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BACKGROUND: The diagnosis of failure to progress, the most common indication for intrapartum cesarean delivery, is based on the assessment of cervical dilation and station over time. Labor curves serve as references for expected changes in dilation and fetal descent. The labor curves of Friedman, Zhang et al, and others are based on time alone and derived from mothers with spontaneous labor onset. However, labor induction is now common, and clinicians also consider other factors when assessing labor progress. Labor curves that consider the use of labor induction and other factors that influence labor progress have the potential to be more accurate and closer to clinical decision-making. OBJECTIVE: This study aimed to compare the prediction errors of labor curves based on a single factor (time) or multiple clinically relevant factors using two modeling methods: mixed-effects regression, a standard statistical method, and Gaussian processes, a machine learning method. STUDY DESIGN: This was a longitudinal cohort study of changes in dilation and station based on data from 8022 births in nulliparous women with a live, singleton, vertex-presenting fetus ≥35 weeks of gestation with a vaginal delivery. New labor curves of dilation and station were generated with 10-fold cross-validation. External validation was performed using a geographically independent group. Model variables included time from the first examination in the 20 hours before delivery; dilation, effacement, and station recorded at the previous examination; cumulative contraction counts; and use of epidural anesthesia and labor induction. To assess model accuracy, differences between each models predicted value and its corresponding observed value were calculated. These prediction errors were summarized using mean absolute error and root mean squared error statistics. RESULTS: Dilation curves based on multiple parameters were more accurate than those derived from time alone. The mean absolute error of the multifactor methods was better (lower) than those of the single-factor methods (0.826 cm [95% confidence interval, 0.820-0.832] for the multifactor machine learning and 0.893 cm [95% confidence interval, 0.885-0.901] for the multifactor mixed-effects method and 2.122 cm [95% confidence interval, 2.108-2.136] for the single-factor methods; P

INTRODUCTION: Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS: We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexicos cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS: The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION: While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.

Objective Methods Results Conclusion The study aimed to calculate the subsequent birth rate for different delivery modes, comparing them with spontaneous vaginal deliveries, using a comprehensive nationwide high‐quality registry.Data from the National Medical Birth Register (MBR) were used to evaluate the birth rate after different delivery modes. All first deliveries for a mother during the years 2004 to 2016 were included. For these women, all second pregnancies from the MBR during the years 2004 to 2018 were retrieved and combined with the data of the first deliveries. A Cox regression model was used to evaluate the risk for the second pregnancy after giving birth the first time. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).A total of 375 619 women with a first and second pregnancy leading to birth were included in this study. Of these, a total of 50 579 women underwent assisted vaginal delivery, 50 429 had an unplanned cesarean section (CS), 22 021 had elective CS, and 252 593 had spontaneous vaginal delivery as a mode of delivery in their first pregnancy. Women with assisted vaginal delivery (aHR, 1.23 [CI, 1.21–1.24]) and unplanned CS (aHR, 1.03 [CI, 1.02–1.05]) had higher birth rates after the first birth, and women with elective CS as a mode of delivery had lower birth rates (aHR, 0.86 [CI, 0.84–0.88]) when compared with women who had spontaneous vaginal delivery.The findings of this study indicate that the CS operation itself is not the only cause of the observed lower birth rate; rather, there are underlying factors that have a greater impact on birth rates. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusions This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room.The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision‐to‐delivery interval, incision‐to‐delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters.The decision‐to‐delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates.The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity. [ABSTRACT FROM AUTHOR]

Background: The impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section. Methods: Singleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section. Results: After chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5–13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1–18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified. Conclusions: The rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section. [ABSTRACT FROM AUTHOR]

Background: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section. Methods: In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. Results: Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15–6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14–4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72–10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06–1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49–0.57) and 0.56 (95%CI 0.51–0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively. Conclusion: In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability. Trial registration: Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Introduction: Although precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01–0.001%, of which gossypibomas make up 80% of cases. Case presentation: A 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively. Conclusion: Retained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Cesarean delivery has been shown to increase the risk of preterm delivery in future pregnancies. The association could be a direct result of the procedure, or because the indications that led to the cesarean delivery also increase the risk of preterm delivery in later pregnancies.298 901 mothers with first and second singleton deliveries from 1999 to 2020 were investigated using data from the Medical Birth Registry of Norway linked with Statistics Norway. The mothers were categorized by mode of cesarean delivery (total, emergency and planned) and vaginal delivery at term in the first pregnancy. We used log‐binomial regression models to estimate relative risks with 95% confidence intervals (CI) of iatrogenic and spontaneous preterm delivery <37 gestational weeks in the second pregnancy. Second, we explored the role of recurrent placental disease in preterm delivery by comparing estimates in mothers with placental disease in neither or both pregnancies.8243 mothers (2.8%) had a preterm delivery in the second pregnancy. The adjusted relative risk (aRR) of preterm delivery was 1.24 (95% CI 1.17–1.32) after cesarean compared with vaginal delivery in the first pregnancy. The association was stronger in previous planned compared with emergency cesarean delivery (aRR 1.52, 95% CI 1.30–1.77 and aRR 1.21, 95% CI 1.14–1.29, respectively). Spontaneous preterm delivery was not associated with the previous mode of delivery; the risk was confined to iatrogenic preterm delivery after both emergency and planned cesarean delivery (aRR 1.69, 95% CI 1.52–1.87 and aRR 2.65, 95% CI 2.12–3.30, respectively). Mothers with placental disease in both pregnancies had a sixfold increased risk of preterm delivery in the second pregnancy compared with mothers with no placental disease, however, the association between mode of delivery and subsequent preterm delivery was similar in mothers with and without placental disease in the pregnancies.Compared with vaginal term delivery in the first pregnancy, cesarean delivery increases the risk of iatrogenic, but not spontaneous preterm delivery in the next pregnancy. Although strongly associated with preterm delivery, placental disease had limited influence on the estimates. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Melatonin has been suggested to have a biological role in the onset and progress of labor. We tested the hypothesis that the addition of melatonin during an induction of labor will reduce the need for a cesarean birth.This trial underwent protocol amendments that are detailed in the main text of the article. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12616000311459). At a multi‐center health service including secondary and tertiary obstetric hospitals, we performed a randomized, double‐blind, placebo‐controlled trial in women with a singleton cephalic pregnancy, free of significant maternal or perinatal complications who were undergoing induction of labor (with or without cervical ripening). Women were randomized to 10 mg melatonin vs placebo, with cervical ripening as required, and then 6‐h during their induction of labor to a maximum of four doses or until birth. The primary outcome was cesarean birth. Secondary outcomes included labor, maternal, and neonatal outcomes. Data were analyzed using intention to treat. Sub‐group analyses based on mode of ripening and parity were also performed.Between 2019 and 2021 we randomized 189 women (103 to melatonin and 86 to placebo). The study was prematurely terminated due to logistical complications resulting from the COVID‐19 pandemic. Cesarean rates were 28/103 (27.2%) in the melatonin group versus 20/84 (23.3%) in the placebo group (RR 1.17 95% CI 0.71–1.92). There were no significant differences in rate of cesarean birth between the melatonin and placebo groups for failure to progress (13.4% and 9.3%, respectively, RR 1.46; 95% CI 0.64–3.32) or suspected fetal distress (10.7% and 10.5%, respectively, RR 1.02; 95% CI 0.44–2.34). The melatonin group had significantly lower rates of spontaneous vaginal birth within 24 h (35.0% vs. 50.0%; RR 0.70 95% CI 0.50–0.98). The rates of secondary outcomes such as total length of labor, rate of postpartum hemorrhage, and instrumental birth were comparable. Babies born in the melatonin group were more likely to need admission to the special care nursery, namely for hypoglycemic monitoring (18.5% vs. 8.1% RR 2.26; 95% CI 1.00–5.10).In women undergoing induction of labor, melatonin does not reduce the cesarean section rate. Melatonin use intrapartum may also be associated with neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions Trial Registration To assess if off‐label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non‐inferiority design.Prospective, randomised, non‐inferiority, open‐label, blinded endpoint trial.Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023.In all, 874 women, without previous caesarean section, with an unripe cervix and a singleton, cephalic foetus at 37 + 0 to 42 + 0 gestational weeks, with a normal cardiotocography, planned for IOL were included.Women were randomised 1:1 to intervention (25 μg oral solution of misoprostol) or control (25 μg oral tablet of misoprostol) two‐hourly for a maximum of eight doses. Subsequent methods of induction followed clinical practice.The primary outcome was vaginal delivery within 24 h tested using non‐inferiority testing procedures at a non‐inferiority margin of 5 percentage points. Secondary efficacy outcomes were tested for superiority of either treatment. Analyses were by intention‐to‐treat.There were 207 (47.4%) vaginal deliveries within 24 h for women receiving oral solution and 192 (43.9%) vaginal deliveries within 24 h for women receiving oral tablet, establishing non‐inferiority with an absolute risk difference of 3.4% (95% CI −3.2% to 10.0%). Women receiving oral solution required fewer doses to reach active labour than women receiving oral tablet (5.7 vs. 6.1, p = 0.007). There were no significant differences for other secondary or safety outcomes.Off‐label oral solution of misoprostol was non‐inferior to the licensed oral tablet regarding efficacy of IOL defined as vaginal delivery within 24 h.Clinicaltrials.gov identifier: NCT05424445 [ABSTRACT FROM AUTHOR]

Introduction: Newer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes. Methods: http://www.clinicaltrials.gov, Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis. Results: A total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 – 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 – 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 – 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 – 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 – 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 – 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score < 7 at 1 min (RR: 1.01: 95% CI: 0.57 – 1.80; P = 0.97), abnormality of fetal heart rate (RR: 1.45, 95% CI: 0.55 – 3.79; P = 0.45) and neonatal asphyxia (RR: 0.35, 95% CI: 0.10 – 1.18; P = 0.09) were also similarly manifested. Conclusions: To conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Fontan surgery is a palliative procedure commonly performed for functional single‐ventricle heart diseases. Fontan circulation is characterized by elevated central venous pressure and low cardiac output. It causes placental hypoxia, which could lead to poor obstetric outcomes. During post‐Fontan pregnancies, ultrasonography may detect abnormal appearance of the placenta. We have focused on higher incidences of unexpected onset of labor when this ultrasonographic finding is present. In this study, we aimed to investigate whether this finding could be an indicator of premature delivery before pre‐scheduled dates in post‐Fontan pregnancies.During post‐Fontan pregnancies, the placenta exhibits a mosaic pattern with areas of low and high echogenicity and unusually thick on ultrasonography. We refer to these changes as “ultrasonographic placental edematous changes.” We retrospectively analyzed clinical charts and ultrasonograms for post‐Fontan pregnancies between 2015 and 2022.Fifteen patients were included in this study. Ultrasonographic placental edematous changes in the placenta during pregnancy were detected in eight cases (53%). Six (75%) of these patients experienced unexpected premature labor. Two patients underwent vaginal delivery because of sudden onset of labor. Four patients underwent emergency cesarean sections. Two patients underwent planned preterm cesarean sections. In the seven pregnancies without placental edematous changes, all deliveries occurred on the pre‐scheduled dates determined based on the maternal heart condition.Pregnancies with ultrasonographic placental edematous changes have a higher risk of unexpected preterm delivery than those without these changes. Ultrasonographic placental edematous changes may serve as predictive markers for unplanned preterm births in post‐Fontan pregnancies. [ABSTRACT FROM AUTHOR]

Background: Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities in maternal blood transfusion. Objective: To assess racial disparities in maternal blood transfusion using detailed, self-identified racial groupings in the United States overall and stratified by mode of delivery. Study design: We performed a population-based, retrospective cohort study of full term, live births (2016–2021) using the National Vital Statistics System's Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of maternal blood transfusion by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors. Results: The study included 17,905,699 deliveries; maternal blood transfusion occurred in 3.4 per 1,000 deliveries. Compared with individuals who identified as White (3.3 per 1,000 transfusion rate), higher odds of transfusion were found among those who identified as American Indian and Alaska Native (AIAN; aOR 2.36, 95% CI 2.23–2.49), Black (aOR 1.15, 95% CI 1.12–1.17), Filipino (aOR 1.33, 95% CI 1.22–1.44), Korean (aOR 1.25, 95% CI 1.10–1.42), and Pacific Islander (aOR 1.63, 95% CI 1.45–1.83). The frequency of transfusion and racial disparities in transfusion varied substantially by mode of delivery. Lower rates of transfusion in Black vs White patients were observed in the spontaneous vaginal delivery (2.2 vs 2.3 per 1000; aOR 0.95, 95% CI 0.92–0.99), forceps (6.8 vs 8.9 per 1000; aOR 0.77, 95% CI 0.60–0.99), vacuum (4.2 vs 5.0 per 1000; aOR 0.85, 95% CI 0.74–0.97, and cesarean delivery with trial of labour (8.8 vs 8.9 per 1000; aOR 0.95, 95% CI 0.91–1.00) groups, while a higher rate was shown among cesarean deliveries without trial of labour (6.8 vs 4.3 per 1000; aOR 1.45, 95% CI 1.40–1.51). Conclusion: Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly for AIAN and Pacific Islander individuals, and vary by mode of delivery. [ABSTRACT FROM AUTHOR]

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized. Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda. Design: We employed a cross-sectional study design. Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson's moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH. Results: We included 105 participants, most were primigravida (n = 100, 43%), aged 15–24 years (n = 100, 52%), with term gestation (n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50–600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR −11,182.1–2226.7 ml). Visual estimation underestimated blood loss in 90% of cases (n = 100), and 21% (n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25–34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11–2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20–4.05, p < 0.012). Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To detect an abnormal intra‐amniotic structure around the internal cervical os using transvaginal sonography at 18–21+6 weeks of gestation.In this cohort study, during a 12‐month period from July 2022 to June 2023, 395 transvaginal scans were performed for second‐trimester cervical‐length screening in singleton pregnancies at 18–21+6 weeks of gestation. Nine abnormal intra‐amniotic structures (AIAS), 87 low‐lying placentas (LLP, second‐trimester placenta previa or placental margin within 2 cm from internal cervical os), and 299 controls (not LLP and no abnormal finding around internal cervical os) were diagnosed. Sonographic features of AIAS and delivery outcomes in the three groups were compared.Sonographic features of nine AIAS cases were: two single bands, one single broad band, one multiple bands, one single tubular, and one multiple tubulars. Blood flow was noted in seven cases. Seven AIAS had disappeared by 26 weeks, one was resolved at 34 weeks, and one (vasa previa and parachute placenta) remained until delivery. Incidences of emergency cesarean section, abnormal placenta and umbilical cord, and abnormal deliveries in AIAS were significantly higher than those in LLP and control groups (P = 0.031). Blood losses during delivery in AIAS and LLP groups were significantly greater than in the control group (P = 0.004), but there was no significant difference in blood loss between AIAS and LLP groups.The incidence of AIAS around the internal cervical os in the second trimester was 2.28% (9/395 fetuses). Mid‐second‐trimester transvaginal sonographic screening for the detection of AIAS around the internal cervical os including vasa previa may be essential to reduce perinatal morbidity. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.Retrospective case–control study conducted at a high‐volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post‐CD relaparotomy, compared with a control group that did not undergo a relaparotomy.Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78–5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54–14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10–10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79–12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06–12.48, P < 0.01).Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions. [ABSTRACT FROM AUTHOR]

Preterm infants are most at risk of iron deficiency. However, our knowledge of the regulation of iron homeostasis in preterm infants is poor. The main goal of our research was to develop and validate an animal model of human prematurity to assess iron status in preterm infants. We performed a cesarean section on sows on the 109th day of pregnancy, which corresponds to the last trimester of human pregnancy. Preterm piglets showed decreased body weight, red blood cell indices, plasma iron level and transferrin saturation. Interestingly, higher hepatic and splenic non-heme iron content and plasma and hepatic ferritin levels were found in premature piglets compared with term ones. In addition, premature piglets showed higher mRNA levels of iron-regulatory hormone hepcidin in the liver than term animals, which have not been reflected in higher plasma hepcidin-25 levels. We also showed changes in hepcidin regulators, including hepatic bone morphogenetic protein 6, plasma erythroferrone and growth differentiation factor 15 in preterm piglets. Consequently, no difference was observed in iron-exporter ferroportin levels in the spleen and liver. Overall, it seems that premature piglets show a pattern of iron metabolism characteristic of functional iron deficiency and iron accumulation in the tissue. [ABSTRACT FROM AUTHOR]

Cesarean section for breech presentation is often recommended. However, cesarean section affects future reproduction. The aim of this study was to assess the effect of mode of the first birth in breech on outcomes of the second birth and the two births together. This is a register-based nationwide cohort study including 23 062 women with a first singleton birth in breech ≥ 34 gestational weeks and a subsequent singleton birth in Sweden 2000–2019. Exposure was mode of first delivery. Main maternal outcome was a composite of fourth-degree perineal injury, postpartum hemorrhage requiring blood transfusion, hysterectomy, or death. Main infant outcome was a composite of stillbirth, extremely preterm birth (< 28 weeks), moderate to severe hypoxic ischemic encephalopathy, therapeutic hypothermia, or death. Outcomes were analyzed using multivariable logistic regression. In the first birth, the infant composite outcome affected < 1% in both groups but the risk was higher in the vaginal breech group (13/1525), compared with the breech CS group (27/21 537), aOR 7.06, 95% CI 2.91–17.1. In the second birth, the infant composite outcome affected < 1% in both groups but the risk was lower for the first vaginal breech group (3/1525) compared with the first breech CS group (152/21 537), aOR 0.26, 95% CI 0.08–0.84. There was no significant difference between the groups in risk of composite infant outcome in the two births assessed together, or in risk of composite maternal outcome. In total, the chance of a two-children family without maternal or infant severe adverse composite outcome was high and similar regardless mode of the breech first birth. [ABSTRACT FROM AUTHOR]

Background: There are limitations to predicting perinatal asphyxia, as current tools rely almost entirely on fetal cardiotocography (CTG). The fetal lack of responsiveness scale (FLORS) is a new diagnostic alternative based on the physiological phenomena associated with fetal hypoxia. Objectives: The objective of this study was to develop, validate, and assess the diagnostic accuracy of the FLORS for predicting severe perinatal hypoxia (SPH). Study Design: A two‐phase retrospective observational cross‐sectional analytical study was conducted. Phase 1 involved the formulation and retrospective validation of the FLORS. A total of 366 fetal CTG records were evaluated twice by seven readers. Phase 2 was a collaborative, retrospective, multicenter diagnostic test study that included 37 SPH and 366 non‐SPH cases. Results: Phase 1: A numeric, physiology‐based scale was developed and refined based on expert opinions. The median time to apply the scale per reading was 38 s. Cronbach's alpha, which is a reliability measure, was significant (p = 0.784). The kappa index for test–retest agreement was moderate to reasonable, with a median value of 0.642. For interobserver agreement, the kappa index per variable was as follows: baseline, 0.669; accelerations, 0.658; variability, 0.467; late/variable decelerations, 0.638; slow response decelerations, 0.617; and trend to change, 0.423. Phase 2, including 37 SPH and 366 non‐SPH cases, showed a sensitivity of 62.2% and specificity of 75.4% for the 2‐point score, whereas the 3‐point score had a sensitivity of 35.1% and specificity of 89.9%. The area under the curve (AUC) was significant at 0.73 (CI 0.645–0.818). Conclusions: FLORS demonstrated significant internal consistency and observer agreement, with a promising sensitivity–specificity balance and significant AUC. Further research is needed to assess its impact on perinatal hypoxia and cesarean delivery. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) is increasingly used in the management of haemorrhage during and after delivery and haemorrhage caused by other medical conditions due to its efficacy and safety. However, increasing report of fatal complications from inadvertent intrathecal TXA injection remains a cause of concern. The aim of this case report is to demonstrate clinical presentation and predictors of accidental intrathecal injection of TXA within the structure and processes of care in a health facility. Case Description: A 37‐year‐old woman, multiparous woman presented with a diagnosis of obstructed labour and, therefore, was scheduled for emergency caesarean section. She was assigned the American Society of Anesthesiology II physical status. Spinal anaesthesia was performed at a sitting position through L4‐L5 interspace using a 25‐G spinal needle gauge. The anaesthetist injected 3 mL of an aesthetic agent that was prepared earlier as hyperbaric bupivacaine 0.5%. About 2 min after receiving the injection, the patient reported gluteal discomfort and itching and severe back pain. She subsequently developed progressive altered mentation followed by generalized tonic–clonic seizures. General anaesthesia was conducted with propofol (100 mg), pethidine (50 mg) and suxamethonium (100 mg). Episodes of tonic–clonic seizures continued despite treatment with multiple doses of diazepam (10 mg), propofol (100 mg) and phenytoin infusion (1 gm). Postoperatively, the patient was transferred to the intensive care unit with persistent tachycardia (125–138 beats per minute), hypertension (157/105–175/118 mmHg) and oxygen saturation of 90%–95%. She died due to cardiac arrest after 21 h of stay. Conclusion: Medication error such as accidental intrathecal injection of TXA continues to jeopardise the safety of surgery under spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Background: The severe postpartum hemorrhage (SPPH) leads to dangerous maternal conditions, and its rate is still increasing and the trend in related risk factors is changing. Placenta-related problems remain the high-risk factor for SPPH. The object is to investigate the prevalence and the risk factors of the severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta. Method: A retrospective analysis of pregnant women with placenta previa or low-lying placenta after 28 weeks gestation from May 2018 to May 2023 in the Peking Union Medical College Hospital was conducted. The primary outcome was severe postpartum hemorrhage defined as blood loss ≥ 1000 mL within 24 h of childbirth, or with signs or symptoms of low blood volume requiring transfusion of ≥ 4U of red blood cells. Univariate and multivariate logistic regression were used to identify potential risk factors of severe postpartum hemorrhage and receiver operating curve to evaluate the prediction performance. Results: Of the 14,964 women, 201 met the inclusive criteria. SPPH rate was 1.3% overall and 18.9% in women with placenta previa or low-lying placenta. Weight (aOR = 0.93, 95%CI 0.87–0.99), increta or percreta placenta (aOR = 7.93, 95%CI 2.53–24.77) were the risk factors. The area under the ROC curve was 0.69(95%CI 0.59–0.80) for increta or percreta placenta alone, and 0.72(95%CI 0.62–0.82) for the combination of times of cesarean sections and anterior placenta. Conclusions: Placenta accreta spectrum was the key independent risk factor of SPPH in women with placenta previa or low-lying placenta. Antenatal risk assessment of SPPH in these population is highly desirable and optimal intervention could be planned. [ABSTRACT FROM AUTHOR]

Background: Overweight/ obesity among under-five children is an emerging public health issue of the twenty-first century. Due to the quick nutritional and epidemiological change, non-communicable diseases, premature death, disability, and reproductive disorders have grown in low-income countries. Besides, little attention has been given. Therefore, we aimed to explore spatial variations and predictors of overweight/obesity among under-five children in Ethiopia using a geospatial technique. Methods: A total weighted sample of 3,609 under-five children was included in the study. A cross-sectional study was conducted using a nationally representative sample of the 2019 Ethiopia Mini Demographic and Health Survey data set. ArcGIS version 10.8 was used to explore the spatial variation of obesity. SaTScan version 9.6 software was used to analyze the spatial cluster detection of overweight/obesity. Ordinary least square and geographically weighted regression analysis were employed to assess the association between an outcome variable and explanatory variables. A p-value of less than 0.05 was used to declare it statistically significant. Results: The spatial distribution of overweight/obesity among under-five children in Ethiopia was clustered (Global Moran's I = 0.27, p-value<0.001). The significant hot spot areas or higher rates of childhood obesity, were found in Southern Amhara, Northwest Somalia, Border of Harari, central Addis Ababa, Eastern SNNPR, and Northwestern Oromia region. In spatial SaT Scan analysis, 79 significant clusters of overweight/obesity were detected. The primary clusters were located in SNNPR, Oromia, and Addis Ababa (RR = 1.48, LLR = 31.40, P-value < 0.001). In the geographically weighted regression analysis, urban residence, cesarean section, rich households, and female children were statistically significant predictors. Conclusions: Overweight or obesity among under-five children show spatial variations across Ethiopian regions. GWR analysis identifies cesarean section, wealth index, urban residence, and child sex as significant predictors. The Ministry of Health and Ethiopian Public Health Institute should target regions with these contributing predictors, promoting localized physical education, health education campaigns, and ongoing community monitoring to encourage active lifestyles and reduce sedentary behaviors among children. [ABSTRACT FROM AUTHOR]

The document contains abstracts from the 2024 Scandinavian Society of Anaesthesia and Intensive Care Congress in Oulu, Finland, covering various studies on topics such as postpartum depression risk, propofol dose requirements, inappropriate prescribing patterns, and care for children with neurodevelopmental disorders. The studies aim to provide insights into mortality rates, patient outcomes, and quality of life in different medical contexts, emphasizing the need for tailored approaches and standardized practices to improve patient outcomes. The document also discusses studies related to critical care in patients with acute brain injury, traumatic brain injury, cardiac arrest, sepsis, and aneurysmal subarachnoid hemorrhage, highlighting potential benefits of interventions in improving survival rates and patient outcomes. Additionally, the text presents findings from research studies in the field of anesthesiology and pain management, exploring topics such as postoperative delirium prediction, pain catastrophizing, pain management protocols, and the feasibility of different pain relief methods. The studies underscore the importance of tailored care, multidisciplinary approaches, and standardized guidelines in improving patient outcomes and quality of care in anesthesia and critical care settings. [Extracted from the article]

To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS).A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6 weeks at a tertiary university-affiliated hospital, from March 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality.The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79–5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17–3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2–7 days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed to ACS (29.2 vs. 22.0 %, p=0.560).Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity. [ABSTRACT FROM AUTHOR]

Hybrid fibre reinforced polymer (FRP)-timber (HFT) thin-walled structural members are a novel technology developed recently as a sustainable alternative to thin-walled steel and aluminium structures. HFT structures are made by forming thin timber veneers and FRP laminates into efficient cross-sectional geometries. While existing studies have demonstrated the potential of HFT thin-walled members to be used as structural elements, a systematic study to investigate the behaviour of HFT thin-walled structures is yet to be carried out. This paper presents a study aimed at investigating the behaviour of HFT C-section columns under concentric axial loading. In total five HFT C-section specimens each from 700 mm to 2000 mm lengths were fabricated and tested. It was found that shorter HFT C-section columns failed due to local buckling while increase in length changed the failure mode to global buckling. Effect of GF orientation and density on load carrying capacity of the HFT C-section columns was investigated numerically. It was found that it's necessary to provide adequate GF volume in transverse to axis direction, but further increase in GF volume in transverse direction did not significantly increase the load carrying capacity. Increase in GF density in parallel to axis direction increased the load carrying capacity. [ABSTRACT FROM AUTHOR]

Objective This study aimed to compare adverse neonatal outcomes associated with the trial of labor after cesarean (TOLAC) at term in pregnancies according to maternal prepregnancy body mass index (BMI; kg/m 2) and the presence of previous vaginal delivery (VD). Study Design This was a repeated cross-sectional analysis of individuals with singleton, cephalic, and term deliveries with a history of one or two cesarean deliveries in the Linked Birth/Infant Death data from 2011 to 2020. Outcomes were examined according to the BMI category including BMI <30, 30 to 39.9, and 40 to 69.9 kg/m 2. The primary outcome was a composite neonatal outcome, defined as any presence of neonatal death, neonatal intensive care unit admission, assisted ventilation, surfactant therapy, or seizures. Outcomes were compared between TOLAC and elective repeat cesarean delivery (eRCD) after stratifying by BMI category and previous VD. Log-binomial regression was performed to obtain adjusted relative risk (aRR) with 99% confidence intervals, controlling for covariates. Results Of 4,055,440 individuals, 2,627,131 had BMI <30 kg/m 2 , 1,108,278 had BMI 30 to 39.9 kg/m 2 , and 320,031 had BMI 40 to 69.9 kg/m 2. In individuals with no previous VD, VD rates after TOLAC were 66.7, 57.2, and 48.1%, respectively. In individuals with previous VD, VD rates after TOLAC were 81.4, 74.7, and 67.3%, respectively. In individuals without previous VD, compared with those who had an eRCD, those who had TOLAC were more likely to experience composite neonatal outcomes in individuals with BMI < 30 kg/m 2 (5.0 vs. 6.5%; aRR = 1.33 [1.30–1.36]), BMI 30 to 39.9 kg/m 2 (6.1 vs. 7.8%; aRR = 1.29 [1.24–1.34]), and BMI 40 to 69.9 kg/m 2 (8.2 vs. 9.0%; aRR = 1.15 [1.07–1.23]). In individuals with previous VD, there was no difference in the composite neonatal outcomes in BMI < 30 kg/m 2 (6.2 vs. 5.8%; aRR = 0.98 [0.96–1.00]), BMI 30 to 39.9 kg/m 2 (7.4 vs. 7.1%; aRR = 0.99 [0.95–1.02]), and BMI 40 to 69.9 kg/m 2 (9.4 vs. 8.7%; aRR = 0.96 [0.91–1.02]). Conclusion TOLAC among obese individuals could be offered in selected cases. Key Points TOLAC among obese individuals could be offered selectively, despite their reduced likelihood of attempting or succeeding at it. Higher BMI individuals show decreased rates of both attempting and achieving successful TOLAC. Despite these trends, attempting TOLAC after a previous vaginal delivery does not heighten neonatal complications. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. Study Design This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 34 0/7 to 36 6/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 34 0/7 and 36 6/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. Results Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11–27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14–3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). Conclusion Latency antibiotics administered to women admitted with ROM between 34 0/7 and 36 6/7 weeks' gestation did not decrease the rate of neonatal sepsis. Key Points Latency antibiotics in late preterm ROM does not decrease neonatal sepsis. Latency antibiotics in late preterm ROM does not prolong gestational age at delivery. Latency antibiotics in late preterm ROM does not affect the mode of delivery. [ABSTRACT FROM AUTHOR]

Objective Intrahepatic cholestasis of pregnancy is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine if patients with a history of pregnancy complicated by cholestasis had an association with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis. Study Design Retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by cholestasis at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by cholestasis with versus without prior cholestasis. Our primary outcome was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for nonreassuring fetal heart tracing. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a p -value less than 0.05 and 95% confidence interval not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine Institutional Review Board approval was obtained for this project. Results Of the 795 multiparous pregnancies complicated by cholestasis, 618 (77.7%) had no prior history of cholestasis and 177 (23.3%) had prior history of cholestasis. Multiparous pregnancies with history of cholestasis had higher rates of prior preterm birth, earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. Pregnancies with history of cholestasis were not associated with spontaneous preterm labor in subsequent pregnancies with cholestasis, but history of cholestasis was associated with iatrogenic preterm birth and neonatal intensive care unit (NICU) admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of cholestasis and other adverse obstetric outcomes. Conclusion Findings suggests that history of prior cholestasis is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis. Key Points Prior cholestasis may not alter risk in subsequent pregnancies. Unclear relationship between cholestasis and hepatobiliary disease. Studies needed to develop cholestasis screening protocol. [ABSTRACT FROM AUTHOR]

Objective To assess the association between use of an oxytocin decision support checklist with oxytocin usage and clinical outcomes. Study Design We conducted a retrospective cohort study of patients with singleton gestations at 37 0/7 weeks or greater who received oxytocin during labor from October 2012 to February 2017 at an integrated community health care system during three exposure periods: (1) prechecklist; (2) after paper checklist implementation; and (3) after checklist integration into the electronic medical record (EMR). The checklist was a clinical decision support tool to standardize the dosing and management of oxytocin. Thus, our primary outcomes included oxytocin infusion rates and cumulative dose. Secondary outcomes included maternal and neonatal outcomes. We controlled for maternal risk factors with multivariable regression analysis and stratified by mode of delivery. Results A total of 34,269 deliveries were included. Unadjusted analyses showed that compared with prechecklist, deliveries during the paper and EMR-integrated periods had a lower cumulative dose (4,670 ± 6,174 vs. 4,318 ± 5,719 and 4,286 ± 5,579 mU, p < 0.001 for both), lower maximal infusion rate (9.9 ± 6.8 vs. 8.7 ± 5.8 and 8.4 ± 5.6 mU/min, p < 0.001 for both), and longer duration of oxytocin use (576 ± 442 vs. 609 ± 476 and 627 ± 488 minutes, p < 0.001 and p = 0.01, respectively). The unadjusted rates of cesarean, 5-minute Apgar <7, mechanical ventilation, and neonatal hospital length of stay were similar between periods. The adjusted mean difference in time from admission to delivery was longer during the EMR-integrated period compared with prechecklist (3.0 [95% confidence interval: 2.7–3.3] hours, p < 0.001). Conclusion Oxytocin checklist use was associated with decreased oxytocin use patterns at the expense of longer labor times. Findings were more pronounced with EMR integration. Key Points An oxytocin decision support checklist is associated with reduced amounts of oxytocin used. However, checklists were associated with longer duration of oxytocin use and of labor. Results were more pronounced in the EMR-integrated checklist compared with paper checklist. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine the relationship of fetal station in the first stage of labor to labor curves and cesarean delivery rates among women presenting in spontaneous labor. Study Design Labor curves for patients with nonanomalous singletons who presented in spontaneous labor to our hospital's Obstetric Triage Unit with intact membranes from January 1, 2012, to August 31, 2016, were reviewed. Cervical exams and time of exam were obtained for each patient from presentation to triage until delivery. Station for each presentation and cervical dilation was estimated using a random effects model and the slope of cervical station change was calculated to estimate the change in dilation by hour. Perinatal outcomes, including cesarean delivery rates, were examined according to fetal station at initial presentation. Factors known to affect labor curves—epidural analgesia, infant birth weight, maternal habitus, and parity—were also examined. Results There were 8,123 patients presented in spontaneous labor with intact membranes. For patients presenting at 6-cm dilation, the rate of change of labor was significantly different when identified to have a station greater than 0 (+1 and more caudad) when compared with those with −1 and more cephalad station (both p < 0.001). This relationship persisted when analyzed according to epidural analgesia, birth weight, maternal habitus, and parity. The frequency of cesarean delivery was significantly higher for women presenting in spontaneous labor with negative fetal station (p < 0.05). When stratified across all dilation (3–9 cm), this trend remained significant (p < 0.001). Conclusion In the first stage of labor, advanced fetal station was significantly associated with differing rates of labor progression, and positive fetal station was significantly less likely to result in cesarean delivery. Physical examination, including station, remains a critical element in labor management. Key Points Fetal station is important in labor management. Fetal station at initial exam is related to time to delivery. Positive fetal station at initial exam is less likely to result in cesarean delivery. [ABSTRACT FROM AUTHOR]

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

Spinal anesthesia is a widely practiced anesthetic technique during cesarean section but is associated with the risk of postdural puncture headache (PDPH). This article reports a case of refractory PDPH following a cesarean section that achieved immediate pain relief after a sphenopalatine ganglion block (SPGB). SPGB has been proposed as a non‐invasive alternative to the traditional epidural blood patch for nonobstetrical PDPH, nonetheless, it is a procedure not commonly performed by obstetricians. By targeting the sphenopalatine ganglion, SPGB offers a viable treatment option for PDPH and provides immediate relief to patients. This case report and literature review suggest that SPGB is a promising, effective, and safe approach for managing PDPH after cesarean section. Considering SPGB as an alternative to epidural blood patch, obstetricians can offer noninvasive treatment options for patients with PDPH. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure. Aim: To compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes. Methods: A prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support. Results: Delivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother's illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037). Conclusions: Women with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers' health. [ABSTRACT FROM AUTHOR]

Background: Dystocia is rare in horses, but is life-threatening for mares and foals. Therefore, veterinary research depends on up-to-date data to optimise equine dystocia management. In addition, knowledge of the prognosis of equine dystocia is necessary to advise animal owners. This retrospective study of equine dystocia aimed to enrich existing datasets with up-to-date information. For the first time, the focus was on the causes of dystocia that occurred alone or in combination. Over a period of 10 years, 72 cases of dystocia were analysed using a standardised, predetermined diagnosis code. Results: Of the 72 cases of dystocia, an isolated cause of dystocia was identified in 37 cases (51.4%) and 35 mares showed a combination of two or more causes (48.6%). Foetal causes were significantly more frequent origin of dystocia (66/69) than maternal causes (3/66) (P < 0.0001). Incorrect posture of the foetal forelimbs and head was the most common combination at 25.7%. The most common isolated cause of dystocia was incorrect posture of the foetal forelimbs (18.9%). A foetotomy was performed in 68% of cases. A caesarean section or an extraction was performed in 13.9% of the cases. Three mares died before any obstetric care was provided. Nine mares (12.5%) were not discharged alive. 73 foals were delivered of which 55 were already dead before veterinary treatment began. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% and 88.9% by the time the mare was discharged. Conclusions: It has been demonstrated for the first time that multiple causes of dystocia in horses are almost as common as isolated causes of dystocia. Neonatal mortality remains high, indicating that the timely detection and treatment of dystocia has the highest priority. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Discussion Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real‐world data and a return‐on‐investment (ROI) analysis approach.We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post‐COVID‐19 program costing estimates were also performed.Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per‐person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not.The BBB‐enhanced community doula program was cost‐saving to payers and increased access to doula support for low‐income people. Even with post‐COVID‐19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget‐conscious Medicaid payers that doula services are affordable. [ABSTRACT FROM AUTHOR]

Previous studies have reported that mode of delivery, particularly cesarean delivery (CD), is associated with neurodevelopmental outcomes in children. This study evaluates behavioral and neuropsychological test scores in children based on mode of delivery.Children enrolled in the Raine Study from Western Australia, born between 1989 and 1992 by instrumental vaginal delivery (IVD), elective CD, and non-elective CD, were compared to those with spontaneous vaginal delivery (SVD). The primary outcome was the Child Behavior Checklist (CBCL) administered at age 10. Secondary outcomes included evaluations of language, motor function, cognition, and autistic traits. Multivariable linear regression was used to evaluate score differences by mode of delivery adjusted for sociodemographic and clinical characteristics, and Poisson regression was used to evaluate for increased risk of clinical deficit.Of 2,855 children, 1770 (62.0 %) were delivered via SVD, 480 (16.8 %) via IVD, 346 (12.1 %) via elective CD, and 259 (9.1 %) via non-elective CD. Non-elective CD was associated with higher (worse) CBCL Internalizing (+2.09; 95 % CI 0.49, 3.96; p=0.01) scores, and elective CD was associated with lower (worse) McCarron Assessment of Neuromuscular Development (MAND) (−3.48; 95 % CI −5.61, −1.35; p=0.001) scores. Differences were not seen in other outcomes, and increased risk of clinical deficit was not observed with either the CBCL Internalizing or MAND scores.Differences in behavior and motor function were observed in children delivered by CD, but given that score differences were not associated with increased incidence of clinical deficit, clinical significance may be limited. [ABSTRACT FROM AUTHOR]

Background: Gastroschisis is a rare congenital anomaly in which abdominal organs herniate through a defect in the abdominal wall. Managing gastroschisis in extremely low birth weight (ELBW) infants presents significant challenges because of their immature physiologies and increased risk of complications. Case presentation: This report discusses the case of a female ELBW infant born via an emergency cesarean section at 29 weeks of gestation, weighing 768 g, who had a prenatal diagnosis of gastroschisis. Postnatal management included immediate surgical intervention using a hand-made silo manufactured from expanded polytetrafluoroethylene (ePTFE) sheets that were sutured to the patient's abdominal wall to accommodate her small abdominal cavity and preserve mesenteric blood flow. Necrotizing enterocolitis with bowel perforation emerged as a complication, which led to the excision of a 10 cm segment of the ileum and the creation of an ileostomy. The infant experienced insufficient weight gain and liver dysfunction. However, she was eventually discharged on day 142 of life, weighing 2774 g, on oral feeding, without significant complications. Conclusions: This case emphasizes how prematurity significantly affected the patient's clinical outcomes, and highlights the importance of individualized management strategies. Our experience demonstrates that custom silo placement allows for the size to be adapted to the abdominal defect, and highlights the critical need to prioritize postnatal bowel perfusion in ELBW infants with gastroschisis. [ABSTRACT FROM AUTHOR]

Background: Post-partum hemorrhage (PPH) is a leading cause of maternal death worldwide. However, the effect of blood transfusion in patients undergoing cesarean section remains unclear. Materials and methods: The analysis was based on the retrospective evaluation of the pre- and post-operative data for 1231 patients who underwent a cesarean section at our hospital between January 2016 and June 2020. Patients were classified into the blood transfusion group (BT) and the no blood transfusion group (NBT) based on their intra-operative blood transfusion status. Results: After propensity score matching, 322 patients were included in both groups and between-group differences in length of hospital stay (LOS), perioperative systemic inflammation indicators, and post-operative complications were evaluated. The LOS was longer in the BT (median, 6.6 days) than the NBT (median, 4.2 days) group (P = 0.026). The post-operative complication rate was higher for the BT than NBT group, as follows: vomiting, 3.2% vs. 4.9%, P = 0.032; fever, 5.41% vs. 2.24%, P = 0.032; wound complications, 15.44% vs. 10.45%, P = 0.028; and intestinal obstructions, 5.88% vs. 2.75%, P = 0.034. Systemic inflammation indicators increased significantly, from the pre-operative baseline, for both groups at post-operative day (POD) 1 and POD3. On multivariate analysis, intra-operative blood transfusion was associated with a longer LOS (hazard ratio, 1.52; 95% confidence interval, 1.07–2.25). Conclusion: Intraoperative blood transfusion for cesarean section was associated with increased levels of systemic inflammation indicators, higher post-operative complication rates, and prolonged hospital stay. [ABSTRACT FROM AUTHOR]

Background: Around 60% of term labours in the UK are continuously monitored using cardiotocography (CTG) to guide clinical labour management. Interpreting the CTG trace is challenging, leading to some babies suffering adverse outcomes and others unnecessary expedited deliveries. A new data driven computerised tool combining multiple clinical risk factors with CTG data (attentive CTG) was developed to help identify term babies at risk of severe compromise during labour. This paper presents an early health economic model exploring its potential cost-effectiveness. Methods: The model compared attentive CTG and usual care with usual care alone and simulated clinical events, healthcare costs, and infant quality-adjusted life years over 18 years. It was populated using data from a cohort of term pregnancies, the literature, and administrative datasets. Attentive CTG effectiveness was projected through improved monitoring sensitivity/specificity and potential reductions in numbers of severely compromised infants. Scenario analyses explored the impact of including litigation costs. Results: Nationally, attentive CTG could potentially avoid 10,000 unnecessary alerts in labour and 2400 emergency C-section deliveries through improved specificity. A reduction of 21 intrapartum stillbirths amongst severely compromised infants was also predicted with improved sensitivity. Attentive CTG could potentially lead to cost savings and health gains with a probability of being cost-effective at £25,000 per QALY ranging from 70 to 95%. Potential exists for further cost savings if litigation costs are included. Conclusions: Attentive CTG could offer a cost-effective use of healthcare resources. Prospective patient-level studies are needed to formally evaluate its effectiveness and economic impact in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Congenital shoulder dislocation due to shoulder girdle malformation is called true congenital shoulder dislocation. It is an extremely rare disorder as compared with traumatic dislocation or secondary to brachial plexus injury. Case presentation: We report a case of atraumatic true congenital shoulder dislocation, one of the few reported cases across the world. The baby was born of a preterm caesarean section at 30 weeks of gestation, ruling out any perinatal trauma. The baby presented with a lateral shoulder crease and reduced movements of the affected upper limb. The diagnosis was confirmed with radiographs and a sonography that ruled out physeal injury. Treatment involved prompt closed reduction and stabilization by swathing in an adducted internally rotated position for two weeks. Conclusion: Owing to the rarity of this condition, the case is being reported to be archived with a handful of other such cases. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The purpose of this study was to compare the effects of two caregiving models on full‐term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother–infant separation of 130 min after elective cesarean birth.Ninety‐five mother–infant pairs participated in a randomized controlled trial, in which full‐term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin‐to‐skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother.The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin‐to‐skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin‐to‐skin group compared to the infants in the mothers' arms group.Healthy full‐term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother–infant separation, initiated breastfeeding successfully and showed stable physiological patterns. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder that occurs at a rate of approximately 0.05% of pregnancies and less than 0.2% of cesarean scars. The ultimate goal in the management of CSEP cases is to remove pregnancy and reduce morbidity while preserving fertility. This case report highlights the successful application of a conservative laparoscopic approach in managing a 14‐week viable CSEP. Case Presentation: A 35‐year‐old multiparous woman (G8P5A2L5) with five previous cesarean sections and five normal healthy children presented to the clinic with a viable CSEP of 14 weeks of gestation as revealed by abdominal and transvaginal ultrasound examination. The decision for a conservative laparoscopic approach was made in light of the patient's desire to preserve fertility. Intervention and outcome: The laparoscopic procedure included the following steps: extensive dissection of adhesions between the bladder and the uterus; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception in an endobag; and suturing of the lower segment defect. The successful execution of these steps resulted in the removal of the ectopic pregnancy while addressing associated structural concerns. This approach allowed for mitigating morbidity and, importantly, preserving the patient's fertility. Conclusion: This case highlights the importance of a conservative laparoscopic approach for CSEP in the second trimester. Imaging techniques play a pivotal role in accurate diagnosis, with minimally invasive technologies offering effective solutions. Individualized, patient‐centered approaches are necessary to prioritize clinical outcomes and patient preferences. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) continues to stand as the primary cause of maternal morbidity and mortality post-delivery, with twin pregnancies carrying a heightened risk of PPH compared to singleton deliveries. Objectives: To investigate the incidence of primary PPH among twin pregnancies and report on maternal and peripartum characteristics within this population. Methods: A literature search was conducted using data from PubMed, EMBASE, Cochrane, Scopus, and Web of Science. The search aimed to identify studies concerning mothers with twin pregnancies and postpartum haemorrhage (PPH) from the inception of each respective database to June 8th, 2023. Pooled means and proportions were analyzed using the generic inverse variance method. This review was registered prospectively with PROSPERO (CRD42023427192). Results: A total of 21 studies involving 23,330 twin pregnant patients were included. Incidence of PPH for vaginal delivery and Caesarean delivery (CS) was found to be 10.9% (95% CI: -0.017, 0.235, I2 = 96%) and 27.0% (95% CI: 0.180, 0.359, I2 = 99%) respectively. In vitro fertilization (IVF) was the most common conception method at 62.0% (95% CI: 0.448, 0.792, I2 = 100%) with 81.1% (95% CI: 0.708, 0.915, I2 = 100%) of twins being dichorionic diamniotic. Conclusion: This meta-analysis demonstrated more than one in ten vaginal deliveries and over one in four cesarean sections result in PPH for twin pregnancies. IVF is the predominant method of conception in this patient group and seems to contribute to subsequent PPH risk in specific mothers. While preliminary, these findings underscore the necessity for further well-designed and high-quality studies to validate these results. [ABSTRACT FROM AUTHOR]

Background: Although subdural hematoma is a rare complication after spinal anesthesia, there have been no reports of an intracranial epidural hematoma after cesarean section with spinal anesthesia. Case presentation: A 32-year-old nulliparous woman at the 35th week of a twin pregnancy underwent an emergency cesarean section due to her first contraction. She had no preoperative complications and the spinal anesthesia was uneventful, with 0.5% bupivacaine 12 mg and fentanyl 15 µg from the L3/4 intervertebral space. She complained of headache and nausea 15 min after spinal anesthesia, demonstrating a consciousness disturbance after surgery. Computed tomography 2 h after the cesarean section revealed an intracranial epidural hematoma. She underwent decompressive craniotomy 1 h later. Conclusion: This case highlights the possible development of an intracranial epidural hematoma in low-risk obstetric patients. [ABSTRACT FROM AUTHOR]

Background: Vaginal noise (VN) is a natural phenomenon that arises when air is forced into the vagina and then expelled as the vaginal wall muscles naturally contract. It has been described as involuntarily passing gas from the vagina. VN is a symptom of pelvic floor (PF) dysfunction and can cause social and psychological issues. Data on it is limited, and women rarely voluntarily report it. So, this study was conducted to determine the prevalence, bother, and relation between VN and PF muscle dysfunction. Material and methods: It was a cross-sectional study that included females with age ranges from 30 to 60 years old, body mass index (BMI) ranges from 18 to 30 kg/m2, married, single, virgin, nulliparous, and multiparous women; those with previous one or more vaginal deliveries or cesarean sections (CS) or history of anterior and/or posterior vaginal wall prolapses; and those who had undergone medical interventions such as vaginal surgeries (e.g., pelvic floor reconstruction, hysterectomy), stress urinary incontinence, urge incontinence, and fecal incontinence. The Vaginal Wind Questionnaire, Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), and Pelvic Floor Bother Questionnaire were used as methods of evaluating the VN prevalence and bother and its relation to PF dysfunction. Results: It was noted that there was a 76.3% prevalence of VN and 75% bother among the study population. Eighty-eight percent of them did not seek any treatment, and VN occurred in 84.3% of females with pelvic floor muscle weakness. Conclusion: VN is common in middle-aged Egyptian women, most frequently occurring with sexual intercourse, vaginal delivery, and pelvic floor muscle weakness. [ABSTRACT FROM AUTHOR]

Background: Lower segment caesarean section (LSCS) is one of the most common surgical procedures done in obstetrics. The growing rate of caesarean sections globally, particularly in India, highlights the need for effective methods to assess the scar integrity. This study aims to compare the clinical findings (presence of scar tenderness) with radiological assessment (scar thickness) to predict intraoperative scar status in women with a history of previous LSCS. Methodology: This retrospective study involved 60 antenatal women with a history of previous LSCS. Data collection was done over six months, including clinical evaluation and transabdominal ultrasonography to measure scar thickness. Intraoperative findings were classified into normal, thinnedout, dehiscent, or scar rupture. Statistical analysis was performed to determine the correlation between clinical and radiological findings and results were tabulated. Results: In this study, the mean duration since the last LSCS was 4.02 ± 2.9 years. Intraoperative scar status was categorised as normal (31.6%), thinned-out (56.6%), scar dehiscence (11.66%), and no cases of scar rupture. Clinical assessment showed scar tenderness with a sensitivity of 36.58%, specificity of 94.73%, positive predictive value (PPV) of 93.75%, and negative predictive value (NPV) of 40.90%. Radiological assessment of scar thickness had a sensitivity of 17.07%, specificity of 89.47%, PPV of 77.77%, and NPV of 33.33%. Scar tenderness demonstrated a significant correlation with intraoperative findings (p-value 0.011), whereas scar thickness did not (p-value 0.705). Conclusion: In this study, clinical examination for scar tenderness was a more reliable predictor of intraoperative scar status compared to radiological assessment of scar thickness. This study suggests that clinical evaluation remains a crucial tool for predicting scar integrity in women with previous LSCS, however the role of measurement of scar thickness radiologically has also shown promising results in a few studies. Also the measurement of scar thickness depends upon inter-observer and intra-observer error. Hence further research is needed to explore the potential role of radiological evaluation involving methods ensuring greater degree of precision. [ABSTRACT FROM AUTHOR]

Background: The incidence of breech presentation at term is about 3-4%. Prematurity and associated fetal congenital anomalies have a higher incidence. Planned caesarean deliveries have become routine for breech babies due to the improved neonatal. Aim: The aim of this study is to compare the maternal and fetal outcomes of patients with breech presentation who delivered vaginally versus those who delivered by caesarean section. Materials & methods: This study was retrospective in nature, encompassing 100 cases where a singleton fetus was admitted to the labor room with a breech position. We studied each case for its demographic profile, parity, gestational age, high risk factors, mode of delivery, indication of caesarean section, and neonatal outcomes. Results: Out of 100 cases, 25% delivered vaginally, 55% underwent emergency caesarean sections, and 20% had elective caesarean sections. 54% of women were nulliparous, and 45% were multiparous. The most common reason for emergency caesarean delivery was a 52% refusal for a trial of vaginal delivery, while 47% of elective caesarean deliveries were due to a primigravida with a breech baby. At 5 minutes of birth, 65% of vaginally delivered babies had an APGAR of >7, compared to 87% of babies delivered by emergency caesarean section and 100% of babies delivered after elective caesarean section. Vaginally delivered babies had an average birth weight of 1.8 kg, 2.5 kg in emergency caesarean, and 2.9 kg in elective caesarean. In different groups, there was no maternal mortality or significant maternal morbidity. Conclusion: In carefully selected patients, planned vaginal delivery in both preterm and term breech can be conducted after proper patient counseling, strict intrapartum monitoring, and the presence of an obstetrician trained in the art of conducting breech deliveries. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. METHODS: Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. RESULTS: Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, 21.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 (P,.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). CONCLUSION: Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the optimal gestational age to deliver pregnant people with chronic hypertension to improve perinatal outcomes. METHODS: We conducted a planned secondary analysis of a randomized controlled trial of chronic hypertension treatment to different blood pressure goals. Participants with term, singleton gestations were included. Those with fetal anomalies and those with a diagnosis of preeclampsia before 37 weeks of gestation were excluded. The primary maternal composite outcome included death, serious morbidity (heart failure, stroke, encephalopathy, myocardial infarction, pulmonary edema, intensive care unit admission, intubation, renal failure), preeclampsia with severe features, hemorrhage requiring blood transfusion, or abruption. The primary neonatal outcome included fetal or neonatal death, respiratory support beyond oxygen mask, Apgar score less than 3 at 5 minutes, neonatal seizures, or suspected sepsis. Secondary outcomes included intrapartum cesarean birth, length of stay, neonatal intensive care unit admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn, and hypoglycemia. Those with a planned delivery were compared with those expectantly managed at each gestational week. Adjusted odds ratios (aORs) with 95% CIs are reported. RESULTS: We included 1,417 participants with mild chronic hypertension; 305 (21.5%) with a new diagnosis in pregnancy and 1,112 (78.5%) with known preexisting hypertension. Groups differed by body mass index (BMI) and preexisting diabetes. In adjusted models, there was no association between planned delivery and the primary maternal or neonatal composite outcome in any gestational age week compared with expectant management. Planned delivery at 37 weeks of gestation was associated with RDS (7.9% vs 3.0%, aOR 2.70, 95% CI, 1.40-5.22), and planned delivery at 37 and 38 weeks was associated with neonatal hypoglycemia (19.4% vs 10.7%, aOR 1.97, 95% CI, 1.27-3.08 in week 37; 14.4% vs 7.7%, aOR 1.82, 95% CI, 1.06-3.10 in week 38). CONCLUSION: Planned delivery in the early-term period compared with expectant management was not associated with a reduction in adverse maternal outcomes. However, it was associated with increased odds of some neonatal complications. Delivery timing for individuals with mild chronic hypertension should weigh maternal and neonatal outcomes in each gestational week but may be optimized by delivery at 39 weeks. [ABSTRACT FROM AUTHOR]