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IntroductionTo describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.MethodsWe conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).FindingsIn the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36).ConclusionsHungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.

Introduction: Our objective was to compare the performance of the first vaginal examination at 8 vs 4 h after amniotomy following Foley ripening in nulliparous labor induction. Material and Methods: A randomized controlled trial was conducted from June 2021 to January 2022. 210 nulliparas at term for labor induction were randomized: 105 each to first vaginal examination at 8 or 4 h after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to expedite labor. Primary outcomes were the amniotomy‐to‐delivery interval (non‐inferiority hypothesis) and maternal satisfaction with their allocated labor care (superiority hypothesis) within 24 h after delivery. Analyses performed using t‐test, Mann–Whitney U test, and Chi‐squared test as appropriate. Results: The amniotomy‐to‐delivery interval was mean ± standard deviation 8.7 ± 3.4 vs 8.4 ± 3.7, mean difference 0.4 (97.5% CI: −0.7 to 1.5) hours, p = 0.442 within the pre‐specified 2‐hour non‐inferiority margin, and maternal satisfaction score with allocated labor care was median [interquartile range] 8[7.5–10] vs 8[7.0–10], p = 0.248 for 8 vs 4 h arms, respectively. The amniotomy to first vaginal examination intervals was 5.9 ± 2.3 vs 3.6 ± 1.0 h, p < 0.001, and the number of vaginal examinations was 2[1–2.5] vs 3 [2, 3], p < 0.001 for 8 vs 4 h, respectively. The first vaginal examination was less likely to have been performed as scheduled, more likely to be indicated by the urge to bear down, and non‐reassuring cardiotocography for the 8 h arm (p < 0.001). Spontaneous vaginal delivery was significantly more likely and instrumental vaginal delivery less likely, but cesarean rate was not significantly different for the 8 h arm (p = 0.017). Conclusions: A routine first vaginal examination at 8 h compared to 4 h is non‐inferior for the time to birth but does not increase maternal satisfaction although the number of vaginal examinations is fewer. The increase in spontaneous vaginal delivery and reduction in instrumental vaginal delivery rates warrant further powered primary evaluation. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Cesarean delivery is the most common mode of delivery among extremely preterm infants but there are insufficient data regarding the best mode of delivery among extremely preterm singletons. The objective of this study was to compare the rate of death or severe neurodevelopmental impairment among extremely preterm singletons by actual mode of delivery.Observational study using prospectively collected data from 25 US medical centers. We included postnatally‐treated singletons with birth weight 401–1000 g, gestational age 22 + 0/7–26 + 6/7 weeks, without a major birth defect, born 2006–2016. Death or severe neurodevelopmental impairment (Bayley Scales of Infant Development‐3rd edition cognitive composite score<70, cerebral palsy (Gross Motor Function Classification Scale >3), bilateral blindness, or bilateral hearing loss) at 18–26 month follow‐up were compared by mode of delivery (cesarean, vaginal including vertex or breech) using propensity score analysis to adjust for baseline characteristics.There was no difference in death or severe neurodevelopmental impairment between cesarean and vaginal (vertex or breech) births (42.4% cesarean vs. 47.2% vaginal; adjusted odds ratio (aOR), 95% confidence intervals (CI); 1.03, 0.91–1.17). Both cesarean delivery (26.8% cesarean vs. 51.5% breech vaginal; aOR: 0.71; 95% CI: 0.55–0.92) and vertex vaginal delivery (28.5% vertex vaginal vs. 51.5% breech vaginal; aOR: 0.59; 95% CI: 0.45–0.76) were associated with lower mortality compared with breech vaginal delivery.Among postnatally‐treated extremely preterm singletons, there was no difference in death or severe neurodevelopmental impairment between cesarean or vaginal delivery. Both vertex vaginal and cesarean delivery were associated with lower mortality compared with breech vaginal delivery. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Occiput posterior (OP) position rates at birth are 5%–8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub‐Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor.The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre‐labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock.The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non‐OA group (27 cesarean section and one vacuum extraction) (p < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13–0.52) for the non‐OA versus the OA group in nulliparous women and 0.25 (95% CI 0.12–0.52) in parous women.The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non‐OA versus OA position in the second stage. [ABSTRACT FROM AUTHOR]

Background and Aims: Regional techniques are a part of multimodal analgesia following cesarean delivery. Cesarean delivery warrants a regional technique, which can provide somatic and visceral analgesia-like quadratus lumborum block (QLB) and erector spinae plane block (ESPB). In this study, we investigated the non-inferiority of ESPB at T12 and transmuscular-QLB (TQLB) at L2-L3 for postoperative analgesia in cesarean delivery. Material and Methods: In this prospective, randomized, non-inferiority trial, 124 patients undergoing cesarean delivery were enrolled to receive bilateral TQLB or ESPB with 20 mL of 0.25% ropivacaine on each side. All patients received prophylactic acetaminophen and ketorolac for 2 days. Our primary objective was to compare the total tramadol consumption in the first 48 h between the two groups. Secondary objectives were to compare cumulative tramadol consumption, postoperative Numeric Rating Scale (NRS) score at rest, and with movement at various time points, the time for first rescue analgesic requirement, development of complications related to the block, and patient satisfaction with analgesia between the two groups. Results: The total tramadol consumption in 48 h (47.3 ± 34.9 mg in ESPB and 50.9 ± 38.7 mg in TQLB), duration of first rescue analgesic (22.8 ± 15.8 h in ESPB and 22.7 ± 15.6 h in TQLB), and patient satisfaction were similar between the two groups. Both groups had similar pain scores except at rest at 6 h and on movement at 4 h, 6 h, and 36 h, whereas the ESPB group had lower NRS scores (P < 0.05). Conclusion: The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB post-caesarean delivery.

Uterocutaneous fistula is a rare pathology that commonly occurs following uterine surgeries, endometriosis, chronic infection, malignancy, and foreign bodies. Many diagnostic and management strategies have been practiced. In this case series, we describe three cases of uterocutaneous fistula following cesarean and myomectomy, which was diagnosed clinically, confirmed by magnetic resonance imaging, and managed successfully by surgery with fertility preservation.

Abstract Background To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants’ institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities.

ABSTRACT Aims/Introduction A debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post‐load glucose and first‐trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus. Materials and Methods A dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9). Results Important associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR

Introduction: Despite increasing incidence of impacted fetal head at cesarean birth and associated injury, it is unclear which techniques are most effective for prevention and management. A high quality evidence review in accordance with international reporting standards is currently lacking. To address this gap, we aimed to identify, assess, and synthesize studies comparing techniques to prevent or manage impacted fetal head at cesarean birth prior to or at full cervical dilatation. Material and Methods: We searched MEDLINE, Emcare, Embase and Cochrane databases up to 1 January 2023 (PROSPERO: CRD420212750016). Included were randomized controlled trials (any size) and non‐randomized comparative studies (n ≥ 30 in each arm) comparing techniques or adjunctive measures to prevent or manage impacted fetal head at cesarean birth. Following screening and data extraction, we assessed risk of bias for individual studies using RoB2 and ROBINS‐I, and certainty of evidence using GRADE. We synthesized data using meta‐analysis where appropriate, including sensitivity analyses excluding data published in potential predatory journals or at risk of retraction. Results: We identified 24 eligible studies (11 randomized and 13 non‐randomized) including 3558 women, that compared vaginal disimpaction, reverse breech extraction, the Patwardhan method and/or the Fetal Pillow®. GRADE certainty of evidence was low or very low for all 96 outcomes across seven reported comparisons. Pooled analysis mostly showed no or equivocal differences in outcomes across comparisons of techniques. Although some maternal outcomes suggested differences between techniques (eg risk ratio of 3.41 [95% CI: 2.50–4.66] for uterine incision extension with vaginal disimpaction vs. reverse breech extraction), these were based on unreliable pooled estimates given very low GRADE certainty and, in some cases, additional risk of bias introduced by data published in potential predatory journals or at risk of retraction. Conclusions: The current weaknesses in the evidence base mean that no firm recommendations can be made about the superiority of any one impacted fetal head technique over another, indicating that high quality training is needed across the range of techniques. Future studies to improve the evidence base are urgently required, using a standard definition of impacted fetal head, agreed maternal and neonatal outcome sets for impacted fetal head, and internationally recommended reporting standards. [ABSTRACT FROM AUTHOR]

Background: To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods: This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results: Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants' institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion: Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities. [ABSTRACT FROM AUTHOR]

Background and Aims: Regional techniques are a part of multimodal analgesia following cesarean delivery. Cesarean delivery warrants a regional technique, which can provide somatic and visceral analgesia-like quadratus lumborum block (QLB) and erector spinae plane block (ESPB). In this study, we investigated the non-inferiority of ESPB at T12 and transmuscular-QLB (TQLB) at L2-L3 for postoperative analgesia in cesarean delivery. Material and Methods: In this prospective, randomized, non-inferiority trial, 124 patients undergoing cesarean delivery were enrolled to receive bilateral TQLB or ESPB with 20 mL of 0.25% ropivacaine on each side. All patients received prophylactic acetaminophen and ketorolac for 2 days. Our primary objective was to compare the total tramadol consumption in the first 48 h between the two groups. Secondary objectives were to compare cumulative tramadol consumption, postoperative Numeric Rating Scale (NRS) score at rest, and with movement at various time points, the time for first rescue analgesic requirement, development of complications related to the block, and patient satisfaction with analgesia between the two groups. Results: The total tramadol consumption in 48 h (47.3 ± 34.9 mg in ESPB and 50.9 ± 38.7 mg in TQLB), duration of first rescue analgesic (22.8 ± 15.8 h in ESPB and 22.7 ± 15.6 h in TQLB), and patient satisfaction were similar between the two groups. Both groups had similar pain scores except at rest at 6 h and on movement at 4 h, 6 h, and 36 h, whereas the ESPB group had lower NRS scores (P < 0.05). Conclusion: The analgesic effect of bilateral ESPB at T12 was non-inferior to that of bilateral TQLB post-caesarean delivery. [ABSTRACT FROM AUTHOR]

Aims/Introduction: A debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post‐load glucose and first‐trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus. Materials and Methods: A dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9). Results: Important associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR <7 at 1 or 5 min, hyperbilirubinemia, and poly‐ or oligo‐hydramnios. Overall, the predictive models showed good performance and large areas under the curves (0.732, 0.765, 0.646, 0.651, 0.730, 0.646, 0.684, 0.716, and 0.678, respectively). Specifically, they had high positive likelihood ratios. Conclusions: High glucose levels were associated with adverse pregnancy outcomes. Post‐load glucose was the most reliable test for predicting the outcomes. Overall, fasting blood sugar was of more predictive value than HbA1c. Our study showed that further research should account for the nonlinearity and interactions inherent in the data. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to outline the perspectives of obstetricians/gynecologists (physicians) and midwives regarding the alarmingly high rates of cesarean sections (CSs) to identify areas for improvement and describe the role of a regional obstetric quality initiative. Material and methods: A cross-sectional study was performed utilizing real-world data from questionaries provided to Greek midwives and obstetricians. Primary outcomes included the attitudes of Greek physicians and midwives toward the CS rates in Greece and around the world, as well as identifying potential solutions for lowering these rates. The secondary outcome was the potential correlation between the answers of the participants and their demographic parameters. Results: A total of 456 physicians and 234 midwives participated in the survey. Greek CS rates (>50 %) were considered “acceptable” and inevitable by 29.7 % and 32 % of the participants, respectively. Stratified analysis based on profession showed that significantly fewer midwives compared to obstetricians would agree with current CS rates. Participants who had obtained their degrees abroad were more likely to consider all CS rates more justified than physicians and midwives who had graduated from Greek medical schools. For all questions, the younger age subgroups responded in a way toward the non-acceptability of CS rates and favored the implementation of rules and practice control according to guidelines. The responses did not differ significantly between male and female physicians. Conclusions: Greek midwives, to a greater degree than obstetricians/gynecologists, consider the current CS rates unjustified and agree on the importance of implementing appropriate interventions to reduce them.

Cesarean delivery is associated with diminished plasma levels of several birth-signaling hormones, such as oxytocin and vasopressin. These same hormones have been previously shown to exert organizational effects when acting in early life. For example, our previous work found a broadly gregarious phenotype in prairie voles exposed to oxytocin at birth. Meanwhile, cesarean delivery has been previously associated with changes in social behavior and metabolic processes related to oxytocin and vasopressin. In the present study, we investigated the long-term neurodevelopmental consequences of cesarean delivery in prairie voles. After cross-fostering, vole pups delivered either via cesarean or vaginal delivery were studied throughout development. Cesarean-delivered pups responded to isolation differently in terms of their vocalizations (albeit in opposite directions in the two experiments), huddled in less cohesive groups under warmed conditions, and shed less heat. As young adults, we observed no differences in anxiety-like or alloparental behavior. However, in adulthood, cesarean-delivered voles of both sexes failed to form partner preferences with opposite sex conspecifics. In a follow-up study, we replicated this deficit in partner-preference formation among cesarean-delivered voles and were able to normalize pair-bonding behavior by treating cesarean-delivered vole pups with oxytocin (0.25 mg/kg) at delivery. Finally, we detected minor differences in regional oxytocin receptor expression within the brains of cesarean-delivered voles, as well as microbial composition of the gut. Gene expression changes in the gut epithelium indicated that cesarean-delivered male voles have altered gut development. These results speak to the possibility of unintended developmental consequences of cesarean delivery, which currently accounts for 32.9 % of deliveries in the U.S. and suggest that further research should be directed at whether hormone replacement at delivery influences behavioral outcomes in later life.

Introduction Material and Methods Results Conclusions Placenta accreta spectrum (PAS) can lead to major peripartum morbidity. Appropriate management approaches depend on the clinical severity, each individual's preference, and the treating team's expertise. Peripartum hysterectomy is the most frequently used treatment option. However, it can impact psychological well‐being and fertility. We investigated whether conservative treatment with focal resection or leaving the placenta in situ is associated with comparable or lower maternal morbidity than hysterectomy in centers of excellence within the International Society for placenta accreta spectrum (IS‐PAS). Furthermore, a survey was conducted to explore potential barriers to conservative management in antenatal counseling and intraoperative decision‐making.Confirmed PAS cases in the prospective IS‐PAS database from 22 registered centers between January 2020 and June 2022 were included in the analysis. A separate online survey with 21 questions was answered by the IS‐PAS center experts about indications, diagnostic criteria, patient counseling, surgical practice, changes from the preoperative treatment plan, and why conservative management may not be offered.A total of 234 cases were included in the analysis: 186 women received hysterectomy and 38 women were treated by focal resection, and 10 by leaving the placenta in situ. Blood loss was lower in the focal resection group and in the placenta in situ group compared to the hysterectomy group (p = 0.04). 46.4% of the women initially planned for focal resection, and 35.7% of those initially planned for leaving the placenta in situ were ultimately treated by hysterectomy. Our survey showed that the IS‐PAS centers preferred hysterectomy according to a woman's wishes (64%) and when they expected less blood loss and morbidity (41%). Eighteen percent of centers did not offer focal resection at all due to a lack of experience with this technique. Reasons for not offering to leave the placenta in situ were avoidance of unexpected reoperation (36%), puerperal infection (32%), or skepticism about the method (23%).Uterus‐preserving treatment strategies such as focal resection appear to be safe alternatives to peripartum hysterectomy. However, less than half of the IS‐PAS centers perform them. Acceptance of conservative treatments could be increased by standardized criteria for their implementation and by systematic training for PAS experts. [ABSTRACT FROM AUTHOR]

Introduction: Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section. Methods: This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P0.05). Conclusion: The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section.

Abstract To identify risk factors for smoking among pregnant women, and adverse perinatal outcomes among pregnant women. A case–control study of singleton full-term pregnant women who gave birth at a university hospital in Jordan in June 2020. Pregnant women were divided into three groups according to their smoking status, active, passive, and non-smokers. They were interviewed using a semi-structured questionnaire that included demographic data, current pregnancy history, and neonatal outcomes. Low-level maternal education, unemployment, secondary antenatal care, and having a smoking husband were identified as risk factors for smoke exposure among pregnant women. The risk for cesarean section was ninefold higher in nulliparous smoking women. Women with low family income, those who did not receive information about the hazards of smoking, unemployed passive smoking women, and multiparty raised the risk of neonatal intensive care unit admission among active smoking women. This risk increased in active and passive women with lower levels of education, and inactive smoking women with low family income by 25 times compared to women with a higher level of education. Smoking is associated with adverse perinatal outcomes. Appropriate preventive strategies should address modifiable risk factors for smoking during pregnancy.

Abstract Background Preoperative anxiety affects 60 to 80% of patients who are candidates for surgery. Reducing preoperative anxiety can improve surgical outcomes, shorten hospital stays, and minimize disruptions in lifestyle. Having information affects people ability to identify important points and improve their understanding, and lack of information causes fear and anxiety, which negatively affects decision-making. Studies have shown that the intervention of education before cesarean section has a beneficial effect on women anxiety level. Providing information before surgery can reduce patients’ anxiety. This study was conducted to determine the effect of information video before elective cesarean delivery on preoperative anxiety and post-operative satisfaction. Methods The search for relevant studies was systematically conducted in PubMed, Scopus, Web of Science, Cochrane Library, SID (Persian database), and Google Scholar (search engine) until July 4, 2023, in both English and Persian languages. The revised tool for assessing the risk of bias in randomized trials (RoB 2.0) and ROBIN-I were used to evaluate the risk of bias, and heterogeneity was assessed using I². In cases of high heterogeneity, a random effects model was used instead of a fixed effects model. Subgroup analysis was performed based on the duration of the video, and the type of intervention for the primary outcome. Sensitivity analysis was conducted based on the type of study. A random-effects meta-regression analysis was conducted to identify potential sources of high heterogeneity for preoperative anxiety. The certainty of the evidence was assessed using GRADE. Results A total number of 557 articles were found in databases. Three hundred sixty-eight studies were screened based on their titles, abstracts, and full texts. Of these, 16 studies were assessed for eligibility, and 7 were excluded. Ultimately, nine papers were included. Meta-analysis results showed that the information video before elective cesarean delivery compared to control group may have little or no effect on preoperative anxiety, but the evidence is uncertain (SMD − 0.22, 95% CI -0.51 to 0.06, 9 trials, 1020 participants, I2 = 80%; very low-certainty evidence). Also, it probably increases the post-operative satisfaction (SMD 0.26, 95% CI 0.10 to 0.42, 5 trials, 618 participants, I2 = 0%; Moderate-certainty evidence). The random effect meta-regression analyses indicated a significant correlation between the mean age of the intervention group (β = 0.137, P

Introduction: Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section. Methods: This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered significant. Results: Vaginal preparation with chlorhexidine has reduced the incidence of infection in the test group (P<0.05). Although the vaginal preparation with chlorhexidine in the case group decreased the incidence of endometritis compared to the control group, this difference was not significant (P>0.05). Conclusion: The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section. [ABSTRACT FROM AUTHOR]

Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. This study aimed to evaluate the mode of delivery in preterm neonates and the associated neonatal outcomes. Material and Methods: This was a retrospective cohort study including all preterm neonates born between January 2010 and December 2020 at the 3rd Department of Obstetrics & Gynecology of Aristotle University of Thessaloniki, Greece. The mode of delivery in relation to gestational age groups and the cause of preterm birth were analyzed. Neonatal outcomes were also evaluated according to gestational age, indication and mode of delivery. Results: A total of 1167 preterm neonates were included in the study; the majority of them were delivered via cesarean section (76.1%). Most of the preterm neonates (n = 715; 61.3%) were delivered at 32+0–36+6 weeks, while cesarean section was the most common mode of delivery after 28+0 weeks. Furthermore, spontaneous onset of labor (OR: 6.038; 95% CI: 3.163–11.527; p < 0.001), multiple gestation (OR: 1.782; 95% CI: 1.165–2.227; p = 0.008) and fetal distress (OR: 5.326; 95% CI: 2.796–10.144; p < 0.001) were the main causes of preterm delivery at 32+0–36+6 weeks. The overall mortality rate was 8.1% among premature neonates. Regarding morbidity, 919 (78.7%) neonates were diagnosed with respiratory disorders, 129 (11.1%) with intraventricular hemorrhage and 30 (2.6%) with necrotizing enterocolitis. Early gestational age at delivery was the main risk factor of neonatal morbidity and mortality. Notably, the mode of delivery did not have any impact on neonatal survival (OR: 1.317; 95% CI: 0.759–2.284; p = 0.328), but preterm neonates born via cesarean section were at higher risk of respiratory disorders, compared to those born via vaginal delivery (OR: 2.208; 95% CI: 1.574–3.097; p < 0.001). Conclusions: Most preterm deliveries occurred in the moderate-to-late preterm period via cesarean section. Early gestational age at delivery was the main prognostic factor of neonatal morbidity and mortality, while the mode of delivery did not have any impact on neonatal survival. Future research on the mode of delivery of the preterm neonates is warranted to establish definitive answers for each particular gestational age. [ABSTRACT FROM AUTHOR]

Background: Placental adhesion disorder, or placenta accreta, is caused by a decidua basalis shortage that leads to the chorionic villi penetrating the myometrium. Different types of placental adhesion disorders are classified according to the degree of uterine adhesion. Cesarean Hysterectomy is indicated in cases of morbid adherence of the placenta in various age groups during childbearing age. Objectives: Evaluation of the influence of placental adhesion on hysterectomy at the time of cesarean in near-missed pregnant women and assessment of factors that increase its incidence among Iraqi women. Methods: This research encompassed a case-control study involving 64 pregnant women, with the participants selected from Al-Yarmouk Teaching Hospital. The pregnant patients were divided into two groups. The first group consisted of thirty-two pregnant women with emergency cesarean hysterectomy due to placental adhesion. The second group was made up of thirty-two pregnant women with elective cesarean hysterectomy due to placental adhesion. Results: In the present study, it has been found that there are no significant differences in the age of patients who undergo elective cesarean hysterectomy as compared to emergency cesarean hysterectomy (p > 0.05). Also, according to the gestational age, most elective surgery patients are full-term pregnancies; meanwhile, the emergency cases are mostly preterm. Elective patient parity was higher than emergency cases at three parity 13 vs 9. The patients with emergency cesarean hysterectomy showed that the presence of two or more scars in the uterus was accreta in about 72% of patients. Meanwhile, the elective patients with placental adherence showed a higher frequency of two or more scars, the same as observed in emergency cases. Still, there were more emergency cases than elective cases. Conclusion: There are elevations in the incidences of placental adhesion, reflecting the increase in cesarean hysterectomy surgeries and near-miss cases. [ABSTRACT FROM AUTHOR]

Rupture of a gravid uterus is a known complication of a cesarean hysterotomy. Uterine rupture of a nongravid uterus is usually caused by trauma, instrumentation, a pelvic mass, infection, or malignancy. Spontaneous rupture of a nongravid uterus is a rare event with only 4 cases reported in the English literature since 2011.This was the case of a healthy 52-year-old woman with a remote history of 2 cesarean deliveries and an endometrial ablation. The patient presented with severe right lower-quadrant pain. The hospital evaluation revealed a hemoperitoneum, a 5 cm endometrial complex or mass, and layering of blood product along the cesarean delivery scar. Exploration confirmed a spontaneous rupture of the previous hysterotomy. The patient was treated successfully with a total abdominal hysterectomy. Pathology report confirmed the uterine wall defect.Uterine rupture in the non-gravid uterus is a rare event. Presentation may be atypical but consistent with the diagnosis. Spontaneous uterine rupture should be considered in the nongravid patient with abdominal pain and a hemoperitoneum of unclear origin.

Introduction: Unfavorable neonatal outcomes in newborns have been associated with excessive medicalization in prenatal care, delivery and birth. Objective: to analyze unfavorable neonatal outcomes in live births in a Brazilian municipality. Methods: cohort study, carried out in public and private maternity hospitals. The sample consisted of live births. The occurrence of prematurity, low birth weight, neonatal resuscitation, use of oxygen, mechanical ventilation, use of antibiotics, admission to the Intensive Care Unit and death were included as unfavorable outcomes. Explanatory models were extracted using logistic regression. Results: 1088 newborns were evaluated, of which 32.7% had some unfavorable neonatal outcome, the most frequent being: resuscitation maneuvers, use of oxygen and prematurity. In the unfavorable neonatal outcome model, it was a risk factor, presenting clinical intercurrence during pregnancy, and protective factors, like having a health plan and prenatal card. In the model for neonatal death, the variables that expressed a significant association were gestational age, Apgar score below 7 at the 5th minute and location of prenatal care. Conclusion: the high occurrence of unfavorable neonatal outcomes is a challenge to be overcome and its prevention involves actions in the process of pregnancy and childbirth.

Intraoperative bladder injury in cesarean deliveries is an important complication that causes maternal morbidity. Bladder adhesions resulting from previous abdominal operations, cesarean section under emergency conditions, cesarean section after prolonged labor or in the second stage of labor are predisposing factors for bladder injury. In order to prevent bladder injury, it is important to be aware of bladder injury during peritoneal incision in risky cases, delivery of the baby, and hysterotomy and fascia closure. In this article, we present the diagnosis and treatment of a patient who was diagnosed with intraperitoneal bladder perforation, intra-abdominal abscess and peritonitis one week after cesarean section, in the light of current literature. In our case, intraoperative diagnosis could not be made, postoperative active hematuria was not observed, the focus was on the diagnosis of postoperative ileus, and intra-abdominal abscesses developed. A multidisciplinary team ensured success in the treatment.

Abstract Background Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge. Methods An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge. Results 308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge. Conclusions Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

With the increase in cesarean section rates, uterine rupture, one of the obstetric emergencies, has become an important clinical condition leading to maternal--fetal mortality and morbidity. According to risk factors for uterine rupture, it can be classified as rupture of a previous scar (cesarean section, myomectomy), traumatic rupture of the uterus (resulting from trauma), spontaneous rupture of the uterus due to underlying pathologies (uterine anomalies, multiparity), and spontaneous uterine rupture in apparently normal primigravida patients. Among these, uterine rupture due to a scarred uterus is the most commonly seen. Currently, optimal cutoff values for predicting uterine scar rupture have not been definitively established. A 35-year-old pregnant woman, gravida 3, parity 2, with a history of 2 previous cesarean sections, was seen during a routine outpatient clinic visit when she was 23 weeks and 2 days pregnant based on her last menstrual period. During the visit, approximately a 5 cm area of amniotic fluid protruding toward the bladder was observed along the old incision line, suggesting a disruption in the continuity of the myometrium at the scar site. Preoperative preparations were made, and the patient was taken for a cesarean section. Interestingly, there was no apparent evidence of dehiscence, which is commonly seen in many patients who have had previous cesarean sections. The cesarean section was successfully completed without complications. [ABSTRACT FROM AUTHOR]

Introduction: Airway safety for difficult intubation or failure to intubate is important during anesthesia. This study assessed the airway before anesthesia, and the diagnostic value of neck circumference (NC) and sternomental distance (SMD) tests was investigated in predicting difficult tracheal intubation during cesarean section.Methods: In a cross-sectional study, 101 women who were candidates for cesarean section were selected through the convenience and non-random sampling method. The modified Mallampati test (MMT), upper lip bite (ULBT), thyromental distance (TMD), neck circumference (NC), and sternomental distance (SMD) tests were performed to estimate the laryngoscopy problem. The success rate of airway assessment by SMD and NC was evaluated using the Cormack-Lehane score. Data analysis was performed using the software SPSS version 16.0.Results: TMD (p=0.034) and NC (p

Background: A high level of hemoglobin at birth is one of the iron reserves needed by infants to deal with iron deficiency anemia. This study aimed to assess the iron status in neonates born by cesarean section and the effect of maternal characteristics and other laboratory measures on neonatal iron levels. Moreover, it was designed to investigate anemia and identify its factors.Methods: This descriptive correlational study was conducted in 2022 on 50 neonates by caesarean section in Babylon Hospital, Iraq. Serum ferritin and other laboratory parameters from neonatal umbilical cord blood were measured in addition to others that had been recorded for both neonates and their mothers.Results: The data were analyzed using the t-test. Out of 50 neonates, 8 infants had low serum ferritin levels and 4 of these 8 had anemia, and 6 of them were born to mothers from rural areas. The mean maternal age of neonates with low serum ferritin was significantly higher than those with normal or high serum ferritin. The results showed that the place of residence and its clean climate and healthy nutrition can have a direct effect on the ferritin level. No significant effect of serum ferritin on WBC, reticulocytes, and platelet counts was observed in this study.Conclusion: Anemia is significantly associated with low serum ferritin neonates; in addition, maternal age and residence have significant effects on neonatal serum ferritin. Considering the high prevalence of iron deficiency anemia in mothers and even in mothers with proper nutrition, iron deficiency in the mother leads to a decrease in the baby's reserves and makes him susceptible to iron deficiency in the first months after birth. The importance of using iron supplements during pregnancy becomes clearer, and one should not be satisfied only with diet. Due to the adverse effects of increasing the number of pregnancies on the mother's iron reserves, appropriate spacing should be observed.

Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia. The goal of this narrative review was to provide a synopsis of pertinent literature on calcium use in obstetrics to explore the potential benefit of calcium carbonate as a simple and low-cost intervention for prevention or treatment of labor dystocia. To answer how calcium and carbonate physiologically contribute to myometrium contractility, we conducted a literature search of English-language peer-reviewed articles, with no year limitation, consisting of the keywords “calcium,” “calcium carbonate,” “calcium gluconate,” “pregnancy,” “hemorrhage,” and variations of “smooth muscle contractility” and “uterine contractions.” Though no overt evidence on calcium carbonate’s ability to prevent labor dystocia was identified; relevant information was found regarding smooth muscle contractility, calcium’s influence on uterine muscle contractility, and carbonate’s potential impact on reducing amniotic fluid lactate levels to restore uterine contractility during labor. Studies reporting the potential effectiveness of calcium gluconate and sodium bicarbonate in preventing labor dystocia offer background, safety information, and rationale for a future randomized control trial to evaluate the ability of calcium carbonate to prevent labor dystocia and reduce rates of cesarean section.

Introduction: The prevalence of cesarean sections (CSs) in both industrialized and developing nations is a significant issue for public health officials, particularly in light of the knowledge of their socioeconomic underlying determinants. Objective: To ascertain the prevalence of CS delivery among nurses, their predictors, and the effect it has on exclusive breastfeeding practice in Tamale, Ghana. Methods: This study used a quantitative technique and an analytical cross-sectional design. Data analysis was done using Statistical Package for the Social Sciences, and variable associations and predictions were identified using chi-square and logistics regression analysis. Results: There were 326 fully completed and returned questionnaires; the majority (40.0%) of respondents were registered general nurses (RGN). The majority of respondents (56.0%) were between the ages of 31 and 40. The prevalence rate of CS delivery was 21.1%. Predictor variables were; Community health nurses/RGN (adjusted odds ratio [AOR] = 3.7, 95% confidence interval [CI] = 1.2–11.0), and second degree/first degree level of educational attainment (AOR = 36.0, 95% CI = 2.4–528.9). The effects of CS delivery on exclusive breastfeeding were; low confidence to exclusively breastfeed, opting to combine both breastfeeding and artificial feeding, and less likely to practice exclusive breastfeeding. Conclusion: Even though CSs and exclusive breastfeeding practices are both problems facing nurses, CSs seem to compound the problem of exclusive breastfeeding among nurses. [ABSTRACT FROM AUTHOR]

Background & objective: Postoperative shivering is a source of much discomfort to the patients following spinal anesthesia (SA), especially in patients undergoing cesarean delivery. The anesthetists have employed various medications and a variety of measures to prevent shivering in their patients. The objective of this study was to investigate the efficacy and safety of intravenous (IV) dexmedetomidine in preventing shivering in patients undergoing cesarean delivery under SA. Methodology: This prospective, double-blind, randomized trial involved 62 parturients undergoing cesarean delivery under SA. They were randomly divided into two groups; patients in dexmedetomidine group (Group D, n = 31) received dexmedetomidine 0.5 µg/kg IV over 10 min followed by infusion of 0.4 µg/kg/h until the end of surgery; whilst patients in the control group (Group C, n = 31) received equivalent loading and infusion volume of 0.9% saline. Both groups were operated upon by a standardized spinal anesthesia technique. The occurrence of shivering, sedation score and hemodynamic parameters were recorded intraoperatively. The recording anesthetist was blinded regarding the study or the control groups. Results: The occurrence of shivering was significantly reduced in Group D as compared to Group C (3.2% vs 64.5%, P < 0.001). Patients in Group D were more sedated as compared to Group C (51.6% vs 0%, P < 0.001). There was no statistically significant difference in systolic and diastolic blood pressure readings between both of the groups. Heart rates in Group D were significantly lower than the Group C but still were within normal physiological range. Conclusion: IV dexmedetomidine was effective in reducing the occurrence of shivering but with significant sedative effect and lowering of heart rate than the placebo. Although the heart rates remained within normal range in both groups [ABSTRACT FROM AUTHOR]

Introduction: Few studies have described obstetric and critical care outcomes in pregnant women with COVID‐19 needing intensive care unit (ICU) admission. Material and methods: Obstetric and critical care outcomes of COVID‐19 women admitted to eight ICUs from April 1, 2020 to September 15, 2021, in the North West of England were retrospectively analyzed. Women admitted to ICU were assigned to three groups: antepartum women discharged from ICU prior to delivery (antepartum ICU‐discharged group), antepartum women who had expedited delivery (antepartum ICU‐delivered group) and a postpartum group. Our aims were to describe maternal characteristics and assess how delivery influenced the obstetric and critical care outcomes in these women. Results: During the study period, 615 women tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), of whom 62 (10.1%) needed ICU admission due to symptomatic COVID‐19. Pregnancy loss (3.2%) was recorded in two women. Detailed obstetric and critical outcomes from 60 women are reported. Nine antepartum women (15%) admitted to ICU were discharged and continued their pregnancy, 13 antepartum women (21.7%) had expedited delivery by cesarean birth after ICU admission and 38 (63.3%) women were admitted to ICU during the postpartum period. Antepartum ICU‐discharged women contracted the SARS‐CoV‐2 at an earlier median gestational age (23 weeks; p = 0.0003) and needed ICU admission at an earlier median gestational age (28 weeks, p = 0.03) compared with antepartum ICU‐delivered (28 and 32 weeks) and postpartum women (35.5 and 36 weeks). Antepartum ICU‐discharged women had the lowest rate of mechanical ventilation receipt (11.1%) compared with antepartum ICU‐delivered women (52.3%) and postpartum women (44.3%) but the difference was not statistically significant (p = 0.13). No significant differences were observed in the frequency and severity of critical care complications in the antepartum ICU‐discharged, antepartum‐ICU delivered and postpartum women. Conclusions: Of the women admitted to ICU antepartum, 40% were discharged while remaining pregnant and 60% had expedited delivery. Antepartum women who were discharged from ICU without giving birth may receive lower rates of mechanical ventilation than those who delivered in ICU or admitted postpartum; however, further studies are needed to confirm or refute this association. [ABSTRACT FROM AUTHOR]

Over the previous three decades, the rate of caesarean sections performed worldwide has grown exponentially. In comparison to a vaginal birth, the risk of all postpartum infections is higher with a cesarean section. One of the key factors contributing to maternal morbidity is the development of infectious complications in the surgical site after a caesarean section. The primary goal of the research was to compare the efficiency of using ampicillin/sulbactam (AMS) and cefepime (CEF) to reduce the incidence of surgical site infections (SSI) following caesarean delivery. This prospective randomized study was conducted among 200 pregnant women scheduled for elective cesarean section. They were collected from the Obstetrics and Gynecology department of Beni-Suef University Hospital, and then they were randomly assigned into two groups. Group (A) received cefepime 30 min before and 12 h after cesarean delivery, while group (B) received ampicillin/sulbactam 30 min before and 12 h after cesarean delivery. The groups were matched regarding the baseline women characteristics. Comparing the cefepime to the ampicillin/sulbactam revealed that the cefepime significantly decreased superficial SSI from 27% to 14% (0.023). A significant decrease was observed in deep SSI with cefepime compared to ampicillin/sulbactam from 24% to 13% (p-value 0.045). Interestingly, when the cefepime was compared to the ampicillin/sulbactam, we noted that the incidence of endometritis significantly decreased from 13% to 5% (p = 0.048). A noted decrease in post-operative fever in cefepime as compared to ampicillin/sulbactam from 18% to 13% (p-value = 0.329). Receiving prophylactic cefepime pre- and post-cesarean delivery significantly decreases post-operative wound infection and endometritis. [ABSTRACT FROM AUTHOR]

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Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches. Material and methods: This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl® in 49 patients and Vicryl® in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate. Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002). Conclusions: The formation of niches and associated PMS rates were less with suture materials that were absorbed faster. [ABSTRACT FROM AUTHOR]

Background: Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge. Methods: An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge. Results: 308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge. Conclusions: Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum. [ABSTRACT FROM AUTHOR]

Background Prenatal diagnosis of congenital heart disease has been associated with early-term delivery and cesarean delivery (CD). We implemented a multi-institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal-Maternal Consortium. Our objective was to decrease early-term (37-39 weeks) delivery and CD in pregnancies complicated by fetal congenital heart disease using a SCAMP methodology to improve practice in a high-risk and clinically complex setting. Methods and Results University of California Fetal-Maternal Consortium site-specific management decisions were queried following SCAMP implementation. This contemporary intervention group was compared with a University of California Fetal-Maternal Consortium historical cohort. Primary outcomes were early-term delivery and CD. A total of 496 maternal-fetal dyads with prenatally diagnosed congenital heart disease were identified, 185 and 311 in the historical and intervention cohorts, respectively. Recommendation for later delivery resulted in a later gestational age at delivery (38.9 versus 38.1 weeks, P=0.01). After adjusting for maternal age and site, historical controls were more likely to have a CD (odds ratio [OR],1.8; 95% CI, 2.1-2.8; P=0.004) and more likely (OR, 2.1; 95% CI, 1.4-3.3) to have an early-term delivery than the intervention group. Vaginal delivery was recommended in 77% of the cohort, resulting in 61% vaginal deliveries versus 50% in the control cohort (P=0.03). Among pregnancies with major cardiac lesions (n=373), vaginal birth increased from 51% to 64% (P=0.008) and deliveries ≥39 weeks increased from 33% to 48% (P=0.004). Conclusions Implementation of a SCAMP decreased the rate of early-term deliveries and CD for prenatal congenital heart disease. Development of clinical pathways may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce healthcare costs.

Accurate prenatal discrimination between a simple, non-adherent uterine scar dehiscence with an underlying placenta and the severe end of the placenta accreta spectrum is problematic as the two can appear similar on prenatal imaging. This may lead to the false diagnosis of placenta accreta spectrum resulting obstetric anxiety, overtreatment and potential iatrogenic morbidity. Despite potential similarities in the etiology, the manifestation and management of these two conditions is very different. The prenatal sonographic features of seven confirmed cases of simple uterine scar dehiscence with an underlying placenta previa were examined. The common sonographic features found for scar dehiscence was a thinned myometrium (

Introduction: Airway safety for difficult intubation or failure to intubate is important during anesthesia. This study assessed the airway before anesthesia, and the diagnostic value of neck circumference (NC) and sternomental distance (SMD) tests was investigated in predicting difficult tracheal intubation during cesarean section. Methods: In a cross-sectional study, 101 women who were candidates for cesarean section were selected through the convenience and non-random sampling method. The modified Mallampati test (MMT), upper lip bite (ULBT), thyromental distance (TMD), neck circumference (NC), and sternomental distance (SMD) tests were performed to estimate the laryngoscopy problem. The success rate of airway assessment by SMD and NC was evaluated using the Cormack-Lehane score. Data analysis was performed using the software SPSS version 16.0. Results: TMD (p=0.034) and NC (p<0.001) indicated substantial association with laryngoscopy grades. The sensitivity was 35.29% and 58.82%, and the specificity was 93.93% and 59.09% for NC and SMD. The accuracy, NPV, and PPV of NC was higher than the SMD test (74% vs. 59%, 73.80% vs. 73.58, and 75% vs. 42.55%). The PPV and NPV were 43.63% and 77.77% for TMD. MMT, with high sensitivity (73.52%) and specificity (90.90%), increased the risk of difficult laryngoscopy up to 24-fold when adjusted for TMD, SMD, and NC [p<0.001; OR=24.38 (6.31-94.25)]. Although NC indicated low sensitivity, it had maximum specificity (93.93%) in predicting difficult intubation. Conclusion: High Mallampati grades increase the risk of difficult laryngoscopy. NC presented low predictive values, and SMD and TMD lack predictive values for difficult intubation. [ABSTRACT FROM AUTHOR]

Background: One of the main problems in cesarean section cases is represented by postoperative pain that can cause delay in recovery and intense complications for patients. Therefore, the present study evaluates the effect and quality of treating infectious tissue and surgical complications using low-level lasers after cesarean section. Methods: In this clinical study, 240 candidates for the same type of surgery using the spinal anesthesia technique, were randomly divided into a laser treatment group and a control group. Finally, the surgical incision in the laser group was irradiated by laser (810 nm). Furthermore, the same method was used for the control group. The first request for analgesia, total analgesic consumption and severity of postoperative pain by visual analogue scale (VAS) were monitored in all patients for 24 hours. Findings: The 240 participants in the present study were equally allocated (1:1 ratio) to the case and control groups. There was a significant difference in average age (P=0.013) between subjects of the two study groups, with controls having a lower average age than participants in the case group based on the obtained results. However, the body mass index did not significantly differ between the two groups (p=0.1). The average use of painkillers (a painkiller is a pill or other form of drug that reduces or stops physical pain), suture removal time, and postoperative pain on days 3, 7, 14, and six weeks after surgery were lower in the case group than in the control group. The obtained difference was statistically significant (p<0.001). Conclusion: According to the findings of this study, using low-level laser therapy with cluster current (wavelength 810 nm and power 300 mW and power density for low-level laser 4 W/cm2) can help reduce postoperative pain and the need for painkillers. [ABSTRACT FROM AUTHOR]

Background: A high level of hemoglobin at birth is one of the iron reserves needed by infants to deal with iron deficiency anemia. This study aimed to assess the iron status in neonates born by cesarean section and the effect of maternal characteristics and other laboratory measures on neonatal iron levels. Moreover, it was designed to investigate anemia and identify its factors. Methods: This descriptive correlational study was conducted in 2022 on 50 neonates by caesarean section in Babylon Hospital, Iraq. Serum ferritin and other laboratory parameters from neonatal umbilical cord blood were measured in addition to others that had been recorded for both neonates and their mothers. Results: The data were analyzed using the t-test. Out of 50 neonates, 8 infants had low serum ferritin levels and 4 of these 8 had anemia, and 6 of them were born to mothers from rural areas. The mean maternal age of neonates with low serum ferritin was significantly higher than those with normal or high serum ferritin. The results showed that the place of residence and its clean climate and healthy nutrition can have a direct effect on the ferritin level. No significant effect of serum ferritin on WBC, reticulocytes, and platelet counts was observed in this study. Conclusion: Anemia is significantly associated with low serum ferritin neonates; in addition, maternal age and residence have significant effects on neonatal serum ferritin. Considering the high prevalence of iron deficiency anemia in mothers and even in mothers with proper nutrition, iron deficiency in the mother leads to a decrease in the baby's reserves and makes him susceptible to iron deficiency in the first months after birth. The importance of using iron supplements during pregnancy becomes clearer, and one should not be satisfied only with diet. Due to the adverse effects of increasing the number of pregnancies on the mother's iron reserves, appropriate spacing should be observed. [ABSTRACT FROM AUTHOR]

Few studies have compared the clinical efficacy and adverse events of combined antiretroviral therapy (cART) regimens in pregnant women seeking obstetrical care. The objective of this study was to compare the efficacy (virus load response), adverse events, and obstetrical and neonatal outcomes of three different regimens of cART in HIV-infected pregnant women initiating treatment in Rio de Janeiro, Brazil. This was a retrospective cohort study of cART-naive pregnant women who initiated either ritonavir-boosted protease inhibitors (atazanavir or lopinavir), efavirenz, or raltegravir plus a backbone regimen. From 2014 to 2018, 390 pregnant women were followed over time. At baseline, the median viral load (VL) for HIV was 4.1 log copies/ml. Among participants who received cART for 2 to 7 weeks, the VL decline was greater for raltegravir (2.24 log copies/ml) than for efavirenz or protease inhibitors (P < 0.001). Virologic suppression was achieved in 87% of women on raltegravir near delivery versus 73% on efavirenz and 70% on protease inhibitors (P = 0.011). Patients on raltegravir achieved virologic suppression faster than those on other regimens (P = 0.019). Overall, the HIV perinatal infection rate was 1.5%. This clinical study compared three potent and well-tolerated cART regimens and demonstrated that a higher proportion of participants on raltegravir achieved an undetectable HIV VL near delivery (P = 0.011) compared to the other arms. These findings suggest that raltegravir-containing regimens are optimal regimens for women with HIV initiating treatment late in pregnancy.

Abstract Background The Obstetric Quality of Recovery score (ObsQoR-10) is a questionnaire used to assess recovery after cesarean delivery. However, the original ObsQoR-10 is in English and was mainly validated in the Western population. We therefore evaluated the reliability, validity, and responsiveness of the ObsQoR-10-Thai in patients undergoing elective cesarean delivery. Methods The original ObsQoR-10 was translated into Thai, and psychometric validation was performed to evaluate the quality of post-cesarean recovery. The ObsQoR-10-Thai, activities of daily living checklist, and 100-mm visual analog scale of global health (VAS-GH) questionnaires were administered to the study participants before and 24 and 48-h postpartum. Validity, reliability, responsiveness, and feasibility of the ObsQoR-10-Thai were assessed. Results We included 110 patients undergoing elective cesarean delivery. The mean ObsQoR-10-Thai score at baseline and 24 and 48-h postpartum was 83.35 ± 11.15, 56.75 ± 11.6, and 70.96 ± 13.65, respectively. The ObsQoR-10-Thai score differed significantly between the two groups divided based on the VAS-GH (≥ 70 vs.

Background: The rates of repeat cesarean section (CS) among women with previous CS are increasing worldwide. The predictors of a repeat CS can vary across different populations. Objective: To determine the predictors of repeat CS among women from Malaysia with one previous lower segment CS (LSCS) who underwent trial of labor (TOLAC). Materials and Methods: This retrospective cohort study included women with one previous LSCS who followed up and delivered their current pregnancy at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between January 01, 2016, and December 31, 2017. Women with singleton pregnancies were included while those who had a history of classical CS, current pregnancy with preterm birth, non-cephalic pregnancy, lethal fetal anomalies, uterine rupture, and severe preeclampsia or planned for elective CS were excluded. Logistic regressions were performed. Results: The study included 388 women who underwent TOLAC and successfully gave childbirth through vaginal birth after cesarean (VBAC) (n = 194) or emergency LSCS (n = 194). Factors significantly associated with repeat CS were no history of vaginal delivery (adjusted odds ratio (aOR): 2.71; 95% confidence interval (CI): 1.60, 4.60; P < 0.001), estimated fetal weight ≥3500 grams (aOR: 4.78; 95% CI: 2.45–9.34; P < 0.001), and presence of meconium-stained liquor (aOR: 2.40; 95% CI: 1.33–4.35; P = 0.004). Conclusion: The above-mentioned predictors of a repeat CS among women from Malaysia with one previous LSCS who underwent TOLAC can be useful for clinicians in making an informed decision.

Abstract Background While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country’s maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality. Methods The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis. Results Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37–4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67–34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09–3.72), and be low and mid-level income compared to women with high income. Conclusion This study’s findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.

Objective: Bladder injury is one of the complications of cesarean section (CS). It is reported that the overall incidence of bladder injury is 0.22-0.44% of CS. It is, however, unclear what factors influence this rate. The aim of this study was to determine if there is a difference in bladder injury rate between scheduled and emergency CS, as well as in primary and repeat CS at a large metropolitan hospital that serves a population at high risk for obstetric complications. In addition, the use of urology consultation following bladder injury and whether demographic factors and labor characteristics affect the rate of bladder injury were investigated. Material and Methods: A total of 8,488 records were reviewed (4,292 primary CS and 4,196 repeat CS) from January 1, 2013 to December 31, 2020. The incidence of bladder injury was calculated and the rate of intraoperative urology/urogynecology consultation was recorded. Then the association between bladder injury and intraoperative urology/urogynecology consultation and between bladder injury and maternal age, body mass index (BMI), and gestational age were compared. Results: There was a significant increase in risk of bladder injury in repeat CS versus primary CS (p=0.01). There was also a significant increase in risk of bladder injury in emergency CS versus scheduled CS (p=0.04). Intraoperative urogynecology/urology consultations were significantly higher in the bladder injury versus no bladder injury groups (p<0.0001). Both emergency CS and repeat CS are predictors of bladder injury with odd ratios of 5.7 and 7.4, respectively. Conclusion: These results add to the existing evidence that bladder injury is a rare complication in CS that may occur more often in women undergoing repeat or emergency CS than primary or scheduled CS. Given that the risk increases with repeat or emergency CS, patients should be made aware of such risks and surgeons should make careful intraoperative considerations with close postoperative follow-ups. [ABSTRACT FROM AUTHOR]