Risk Factors For Cesarean Section Research Articles

Risk factors for cesarean section of the second twin after vaginal delivery of the first twin.

To document risk factors for combined delivery, defined as unplanned cesarean section for the second twin after vaginal delivery of the first twin, particularly focusing on delivery interval between twins. A multi-center cross-sectional study among a cohort of 5411 women with twin pregnancy experiencing vaginal delivery of the first twin in 2007-2016 at 191 tertiary referral hospitals in Japan was conducted. Primary outcome was the occurrence of combined delivery, and data were collected through the Japan Society of Obstetrics and Gynecology perinatal database. Risk factors for combined delivery were investigated using Poisson regression analysis. Combined delivery occurred in 235 women (5.1%) and was significantly associated with delivery interval (P < 0.001). Multivariate analysis showed women with ≥ 25kg/m2 pre-pregnancy body mass index (BMI) and with birthweight < 1500g of the second twin had significantly higher risk for combined delivery than women with 18.5-25kg/m2 pre-pregnancy BMI and with birthweight ≥ 2500g of the second twin (adjusted risk ratio (aRR) 1.72, 95% confidence interval (CI) 1.15-2.57, and aRR 2.06, 95% CI 1.14-3.72, respectively). Breech and transverse presentation of the second twin were also risk factors for combined delivery compared with cephalic presentation (aRR 3.60, 95% CI 2.67-4.85, and aRR 9.94, 95% CI 6.50-15.0, respectively). Although association of combined delivery with pre-pregnancy BMI was attenuated after adjustment by delivery interval, association with birthweight of the second twin was strengthened. Delivery interval was significantly associated with combined delivery and mediated the association between combined delivery and some other risk factors.

Establishment and Validation of a Machine Learning-Based Prediction Model for Termination of Pregnancy via Cesarean Section.

This study aimed to investigate the risk factors of cesarean section and establish a prediction model for cesarean section based on the characteristics of pregnant women. The clinical characteristics of 2552 singleton pregnant women who delivered a live baby between January 2020 and December 2021 were retrospectively reviewed. They were divided into vaginal delivery group (n = 1850) and cesarean section group (n = 702). These subjects were divided into training set (2020.1-2021.6) and validation set (2021.7-2021.12). In the training set, univariate analysis, Lasso regression, and Boruta were used to screen independent risk factors for cesarean section. Four models, including Logistic Regression (LR), K-Nearest Neighbor (KNN), Classification and Regression Tree (CART), and Random forest (RF), were established in the training set using K-fold cross validation, hyperparameter optimization, and random oversampling techniques. The best model was screened, and Sort graph of feature variables, univariate partial dependency profile, and Break Down profile were delineated. In the validation set, the confusion matrix parameters were calculated, and receiver operating characteristic curve (ROC), precision recall curve (PRC), calibration curve, and clinical decision curve analysis (DCA) were delineated. The risk factors of cesarean section included age and height of women, weight at delivery, weight gain, para, assisted reproduction, abnormal blood glucose during pregnancy, pregnancy hypertension, scarred uterus, premature rupture of membrane (PROM), placenta previa, fetal malposition, thrombocytopenia, floating fetal head, and labor analgesia. RF had the best performance among the four models, and the accuracy of confusion matrix parameters was 0.8956357. The Matthews correlation coefficient (MCC) was 0.753012. The area under ROC (AUC-ROC) was 0.9790787, and the area under PRC (AUC-PRC) was 0.957888. RF prediction model for caesarean section has high discrimination performance, accuracy and consistency, and outstanding generalization ability.

Factors Associated with Cesarean Operations of Gestational Diabetic Mellitus and Diabetes Complications

Objective: To identify risk factors of cesarean delivery in pregnant women with diabetes mellitus and complications caused by gestational diabetes. Materials and Methods: A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Phatthalung Hospital. The participants consisted of pregnant women who labored at Phatthalung Hospital between 2017 and 2021. The inclusion criteria comprised women who labored from 28 to 42 weeks and had complete medical records. Patients having previous cesarean sections, cesarean section on maternal demand, and twin pregnancy were excluded. The study group was diabetic mellitus pregnant women, while non-diabetic pregnant women was generated by random numbers at ratio of 1:1 as control group. The data collected were demographic data, age, body mass index (BMI), number of gestations, parity, abortion, type of diabetic mellitus, underlying disease, route of delivery, indications for cesarean delivery, and maternal and neonatal outcomes. Results: Two thousand twelve pregnant women consisted of 1,006 pregnancies with diabetes and 1,006 non-diabetic pregnancies. Pregnant women with diabetes significantly increased the risk of cesarean section 1.42 time (95% CI 1.19 to 1.70, p&lt;0.001). The greatest indication for cesarean section of both groups was cephalopelvic disproportion, but failure for induction of labor and macrosomia were found in the study group more than in the control group. Logistic regression analysis, adjusted for age group, number of gestations, and BMI, showed that pregnancy-induced hypertension and newborn weight of 4,000 g or more were risk factors for cesarean section among diabetic pregnancies. The maternal complications of the study group were preeclampsia, indicated preterm labor, and premature rupture of membranes. The common fetal complications were macrosomia and birth asphyxia. Conclusion: Risk factors of cesarean section among pregnant women with diabetes included preeclampsia and newborn weight of 4,000 g or more. Gestational diabetes increased significantly the maternal and fetal complications. Keywords: Gestational diabetic mellitus; Cesarean section; Complications

Risk factors associated with cesarean section and adverse fetal outcomes in intrahepatic cholestasis of pregnancy.

To determine the risk factors for cesarean section (CS) and adverse fetal outcomes (AFOs) in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. A total of 227 nulliparous women with a singleton fetus complicated by ICP were included. The patients were divided into two groups according to the levels of total bile acids, that is, mild (10 μmol/L < total bile acids < 40 μmol/L) and severe (≥40 μmol/L). The patients' clinical characteristics and fetal outcomes were assessed. Among the 227 eligible women, 177 (78.0%) were allocated to the mild group and 50 (22.0%) were in the severe group. Women with severe ICP also had a significantly higher incidence of planned and unplanned CS compared with mild ICP subjects (52.0% vs. 23.7% and 22.0% vs. 6.8%, respectively; p < 0.001). The indications for CS showed that fetal intolerance (65.4% vs. 14.3%) was higher in severe ICP compared with mild ICP (p < 0.001). Severe ICP was associated with an increased risk of preterm delivery (p < 0.001), low birthweight (p = 0.001), and neonatal intensive care unit (NICU) admission (p < 0.001). Women with severe ICP (OR 6.397, 95%CI 3.041-13.455, p < 0.001) or preeclampsia (OR 12.434, 95%CI 5.166-29.928, p < 0.001) had increased risks of AFOs compared to controls. Severe ICP and preeclampsia are associated with a higher incidence of AFOs.

The relationship between incidence of cesarean section and physical activity during pregnancy among pregnant women of diverse age groups: Dose-response meta-analysis.

There is a lack of evidence related to physical activity and risk of cesarean section (CS) by age and/or weight in pregnant women. To evaluate the effect of physical activity on the incidence of CS and explore the relationship of age and body mass index (BMI) with incidence of CS. A systematic search was conducted in CNKI, WANGFANG, Web of Science, and PubMed from inception to 31 August 2021. Experimental studies were included if the participants were pregnant, if intervention included physical activity and controls received routine prenatal care only, and if primary outcome was CS. Meta-analysis included a heterogeneity test, data combination, subgroup analysis, forest plot, sensitivity analysis, and dose-response regression analysis. Sixty-two studies were included. Physical activity during pregnancy decreased the incidence of CS (relative risk [RR] 0.81, 95% confidence interval [CI] 0.74-0.88, P < 0.001). The incidence of CS was lower among the overweight/obese group (RR 0.78, 95% CI 0.65-0.93) compared with the normal weight group (RR 0.82, 95% CI 0.74-0.90). The incidence of CS was lowest among the young age group (RR 0.61, 95% CI 0.46-0.80) compared with the middle age group (RR 0.74, 95% CI 0.64-0.85) and the older age group (RR 0.90, 95% CI 0.82-1.00). The critical value, when age becomes a risk factor for CS, was 31.7 years in the intervention group and 28.5 years in the control group. Physical activity during pregnancy can reduce the incidence of CS, especially among obese people, and prolong the gestational age span.

A population-based study of caesarean section in women with juvenile idiopathic arthritis.

The literature on delivery methods in women with JIA is limited. Active inflammation is a risk factor for caesarean section (CS) in other arthritic diseases. A CS entails a higher risk for complications than vaginal delivery and restricted physical activity in the first weeks after birth. Our objective was to explore a possible association of inflammatory active disease and the proportion of CS in women with JIA. Data from the Norwegian nationwide observational register RevNatus were linked with data from the Medical Birth Registry of Norway (MBRN). Cases comprised singleton births in women with JIA (n = 196) included in RevNatus from 2010 to 2019. Singleton births registered in the MBRN during the same period of time, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798). CS was more frequent in women with JIA (20.4%) and in the subgroup of women with inflammatory active JIA (30.0%) than in population controls (15.6%). Women with active JIA had a risk for elective CS similar to population controls [risk difference 2.3% (95% CI -2.5, 12.9)] and a higher risk for emergency CS [risk difference 14.0% (95% CI 4.3, 27.4)] compared with population controls. Women with active JIA had a higher risk for emergency CS, but not elective CS, compared with population controls.

Maternal, obstetric, and fetal Doppler characteristics in a high-risk population: prediction of adverse perinatal outcomes and of cesarean section due to intrapartum fetal compromise.

To evaluate the capacity of fetal Doppler, maternal, and obstetric characteristics for the prediction of cesarean section due to intrapartum fetal compromise (IFC), a 5-min Apgar score < 7, and an adverse perinatal outcome (APO), in a high-risk population. This was a prospective cohort study involving 613 singleton pregnant women, admitted for labor induction or at the beginning of spontaneous labor, who underwent Doppler ultrasound within the last 72 h before delivery. The outcome measures were cesarean section due to IFC, a 5-min Apgar score < 7, and any APO. We found that maternal characteristics were neither associated with nor predictors of an APO. Abnormal umbilical artery (UA) resistance index (RI) and the need for intrauterine resuscitation were found to be significant risk factors for cesarean section due to IFC (p = 0.03 and p < 0.0001, respectively). A UA RI > the 95th percentile and a cerebroplacental ratio (CPR) < 0.98 were also found to be predictors of cesarean section due to IFC. Gestational age and a UA RI > 0.84 were found to be predictors of a 5-min Apgar score < 7 for newborns at < 29 and ≥ 29 weeks, respectively. The UA RI and CPR presented moderate accuracy in predicting an APO, with areas under the ROC curve of 0.76 and 0.72, respectively. A high UA RI appears to be a significant predictor of an APO. The CPR seems to be predictive of cesarean section due to IFC and of an APO in late preterm and term newborns.

Does Advanced Maternal Age Comprise an Independent Risk Factor for Caesarean Section? A Population-Wide Study.

To investigate the association between a mother's age and the risk of caesarean section (CS) when controlling for health factors and selected sociodemographic characteristics. Binary logistic regression models for all women who gave birth in Czechia in 2018 (N = 111,749 mothers who gave birth to 113,234 children). An increase in the age of a mother significantly increases the odds of a CS birth according to all of the models; depending on the model, OR: 1.62 (95% CI 1.54-1.71) to 1.84 (95% CI 1.70-1.99) for age group 35-39 and OR: 2.83 (95% CI 2.60-3.08) to 3.71 (95% CI 3.23-4.27) for age group 40+ compared to age group 25-29. This strong association between the age of a mother and the risk of CS is further reinforced for primiparas (probability of a CS: 11% for age category ≤ 19, 23% for age category 35-39, and 38% for age category 40+). However, the increasing educational attainment of young women appears to have weakened the influence of increasing maternal age on the overall share of CS births; depending on the model, OR: 0.86 (95% CI 0.80-0.91) to 0.87 (95% CI 0.83-0.91) for tertiary-educated compared to secondary-educated women. The age of a mother comprises an independent risk factor for a CS birth when the influence of health, socioeconomic, and demographic characteristics is considered.

Antenatal care as a risk factor for caesarean section: a case study in Brazil

BackgroundAntenatal care is an important tool to prevent complications and decrease the incidence of maternal and antenatal morbidity and mortality. In Brazil, quality, access, and coverage of antenatal care are described as insufficient. Consequently, high rates of caesarean section, congenital morbidities such as syphilis, maternal and early neonatal mortality occur, as well as obstetric violence and dissatisfaction with healthcare. It is important to reflect on health disparities in antenatal care. This study aimed to carry out a critical analysis of antenatal care in one city of São Paulo state in Brazil.MethodsA case study was performed, structured in a descriptive cross-sectional epidemiological study and two qualitative studies. Data for the epidemiological study was obtained from the Informatics Department of the Unified Health System (DATASUS) of Brazil, which was processed in the Epi-info v software 7.2. and treated descriptively and by the Mantel–Haenszel or Fisher's exact tests. Qualitative data was collected through semi-structured interviews with 30 pregnant women and 8 nurses in the primary healthcare service of one city in São Paulo. The qualitative data analysis was based on thematic content analysis.ResultsThe data revealed a limited quality of antenatal care. More than six antenatal visits increased the probability of a caesarean section by 47% and babies born vaginally had a lower Apgar score. There was little participation of nurses in antenatal care and women described it as “a quick medical appointment”, limited by protocols, based on procedures and insufficient in dialogue. Antenatal care appeared to be fragmented and permeated by challenges that involve the need for change in management, performance, and ongoing training of professionals, as well as in the guarantee of women’s rights.ConclusionsCaesarean section was statistically related to the number of antenatal care visits. Interactions between professionals and pregnant women were poor and resulted in dissatisfaction. There is an urgent need to connect health indicators with the findings from professionals and women’s experiences to improve the quality of antenatal care.

Risk factors for cesarean section in women of urban Puducherry, India: A matched case–control study

Cesarean section (CS) is generally performed either to ensure maternal and child safety when vaginal delivery is not possible. The WHO has indicated that CS rates of more than 10% are considered overutilization. Increased CS rates can cause an increase in postpartum antibiotic treatment and longer hospital stay. In this research, we conducted a matched case–control study, including all women who gave birth through CS and resided in the study area over a 3-year period before the survey as cases and similar age- and year-matched women who had normal vaginal delivery during the same period as controls. The data were collected using a semi-structured pro forma through personal interviews and verified with discharge cards. We obtained a sample of 140 women (70 matched cases and controls) as study participants. Our results show that unadjusted analysis revealed socioeconomic status, history of gestational diabetes mellitus, previous lower segment CS (LSCS), and malpresentation emerged as risk factors, whereas in the adjusted analysis, we observed that previous LSCS (aOR 45.4 [4.3 – 483.6]), malpresentation (aOR 11.0 [1.6 – 73.8]), and belonging to middle (aOR 3.3 [1.0 – 10.8]) and upper class (aOR 23.55 [CI: 1.2 – 463.8]) remained as independent risk factors. Our study identified independent risk factors for CS that needs to be tackled for bringing down the CS rates.

Evaluation of obstetric management of women with macrosomic foetuses in two Level 3 maternity hospitals in France and identification of predictive factors for obstetric and neonatal complications

ObjectiveFoetal macrosomia is associated with high maternal and neonatal morbidity; however, obstetric management of suspected macrosomia has not been well defined. This study aimed to analyse obstetric management in a population of women who delivered macrosomic new-borns and assess maternal and neonatal outcomes and risk factors for complications in such cases. Study designThis two-centre retrospective study conducted in France over a 10-year period comprised 1724 women who had delivered macrosomic new-borns (defined as those whose weight was > 90th percentile according to the Association of Users of Computerised Records in Perinatology, Obstetrics, and Gynaecology curve) from 37SA. ResultsIn this study, the caesarean section and instrumental extraction rates were 24.1% and 15.7%, respectively, and the postpartum haemorrhage rate was 7%. The rate of shoulder dystocia was 23.1% (including brachial plexus injuries, 0.4%; and clavicular fractures, 2.0%). Significant risk factors for caesarean section were maternal height < 160 cm, nulliparity, history of caesarean section, excessive uterine height, induction of labour and duration of labour > 10 h. The risk factors for shoulder dystocia were maternal height < 160 cm and instrumental extraction. ConclusionThe study findings may help determine predictive factors for an unfavourable outcome at the time of delivery of a macrosomic foetus, thus allowing clinical teams to better anticipate and manage potential complications.

Facteurs de risque de césarienne sur deuxième jumeau après accouchement voie basse du premier jumeau : étude cas-témoins

ObjectivesTo identify risk factors for cesarean section of the second twin after vaginal delivery of the first twin. MethodsCase-control study conducted between 2004 and 2018 in a tertiary center, CHU Toulouse. Cases were women with twin pregnancy who had vaginal delivery of the first twin and emergency cesarean of the second twin. Controls were women with twin pregnancy who delivered both twins vaginally. Deliveries before 24 weeks of gestation, birth weight of less than 500 grams, fetal death in utero, terminations of pregnancy and delayed delivery were excluded. The association between potential risk factors and cesarean delivery of the second twin was analyzed using multivariable logistic regression. ResultsTwenty-four patients who had vaginal delivery of the first twin and emergency cesarean of the second twin and 48 patients who delivered both twins vaginally were included. Neonatal morbidity was increased in the group of women who had an emergency cesarean of the second twin. In multivariable analysis, overweight (OR=10.5 [95% CI: 1.78–62.03] for women with body mass index above 25 compared to women with body mass index below 25), weight gain during pregnancy (OR=1.27 [95% CI: 1.01–1.48] for each kilogram) and preterm labor (OR=4,43 [IC 95%:1,10–17,80]) were associated with significantly increased risk of cesarean section of the second twin. ConclusionOverweight and weight gain during pregnancy are associated with increased risk for cesarean section of the second twin.

Association between cesarean section rate and maternal age in twin pregnancies

To evaluate the effect of maternal age to the cesarean section rate of twin pregnancies in late preterm and term gestation. A retrospective study was performed on twin pregnancies delivered at Seoul National University Bundang Hospital from June 2003 to December 2020. Preterm births before 34weeks of gestation were excluded, and only live births were analyzed. The patients were classified into four groups according to maternal age (<30, 30-34, 35-39, and≥40 years). The primary outcome was the rate of cesarean section. The median value of maternal body mass index, the rate of assisted reproductive technology, dichorionic twin pregnancy, preeclampsia, and gestational diabetes increased significantly according to the maternal age group (all p<0.05). Among a total of 2,075 twin pregnancies, the rates of cesarean section were 65, 74, 80, and 95% for groups with maternal age under 30, 30-34, 35-39, and≥40 years, respectively (p<0.001). The cesarean section rates after a trial of labor were 22, 22, 28, and 63%, respectively (p=0.032). Maternal old age was an independent risk factor for cesarean section after a trial of labor in both nulliparous and multiparous women after adjusting for confounding factors. The rate of cesarean section in twin pregnancies significantly increased as maternal age increased, even in multiparous women.

AN OBSERVATIONAL STUDY OF CESAREAN TRENDS AT A TEACHING HOSPITAL IN PUNJAB

Objectives: The objective of the study was to study the indications and risk factors for caesarean section (CS) and to study the caesarean rates in various patient groups as per Robson’s classification. Methods: This prospective observational study was conducted at Government Medical College Amritsar over a period of six months. All the patients admitted for delivery beyond 22 weeks were allotted to Robson groups on admission and the indications of all CS were recorded. The data collected were tabulated and analyzed statistically. Results: There were 553 deliveries in the study period, of which there were 241 CS amounting to a caesarean rate of 43.6%. Nulliparity, previous caesarean delivery and malpresentation were significant risk factors for CS but induction of labor was not associated with increased probability of caesarean delivery. Previous caesarean delivery was the most common indication of CS followed by foetal distress. Among Robson groups, group 10 had the biggest group size and biggest contribution to cesarean rates followed by group 5. Conclusion: Tertiary care government hospitals have a higher cesarean rates due to referral of high-risk pregnancies. Increasing the rates of trial of labour after caesarean is one of the interventions that may serve to decrease the caesarean rates in such institutions.

SARS-CoV-2 Infection and C-Section: A Prospective Observational Study.

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson’s classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson’s 10th category). However, delivery care was similar between asymptomatic and mild–moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother’s clinical conditions that required a rapid and early termination of pregnancy.

Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4).

The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

Risk factors for unsuccessful vaginal birth after caesarean at full dilatation.

The purpose of this study was to determine the risk factors for caesarean sections in the second stage of labour after a previous caesarean section among women who underwent trial of labour (TOL). From a total of 639 women who experienced one caesarean section, 456 women were qualified for TOL. From this group, 105 women were subjected to a caesarean section in the first stage of labour and another 351 women reached the second stage of labour. From the latter group, 309 women delivered naturally and 42 were subjected to a caesarean section. Risk factors for the necessity of performing a caesarean section in the second stage of labour after a previous caesarean section was the weight gain during pregnancy (OR = 1.07), the height of fundus uteri (OR = 1.25) before delivery, and the estimated foetal weight (OR = 1.01), a past delivery of a child with a birth weight exceeding 4.000 g (OR = 2.14), the presence of pre-gestational diabetes (OR = 15.4) and gestational diabetes (OR = 2.22), necessity of applying a delivery induction (OR = 2.52), stimulation of uterine activity during delivery (OR = 2.43) and application of epidural analgesia (OR = 4.04). A factor reducing the risk of a caesarean section in the second stage was a vaginal delivery in a woman's history (OR = 0.21). Women should be encouraged to deliver naturally after a previous caesarean section, especially when their history includes a vaginal delivery and if there is no need for labour induction.

Risk factors for Caesarean sections in Ghana: evidence from the Ghana Maternal Health Survey.

A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15-49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10-5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14-0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08-3.14). The findings suggest that beyond maternal complications, women's socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study.

Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR = 4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR = 3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR = 3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR = 0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.

Physical activity, sitting time and sleep duration before and during pregnancy and pregnancy outcomes: A prospective panel study.

To examine how changes in physical activity, sitting time and sleep duration through pre-, mid- and late pregnancy are in association with Caesarean section, medically indicated Caesarean section and small for gestational age. While circadian activities could change throughout pregnancy, studies exploring the effect of change in those activities on pregnancy outcomes remain limited. This study applied a prospective panel design. A self-reported questionnaire was used to assess the three activities before and during pregnancy and was administered three times from August 2015-July 2017. Multiple logistic regression models were used. The analysis included 488, 477 and 455 participants in the models for Caesarean section, medically indicated Caesarean section and small for gestational age, respectively. This study followed the STROBE guidelines. The mean age of participants was 32.18years, and more than half (54.90%) were primiparous. Sleep duration of >8hr/day before pregnancy and experiencing a decrease in mid-pregnancy was a risk factor for Caesarean section and medically indicated Caesarean section. Sitting ≥8hr/weekday in pre-, mid- and late pregnancy had a protective effect for Caesarean section and medically indicated Caesarean section. Sitting <8hr in mid-pregnancy and experiencing a decrease in late pregnancy was a risk factor for small-for-gestational-age infants. Physical activity was not significantly related to pregnancy outcomes. Sleep duration of 7-8hr and sitting time of more than 8hr/day seem beneficial for women both before and during pregnancy. Health professionals could assess pregnant women or those intending to become pregnant regarding their sleep and sitting behaviour and provide relevant interventions.