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Background: Women are at increased risk of developing anxiety or depression disorders after Cesarean section (CS). This study aims to evaluate whether an appointment with a senior obstetrician combined with an ultrasound examination reduces levels of anxiety in women after CS. Methods: A prospective observational study was conducted in Sweden. Women underwent an appointment with an obstetrician 6–9 months after their first CS. Before the appointment, women were asked to fill in the state and trait subscales of the Spielberger State-Trait Anxiety Inventory and the Beck's Depression Inventory. The women's experience of the childbirth was discussed and an ultrasound examination of the hysterotomy scar was performed. After the appointment, the participants filled in the state scale again. The women were divided into low trait anxiety (< 40) and high trait anxiety (≥ 40) groups for comparisons. Results: 147 women were included. Of those, 114 (78%) had lower trait score <40 (mean 29.2 ± 5.4) and 33 (22%) had higher trait score ≥ 40 (mean 47.4 ± 6.5). Mean difference of state score in the low trait anxiety group before and after the examination was 4.8 ± 5.6 (95% CI 7.20 to 11.97, p<0.0001) and in the high trait anxiety group, the mean difference was 9.2 ± 6.5 (95% CI 3.77 to 5.82, p<0.0001). Limitations: A clinical examination with a diagnosis of depression in these women was not made by a psychiatrist. Conclusions: A supportive obstetric consultation combined with an ultrasound examination of the uterine scar decreased anxiety levels in women after CS, particularly in patients with higher anxiety

Background: Women are at increased risk of developing anxiety or depression disorders after Cesarean section (CS). This study aims to evaluate whether an appointment with a senior obstetrician combined with an ultrasound examination reduces levels of anxiety in women after CS. Methods: A prospective observational study was conducted in Sweden. Women underwent an appointment with an obstetrician 6–9 months after their first CS. Before the appointment, women were asked to fill in the state and trait subscales of the Spielberger State-Trait Anxiety Inventory and the Beck's Depression Inventory. The women's experience of the childbirth was discussed and an ultrasound examination of the hysterotomy scar was performed. After the appointment, the participants filled in the state scale again. The women were divided into low trait anxiety (< 40) and high trait anxiety (≥ 40) groups for comparisons. Results: 147 women were included. Of those, 114 (78%) had lower trait score <40 (mean 29.2 ± 5.4) and 33 (22%) had higher trait score ≥ 40 (mean 47.4 ± 6.5). Mean difference of state score in the low trait anxiety group before and after the examination was 4.8 ± 5.6 (95% CI 7.20 to 11.97, p<0.0001) and in the high trait anxiety group, the mean difference was 9.2 ± 6.5 (95% CI 3.77 to 5.82, p<0.0001). Limitations: A clinical examination with a diagnosis of depression in these women was not made by a psychiatrist. Conclusions: A supportive obstetric consultation combined with an ultrasound examination of the uterine scar decreased anxiety levels in women after CS, particularly in patients with higher anxiety

Introduction: Placenta accreta spectrum (PAS) carries a high burden of adverse maternal outcomes, especially significant blood loss, which can be life-threatening. Different management strategies have been proposed but the association of clinical risk factors and surgical management options during cesarean delivery with high blood loss is not clear. Material and methods: In this international multicenter study, 338 women with PAS undergoing cesarean delivery were included. Fourteen European and one non-European center (USA) provided cases treated retrospectively between 2008 and 2014 and prospectively from 2014 to 2019. Peripartum blood loss was estimated visually and/or by weighing and measuring of volume. Participants were grouped based on blood loss above or below the 75th percentile (>3500 ml) and the 90th percentile (>5500 ml). Results: Placenta percreta was found in 58% of cases. Median blood loss was 2000 ml (range: 150-20 000 ml). Unplanned hysterectomy was associated with an increased risk of blood loss >3500 ml when compared with planned hysterectomy (adjusted OR [aOR] 3.7 [1.5-9.4], p = 0.01). Focal resection was associated with blood loss comparable to that of planned hysterectomy (crude OR 0.7 [0.2–2.1], p = 0.49). Blood loss >3500 ml was less common in patients undergoing successful conservative management (placenta left in situ, aOR 0.1 [0.0–0.6], p = 0.02) but was more common in patients who required delayed hysterectomy (aOR 6.5 [1.7–24.4], p = 0.001). Arterial occlusion methods (uterine or iliac artery ligation, embolization or intravascular balloons), application of uterotonic medication or tranexamic acid showed no significant effect on blood loss >3500 ml. Patients delivered by surgeons without experience in PAS were more likely to experience blood loss >3500 ml (aOR 3.0 [1.4–6.4], p = 0.01). Conclusions: In pregnant women with PAS, the likelihood of blood loss >3500 ml was reduced in planned vs unplanned cesarean delivery, and when the surgery

Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6–R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. Conclusions: The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.

Introduction. Cesarean delivery rates are rising due to multiple factors, including less use of operative vaginal delivery and vaginal birth after cesarean delivery, which often reflect local obstetric practices. Objectives of the study were to analyze the relations between cesarean delivery, these practices, and perinatal outcomes. Material and methods. We included all deliveries in the 72 hospitals of Lombardia, a region in northern Italy, during the year 2013. The delivery certificate was used as data source. Pearson’s correlation coefficient and logistic regression were used for statistical analysis. Results. We included 87 896 deliveries. The number of deliveries per hospital ranged from 140 to 6123. The rate of cesarean delivery was 28.3% (range 9.9–86.4%), operative vaginal delivery 4.7% (range 0.2–10.0%), and vaginal birth after cesarean 17.3% (range 0–79.2%). We found a significant inverse correlation between rates of overall cesarean delivery and operative vaginal delivery (r = -0.25, p = 0.04). The correlation between rate of overall cesarean delivery and vaginal birth after cesarean was also inverse and significant (r = -0.57, p < 0.001). There was no association between overall cesarean delivery rate and the rates of Apgar score at 5 min <7 in term and late preterm neonates (r = -0.92, p = 0.46) and of perinatal mortality (r = -0.19, p = 0.13), respectively. The associations were independent of hospital volume of activity. Conclusions. An obstetric practice that encourages vaginal instrumental delivery in delayed second stage of labor or vaginal birth after previous cesarean delivery, could reduce the rising cesarean delivery rate. This will require a change in obstetric culture, continuing education of healthcare providers, and leadership.

Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction. Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE(2) (prostaglandin-E-2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups. Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE(2), amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p=0.9). All ruptures occurred in women with no prior vaginal delivery. Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.

Introduction: There is concern about the risk of uterine rupture in the subsequent pregnancy after myomectomy. This risk is reported in literature to be around 0.7–1%. The aim of this study was to evaluate the incidence of uterine rupture and associated risk factors in women who had a trial of labor after prior myomectomy. Material and methods: A systematic review of the literature was performed including all cohort studies with at least five cases reporting outcomes of pregnancies after prior myomectomy. The terms “myomectomy”, “pregnancy”, “trial of labor” and “uterine rupture” were used in PubMed and EMBASE searches for identification purposes. Every reference was reviewed for possible inclusion and all eligible cases of uterine rupture were considered. Results: Twenty-three studies with at least five cases of pregnancy after myomectomy were identified, with an overall incidence of uterine rupture of 0.6% (0.3–1.1%) (n = 11/1825). Of these 23 studies, 11 studies reported detailed data about trial of labor after myomectomy and related pregnancy outcomes, including 1034 pregnancies and 756 viable (≥24 weeks) deliveries. The overall incidence of uterine rupture after myomectomy in the included studies was 0.93% (0.45–1.92%) (n = 7/756); specifically, it was 0.47% (0.13–1.70%) (n = 2/426) in women undergoing trial of labor after myomectomy, and 1.52% (0.65–3.51%) (n = 5/330) in women before the onset of labor. Of the seven uterine ruptures, five (71%) occurred within 36 weeks (range 24–40 weeks). Conclusions: Trial of labor after myomectomy is associated with a 0.47% risk of uterine rupture. There were no identified risk factors among the variables studied. The present systematic review of the literature revealed that uterine rupture after prior myomectomy occurred mainly before 36 weeks and before labor.

Objective: To determine the incidence, risk factors, complications, management modalities and maternal and perinatal outcome of rupture uterus in pregnancy. Methods: This retrospective study was carried out at a teaching institute, for a period of 10 years from January 2006 to December 2015. Clinical records of cases of uterine rupture were reviewed and information on demographic characteristics, clinical presentation, intraoperative findings, surgical intervention and maternal and perinatal outcome was collected. Result: Out of 63237 deliveries, 116 cases of rupture uterus were reported with an incidence of rupture uterus 1 in 545. Majority 52 (44.83%) of cases were in age group 26-30 years. Only 1 was primigravida, 16 (13.79%) were of parity > 5 and remaining of parity 1- 4. Majority were unbooked cases. 93 (80.17%) were referred from other health centers and only 23 (19.83%) cases were admitted directly. Uterine scar (58.62%) and obstructed labor (24.13%) were the common risk factors. Anterior uterine wall of lower uterine segment was the most common site of rupture. Repair of rupture site with or without bilateral tubal ligation was done in 60 (51.72%) cases, while subtotal hysterectomy was performed in 46 (39.65%) cases. Hypovolumic shock was the major cause of maternal death. Conclusion: Promotion of skilled attendance at birth, identification of high risk women and timely referral, use of oxytocic drugs cautiously , correct use of partograph, preventing unnecessary caesarean sections and education of people about supervised pregnancy and delivery are essential in reducing the occurrences of uterine rupture.

Objective: To determine the incidence, risk factors, complications, management modalities and maternal and perinatal outcome of rupture uterus in pregnancy. Methods: This retrospective study was carried out at a teaching institute, for a period of 10 years from January 2006 to December 2015. Clinical records of cases of uterine rupture were reviewed and information on demographic characteristics, clinical presentation, intraoperative findings, surgical intervention and maternal and perinatal outcome was collected. Result: Out of 63237 deliveries, 116 cases of rupture uterus were reported with an incidence of rupture uterus 1 in 545. Majority 52 (44.83%) of cases were in age group 26-30 years. Only 1 was primigravida, 16 (13.79%) were of parity > 5 and remaining of parity 1- 4. Majority were unbooked cases. 93 (80.17%) were referred from other health centers and only 23 (19.83%) cases were admitted directly. Uterine scar (58.62%) and obstructed labor (24.13%) were the common risk factors. Anterior uterine wall of lower uterine segment was the most common site of rupture. Repair of rupture site with or without bilateral tubal ligation was done in 60 (51.72%) cases, while subtotal hysterectomy was performed in 46 (39.65%) cases. Hypovolumic shock was the major cause of maternal death. Conclusion: Promotion of skilled attendance at birth, identification of high risk women and timely referral, use of oxytocic drugs cautiously , correct use of partograph, preventing unnecessary caesarean sections and education of people about supervised pregnancy and delivery are essential in reducing the occurrences of uterine rupture.

The aim of this study was to identify the most important risk factors for postpartum suppurative inflammatory complications in women with uterine scar. 165 women with a postoperative uterine scar were examined. It was found that the most significant risk factors for inflammatory complications in early postpartum period in women with a uterine scar were the presence of moderate or severe anemia in pregnancy (OR = 4.88; 95% CI: 3.69–46.97), a symptomatic bacteriuria/gestational pyelonephritis (OR = 2.82; 95% CI: 1.52–18.69), nonspecific vaginitis (OR = 5.58; 95% CI: 5.9–11.85), inflammatory changes in placenta (OR = 3.64; 95% CI: 2.25–63.93), hysterorrhaphy with surgical gut (OR = 5.15;95% CI: 4.56-65.12), two-row hysterorrhaphy (OR = 4.09; 95% CI: 2.09–17.22)., Целью проведенного исследования было определение наиболее значимых факторов риска развития послеродовых гнойно-воспалительных осложнений у женщин с рубцом на матке. Было обследовано 165 женщин с послеоперационным рубцом на матке. Установлено, что наиболее значимыми факторами риска развития гнойно-воспалительных осложнений раннего послеродового периода у женщин с рубцом на матке являются: анемия беременных средней и тяжелой степени (OШ = 4,88; 95% ДИ: 3,69–46,97), бессимптомная бактериурия/гестационный пиелонефрит (OШ = 2,82; 95% ДИ: 1,52–18,69), неспецифический кольпит (OШ = 5,58; 95% ДИ: 5,9–11,85), воспалительные изменения последа (OШ = 3,64; 95% ДИ: 2,25–63,93), гистерорафия кетгутом (OШ = 5,15; 95% ДИ: 4,56–65,12), двухрядная гистерорафия (OШ = 4,09; 95% ДИ: 2,09–17,22)., Метою проведеного дослідження було визначення найбільш значущих факторів ризику розвитку післяпологових гнійно-запальних ускладнень у жінок із рубцем на матці. Було обстежено 165 жінок із післяопераційним рубцем на матці. Встановлено, що найбільш значущими чинниками ризику розвитку гнійно-запальних ускладнень раннього післяпологового періоду в жінок із рубцем на матці є: анемія вагітних середнього та тяжкого ступеня (ВШ = 4,88; 95% ДІ: 3,69–46,97), безсимптомна бактеріурія/гестаційний пієлонефрит (ВШ = 2,82; 95% ДІ: 1,52–18,69), неспецифічний кольпіт (ВШ = 5,58; 95% ДІ: 5,9–11,85), запальні зміни посліду (ВШ = 3,64; 95% ДІ: 2,25–63,93), гістерорафія кетгутом (ВШ = 5,15; 95% ДІ: 4,56–65,12), дворядна гістерорафія (ВШ = 4,09; 95% ДІ: 2,09–17,22).