregnant adolescent girls between the ages of 13 and 19 and 985 pregnant adult women between the ages of 20 and 47. Results: The probability of adolescent pregnancy is 3.081 times greater among Syrian refugees than among Turkish natives (p

Determinants of caesarean section delivery: a nationwide study in Indonesia

Background The number of caesarean section deliveries among mothers in Indonesia has increased every year. Aim This study was conducted to identify the prevalence and determinants of caesarean section in Indonesia. Methods A cross-sectional design using the 2017 Indonesian Demographic Health Survey was conducted. A total of 12 789 mothers were recruited, and bivariate analysis and binary logistic regression were used. Results The determinants among women that were significant factors in performing caesarian section deliveries were maternal age &gt;35 years, urban residence, high level of education, poorest wealth index, having more than four visits to antenatal care centres, close proximity to health facilities and first-time birth. Conclusions The rate of caesarean section deliveries in Indonesia was 17.7%. Monitoring and evaluation of the increasing number of caesarean sections without medical necessity and the severity of labour is needed.

Cesarean section delivery rates, determinants, and indications: a retrospective study in Dekemhare Hospital

Objectives: Cesarean section delivery is at increasing rate worldwide. The present study was designed to explore the cesarean section delivery rate, and its common indications along with their socio-demographic determinants in Dekemhare Hospital, Southern region of Eritrea. Methods and Materials: A retrospective study was utilized to retrieve data of all women who delivered in Dekemhare Hospital during 2019. Using a structured questionnaire, all information required was recorded using data files such as birth (vaginal and cesarean) files, pregnancy registration file, and neonatal data. All women who delivered by cesarean section, their indications were collected reviewing registration records of the operating theater where the procedure was conducted. To describe the results, both descriptive and analytical analysis were conducted using SPSS version 25. χ2 test and multivariate logistic regression analysis were done to identify determinants of cesarean section. A significance level of 0.05 was used as a cut point of statistical significance. Main Findings: The rate of cesarean section delivery was 10.1%. The top 6 indications of cesarean section were: malposition (26.3%), prolonged and obstructed labor (21.2%), mal-presentation (14.4%), previous/repeat cesarean section (10.2%), amniotic fluid disorders (9.3%), and fetal distress (5.9%). Mothers who were nulliparous [odds ratio (OR): 9.2; 95% confidence interval (CI): 1.8–14.3; P-value: 0.007], referral from other health facility (OR: 7.8, 95% CI: 3.7–16.5, P-value &lt;0.0001), and who had delivered stillbirths (OR: 8.2; 95% CI: 1.7–38.9; P-value: 0.008) were more likely to deliver through cesarean section. Conclusion: The rate of cesarean section in Dekemhare hospital is fairly optimal (10.1%). Prolonged and obstructed labor, mal-presentation and malposition were the most common indications. Nulliparous and referral mothers had higher risk of cesarean section. Decision-making for cesarean section should outweigh the benefits and risks of the intervention within the context of women’s entire reproductive life-cycle.

Pregnancy Characteristics Of Conjoined Twins Born At Dr. Soetomo Hospital Surabaya Period 2010-2019

Background: Conjoined twins are a rare complication of pregnancy. The prevalence of occurrence is 1 in 200,000 pregnancies. As many as 40% of babies in cases of conjoined pregnancies die at birth and 30% die in the first days of life. Objective: To present the characteristics of a conjoined pregnancy born in Dr. Soetomo Hospital, Surabaya, 2010-2019 period which is a referral hospital in Eastern Indonesia. Methods: This study is a retrospective descriptive study on the case of conjoined twins born in Dr. Soetomo Hospital, Surabaya, in the 2010-2019 period. The data is taken from the electronic medical record of Dr. Soetomo Hospital. Results: In this study, there were 16 cases of conjoined twins who were born in Dr. Soetomo Hospital. Most cases were conjoined twins of Thoracoabdominopagus (12 patients), Parapagus (2 patients), Cephalopagus (1 patient), and Omphalopagus (1 patient). Methods of delivery of conjoined twins were performed with caesarean section (9 cases), and vaginal delivery (7 cases). There were 9 cases of babies who died immediately at birth, and 7 cases of babies who were still alive until a few hours and a few days after birth. The age at diagnosis of conjoined twins was found at gestational age &lt;20 weeks (6 cases), and when gestational age&gt; 20 weeks (10 cases). Conclusion: This case of conjoined twins is a rare case and requires multidisciplinary discussion. Early diagnosis is necessary to terminate the pregnancy as early as possible, in order to reduce the Caesarean Section delivery rate. In Dr. Soetomo Hospital for the period 2010-2019, the most cases of conjoined twins were Thoracoabdominopagus. Keywords: Conjoined twins, Pregnancy

Cesarean deliveries by nativity among United States Hispanic Population

The population of Hispanic identifying individuals has been steadily increasing. Prior publications have demonstrated higher rates of cesarean section (CS) among Hispanic women compared with white women. It is unclear what impact nativity (US born or not US born) has on CS delivery rates. We examined the association between nativity with CS in individuals of Hispanic ethnicity.

Pengaruh Sholawat Nariyah Terhadap Kecemasan Pada Pasien Sectio Caesarea Dengan Spinal Anestesi

The percentage of caesarean section delivery rate increased from 10% from 2013 to 17% in 2018. Sectio caesarea is at risk of experiencing complications, one of which is anxiety, the level of anxiety in Sectio Caesaria patients is reported to reach 60% to 92%. One of the actions to overcome anxiety is with sholawat nariyah. Objective: to determine the effect of sholawat nariyah on anxiety in sectio caesarea patients with spinal anesthesia at Sunan Kalijaga Hospital Demak. Methods: research using Quasy Experiment with pretest-posttest control group design. The population of all sectio caesarea patients with non-probability techniques was 48 respondents. The instrument uses a questionnaire. Results: after the test, the results of sholawat nariyah have an effect on the treatment group, while in the control group there is no significant effect. The results of the analysis obtained ρ value: 0.001, if the value ρ &lt;0.05 with a mean value of 5.00 it said that statistically there was an effect of sholawat nariyah on the level of anxiety in sectio caesarea patients with spinal anesthesia. Conclusion: there is an effect of sholawat nariyah on the level of anxiety in sectio caesarea patients with spinal anesthesia

Adverse pregnancy outcomes and mother-to-child transmission in patients with hepatitis B virus infection and intrahepatic cholestasis of pregnancy.

The aim of this study was to investigate adverse pregnancy outcomes (APOs) and mother-to-child transmission (MTCT) of intrahepatic cholestasis in pregnancy (ICP) in hepatitis B virus infection (HBV) patients. We performed a retrospective study at Beijing Youan Hospital in China from January 2010 through May 2017. A total of 232 patients were enrolled, including 106 HBV-infected ICP patients (Group H + C), 20 ICP patients (Group C) and 106 HBV-infected patients (Group H). Characteristics, APOs and MTCT rate of HBV were compared between groups. Group H + C was subdivided into 3 groups according to total bile acid (TBA) values and gestational age at diagnosis (GA). APOs were also compared within Group H + C according to TBA values and GA. There was no difference in live birth delivery mode and APOs between Groups H + C and C. Compared with Groups H, no difference was in live birth and MTCT rates of HBV. However, cesarean section delivery and APOs rates were higher in Group H+C (p < 0.05). Compared with Group H, adverse maternal outcomes such as postpartum hemorrhage and premature birth were more likely to occur in Group H + C (p < 0.001). Adverse fetal outcomes, the proportions of amniotic fluid reaching III degrees (AFIII), NICU admission, neonatal asphyxia and SGA were significantly higher among Group H + C than Group H (p < 0.05). Contamination of the AFIII rate increased with increasing TBA (p < 0.05). The rate of preterm birth and small for gestational age (SGA) was more common in GA 28-32 w compared with GA < 28 w and > 33 w (p < 0.01). H + C patients had more APOs than HBV patients, but the difference was not significant when compared with ICP patients. Although we did not find any difference in MTCT rate between H + C and HBV patients, active treatment to prevent neonatal asphyxia and HBV infection should be considered. Therefore, it is necessary to emphasize maternal and fetal monitoring during pregnancy and delivery.

Epidural Analgesia for Labour: Comparing the Effects of Continuous Epidural Infusion (CEI) and Programmed Intermittent Epidural Bolus (PIEB) on Obstetric Outcomes.

In the last few years there is a trend of transiting from the continuous epidural infusion (CEI) method for epidural analgesia to a new method - programmed intermittent epidural analgesia (PIEB). This change improves the quality of epidural analgesia, thanks to an increased spread of the anaesthetic in the epidural space and higher maternal satisfaction. Nevertheless, we must make sure that such change of method does not lead to worse obstetric and neonatal outcomes. This is a retrospective observational case control study. We compared several obstetrical outcomes between the CEI and PIEB groups, such as the rates of instrumental delivery, rates of caesarean section, duration of first and second stages of labour well as APGAR scores. We further segmented the subjects and examined them in groups of nulliparous and multiparous parturients. 2696 parturients were included in this study: 1387 (51.4%) parturients in the CEI group and 1309 (48.6%) parturients in the PIEB group. No significant difference was found in instrumental or caesarean section delivery rates between groups. This result held even when the groups were differentiated between nulliparous and multiparous. No differences were revealed regarding first and second stage duration or APGAR scores. Our study demonstrates transition from the CEI to the PIEB method does not lead to any statistically significant effects on either obstetric or neonatal outcomes.

Preferences between Caesarean Section and Normal Vaginal Delivery among the reproductive women in Bangladesh

Amount of death due to pregnancy are gradually decreasing worldwide, among all of these estimated deaths, one-fifth of the maternal death recorded in southern Asia. The increasing rate of caesarean section (CS) delivery and the improved safety of surgical skill are the big reason of reduced pregnancy related mortality rate. Bangladesh has the increasing CS rate on southern Asia. This study aimed to identify the different factors affecting the increasing rate of CS in Bangladesh This cross-sectional survey was conducted between January 2020 - March 2020 among the married women at reproductive age (15-49 years age) having at least one under five years child of Dhaka and Noakhali district in Bangladesh. A questionnaire was designed to survey the preference of their delivery mode. Bivariate logistic regression analysis was performed to identify the factors. A total of 357 Bangladeshi women participated in the survey and 55.7% declared they would prefer normal vaginal delivery (NVD) and 37.3% had no clear preference. The actual scenario was the overall CS rate was 51.8% during 2015-2019. But it was very high (77.8%) for the 40 years and above women. The study revealed several important factors that significantly affect the increasing rate of CS for childbirth. Maternal age, religion, current place of residence, working status, monthly household income, birth order, marital age and year of childbirth were found to have significant effect on the high rate of CS. All those who have had face CS at least once in our study faced various problem, they reported. Most of them was feeling tired to do little work and suffered long term back pain. This study will help policy makers in formulating appropriate programs to cope with this challenge efficiently and effectively. Some Special programs should be taken to increase the social awareness and values to save both mother and child, which may lead to decrease the rate of CS in Bangladesh.

Cesarean section and pregnancy outcomes of preterm premature rupture of membranes under different fertility policies in China

BackgroundThe aim of the present study was to compare the outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) in China.MethodsThe present study was a single-center retrospective study of women admitted to Beijing Obstetrics and Gynecology Hospital in 2012, 2014, and 2017. Deliveries at <24 and >37 weeks, fatal deformities, stillbirths, and multiple pregnancies were excluded. Pregnancies were divided into 24–27+6, 28–33+6, and 34–36+6 weeks according to weeks of gestation in each year. In total, 1,178 pregnancies complicated by PPROM were analyzed in terms of incidence rate, risk factors, delivery mode, and neonatal outcomes.ResultsThe rate of PPROM was 3.11% in 2012, 2.35% in 2014, and 2.4% in 2017; the difference was significant (P<0.001). Age [odds ratio (OR): 1.046, P<0.001], intrauterine infection (OR: 2.087, P=0.007), and vaginitis (OR: 1.812, P=0.039) were risk factors for PPROM. In all 3 years, patients with PPROM tended to choose vaginal delivery rather than cesarean section (CS) delivery (68.9% in 2012, P<0.001; 76.5% in 2014, P<0.001; 69.3% in 2017, P<0.001), and the rate of vaginal deliveries in 2014 was higher than that in 2012 and 2017 (P=0.027). Indications for PPROM at 34–36+6 weeks varied significantly among the 3 years (P<0.001). No significant difference was found in body weight, body length, and Apgar score at 1, 5, and 10 min; however, there was a significant difference in Apgar score after 1 min at 28–33+6 weeks (P=0.012).ConclusionsThe incidence rate of PPROM at our single center varied between 2012, 2014, and 2017. Risk factors for pregnancies complicated by PPROM include age, intrauterine infection, and vaginitis. The rate of CS delivery varied, and breech/transverse presentation was the major indication for patients with PPROM at 34–36+6 weeks.

Brain Volumes in Mice are Smaller at Birth After Term or Preterm Cesarean Section Delivery

AbstractThe rate of cesarean section (CS) delivery has steadily increased over the past decades despite epidemiological studies reporting higher risks of neonatal morbidity and neurodevelopmental disorders. Yet, little is known about the immediate impact of CS birth on the brain, hence the need of experimental studies to evaluate brain parameters following this mode of delivery. Using the solvent clearing method iDISCO and 3D imaging technique, we report that on the day of birth, whole-brain, hippocampus, and striatum volumes are reduced in CS-delivered as compared to vaginally-born mice, with a stronger effect observed in preterm CS pups. These results stress the impact of CS delivery, at term or preterm, during parturition and at birth. In contrast, cellular activity and apoptosis are reduced in mice born by CS preterm but not term, suggesting that these early-life processes are only impacted by the combination of preterm birth and CS delivery.