Delivery Success Rate Research Articles

Preference and determinants of delivery mode in pregnant women with one cesarean scar: a cross-sectional study in two urban Ugandan public hospitals

BackgroundThe number of cesarean sections among women with a previous scar has continued to increase in Uganda. Such women can opt for a trial of labor, and the success rate for spontaneous vaginal delivery is 60–80%. This study assessed the preference and determinants of delivery mode among pregnant women with one cesarean scar.MethodsA cross-sectional analytical study was conducted among pregnant women who were attending antenatal care in two public hospitals in Uganda from 1st September to 1st October 2022. Kish Lisle formula was used to get a total sample of 169 pregnant women with one previous scar and nonrecurring indication for cesarean section. These were consecutively recruited into the study, and a modified Poisson regression was performed to identify factors associated with the preferred mode of delivery.ResultsThe mean age of the participants was 28 (4.88) years. Out of 169 women, the majority 137 (81%) preferred a trial of labor. Mothers who preferred to have more than four children were more likely to opt for a trial of labor (aPVR = 0.27, CI;1.01–1.49, p = 0.009). Mothers who were concerned about the cost associated with cesarean section were more likely to choose a trial of labor (aPVR = 1.2, CI;1.01–1.49, p = 0.03), and mothers who perceived that a cesarean section affects body image (aPVR = 3.06, CI;1.39–6.75, p = 0.03) and being employed (aPVR = 0.84, CI:0.74–0.96, p = 0.01) were more likely to prefer a cesarean section.ConclusionTrial of labor after cesarean remains the preferred mode of delivery among women. The desire to have more children and concern about medical expenses increased the likelihood of having a vaginal birth preference. Women with body image concerns and being employed increased the likelihood of a cesarean section preference. It is recommended to consider a trial of labor after cesarean section for all women with nonrecurring indications for cesarean section. Empowering women through health education on the risks and benefits of cesarean section helps them make an informed choice.

Enhanced Intracellular Delivery via a Titanium-Coated TiO2 Microstructure Device: Leveraging an Infrared Laser for Optimal Efficiency.

This study presents a novel optoporation technique using a titanium-coated TiO2 microstructure (TMS) device activated by an infrared diode laser for highly efficient intracellular delivery. The TMS device, fabricated with 120 nm titanium coating on a titanium dioxide (TiO2) microstructure containing microneedles (height ∼2 μm and width ∼4.5 μm), demonstrates enhanced biocompatibility and thermal conductivity compared to the conventional TiO2 microstructure (MS). Exposure to the TMS device with an IR diode laser (980 nm) generates heat, forming photothermal bubbles that disrupt the cell membrane and create transient pores for biomolecular delivery. Unlike traditional optoporation methods, which rely on large, vibration-sensitive lasers, the IR diode laser-assisted TMS device-based optoporation technique offers a compact, cost-effective, and portable alternative, making it suitable for clinical and research applications in resource-constrained environments. The performance of the TMS and MS devices was compared in various cancer cell lines (HeLa, L929, and N2a), with the TMS device showing superior delivery success rates for biomolecules of varying molecular sizes. Notably, the TMS device achieved a 99.30% delivery success rate for the smallest molecule, PI dye, and an 85.17% success rate for the largest studied molecule, β-galactosidase enzyme-Cy5. Furthermore, the TMS device consistently provided a higher delivery success rate at lower laser power, minimizing cellular stress and preserving cell survivability. Moreover, using Western Blot analysis, the TMS device demonstrated lower levels of apoptosis compared to the MS device, with statistically significant differences, highlighting its potential for efficient intracellular delivery while minimizing cellular stress and damage. These results highlight the potential of the TMS device as an advanced tool for large-size intracellular biomolecular delivery, offering significant improvements in stability, efficiency, and cell survivability.

Selection of the apposite vacuum extractor during operative delivery: A biomechanical study.

Operative delivery is a technique used during vaginal or cesarean birth to facilitate the patient's labor course through the assistance of a vacuum extractor. This method is increasingly used compared with forceps. This study aimed to investigate the forced effects of vacuum extractors comprising vacuum cups with different thicknesses on the fetal head and the vacuum extractor during vacuum-assisted delivery and to determine the optimal thickness for reducing the failure rate and minimizing neonatal and maternal morbidity. A biomechanical model was developed to examine the impact of vacuum cups with varying thicknesses. This simulation three-dimensional (3D) geometry model was used to evaluate hemispherical-shaped vacuum extractors made of silicone rubber having a similar cup diameter of 70 mm with varying thicknesses (1 mm to 5 mm), which were applied to the three models (flat surfaces, hemispherical balls, and fetal head). Under one boundary condition and two different loading conditions, finite element analysis was utilized to simulate the force of vacuum extractors on the fetal head during the process of operative delivery. The main observation indicators were the reaction forces of the constructed model, and von Mises stress on both the vacuum extractors and fetal head. For the reaction forces on each axis, we found that the sum of the reaction force values on each axis was increased as the thickness of the vacuum extractor was increased, regardless of the surface type. Additionally, the reaction force of the fixed-support end was increased with the increased thickness of the vacuum extractor. The von Mises stress distributions of vacuum extractors comprising vacuum cups with different thicknesses, revealed that the thinner the cup, the greater the von Mises stress exerted on the extractor itself regardless of the surface type. The distribution of von Mises stress on the skull structure of the fetal head, showed that the thinner the cup, the greater the von Mises stress exerted on the skull structure regardless of the surface type. A thinner vacuum extractor cup may result in greater injury to the fetus; hence, a thicker vacuum extractor cup is preferably utilized during vacuum-assisted operative delivery. Using a thicker vacuum extractor should yield a higher successful delivery rate and reduce fetal injury.

Safety of vaginal breech delivery following an unsuccessful external cephalic version: a comparative study.

To determine whether patients undergoing a trial of labor with a breech presentation following a failed attempt of external cephalic version (ECV) are at increased risk of adverse maternal and neonatal outcomes. This retrospective cohort study was conducted at a single university-affiliated medical center. The study group comprised women with singleton pregnancies at term, categorized into three groups: those who underwent a failed external cephalic version (ECV) and subsequently attempted a trial of breech delivery (Breech-failed-ECV group), those who attempted an assisted vaginal breech delivery without a prior ECV attempt (Breech-no-ECV group), and those with vertex presentation following a successful ECV (Vertex-ECV). The primary outcome measured was the mode of delivery. Secondary outcomes included adverse maternal and neonatal outcomes. The study group consisted of 229 patients who attempted a vaginal delivery during the study period following a diagnosis of non-cephalic presentation at term.There were 42 women in the Breech failed-ECV group, 102 in the Breech-no-ECV group, and 85 in the Vertex-ECV group. Among patients undergoing a trial of labor with a breech presentation, there were no significant differences in successful vaginal delivery rates between those who had an attempted ECV and those who did not (80.39% vs. 80.95%, p > 0.05), nor in the rate of adverse maternal or neonatal outcomes between the groups. However, the Vertex-ECV were more likely to have a vaginal delivery (91.78 vs 80.56%, p = 0.03) and less likely to experience adverse neonatal outcomes, including meconium-stained amniotic fluid, non-reassuring fetal heart rate (NRFHR), compared to those who underwent labor with a breech presentation (p < 0.05). A failed external cephalic version does not adversely affect maternal or neonatal outcomes in patients undergoing a trial of labor with a breech presentation and meet the criteria of our study.

External cephalic version in nonvertex second twin-Success rate, mode of delivery, and safety: A systematic review.

One of the key challenges regarding the management of twins involves choosing the optimal mode of delivery, which is strongly influenced by the final presentation of both fetuses. In cases of vertex-nonvertex pregnancies attempting the trial of vaginal delivery, external cephalic version (ECV) is one of possible management options. The main objective of this review was to collect and summarize available data in terms of the application of ECV in the population of nonvertex second twins. Using the PRISMA guidelines, we searched for original, English-language studies investigating ECV in nonvertex second twins. The PubMed/MEDLINE, SCOPUS, and COCHRANE databases were searched until May 2024. Reviews, case reports, editorials, and conference papers were excluded from further analysis. Out of 260 papers retrieved, 10 were subjected to the final analysis in terms of success rates, modes of delivery, and adverse outcomes. The total number of ECVs was 289, with an overall success rate of 64.4%. In the group of successful versions, vertex vaginal delivery was achieved in 171 cases (91.9%). The incidence of adverse maternal and neonatal outcomes was low. The purpose of this review was to consolidate and update the current knowledge regarding ECV in nonvertex second twins. Based on the results of this series of studies, ECV appears to be a reasonable management option. However, it is important to highlight several significant limitations. The primary concern is the lack of recent research in this field over the past three decades, with the most recent study in our review being published in 1998. Furthermore, the actual number of studies addressing this topic is relatively low, characterized by a retrospective nature and questionable methodologies. These limitations make it challenging to draw definitive conclusions for clinical practice. This is an important message for our community, emphasizing the need for further studies in this area, particularly randomized controlled trials, to evaluate the safety and success rate of vaginal twin delivery after ECV when the second twin presents in a nonvertex position.

Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery.

Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population. This was a 16-year retrospective multicenter case-control cohort study (2002-2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs. Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3-66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4-73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54-0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2-0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4-3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0-3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1-2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3-3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture. Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.

Comparison of the efficacy and safety of dinoprostone and double-balloon catheters in cervical ripening: a propensity score matching retrospective study.

The methods of prompting cervical ripening (CR) include mechanical and pharmacological approaches. The former seems safer. However, this superiority may change with the application of a new labor curve. Therefore, we aimed to compare the efficacy and safety of dinoprostone and double-balloon catheters (DBC) in promoting CR in induction of labor (IOL). A total of 877 primipara women with Bishop score ≤ 6 were divided into the dinoprostone group (n = 502) and DBC group (n = 375) according to the IOL way. The women in the dinoprostone group received dinoprostone to perform IOL, while those in the DBC group received DBC to perform IOL. The natural birth rate, time to labor onset and birth, and maternal and neonatal complications were compared between the two groups. A propensity score match (PSM) was used to eliminate the selection bias. A total of 516 cases were left after PSM (1:1) to Bishop score. The dinoprostone was associated with an improved Bishop score. However, there were no significant differences in the vaginal delivery rate, the stage of labor, and the time from ripening to labor onset and delivery between the two groups (p > 0.05). The incidence rates of puerperal infection and blood loss were notably higher in the DBC group than in the dinoprostone group (p < 0.05). However, there was no statistical difference in the incidence of postpartum hemorrhage between the two groups (p > 0.05). Dinoprostone is associated with a lower puerperal infection rate and improved Bishop score in IOL without an increased success rate of vaginal delivery.

Dydrogesterone vs. Progesterone: Which is More Effective in Threatened Miscarriage?

Background/Aims: Threatened miscarriage, marked by vaginal bleeding during the first 20 weeks of pregnancy, is a frequent complication with potential adverse outcomes. Dydrogesterone and micronized progesterone are commonly prescribed to manage this condition, yet their comparative efficacy remains under debate. This study aims to evaluate the effectiveness and safety of dydrogesterone versus micronized progesterone in treating threatened miscarriage. Methods: A retrospective case-control study was conducted at Our Hospital, including 123 pregnant women aged 6 to 20 weeks presenting with uterine bleeding. Participants were divided into two groups based on receiving either dydrogesterone (n=56) or micronized progesterone (n=67). Pregnancy outcomes, including miscarriage rates, preterm labor, and mode of delivery, were recorded and analyzed using SPSS software. Results: The miscarriage rate was slightly higher in the dydrogesterone group (9.6%) compared to the progesterone group (5.9%), though this difference was not statistically significant (p=0.729). Both groups exhibited high rates of successful delivery, with no significant difference between them (p&amp;gt;0.05). Additionally, no significant differences were observed in the incidence of pregnancy complications or mode of delivery between the two groups. Conclusion: Both dydrogesterone and micronized progesterone are effective in managing threatened miscarriage, with no significant differences in pregnancy outcomes. The choice of treatment should be individualized based on patient tolerance and side effect profiles. Further large-scale, randomized trials are needed to confirm these findings and refine treatment guidelines.

Efficacy and Safety of Mifepristone and Misoprostol Compared to Misoprostol Alone for the Resolution of Miscarriage and Intrauterine Fetal Death: A Systematic Review and Meta-Analysis.

To determine the efficacy and safety of mifepristone and misoprostol together (intervention) compared to misoprostol alone (comparator) for the resolution of miscarriage and intrauterine fetal death. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology through July 2024 that evaluated the efficacy and safety of mifepristone and misoprostol together compared to misoprostol alone for the resolution of miscarriage and intrauterine fetal death through July 2024. Primary endpoints were overall delivery success, 24-hour delivery success, and incidence of safety outcomes. A P-value of <0.05 was considered statistically significant, and heterogeneity was reported as the I2 value. Twelve randomized controlled trials (RCTs) were included. Overall delivery success was higher in the intervention group (0.73 [CI 0.64-0.82], P < 0.01). Twenty-four-hour delivery rate was higher (1.54 [CI 1.32-1.77], P = 0.06), and a shorter time to delivery interval (9.22-18.78 vs 15.47-37.1 hours) was observed in the intervention group. Gastrointestinal adverse effects were more frequent in the intervention group (0.04 [CI -0.03 to 0.12], P < 0.01). Mifepristone and misoprostol together demonstrated higher delivery success rates and comparable safety outcomes to misoprostol alone, demonstrating the potential of improving patient care and positively impacting the time to successful delivery for patients at the bedside. The use of mifepristone and misoprostol together for the resolution of miscarriage and intrauterine fetal death is warranted over the use of misoprostol alone.

Commissioning of the tracer-encapsulated solid pellet (TESPEL) injection system for Wendelstein 7-X and first results for OP1.2b

Abstract A new tracer-encapsulated solid pellet (TESPEL) injection system was successfully commissioned for the stellarator fusion experiment Wendelstein 7-X (W7-X) during its OP1.2b operational campaign. TESPELs are polystyrene encapsulated solid pellets loaded with tracer impurities that have been employed in other stellarator devices for impurity transport studies. During the OP1.2b campaign approximately 140 pellet injections were performed with a successful delivery rate of 89%, thus this system has proven to be very reliable. Here, the experimental set-up and methodology are described first. In addition, it is outlined how, through the analysis of TESPEL time-of-flight signals and of the temporal evolution of line emissions originating from shell and tracer species as well as comparisons with ablation models, the radial localization of the deposited tracer is determined. This contribution also provides a general overview of the TESPEL injector performance during OP1.2b, discusses the global effects of TESPEL injections on W7-X plasmas and reports on first results in terms of a summary of TESPEL injections, plasma response to TESPELs, the post-deposition evolution of tracer spectral emission lines and soft x-ray emissions.

Efficacy of controlled-release dinoprostone vaginal insert for elective induction of labor before due date.

The induction of labor before due date has recently been proved to reduce the rate of cesarean sections and is not associated with increased risk of adverse perinatal outcomes as compared to expectant management. Controlled-release dinoprostone (PGE2) vaginal insert has recently been approved for use in Japan. However, evidence regarding its efficacy in cervical ripening and labor induction before due date remains limited. We aimed to compare the efficacy of PGE2 vaginal inserts and mechanical dilation for labor induction before due date. This retrospective cohort study included 206 mothers at 37, 38, and 39 weeks' gestation delivered at our institution between January 2021 and October 2022. Perinatal outcomes, including the success rate of vaginal delivery, were compared between the PGE2 (n = 46) and metreurynter/laminaria tent (non-PGE2) (n = 160) groups. The success rate of vaginal delivery was defined as the proportion of women who delivered vaginally within 48 h of initiating oxytocin augmentation. The success rate of vaginal delivery was significantly higher in the PGE2 group (37/49, 80.4%) than in the non-PGE2 group (106/177, 66.2%). Emergency cesarean section related to non-reassuring fetal status was performed with none in the PGE2 group and with eight (5.0%) in the non-PGE2 group. The rate of vaginal delivery was significantly higher in the PGE2 group for elective labor induction between 37 and 39 weeks. The PGE2 vaginal insert could increase the success rate of vaginal delivery for elective induction of labor at 39 weeks.

An adaptive and multi-path greedy perimeter stateless routing protocol in flying ad hoc networks

An adaptive and multi-path greedy perimeter stateless routing protocol in flying ad hoc networks

Temperature Humidity Control System and Fire Detection for Room Server Based Internet Of Things

The objective of this research is to develop an Internet of Things (IoT)-based temperature, humidity, and fire detection control system to monitor server rooms at INSTIKI. The research methodology employed involved the collection of primary data through interviews and observations, as well as secondary data through a comprehensive literature review. The system is implemented using a variety of electronic components, including the NodeMCU ESP32, the DHT22 sensor, the MQ2 gas sensor, the KY-026 flame sensor, the PZEM-004t sensor, the infrared emitter LED, the 20x4 I2C LCD, the buzzer, the 5V modules adapters, the step-down modules, and the SIM800l modules. The findings of this study illustrate that the devised system is effective in monitoring temperature, humidity, smoke, fire, and electricity in the INSTIKI server room. The monitoring data is displayed via a web platform, while warning notifications are sent via SMS and Telegram in the event of dangerous situations, resulting in a 100% success rate for notification delivery. The testing of the air conditioning temperature controls using SMS also achieved a 100% success rate. However, the efficacy of the IR Remote is contingent upon the distance and position of the Infrared Emitter LED in relation to the AC's receiver sensors, as well as the quality of the signal received by the GSM800l module.

Reproductive outcomes after fertility-sparing surgery for cervical cancer - results of the multicenter FERTISS study

Fertility-sparing treatment (FST) for patients with cervical cancer intends to achieve oncologic outcomes comparable to those after radical treatment while maximizing reproductive outcomes, including the ability to conceive and minimizing the risk of prematurity. International multicentre retrospective FERTISS study focused on patients treated with FST analysed timing of FST relative to pregnancy, conception attempts and methods, abortion rates, prophylactic procedures reducing the risk of severe prematurity, pregnancy duration, and delivery mode. Of the 733 patients treated at 44 centres in 13 countries, 49.7% attempted to conceive during median follow-up of 72months and 22.6% (166/733) patients achieved a successful pregnancy. Success rate was significantly higher after non-radical surgery (63.2%; 122/193) compared to radical trachelectomy (25.7%; 44/171, p<0.001). Available perinatological data shows that 89.5% (111/124) of the patients became pregnant naturally. There was no significant difference in the abortion rate in the first pregnancy nor delivery success rates between non-radical and radical procedures patients. Preterm delivery (<38weeks gestation) occurred more frequently after radical than non-radical procedures (76.5% vs. 57.7%, p=0.15). Almost all patients (97.3%; 73/75) who underwent regular ultrasound cervicometry in pregnancy with subsequent prophylactic procedures delivered a live fetus, compared to 30.6% (15/49) women without such management, p<0.001. Patients who underwent non-radical surgery had significantly higher pregnancy rates. Most pregnancies resulted in a viable fetus, but radical trachelectomy led to a higher rate of preterm births in the severe prematurity range. Half of the patients did not attempt pregnancy after FST.

Neonatal outcomes of planned vaginal delivery versus planned cesarean section for breech presentation at term: Population-based study on 546,842 breech births across the United States between 2008 and 2017

Over the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses. This retrospective population-based cohort study utilized data from the United States' Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes. It was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at 〈 6 h of life, 1.47, 1.42-1.52, ventilation support at 〉 6 h of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50. In women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.

Chronic endometritis - a constantly discussed issue in infertile women.

A review of current knowledge on the pathophysiology, diagnostic and treatment options for chronic endometritis in infertile women. One of the major causes of failed in vitro fertilization (IVF) is undiagnosed intrauterine pathologies, including chronic inflammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbiome with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infiltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often difficult because there is no specific clinical or laboratory diagnostic method. The following investigative options are commonly used for the diagnosis of chronic endometritis: diagnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate diagnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the diagnostic process. Chronic endometritis is often a clinically silent disease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the diagnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal diagnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refine this knowledge.

An IOV Spectrum Sharing Approach based on Multi-Agent Deep Reinforcement Learning

Highly dynamic Internet of Vehicles spectrum sharing can share spectrum owned by vehicle-to-infrastructure links through multiple workshop links to achieve efficient resource allocation. Aiming at the problem that the rapid variations in channel states in highly dynamic vehicular environments can make it challenging for base stations to gather and manage information about instantaneous channel states, we present a multi-agent deep reinforcement learning-based V2X spectrum access algorithm. The algorithm is designed to optimize the throughput of V2I user under V2V user delay and reliability constraints, and uses the experience gained from interacting with the communication environment to update the Q network to improve spectrum and power allocation strategies. Implicit collaborative agents are trained through an improved DQN model combined with dueling network architecture and long short-term memory network layers and public rewards. With lagged Q-learning and concurrent experience replay trajectories, the training process was stabilized and the non-stationarity problem caused by concurrent learning of multiple agents was resolved. Simulation results demonstrate that our presented algorithm achieves a mean successful payload delivery rate of 95.89%, which is 16.48% greater than that of the randomized baseline algorithm. Our algorithm obtains approximately the optimal value and shows performance close to the centralized brute force algorithm, which provides a better strategy for further minimizing the signaling overhead of the Internet of Vehicles communication system.

Validation of a new calculator for predicting success of vaginal birth after cesarean delivery

Race as a variable in a predictive model for a successful vaginal birth after cesarean delivery has been challenged as contributing to health inequity. In May 2022, the National Institute of Child Health and Development released a modified calculator that removed race as a variable. The aim of this study was to externally validate the revised calculator amongst a cohort at our institution. We reviewed all patients who underwent a trial of labor after cesarean delivery in 2018 to 2020 at a tertiary academic medical center and calculated the predicted probability of successful vaginal birth after cesarean delivery for each patient using both original and revised classification calculators and compared these to observed birth outcomes. The area under the receiver operating characteristic curve was calculated for each model. From the cohort of 225 patients that fit inclusion criteria, 37% (n=83) identified as African American or Hispanic, the vaginal birth after cesarean delivery success rate was 75% for the entire population, and 76% among African American and/or Hispanic patients. The area under the receiver operating characteristic curve of the original calculator was 0.71, compared to 0.74 for the new calculator. For African American and/or Hispanic patients, the average predicted success rates between the models rose from 60% to 69%. Our review confirmed that African American and Hispanic patients were calculated to have a lower prediction score for a successful vaginal birth after cesarean delivery based on the original calculator as compared to the revised calculator. Our results also suggest that race/ethnicity did not significantly contribute to classification ability of the calculator in our patient population.

Correlative analysis of different treatments of persistent occipitotransverse position on the outcome for mother and infant.

To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety-six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants.

Elective Induction of Labor Following Prior Cesarean Delivery.

Following the ARRIVE trial, induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction in those patients with a prior cesarean delivery is not well described, and they were not included in the original trial. We aim to determine the risk of uterine rupture in those patients undergoing elective induction of labor with prior cesarean delivery. This was a retrospective cohort of participants with prior cesarean delivery from 1996 to 2000. Participants were included if they had ≤ 2 prior cesareans. Participants were excluded if they had a history of an unknown prior incision, a classical incision, gestational age < 39 weeks, any diabetes, chronic hypertension, twin gestation, collagen or vascular disease, or HIV. Those undergoing expectant management were compared to those undergoing elective induction with no medical or obstetrical indications for delivery. Analysis was performed at three gestational age groups: 39 weeks, 40 weeks, and 41 weeks. The primary outcomes were uterine rupture, rates of successful vaginal delivery, and a composite major morbidity risk. Multivariable logistic regression was performed. At 39 weeks, 618 (10.3%) elective inductions were compared to 5365 (89.7%) undergoing expectant management; uterine rupture occurred more frequently (13 patients (2.1%) vs. 49 patients (0.9%); aOR, 2.5; 95% CI, 1.3 - 4.6) with fewer successful VBAC (66.8% vs. 75%; aOR, 0.6; 95% CI, 0.5 - 0.7). The risk of uterine rupture was similar between groups at 40 (5 patients (0.8%) vs. 21 patients (1.2%); P=0.387) and 41 weeks (7 patients (1.4%) vs. 2 patients (0.8%); P=0.448). Patients undergoing elective induction of labor with a prior cesarean scar had an increased risk of uterine rupture when compared to expectant management at 39 weeks, with fewer successful VBAC.