High risk and low incidence diseases: Postpartum hemorrhage.

Identifying and reporting dystocia in laboratory rodents.

To determine the incidence of relaparotomy after cesarean delivery in a tertiary referral center, and to evaluate its indications, timing, and association with maternal morbidity. This retrospective study included women who underwent relaparotomy within 30 days following cesarean delivery between June 2020 and October 2025 in a tertiary center managing high-risk obstetric cases. Baseline maternal, obstetric, and operative characteristics were recorded. Relaparotomy indications were analyzed according to timing and primary cesarean indication. Maternal morbidity, hospital stay, and intensive care unit (ICU) admission were assessed. An exploratory Poisson regression analysis was performed to evaluate potential associations between baseline variables and repeated relaparotomy. Multivariable linear regression was used to analyze factors associated with perioperative hemoglobin change. Among 44 486 cesarean deliveries, 83 women required relaparotomy (0.19%). Uterine atony and hemorrhage were the most common indications for relaparotomy in the early postoperative period, whereas infectious complications became more frequent later. Bladder injury and intra-abdominal abscess were associated with longer hospitalization, while ICU stay did not differ significantly by indication. Repeated relaparotomy occurred in 15.7% of patients; no baseline maternal or operative variables were significantly associated with this outcome in exploratory analysis. Relaparotomies for non-atony bleeding were associated with greater hemoglobin decline, longer operative duration, and increased transfusion requirement. Maternal morbidity occurred in 20.5% of cases, and one maternal death was observed in a patient with placenta accreta spectrum complicated by hemorrhage. Relaparotomy after cesarean delivery, although rare, represents a severe postoperative event associated with substantial maternal morbidity. It is not limited to technically complex index procedures and may follow apparently uncomplicated surgeries. The predominance of hemorrhagic causes early and infectious causes later underscores the need for extended postoperative surveillance. Effective hemostatic control, early recognition of infection, and management in experienced tertiary centers are central to improving maternal outcomes.

Paired-operator simulation training for intrauterine tamponade balloon placement: A feasibility study with integrated TeamSTEPPS assessment.

Understanding the mechanism of oxytocin-induced uterine contractility is critical for addressing conditions at both extremes of the uterine contractility spectrum, preterm labour and uterine atony. We hypothesized that oxytocin induces extracellular calcium influx and uterine contraction through activation of the transient receptor potential vanilloid 4 (TRPV4) channel. To test this hypothesis, uterine tissue was obtained with informed consent from pregnant patients undergoing term, non-labouring caesarean delivery. In human myometrial tissue and smooth muscle cells in primary culture (mSMCs), TRPV4 and oxytocin receptor (OXTR) proteins colocalize at distances less than 40nm. In mSMCs, both pharmacological blockade of TRPV4 and TRPV4 depletion via small interfering RNA prevent oxytocin-induced calcium influx and contraction. In contrast, voltage-gated calcium channel blockade does not diminish oxytocin-induced calcium transients. Pharmacological blockade of OXTR has no effect on TRPV4 agonist-induced calcium influx or contractility. In uterine tissue from patients with oxytocin-resistant uterine atony, there is a marked reduction in glycosylated OXTR expression and in proximity ligation between OXTR and TRPV4 compared with tissue from control patients with optimal postpartum contractility. Taken together, these findings demonstrate that in the gravid uterine smooth muscle, TRPV4 activation is required for oxytocin-induced uterine contraction. They also suggest reduced OXTR-TRPV4 protein-protein interaction as a novel pathophysiological mechanism underlying uterine atony in non-labouring parturients. These findings highlight the physiological importance of oxytocin signalling via the TRPV4 channel and may motivate the development of targeted, TRPV4-focused treatments to modulate uterine contractility. KEY POINTS: Oxytocin-induced contraction in smooth muscle cells from term pregnant human myometrium requires activation of the TRPV4 calcium channel. TRPV4 and oxytocin receptor (OXTR) colocalize at <40nM and interact functionally in myometrial smooth muscle cells. TRPV4 antagonism or siRNA-mediated TRPV4 knockdown abolishes oxytocin-induced calcium influx and contractility. In patients with oxytocin-resistant uterine atony, glycosylated OXTR quantity and TRPV4-OXTR colocalization are markedly reduced. These findings identify TRPV4 as a critical mediator of uterine contractility. TRPV4 antagonists may have a role as novel therapeutic agents for preventing or treating preterm labour.

26-CCC-10378-ACC FROM UTERINE ATONY TO CORONARY VASOSPASM: A CASE OF POSTPARTUM MYOCARDIAL INJURY

Introduction: Peripartum/postpartum hysterectomy is a rare but life-saving intervention for uncontrolled obstetric hemorrhage.Placenta accreta spectrum (PAS) and uterine atony are the most common indications; yet their clinical context and operative pathways may differ, particularly in centers where PAS is managed under urgent or emergent conditions.We evaluated indications, surgical management, and outcomes over a 10-year period and explored differences between uterine atony-related and PAS-related cases. Material and Methods:This retrospective, single-center study included women who underwent peripartum or postpartum hysterectomy for uncontrolled obstetric hemorrhage between January 2015 and June 2025.Cases were classified as uterine atony or PAS/placenta previa-related hemorrhage based on operative findings, clinical course, and pathology.Continuous variables were summarized as median [interquartile range (IQR)] and compared using the Mann-Whitney U test; categorical variables were compared using Fisher's exact test.Effect estimates with 95% confidence intervals (bootstrap for continuous variables) are provided in the tables; comparisons were exploratory.Results: Among 31,571 deliveries, 34 hemorrhage-related peripartum/postpartum hysterectomies were identified (incidence: 1.1 per 1,000 deliveries): 18 for uterine atony (52.9%) and 16 for PAS-related

Does peripartum intravenous calcium administration reduce the occurrence of uterine atony in caesarean sections?: A systematic review and meta-analysis.

Monochorionic triamniotic multiple pregnancy is a rare and high-risk condition. We present the management of a cascade of severe complications in an adolescent pregnant patient. A 17-year-old primigravida with a 24-week monochorionic triamniotic triplet pregnancy was admitted for threatened preterm labor with cervical dilation. A rescuecervical cerclage was performed. The clinical course was complicated by high-risk pulmonary thromboembolism, confirmed by echocardiography and Doppler ultrasonography, requiring therapeutic anticoagulation. Subsequently, the patient developed nosocomial pneumonia and severe anemia. At 26.3 weeks of gestation, an emergency cesarean sectionwas performed due to labor, delivering three preterm newborns. The mother experienced uterine atony, which was successfully managed with compressive sutures. This case underscores the feasibility of an aggressive, multidisciplinary approach in critical obstetric situations with sequential complications. Individualized decision-making, despite limited evidence in such complex scenarios, can lead to favorable maternal and fetal outcomes. Adolescence may be an additional risk factor in multiple pregnancies.

Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to "unexplained infertility" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.

BACKGROUND: Cesarean delivery rates continue to rise, as does the percentage of intrapartum cesarean section, highlighting the relevance of research on the subject. Risk factors for emergency cesarean delivery include a burdened medical or obstetric and gynecological history (hypertension, diabetes mellitus, etc.) as well as pregnancy complications (pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, fetal malpresentation, etc.). Analyzing these factors can help to identify risk groups, improve labor management, and reduce maternal and neonatal morbidity. AIM: The work aimed to assess the impact of maternal history and course of labor on the mode of delivery and neonatal outcomes. METHODS: The study included 391 patients. Patients were divided into the main group (intrapartum cesarean section) and the control group (cesarean section before the onset of labor). The main group was divided into three subgroups. Subgroup 1 (latent phase) included 48 patients who had a cesarean section at a cervical dilatation of 1–4 cm; subgroup 2 (active phase) included 43 patients who had a cesarean section at a cervical dilatation of 5–9 cm; and subgroup 3 included 195 patients who had a cesarean section at full dilatation. The control group (n = 105) included patients who had a cesarean section before the onset of labor. Each patient's medical records on the course of pregnancy and labor and mode of delivery were analyzed. RESULTS: Overweight and obesity were most common in the control group; moreover, this group had the shortest gestational age at the time of cesarean section. Chronic hypertension was more common in the active phase subgroup than in the full dilatation subgroup (р 0.05). Oxytocin induction was less common in the full dilatation subgroup (p 0.05). In the latent phase subgroup, primary uterine inertia was the most common indication for cesarean section (p 0.05), whereas secondary inertia was more common in the active phase and full dilatation subgroups (р 0.05). The full dilatation subgroup had the highest intraoperative blood loss (~ 600 mL; p 0.05). The highest birth weight was reported in the full dilatation subgroup (3632 g; p 0.05), while the highest 1-minute Apgar scores were observed in the latent phase subgroup (8 points; p 0.05). CONCLUSION: The maternal history and course of labor have a direct impact on the mode of delivery and neonatal outcomes. The findings highlight the relevance of assessing maternal history and course of labor in real-world practice.

Postpartum hemorrhage is a major cause of maternal morbidity and mortality. Abdominal packing is a technique used to control bleeding when other methods fail. This study aimed to evaluate the outcomes of patients who underwent abdominal packing for postpartum hemorrhage. This retrospective study included 11 patients who underwent abdominal packing for severe obstetric hemorrhage (10 cases of postpartum hemorrhage and one case of second-trimester pregnancy termination complicated by severe hemorrhage) at Mersin University Faculty of Medicine Hospital between 2005 and 2023. Data were collected from medical records. The primary outcome was the successful immediate control of refractory hemorrhage and temporary stabilization of the patient's hemodynamic status. Secondary outcomes included transfusion requirements, complications, and length of hospital stay. All 11 patients underwent hysterectomy for postpartum hemorrhage and subsequently required abdominal packing due to persistent bleeding. The median age was 33 years, and the median gravidity was 3. The primary causes of postpartum hemorrhage were uterine atony (54.5%), placenta previa (36.4%), and disseminated intravascular coagulation (9.1%). The median number of packs used was 3, and packs were removed after 24 hours in all cases. Abdominal packing successfully controlled persistent bleeding in all patients following hysterectomy. The median length of hospital stay was 6 days. All patients required blood transfusions. The most common complication was pulmonary edema (90.9%). All patients survived. Abdominal packing may serve as a valuable temporary rescue measure for severe, refractory obstetric hemorrhage in selected cases where conventional methods are insufficient. Careful patient selection and close postoperative monitoring are essential.

This study analyzed 22 criminal cases involving obstetricians and gynecologists to identify legal trends and propose measures to reduce the legal burden on medical professionals while maintaining stable healthcare services. The cases were retrieved from the Supreme Court of Korea Judicial Information Disclosure Portal using keywords such as “obstetrics,” “gynecology,” “expectant mother,” “fetus,” “neonate,” “delivery,” “uterus,” and “placenta.” The cases were classified into two categories: medical malpractice (16 cases, 72.7%) and abortion and bioethics (6 cases, 27.3%). Guilty verdicts were issued in 8 cases (36.4%), whereas 14 cases (63.6%) resulted in acquittal. The qualitative analysis showed that courts consistently protected physicians’ clinical discretion in unpredictable and unavoidable situations, such as amniotic fluid embolism and uterine atony, provided that standard medical protocols were followed. Procedural appropriateness, rather than the perfection of clinical outcomes, appeared to be the primary basis for judicial protection. Although the judiciary acknowledges the inherent limitations of medical practice and tends to protect physicians when established guidelines are followed, the high frequency of criminal prosecution remains a substantial burden on healthcare providers and may threaten the sustainability of obstetric care.

Background: Postpartum hemorrhage is a major cause of maternal morbidity and mortality, particularly in vaginal delivery, with uterine atony as the most common etiology. Therefore, the administration of uterotonic agents during the third stage of labor plays an important role in preventing postpartum hemorrhage. Methylergometrine is still widely used; however, data regarding its effect on the severity of postpartum hemorrhage in Indonesia remain limited. Purpose: To compare the severity of postpartum hemorrhage among women with normal vaginal delivery who received and did not receive methylergometrine at RSUD Dr. Moewardi Surakarta. Method: This study was an observational analytic study with a retrospective cohort design using secondary data from medical records. A total of 92 women with normal vaginal delivery who experienced primary postpartum hemorrhage during the period 2022–2024 were included and divided into groups receiving and not receiving methylergometrine. The severity of postpartum hemorrhage was classified into mild–moderate and severe. Data were analyzed using univariate and bivariate analyses with the Fisher’s exact test at a significance level of p &lt; 0.05. Results: All women who received methylergometrine experienced mild–moderate postpartum hemorrhage, whereas 9.5% of severe postpartum hemorrhage cases were found in the group that did not receive methylergometrine. There was a significant association between methylergometrine administration and the severity of postpartum hemorrhage (p = 0.026), with an odds ratio of 0.905 (95% CI: 0.820–0.998). Conclusion: Methylergometrine administration was significantly associated with a reduced severity of postpartum hemorrhage in women with normal vaginal delivery.

This review provides an updated overview of anesthetic considerations for malpresentation and multiple gestation. Key topics include analgesia for external cephalic version (ECV), labor analgesia for vaginal delivery in malpresentation and multiple gestation, anesthetic considerations for cesarean delivery in these scenarios, and management of postpartum hemorrhage risk. Neuraxial analgesia improves both maternal comfort and procedural success during ECV for malpresentation. Neuraxial labor analgesia facilitates safer vaginal delivery in multiple gestation pregnancies. Cesarean delivery for multiple gestation carries an increased risk of uterine atony, with higher oxytocin requirements (ED90 > 4 IU) compared with singleton pregnancies. Anesthesiologists should maintain vigilance and readiness for rapid intervention when caring for patients with malpresentation and/or multiple gestation. Persistent gaps exist between recent evidence and routine clinical practice; therefore, implementation studies and multidisciplinary consensus guidelines are warranted.

Gossypium herbaceum, though small in presence within the homoeopathic pharmacopeia, stands as a powerful regulator of female reproductive functions. It acts chiefly on uterus and ovaries, restoring menstrual rhythm, relieving congestive pelvic pain, and addressing infertility arising from uterine inertia or suppressed menstruation. The drug’s utility extends to lactation disturbances, early abortions, and dysmenorrhoea with neuralgic pain.

Anesthetic management of intrapartum cesarean deliveries with an in-situ epidural catheter during second-stage versus first-stage of labor: a single-center retrospective study (2022-2024).

Carbetocin versus oxytocin for the prevention of uterine atony during cesarean delivery: a real-world retrospective historical control cohort study (2022-2023).

Background: Primary postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in developing countries. Early identification of clinicodemographic risk factors is essential for prevention and improved maternal outcomes. Objective: To assess the clinicodemographic risk factors and maternal outcomes associated with primary postpartum hemorrhage in a tertiary care hospital. Methods: This prospective observational study included 100 women who developed primary PPH within the first 24 hours after delivery. Primary PPH was defined according to World Health Organization criteria. A structured proforma was used to document sociodemographic characteristics, obstetric risk factors, causes of PPH, and maternal outcomes. Data were analyzed using SPSS version 26. Chi-square or Fisher’s exact tests were applied to evaluate associations between risk factors and adverse maternal outcomes, with a p-value &lt;0.05 considered statistically significant. Results: The mean maternal age was 29.4 years. Major risk factors identified were multiparity (62%), anemia (61%), and rural residence (65%). Cesarean delivery accounted for 44% of cases. Uterine atony was the most common cause of PPH, responsible for 72% of cases. Maternal outcomes included the need for blood transfusion (68%), surgical intervention (19%), ICU admission (15%), and hysterectomy (4%). Maternal mortality was reported in 2% of cases. Anemia, multiparity, cesarean delivery, and prolonged labor showed significant associations with severe maternal outcomes (p ≤ 0.05). Conclusion: Primary postpartum hemorrhage is strongly associated with modifiable clinicodemographic factors, particularly anemia, multiparity, and inadequate prenatal care. Early risk stratification, correction of maternal hemoglobin levels, and timely obstetric intervention are crucial to reducing severe morbidity and mortality. Strengthening antenatal care and ensuring optimal emergency obstetric preparedness remain key strategies for improving maternal health outcomes.

Streptococcus agalactiae (GBS) infection is significant in obstetric and neonatal complications. Maternal age, particularly adolescent pregnancy, may influence the prevalence of GBS colonization and associated clinical outcomes. This study aimed to evaluate the impact of maternal age on obstetric and neonatal outcomes, with a specific focus on the modifying effect of GBS status. The analysis explored whether the associations between maternal age and selected outcomes remained statistically significant after adjusting for GBS interactions. A retrospective matched cohort study was conducted with 582 participants, comprising a study group and a matched control group selected through propensity score matching. The study group included adolescents (≤ 19 years, n = 194) and older individuals (> 19 years, n = 388). Inclusion criteria required GBS screening after the 35th week of gestation, bacterial culture upon hospital admission, and delivery during the same hospitalization. Statistical analyses included logistic and linear regression models adjusted for interactions with GBS. In unadjusted analyses, adolescent mothers showed a higher likelihood of postpartum hemorrhage (OR = 2.715, p = 0.02), uterine atony (OR = 3.594, p = 0.043), transient tachypnea of the newborn (TTN) (OR = 6.16, p = 0.027), and shorter neonatal length (Estimation = -0.791, p = 0.001). However, after adjusting for interactions with GBS, these associations lost statistical significance: postpartum hemorrhage (AOR = 0.67, p = 0.711), uterine atony (AOR = 2.417, p = 0.315), TTN (AOR = 4.87, p = 0.117), and neonatal length (Estimation = -0.207, p = 0.584). These findings indicate that GBS colonization confounds the observed relationships between maternal age and these outcomes. These results underscore the importance of accounting for GBS status in assessing age-related risks during pregnancy and tailoring clinical management accordingly.