Emergency Caesarean Section Rate Research Articles

Bouncing your way to labour and birth using biomechanics and fetal optimal positioning

Background/Aims ‘Labour hopscotch’ is a visual tool that encourages activity during pregnancy and childbirth. It has been used in one advanced midwife practitioner service since 2017 and more widely across in Ireland since 2020. The biomechanics for birth toolkit was added to advanced midwife practitioner care in 2022. This study's aim was to ascertain if the biomechanics for birth toolkit impacted gestation of spontaneous onset of labour rates and birth outcomes. Methods A retrospective study of onset of labour and birth outcomes was conducted for women before (n=155) and after (n=154) the biomechanics for birth toolkit was incorporated into care. Results Before the toolkit was included, there was a 57.2% spontaneous onset of labour rate, with 33.2% birthing before 41 weeks. After the kit's inclusion, there was a 72.2% spontaneous onset of labour, with 91.8% birthing before 41 weeks. Induction rates dropped from 42.8% to 27.8%, with emergency caesarean section rates following induction dropping from 33.1% to 23.8%. Conclusions Using the biomechanics for birth toolkit alongside the labour hopscotch tool could increase spontaneous onset of labour rates, optimise physiological birth, reduce inductions and emergency caesarean section following induction.

Dose Sildenafil Citrate Reduce the Incidence of Emergency Cesarean Section and Fetal Distress During Labor? A Randomized Double-Blinded Clinical Trial

Background: Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD.
 Methods: In a randomized double-blinded clinical trial, a total of 208 low-risk sub-jects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23.
 Results: The mean age of mothers was 28.98±5.6 years and 120 cases were primi-gravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than place-bo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR= 2.83%, 95%CI of 1-8.24).
 Conclusion: The results showed that SC can effectively decrease the rate of emer-gency CS and FD during labor.

Prevalence and Outcome of Repeat Caesarean Delivery: A Retrospective Review in Rasheed Shekoni Federal University Teaching Hospital Dutse, North-west Nigeria

Background: Caesarean section is the most common Obstetric surgical procedure. Repeat CS has been a significant contributor to the overall increase in CS rate and accounts for about one- third of all caesarean deliveries worldwide. Objective: This study aimed to determine the prevalence and outcome of repeat Caesarean section. Materials and methods: The study was a 3-year retrospective review of Caesarean sections, carried out between 1st July 2020 and 31st June 2023 in the department of Obstetrics and Gynecology of Rasheed Shekoni Federal University Teaching hospital. The case files of the participants were retrieved from the record department. Data analysis was carried out using IBM statistical package for social sciences (SPSS) version 26. Measured variables were expressed in frequencies and percentage. Test for association was done using chi-square non-parametric test, setting P-value at <0.05. Results: A total of 144 were repeat caesarean deliveries were performed out of 344 Caesarean sections done during the review period, giving an incidence rate of 41.9%. The mean age of the patients was 30.42 ± 50 years and the mean parity was 4.47±2.62. Most (51.39%) of the repeat CS were elective. Majority (93.06) of the patients had EBL ≤1000ml and most (82.6%) of the babies delivered had 5th minute Apgar score of ≥7. Conclusion: The repeat Caesarean section rate in this study is high. Similarly, the emergency Caesarean section rate at first and second order repeat Caesarean deliveries is high. Additionally maternal and fetal complications are higher among women lower order Caesarean deliveries.

Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia

Background To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS. Methods We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018–February 2020) and 18,597 births during the pandemic (March 2020–December 2021). Data were analysed using multinominal logistic regression. Results The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%). Conclusions Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.

Comparison of efficacy and safety of the Dinoprostone Vaginal tape and Dinoprostone vaginal tablet for the induction of labor in para three and more women: A retrospective cohort Study

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p>0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p>0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

Maternal Prepregnancy Obesity Affects Foetal Growth, Birth Outcome, Mode of Delivery, and Miscarriage Rate in Austrian Women

The increasing obesity rates among women of reproductive age create a major obstetrical problem as obesity during pregnancy is associated with many complications, such as a higher rate of caesarean sections. This medical record-based study investigates the effects of maternal prepregnancy obesity on newborn parameters, birth mode, and miscarriage rate. The data of 15,404 singleton births that had taken place between 2009 and 2019 at the public Danube Hospital in Vienna were enrolled in the study. Newborn parameters are birth weight, birth length, head circumference, APGAR scores, as well as pH values of the arterial and venous umbilical cord blood. In addition, maternal age, height, body weight at the beginning and the end of pregnancy, and prepregnancy body mass index (BMI) (kg/m2) have been documented. The gestational week of birth, the mode of delivery, as well as the number of previous pregnancies and births, are included in the analyses. Birth length, birth weight, and head circumference of the newborn increase with increasing maternal BMI. Furthermore, with increasing maternal weight class, there tends to be a decrease in the pH value of the umbilical cord blood. Additionally, obese women have a history of more miscarriages, a higher rate of preterm birth, and a higher rate of emergency caesarean section than their normal-weight counterparts. Consequently, maternal obesity before and during pregnancy has far-reaching consequences for the mother, the child, and thus for the health care system.

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study.

Background: The efficacy and safety of a cervical ripening balloon (CRB) in women with a previous cesarean section (CS) and unfavorable Bishop score are still controversial. Methods: A retrospective cohort study was performed across six tertiary hospitals from 2015 to 2019. Women with one previous transverse CS, singleton cephalic term pregnancy and BS < 6 were included if submitted to labor induction with a CRB. The main outcome was the rate of vaginal birth after cesarean (VBAC) after CRB ripening. Secondary outcomes were abnormal composite fetal and maternal outcomes. Results: Of the 265 women included, 57.3% had successful vaginal birth. Augmentation improved vaginal delivery (32.2% vs. 21.2%). Intrapartum analgesia was associated with an increased VBAC rate (58.6% vs. 34.5%). Maternal BMI ≥30 and age ≥40 years increased emergency CS rate (11.8% vs. 28.3% and 7.2 vs. 15.9%). Composite adverse maternal outcome occurred in 4.8% of CRB group women and increased to 17.6% when associated with oxytocin. Uterine rupture occurred in one case (0.4%) in the CRB-oxytocin group. Poorer fetal outcome occurred after emergency CS, if compared to successful VBAC (12.4% vs. 3.3%). Conclusions: In women with a previous CS and unfavorable Bishop score, induction of labor with a CRB can be considered safe and effective.

Fish oil supplementation during pregnancy and postpartum in mothers with overweight and obesity to improve body composition and metabolic health during infancy: A double-blind randomized controlled trial

BackgroundMaternal obesity during pregnancy is associated with an increased risk of obesity and metabolic disease in the offspring. Supplementation with fish oil (FO), which is insulin sensitizing, during pregnancy in mothers with overweight or obesity may prevent the development of greater adiposity and metabolic dysfunction in their children. ObjectivesTo determine the effects of FO supplementation throughout the second half of pregnancy and lactation in mothers with overweight or obesity on infant body composition and metabolism. MethodsA double-blind randomized controlled trial of 6 g FO (3.55 g/d of n-3 PUFAs) compared with olive oil (control) from mid-pregnancy until 3 mo postpartum. Eligible women had singleton pregnancies at 12–20 wk of gestation, and BMI ≥ 25 kg/m2. The primary outcome was the infant body fat percentage (DXA scans) at 2 wk of age. Secondary outcomes included maternal metabolic markers during pregnancy, infant anthropometry at 2 wk and 3 mo of age, and metabolic markers at 3 mo. ResultsA total of 129 mothers were randomized, and 98 infants had a DXA scan at 2 wk. Primary outcome: Imputed and nonimputed analyses showed no effects of FO supplementation on infant body fat percentage at age 2 wk. Secondary outcomes: There were no treatment effects on infant outcomes at 2 wk, but FO infants had a higher BMI z-score (P = 0.025) and ponderal index (P = 0.017) at age 3 mo. FO supplementation lowered maternal triglycerides by 17% at 30 wk of pregnancy (P = 0.0002) and infant triglycerides by 21% at 3 mo of age (P = 0.016) but did not affect maternal or infant insulin resistance. The rate of emergency cesarean section was lower with FO supplementation [aRR = 0.38 (95%CI 0.16, 0.90); P = 0.027]. ConclusionsFO supplementation of mothers with overweight or obesity during pregnancy did not impact infant body composition. There is a need to follow up the offspring to determine whether the observed metabolic effects persist.Clinical trial registry number: This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617001078347p). In addition, the Universal Trial Number, WHO, was obtained (U1111-1199-5860).

Childbirth simulation to assess cephalopelvic disproportion and chances for failed labor in a French population

Reducing failed labor and emergency cesarean section (CS) rates is an important goal. A childbirth simulation tool (PREDIBIRTH software and SIM37 platform) that evaluates a 5-min magnetic resonance imaging (MRI) assessment performed at 37 weeks of gestation was developed to enhance the consulting obstetrician’s ability to predict the optimal delivery mode. We aimed to determine the potential value of this childbirth simulation tool in facilitating the selection of an optimal delivery mode for both mother and infant. A retrospective cohort study was performed on all patients referred by their obstetricians to our level 2 maternity radiology department between December 15, 2015 and November 15, 2016, to undergo MRI pelvimetry at approximately 37 weeks of gestation. The childbirth simulation software was employed to predict the optimal delivery mode based on the assessment of cephalopelvic disproportion. The prediction was compared with the actual outcome for each case. Including childbirth simulations in the decision-making process had the potential to reduce emergency CSs, inappropriately scheduled CSs, and instrumental vaginal deliveries by up to 30.1%, 20.7%, and 20.0%, respectively. Although the use of the simulation tool might not have affected the overall CS rate, consideration of predicted birthing outcomes has the potential to improve the allocation between scheduled CS and trial of labor. The routine use of childbirth simulation software as a clinical support tool when choosing the optimal delivery mode for singleton pregnancies with a cephalic presentation could reduce the number of emergency CSs, insufficiently justified CSs, and instrumental deliveries.

Gender divergence: scoping the surgical gap.

Women constitute 62 per cent of UK medical school entries, yet the percentage in higher surgical training is half this (32 per cent), and the proportion of female consultants on the specialist register is only 14 per cent1. Hidden curricula are subtle value-based lessons with moral undertones; they are absorbed without explicit intention but may perpetuate and boost existing disparities such as gender bias. Gender stereotypes continue to prevail in modern cultures, with female attributes considered warmer and more caring than the colder and more confident male behaviour. Moreover, straying from such traditional dogma can lead to negative perceptions. Microaggression is also prevalent, and defined as subtle insults and hostility toward minority stigmatized groups, including women2. Infertility among doctors is high, with one in four female physicians experiencing conception difficulties, compared with the general population rate of 9–18 per cent3. Challenging on-call rotas and long geographical commutes can make pregnancy daunting. Female surgeons, in particular, have been reported to have significantly higher rates of infertility, with 32 per cent of a cohort of female US residents experiencing difficulties4. Arguably, higher infertility may be due to decisions to defer starting families until training has completed, and Rangel et al. reported that 65 per cent of studied female surgeons delayed pregnancy because of training-related concerns5. The average age for their first pregnancy was 33 years, compared with 31 years in controls, and the effect of age on fertility is well recognized. Moreover, miscarriage rates among female surgeons have been reported to be 42 per cent, double that of the general population5. Rates of pregnancy complications (intrauterine growth retardation, placental abruption, preterm labour, and low birthweight) have also been reported to be significantly higher in female surgeons, with 48 per cent suffering major morbidity, compared with 27 per cent in non-surgeon partners6. Pregnant surgeons also suffered higher rates of emergency caesarean section, musculoskeletal disorders, and postnatal depression. Operating for 12 hours or more per week during the third trimester of pregnancy was shown to increase morbidity 1.5-fold5. Mohan et al. reported that 27.1 per cent of UK and Republic of Ireland female surgeons felt unsupported during pregnancy7.

Associations among maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW large rural town, and comparison to NSW state data.

To determine associations between maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW rural hospital, and compare these to state data. Data (maternal characteristics, labour type, delivery mode and maternal antenatal complications) pertaining to women who had delivered a singleton birth at Griffith Base hospital were analysed. Retrospective data analysis of Griffith Base Hospital 'eMaternity' database SETTING: Single large rural town in NSW. Women who delivered a singleton birth between July 2018 and June 2019 inclusive at Griffith Base Hospital. 1. Comparison of maternal characteristics of age, BMI, gravida, parity and gestation data between labour type (spontaneous, augmented, induced and planned caesarean section) and delivery modes (vaginal, instrumental vaginal and caesarean section). 2. Associations between labour type, augmentation or induction method, delivery mode and maternal antenatal complications. 3. Multiple regression analysis for influence of age, BMI, parity and labour type on emergency caesarean section outcome. 4. Comparison of maternal, labour and delivery data with NSW state data. Among 457 women, there were higher rates of obesity and spontaneous labour, lower rates of planned caesarean section and augmented labour, and similar rates of induction of labour and emergency caesarean section, compared with NSW. Emergency caesarean section was significantly associated with older age (β=0.163), and labour augmentation (β=0.114) and induction (β=0.169). Labour augmentation with synthetic oxytocin, and induction with balloon catheter, were associated with the highest rates of emergency caesarean section. This large rural town had fewer labour and delivery medical interventions compared with NSW overall. Augmentation and induction of labour contribute to increasing caesarean section rates: directly via associations with emergency caesarean section, and indirectly because previous caesarean section was the most common reason for elective caesarean section.

Magnetic resonance imaging in late pregnancy to improve labour and delivery outcomes – a systematic literature review

BackgroundMagnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma.ObjectiveTo study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth.MethodsSystematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies.ResultsEighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth.ConclusionMRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored.

Smartphone Apps for Surveillance of Gestational Diabetes: Scoping Review

Developments and evolutions in the information and communication technology sector have provided a solid foundation for the emergence of mobile health (mHealth) in recent years. The cornerstone to management of gestational diabetes mellitus (GDM) is the self-management of glycemic indices, dietary intake, and lifestyle adaptations. Given this, it is readily adaptable to incorporation of remote monitoring strategies involving mHealth solutions. We sought to examine and assess the available smartphone apps which enable self-monitoring and remote surveillance of GDM with a particular emphasis on the generation of individualized patient feedback. Five databases were searched systematically for any studies evaluating mHealth-supported smartphone solutions for GDM management from study inception until January 2022. The studies were screened and assessed for eligibility of inclusion by 2 independent reviewers. Ultimately, 17 studies were included involving 1871 patients across 11 different countries. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) conceptual framework was adhered to for data extraction and categorization purposes. All studies analyzed as part of this review facilitated direct uploading of data from the handheld glucometer to the downloaded patient-facing smartphone app. Glycemic data were captured by all studies and were reassuringly found to be either improved or noninferior to extant models of hospital-based care. Feedback was delivered in either an automated fashion through in-app communication from the health care team or facilitated through bidirectional communication with the app and hospital portal. Although resource utilization and cost-effective analyses were reported in some studies, the results were disparate and require more robust analysis. Where patient and staff satisfaction levels were evaluated, the response was overwhelmingly positive for mHealth smartphone-delivered care strategies. Emergency cesarean section rates were reduced; however, elective cesarean sections were comparatively increased among studies where the mode of delivery was assessed. Most reviewed studies did not identify any differences in maternal, perinatal, or neonatal health when app-based care was compared with usual in-person review. This comprehensive scoping review highlights the feasibility, reliability, and acceptability of app-assisted health care for the management of GDM. Although further exploration of the economic benefit is required prior to implementation in a real-world clinical setting, the prospect of smartphone-assisted health care for GDM is hugely promising.

Obstetric and Neonatal Outcomes in Mild Idiopathic Polyhydramnios

Background: Idiopathic polyhydramnios is a controversial clinical condition, as data on perinatal outcomes are conflicting and vary depending on the severity of the condition. The aim of the present study was to compare obstetric and neonatal outcomes between pregnant women with mild idiopathic polyhydramnios and a control population. Methods: A retrospective cohort study was performed at a single university hospital comparing the obstetrics and neonatal outcomes of pregnancies with mild idiopathic polyhydramnios (n = 109) and control pregnancies (n = 2550). Results: Cesarean section (CS) was significantly increased in the group with polyhydramnios compared to controls (46% vs. 32%, respectively, p = 0.047) due to a higher rate of emergency CS in the polyhydramnios group (p = 0.041) because of abnormal cardiotocography (7.3% vs. 2.9%; p = 0.018) or labor dystocia (8.2% vs. 2.9%; p = 0.006). No statistically significant difference was found in the Apgar score, in the rate of neonatal hypoxia, or in the incidence of macrosomia between groups. In four cases, additional diagnoses of anomalies were made after birth, with a rate of 3.2%, which is comparable to the general population. Conclusion: Besides an increased risk of CS, patients with mild idiopathic polyhydramnios should be reassured regarding maternal and feto-neonatal outcomes. The management of pregnancies with stable mild idiopathic polyhydramnios should not differ from uncomplicated pregnancies, except for the need for increased labor surveillance.

Pregnancy outcomes in pregnant women with diabetes treated with insulin alone and insulin with metformin

Aim: The goal of this study was to compare maternal and neonatal results in diabetic pregnant ladies who were treated either insulin and metformin or insulin only.Methods: 220 pregnant diabetic women with type 1, 2 or gestational diabetes were randomisely assigned into two groups .each group is 110 pregnant diabetic women. One group takes insulin and metformin treatment to achieve glycemic targets and other take insulin only treatment. Pregnancy results in 110 ladies who stayed solely on insulin have been compared to pregnancy results in 110 pregnant diabetic ladies treated with insulin and metformin who were matching for age, weight, as well as ethnicity.Results: No significant variations in maternal risk factors existed at the start of the study. Group II from enrolling to term, they gained significantly more weight (5.90 vs. 4.39 kg; P &lt; 0.000). When it came to gestational hypertension, there was no significant difference between groups I and II (14.5 against 19.1%, P = 0.367), pre-eclampsia (7.27 vs. 9.09%, P = 0.622),insulin dosage was decreased in group I statistically significant (mean 39.5±16.5 vs. 55.4±17.5 units, P= 0.000), vaginal delivery (41.8 vs. 47.3%, P = 0.416) or rate of elective Caesarean section (39.1 vs. 32.7%, P = 0.325), rate of emergency caesarean section (19.1 vs. 20%, P=0.865), perinatal loss (4 cases in group II vs. 3 cases in group I;P=0.701). Group I had a lower rate of neonatal morbidity; prematurity (16.63 vs. 24.55%, P = 0.417), neonatal hypoglycemia (7.3 vs. 24.5 %, P= 0.000), respiratory distress (13.64 vs. 30 %, P= 0.003), neonatal jaundice (13.6 vs. 33.6%, P &lt; 0.000) and admittance to the newborn intensive care unit (24.55 vs. 35.45%, P = 0.077). Macrosomia occurrence (There was a significant difference in birth weight centiles &gt; 90 [group I (16.4%) vs. group II (29.1%); P = 0.024]. The incidence of polyhydramnios was significantly different [group I (13.6%) vs. group II (32.7%); P = 0.001].Shoulder dystocia [group ? (2.7%) vs. group II (4.5%); P=0.721].Conclusions: Diabetic pregnant women who were treated with insulin plus metformin who had equal baseline risk factors for unfavourable pregnancy outcomes gained less weight and needed less insulin to maintain glycemic control. Furthermore improved neonatal outcomes as macrosomia, neonatal hypoglycemia, respiratory distress and special care baby admission compared with those treated with insulin alone.

Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study.

ObjectiveTo assess the association between hospital‐level rates of induction of labour and emergency caesarean section, as measures of ‘practice style’, and rates of adverse perinatal outcomes.DesignNational study using electronic maternity records.SettingEnglish National Health Service.SampleHospitals providing maternity care to women between April 2015 and March 2017.Main outcome measuresStillbirth, admission to a neonatal intensive care unit and babies receiving mechanical ventilation.ResultsAmong singleton term births, the risk of stillbirth was 0.15%, the risk of admission to a neonatal intensive care unit was 5.4% and the risk of mechanical ventilation 0.54%. There was considerable between‐hospital variation in the rate of induction of labour (minimum 17.5%, maximum 40.7%) and in the rate of emergency caesarean section (minimum 5.6%, maximum 17.1%). Women who gave birth in hospitals with a higher rate of induction of labour had better perinatal outcomes. For each 5%‐point increase in induction, there was a decrease in the risk of term stillbirth of 9% (OR 0.91, 95% CI 0.85–0.97) and a decrease in the risk of mechanical ventilation of 14% (OR 0.86, 95% CI 0.79–0.94). There was no significant association between hospital‐level induction of labour rates and neonatal unit admission at term (p > 0.05). There was no significant association between hospital‐level rates of emergency caesarean section and adverse perinatal outcomes (all with p > 0.05).ConclusionsThere is considerable between‐hospital variation in the use of induction of labour and emergency caesarean section. Hospitals with a higher rate of induction had a lower risk of adverse birth outcomes. A similar association was not found for caesarean section.

The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis.

Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.

Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies

ObjectivesTo appraise adverse pregnancy outcomes after the adoption of IADPSG/WHO guidelines in Belgium. MethodsA retrospective study of the Center for Perinatal Epidemiology registry was conducted. Demographic changes and adverse pregnancy outcomes were compared between a pre- and post-guideline period in women with and without hyperglycemia in pregnancy (HIP). Adjusted odds ratios with a 95% confidence interval (CI) were used to compare maternal and neonatal outcomes controlling for potential confounders (maternal age, body mass index (BMI), hypertension, parity, and multiple births). ResultsThe prevalence of HIP increased (6.0%–9.2%). In the overall population regardless of glycemic status, gestational weight gain (12.3 ± 5.7 vs 11.9 ± 5.8; p < 0.001), hypertension (0.92; 95% CI, 0.89–0.94; p < 0.001), and neonatal intensive care unit/special care nursery (0.89; 95% CI, 0.87–0.91; p < 0.001) decreased despite increasing maternal age and pre-pregnancy BMI. Emergency cesarean section rates (1.07; 95% CI, 1.05–1.09; p < 0.001) increased, but not in the HIP population (1.02; 95% CI, 0.95–1.10; ns). The overall incidence of preterm birth (1.09; 95% CI, 1.06–1.12; p < 0.001), stillbirth (1.10; 95% CI, 1.01–1.21; p < 0.05), and perinatal mortality (1.10; 95% CI, 1.01–1.19; p < 0.05) increased, except in the HIP population (1.03; 95% CI, 0.95–1.11; ns), (1.04; 95% CI, 0.74–1.47; ns) and (1.09; 95% CI, 0.80–1.49; ns), respectively. The overall incidence of small- for-gestational-age remained unchanged (0.99; 95%CI, 0.97–1.01; ns) regardless of glycemic status. In the HIP population, large-for-gestational age (0.90; 95% CI, 0.84–0.95; p < 0.001) and macrosomia (0.84; 95% CI, 0.78–0.92; p < 0.001) decreased. ConclusionAfter the implementation of IADPSG/WHO guidelines, the prevalence of HIP increased by 53.7% and the incidence of major HIP-related pregnancy complications appears to be lower. However, we cannot conclude that the reduction of LGA-macrosomia is due to a better management of diabetes or due to greater recruitment of women with mild HIP associated with a lower risk of obstetrical complications.

Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study

Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques.

A STUDY TO EVALUATE MATERNAL AND FETAL OUTCOME IN TERM PREGNANCY WITH MECONIUM STAINED AMNIOTIC FLUID: A PROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE CENTRE IN INDIA

Background: Globally, 7-22% of all live births are complicated by meconium stained amniotic uid (MSAF). MSAF is considered a predictor of adverse fetal outcome, and meconium aspiration syndrome, a major cause of perinatal morbidity and mortality. This study aimed to nd out the incidence of MSAF and to nd a clinical correlation of neonatal outcome with amnioinfusion and mode of delivery among the study groups. Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India from October 2017 to March 2019. 206 patients who fullled the inclusion criteria were studied. Subgroups of with/without amnioinfusion were analyzed in terms of mode of delivery and neonatal outcome. Results: The incidence of MSAF in term pregnancies was found to be 9.13 %. Patients were divided into 2 study groups: thick MSAF and thin MSAF. 76.2% of patients were managed with amnioinfusion. A signicant reduction in the number of cesarean sections observed among patients with thick MSAF. A signicant improvement in APGAR score was observed in newborns with amnioinfusion for thick MSAF. There was a decrease in neonatal intensive care unit stay, neonatal morbidity and mortality. Conclusion: Taking the risks of MSAF into consideration, a trial of labour should be given where continuous electronic fetal monitoring and emergency cesarean section facilities are available. Amnioinfusion decreased the rate of emergency cesarean section and improved the APGAR score in patients with thick MSAF.