Vaginal Delivery Group Research Articles

Obstetric Anal Sphincter Injury: Vaginal Birth After Cesarean Versus First Vaginal Delivery.

Modern data regarding the relationship between vaginal birth after cesarean (VBAC) and obstetric anal sphincter injury (OASI) are minimal with mixed results. The aim of the study was to determine if VBAC is associated with an increased risk of OASIs. This was a retrospective cohort study of liveborn deliveries from 2018 to 2022 within a large, multihospital academic health system. The primary outcome was the proportion of OASIs compared between patients who underwent a first vaginal delivery (primiparous vaginal delivery group) versus patients who underwent a first VBAC (VBAC group). A total of 17,044 patients were included. A total of 16,208 had a primiparous vaginal delivery and 836 underwent VBAC. Vaginal birth after cesarean patients were older (29.9 vs 27.0 years, P < 0.01), more likely to self-identify as Black or Asian race (26.1% vs 18.0%, P < 0.01), and had lower maternal weight (182.7 vs 187.2 lbs, P < 0.01). The proportion of OASIs was significantly higher in the VBAC group (6.9% vs 5.1%, P = 0.02). Vacuum-assisted vaginal deliveries were more common in the VBAC group (7.7% vs 5.4%, P < 0.01).On multivariable logistic regression, VBAC was not significantly associated with OASIS (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.75-1.36, P = 0.95). Operative vaginal delivery (OR = 6.44, CI = 5.51-7.52, P < 0.01), older maternal age (OR = 1.05, CI = 1.03-1.07), and Asian race (OR 2.62, CI = 2.10-3.26) demonstrated increased odds of OASIs. Patients who identified as Black demonstrated lower odds of OASIs (OR = 0.68, CI = 0.50-0.93). While there was a greater proportion of OASIs in the VBAC group compared to the primiparous vaginal delivery group, VBAC was not an independent risk factor.

The effect of maternal and fetal weight on the risk of emergency cesarean section in nulliparous women.

Although many studies based on different ethnic groups have analyzed the impact of maternal and infant weight on overall cesarean section rates in recent years, research on the impact of maternal and infant weight on emergency cesarean section (EmCS) rates is lacking, especially in the Chinese population. This study aimed to analyze whether maternal and fetal weight could influence the risk of EmCS. A total of 8427 nulliparous women who delivered vaginally (full-term, singleton, and cephalic presentation) were included in this study and divided into the normal vaginal delivery (VD) and EmCS groups. Of 8427 cases, 909 (10.8%) were delivered by EmCS because of failed VD. Compared with pregnant women with a normal body mass index, the risk of EmCS in overweight women increased significantly (P < .001). Birth weight > 3550 g was associated with an increased risk of EmCS. Subgroup analyses showed that among women with underweight and normal weight, old age, inadequate gestational weight gain, and large for gestational age were independent high-risk factors for EmCS (P < .05), whereas small for gestational age was the low-risk factor. Compared with the fetal distress group, the weight of newborns in the nonfetal distress group was significantly higher (P < .001), and the main cause of EmCS in women with macrosomia, large for gestational age, or birth weight ≥ 3550 g was fetal distress (P < .05). The prepregnancy maternal and fetal weights can affect the risk of EmCS. Weight management should be enhanced to control gestational weight gain according to the prepregnancy body mass index to reduce the risk of EmCS due to failed VD.

The significance of ultrasound parameters and clinical factors in predicting successful labor induction among nulliparous women.

To compare the values of ultrasound and clinical parameters for predicting outcomes of induction of labor (IOL) among healthy nulliparous women with a singleton, term cephalic pregnancy. The cervical length, cervical strain elastography, posterior cervical angle, head-perineum distance, Bishop score, and maternal parameters were assessed before IOL with a combined method-Foley catheter and Misoprostol perorally. The main outcome was vaginal delivery. Variation in cervical tissue elasticity, represented by elasticity index (E), was significantly different between outcome groups-vaginal delivery and cesarean section (CS) in internal os, in the anterior lip near the cervical canal and the midpoint of the anterior and posterior lip (p < 0.05). The E was higher-softer in the vaginal delivery group. The overall elasticity was significantly higher in the middle part of the cervix in the vaginal delivery group. However, other ultrasound metrics did not differ significantly across the outcome groups. Overall, women who delivered vaginally were taller and had a lower pre-pregnancy BMI (p = 0.02 for both variables). Univariate and multivariate analyses showed maternal height was the significant independent predictor of CS (AOR 0.91, 95% CI 0.84-0.98). The prognostic value for vaginal delivery, based on cervical length, maternal height, Bishop score, and parameters of cervical strain elastography, was poor (AUC < 0.7). The study underscores the importance of cervical tissue elasticity in predicting vaginal delivery outcomes, while also highlighting that maternal height is a significant independent predictor of cesarean delivery. However, evaluated metrics in the study have limited prognostic value for predicting vaginal delivery. This suggests a need for further research to identify more reliable predictors of delivery outcomes.

The value of routine hemoglobin level evaluation following elective cesarean section: Is it worthwhile?

The aim of this study was to assess the usefulness of routine hemoglobin testing following elective and urgent cesarean section (CS) in patients without primary postpartum hemorrhage (PPH). This retrospective cohort study included women who underwent vaginal delivery (VD), elective CS, and urgent CS at Carmel Medical Center from 2015 to 2020. Data were extracted from the obstetric database, excluding deliveries with PPH. Demographic and obstetric variables were recorded. Primary outcomes were the need for packed red blood cell transfusion. A total of 19 446 women were included, with five (0.3%) requiring a blood transfusion in the elective CS group, 27 (0.17%) in the VD group, and eight (0.4%) in the urgent CS group. Urgent CS was associated with a higher risk of blood transfusion, but there was no significant difference between elective CS and VD. Elective CS showed the lowest rates of post-delivery hemoglobin below 7 g/dL 1 (0.1%) compared to VD 16 (0.6%) and urgent CS 13 (0.7%). Routine postoperative hemoglobin testing following elective CS in asymptomatic patients without PPH appears unnecessary. This study supports reconsidering routine hemoglobin testing following elective CS, aligning with the goal of optimizing resource utilization while maintaining patient quality.

Impact of previous cesarean delivery on pregnancy and neonatal outcomes in subsequent in vitro fertilization/intracytoplasmic sperm injection and single frozen-thawed embryo transfer: a historical cohort study with a large sample size.

This study aims to explore the impact of a woman's previous cesarean delivery (CD) on pregnancy and neonatal outcomes for subsequent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and single frozen-thawed embryo transfer (FET), compared with vaginal delivery (VD). This was a retrospective cohort study that included a total of 5817 patients who desired to transfer a single vitrified-thawed blastocyst from the same oocyte retrieval cycle as their last live birth between January 2011 and January 2021 at a single reproductive medicine center. Patients with a single previous CD were classified in the CD group, while those with a single VD were assigned to the VD group. All patients underwent single blastocyst transfer. To minimize the effect of confounding factors, modified Poisson regression analyses with different adjustment models and propensity score matching (PSM) analyses were performed. Women with a previous CD had significantly lower rates of biochemical pregnancy, clinical pregnancy, and live births than those with a previous VD. Meanwhile, the CD rate was significantly higher in the CD group. There were no significant differences in the rates of multiple pregnancies, miscarriage, ectopic pregnancy, multiple live births, maternal complications, or preterm and neonatal outcomes. A previous CD is associated with a significant reduction in the rates of biochemical pregnancy, clinical pregnancy, and live birth in patients undergoing subsequent single frozen-thawed blastocyst transfer. Additionally, it increases the rates of repeat CD.

Integrated proteomics and metabolomics network analysis across different delivery modes in human pregnancy: a pilot study

BackgroundDelivery mode has been linked to child health, e.g., allergic disease. However, it remains unclear whether protein and metabolite differences across different delivery modes may underlie child development.MethodsA cohort comprising 16 spontaneous onset vaginal delivery (VD), 16 prelabor cesarean delivery on maternal request (CS), and 8 intrapartum cesarean section (Intra_CS) women were analyzed using label-free proteomic and untargeted metabolomics assays on amniotic fluid and cord blood samples, respectively. We used weighted gene co-expression network analyses (WGCNA) to identify modules of highly correlated proteins or metabolites that associated with delivery modes and related clinical traits. KEGG enrichment analyses were performed to investigate the biological function of the identified modules. Integrative multiomics analysis was employed to examine the biological interplay between proteomic and metabolic interactions.ResultsCompared to the CS group, the proteomic and metabolomic profiles were similar between the Intra_CS and VD groups in our study. We did not identify any enriched protein or metabolite pathways related to immune development that could influence the risk of allergic diseases in offspring across different delivery modes. However, we identified seven protein modules correlated with the duration from the rupture of the membranes to full dilation of the cervix, with the actin cytoskeleton module significantly enriched. A metabolic module in cord blood that correlated with VD was enriched in subclasses including C21 steroids, steroid sulfates, and oxysterols. Integrative analysis of proteomic and metabolomic data suggested pathways related to mode of delivery and duration of labor, encompassing the actin cytoskeleton, NADP metabolic process, nicotinate, and nicotinamide metabolism in amniotic fluid, and the steroid hormone biosynthesis pathway in cord blood.ConclusionsDifferences in steroid hormones and the actin cytoskeleton pathway according to proteomics and metabolomics in amniotic fluid and cord blood were more indicative of the labor process. These findings could guide future studies on delivery-associated biochemical pathways.

Maternal and neonatal short-term outcome after vaginal breech delivery >36weeks of gestation with and without MRI-based pelvimetric measurements: a Hannover retrospective cohort study.

Planning the mode of delivery of a full-term breech singleton remains a challenging task. The aim of this work is to compare the neonatal and maternal short-term outcomes after planned vaginal delivery and caesarean section and to evaluate the influence of an MRI pelvimetry on the short-term outcomes in order to provide appropriate advice to pregnant women with breech presentation. This is a retrospective monocentric analysis of all deliveries with singleton pregnancies from breech presentation >36+0weeks of gestation between 08/2021 and 09/2023. Short-term maternal and neonatal morbidity data were collected for intended vaginal deliveries and caesarean sections. Neonatal and maternal short-term outcomes of intended vaginal deliveries with and without MRI pelvimetry were compared. In the planned vaginal delivery group, APGAR scores and arterial umbilical cord pH were significantly lower than in the planned caesarean group. The rate of asphyxia was similar in both groups. Although not significant, the rate of NICU admission was higher in the vaginal birth group (6.7 % vs. 2.7 %; p=0.27), and infants born by caesarean remained in the NICU longer (1.3 % vs. 1.8 %; p=1.0). Neonates born to women who underwent MRI prior to attempted vaginal delivery had better short-term neonatal outcomes and shorter NICU stays compared with women who did not undergo MRI, after multivariate analysis for fetal birth weight, parity, and gestational age. Vaginal breech delivery is associated with lower APGAR scores and umbilical arterial pH compared with caesarean section but does not result in increased neonatal asphyxia or NICU admission. Length of stay in the NICU is shorter when a newborn is admitted after vaginal delivery. MRI pelvimetry may improve the outcome of the newborn by further selection.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

Nomograms and Reference Ranges for Intra-Cranial Ventricular Dimensions in Indian Neonates.

To establish normal reference values for commonly used ventricular indices - Anterior Horn Width (AHW), Ventricular Index (VI) and Thalamo-Occipital Distance (TOD)-against common variables including gestational age, birth weight and head circumference in Indian newborns. This was a cross-sectional study. Cranial ultrasound was performed between post-natal days 3 to 7. Anterior fontanelle was taken as the acoustic window. Data were analyzed to determine correlation, coefficient of determination (R2), regression equations and plotted against gestational age (GA). Total 2200 newborns were included in the study.The study observed that there is an increase in VI, AHWand TODwith an increase in gestational age (p-value < 0.001) and birth weight (p-value < 0.001). No significant correlation of gender and singleton or multiple gestation-with the intraventricular dimensions was observed (p-value > 0.05). All the three ventricular parameters were found to have a significantly lower mean value in the normal vaginal delivery group as compared to the LSCS group. There was a good correlation between ventricular indices of the left and right side. Nomograms of AHW, TOD, and VI were prepared with respect to gestational age. Intracranial ventricular size dimensions vary significantly with increasing gestational age and birth weight. The new nomograms for various ventricular indices of Indian neonates can assist in objectively assessing ventricular sizes.

Comparison of intestinal and pharyngeal microbiota in preterm infants on the first day of life and the characteristics of pharyngeal microbiota in infants delivered by cesarean section or vaginally.

This study aimed to explore the distribution of intestinal and pharyngeal microbiota on the first day of life in preterm infants and compare the composition of microbiota in infants delivered by cesarean section or vaginally. This study included 44 late preterm infants with a gestational age of 34-36 + 6 weeks. Stool and throat swab samples were collected from the preterm infants on the first day of life. The infants were divided into cesarean section and vaginal delivery groups. Illumina NovaSeq high-throughput sequencing technology was used to sequence the V3-V4 hypervariable region of the 16S rRNA gene of all bacteria in the samples. Venn diagram was used to identify shared operational taxonomic units (OTUs) in the intestines and pharynges. Microbial analysis was conducted at the phylum and genus levels, and α and β diversity comparisons were performed. (1) Gestational age may have significantly affected the microbial colonization of the intestines and pharynges of preterm infants on the first day after birth (p ≤ 0.001). (2) More OTUs were detected in the pharynx than in the intestines, both have a total of 819 shared OTUs. Proteobacteria, Firmicutes, and Bacteroidota were the dominant phyla in both. At the genus level, Streptococcus had a lower relative abundance in stool samples (0.5%) compared to throat samples (0.5% vs. 22.2%, p = 0.003). 3) The relative abundance of Streptococcus in pharyngeal samples was 26.2% in the cesarean section group much higher than the 3.8% in the vaginal delivery group (p = 0.01). The early postnatal period is a critical time for the establishment of an infant's microbiota. Gestational age at birth may influence microbial colonization, while birth weight, gender, and mode of delivery do not. The intestinal and pharyngeal microbiota composition of preterm infants on the first day after birth showed high similarity, but larger samples are needed for further validation.

Evaluation of the Effect of Vaginal Delivery on Stress Urinary Incontinence and Bladder Neck Mobility with Transperineal Ultrasonography

Aim: Stress urinary incontinence is a common and distressing situation in females, impacting emotional and psychological well-being by interrupting sexual, physical, and social forms of life. Perineal trauma, especially at childbirth, is one of the most common contributing factors. The objective of this research is assessing the impact of vaginal delivery, a factor known to elevate the likelihood of postpartum stressxincontinence, on bladder neck mobility. This evaluation will be conducted utilizing transperinealxultrasonography, a noninvasivexand well-toleratedxdiagnostic technique. Materials and Methods: In our study, 116 patients who gave birth in our hospital between January 2020 and May 2022 were evaluated retrospectively. The presence of stress urinary incontinence and transperineal ultrasonography data of all patients were examined from the patient files. To evaluate changes in bladder neck motility, ultrasound measurements made both prenatally and postnatally were evaluated retrospectively. Results: With regard to the demographic values of the patients, a statistically significant difference was seen in terms of the presence of urinary incontinence when multiparous and primiparous patients were compared with patients in the cesarean section group (p:0.01). There was a significant difference in ΔDx, ΔDy, and M values for the cesarean delivery group as compared to both the primiparous and multiparous vaginal delivery groups (p

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n = 8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p = 0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

A Prospective Observational Study to Determine Perinatal Outcome of Second Twin According to Mode of Delivery in a Tertiary Care Hospital

Introduction: The mode of delivery in twin pregnancy is a challenging decision for an obstetrician as the outcome of the 2nd twin is significantly affected by that. Materials and Methods: The prospective comparative observational study was conducted for the time span of March 2021–August 2022 in a tertiary care hospital in East India. Forty-four pregnant women with twin pregnancy with gestation age &gt;32 weeks who underwent vaginal delivery (VD) were compared with 44 pregnant with twin pregnancy who underwent cesarean section (CS). Maternal socioeconomic and obstetric parameters were noted, and the perinatal outcome of the 2nd twin was observed and compared between both elective CS and VD groups. Results: Perinatal outcome of 2nd twin through CS showed significantly better Apgar score at 1 min and at 5 min. Umbilical artery pH &gt; 7.2 was found more in the CS group than in the VD group. Intertwin delivery interval of ≥10 min was found to be significantly associated with low Apgar score. Conclusion: The strict vigilance during follow-up of the patient in the antenatal period and proper assessment of maternal and fetal state during VD might improve the outcome of the 2nd twin to prevent unnecessary CS and its complications following it.

Transperineal Three-Dimensional Ultrasound Combined with Real-Time Shear Wave Elastography Imaging to Assess Changes in Pelvic Floor Structure During Pregnancy and Delivery

Background: Pelvic organ prolapse seriously affect women’s physical and mental health. To quantitatively analyze the structure of the pelvic floor during pregnancy and delivery, we utilized transperineal three-dimensional ultrasound (TP-3DUS) imaging combined with real-time shear wave elastography (RT-SWE). This analysis aims to provide exploratory data on female pelvic floor parameters, such as the hardness and thickness of the levator ani muscle (LAM), and to offer personalized recommendations for the prevention and treatment of early clinical pelvic organ prolapse (POP). Methods: From March 2021 to August 2022, a study was conducted at the Affiliated Hospital of Yunnan University involving 150 pregnant patients at various gestational ages, 110 primiparas at 42–45 days post-delivery, and 55 healthy non-childbearing women. RT-SWE was used to quantitatively evaluate changes in the elasticity of the puborectalis muscle (PRM), while TP-3DUS imaging was used to measure various parameters of the pelvic floor. This study investigated changes in pelvic floor structure during pregnancy and postpartum. It evaluated the efficacy of PRM elasticity, levator hiatus (LH) area (LHA), and the thickness of the LAM, along with their combined application in diagnosing early postpartum POP. Results: As gestational weeks progress, the elasticity of PRM increased, while the thickness of LAM decreased. In the control group, cesarean section group, and vaginal delivery group, the elasticity of the PRM and the thickness of the LAM progressively decreased. The area, perimeter, LH anteroposterior (LHAP) diameter and LH lateral diameter (LHLD) increased sequentially in these groups. The combination of LHA, PRM elasticity, and thickness of the LAM in both vaginal delivery and cesarean section groups demonstrated the highest diagnostic efficiency for POP. Conclusions: The combination of TP-3DUS Imaging and RT-SWE represents a novel, effective, and convenient method for evaluating the structure and muscle elasticity of the pelvic floor during pregnancy and the early postpartum period. LHA, PRM hardness, and thickness of the LAM individually possess a diagnostic value for early postpartum POP. However, their combination yields the highest diagnostic efficiency.

The mode of delivery after operative fixation of pelvic ring fractures–a retrospective observational study

PurposeThe purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum.MethodsAll women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36 months.ResultsA total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware.ConclusionWomen with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed.Level of evidenceLevel III.

Effect of different delivery modes on intestinal microbiota and immune function of neonates

Different delivery methods can cause variations in the composition and structure of intestinal microbiota in neonates. However, the impact of the microecological environment on host immune function requires further investigation. In this study, 75 healthy neonates were divided into two groups: vaginal delivery group (n = 36) and cesarean section group (n = 39). Fecal and peripheral blood samples were collected from the 7th to the 10th day. 16S rRNA sequencing technique was performed to investigate the gut microbiota on fecal samples. Levels of immunoglobulins and Th1 and Th2 cells in the peripheral blood of neonates were measured. The abundance of Escherichia, Bifidobacterium, and Bacteroides in neonates in the cesarean section group was significantly lower than that in the vaginal delivery group. Metabolic pathway analysis showed three significantly up-regulated metabolic pathways in the intestinal microbiota of neonates in the cesarean section group. The levels of serum IgG and IL-12p70 in the cesarean section group were lower than those in the vaginal delivery group, and the proportion of IFN-γ/IL-4 was significantly lower in the cesarean section group compared to the vaginal delivery group. The mode of delivery has potential impact on the intestinal microbiota and immune functions of neonates, potentially leading to an imbalance of Th1/Th2 cells in neonates delivered by cesarean section.

The effect of cesarean section on the dimensions and ratios of mons pubis

BackgroundPregnancy and labor can impact women’s body contours. After a cesarean section, some women may experience aesthetic issues such as the formation of a panniculus and a bulging mons pubis. This study aimed to investigate the impact of cesarean sections on the dimensions of the mons pubis and their ratios.MethodsThe study included 194 multiparous Caucasian women. Participants’ ages ranged from 18 to 40 years, and their BMI ranged from 18 to 30. They were divided into two BMI groups. Each group was further subdivided based on the mode of delivery into vaginal delivery (VD) and cesarean section (CS) groups. Manual measurements of the three dimensions of the mons pubis (monal height, monal width, and monal length) were conducted. Measurements were recorded in centimeters in the lithotomy position using iGaging 8-inch digital outside calipers. Monal height is the distance between the anterior surface of the symphysis pubis and the maximum height of the mons pubis (calculated by measuring the distance between the anterior wall of the vagina and the maximum height of the mons pubis minus the distance between the anterior wall of the vagina and the anterior surface of the symphysis pubis). Monal width is the maximum transverse distance between the merging borders of the mons pubis and the fat of the lower abdominal wall. Monal length is the maximum longitudinal distance between the merging upper border of the mons pubis and the fat of the lower abdominal wall and the upper end of the pudendal cleft.ResultsNo significant statistical difference was observed between the three dimensions of the mons pubis in vaginal delivery and cesarean section populations in the two groups. The changes in the ratios between the two groups’ different monal dimensions in the cesarean section population are minimal and do not follow a consistent pattern. There were no significant differences between the dimensions of single and repeated CS populations, with non-trendy changes in the different ratios in the repeated CS group.ConclusionEven when repeated, cesarean section minimally affects the dimensions and ratios of the mons pubis. However, more studies with standardized fascial and subcutaneous fat closure are needed.

Impact of planned delivery mode on neonatal outcomes and costs in twin pregnancies in Kenya

BackgroundTwin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical. ObjectiveTo evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya. Study DesignThis retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category. ResultsThe study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15–0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82). ConclusionPlanned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.

Association of Constipation with Modes of Delivery: A Retrospective Questionnaire-based Study

Introduction and HypothesisPelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information regarding the mode of delivery in relation to constipation is limited. We hypothesise that women with a history of vaginal delivery report constipation more often than women with a history of caesarean section.MethodsThis was a retrospective cross-sectional multicentre study conducted in the Netherlands. All included patients (n = 2,643) completed the Groningen Defecation and Fecal Continence questionnaire to assess bowel problems of the last 6 months. Parametric tests, Chi-squared, univariable and multivariable regression analyses were performed.ResultsAmong 2,643 parous women, 2,248 delivered vaginally (85.1%) and 395 (14.9%) by caesarean section. Altogether, 649 women (24.6%) suffered from constipation. Women in the vaginal delivery group were constipated more often than women in the caesarean section group (25.5% versus 19.0%, p = 0.005). For women who had delivered vaginally, multivariable regression analysis showed an odds ratio for constipation of 1.47 (95% confidence interval, 1.109–1.938, p = 0.007). The odds ratio for constipation in women with a spontaneous perineal tear was 1.4 times higher than in women with an intact perineum (p = 0.030). Furthermore, the vaginal delivery group reported difficulties regarding bowel emptying (p = 0.048), straining (p = 0.027), incomplete defecation (p = 0.043), not able to defecate daily (p = 0.018), manually assisted defecation (p = 0.015) and had higher Renzi scores (p = 0.043) more often.ConclusionsWomen in the vaginal delivery group have higher prevalences and odds ratios for constipation. Furthermore, a perineal tear during vaginal delivery increases the odds ratio for constipation.

#330 Pattern of short-term outcomes of renal function in postpartum acute kidney injury patients: a single-center study in Bangladesh

Abstract Background and Aims Postpartum acute kidney injury (PPAKI) is a formidable health problem in pregnant woman especially in developing country. Monitoring outcomes like serum creatinine levels and glomerular filtration rates is vital. Understanding these short-term results is crucial for timely interventions and better patient care, improving prognosis in this critical condition. The aim of the study was to assess the short-term outcomes of renal function in postpartum acute kidney injury patients. Method This prospective observational study was conducted at Mymensingh Medical College Hospital in Bangladesh between March 2020 and April 2021. The study enrolled 153 postpartum acute kidney injury (AKI) patients from the Departments of Nephrology and Departments of Obstetrics &amp; Gynaecology using purposive sampling. Data on patient demographics, etiology, and presentation were collected. Statistical analysis was performed using SPSS version 23.0 and a p- value of &amp;lt;0.05 was considered statistically significant. Results After three months, among 153 postpartum acute kidney injury (PPAKI) patients, 77.8% of the patients fully recovered, 5.2% of the patients developed chronic kidney disease. Dialysis was required in 24.2% of the patients, among them 2.2% remained on dialysis. Sadly, 15.7% didn't survive, that highlight the severity of postpartum acute kidney injury. Mortality rates didn't significantly differ between vaginal delivery (14.9%) and cesarean section (16.0%) groups (p=0.488). Both groups show positive outcomes, with 75.5% of vaginal delivery and 79.2% of cesarean section patients achieving full recovery. Blood urea also significantly decreased from 128.51 ± 39.59 to 101.65 ± 55.57 mg/dl during this period Conclusion Most postpartum acute kidney injury patients show promising recovery, but some still grapple with persistent renal impairment. Tragically, mortality rates underscore the severity of this condition. Importantly, survival rates don't significantly differ between vaginal delivery and cesarean section patients, emphasizing timely interventions.