Risk Of Cesarean Delivery Research Articles

COVID‐19 as a risk factor for hypertensive disorders of pregnancy: A retrospective cohort study

AbstractObjectiveThe aim of this study was to assess whether coronavirus disease 2019 (COVID‐19) infection during pregnancy is a risk factor for hypertensive disorders of pregnancy.MethodsA retrospective evaluation was conducted on obstetric patients who gave birth between March 2020 and December 2021 at an academic urban referral center. The patients were categorized as COVID‐19‐positive or COVID‐19‐negative during pregnancy. The primary outcome was the development of a hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery, mode of delivery, maternal death, maternal intensive care unit (ICU) admission, neonatal ICU admission, intrauterine fetal demise/stillbirth, fetal growth restriction and prolonged hospital stay. χ2 tests, Fisher's exact tests, Student's two‐sample tests and multiple logistic regressions were used to evaluate the association between COVID‐19 status and outcomes.ResultsOf 2760 reviewed charts, 2426 (87.9%) met the inclusion criteria. Of 2426 patients, 203 were COVID‐positive and 2223 were COVID‐negative. There were no significant demographic differences between the two groups. After adjusting for confounding effects, COVID‐19 was determined to be a risk factor for combined hypertensive disorders of pregnancy (odds ratio [OR] 1.93, 95% confidence interval [CI]: 1.39–2.66) and pre‐eclampsia specifically (OR 2.01, 95% CI 1.38–2.88). COVID‐19 infection during pregnancy was weakly associated with an increased risk of caesarean delivery (p = 0.046) on univariate analysis but not on multivariate analysis, whereas it was associated with an increased risk of maternal ICU admission (p = 0.003), and prolonged hospital stay (p < 0.001) both before and after multivariate analysis.ConclusionThis study suggests that COVID‐19 infection during pregnancy is a risk factor for pre‐eclampsia. The study was unable to draw conclusions about more severe hypertensive conditions of pregnancy hemolysis, elevated liver enzymes and low platelet count; Eclampsia. COVID‐19 was determined to be a risk factor for prolonged hospital stay and maternal ICU admission, but there was no significant correlation between COVID‐19 and caesarean delivery on multivariate analysis.

Risk Factors and Outcomes Associated with Maternal Obesity and Overweight: A Cross Sectional Study among Moroccan Women in Marrakech.

Obesity is becoming a real challenge for public health among pregnant women. This study aimed to identify sociodemographic and lifestyle risk factors and outcomes linked to maternal obesity and overweight. A cross-sectional study was carried out from Nov 2021 to Dec 2022 in the maternity health facility of Mohammed VI Hospital, as well as in one of the main health centers with a delivery unit in Marrakech, Morocco. Parturients were divided into four categories according to their pre pregnancy BMI: underweight, normal weight, overweight and obese. We used the chi-square test (χ2) to analyze the sociodemographic and lifestyle factors associated with maternal obesity and overweight. The same tool was utilized to explore maternal and neonatal complications. Overall, 400 parturient women with singleton pregnancies were included in the study. The prevalence of overweight and obesity was 29.8% and 31.5% respectively. Maternal age, type of housing, practicing sports, feelings about pregnancy were correlated with an increased risk of maternal obesity and being overweight. The risks of gestational diabetes, hypertension, anemia, cesarean delivery, and fetal macrosomia were higher among overweight and obese women compared to normal weight ones. The differences were significant (P<0.05). Maternal overweight and obesity are strongly linked with socio-economic, lifestyle, and psychological factors which can lead to serious complications for both mother and baby. Further research is needed to develop appropriate preventive measures and interventions for maternal obesity and overweight.

Association between Doppler assessment and secondary cesarean delivery for intrapartum fetal compromise in small-for-gestational-age fetuses

PurposeTo elucidate the association between arterial and venous Doppler ultrasound parameters and the risk of secondary cesarean delivery for intrapartum fetal compromise (IFC) and neonatal acidosis in small-for-gestational-age (SGA) fetuses.MethodsThis single-center, prospective, blinded, cohort study included singleton pregnancies with an estimated fetal weight (EFW) < 10th centile above 36 gestational weeks. Upon study inclusion, all women underwent Doppler ultrasound, including umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, fetal aortic isthmus (AoI) PI, umbilical vein blood flow (UVBF), and modified myocardial performance index (mod-MPI). Primary outcome was defined as secondary cesarean section due to IFC.ResultsIn total, 87 SGA pregnancies were included, 16% of which required a cesarean section for IFC. Those fetuses revealed lower UVBF corrected for abdominal circumference (AC) (5.2 (4.5–6.3) vs 7.2 (5.5–8.3), p = 0.001). There was no difference when comparing AoI PI, UA PI, ACM PI, or mod-MPI. No association was found for neonatal acidosis. After multivariate logistic regression, UVBF/AC remained independently associated with cesarean section due to IFC (aOR 0.61 [0.37; 0.91], p = 0.03) and yielded an area under the curve (AUC) of 0.78 (95% CI, 0.67–0.89). A cut-off value set at the 50th centile of UVBF/AC reached a sensitivity of 86% and specificity of 58% for the occurrence of cesarean section due to IFC (OR 8.1; 95% CI, 1.7–37.8, p = 0.003).ConclusionLow levels of umbilical vein blood flow (UVBF/AC) were associated with an increased risk among SGA fetuses to be delivered by cesarean section for IFC.

The association between increased fetal movements in the third trimester and perinatal outcomes; a systematic review and meta-analysis

BackgroundFetal movement monitoring is one of the strategies used to assess the fetus’s health. Until now, most studies focused on the decreased fetal movement and neonatal outcome, although this systematic review and meta-analysis is designed to assess the association between increased fetal movements (IFM) with perinatal outcomes.MethodThe electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched for studies investigating the perinatal outcome of women with increased fetal movements from inception to July 2023. Following that, a random-effect meta-analysis model was used to obtain the combined diagnostic and predictive parameters including perinatal mortality (still birth and early neonatal mortality), operative delivery, Apgar score, neonatal resuscitation at birth and NICU Admission.ResultsAfter the initial screening, seven studies examining the association between increased third trimester fetal movement and various perinatal outcomes were included. Meta-analysis revealed a significant reduction in the risk of cesarean delivery among patients with IFM compared to controls, suggesting a potential protective effect during childbirth. However, no statistically significant difference was observed in birth weight, small or large for gestational age births, neonatal intensive care unit admission, maternal age, umbilical cord around the neck, gestational diabetes mellitus, and hypertension, indicating that IFM may not be a major predictor of adverse perinatal outcomes or maternal conditions. Notably, IFM was significantly associated with a higher likelihood of labor induction.ConclusionThe findings suggest that IFM may have a protective effect against cesarean delivery. Additionally, IFM does not appear to be significantly associated with maternal age, umbilical cord around the neck, gestational diabetes mellitus and hypertension. However, the observed significant association with labor induction warrants further investigation.

The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis

ObjectiveThe objective of the meta-analysis was to determine the influence of uterine fibroids on adverse outcomes, with specific emphasis on multiple or large (≥ 5 cm in diameter) fibroids.Materials and methodsWe searched PubMed, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and SinoMed databases for eligible studies that investigated the influence of uterine fibroids on adverse outcomes in pregnancy. The pooled risk ratio (RR) of the variables was estimated with fixed effect or random effect models.ResultsTwenty-four studies with 237 509 participants were included. The pooled results showed that fibroids elevated the risk of adverse outcomes, including preterm birth, cesarean delivery, placenta previa, miscarriage, preterm premature rupture of membranes (PPROM), placental abruption, postpartum hemorrhage (PPH), fetal distress, malposition, intrauterine fetal death, low birth weight, breech presentation, and preeclampsia. However, after adjusting for the potential factors, negative effects were only seen for preterm birth, cesarean delivery, placenta previa, placental abruption, PPH, intrauterine fetal death, breech presentation, and preeclampsia. Subgroup analysis showed an association between larger fibroids and significantly elevated risks of breech presentation, PPH, and placenta previa in comparison with small fibroids. Multiple fibroids did not increase the risk of breech presentation, placental abruption, cesarean delivery, PPH, placenta previa, PPROM, preterm birth, and intrauterine growth restriction. Meta-regression analyses indicated that maternal age only affected the relationship between uterine fibroids and preterm birth, and BMI influenced the relationship between uterine fibroids and intrauterine fetal death. Other potential confounding factors had no impact on malposition, fetal distress, PPROM, miscarriage, placenta previa, placental abruption, and PPH.ConclusionThe presence of uterine fibroids poses increased risks of adverse pregnancy and obstetric outcomes. Fibroid size influenced the risk of breech presentation, PPH, and placenta previa, while fibroid numbers had no impact on the risk of these outcomes.

The Impact on Birth Outcomes of Sonographic Fetal Weight Estimation in Neonatal Macrosomia.

Our objective was to examine the association between sonographic estimated fetal weight (EFW) and obstetrical and neonatal outcomes in women with neonatal macrosomia. This study, conducted at a tertiary university-affiliated hospital from 2017 to 2021, compared obstetrical and neonatal outcomes between two groups of women who delivered macrosomic newborns (actual birthweight ≥ 4,000 g): (1) those with EFW ≥ 3,800 g (suspected impending macrosomia) and (2) those with EFW < 3,800 g (unsuspected impending macrosomia). During the study period, 854 women with neonatal macrosomia attempted vaginal delivery. Only 9.2% had a sonographic EFW ≥ 4,000 g. Among women with EFW ≥ 3,800 g (n = 317) compared with EFW < 3,800 g (n = 537), the cesarean delivery (CD) rate was higher (17.0 vs. 10.5%, p = 0.004) and the operative delivery rate was lower (3.2 vs. 0.6%, p = 0.015). Among primiparous women, the CD rate was higher among those with EFW ≥ 3,800 versus <3,800 g (37.3 vs. 23.2%, p = 0.033). EFW ≥3,800 g was associated with CD, regardless of predelivery body mass index, parity, diabetes mellitus, maximal fetal weight at previous deliveries, actual birthweight, and labor induction (p = 0.014). EFW ≥ 3,800 g and diabetes mellitus were independent predictors of CD. Among women with EFW ≥3,800 g and diabetes mellitus, the risk of CD was double that of those without diabetes and with EFW ≥ 3,800 g (31.4% vs. 15.2%, p = 0.02), although their actual birthweights were similar. Obstetrical and neonatal outcomes were similar between those with sonographic EFW ≥ 3,800 and < 3,800 g. Larger EFW increased CD risk among pregnancies with actual neonatal macrosomia. Antenatally suspected macrosomia might alter labor management due to concerns for potential complications, especially when associated with primiparity, diabetes mellitus, or maternal obesity. The increase in the CD rate did not show an association with improved maternal and neonatal outcomes. · Antenatally suspected macrosomia might alter labor management due to concerns about complications.. · Larger EFW increased cesarean delivery risk among pregnancies with actual neonatal macrosomia.. · The increase in the cesarean delivery rate was not associated with improved outcomes..

PREVALENCE OF GESTATIONAL DIABETES AND RELATED COMPLICATIONS IN DISTRICT SIALKOT

Gestational diabetes mellitus (GDM) is a prevalent medical complication during pregnancy, associated with adverse maternal and neonatal outcomes. Understanding the impact of GDM on pregnancy complications is essential for effective management and care. Objective: This study aimed to compare the incidence of various complications between pregnant women with and without GDM. Method: A total of 200 pregnant women were recruited from Govt. Sardar Begum Teaching Hospital Sialkot and Civil Hospital Sialkot. These patients were given 75 g oral glucose irrespective of the meals, and their plasma glucose was estimated at two h. Patients with plasma glucose values of 140 mg/dl were labelled GDM; the rest were the control or non-GDM groups. All GDM patients were followed up and treated with diet and insulin therapy till delivery to know maternal and fetal outcomes. Results: Among the enrolled pregnant women, 70 (35%) were diagnosed with GDM. Significant differences were observed between the Non-GDM and GDM groups in terms of Cesarean section delivery (23.8% vs 55.7%, P=0.001), hypertension (13.8% vs 74.3%, P=0.031), and preterm birth (17.7% vs 24.3%, P=0.001). However, no significant difference was found in the incidence of fetal abnormalities between the two groups (9.2% vs. 8.6%, P=0.012). Additionally, the risk of intrauterine fetal demise was comparable between the Non-GDM and GDM groups (10.0% vs. 11.4%, P=0.031). Conclusion: Pregnant women with GDM are at increased risk of Cesarean section delivery, hypertension, and preterm birth compared to those without GDM. However, the incidence of fetal abnormalities and intrauterine fetal demise does not significantly differ between the two groups. Early detection and management of GDM are crucial to minimise adverse pregnancy outcomes.

Risk of intrapartum cesarean delivery in twin pregnancies: A retrospective cohort study.

To compare the risk of intrapartum cesarean delivery (CD) between patients with twin and singleton pregnancies undergoing a trial of labor and identify risk factors for intrapartum CD in twin pregnancies. The present study was a retrospective cohort study of patients with a twin or singleton pregnancy who underwent a trial of labor at ≥340/7 weeks in a single center (2015-2022). The primary outcome was the rate of intrapartum CD. In twin pregnancies, this outcome was limited to CD of both twins. The association of plurality with intrapartum CD was estimated using multivariable Poisson regression. A total of 20 754 patients met the study criteria, 669 of whom had a twin pregnancy. Patients with twins had a greater risk of intrapartum CD (of both twins) than those with singleton pregnancies (22.1% vs 15.9%, respectively; aRR 1.38 [95% CI: 1.15-1.66]), primarily due to a greater risk of failure to progress. In addition, 4.1% of the twin pregnancies had a CD for the second twin, resulting in an overall CD rate in twin pregnancies of 26.2%. Variables associated with intrapartum CD in twin pregnancies included nulliparity (aOR 3.50, 95% CI: 2.34-5.25), birthweight discordance >20% (aOR 2.47, 95% CI: 1.27-4.78), and labor induction (aOR 1.64, 95% CI: 1.07-2.53). The rate of intrapartum CD was highest when all three risk factors were present (67% [95% CI: 41%-87%]). Twin pregnancies are associated with a greater risk of intrapartum CD than singleton pregnancies. Information on the individualized risk of intrapartum CD may be valuable when counseling patients with twins regarding mode of delivery.

Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): individual management based on artificial intelligence - a secondary analysis

BackgroundCurrent guidelines regarding oxytocin stimulation are not tailored to individuals as they are based on randomised controlled trials. The objective of the study was to develop an artificial intelligence (AI) model for individual prediction of the risk of caesarean delivery (CD) in women with a cervical dilatation of 6 cm after oxytocin stimulation for induced labour. The model included not only variables known when labour induction was initiated but also variables describing the course of the labour induction.MethodsSecondary analysis of data from the CONDISOX randomised controlled trial of discontinued vs. continued oxytocin infusion in the active phase of induced labour. Extreme gradient boosting (XGBoost) software was used to build the prediction model. To explain the impact of the predictors, we calculated Shapley additive explanation (SHAP) values and present a summary SHAP plot. A force plot was used to explain specifics about an individual’s predictors that result in a change of the individual’s risk output value from the population-based risk.ResultsAmong 1060 included women, 160 (15.1%) were delivered by CD. The XGBoost model found women who delivered vaginally were more likely to be parous, taller, to have a lower estimated birth weight, and to be stimulated with a lower amount of oxytocin. In 108 women (10% of 1060) the model favoured either continuation or discontinuation of oxytocin. For the remaining 90% of the women, the model found that continuation or discontinuation of oxytocin stimulation affected the risk difference of CD by less than 5% points.ConclusionIn women undergoing labour induction, this AI model based on a secondary analysis of data from the CONDISOX trial may help predict the risk of CD and assist the mother and clinician in individual tailored management of oxytocin stimulation after reaching 6 cm of cervical dilation.

Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study

ObjectivesIt is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. MethodsRetrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15–55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. ResultsWe matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20–1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03; 95% CI 1–1.07). ConclusionsThe higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.

Effect of Maternal Obesity on Pregnancy Outcomes and Metabolic Consequences

Background: Maternal obesity has emerged as a critical public health issue with profound implications for both maternal and neonatal health. The increasing prevalence of obesity among women of reproductive age underscores the urgency of examining its impact on pregnancy outcomes and the metabolic health of offspring. Previous studies have identified associations between maternal obesity and adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and cesarean delivery, as well as long-term metabolic disturbances in offspring. Objective: This study aimed to investigate the effects of maternal obesity on pregnancy outcomes and to elucidate the potential metabolic consequences for offspring, contributing to the understanding of intergenerational transmission of metabolic risk. Methods: Conducted at the Gyne B Unit of Hayatabad Medical Complex, Peshawar, this retrospective cohort study included 6,910 obstetric admissions from January to December of the previous year. Pregnant women aged 18-45 years with singleton pregnancies were included, excluding those with pre-existing medical conditions. BMI was calculated from self-reported pre-pregnancy weight and height. Outcomes analyzed included GDM, HDP, mode of delivery, macrosomia, neonatal hypoglycemia, stillbirth, and neonatal mortality. Data analysis utilized SPSS version 25, employing descriptive statistics, chi-square tests, t-tests or Mann-Whitney U tests, and multivariable logistic regression models. Results: Among the participants, 55.7% were of normal weight, 20.6% overweight, and 18.4% obese. Obese pregnant women demonstrated significantly higher rates of GDM (8.6% vs. 23.7%, p=0.001), HDP (18.3% vs. 6.4%, p=0.011), and cesarean delivery (55.7% vs. 30.1%, p=0.003) compared to their normal-weight counterparts. Offspring of obese mothers had a higher incidence of fetal macrosomia (10.2% vs. 5.4%, p=0.001) and neonatal hypoglycemia (10.4% vs. 6%, p&lt;0.001). Conclusion: The study confirms the significant association between maternal obesity and adverse pregnancy outcomes, including increased risks of GDM, HDP, and cesarean delivery. Furthermore, offspring of obese mothers are at an elevated risk of metabolic disturbances, indicating the necessity of addressing maternal obesity to improve health outcomes for both mothers and their children.

Association of maternal leukocyte, monocyte, and neutrophil counts with hypertensive disorders of pregnancy: the Japan Environment and Children’s Study (JECS)

Hypertensive disorders of pregnancy (HDP) increase the risk of preterm births and cesarean delivery. This study aimed to investigate whether maternal blood leukocyte, monocyte, or neutrophil counts in the first trimester are related to the development of HDP. Data were collected from the Japan Environment and Children’s Study, a large birth cohort study (n = 38,194) that recruited pregnant women in 15 Regional Centers across Japan (from January 2011 to March 2014). The odds ratios (ORs) for mild/severe HDP according to the cut-off value of leukocyte/neutrophil/monocyte counts by the receiver operating characteristic curve showed high ORs. Furthermore, pregnant women with the highest quartiles of leukocyte and monocyte counts had higher adjusted ORs (aORs) for mild (leukocyte: aOR = 1.27, 95% confidence interval [CI]: 1.02–1.58; monocyte: aOR = 1.30, 95% CI 1.04–1.63) and severe HDP (leukocyte: aOR = 1.51, 95% CI 1.08–2.13; monocyte: aOR = 1.44, 95% CI 1.03–2.01) compared with those with the lowest quartiles of those counts. In addition, pregnant women with the highest neutrophil counts had higher aOR for mild HDP (aOR = 1.26, 95% CI 1.02–1.56) compared with those with the lowest count. In conclusion, high leukocyte and monocyte counts in the first trimester are associated with the development of HDP. Thus, they may be used to predict subsequent HDP.

Timing of planned cesarean delivery among patients with two previous cesarean sections.

The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. A population-based retrospective cohort study including all term singleton third CDs (≥ 37weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust forconfounders. The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6weeks of gestation, and 44 were at ≥ 39weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4days. Additionally, CDs at 37 + 0 to 37 + 6weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.

External cephalic version complicated by bradycardia and placental abruption– a case report

Introduction: Pregnancies with the fetus in breech position at term are routinely managed by offering external cephalic version to increase the likelihood of vaginal birth in the cephalic position and reducing the risk of cesarean delivery. Although complications from external cephalic version are infrequent, placental abruption is a rare but serious risk, occurring in 0.08% of attempts. Methods: This case report details the experience of a woman with an uncomplicated singleton pregnancy with fetal breech presentation at gestational age 37 weeks and 2 days, coming for an outpatient external cephalic version. Preceding the external cephalic version, a fetal ultrasound and cardiotocography were both normal. Intravenous salbutamol was administered shortly before the procedure. Results: The external cephalic version was complicated by a three minute episode of fetal bradycardia, which resolved spontaneously without any maternal symptoms of abdominal pain or vaginal bleeding. Within 35 minutes post-procedure, an ultrasound revealed a de novo placental lake with a jet, potentially coming from a placental artery. The patient also started reporting increasing pain and upon palpation of the abdomen, increased uterine tone was noted. Emergency cesarean was performed resulting in the birth of a healthy girl with normal Apgar scores. Fetal hemoglobin was low at 8.3 mmol/L (reference 9.4 -14.4 mmol/L). Conclusion: This case accentuates the importance of caution in women with symptoms of placental abruption such as uterine contractions, increased tone, or vaginal bleeding, especially following a bradycardic event after external cephalic version. While such complications are rare, clinicians should consider a post-procedure fetal ultrasound before discharge in cases where bradycardia is observed. Funding None Trial registration Not relevant.

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

IntroductionIt is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood.MethodsRetrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders.ResultsPregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147).Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069).ConclusionPregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies.Graphical

Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo".

This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

Are Racial Disparities in Cesarean Due to Differences in Labor Induction Management?

While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR): [22-30] vs. 32 years IQR: [30-35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) = 1.41, 95% confidence interval (CI): [1.06-1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. · The etiologies for racial disparities in cesarean are likely multifaceted.. · In this work, there were no differences by race in measures of labor induction management.. · Biases outside of induction management during labor may be targeted to reduce CD disparities..

Perilous myoma in the puerperium: A case report

Leiomyoma, a benign solid tumour found in the female genital tract, affects 3%-13% of pregnancies. These growths occur as sub serosal, intramural, or submucosal tumours. Approximately 10%–30% of pregnant women experience fibroid-related complications, such as spontaneous abortion, preterm labour, soft tissue dystocia, uterine inertia, feto pelvic disproportion, fetal malposition, and postpartum hemorrhage and a higher risk of caesarean delivery. This case report aims to shed light on the complexities arising in the postpartum period for women previously diagnosed with large fibroids during pregnancy. By exploring a specific case, this report emphasizes the importance of understanding and addressing these complications comprehensively. A 27-year-old primigravida sought antenatal care at 8 weeks of gestation with a 6cm intramural fibroid. Her pregnancy progressed smoothly, leading to a healthy vaginal delivery. However, at 7 weeks postpartum, she experienced pelvic discomfort, heavy lochia, and bleeding. Imaging revealed a submucosal fibroid protruding into the endometrial cavity with degenerating component Myomectomy performed. This case underscores the necessity of a comprehensive understanding of complications associated with large fibroids, spanning both the antenatal and postpartum periods. Heightened awareness and timely intervention are crucial to ensuring optimal outcomes for both maternal and foetal health.

Umbilical artery thrombosis risk factors and perinatal outcomes

PurposeThe purpose of this study was to investigate the risk factors for umbilical artery thrombosis (UAT) and the relationship between umbilical artery thrombosis and perinatal outcomes.MethodsThis was a retrospective study that enrolled singleton pregnant women who were diagnosed with umbilical artery thrombosis. The control group recruited pregnant woman with three umbilical vessels or those with isolated single umbilical artery (iSUA) who were matched with umbilical artery thrombosis group. The risk factors and perinatal outcomes were compared between the groups.ResultsPreconception BMI (OR [95%CI]: 1.212 [1.038–1.416]), abnormal umbilical cord insertion (OR [95%CI]: 16.695 [1.333-209.177]) and thrombophilia (OR [95%CI]: 15.840 [1.112-223.699]) were statistically significant risk factors for umbilical artery thrombosis. An elongated prothrombin time (OR [95%CI]: 2.069[1.091–3.924]) was strongly associated with the occurrence of UAT. The risks of cesarean delivery, preterm birth, fetal growth restriction, neonatal asphyxia, and intraamniotic infection were higher in pregnancies with UAT than in pregnancies with three umbilical vessels or isolated single umbilical artery (P<0.05). Additionally, the incidence of thrombophilia was higher in pregnant women with umbilical artery thrombosis than those with isolated single umbilical artery (P = 0.032). Abnormal umbilical cord insertion was also found to be associated with an elevated risk of iSUA (OR [95%CI]: 15.043[1.750-129.334]).ConclusionsAbnormal umbilical cord insertion was the risk factor for both umbilical artery thrombosis and isolated single umbilical artery. The pregnancies with umbilical artery thrombosis had a higher risk of the adverse perinatal outcomes.

New definitions, old complications: The association between duration of transition from latent to active labor and adverse obstetrical outcomes.

To explore the relationship between the duration of transition from latent to active labor and various obstetric, maternal, fetal, and neonatal outcomes. A retrospective cohort study was conducted on term, singleton deliveries at Soroka University Medical Center from 2013 to 2018. Data were extracted from electronic medical records. The exposure variable was defined as prolonged transition, which was itself defined as the upper 10th centile of dilation duration from 4 to 6 cm. Clinical and demographic characteristics were compared using χ2 test. Multivariate logistic regression was used to estimate the contribution of a prolonged transition with each adverse outcome adjusting for potential confounders. In all, 12 104 deliveries met the inclusion criteria. The mean ± standard deviation of duration of dilation from 4 to 6 cm was 03:07:58 ± 03:03:42 (hours:minutes:seconds). Progress curves varied significantly among patients with different obstetrical and demographic characteristics. Prolonged transition was significantly linked to an increased risk of cesarean delivery (adjusted odds raito 2.607, 95% confidence interval 2.171-3.130, area under the curve 0.689) and higher rates of maternal and neonatal morbidity. Patients experiencing transition phases exceeding the 90th centile faced an elevated risk of cesarean delivery and postpartum complications. Future studies should focus on interventions during the transition phase to improve pregnancy outcomes and enhance patient safety.