Section Rate Research Articles

The Trends of C- Section Rates between the Past and Recent around the world and especially in Egypt from 2008-2022

The Trends of C- Section Rates between the Past and Recent around the world and especially in Egypt from 2008-2022

#2095 Genetic kidney disease in pregnancy – experience of tertiary referral hospital

Abstract Background and Aims Genetic kidney diseases (GKD) are rarely seen in pregnancy and some diagnosis will only be made during gestation, due to a high proportion of chronic kidney diseases (CKD) of unknown etiology and recent advances in genetic testing. Genetic counseling and, when possible, preimplantation genetic testing (PGT) should be offered pre-pregnancy to this specific CKD population. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of pregnant women with GKD surveilled at Hospital Santa Maria, at the nephro-obstetric clinic from 2011 to 2023. Results We evaluated 34 pregnancies in 28 women, mean maternal age 30±6 years-old [21-37], 89% Caucasian. Molecular genetic testing was performed pre-pregnancy, during and post-pregnancy in 12/19, 2/19 and 5/19 patients, respectively. At baseline, mean serum creatinine (SCr) and proteinuria (Pr) was 1.0±0.9 mg/dL and 222±516 mg/g, with CKD stage 1/2/3/4/5 in 27/2/2/1/2 gestations and chronic hypertension (HTN) in 11/34 pregnancies. Only 1/28 patients performed PGT, while 1/28 patient declined it. De novo or increased Pr occurred in 10/34 gestations and de novo or worsening HTN in 5/34 gestations. Deterioration of renal function occurred in one patient (CKD3) without recovery and one patient (CKD5) induced dialysis 4 months post-pregnancy. Nephrotic Pr developed in 4/34 gestations. One patient (FSGS APOL1) was treated with tacrolimus and low dose steroids. The patient with TSC re-started sirolimus on week 22 to treat severe fetal ventricular rhabdomyoma. Miscarriage occurred in 2 pregnancies. The C section rate was 21,8%. There were 7 preterm deliveries of which 3 before 32 weeks of pregnancy, mainly due to severe preeclampsia. Mean gestational age at delivery was 37,6 ± 4 weeks (26-41), mean birth weight 2756 ± 831 g (560-3835). Eight newborns were admitted to neonatal ICU due prematurity, fetal TSC, and feeding difficulties. Pulmonary hemorrhage and sepsis caused the death of 2 newborns. We found 1 maternal death, due to rupture of a cerebral aneurism 1 month postpartum (PKD patient). Conclusion Our cohort was very heterogenous regarding CKD etiologies, but generally with good kidney function, which allowed overall good obstetric outcomes. Still, maternal, obstetric and fetal complications, namely HTN, Pr, PE and prematurity had an increased incidence compared to pregnancy in healthy patients. This particular population should be approached by an experienced multidisciplinary team in CKD pregnancy care to optimize outcome.

Analysis of the risk of complications during pregnancy in pregnant women with assisted reproductive technology: a retrospective study using registry linkage from 2013 to 2018 in Shanghai, China

BackgroundTo evaluate the differences in pregnancy outcomes between assisted reproductive technology (ART) patients and natural pregnant women in Shanghai, China in the past 6 years objectively. And to assess the feasibility of the research method of registry-database linkage in mainland China.MethodsThis retrospective study was conducted using registry-database linkage. A total of 8102 pregnancies with ART and 8096 parturients with spontaneous conception (SC) from 10 reproductive centers and 111 hospitals composed our retrospective study. The primary outcomes were the rates of obstetric complications (pregnancy-induced hypertention [PIH], gestational diabetes mellitus [GDM], placenta previa, mode of delivery, preterm birth [PTB], low birth weight [LBW], and macrosomia). The prenatal outcomes were compared between ART and SC parturients, frozen-thawed embryo transfer (FET) and fresh embryo transfer, and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We calculated odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe final matching rate of the target population was 92% by using registry linkage. ART resulted in a higher rate of multiple birth, PTB, LBW, cesarean section, placenta previa and GDM compared with SC in the singleton cohort. In ART patients, pregnant women with FET had a significantly higher risk of PIH than those with fresh embryo transfer (14.1% Vs 9.3%, AOR1.528, 95% CI 1.303–1.793), but there was no difference between IVF and ICSI. FET is also related to the severity of PIH.ConclusionsART increased the rate of complications during pregnancy, the risk and severity of PIH in patients with FET was higher than that in patients with fresh embryo transfer. The registry-database linkage study is an objective and feasible research method in mainland China.

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis.

ObjectiveAlthough the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.Search MethodsFrom January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.Results22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26–4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27–0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19–0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.ConclusionHysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients

The Influence of Laparoscopic Sleeve Gastrectomy on Pregnancy, Delivery, and Infant: Does Timing of Pregnancy Following Laparoscopic Sleeve Gastrectomy Affect Outcomes?

Maternal obesity is associated with newborn morbidity and mortality; however, the literature discussing bariatric surgical effects on women's fertility and pregnancy has reached diverse conclusions. We examined the effect of laparoscopic sleeve gastrectomy (LSG) on pregnancy, birth, and newborn outcomes regarding the time of conception. We conducted a retrospective review of women who had LSG and conceived between 2007 and 2017. Data included maternal parameters, pregnancy progression, delivery, and newborn status. Pregnancies were divided into subgroups according to surgery to conception interval (≤ 12, 12-24, ≥ 24months). We reviewed 68 patients: 48 (70%) conceived once, 13 (19%) conceived twice, 7 women (10%) conceived three times. There were 95 pregnancies and 80 live births. The group sizes were 18 (18.9%), 29 (30.5%), and 48 (50.5%) pregnancies for ≤ 12, 12-24, and 24months after surgery, respectively. No difference was found between the subgroups regarding basic characteristics at time of surgery (age (p = 0.100), weight (p = 0.180), BMI (p = 0.616); and at beginning of pregnancy weight (p = 0.309), BMI (p = 0.707), %EBMIL (p = 0.321)). No significant differences were found concerning pregnancy progression, complications, and the newborns' weight (p = 0.41), GCT (p > 0.99), preeclampsia (p = 0.492), eclampsia (p > 0.99), Pre-term (p = 0.428), live birth (p = 0.432), LGA (p > 0.99), SGA (p = 0.732). A statistically significant trend of increased rates of caesarean section in subject with longer surgery-to-conception intervals was detected (P = 0.022). Our results did not show that the interval between LSG and conception affects the pregnancy and newborn outcomes. Therefore, we believe that early conception following LSG does not increase the risk of maternal or neonatal morbidity or mortality.

Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study

BackgroundThe use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database.MethodsWe included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models.ResultsOf the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital.ConclusionUruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

Study of Oligohydramnios and Perinatal Outcome in Term Pregnancy

BACKGROUND
 Oligohydramnios is associated with an increased risk of adverse pregnancy outcomes. The perinatal mortality rate in oligohydramnios is high. Oligohydramnios is also associated with fetal heart conduction abnormalities, meconium staining of the amniotic fluid, umbilical cord compression, lower Apgar scores, poor tolerance of labour and fetal acidosis. We wanted to assess the perinatal outcome in term pregnancies complicated with oligohydramnios in this study.
 METHODS
 A prospective cohort study was conducted among 200 cases of pregnant women with singleton term pregnancy with intact membranes and AFI < 5cm admitted from January 2019 to June 2020 in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. Antenatal patients with oligohydramnios confirmed by USG were induced within 24 hrs based on the Bishops score. History and examination findings were recorded in a predesigned proforma. Mode of delivery and APGAR scores were also noted. Neonatal complications and the need for ICU admission were studied up until their NICU admission or hospital stay.
 Statistical Analysis: Statistical tests of association using SPSS (version 20.0) were employed at the level of significance of 5 %.
 RESULTS
 The majority of patients in this study were primigravida (60.5 %) and belonged to the age group 20-29 yrs (73.5 %). There was a higher rate of induction (67.5 %) in oligohydramnios patients. Around 26 % had meconium-stained amniotic fluid. The rate of caesarean section was found to be 22.5 % and that of instrumental delivery was 3.5 %. Oligohydramnios was associated with a higher rate of NICU admission (27.5 %). The most common complications noted were jaundice (9.8 %), birth asphyxia (4.9 %), meconium aspiration syndrome (3.4 %) and respiratory distress syndrome (1 %). Only 1 case of neonatal mortality was seen in this study.
 CONCLUSIONS
 Oligohydramnios adversely affects the maternal and perinatal outcome. It is associated with higher rates of induction, caesarean section, meconium-stained amniotic fluid, low APGAR scores, fetal distress and perinatal morbidity and mortality. However, the outcome can be improved by good antepartum and intrapartum monitoring and neonatal care.

Exploring the value of intraoperative frozen section in the diagnosis and treatment of patients with early-stage ovarian cancer: A retrospective analysis of 421 patients.

e17568 Background: Rapid and accurate judgment of the source and nature of tumors is conducive for surgeons to select the appropriate scope and method of surgery, and avoid unnecessary over-treatment or under-treatment. This study aimed to explore the diagnostic and treatment value of intraoperative frozen section pathology in patients with early-stage ovarian cancer (EOC) in the real world. Methods: We retrospectively collected the clinical and pathological data of EOC at West China Second University Hospital between January,2013 and December,2017, which diagnosed as stage ⅠA- IIA EOC according to the International Federation of Gynecology and Obstetrics (FIGO) 2014 standard of Ovarian cancer, fallopian tube cancer and peritoneal cancer. Results: There were totally 421 cases of EOC in the Second West China Hospital of Sichuan University from 2013 to 2017. The average age was 42.9 ± 13.5 years old. There were 395 patients who had finished the comprehensive staging surgeries. Group A consisted of 239 patients (60.5%) who had completed staging operation through only one surgery, while Group B consisted of 156 cases (39.5%) who had completed that through a second-time surgery. The frozen section submission rate of staging operation in the two groups were 99.2% (237/239) and 35.3% (55/156), respectively. Meanwhile, the coincidence rates of frozen and paraffin sections in the two groups were 98.3% (233/237) and 70.9% (39/55). The submission rate and coincidence rate of intraoperative frozen sections in Group A were higher than those in Group B (the submission rate: X2= 199.983, P< 0.05; the coincidence rate: X2= 52.541, P < 0.05). Conclusions: Our results confirm that increasing the submission rate of intraoperative frozen section and improving the accuracy of frozen section attach great importance to the diagnosis and treatment of EOC. Once identified, timely and comprehensive staging surgery can help improve patient outcomes for those who do not take fertility preservation into consideration.[Table: see text]

The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea

BackgroundPhysiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery.MethodsResearch data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression.ResultsAmong a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension.ConclusionThis population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.

The Rate of and Factors Associated with Delivery by Caesarean Section among Women with Epilepsy: Time Trend in a Single-Centre Cohort in Mazovia, Poland.

Data from literature suggest that the rate of caesarean section (CS) in women with epilepsy (WWE) is higher than in the general population. In Poland, there is neither a national registry nor another data set to access the outcome of pregnancy in WWE. Therefore, we address this gap by prospectively studying CS rates among 1021 WWE pregnancies at a single centre, their trends over time, and factors increasing the likelihood of the CS. To determine whether the diagnosis of epilepsy itself increased this likelihood, mixed models were used to analyse the contributions of specific variables, including the presence of seizures at different pregnancy-related timepoints. Over 20 years, the mean rate of CS in WWE was progressively growing and was higher than in the general population in Mazovia (47% vs. 32%). Generalized seizures in the third trimester increased the likelihood of CS with the highest odds (OR 4.4). The most frequent indication for a CS was obstetric (58.1%), followed by epilepsy-related (25.2%). Almost half of women who indicated epilepsy as the sole reason for CS had no seizure during pregnancy, and nearly 70% did not have generalized seizures. This suggests the overuse of epilepsy as an indication of CS and encourages defining more strict criteria.

Racial disparities in caesarean delivery among nulliparous women that delivered at term: cross-sectional decomposition analysis of Nebraska birth records from 2005-2014

BackgroundPrevious studies suggest higher rates of caesarean section among women who identify as racial/ethnic minorities. The objective of this study was to understand factors contributing to differences in caesarean rates across racial and ethnic groups.MethodsData was collected from 2005 to 2014 Nebraska birth records on nulliparous, singleton births occurring on or after 37 weeks gestation (n = 87,908). Risk ratios (RR) and 95% confidence intervals (CI) for caesarean were calculated for different racial and ethnic categories, adjusting for maternal age, marital status, county of residence, education, insurance status, pre-pregnancy BMI, and smoking status. Fairlie decomposition technique was utilized to quantify the contribution of individual variables to the observed differences in caesarean.ResultsIn the adjusted analysis, relative to non-Hispanic (NH) White race, both Asian-NH (RR 1.21, 95% CI 1.14, 1.28) and Black-NH races (RR 1.13, 95% CI 1.08, 1.19) were associated with a significantly higher risk for caesarean. The decomposition analysis showed that among the variables assessed, maternal age, education, and pre-pregnancy BMI contributed the most to the observed differences in caesarean rates across racial/ethnic groups.ConclusionThis analysis quantified the effect of social and demographic factors on racial differences in caesarean delivery, which may guide public health interventions aimed towards reducing racial disparities in caesarean rates. Interventions targeted towards modifying maternal characteristics, such as reducing pre-pregnancy BMI or increasing maternal education, may narrow the gap in caesarean rates across racial and ethnic groups. Future studies should determine the contribution of physician characteristics, hospital characteristics, and structural determinants of health towards racial disparities in caesarean rates.

Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes of Pregnant Women with Preeclampsia.

Background In a global environment of increasing cesarean delivery rate, promoting vaginal delivery, reducing the rate of first cesarean section, and the incidence of vaginal delivery complications are the objectives of obstetric medical quality and safety in China. As a common obstetric complication, preeclampsia affects the safety of many pregnant women. It is the obstetrician's great responsibility to promote vaginal delivery and improve delivery outcomes in preeclampsia. To this end, we explored the roles of active labor management under the smart medical model in improving the outcomes of vaginal delivery for pregnant women with preeclampsia. Methods The clinical data of 219 cases of preeclampsia pregnant women who delivered vaginally in our hospital from January 2017 to December 2020 were retrospectively analyzed. According to different labor process management, they were divided into study group (active labor process management group) and control group (normal labor process management group). Active labor process management methods included intrapartum ultrasound, central fetal heart rate monitoring, Doula delivery, labor analgesia, and quality of life care. The differences in delivery process, delivery outcome, bleeding causes, and hemostatic measures were compared between the two groups. Results (1) The incidence of preeclampsia in our hospital showed an increasing trend in recent four years; (2) in smart hospitals, the active management of labor process reduced the probability of transferring to the cesarean section in preeclampsia pregnant women with vaginal trial failure; and (3) active labor process management reduced the rate of lateral episiotomy, decreased the postpartum hemorrhage volume within two hours, and improved the vaginal delivery outcome of preeclampsia pregnant women. Conclusions In the era of the rapid development of the Internet, vigorously promoting the construction of smart hospitals and actively managing the delivery process can reduce the failure rate of vaginal trial delivery and improve the outcomes of vaginal delivery in preeclampsia women.

Role of Cerebro-Placental Ratio in prediction of adverse perinatal outcome in hypertensive disorder of pregnancy

Hypertensive disorder of pregnancy is a multisystem disorder associated with an increased risk of perinatal mortality worldwide. Doppler velocimetry of uterine, umbilical, and fetal vessels is an established method of antenatal monitoring identifying fetus at risk. The cerebroplacental ratio (CPR) is emerging as an important predictor of the adverse perinatal outcome as it considers both umbilical and middle cerebral artery doppler. The aim of this study is to find the role of CPR in the prediction of adverse perinatal outcome in the hypertensive disorder of pregnancy. A prospective descriptive study was done on women admitted to a tertiary care hospital in Kathmandu from July 2020 to June 2021 after taking ethical clearance from Institutional Review Committee. A total of 136 hypertensive pregnant women beyond 34 weeks of gestation underwent Doppler ultrasound, and CPR ratio &lt;1.08 (done within one week of delivery) was considered abnormal. During the study, CPR was normal in 101 women (74.3%) and was abnormal in 35 women (25.7%). The study showed that the rate of cesarean section was high in women with abnormal CPR than with normal CPR (77.1% vs 45.5%). The caesarean section done for fetal distress (70.4% vs 39.1%), Apgar score &lt; 7 in 5 minutes (14.3% vs 3.0%), NICU admission rate (54.3% vs 27.7%), and duration of NICU stay (3.9 + 4.08 vs 0.79 +1.94 days) were high in women with abnormal CPR. The cerebroplacental ratio in hypertension in pregnancy can provide useful information regarding fetal well-being and help us in improving fetal outcomes.

Comparison of Effect of Meperidine Versus Fentanyl as an Adjuvant to Epidural Bupivacaine on Duration of Labor: A Randomized Controlled Study

Epidural analgesia (EA) is one of the best pain relief for many pregnant women in labor. This study was conducted to evaluate the effect of epidural analgesia provided by a combination of bupivacaine plus meperidine or fentanyl on the mother, fetus, and labor process in term nulliparous women. A total of 558 nulliparous women were randomized into two groups of 279 subjects. The BF (Bupivacaine-Fentanyl) group received 16 ml bupivacaine 0.125% plus 50 mg fentanyl as a loading dose; then, an intermittent bolus of the same solution was administered once the patient requested analgesia. The BM (Bupivacaine-Meperidine) group received a loading dose of 16 ml bupivacaine 0.125% plus 20 mg meperidine followed by an intermittent bolus of the same solution if the patient requested analgesia. The time of labor phases 1 and 2 and the incidence of side effects were recorded. After the intervention, the pain score was significantly lower in the meperidine group compared to the fentanyl group during labor (P=0.006). The duration of the active phase of labor (P=0.04) and the rate of cesarean section (P=0.01) were significantly higher in the fentanyl group compared to the meperidine group. The duration of the second stage of labor was not significantly different between the two groups (P=0.24). Apgar score was significantly higher in the meperidine group. This study found that epidural meperidine could be a suitable alternative to fentanyl for improving pain relief and shortening the active phase of delivery without increasing the risk of the neonatal low Apgar score.

Birth rate after major trauma in fertile-aged women: a nationwide population-based cohort study in Finland

BackgroundTo date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman.MethodsIn this retrospective register-based nationwide cohort study, data on all fertile-aged (15–44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care. A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, and 1769 in hip or thigh fracture group. The data were subsequently combined with data from the National Medical Birth Register. We used Cox regression model to analyze the hazard for a woman to give birth during 5-year follow-up starting from a major trauma. Women with wrist fractures (4957 women) formed a reference group. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI).ResultsDuring 5-year follow-up after major trauma, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth. The cumulative birth rate was lower in the hip or thigh fracture group in women aged 15–24 years (HR 0.72, CI 0.58–0.88) and 15–34 years (HR 0.65, CI 0.52–0.82). Women with pelvic fracture aged 25–34 years also had a lower cumulative birth rate (HR 0.79, CI 0.64–0.97). For spine fractures and TBIs, no reduction in cumulative birth rate was observed. Vaginal delivery was the primary mode of delivery in each trauma group. However, women with pelvic fractures had higher rate of cesarean section (23.9%), when compared to other trauma groups.ConclusionsOur results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.

Factors Associated with Vaginal/Cesarean Birth Attitudes among Medical Students.

Background: Polish perinatal care is facing a high, ever-increasing cesarean section (CS) rate that is currently at 43%. Crucially, reports have revealed that the attitudes, experiences, and skills of clinicians directly contribute to this elevated CS rate. Methods: This cross-sectional study, which included 748 Polish medical students, aimed to identify medical students’ attitudes regarding birth methods. A descriptive questionnaire was distributed via the academic email addresses of surveyed medical students. Group comparisons were performed using Welch’s t-test for continuous data or a Chi-squared test for categorical data. We also used the Mann–Whitney U test and Kruskal–Wallis H test. Results: Midwifery students (96.2%) were the most unified group of students, with most agreeing that VB (vaginal birth) presents a safer option for women at low risk for VB-related complications vs. cesarean section. Of Medical Faculty students, 68% believed that fewer complications typically occur during vaginal birth than during CS. Students in their final vs. initial years of study furthermore considered VB more beneficial for women than CS. Conclusions: An important factor identified at the individual clinician level is the presence of leadership and executive support. For medical students, we can interpret this as support from their trainers and supervisors.

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

BackgroundOptimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database.MethodsRetrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes.Results51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins.ConclusionVaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.

Effect of Depressive Disorders and Their Pharmacological Treatment during Pregnancy on Maternal and Neonatal Outcome.

Purpose: Depressive disorders are related to obstetrical and neonatal complications. The purpose of this study is to evaluate the outcomes of pregnancy in women suffering from depressive disorders, who are treated or not treated with pharmacotherapy during pregnancy. Methods: The maternal and neonatal outcomes of 281 pregnant women with depressive disorders (D group—DG), who delivered their babies at Sant’Anna Hospital of Turin, were compared with those of a control group of 200 depression-free, healthy, pregnant women, who were matched for maternal age (C group—CG). Of the depressed patients, those who received pharmacotherapy during pregnancy (DG-Tr, n = 199, 70.8%) were compared with those who did not (DG-Untr, n = 82, 29.2%). The comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. A linear regression analysis was run to examine the association between APGAR scores at 5 min and certain clinical variables. Results: The women in DG showed higher rates of cesarean section, preterm delivery, induction of labor and SGA babies, and low neonatal weights and 5-min APGAR scores, compared to the untreated patients. Those treated with psychotropic drugs showed lower rates of cesarean section, but lower 5-min APGAR scores, compared to those who were untreated. However, after controlling for confounding variables, the 5-min APGAR scores were linearly associated with neonatal weight and not with the use of psychotropic treatment. No significant differences were observed between the treated and untreated women, regarding the rates of preterm delivery, induction of labor, SGA and low neonatal weight. Conclusion: In pregnant patients with depressive disorders, poorer outcomes are expected vs. healthy controls. Pharmacological treatment is associated with a reduced rate of cesarean section, without inducing other complications for the mother and the newborn.

Application of a Femtosecond Laser in the Fabrication fused Silica Sensing Elements for MEMS Accelerometers

A group method of manufacturing quartz sensing elements of MEMS Q-flex type accelerometers is known, which is based on sequential liquid and plasma chemical etching in fluorinated plasma. In order to reduce the defects of the final products, labor costs for their manufacture and to obtain a rectangular etching profile of through holes in the section of the sensing element, an alternative technology for forming holes has been developed. The technology is thus the laser radiation pretreatment of fused silica glass with ultrashort pulse duration (about hundreds of femtoseconds) for the entire thickness of the substrate and subsequent liquid etching holes. The conducted studies revealed a local increase in the etching rate of irradiated section of fused silica glass during liquid etching with hydrofluoric acid or alkaline solution. The influence of the etching solution concentration on the change in the etching rate and the roughness of quartz is analyzed. The technology is universal and it can be used for high-precision volumetric processing of product formed from fused silica glass up to 4 mm thick.

ВЛИЯНИЕ COVID-19 НА ИСХОД БЕРЕМЕННОСТИ И ОЦЕНКА ВАКЦИНОПРОФИЛАКТИКИ SARS-CoV-2 У БЕРЕМЕННЫХ И КОРМЯЩИХ ЖЕНЩИН

Aim of the study: to discuss available information on vaccination of pregnant and breastfeeding women against COVID-19. Pregnant women with SARS-CoV-2 infection are at high risk of developing severe COVID-19 and adverse outcomes due to increased rates of preterm birth, caesarean section, and neonatal admissions to the intensive care unit. Concomitant chronic diseases increase the number of maternal and fetal complications. Taking into account the passive immunization of the newborn by transplacental transfer of maternal protective antibodies into the fetus and newborn blood circulation and then through breast milk, the role of vaccination in pregnant and breastfeeding women increases. Conclusions: after an individual risk-benefit assessment, COVID-19 vaccine should be recommended for pregnant and breastfeeding women.