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What happens when the findings of a prominent medical study are overturned? Using a medical trial on breech births, we estimate the effect of the reversal of such a medical study on physician choices and infant health outcomes. Using the United States Birth Certificate Records from 1995 to 2010, we employ a difference‐in‐differences estimator for C‐sections, low Apgar, and low birth weight measures. We find that the reversal of a multi‐site, high profile, randomized control trial on the appropriate delivery of term breech births, the Term Breech Trial, led to a 15%–23% decline in C‐sections for such births at a time when the overall trend in C‐sections was rising. We find our largest estimated effects amongst traditionally disadvantaged groups (i.e., non‐white, and minimal education). However, we do not find that such a change in practice had significant impacts on infant health. Contrary to prior studies, we find that physicians updated their beliefs quickly, and do indeed adjust to new medical research, particularly young physicians, prior to mandatory policy or professional guidelines. [ABSTRACT FROM AUTHOR]

Using detailed patient-level data, we show that patients who enjoyed relevant medical training (physicians and midwives) are 3.1 percentage points less likely to receive a C-section than semi-expert patients (nurses and physiotherapists). We examined whether this treatment gap diminishes after a Dutch law reform that aimed to (1) strengthen patients' position in health care processes and (2) increase quality of care through more openness about clinical decisions and learning from medical incidents. We hypothesize that prescriptions of the law, such as more internal debates about appropriate treatment and improved communication of clinical decisions and potential complications during consultations, are expected to make semi-expert patients more informed. Exploiting the reform in a difference-in-differences approach, in which semi-expert patients constitute the treatment group and expert patients the control group, we show that the likelihood of semi-expert patients receiving a C-section after the reform is eight percentage points lower than the changes in C-section rates among expert patients. Given that the reform especially impacted the information level of semi-experts, these findings seem to support the idea that the treatment gap is driven, at least to some extent, by agency discrimination. [ABSTRACT FROM AUTHOR]

The elevated frequency of Cesarean sections (C-sections) in OECD countries not only burdens health systems financially but also heightens the risks for mothers and infants. This study explores the feasibility of reducing C-section rates by examining the Israeli ultra-Orthodox population, noted for its large families and low C-section rates. We analyze birth data from an Israeli hospital, focusing on ultra-Orthodox mothers with husbands who are yeshiva students compared to other mothers. Our findings reveal that all else being equal, mothers married to yeshiva students exhibit a lower likelihood of undergoing a C-section and a higher propensity to seek private medical services to avoid this procedure. This behavior is attributed to their preference for large families and the desire to minimize C-sections, which may restrict the number of possible future pregnancies. These insights underscore the potential effectiveness of initiatives encouraging mothers to opt for vaginal deliveries, thereby reducing healthcare costs and maternal-infant risks. [ABSTRACT FROM AUTHOR]

Objective: To determine the possible association between acute fetal stress during labor and maternal blood levels of osteopontin (OPN), white blood cells, sedimentation, and C-reactive protein (CRP). Methods: The study included women with a term pregnancy (37 weeks or more) who had a cesarean section during the active phase of labor. The study included 30 term pregnancies who underwent cesarean section for fetal distress and 30 pregnant women who underwent cesarean section for other indications (prior uterine surgery, head-pelvis incompatibility, large baby, non-progressing plot) as a control group. The levels of OPN and other inflammatory markers (leukocytes, sedimentation, CRP) in the maternal venous blood of 60 pregnant women were compared, and whether there was a significant association between the groups was investigated. Results: OPN levels in the fetal stress group were higher than those in the control group, and the difference was statistically significant (p=0.008). There was no statistically significant difference in white blood cell, blood sedimentation, and CRP levels between the two groups (p>0.005). Conclusion: Placental inflammation plays a role in the etiology of fetal stress, and OPN may be released because of fetal stress. The increase in OPN in maternal blood during labor may be an important marker for predicting fetal stress. [ABSTRACT FROM AUTHOR]

Due to design errors and changes in the use of buildings, reinforced concrete (RC) columns must often be strengthened to support additional live loads. The column must be designed to withstand both axial loads and bending moments, and an interaction diagram is necessary to demonstrate the column failure. The most common technique for strengthening RC columns uses a steel jacket consisting of four steel angles and battens. In this study, another strengthening technique was proposed that uses two steel C-sections with steel battens. A new approach for constructing an axial force-bending moment interaction diagram for RC columns strengthened with steel C-section jackets using an analytical model based on the plastic stress distribution method was introduced. A finite element (FE) model was created using Abaqus software, and the FE results were consistent with the experimental and analytical results. The analytical and FE results showed that this strengthening method was effective and increased the axial load and bending moment capacities of the strengthened columns. This increase was explained by the confining effect of the steel jacket and the ability of the steel C-sections to withstand a large part of the applied load. This approach offers an effective and economical solution for the reinforcement of RC columns and provides a reliable and safe option for structural engineers. [ABSTRACT FROM AUTHOR]

Simple Summary: Inadequate consumption of maternal colostrum and lack of sufficient transfer of immunoglobulin G (IgG) to the circulation increases the risk of disease and death for beef calves. Assisted calving and cesarean section (C-section) are important risk factors for the inability of beef calves to stand, nurse colostrum from their dam, and acquire passive immunity. Colostrum replacement recommendations for beef calves, and especially for those delivered by C-section, are unavailable. The objective of this study was to determine whether or not administration of a colostrum replacement product alone or in combination with consumption of maternal colostrum would increase the serum IgG concentrations of beef calves delivered by elective C-section, compared to C-section-born calves not supplemented with colostrum. An elective C-section was performed in 32 pregnant beef cows and first-calf heifers. Immediately after delivery, newborn calves were randomly assigned to one of three different treatment groups. Group A calves (n = 7) were fed one packet of a commercial colostrum replacer (CR) product providing 60 g of IgG within 30 min of life. A second packet of the same CR was fed at 6 h of life. Group B calves (n = 13) were fed the same CR at the same frequency as group A; however, these calves were reunited with their dams after the second CR feeding to allow additional nursing of maternal colostrum. Group C calves (n = 12) were united with their dams immediately after surgery without colostrum intervention. Serum IgG levels at 48 h of life were greater in calves from group C and in calves born to multiparous cows. Based on the results of this study, neither colostrum replacement nor supplementation result in higher serum IgG concentrations in beef calves delivered by elective C-section compared with natural nursing. Assistance during calving and cesarean section (C-section) are important risk factors for the failure of transfer of passive immunity (FTPI) in beef calves, which increases the risk of morbidity and mortality in beef calves during the preweaning period. Colostrum replacement recommendations for beef calves, and especially for those delivered by C-section, are unavailable. The objective of this study was to determine whether or not colostrum replacement or supplementation with a commercially available product could increase serum IgG concentrations in beef calves delivered by elective C-section, compared to beef calves that nursed colostrum naturally. An elective C-section was performed in 32 pregnant beef cows and first-calf heifers. Immediately after delivery, newborn calves were randomly assigned to one of three different treatment groups. Group A calves (n = 7) were fed one packet of a commercial colostrum replacer (CR) product providing 60 g of IgG within 30 min of life. A second packet of the same CR was fed at 6 h of life. Group B calves (n = 13) were fed the same CR at the same frequency as group A; however, these calves were reunited with their dams after the second CR feeding to allow additional nursing of maternal colostrum. Group C calves (n = 12) were united with their dams immediately after surgery without colostrum intervention. Serum IgG levels at 48 h of life were greater in group C calves and in calves born to multiparous cows. Based on the results of this study, neither colostrum replacement nor supplementation result in higher serum IgG concentrations in beef calves delivered by elective C-section compared with natural nursing. [ABSTRACT FROM AUTHOR]

This case series describes the post-mortem findings in 17 bitches (Canis lupus familiaris) with a recent (<7 days) history of caesarean section, most (94%) of which had undergone conservative caesarean section with preservation of the uterus. Brachycephalic breeds accounted for 71% of all cases, with the French Bulldog (35%, n = 6), English Bulldog (18%, n = 3) and Boston Terrier (12%, n = 2) overrepresented. Eleven animals (65%) died between 4 and 48 h after surgery, whereas six (35%) died during the procedure. The most common cause of death was septicaemia (41%, n = 7) associated with Streptococcus canis (29%, n = 5) and/or Escherichia coli (24%, n = 4). Other causes of death included brachycephalic obstructive airway syndrome (BOAS)-associated respiratory failure (24%, n = 4), haemorrhagic shock (18%, n = 3), inconclusive (12%, n = 2) and gastric dilatation and volvulus (6%, n = 1). Histopathological changes were seen in the uterus of 10 cases and included marked inflammation (60%, n = 6), marked haemorrhage (20%, n = 2) or both (20%, n = 2). Metritis was often characterized by fibrinonecrotic, neutrophilic to mixed inflammation, consistent with acute infection. However, prominent lymphohistiocytic infiltrates in two cases suggested that infection had been present prior to surgery. Peritonitis, myositis and panniculitis commonly (35%, n = 6) surrounded the incision sites. The presence of inflammation and bacterial colonies within multiple surgical sites suggested iatrogenic implantation of bacteria, potentially from the uterine lumen. Bacterial culture and isolation, as well as tape measurements for evaluation of conformational BOAS risk factors where applicable, are recommended as part of the routine post-mortem work-up for bitches that die shortly after caesarean section. [ABSTRACT FROM AUTHOR]

Klippel–Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by extensive capillary and venous malformations that pose unique challenges during pregnancy. This case report discusses the successful management of a 34‐year‐old pregnant woman with KTS who had two caesarean sections, resulting in the birth of two healthy babies. Despite the lack of evidence‐based guidelines for obstetrical management in KTS, a multidisciplinary team collaborated to devise a high‐risk thrombosis management plan, involving the use of compression stocking and low molecular weight heparin prophylaxis. The patient's elevated risk of thrombosis, exacerbated during pregnancy, informed the decision of caesarean sections, aligning with finding that in most KTS pregnancies, this method of delivery based on obstetric indications and arteriovenous malformations is chosen. This case highlights the importance of systematic and patient‐centered care, advocating for comprehensive obstetric management guidelines to address the unique challenges posed by KTS during pregnancy. Further research is warranted to enhance our understanding and refine guidelines for individuals with vascular abnormalities linked to KTS. [ABSTRACT FROM AUTHOR]

A four-year-old pregnant African lioness with dystocia was referred to the university teaching hospital. History-taking revealed the parturition had started four hours ago, but the cubs couldn't come out due to incomplete dilation of the cervix. This article describes the procedures before, during, and after the surgical operation, including the anesthesia protocol performed and performing a Cesarean section through the midline celiotomy to remove a dead and two live cubs from the uterus and successfully heal the dam without any complications. This surgery was performed about three years ago. After the operation to date, the lioness is in perfect health and she gave birth to 2 and 3 healthy cubs, respectively in two of her last parturition with no need for any help.

BackgroundAlthough several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications.MethodsWe used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15-49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section).Results16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0-100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p

Background: C-section (caesarean section) is a lifesaving procedure when certain complications arise during pregnancy and labor. however, it's a major surgery and associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long term effects. Objective: To describe indications and determinants of caesarean section in Al Batool teaching hospital in Diyala during the study period. Patients and Methods: Across sectional study conducted among women admitted to Al Batool teaching hospital and delivered by C-section from first of October 2022 to 15th of march 2023. Results: A total of 150 women underwent C-section enrolled in this study during the study period, age of participants ranged from 19-35. out of them, 88(59%) sections were elective and 62(41%) sections were emergent. commonest indication for emergency C-section was fetal distress (62%) and commonest indication for elective C-section was previous cesarean (33%). Conclusion: Parity, residence, education, and antenatal care visits were significant determinants for C-section. previous C-section, maternal request and malpresentation were commonest indications for such procedure. [ABSTRACT FROM AUTHOR]

Background and Aims: Postpartum depression (PPD) is a globally recognized public health concern, yet research focusing on women in urban areas of Bangladesh remains unexplored. This study aimed to address this research gap by investigating the prevalence and associated factors of PPD within the first 2 years after childbirth. Methods: A cross‐sectional study was conducted, enrolling 259 women (26.66 ± 4.57 years) residing in urban areas who were attending healthcare delivery centers. Sociodemographic factors, child‐related issues, pregnancy‐related complications, and PPD using the Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data analysis involved the application of χ2 tests and logistic regression analysis using SPSS software. Results: This study found a 60.6% prevalence of PPD using a cutoff of 10 (out of 30) on the EPDS scale. Logistic regression analysis identified several significant factors associated with PPD, including high monthly family income (odds ratio [OR] = 47.51, 95% confidence interval [CI]: 8.34–270.54, p < 0.001), income dissatisfaction (OR = 14.28, 95% CI: 4.75–42.87, p < 0.001), up to two gravidities (OR = 2.94, 95% CI = 1.25–6.90, p = 0.013), pregnancy‐related complications (OR = 2.70, 95% CI = 1.05–6.96, p = 0.039), increased antenatal care visits, and higher childbirth expenses. Conclusion: This study underscores the high prevalence of PPD among urban mothers in Bangladesh. The identified risk factors emphasize the need for targeted mental health initiatives, specifically tailored to support the vulnerable group. Implementing such initiatives can effectively address the challenges posed by PPD and enhance the well‐being of postpartum women in urban areas. [ABSTRACT FROM AUTHOR]

Sudden respiratory and circulatory collapse during or immediately after delivery, vaginal or surgical, can have many causes that can lead to poor maternal outcomes. A pregnancy-induced amniotic fluid embolism and anaphylaxis are two distinct medical conditions that appear similar clinically but have very different underlying mechanisms and treatment approaches. Amniotic fluid embolism is a rare but life-threatening obstetric emergency that leads to a systemic inflammatory response that can be easily confounded with an anaphylactic reaction. We report the case of a patient with no comorbidities or allergies before the current pregnancy that was proposed for delivery by C-Section under spinal anesthesia. After delivery of the placenta and administering the test dose of antibiotic, the patient developed sudden circulatory collapse, altered neurological status, and critical respiratory distress. At that point, the two presumed diagnoses were amniotic fluid embolism and anaphylaxis. Concurrently with the diagnostic pathway, supportive measures (intubation, mechanical ventilation, hemodynamic support) were taken. The clinical evolution was favorable, and after day three, the patient was discharged from the hospital. Our case highlights the significance of promptly distinguishing between anaphylaxis and amniotic fluid embolism to facilitate the timely management of the critical situation.

Abstract Background Caesarean sections (CSs) constitute a large proportion of fetal deliveries, yet no consensus exists on optimal surgical method. Objectives To investigate the safety and efficacy of the Pfannenstiel‐Kerr method (PKM) in comparison to Misgav‐Ladach method (MLM) and Modified Misgav‐Ladach method (MMLM) for CS. Search Strategy Cochrane, Embase, PubMed, CiNAHL, Scopus, and Web of Science were searched from database inception to March 2023. Selection Criteria Prospective studies comparing MLM with PKM or MMLM with PKM. Data Collection and Analysis Three authors independently conducted data extraction and assessed quality. Pooled means and proportions were analyzed using inverse variance and Mantel‐Haenszel methods. Main Results Twenty‐seven studies with 15 251 patients, met the selection criteria. Both MLM (mean difference [MD]: −12.09 min, 95% confidence interval [CI]: −14.40, −9.77, Tau2 = 16.79, I2 = 97%), (MD: −125.98 mL, 95% CI: −172.13, −79.83, Tau2 = 3458.59, I2 = 87%) and MMLM (MD: −11.38 min, 95% CI: −14.72, −8.04, Tau2 = 30.56, I2 = 100%), (MD: −62.61 mL, 95% CI: −103.13, −22.09, Tau2 = 1451.35, I2 = 92%) demonstrated shorter operative time and decreased blood loss, respectively, compared to PKM. Similarly, both MLM (MD: −1.70 min, 95% CI: −2.26, −1.14, Tau2 = 0.51, I2 = 97%), (MD: −0.77 d, 95% CI: −1.35, −0.19, Tau2 = 0.60, I2 = 98%) and MMLM (MD: −2.80 min, 95% CI: −3.89, −1.70, Tau2 = 1.74, I2 = 100%), (MD: −0.58 d, 95% CI: −1.00, −0.17, Tau2 = 0.29, I2 = 100%) demonstrated shorter fetal extraction time and length of hospital stay, respectively, compared to PKM. Conclusions MLM and MMLM should be considered safe and effective alternative approaches to CSs.

Abstract Background Reduction of Tanzania’s neonatal mortality rate has lagged behind that for all under-fives, and perinatal mortality has remained stagnant over the past two decades. We conducted a national verbal and social autopsy (VASA) study to estimate the causes and social determinants of stillbirths and neonatal deaths with the aim of identifying relevant health care and social interventions. Methods A VASA interview was conducted of all stillbirths and neonatal deaths in the prior 5 years identified by the 2015-16 Tanzania Demographic and Health Survey. We evaluated associations of maternal complications with antepartum and intrapartum stillbirth and leading causes of neonatal death; conducted descriptive analyses of antenatal (ANC) and delivery care and mothers’ careseeking for complications; and developed logistic regression models to examine factors associated with delivery place and mode. Results There were 204 stillbirths, with 185 able to be classified as antepartum (88 [47.5%]) or intrapartum (97 [52.5%]), and 228 neonatal deaths. Women with an intrapartum stillbirth were 6.5% (adjusted odds ratio (aOR) = 1.065, 95% confidence interval (CI) 1.002, 1.132) more likely to have a C-section for every additional hour before delivery after reaching the birth attendant. Antepartum hemorrhage (APH), maternal anemia, and premature rupture of membranes (PROM) were significantly positively associated with early neonatal mortality due to preterm delivery, intrapartum-related events and serious infection, respectively. While half to two-thirds of mothers made four or more ANC visits (ANC4+), a third or fewer received quality ANC (Q-ANC). Women with a complication were more likely to deliver at hospital only if they received Q-ANC (neonates: aOR = 4.5, 95% CI 1.6, 12.3) or ANC4+ (stillbirths: aOR = 11.8, 95% CI 3.6, 38.0). Nevertheless, urban residence was the strongest predictor of hospital delivery. Conclusions While Q-ANC and ANC4 + boosted hospital delivery among women with a complication, attendance was low and the quality of care is critical. Quality improvement efforts in urban and rural areas should focus on early detection and management of APH, maternal anemia, PROM, and prolonged labor, and on newborn resuscitation.

A four-year-old pregnant African lioness with dystocia was referred to the university teaching hospital. History-taking revealed the parturition had started four hours ago, but the cubs couldn't come out due to incomplete dilation of the cervix. This article describes the procedures before, during, and after the surgical operation, including the anesthesia protocol performed and performing a Cesarean section through the midline celiotomy to remove a dead and two live cubs from the uterus and successfully heal the dam without any complications. This surgery was performed about three years ago. After the operation to date, the lioness is in perfect health and she gave birth to 2 and 3 healthy cubs, respectively in two of her last parturition with no need for any help. [ABSTRACT FROM AUTHOR]

Background: Reduction of Tanzania's neonatal mortality rate has lagged behind that for all under-fives, and perinatal mortality has remained stagnant over the past two decades. We conducted a national verbal and social autopsy (VASA) study to estimate the causes and social determinants of stillbirths and neonatal deaths with the aim of identifying relevant health care and social interventions. Methods: A VASA interview was conducted of all stillbirths and neonatal deaths in the prior 5 years identified by the 2015-16 Tanzania Demographic and Health Survey. We evaluated associations of maternal complications with antepartum and intrapartum stillbirth and leading causes of neonatal death; conducted descriptive analyses of antenatal (ANC) and delivery care and mothers' careseeking for complications; and developed logistic regression models to examine factors associated with delivery place and mode. Results: There were 204 stillbirths, with 185 able to be classified as antepartum (88 [47.5%]) or intrapartum (97 [52.5%]), and 228 neonatal deaths. Women with an intrapartum stillbirth were 6.5% (adjusted odds ratio (aOR) = 1.065, 95% confidence interval (CI) 1.002, 1.132) more likely to have a C-section for every additional hour before delivery after reaching the birth attendant. Antepartum hemorrhage (APH), maternal anemia, and premature rupture of membranes (PROM) were significantly positively associated with early neonatal mortality due to preterm delivery, intrapartum-related events and serious infection, respectively. While half to two-thirds of mothers made four or more ANC visits (ANC4+), a third or fewer received quality ANC (Q-ANC). Women with a complication were more likely to deliver at hospital only if they received Q-ANC (neonates: aOR = 4.5, 95% CI 1.6, 12.3) or ANC4+ (stillbirths: aOR = 11.8, 95% CI 3.6, 38.0). Nevertheless, urban residence was the strongest predictor of hospital delivery. Conclusions: While Q-ANC and ANC4 + boosted hospital delivery among women with a complication, attendance was low and the quality of care is critical. Quality improvement efforts in urban and rural areas should focus on early detection and management of APH, maternal anemia, PROM, and prolonged labor, and on newborn resuscitation. [ABSTRACT FROM AUTHOR]

Research was conducted employing the extended socio-ecological model (ESEM) to examine factors associated with cesarean sections (CSs) and vaginal deliveries (VDs) among the women in our study population. Using the ESEM to determine South-Punjab and Pakistani women's mode of delivery predictors. The cross-sectional study with a sample size of 908 patients was conducted through private and public obstetrics and gynecology departments in South Punjab, Pakistan, from 12 June 2022 to 29 May 2023. The Chi-square analysis compared baseline variables, delivery outcomes and delivery methods. Logistic regression analysis is used to determine predictive factors. The study revealed that 75.66% of women had CS, while 24.34% had VD. Education level, age, residential area and fetal presentation all had significant associations with mode of delivery. Logistic regression analysis suggested that gynecologist recommendation, belief in CS safety, abnormal fetal presentation, maternal anemia and meconium aspiration syndrome were all significant predictors of CS. The ESEM model concluded that age, fatigue and women's preference for CS due to its reliability for her and her fetus were predictive factors for mode of delivery choices among South-Punjab Pakistani women. [ABSTRACT FROM AUTHOR]

Though there are multitudes of analgesic techniques available to relieve labor pain, epidural analgesia is considered as most effective against labor pain. Many studies have investigated whether and how the epidural analgesia may have an impact on the first and second stage of labor, maternal and neonatal outcomes and birth experience but the results are still controversial. There was an interest to analyze on delivery outcomes of Bloom Life Hospital at Chennai, on the delivery outcomes (maternal and fetal) on using Epidural analgesia (0.2% ropivacaine + 50 mic Fentanyl). Data was accessed from bloom Life Hospital (N= 223 parturients) administered with Epidural analgesia between April 2015 to October 2021. The obtained data was coded and the preliminary analysis was performed descriptively analyzed. The descriptive analysis revealed that among 223 parturients who received EA 89% (N=174) had Normal Vaginal delivery. Only 28 among the study participants (12.5%) had ins/outlet forceps delivery. Neonatal outcomes revealed that 138 among 224 babies did not require NICU admission. The study data has clearly revealed that Epidural Analgesia did not increase the rates of CSection. In Future, prospective study has been planned to know the impact of EA on labor, delivery, maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Postpartum depression (PPD) is a globally recognized public health concern, yet research focusing on women in urban areas of Bangladesh remains unexplored. This study aimed to address this research gap by investigating the prevalence and associated factors of PPD within the first 2 years after childbirth. Methods A cross‐sectional study was conducted, enrolling 259 women (26.66 ± 4.57 years) residing in urban areas who were attending healthcare delivery centers. Sociodemographic factors, child‐related issues, pregnancy‐related complications, and PPD using the Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data analysis involved the application of χ2 tests and logistic regression analysis using SPSS software. Results This study found a 60.6% prevalence of PPD using a cutoff of 10 (out of 30) on the EPDS scale. Logistic regression analysis identified several significant factors associated with PPD, including high monthly family income (odds ratio [OR] = 47.51, 95% confidence interval [CI]: 8.34–270.54, p

Background: C-section (caesarean section) is a lifesaving procedure when certain complications arise during pregnancy and labor. however, it’s a major surgery and associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long term effects. Objective: To describe indications and determinants of caesarean section in Al Batool teaching hospital in Diyala during the study period. Patients and Methods: Across sectional study conducted among women admitted to Al Batool teaching hospital and delivered by C-section from first of October 2022 to 15th of march 2023. Results: A total of 150 women underwent C-section enrolled in this study during the study period, age of participants ranged from 19-35. out of them, 88(59%) sections were elective and 62(41%) sections were emergent. commonest indication for emergency C-section was fetal distress (62%) and commonest indication for elective C-section was previous cesarean (33%). Conclusion: Parity, residence, education, and antenatal care visits were significant determinants for C-section. previous C-section, maternal request and malpresentation were commonest indications for such procedure.

Assistance during calving and cesarean section (C-section) are important risk factors for the failure of transfer of passive immunity (FTPI) in beef calves, which increases the risk of morbidity and mortality in beef calves during the preweaning period. Colostrum replacement recommendations for beef calves, and especially for those delivered by C-section, are unavailable. The objective of this study was to determine whether or not colostrum replacement or supplementation with a commercially available product could increase serum IgG concentrations in beef calves delivered by elective C-section, compared to beef calves that nursed colostrum naturally. An elective C-section was performed in 32 pregnant beef cows and first-calf heifers. Immediately after delivery, newborn calves were randomly assigned to one of three different treatment groups. Group A calves (n = 7) were fed one packet of a commercial colostrum replacer (CR) product providing 60 g of IgG within 30 min of life. A second packet of the same CR was fed at 6 h of life. Group B calves (n = 13) were fed the same CR at the same frequency as group A; however, these calves were reunited with their dams after the second CR feeding to allow additional nursing of maternal colostrum. Group C calves (n = 12) were united with their dams immediately after surgery without colostrum intervention. Serum IgG levels at 48 h of life were greater in group C calves and in calves born to multiparous cows. Based on the results of this study, neither colostrum replacement nor supplementation result in higher serum IgG concentrations in beef calves delivered by elective C-section compared with natural nursing.

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.

In massive pulmonary embolism (PE), anticoagulation and thrombolytics may increase the risk of retroperitoneal bleeding following vascular cannulation for extracorporeal hemodynamic support resulting in abdominal compartment syndrome (ACS). A 27-year-old women at 33 weeks of gestation presented with acute chest pain and shortness of breath. Massive PE was diagnosed. Intravenous unfractionated heparin was started together with catheter-directed tissue plasminogen activator (tPA) infusion and mechanical thrombectomy. During the procedure, cardiac arrest developed. Cardiopulmonary resuscitation, intravenous tPA, and urgent perimortem cesarean delivery were performed. After return of spontaneous circulation, profound right ventricular failure required venoarterial membrane oxygenation. Six hours afterward, ACS secondary to retroperitoneal bleeding developed, requiring surgical intervention. ACS may result from retroperitoneal bleeding following cannulation for extracorporeal hemodynamic support.

Introduction: A long-term Cesarean section (CS) issue that is gaining increased attention globally is called niche. Not all individuals whose surgical scar from a C-section has a niche have clinical symptoms. The purpose was to evaluate uterine niche predominance in women who experienced abnormal uterine bleeding following C-section. Method: For one year, nonpregnant women of reproductive age who underwent an abnormal uterine bleeding diagnosis at the gynecology clinic and had a C-section performed more than six months prior were included in the study. The conventional scar measures, residual myometrial thickness, and the width and depth related to the hypoechoic niche were measured by transvaginal ultrasound. Results: By TVS, the C-section niche was found in 23% of females. Among women with identified niches, premenstrual syndrome was the most common prevalent clinical bleeding tendency. Conclusion: The CS niche and unexplained abnormal uterine bleeding, particularly postmenstrual spotting, may be related. Recommendation: Regarding suggestions for averting scar abnormalities from cesarean sections, more randomized controlled trials to be carried out to assess diverse surgical methods. Currently, there is no solid proof that a single technique of one hysterotomy closure is better than the other to avoid scarring from cesarean sections.

Research was conducted employing the extended socio-ecological model (ESEM) to examine factors associated with cesarean sections (CSs) and vaginal deliveries (VDs) among the women in our study population. Using the ESEM to determine South-Punjab and Pakistani women’s mode of delivery predictors. The cross-sectional study with a sample size of 908 patients was conducted through private and public obstetrics and gynecology departments in South Punjab, Pakistan, from 12 June 2022 to 29 May 2023. The Chi-square analysis compared baseline variables, delivery outcomes and delivery methods. Logistic regression analysis is used to determine predictive factors. The study revealed that 75.66% of women had CS, while 24.34% had VD. Education level, age, residential area and fetal presentation all had significant associations with mode of delivery. Logistic regression analysis suggested that gynecologist recommendation, belief in CS safety, abnormal fetal presentation, maternal anemia and meconium aspiration syndrome were all significant predictors of CS. The ESEM model concluded that age, fatigue and women’s preference for CS due to its reliability for her and her fetus were predictive factors for mode of delivery choices among South-Punjab Pakistani women.

Introduction: timely access to safe cesarean section (c-section) delivery can save the lives of mothers and neonates. This paper explores how distance affects c-section access in rural sub-Saharan Africa, where women in labor present to health centers before being referred to district hospitals for surgical care. Methods: this study included all adult women delivering via c-section between April 2017 and March 2018 in Kirehe District, Rwanda. We assessed the association between travel times and village-level c-section rates. Results: the estimated travel time from home-to-health center was 26 minutes (IQR: 13, 41) and from health center-to-hospital was 43 minutes (IQR: 2, 59). There was no significant association between travel time from home-to-health center and c-section rates (RR=1.01, p=0.42), but the association was significant for health center-to-hospital travel times (RR=0.96, p=0.01); for every 15-minute increase in travel time, there was a 4% decrease in c-sections for a health center catchment area. Conclusion: in the context of decentralized health services, minimizing health center to hospital referral barriers is of utmost importance for improving c-section access in rural sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: During surgery in the lower part of the body especially during c-sections done by obstetricians, the favourable way of anesthetizing patients is by giving spinal anesthesia also called subarachnoid block. However, during subarachnoid block, hypotension and bradycardia may occur which has adverse effects on the fetus as well as the mother. The Bezold Jarisch pathway induced by serotonin after the anaesthesia causes the above events. Serotonin acts on 5-HT3 receptors located in the vagal nerve ending of the heart. Ondansetron blocks the activity of serotonin in its receptors. Aim: This study assesses the effectiveness of ondansetron in blocking the serotonin receptors to prevent hypotension and bradycardia in parturients having c-section surgery which requires subarachnoid block. Method: 72 women undergoing parturition by c-section were selected for the study. They were divided into two groups randomly. O group consisted of 36 women who were given 4.5mg (2.25 ml) of ondansetron intravenously before spinal anesthesia. S group women also consisted of 36 women who were given 2.25ml of normal saline before spinal anaesthesia. 2ml of 0.5% hyperbaric bupivacaine was injected intrathecally. Both groups were closely monitored for their heart rate, blood pressure, and requirements of vasopressor agents. Results: The reduction of the average pressure in the arteries was lower than 35 minutes in the group that received ondansetron. The incidence of emesis and nausea was lesser among these patients when compared to the other group. The other group had a reduction of mean arterial pressure around 14 min. Conclusion: The requirement for vasopressors decreased among the women having c-sections who had been given Ondansetron 4.5 mg intravenously before anaesthesia. Recommendation: Ondansetron may be recommended as a prophylaxis for hypotension and bradycardia following spinal anaesthesia; the level of evidence was moderate with a high level of heterogeneity.

Background: Birth by caesarean section (CS) is associated with development of allergic diseases, but its role in the development of atopic dermatitis (AD) is less convincing. Objective: Our primary aim was to determine if birth mode was associated with AD in 3-year-olds and secondarily to determine if birth mode was associated with early onset and/or persistent AD in the first 3 years of life. Methods: We included 2129 mother–child pairs from the Scandinavian population-based prospective PreventADALL cohort with information on birth mode including vaginal birth, either traditional (81.3%) or in water (4.0%), and CS before (6.3%) and after (8.5%) onset of labor. We defined early onset AD as eczema at 3 months and AD diagnosis by 3 years of age. Persistent AD was defined as eczema both in the first year and at 3 years of age, together with an AD diagnosis by 3 years of age. Results: AD was diagnosed at 3, 6, 12, 24, and/or 36 months in 531 children (25%). Compared to vaginal delivery, CS was overall associated with increased odds of AD by 3 years of age, with adjusted odds ratio (95% confidence interval) of 1.33 (1.02-1.74), and higher odds of early onset AD (1.63, 1.06-2.48). The highest odds for early onset AD were observed in infants born by CS after onset of labor (1.83, 1.09-3.07). Birth mode was not associated with persistent AD. Conclusion: CS was associated with increased odds of AD by 3 years of age, particularly in infants presenting with eczema at 3 months of age.

Studying quasi‐experimental data from French hospitals from 2010 to 2013, we test the effects of a substantial diagnosis‐related group (DRG) tariff refinement that occurred in 2012, designed to reduce financial risks of French maternity wards. To estimate the resulting DRG incentives with regard to the choice between scheduled C‐sections and other modes of child delivery, we predict, based on pre‐admission patient characteristics, the probability of each possible child delivery outcome and calculate expected differences in associated tariffs. Using patient‐level administrative data, we find that introducing additional severity levels and clinical factors into the reimbursement algorithm had no significant effect on the probability of a scheduled C‐section being performed. The results are robust to multiple formulations of DRG financial incentives. Our paper is the first study that focuses on the consequences of a DRG refinement in obstetrics and develops a probabilistic approach suitable for measuring the expected effects of DRG fee incentives in the presence of multiple tariff groups. [ABSTRACT FROM AUTHOR]

Brain tumors and intracranial bleeding are rare cases in pregnancy. Anesthesia management for a C-section with comorbidity remains challenging. We presented a 33-year-old woman (34–36 weeks pregnant) with the complaint of weakness in her right extremities, blurred vision, and ptosis of her left eye from a month before hospitalization. The brain computed tomography (CT) revealed a mass at the left parasellar region with a bleeding component and cerebral edema accompanied by subfalcine herniation. We conducted general anesthesia for cesarean delivery in a patient with a brain-protective technique. Brain CT revealed a decrease in the mass size and neither intracranial bleeding nor cerebral edema. In conclusion, general anesthesia management provided a good outcome in a parturient with a brain tumor and intracranial bleeding that underwent C-section. The mechanism of clinical improvement and tumor regression is unclear and requires further research, but it is believed that it is related to pregnancy hormones.

Plain language summary In several studies and reports, women have described mistreatment by health providers during childbirth in health facilities. Particularly in low- and middle-income countries, such mistreatment has negative effects on women’s decisions to seek maternity care in health facilities. It is unclear if women with complications are more or less likely to experience some forms of mistreatment compared to women without complications. In this study, we examined 31 experience of care indicators in three domains: (1) Supportive Care; (2) Respect and Dignity; and (3) Communication and Autonomy from the validated Person-Centered Maternity Care (PCMC) questionnaire. We compare these experience of care indicators between women who report obstetric complications and those who don’t report complications, by the reported severity of the complications, and by their mode of delivery. The study included data from three countries: Ghana, Kenya, and India. The results showed that the experience of care among women who reported obstetric complications was not consistently better or worse than that of those who did not have complications. Therefore, efforts should be made to improve the experience of care in health facilities for every birthing woman. Additionally, women who delivered via c-section had consistently better experiences than women who delivered vaginally. More studies are needed to understand the relationship between mode of delivery and women’s experience of care.

Background: The birth of a child is a source of joy in the family. But the one who truly feels the implications of this "miracle" is the mother, because she will cope with both the joys and the fears that implicitly flow from this experience. Aim: This paperwork aims to highlight one of the important aspects affected by the type of birth chosen, namely the quality of life of the mother-in-law immediately after birth, with immediate repercussions on the ability of the mother-in-law to play the role of mother. Material and methods: The study was conducted in May 2021, at the maternity hospital in Oradea, on 36 subjects, the average age of 24.38 ± 4,884 (min. 20 / max. 35 years), in the first days after birth, 55.6% primiparous, 44.4% multiparous; 63.9% come from urban areas, 36.1% from rural areas. The subjects were divided in two groups as follows: 18 women with natural birth as study group, and 18 women with caesarian section as the control group. As assessment tools we used: Beck Depression Inventory, Apgar score, Functional Independence Measure and Verbal Analog Scale. For statistical analysis we used SPSS 15.00 version. Results: There are significant differences between the 2 groups in terms of pain intensity when switching from supine to lateral decubitus; lying in bed, the intensity of the pain while walking; when handling and breastfeeding; the degree of functional independence in personal hygiene and the handling of the newborn and the degree of depression. There are no significant differences for functional independence in breastfeeding and APGAR scores. Conclusions: As a general conclusion we can say that it appears that the normal birth is much more beneficial both for the mother (physically, mentally, independence and recovery) and and for the child (Apgar score).

In the last decade, c-sections have become a trend among pregnant women. Several studies have discussed indications for c-sections, including some risk factors that might affect the skyrocketing number of c-sections around the world. This study aimed to determine the correlation between previous c-section history and preeclampsia or eclampsia status with the mode of delivery at Dr. Ramelan Central Naval Hospital, Surabaya. A total of 272 medical records of pregnant women from January 2019 to October 2021 were collected. Women without previous history of c-sections had 0.051 (95% CI 0.021-0.120) lower risk of having a c-section in the current delivery, and women without preeclampsia or eclampsia status had 0.200 (95% CI 0.116-0.345) lower risk of having c-section in the current delivery.

Abstract Background Ex-vivo myography enables the assessment of muscle electrical activity response. This study explored the viability of determining the physiological responses in muscles without tendon, as rectus abdominis muscle (RAM), through ex-vivo myography to assess its potential as a diagnostic tool. Results All tested RAM samples (five different samples) show patterns of electrical activity. A positive response was observed in 100% of the programmed stimulation. RAM 3 showed greater weight (0.47 g), length (1.66 cm), and width (0.77 cm) compared to RAM 1, RAM 2, RAM 4 and RAM 5 with more sustained electrical activity over time, a higher percentage of fatigue was analyzed at half the time of the electrical activity. The order of electrical activity (Mn) was RAM 3 > RAM 5 > RAM 1 > RAM 4 > RAM 2. No electrical activity was recorded in the Sham group. Conclusions This study shows that it is feasible to assess the physiological responses of striated muscle without tendon as RAM, obtained at C-section, under ex vivo myography. These results could be recorded, properly analyzed, and demonstrated its potential as a diagnostic tool for rectus abdominis muscle electrical activity.

Background and aim. There are controversial data in literature regarding the influence of abdominal and pelvic surgery on the onset of gastrointestinal symptoms. The aim of this study was to assess whether women who had a C-section (cesarean section) are more likely to develop irritable bowel syndrome (IBS) early after delivery than those who have given birth naturally. Method. A cross-sectional study investigated women who had undergone C-section and were compared with a control group of women who had natural delivery. Data were obtained from Maternity Ward of Korce Hospital, in Albania. We conducted a telephone interview based on a questionnaire containing items to diagnose IBS based on the Rome IV criteria. The interviews were conducted 9 to 12 months after delivery. Results. The prevalence of IBS in both groups taken together 4.6%. In the C-section group, prevalence of IBS was 4.3%, while in the control group it was 5.2%. All the patients with IBS had subtype with predominance of constipation. The RR 0.814 (CI 95%, 0.1423-4.66) does not confirm the hypothesis that C-section may induce early onset of IBS more often than natural birth. Conclusion. The prevalence of IBS was (4.6%), within the known range of the Rome Foundation Global Study. Delivery by C-section does not have a role in developing IBS symptoms more than delivery by natural way in this group of Albanian women. [ABSTRACT FROM AUTHOR]

Cold-formed steel structures are a type of steel fabrication that is commonly employed in building construction. Before manufacture, they are designed precisely to the appropriate dimensions using the ABAQUS software. Both the strength of the cross-section and distortional buckling determine the load-carrying capability of the section. It was found that thin walls in some cold-formed sections suffered distortional buckling under light loads, and that these elements continued to be strong even after the members buckled. To prevent local buckling, stiffness is offered by the web part. There are several methods for determining the modes and elastic buckling stress. They are finite element analysis, finite strip analysis, and conventional Fourier series solutions. The thickness of the specimen and types of stiffener selection which influence the ultimate strength and deflection should be the issue in the design of the appropriate sigma section. The non-linear numerical analysis of the web-stiffened triangular section was performed using ABAQUS v6.4. It has been demonstrated that sections with height-to-thickness (h/t) ratios have load-bearing capacities. When compared to the lower h/t ratio sections, they demonstrated an improvement in load-carrying capability from 35.13% to 37.2%. [ABSTRACT FROM AUTHOR]

Rates of obesity in pregnant women are increasing. Obesity is linked to increased patient risk of developing postoperative wound complications such as surgical site infection, wound dehiscence and haematoma formation. Closed incision negative pressure wound therapy (ciNPWT) has been introduced as a prophylactic intervention to reduce caesarian section (C-section) wound complications. Evidence from randomised controlled trials and retrospective studies has shown variable rates of success in reducing risk of SSI. The studies reviewed in this article found that ciNPWT had no statistically significant impact in reducing rates of wound dehiscence and haematoma formation or increasing long-term satisfaction with the appearance of scar tissue following C-section. Further research into the use of cINPWT to prevent surgical site infection is needed to determine the effectiveness of this therapy in reducing this wound complication. [ABSTRACT FROM AUTHOR]

Background and aims: The key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh. Methods: This study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model. Results: CS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45-49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67). Conclusion: The findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate that the application of an enhanced recovery after surgery (ERAS) protocol in elective cesarean sections is associated with reduced hospital stay without increasing maternal complications. Material and methods: This retrospective, comparative study included patients who underwent an elective cesarean section. The patients were divided into groups: group 1, women who received elements of standardized care according to ERAS guidelines, and group 2, women who did not receive this care. Results: The study included 295 patients, 139 in group 1 (ERAS) and 156 in group 2. The demographic characteristics were similar. Hospital stay and postoperative pain at 24 and 48 hours were lower in patients in group 1; these differences were statistically significant (p < 0.001). The overall complication rate, head pain, surgical wound infection, urinary retention, and readmission were similar in both groups. Conclusions: The application of an ERAS protocol can reduce hospital stay and postoperative pain without increasing the postoperative complication rate in patients who undergo an elective cesarean section. In developing countries, the application of this protocol could help in optimizing available health system resources. [ABSTRACT FROM AUTHOR]

Background: Births are increasingly started artificially using medications such as prostaglandin, oxytocin, or other mechanical methods, a process known as induction of labour (IOL). The aim of the study was to identify the success rate of a repeat cycle of induction of labour (IOL) with prostaglandins, and any association between smoking and patient response to prostaglandin. Methods: This was a retrospective cohort study set in Basildon and Thurrock University Hospital, UK. IOL data from patients were collected between 1 January 2021 and 30 March 2021. Data were retrieved from hospital records and categorised by prostaglandin cycle(s), administration of oxytocin, artificial rupture of membranes (ARM), spontaneous rupture of membranes (SROM), smoking status, patient BMI, age, ethnicity, gestation age, Bishop score, and delivery method (assisted, unassisted, or Caesarean (C-)section). The data were analysed using Chi-square, binomial and multinomial logistic regression. The success rate was interpreted from relative frequencies of delivery method (unassisted, assisted or C-section). Results: Unassisted vaginal delivery (n =121; 48.0%) was the most common outcome with prostaglandin IOL followed by C-section (n = 105 41.7%). Only 10.3% had an assisted vaginal delivery. Of those who had a repeated IOL cycle, 85.7% had a C-section. There was no difference in prostaglandin administration by smoking status or any association between smoking status and mode of delivery in IOL. Conclusions: Repeat cycle of IOL does not enhance the vaginal delivery with only 14.3% unassisted vaginal births. There was no evidence that smoking impacted on response to prostaglandins or method of delivery.

In today’s medical field, doctors rely on electrocardiograms (ECG) to monitor fetal heart rate and overall fetal health during labor. ECG readings, although accurate, tend to be very difficult to interpret and consequently tell doctors very little in terms of fetal distress levels during labor. Due to this lack of specificity, physicians often turn to emergency intervention by performing Cesarean sections (C-sections). Nearly half of these C-sections are unnecessary which poses extreme risks to the fetus and the mother, and is a financial burden on insurance companies as well. To combat these issues, our team proposes pHetal Meter, a handheld device that can give a rapid, bedside reading of fetal blood pH. Fetal blood pH levels are currently the gold standard for early detection of fetal distress during labor. The device will be able to quickly and accurately detect whether or not the fetus is in distress. Our device will be nurse-operable, cause little to no pain or discomfort to the mother, and allow for faster and more direct results. When used alongside current technology, physicians will no longer need to guess whether an emergency C-section is necessary, and will be able to rapidly determine fetal distress levels. pHetal Meter uniquely bridges an unmet medical need by quickly and accurately determining intrapartum fetal health, and drastically lowering the risks and costs incurred by unnecessary C-sections. Advisors: Christine King, Ph.D. Department of Biomedical EngineeringDinh Vu, MD, MBA, Department of Obstetrics and Gynecology, Saddleback Medical CenterDepartment of Biomedical engineering and material Science Engineering, University of California Irvine

Abstract Introduction While it is recognized that there are costs associated with postoperative patient follow-up, risk assessments of catastrophic health expenditures (CHEs) due to surgery in sub-Saharan Africa rarely include expenses after discharge. We describe patient-level costs for cesarean section (c-section) and follow-up care up to postoperative day (POD) 30 and evaluate the contribution of follow-up to CHEs in rural Rwanda. Methods We interviewed women who delivered via c-section at Kirehe District Hospital between September 2019 and February 2020. Expenditure details were captured on an adapted surgical indicator financial survey tool and extracted from the hospital billing system. CHE was defined as health expenditure of ≥ 10% of annual household expenditure. We report the cost of c-section up to 30 days after discharge, the rate of CHE among c-section patients stratified by in-hospital costs and post-discharge follow-up costs, and the main contributors to c-section follow-up costs. We performed a multivariate logistic regression using a backward stepwise process to determine independent predictors of CHE at POD30 at α ≤ 0.05. Results Of the 479 participants in this study, 90% were classified as impoverished before surgery and an additional 6.4% were impoverished by the c-section. The median out-of-pocket costs up to POD30 was US$122.16 (IQR: $102.94, $148.11); 63% of these expenditures were attributed to post-discharge expenses or lost opportunity costs (US$77.50; IQR: $67.70, $95.60). To afford c-section care, 64.4% borrowed money and 18.4% sold possessions. The CHE rate was 27% when only considering direct and indirect costs up to the time of discharge and 77% when including the reported expenses up to POD30. Transportation and lost household wages were the largest contributors to post-discharge costs. Further, CHE at POD30 was independently predicted by membership in community-based health insurance (aOR = 3.40, 95% CI: 1.21,9.60), being a farmer (aOR = 2.25, 95% CI:1.00,3.03), primary school education (aOR = 2.35, 95% CI:1.91,4.66), and small household sizes had 0.22 lower odds of experiencing CHE compared to large households (aOR = 0.78, 95% CI:0.66,0.91). Conclusion Costs associated with surgical follow-up are often neglected in financial risk calculations but contribute significantly to the risk of CHE in rural Rwanda. Insurance coverage for direct medical costs is insufficient to protect against CHE. Innovative follow-up solutions to reduce costs of patient transport and compensate for household lost wages need to be considered.

Background: In line with global trends, India has witnessed a sharp rise in C-section (CS) deliveries, especially in the private sector. Methodology: Study attempts to explore change in CS delivery in India at national, regional and State/UT levels. We have used factsheet data from the most recent nationally representative survey data i.e., NFHS to examine changes in private and public healthcare facilities, and to determine a difference in rural and urban in CS deliveries. Results: The CS rate has increased from 17.2% to 21.5% in 2019-21. CS was more than twice (40.9%) amongst the private healthcare facilities during the fourth round of NFHS which has shown a considerable increase during the fifth round of NFHS (47.4%). There is equal distribution (12.8% during 2015-16 to 17.6% in 2019-21 in rural areas v/s 28.2% during 2015-16 to 32.3% in 2019-21in urban areas) of CS deliveries amongst the rural and urban areas to the total deliveries. Conclusion: Study found that with every one in five deliveries being caesarean, the figure is significantly high as per the recommended cut off by WHO. Thus, it is essential to explore factors regarding emergency or elective caesarean section and to understand if the health facilities are following the recommended protocols for performing CS deliveries.

Background and aimsThe key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh.MethodsThis study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model.ResultsCS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45–49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67).ConclusionThe findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.