C-section Rate Research Articles

Proteinuria is associated with worse outcomes in babies born to mothers with preeclampsia: A retrospective cohort study at a tertiary referral hospital in Brazil.

To evaluate whether the presence of proteinuria, although no longer mandatory in the revised diagnostic criteria, results in worse maternal and fetal outcomes in preeclampsia (PE). A retrospective cohort study was conducted, analyzing data from pregnant patients diagnosed with PE between January 2015 and December 2019 at a tertiary care center in Brazil. Ethical approval was obtained, and the patient records were reviewed to assess maternal and perinatal outcomes based on the revised diagnostic criteria by the College of Obstetricians and Gynecologists, focusing on the presence or absence of proteinuria. The study included 816 pregnant patients with PE, of whom 685 (83.9%) were diagnosed based on proteinuria. The revised criteria, which include indicators of organ damage, identified an additional 131 cases (16.4%). Analysis showed no significant differences in maternal outcomes between proteinuria and non-proteinuria groups, including intensive care unit (ICU) admission, acute pulmonary edema (APE), HELLP syndrome, eclampsia, or C-section rates. However, babies born to mothers with proteinuria PE experienced worse outcomes, including fetal growth restriction, low birth weight, ICU admission, and higher rates of preterm birth. Relative risk analysis demonstrated a high risk of babies being born with low birth weight, ICU admission, and being born preterm and very preterm in cases where proteinuria was present in mothers with PE. The presence of proteinuria is associated with significantly worse outcomes in babies born to mothers with preeclampsia, while no significant differences were observed in maternal outcomes.

Determinants of Caesarean Deliveries in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Caesarean section, a frequently conducted surgical procedure in obstetrics, is instrumental in safeguarding the well-being of both mothers and infants by addressing complications related to pregnancy and childbirth. While it significantly contributes to reducing maternal and infant mortality rates, its overuse can pose serious health risks. The prevalence of caesarean deliveries has surged globally, including in Bangladesh. This rise in caesarean deliveries has prompted this research to investigate the prevalence and various associated factors in the country. To achieve the study objectives, data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted from 2017 to 2018. After preprocessing the data, a total of 4,884 women were included in the study. Frequency analysis was conducted to illustrate the distribution of sociodemographic characteristics among Bangladeshi women. Chi-square tests were performed to assess their association with caesarean delivery. Furthermore, multi-level logistic regression analysis was employed to identify the variables that have a significant impact on the likelihood of caesarean delivery. The study revealed that in Bangladesh, the prevalence of caesarean section deliveries was approximately 33.1%, with the majority of these occurring in the Dhaka division, accounting for approximately 25.3%. Women aged 20 or older were 1.62 times more likely to opt for a C-section during childbirth (OR 1.62, [1.38-1.89]) compared to those under 20. Overweight or obese women had twice the likelihood of delivering via C-section. Higher socioeconomic status also increased the probability of choosing a caesarean delivery. Women who had exposure to any form of media were 57% more likely to opt for a caesarean delivery (OR 1.57 [1.31-1.87]), while not working women had a 48% higher likelihood of having a C-section. Additionally, the study found that the use of caesarean delivery was positively associated with the husband's education level, the number of children previously born, and the number of antenatal care visits. The study revealed that the rate of C-sections in Bangladesh surpasses WHO recommendations significantly. It also identified various factors driving this trend, including women's education levels, socioeconomic status, media exposure, female obesity, age at first childbirth, and husband’s education. These insights may serve as a foundation for developing strategies to regulate the caesarean delivery rate. Urgent policy directives are essential within Bangladesh's healthcare system, coupled with vigilant monitoring of clinical indications for C-sections, to mitigate the adverse effects of unnecessary procedures. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 31−44

Regional differences in autism and intellectual disability risk associated with cesarean section delivery.

Prior epidemiological studies investigating the association between delivery mode (i.e., vaginal birth and cesarean section [C-section]) and autism spectrum disorder (ASD) and intellectual disability (ID) risk have reported mixed findings. This study examined ASD and ID risks associated with primary and repeat C-section within diverse US regions. During even years 2000-2016, 8-years-olds were identified with ASD and/or ID and matched to birth records [ASD only (N = 8566, 83.6% male), ASD + ID (N = 3445, 79.5% male), ID only (N = 6158, 60.8% male)] using the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network methodology. The comparison birth cohort (N = 1,456,914, 51.1% male) comprised all births recorded in the National Center for Health Statistics corresponding to birth years and counties in which surveillance occurred. C-section rates in the birth cohort demonstrated significant regional variation with lowest rates in the West. Overall models demonstrate increased odds of disability associated with primary and repeat C-section. Adjusted models, stratified by region, identified significant variability in disability likelihood associated with repeat C-section: increased odds occurred for all case groups in the Southeast, for ASD only and ID only in the Mid-Atlantic, and no case groups in the West. Regional variability in disability risk associated with repeat C-section coincides with differences in birth cohorts' C-section rates. This suggests increased likelihood of disability is not incurred by the procedure itself, but rather C-section serves as a proxy for exposures with regional variability that influence fetal development and C-section rates.

Exploring Caesarean Birth 8: Discharge Planning and Education After Caesarean Birth

In the final article in this series, Leonie Rastas discusses discharge planning and education by maternity units after caesarean birth. Australia’s caesarean birth rate has risen 500% from the 1980 rate of 7%. The caesarean section (C-section) rate is predicted to reach 45% by 2030.1 This has impacted discharge planning and education by maternity units, particularly considering shortened hospital stays. Given every pregnancy is at risk of surgical intervention, it is incumbent on antenatal educators to include the implications of caesarean birth and the recovery expectations to help minimise the aftershock of unplanned surgery.

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit.

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.

Cesarean birth is associated with lower motor and language development scores during early childhood: a longitudinal analysis of two cohorts

With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley’s Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (β =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (β=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (β=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (β=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest β at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings.

Early Mobilization Training Education for Sectio Caesarea Patients

Background: The global rise in caesarean section (C-section) rates, particularly in Asia where the incidence stands at 19.5%, underscores the need for effective post-operative care strategies. Early mobilization is critical for post-C-section recovery, as it enhances patient mobility, reduces complications, and promotes overall health. Purpose: This study aims to assess the impact of early mobilization education on post-C-section patients' knowledge. Methods: This community service initiative, conducted at the Albarokah Room of Purwokerto Islamic Hospital, targeted 30 post-C-section maternal patients. The educational intervention was delivered using audiovisual media and the caramah method. Knowledge levels were assessed using a pre- and post-intervention questionnaire, which evaluated understanding of early mobilization, its benefits, contraindications, and procedural stages. Findings: Prior to the educational intervention, participants' knowledge was predominantly categorized as poor, with 40% (12 participants) scoring in this range. Post-education assessment revealed a significant improvement, with 100% (30 participants) achieving a good knowledge level regarding early mobilization. Conclusions: The implementation of early mobilization education through audiovisual media markedly improved participants' knowledge about early mobilization post-C-section. This study demonstrates that structured educational interventions can effectively enhance patient understanding and potentially improve post-operative outcomes. Further research is warranted to explore long-term effects on recovery and health

Implementation of a Labor Dystocia Checklist to Reduce NTSV C-Section Rates.

Cesarean section (c-section) rates among nulliparous, term, singleton, and vertex (NTSV) pregnancies are increasing, posing risk to the infant and birthing parent. To reach the Healthy People 2030 goal of an NTSV c-section rate below 23.6%, teams must remain aware of their NTSV c-section rate and implement mechanisms to reduce it. This project was conducted to assess the impact of quality improvement interventions implemented by family medicine residents to reduce a hospital's NTSV rate. From 2021 to 2023, family medicine residents were educated on evidenced-based diagnosis of labor dystocia, failed induction of labor, arrest of dilation, and arrest of descent in first-time birthing parents. Learning was reinforced by implementing the Colorado Perinatal Care Quality Collaborative's labor dystocia checklist. Quarterly assessment of the hospital's NTSV rate and checklist utilization were monitored and widely reported. After the implementation of a standard checklist, the NTSV c-section rate at the tertiary care center declined from 35.6% in 2020 to a sustained rate below the 2030 Healthy People goal of 23.6%. Notably, patients with public insurance saw the greatest reduction in NTSV c-section rates. Hospital staff highlighted the benefits of using the checklist, including more effective electronic documentation of labor progression, improvement in team dynamics, and increased team communication. Using a labor dystocia checklist is a successful method for teams to reduce NTSV c-section rates and can be used as a training tool for family medicine and obstetrics and gynecology residency programs that care for laboring persons.

Exploring Cesarean Section Delivery Patterns in South India: A Bayesian Multilevel and Geospatial analysis of Population-Based Cross-Sectional Data

BackgroundThis paper focuses on the period from 2019 to 2021 and investigates the factors associated with the high prevalence of C-section deliveries in South India. We also examine the nuanced patterns, socio-demographic associations, and spatial dynamics underlying C-section choices in this region. A cross-sectional study was conducted using large nationally representative survey data.MethodsNational Family Health Survey data (NFHS) from 2019 to 2021 have been used for the analysis. Bayesian Multilevel and Geospatial Analysis have been used as statistical methods.ResultsOur analysis reveals significant regional disparities in C-section utilization, indicating potential gaps in healthcare access and socio-economic influences. Maternal age at childbirth, educational attainment, healthcare facility type size of child at birth and ever pregnancy termination are identified as key determinants of method of C-section decisions. Wealth index and urban residence also play pivotal roles, reflecting financial considerations and access to healthcare resources. Bayesian multilevel analysis highlights the need for tailored interventions that consider individual household, primary sampling unit (PSU) and district-level factors. Additionally, spatial analysis identifies regions with varying C-section rates, allowing policymakers to develop targeted strategies to optimize maternal and neonatal health outcomes and address healthcare disparities. Spatial autocorrelation and hotspot analysis further elucidate localized influences and clustering patterns.ConclusionIn conclusion, this research underscores the complexity of C-section choices and calls for evidence-based policies and interventions that promote equitable access to quality maternal care in South India. Stakeholders must recognize the multifaceted nature of healthcare decisions and work collaboratively to ensure more balanced and effective healthcare practices in the region.

Challenging biases in delivery mode decisions for women with pelvic fracture history: a call for evidence-based practices and patient-centered care.

Pelvic fractures significantly impact young individuals, with a prevalence of 20 per 100,000, leading to long-term complications such as chronic pain and genitourinary dysfunction. Notably, women with a history of pelvic fractures face increased cesarean section (C-sections) rates during childbirth. This editorial investigates the factors contributing to higher C-section rates in these women, including provider assumptions about delivery complications and systemic hospital biases. Despite these trends, evidence suggests that vaginal delivery can be successful, especially when considering factors like pelvic displacement and the timing of delivery post-fracture. We advocate for education programs to challenge provider biases, transparent patient communication, and evidence-based practices prioritizing patient-centered care. Addressing these issues can enhance maternal and fetal outcomes, supporting women in making informed decisions about their delivery options.

Epidemiology of Brachial Plexus Birth Injury and the Impact of Cesarean Section on Its Incidence.

While prior research provided thorough analysis of the epidemiology of brachial plexus birth injury (BPBI) from 1997 to 2012, recent trends are unknown. The goal of this study was to update the understanding of the epidemiology and risk factors for BPBI. Installments of the Kids' Inpatient Database (1997 to 2019) were used to estimate BPBI incidence in the United States in comparison to several independent variables over time. An interaction between cesarean (C-) section and newborn weight was explored by defining BPBI rates in a stratified manner. A logistic regression model accounting for this interaction was developed to produce odds ratios for independent factors. Lastly, the temporal relationship between BPBI rates and C-section rates was explored using linear regression. BPBI rates were steady around 0.9 to 1.1 per 1000 live births between 2006 and 2019. C-section rates were similarly stable between 32.3% and 34.0% over this period. Stratified analysis indicated C-section delivery was protective against BPBI across newborn weight classes, but the magnitude of this protective value was highest among newborns with macrosomia. Shoulder dystocia was the strongest risk factor for BPBI in the logistic regression model [adjusted odds ratio (AOR): 56.9, P<0.001]. The AOR for a newborn with macrosomia born through C-section (AOR: 0.581, 95% CI: 0.365-0.925) was lower than that for a normal weight newborn born vaginally (AOR: 1.000, P=0.022). Medicaid insurance coverage (AOR: 1.176, 95% CI: 1.124-1.230, P<0.001), female sex (AOR: 1.238, 95% CI: 1.193-1.283, P<0.001), and non-White race (AOR: 1.295, 95% CI: 1.237-1.357, P<0.001) were independent risk factors for BPBI. Over time, the rate of BPBI correlated very strongly with the rate of C-section (R2=0.980). While BPBI and C-section rates were relatively stable after 2006, BPBI incidence strongly correlated with C-section rates. This highlights the need for close surveillance of BPBI rates as efforts to lower the frequency of C-section evolve. Female, Black, and Hispanic newborns and children with Medicaid insurance experience BPBI at a higher rate, a finding which could direct future research and influence policy. Level IV-case series.

Assessing maternity care access: impacts on cesarean sections and dystocia

BackgroundAs South Korea grapples with a declining birthrate, maternity care accessibility has become challenging. This study examines the association with labour intervention and pregnancy complication, specifically focusing on C-section and dystocia in maternity disparities.MethodsData from the South Korean NHIS-NID was used to analyze 1,437,186 women with childbirths between 2010 and 2015. The research defines 50 specific districts as Obstetrically Underserved Areas produced by the Ministry of Health and Welfare in 2011. C-Section were assessed through using medical procedure and DRG codes, while dystocia was defined using ICD-10 code. Logistic regression analysis was used to examine the significance of the association.ResultsAmong the population residing in underserved areas, 42,873 out of a total of 1,437,186 individuals were identified. For nationwide cases, the odds ratios (ORs) for C-Section were 1.11 (95% CI: 1.08–1.13) and dystocia were 1.07 (95% CI: 1.05–1.09). In relatively accessible urban areas, the ORs for C-Section and dystocia, based on whether they were obstetrically underserved areas, were 1.16 (95% CI: 1.13–1.18) and 1.10 (95% CI: 1.08–1.19), respectively.ConclusionPoor accessibility to maternity care facilities is closely linked to high-risk pregnancies, including an increased incidence of dystocia and a higher rate of C-sections. Insufficient access to maternity care not only raises the risk of serious pregnancy complications. Consequently, there is a pressing need for multi-faceted efforts to bridge this disparity.

Balancing the scales? Evaluating the impact of results-based financing on maternal health outcomes and related inequality of opportunity in Zimbabwe

This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study.

International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))? In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data. During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status. Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

Evaluating the impact of a trial of labor after cesarean section on labor duration: a retrospective cohort study

BackgroundCesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases.MethodsThis retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor.ResultsThe unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70–0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74–1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself.ConclusionsAfter adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration.

O-092 Prevalence of multiple gestation births and perinatal outcomes in pregnancies secondary to clomiphene citrate treatment: a nationwide cohort study

Abstract Study question Is the incidence of multiple gestation births higher in pregnancies obtained after clomiphene citrate (CC) treatment compared to spontaneous pregnancies? Summary answer The rate of multiple gestation births in pregnancies obtained after CC treatment is significantly increased compared to spontaneous pregnancies. What is known already CC is a selective estrogen modulator frequently used to induce ovulation in infertile women. Data regarding the prevalence of multiple gestation births and adverse perinatal outcomes after CC are contradicting and based on meta-analysis of small sample size studies. Multiple gestations are frequently associated with complications such as preeclampsia, premature labor, and growth restriction, which contribute to higher mortality and morbidity rates. Study design, size, duration Using the French National Health Data System (SNDS) spanning 2013 to 2019, we conducted a nationwide cohort study including all pregnancies lasting more than 22 weeks of gestation, in women aged between 18-43 years. Participants/materials, setting, methods For each women, the first pregnancy during study was included. Women with the dispensing of IVF/ICSI treatment and/or gonadotrophins were excluded. Pregnancies exposed to CC (during the period [-60days,-11days] before the beginning of the pregnancy) were 1:10 matched to unexposed pregnancies. Pregnancies exposed to CC between 12 to 2months or less than 11 days before the beginning of the pregnancy were excluded to mitigate misclassification bias. The primary outcome was the multiple gestation birth rate. Main results and the role of chance Of 3,173,013 pregnancies, 32,010 (10 ‰) occurred in women exposed to clomiphene. The multiple pregnancy rate was significantly higher in pregnant women exposed with CC compared to matched controls (odd ratio 4.1, 95% CI [3.9-4.3]) such as twin pregnancies (OR 4.1, 95% CI [3.9-4.3]) and triple or more pregnancies (OR 5.1, 95% CI [3.8-7.2]). Women exposed to CC presented significantly more adverse obstetrical and perinatal outcomes, including stillbirths, premature delivery threats, premature rupture of membranes, gestational diabetes, placenta previa, gravid hypertension, pre-eclampsia, preterm birth, small for gestational age (SGA), C-section rate, and major birth defect rate. After stratification on multiple pregnancy and adjustment on confounders (history of psychiatric disease, diabetes, arterial hypertension, obesity and embryo reduction during pregnancy), women exposed to CC had a significantly higher risk of stillbirth, gestational diabetes, placenta previa, pre-eclampsia, preterm delivery and SGA in case of singleton pregnancies. Additionally, in the case of multiple pregnancies, they had a higher risk of placenta previa, preterm delivery, and SGA compared to non-exposed women. Limitations, reasons for caution The use of filled prescriptions as a measure of drug exposure could be subject to bias such as misclassification bias, although we attempt to mitigate it. Wider implications of the findings Clomiphene use is strongly associated with multiple gestation births and with adverse obstetrical and perinatal outcomes even in singleton pregnancies. These findings should provide awareness of practitioners and patients about its use. It underscore the importance of attentively monitoring follicular growth during the treatment process to avoid multiple pregnancies. Trial registration number NA

Comparison of the rate and indications of caesarean section in primigravida and multigravida in a maternity hospital of Pakistan.q

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value &lt;0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

Improving gestational diabetes care: Mobile glucose monitoring to reduce complications

BackgroundGestational diabetes mellitus (GDM) incurs risks for both mother and baby and requires close medical attention throughout pregnancy. This retrospective study examined the impact of myDiabby® software on GDM care and complications. Material and methodsThe study population was divided between a pre-MyDiabby® group, with traditional monitoring before September 2017, and a myDiabby® group, using the myDiabby® app after September 2017. The aim was to compare the main complications of GDM and blood glucose control between the two groups, using Fisher's exact test or bilateral Student t-test as appropriate. Backward logistic regression was used to identify independent factors associated with glycemic control and caesarean section (C-section). ResultsThere were 622 pre-myDiabby® and 649 myDiabby® patients. The myDiabby® group showed significantly lower risk of C-section (17.2% vs. 11.3%, P=0.004). After adjustment for pre-pregnancy body mass index (BMI), maternal age, prematurity, macrosomia and eclampsia, telemedicine was independently associated with a lower rate of C-section (OR=0.67, 95% CI: 0.51–0.89, P=0.005). Glycemic control improved (66.6% vs. 85.4%, P<0.001), with only a trend for need of insulin treatment. MyDiabby® remained associated with glycemic control (OR=3.15, 95% CI: 2.87–4.33, P<0.001) independently of pre-pregnancy BMI, insulin treatment or personal history of GDM. ConclusionThese findings highlight the potential benefits of using telemedicine tools in the management of GDM during pregnancy.

Clinical Characteristics and Maternal and Neonatal Outcomes of Pregnant Women Positive, Negative, and Recovered With COVID-19 Pneumonia

Background: The pandemic of coronavirus disease 2019 (COVID-19) has caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant Hispanic women with COVID-19. Methods: This study was a retrospective chart review. This cohort included pregnant females between the ages of 18-60 who had tested positive for COVID-19 and tested negative for COVID-19 from the electronic medical records of Texas Tech Health Sciences Department of OB/GYN clinics, University Medical Center (UMC), and El Paso Children’s Hospital (EPCH) from March 2020 to June 2021, in addition to their neonates. Records were analyzed to collect information on demographics, BMI, gestational age, COVID status at the time of delivery, history of exposure to COVID, signs and symptoms of COVID, presenting symptoms, comorbidities, and treatment of COVID before and after delivery. Further, mode of delivery, pregnancy complications, complications during labor, and adverse outcomes (maternal death, admission to ICU, length of stay in ICU). We also collected diagnostic data. The control group included age-matched pregnant individuals without a diagnosis of COVID. The control group was evaluated for the same variables and outcome assessment. For the neonatal outcomes, the mothers were matched to the neonate. Data collected on neonatal outcomes included demographics, date of delivery, APGAR score, admission to the newborn nursery or NICU, the reason for NICU admission, birthweight, length, head circumference, fetal abnormalities, prematurity, neonatal death, COVID test results, breastfeeding (expressed or direct), and length of hospital stay. We also collected diagnostic data for neonates. Statistical analyses was performed using descriptive statistics for the various variables, a t-test to determine differences between the two groups for the continuous variables, and a chi-square test for the categorical variables. Results: During the period March 21, 2020 - June 15, 2021, 370 pregnant women, out of which 100 women were COVID-positive, 71 women who were recovered, and 188 controls. COVID-positive women had more elevated fibrinogen, WBC, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase but nonsignificant CRP levels. Most of the COVID-positive and COVID recovered women had preeclampsia during pregnancy, 29.24% COVID positive women delivered via C-section, while 68.42% of women delivered vaginally. The mean length of stay was 2.97 days for both groups. There 79.41% of women chose to breastfeed. One maternal death was recorded, while only two women had ICU admissions. Compared to the COVID-positive, the recovered women still had significantly elevated fibrinogen but not ALP, ALT, AST, and CRP. The COVID recovered women had lower counts of vaginal delivery (56.3%) and higher C-section rates (39.4%) among the three groups. The recovered group had higher premature deliveries (18%) than the other two groups (8%, 17%). Among the neonatal outcomes, there were four neonatal deaths in the COVID group, two neonates had COVID transmission during delivery, and 19.4 % of neonates were admitted to the NICU. Among neonatal vitals, blood pressure was higher in the positive (41%) and recovered (32.39%) groups than in controls (27.6%). Neonatal hypoglycemia was also higher in the recovered group (27.5%) than in the positive (17.11%) and control group (18.4%). Conclusions: Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had a vaginal or cesarean delivery. There were complications observed in women who recovered from COVID during pregnancy.

Resource setting impacts neonatal but not maternal survival in bitches treated for dystocia: 243 cases (2015-2020).

To compare maternal and fetal outcomes of dystocia managed surgically and nonsurgically at referral hospitals (RHs) versus community medicine clinics (CMCs), determine the rate of C-section, and evaluate the incidence of hypoglycemia and hypocalcemia in bitches presented with dystocia. Bitches presented with dystocia at 2 RHs and 2 CMCs. Information on signalment, presence of hypoglycemia and/or hypocalcemia, diagnostic imaging performed, nonsurgical and surgical interventions performed, maternal and fetal outcomes, and total cost of care was obtained from the electronic medical records of bitches presenting for dystocia between October 2015 and October 2020. Descriptive statistics were performed and outcome compared between RHs and CMCs using a Fisher exact test, with a P < .05 considered significant. 230 bitches were evaluated with 243 separate episodes of dystocia, with 183 (75%) episodes treated at an RH and 60 (25%) at a CMC. There was a low incidence of hypoglycemia (5% [9/178]) and ionized hypocalcemia (1% [2/164]). Seventy-three percent (177/243) of bitches underwent surgical intervention, 25% (61/243) received nonsurgical management, and 2% (5/243) transferred to their primary veterinarian. There was no difference in survival for bitches operated at an RH compared with a CMC. However, bitches operated at an RH were more likely (P = .04) to be discharged with at least 1 live neonate. In bitches diagnosed with dystocia, hypoglycemia and hypocalcemia were rare. The majority of bitches underwent a C-section. The setting where the C-section was performed did not impact maternal survival.