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Objective: Primary immune thrombocytopenia (ITP) is an acquired disorder of platelets with a complex and unclear mechanism of increased immune destruction or impaired production of platelets. While the management of ITP is evolving, there is still a need for guidance, particularly in certain circumstances such as pregnancy, emergencies, or patients requiring co-medications. We aimed to determine the tendencies of hematologists in Türkiye in the event of such special considerations. Materials and Methods: Applying a modified Delphi method, the Turkish National ITP Working Group, founded under the auspices of the Turkish Society of Hematology, developed a questionnaire consisting of statements regarding pregnancy, emergencies, and circumstances requiring co-treatment with antiaggregants or anticoagulants. A total of 107 hematologists working in university or state hospitals voted for their agreement or disagreement with the statements for two sequential rounds. Results: The participating hematologists reached an agreement on starting treatment for pregnant patients with platelets of less than 30x109/L and delivery either vaginally or by cesarean section being safe at platelet counts above 50x109/L. For emergencies and the rescue management of ITP, the panel agreed against the use of high-dose corticosteroids alone, preferring combinations with transfusions or intravenous immunoglobulin. For patients who require interventions, platelet counts of >50x109/L were regarded as safe for low-risk procedures as well as co-treatment with antiplatelets or anticoagulants. Conclusion: As the National ITP Study Group, we have observed the need to increase the practice guidance regarding patients with primary ITP requiring additional treatments including invasive interventions and co-treatments for coagulation. Decisions on the management of ITP during pregnancy should be individualized. There is a lack of consensus on the thresholds of platelet counts as well as co-morbidities and co-medications. This lack of consensus may be due to variations in practices. [ABSTRACT FROM AUTHOR]

Background: Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. Objective: This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. Methods: Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. Results: Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. Conclusion: The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted. [ABSTRACT FROM AUTHOR]

The surge in cesarean section (CS) deliveries in China over the past several decades has led to significant international discussion, yet critical social science inquiry remains limited. Drawing on insights from sociological and anthropological studies of childbirth, this article moves away from the premise that having a CS is a matter of individual choice. Instead, we treat childbirth as ground zero of a set of complex negotiations between multiple actors, and we show how the biopolitical and politico-economic reconfiguration of the process of childbirth governance from the 1990s onwards has contributed to a dramatic increase in cesarean deliveries. Combining ethnographic materials from China's rural and urban areas with an analysis of documents and quantitative data, we argue that the surge in CS rates in post-1990s China is part of a larger globalized process of the technocratic medicalization of birth, which has had a profound impact on the normative procedures and conditions shaping the process of childbirth, including the methods and forms of knowledge guiding childbirth management. This has contributed to the increasing normalization of a highly medicalized and interventionist model of childbirth, which has in turn facilitated the routinization of cesarean procedures. [ABSTRACT FROM AUTHOR]

Objectives: Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021. Methods: We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020). Results: Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states. Conclusion: In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To reaffirm the value of a joint obstetric and renal clinic on obstetric outcomes in patients with high‐risk pregnancies due to chronic kidney disease (CKD). Methods: This was a retrospective cohort study of patients who attended the clinic between 2005 and December 2021. The hospital is a regional tertiary unit for renal medicine and a maternal medicine hub. The data included all women with pre‐existing renal conditions who were cared for in a dedicated renal and obstetric clinic. Datasets were extracted from hospital notes, the renal database, clinical data and maternity electronic health records. The data analyzed included pre‐existing renal conditions, biochemical parameters related to the renal condition, pregnancy outcomes included miscarriages, gestation, mode of delivery, postpartum hemorrhage (PPH), loss, birth weight and neonatal admission. Results: The results were as follows: Lupus nephritis: four term deliveries; three had pre‐eclampsia; two PPH and two miscarriages. Four estimated glomerular filtration rates (eGFRs) returned to baseline levels within 12 months. With regard to IgA nephropathy there were five live births, four term deliveries, two pre‐eclampsia (PE) and five cesarean sections (CS). All eGFRs returned to baseline within 12 months. With regard to patients with adult polycystic kidney disease (APKD), there were six live births, two had pre‐eclampsia and there were five term vaginal deliveries. Conclusion: Patients with lupus nephritis, APKD, and IgA demonstrated a higher incidence of adverse pregnancy outcomes as compared with our local pregnant population. Our findings reflect those of larger studies and support the role of combined renal/obstetric clinics. More research and larger scale studies are needed into specific CKD conditions and their outcomes. Synopsis: The obstetric patients with renal disease that were included in our data had a higher incidence of adverse pregnancy outcomes than the local pregnant population. [ABSTRACT FROM AUTHOR]

Objective: To identify the risk factors for placenta accreta spectrum (PAS) disorders in women without prior cesarean section (CS). Methods: This retrospective case–control study investigated patients without prior CS who gave birth at Peking University Third Hospital between January 1, 2015 and December 31, 2021. Patients diagnosed with PAS according to the clinical diagnostic criteria of the 2019 International Federation of Gynecology and Obstetrics (FIGO) classification were included as the study group. Patients were matched as the control group according to delivery date and placenta previa, in a 1:2 allocation ratio. Maternal characteristics were compared between the two groups. Results: The study included 348 patients in the study group and 696 in the control group. The multivariate analysis showed that the independent risk factors of PAS consisted of operative hysteroscopy (once: adjusted odds ratio [aOR] 2.38, 95% CI 1.28–4.24, P = 0.006; twice or more: aOR 5.43, 95% CI 1.04–28.32, P = 0.045), uterine curettage (once: aOR 2.54, 95% CI 1.80–3.58, P < 0.001; twice: aOR 3.01, 95% CI 1.81–5.02, P < 0.001; three or more times: aOR 9.18, 95% CI 4.64–18.18, P < 0.001), multifetal pregnancy (aOR 5.64, 95% CI 3.01–10.57, P < 0.001), adenomyosis (aOR 2.77, 95% CI 1.23–6.22, P = 0.014), in vitro fertilization (aOR 1.51, 95% CI 1.04–2.20, P = 0.030) and pre‐eclampsia (aOR 2.72, 95% CI 1.36–5.45, P = 0.005), and the independent protective factor was being multiparous (aOR 0.37, 95% CI 0.25–0.54, P < 0.001). Conclusion: After controlling the effect of placenta previa, we found that patients with PAS without prior CS had unique maternal characteristics. Classification and quantification of the intrauterine surgeries they have undergone is essential for identifying high‐risk patients. Early identification of high‐risk groups by risk factors has the potential to improve the prognosis considerably. Synopsis: Patients with placenta accreta spectrum without prior cesarean section had unique maternal characteristics, and it is essential to classify and quantify the intrauterine surgeries they have previously undergone. [ABSTRACT FROM AUTHOR]

Background: Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot‐assisted laparoscopic myomectomy (RLM). Objectives: To compare the perioperative and postoperative outcomes of RLM, AM, and LM. Search Strategy: We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023. Selection Criteria: We included all studies reporting peri‐ and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM. Data Collection and Analysis: Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random‐effects model for meta‐analysis when appropriate. We used the funnel plot to assess the publication bias. Main Results: A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22–61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10–0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different. Conclusions: The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM. Synopsis: The safety and effectiveness of robot‐assisted laparoscopic myomectomy are superior to those of abdominal myomectomy but inferior to those of laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a common pathology in reproductive‐aged women, although data regarding pregnancy outcomes are scarce. In the present study, we aimed to compare pregnancy and perinatal outcomes between women who suffered from IIH to those who did not. Methods: A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. All pregnant women who delivered or had a maternal death in the US (2004–2014) were included. Women with an ICD‐9 diagnosis of IIH before or during pregnancy were matched to controls without IIH according to age, race, insurance type, and income quartile, in a 1:20 ratio. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Results: Overall, 9 096 788 deliveries were identified. Of these, 1454 women (0.016%) had a diagnosis of IIH (study group) and were compared to 29 080 women without IIH (control group). Women with IIH, compared to those without, were more likely to be obese (body mass index >30 kg/m2) and suffer from pregestational diabetes mellitus and chronic hypertension (P < 0.001, all). After adjusting for confounders, patients in the IIH group, compared to those without, had a higher rate of pregnancy‐induced hypertension (aOR 1.82, 95% CI: 1.57–2.1, P < 0.001), pre‐eclampsia (aOR 1.98, 95% CI: 1.61–2.45, P < 0.001), preterm delivery (aOR 1.88, 95% CI: 1.59–2.23, P < 0.001), CD (aOR 2.41, 95% CI: 2.12–2.73, P < 0.001), wound complications (aOR 3.2, 95% CI: 1.89–5.42, P < 0.001), and congenital anomalies (aOR 2.18, 95% CI: 1.4–3.4, P < 0.001). Conclusion: Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies. Synopsis: Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies. [ABSTRACT FROM AUTHOR]

Introduction: In clinical experience, occiput posterior (OP) position is associated with longer labor duration than occiput anterior (OA) position, but few studies have investigated the association between labor duration and fetal position. We aimed to compare duration of the active phase of labor in OP deliveries with OA deliveries in a contemporary population using survival methods. Secondary aims were to compare the frequencies of operative interventions, obstetric anal sphincter injuries (OASIS), postpartum hemorrhage, and newborn outcomes in OP with OA deliveries. Material and Methods: We did a historical cohort study in three university hospitals in Norway from 2012 to 2022. Women with a single fetus in cephalic presentation, no previous cesarean section and gestational age ≥37 weeks were eligible and stratified into the first four groups of the Robson ten‐group classification system (TGCS). We estimated the mean duration and calculated the hazard ratio (HR) for delivery using survival analyses. Cesarean sections and instrumental vaginal deliveries were censored. Results: The study population comprised 112 019 women, 105 571 (94.2%) were delivered in OA and 6448 (5.8%) in OP position. The estimated mean duration of the active phase of labor was longer in women with the fetus in OP position in all four TGCS groups. The estimated duration was longer in the OP groups in analyses stratified with respect to epidural analgesia and oxytocin augmentation. The graphical abstract illustrates the probability of delivery in OP compared with OA position in merged TGCS groups 1 and 2a, as a function of time. The unadjusted HR was 0.33 (95% CI 0.31–0.36) for fetuses delivered in OP position compared with OA position in TGCS group 1, 0.25 (95% CI 0.21–0.27) in group 2a, 0.70 (95% CI 0.67–0.73) in group 3, and 0.61 (95% CI 0.55–0.67) in group 4a, respectively. Neither maternal age, gestational age, BMI nor birthweight had confounding effect. Operative delivery rates and OASIS rates were higher in OP position in all four groups. Conclusions: We found longer duration of the active phase of labor in women with the fetus delivered in OP position in all four TGCS groups. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric hemorrhage remains a largely preventable cause of maternal mortality globally. The contribution of uterine atony to hemorrhage‐related maternal mortality has decreased in France, while the contribution of other causes of obstetric hemorrhage such as surgical injury during cesarean has been reported to increase. However, little evidence exists regarding the risk factors and care processes of women who died from this cause of hemorrhage. Therefore, we aimed to describe the clinical profile, underlying mechanisms, and preventability factors among women who died from obstetric hemorrhage by surgical injury during cesarean section. Material and Methods: Nationwide analysis of all hemorrhage‐related maternal deaths by surgical injury during cesarean in France identified by the nationwide permanent enhanced maternal mortality surveillance system (ENCMM) between 2007 and 2018. We described the characteristics of the women, delivery hospitals, circumstances of hemorrhage, features of obstetric and resuscitation/transfusion care, and main preventability factors. Results: Between 2007 and 2018, hemorrhage‐related maternal mortality in France decreased from 1.6/100 000 live births (95% CI 1.1–2.2) (39/2 472 650) in 2007–2009 to 0.8/100 000 live births (95% CI 0.5–1.3) (19/2 311 783) in 2016–2018. Hemorrhage‐related maternal mortality ratio due to surgical injury during cesarean increased from 0.08 (95% CI 0.01–0.3) (2/2 472 650) to 0.2 (95% CI 0.07–0.5) (5/2 311 783) per 100 000 live births. Among the 18 women who died from surgical injury during cesarean over the 12‐year study period, we report a high prevalence of obesity (67%, 12/18), previous cesarean (72%, 13/18), and second‐stage cesareans (56%, 10/18). In 22% (4/18), cesarean section was performed in a hospital providing <1000 births annually, with no blood bank (39%, 7/18) or no adult intensive care (44%, 8/18) on‐site. Overall preventability of deaths was 94% (17/18). Main preventability factors were related to delay in hemorrhage diagnosis (77%, 14/18) due to late recognition of abnormal parameters (33%, 6/18) and late bedside ultrasound (56%, 10/18), and delay in management due to insufficient surgical skills (56%, 10/18). Conclusions: In France, surgical injury during cesarean section is an increasing, largely preventable contributor to hemorrhage‐related maternal mortality, as other causes of fatal hemorrhage have become less frequent. The profile of these women showed a high prevalence of obesity, previous cesarean, second‐stage cesarean, and delivery in hospitals with limited medical and surgical resources, which suggests explanatory mechanisms for the fatal outcome and opportunities for prevention. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to assess non‐inferiority of the unique approach used in our institution of combined 10 IU IM (intramyometrial) and 10 IU IV (intravenous) oxytocin to carbetocin IV in preventing severe postpartum blood loss in elective cesarean sections. The design was a prospective controlled phase IV non‐inferiority interventional trial. The setting was a tertiary center at University Hospital, Zurich, Switzerland. Material and Methods: The population consisted of 550 women undergoing elective cesarean section after 36 completed weeks of gestation at low risk for postpartum hemorrhage (PPH). Participants were assigned to either combined oxytocin regimen (10 IU IM and 10 IU IV) or carbetocin (100 μg IV). Non‐inferiority for oxytocin for severe PPH was assessed with a 0.05 margin using the Newcombe–Wilson score method. The main outcome measures were severe postpartum blood loss defined as delta hemoglobin (∆Hb, Hb prepartum—Hb postpartum) ≥30 g/L. Results: Non‐inferiority of combined oxytocin (IM/IV) in preventing severe postpartum blood loss was not shown (17 women in the oxytocin group vs. 7 in the carbetocin group). The number needed to treat when using carbetocin was 28. The risk difference for ∆Hb ≥30 g/L was 0.04 (oxytocin 0.06 vs. 0.03), 95% confidence interval (CI) (0.00–0.08). No significant difference was observed for ∆Hb (median 12 [IQR 7.0–19.0] vs. 11 [5.0–17.0], p = 0.07), estimated blood loss (median 500 [IQR 400–600] vs. 500 [400–575], p = 0.38), or the PPH rate defined as estimated blood loss ≥1000 mL (12[4.5] vs. 5 [2.0], risk difference 0.03, 95% CI (−0.01 to 0.06), p = 0.16). More additional uterotonics were administered in the oxytocin group compared to the carbetocin group (15.2% vs. 5.9%, p = 0.001). Total case costs were non‐significantly different in the oxytocin group (US $ 10 146 vs. 9621, mean difference 471.4, CI (−476.5 to 1419.3), p = 0.33). Conclusions: Combined (IM/IV) oxytocin is not non‐inferior to carbetocin regarding severe postpartum blood loss defined as postpartum Hb decrease ≥30 g/L in elective cesarean sections. We recommend carbetocin for use in clinical practice for elective cesarean sections. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of oligohydramnios in the mid‐trimester is challenging, because of the high incidence of adverse perinatal outcomes mainly due to bronchopulmonary dysplasia. Antenatal amnioinfusion has been proposed as a possible treatment for oligohydramnios with intact amnions, but there are few relevant studies. This study aimed to evaluate the effectiveness of transabdominal amnioinfusion in the management of oligohydramnios without fetal lethal malformations in the second and early third trimesters. Material and Methods: It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18–32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real‐time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed. Results: Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04–0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04–0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups. Conclusions: Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia. [ABSTRACT FROM AUTHOR]

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]

The article focuses on evaluating the effectiveness of various treatment strategies for managing cesarean scar ectopic pregnancies, highlighting the high success rates of surgical options compared to medical treatments. Topics include a comparative analysis of surgical and medical treatment outcomes, the safety and success rates of different methods, and recommendations for patient counseling and shared decision-making.

Purpose: Suicide attempts (SA) during perinatal period have the potential to adversely affect a woman's health and her developing infant. To date, little is known about perinatal SA and their risk factors. This study aimed to synthetize the evidence on risk factors of SA in pregnant and postpartum women. Methods: We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, and CINAHL, following the PRISMA guidelines for reporting. A meta-analysis was conducted only for risk factors examined in at least three distinct samples. Results: A total of ten studies were eligible for inclusion. All the studies found significant associations in regression models between perinatal SA and other variables (sociodemographic, clinical factors obstetric, neonatal, and psychosocial). The meta-analysis showed that unmarried women (pooled OR = 1.87, 95% CI = 1.26–2.78), with no higher education (pooled OR = 1.89, 95% CI = 1.31–2.74) and affected by a mood disorder (pooled OR = 11.43, 95% CI = 1.56–83.87) have a higher risk of postpartum SA; women who smoke during pregnancy (pooled OR = 3.87, 95% CI = 1.35–11.11) have a higher risk of SA in pregnancy; and women with previous suicidal behavior(pooled OR = 38.04, 95% CI = 3.36–431.17) have a higher risk of perinatal SA, whether during pregnancy or in the postpartum period. The type of sample, whether community or clinical, is a relevant moderating factor. Conclusion: Our study extends prior reviews about suicidal behaviors in women by studying perinatal suicide attempts independently, as well as it synthesized data on some sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies about specific risk factors for perinatal SA are needed in order to improve early detection and intervention of women at risk. [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit. Methods: We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables. Results: A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P <.001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge. Conclusion: Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits. Significance: Most pregnancy-related maternal deaths occur during the postpartum period; therefore, optimization of postpartum care is a priority for obstetric clinicians. Postpartum encounters before 6 weeks are sought most frequently by primiparas or postpartum persons who breastfeed or have prolonged hospitalization, episiotomy, or operative vaginal/cesarean delivery. Understanding who initiates early postpartum encounters, preferred methods of contact, and their most frequently asked questions will allow obstetric health practices to better meet the postpartum needs of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We emulated a modified randomized trial (Metformin in Women With Type 2 Diabetes in Pregnancy [MiTy]) to compare the perinatal outcomes in women continuing versus discontinuing metformin during pregnancy among those with type 2 diabetes treated with metformin plus insulin before pregnancy. RESEARCH DESIGN AND METHODS: This study used two health care claims databases (U.S., 2000–2020). Pregnant women age 18–45 years with type 2 diabetes who were treated with metformin plus insulin at conception were eligible. The primary outcome was a composite of preterm birth, birth injury, neonatal respiratory distress, neonatal hypoglycemia, and neonatal intensive care unit admission. Secondary outcomes included the components of the primary composite outcome, gestational hypertension, preeclampsia, maternal hypoglycemia, cesarean delivery, infants large for gestational age, infants small for gestational age (SGA), sepsis, and hyperbilirubinemia. We adjusted for potential baseline confounders, including demographic characteristics, comorbidities, and proxies for diabetes progression. RESULTS: Of 2,983 eligible patients, 72% discontinued use of metformin during pregnancy. The average age at conception was 32 years, and the prevalence of several comorbidities was higher among continuers. The risk of the composite outcome was 46% for continuers and 48% for discontinuers. The adjusted risk ratio was 0.92 (95% CI 0.81, 1.03). Risks were similar between treatments and consistent between databases for most secondary outcomes, except for SGA, which was elevated in continuers only in the commercially insured population. CONCLUSIONS: Our findings were consistent with those reported in the MiTy randomized trial. Continuing metformin during pregnancy was not associated with increased risk of a neonatal composite adverse outcome. However, a possible metformin-associated risk of SGA warrants further consideration. [ABSTRACT FROM AUTHOR]

This trial was carried out to investigate the effect of forced air warming in various body areas of women on hypothermia during cesarean delivery. The patients in the study groups (n = 76) were assigned to the full-body warming group, upper-extremity warming group, lower-extremity warming group, and control groups. The intervention groups received forced-air warming 30 min before the surgery and continued until 30 min after surgery. The incidence of hypothermia was significantly higher in the control group than in the other groups at the 60th minute of the operation (p < 0.01). The intervention and control groups showed significant differences in the frequency of shivering at the entrance to the PACU (p = 0.001). Thermal comfort scores have significant difference between the control group and all of the intervention groups (p<.001). It is said that the full-body forced-air warming technique prevents hypothermia, shivering, and thermal discomfort in women Cesarean Section (CS). [ABSTRACT FROM AUTHOR]

The article highlights the disconnect between cesarean birth reduction efforts and the majority of cesarean births that occur without labor attempts. Topics discussed include the predominance of cesarean births in women who did not attempt vaginal delivery, the limitations of current reduction strategies, and the need for improved data collection and tailored interventions to address the broader issues influencing cesarean rates.

Objective: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. Study Design: We used semi‐structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. Results: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital‐directed maternity care, to a trend that favors planned cesarean birth, driven by generation‐specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. Conclusions: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues. [ABSTRACT FROM AUTHOR]

Background: Rates of cesarean birth (CBs) are steadily increasing and account for 36.7% of all births in New South Wales (NSW), with primary cesareans driving the increase. NSW Health guidelines recommend women attempt a vaginal birth after a previous CB (VBAC); however, rates of VBAC are decreasing, particularly within the private hospital setting. This study aimed to determine the rates of adverse outcomes for women who planned a VBAC (pVBAC) compared with women who planned an elective repeat CB (pERCB) at one private hospital in Sydney, Australia. Method: This retrospective data review evaluated patient records over a 10‐year period (2010–2019). Records (n = 2039) were divided into four groups: pVBAC, pVBAC + EMCB, labor + ERCB (lab + ERCB), and pERCB. The incidence of adverse maternal and neonatal outcomes is reported as counts and percentages. Regression and chi‐squared tests were used to compare groups. Significance was determined at a p‐value of <0.05. Results: Overall, very low rates (N = 148, 7.3%) of women had a VBAC compared with a repeat CB at this private hospital over the 10‐year period. The incidence of adverse outcomes was low regardless of study group. Outcomes differed significantly between groups for postpartum hemorrhage (pERCB seven times less likely than VBAC group) and special care nursery admission (pVBAC + EMCB is 4.6 times more likely than in the VBAC group). Conclusion: Overall, it is safe to attempt a VBAC at this private hospital, and labor after a cesarean should be recommended, yet very few women had a VBAC at the study site. The incidence of adverse outcomes was low compared with other published research. [ABSTRACT FROM AUTHOR]

Background: In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. Methods: The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health‐related quality of life, and infant feeding practices. Analysis was by intention to treat. Results: N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain‐discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Conclusions: Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence‐informed decisions about monitoring options should STan become more widely available. [ABSTRACT FROM AUTHOR]

Background: We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics. Methods: We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner‐ and hospital‐level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient. Results: Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient‐level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8–1066.7) and third−/fourth‐degree perineal laceration (aOR 25.7, 95% CI 17.4–37.9). Receiving care from a certified nurse‐midwife (aOR 0.63, 95% CI 0.48–0.82) or family medicine physician (aOR 0.60, 95%CI 0.39–0.91) was associated with lower prescribing rates. Hospital‐level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61–15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15–0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%). Discussion: Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner‐ and hospital‐level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. Methods: Population‐based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi‐square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. Results: Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower‐risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13–1.32)), 39 (aOR 1.31(1.23–1.40)), 40 (aOR 1.42(1.35–1.50)), and 41 weeks of gestation (aOR 1.43(1.35–1.51)). Perinatal mortality was rare in both groups and non‐significantly lower in the induced group at most gestations. Discussion: For lower‐risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only. [ABSTRACT FROM AUTHOR]

• Association of caesarean and others PPH risk factors leads to near 50% PPH. • Carbetocin reduces PPH compared to oxytocin in high risk women. • Carbetocin reduces severe PPH compared to oxytocin in high risk women. • Carbetocin reduces the need for escalation of therapy. To evaluate the efficacy of carbetocin versus oxytocin in preventing postpartum haemorrhage (PPH) in women with risk factors for PPH who were delived by caesarean section. This retrospective, monocentric, before-and-after cohort study assessed patients with haemorrhagic risk factors who underwent caesarean section after 24 weeks of gestation and who had haemorrhagic risk factors between August 2014 to December 2019. This study enrolled 518 patients, including 250 in the oxytocin group and 268 in the carbetocin group. The use of carbetocin was independently associated with a PPH decrease compared to oxytocin use (adjusted odds ratio [OR]: 0.52; 95 % confidence interval [CI]: 0.35–0.79; p = 0.002). Carbetocin use was associated with a reduction in the need for therapy escalation (6 % vs 10.8 %; p = 0.046). Carbetocin was more effective than oxytocin in preventing PPH after caesarean section in high-risk patients. [ABSTRACT FROM AUTHOR]

• We investigated whether there is a relationship between short interpregnancy interval following missed abortion and pregnancy outcomes. • We found that short interpregnancy interval following missed abortion is associated with increased risk for preterm births. Short inter-pregnancy interval (IPI) of <18 months following a live birth, has been associated with adverse pregnancy outcome. This study aimed to evaluate whether a short IPI following a medically treated missed abortion (MA) poses similar perinatal risks in a subsequent pregnancy. The retrospective analysis included patients with history of an MA at up to 10 weeks of gestation, treated with misoprostol (pgE1) only, and with a documented subsequent live pregnancy (2010–2022). 1110 Patients were allocated into two groups: IPI ≤18 months and IPI >18 months. The primary outcome was the risk for a spontaneous preterm birth (PTB) <37 weeks of gestation in the consecutive pregnancy. Secondary outcomes included maternal and neonatal adverse outcomes. Statistical analysis was performed using the Statistical Program for Social Sciences for Windows version 26 (SPSS Inc, Chicago, IL). The cohort included 1,110 patients: 430 (38.74 %) patients with IPI <18 months and 680 (61.26 %) patients with IPI >18 months. The characteristics of the two groups were not significantly different. The rates of spontaneous PTB <37 and <34 weeks of gestation were significantly higher in the short vs. long IPI cohort (16.28 % vs. 7.06 % and 6.74 % vs. 5.0 %, respectively, p < 0.05). These patients also had a higher risk for Cesarean delivery (31.63 % vs. 23.34 %, p = 0.005) and postpartum hemorrhage (4.42 % vs. 2.06 %, p = 0.029) compared to patients with IPI >18 months. The observed differences remained statistically significant even after adjusting for potential confounding variables using multiple regression analysis. No other significant differences in neonatal or maternal outcomes were noted. Short IPI (≤18 months) following a medical treatment MA may be associated with an increased risk of PTB, Cesarean delivery and PPH. [ABSTRACT FROM AUTHOR]

Aims: To determine risk factors for 1‐year postpartum weight retention (PPWR) and glucose intolerance (prediabetes + diabetes) in women with a previous history of gestational diabetes (GDM) and prediabetes in early postpartum. Methods: In this exploratory analysis of the MELINDA randomized controlled trial, we report data of 167 women with prediabetes at the 6–16 weeks (early) postpartum oral glucose tolerance test after a recent history of GDM. Results: Of all participants, 45% (75) had PPWR >0 kg at 1‐year postpartum. Compared to women without PPWR, women with PPWR had higher gestational weight gain [10.5 ± 6.4 vs. 6.5 ± 4.5 kg, p < 0.001], higher BMI (p < 0.01) and a worse metabolic profile (higher waist circumference, worse lipid profile and more insulin resistance) (all p < 0.05) both in early and late postpartum. Of all women with PPWR, 40.0% developed metabolic syndrome, compared to 18.9% of women without late PPWR (p = 0.003). The only independent predictor for late PPWR was weight retention in early postpartum (p < 0.001). Of all participants, 55.1% (92) had glucose intolerance (84 prediabetes, 8 diabetes) 1‐year postpartum. Independent predictors for late postpartum glucose intolerance were lower gestational age at start insulin therapy in pregnancy and delivery by caesarean section (resp. p = 0.044 and 0.014). Conclusions: In women with a previous history of GDM and prediabetes in early postpartum, PPWR in early postpartum was a strong independent predictor for late PPWR, while earlier start of insulin therapy during pregnancy and delivery by caesarean section were independent predictors of glucose intolerance in late postpartum. [ABSTRACT FROM AUTHOR]

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

Introduction: Enteral feeding tubes are commonly utilized in the neonatal intensive care unit (NICU) due to the underdevelopment of coordination between sucking, swallowing, and breathing, or due to various diseases affecting the respiratory, cardiovascular, gastrointestinal, or neurological systems. The aim of the study was to investigate the differences in bacterial colonization patterns in hospitalized infants who received enteral feeding through either nasogastric (NG) or orogastric (OG) feeding tubes. Materials and Methods: This study was a hospital-based cross-sectional investigation that was carried out on infants who were admitted to the NICU. The NICU gathered feeding tubes throughout 4 months, beginning in August 2022 and continuing through December 2022. In addition, informed consent was collected from the participant's parents or legal guardians for the entire group of people who took part in the research. The fact that the patient participated in this study had no bearing on the level of care that they were given. The research team gave serious consideration to recruiting any of the newborns who were receiving medical attention in the NICU and who had a feeding tube inserted during the time that sample collection was taking place. The infants did not receive any probiotics as a form of treatment in any of the cases. Results: Infants with NG tubes had a significantly higher number of C-sections (P = 0.04), infants with NG tube were exclusively breastfed (P = 0.02), and one or more dose of antenatal steroids was administered more in infants with OG tube (P = 0.04). The most common types of bacteria found in NG and OG tubes were Proteobacteria (with a mean relative abundance of 50% and 60%, respectively), Firmicutes (with a mean relative abundance of 33% and 23%, respectively), and Actinobacteria (9% and 7%, respectively). Conclusion: Oral versus nasal feeding tube insertion was found to have a greater influence on bacterial colonization than any of the other clinical factors that were evaluated. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed at assessing the adverse outcomes of pregnancy in women with endometriosis. Material and methods: The Cochrane, Embase and PubMed databases were searched for identifying the required studies published before June 2019. Meta-analyses of relative risk (RR) were performed under the random-effects model to estimate the risk of selected adverse outcomes of pregnancy in females with endometriosis. Results: Twenty-eight studies (53,141 women with and 2,355,923 women without endometriosis data) were selected for meta-analysis. Endometriosis bearing females had a significantly higher risk placenta previa (RR 3.92 [95% CI 2.48--6.20]), miscarriage (RR 1.31 [95% CI 1.06--1.61), gestational hypertension (RR 1.30 [95% CI 1.02--1.65]), cesarean section (RR 1.48 [95% CI 1.33--1.65]) and preeclampsia (RR 1.18 [95% CI 1.09--1.28]). The incidence of placental abruption was not statistically significant between the groups (RR 3.62 [95% CI [0.99--13.28]). Conclusions: Women suffering from endometriosis are at higher risks of miscarriage, preterm birth, gestational hypertension, placenta previa, cesarean section, and preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of a 50 mg caffeine coffee consumption on bowel function recovery after cesarean delivery. Materials and Methods: A randomized controlled trial was conducted. One hundred sixty-two post-cesarean delivery patients were enrolled and allocated to one of the two groups, Group 1, which included 81 volunteers, with a cup of 50 mg caffeine coffee and Group 2, which also included 81 volunteers, with a cup of warm water at postpartum ward, two hours after the operation. The primary outcome was to compare the time to first flatus after surgery between patients of each group. The secondary outcome was to compare the time to first defecation, time to tolerate a solid diet, and the incidence of postoperative ileus between groups. Results: The mean time to first flatus and standard deviation was 28.93±20.20 and 30.52±16.27 hours, time to first defecation was 62.45±28.00 and 63.45±25.53 hours, and the incidence of postoperative ileus was 17.28% and 19.75%. All results in both groups were not significantly different in the 50 mg caffeine coffee group and the warm water group. Conclusion: Drinking coffee with a cup of 50 mg caffeine coffee after cesarean delivery did not significantly improve the bowel function recovery. The higher dosage of caffeine coffee needs further studies. [ABSTRACT FROM AUTHOR]

Background: A cesarean infection is a referral hospital acquired bacterial infection that occurs after deliver by cesarean section which could be emergency or elective. As highlighted by the various researchers that the infections following a cesarean delivery, which some people call a C-section, are common. The wound coming into contact with bacteria or other harmful microbes is a common cause of these infections. The main objective of this study was the assessment of bacteria isolated from cesarean infection patients attending Ruhengeri level two teaching hospital. Methodology: A cross-sectional study was conducted and total of 30 wound swabs of cesarean were collected from inpatient of Ruhengeri level two teaching hospital. Data were analyzed using SPSS statistical software (version 20). Results: The results showed that the most predominant bacteria isolated from patients with cesarean infection was S. aureus (28.1%) followed by S. pyogenes (18.8%), K. pneumoniae (18.8%), P. aeruginosa (12.5%), S.epidermidis (9.4%), E. coli (6.3%) and P. mirabilis(6.3%). Antibiotics sensitivity test was performed, so this study showed the predominant antibiotic which were sensitively to different bacteria were Chloramphenicol, Gentamycin and Norfloxacin and most bacteria were resistance to Rifampicin and Vancomycin. Conclusion: This study has shown that there are many bacteria that may be isolated in cesarean infection. It has also shown that some of the isolated bacteria were sensitive and other were resistant to Rifampicin and Vancomycin. The study recommends that Rwandan government should create more clinical microbiological laboratory, in Rwanda, in order to minimize the antibiotic resistance and also on the side of health care providers, especially at Ruhengeri level two teaching hospital, they should use the experienced workers in order to minimise the risks of getting caesarean infection and also to recommend the patients taking care their wound. [ABSTRACT FROM AUTHOR]

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2-0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to compare the impact of the physiotherapeutic method combined with TENS and physiotherapy alone on post-cesarean pain levels and the time required for intestinal peristalsis recovery. The study was conducted at the Specialist Hospital in Kraków, from January to March 2020. Methods: The study was designed as a parallel randomized controlled trial (RCT). Participants were randomly assigned to one of three groups: TENS (n=52), nTENS (n=50) and control group (n=34), based on block randomization of 6. The allocation sequence was provided using a computer-generated random list. The participants were 136 postpartum primiparous women after cesarean birth, aged ≥18 years, having a healthy newborn, with no contradictions to TENS. The TENS group received a physiotherapeutic procedure involving a 20-minute exercise program plus a 40-minute session of TENS. The nTENS group received physiotherapeutic procedure alone, and the control group was under the routine care of midwives. The pain was assessed using the Numerical Rating Scale (NRS) at 6, 7, 12 and 24 hours after cesarean birth and twice during verticalization. Results: TENS and nTENS groups had decreased pain intensity immediately after the intervention compared to the control group (p=0.002, p=0.027, respectively). During the first stage of the verticalization, the smallest increase in pain was observed in the TENS (p=0.044 compared to nTENS, p=0.000 compared to the control group). Within the increase in the pain score, the intestinal peristalsis recovery time was longer. In both groups undergoing physical therapy, a shortened recovery time of intestinal peristalsis was demonstrated (p=0.000). Conclusions: The proposed physiotherapy program, combined with TENS and instruction, proved effective in relieving post-cesarean pain and accelerating the time to first defecation and should be considered part of the standard patient management program in maternity units. [ABSTRACT FROM AUTHOR]

Perinatal clavicular fracture is the most common birth injury that may cause neonatal morbidities such as obstetric brachial palsy (OBP) ranging from 0.2 to 3.5%. We aimed to compare the relationship between perinatal clavicular fracture and induced vaginal delivery. All the live births and the neonatal outpatient clinic admissions between June 2016 and December 2022 have been investigated retrospectively. A total of 185 newborn infants with a mean gestational age of 38.3±1.6 weeks and a mean birth weight of 3,451±430.10 grams were enrolled. When compared to all in-born live births, the overall incidence of clavicular fracture was 0.78%. One hundred eighty-one (97.8%) infants were born vaginally and 4 (2.2%) were born by cesarean sections (C-sections). The incidence of clavicular fracture among in-born vaginally delivered infants was 1.26% (n=153) and among C-section deliveries was 0.04% (n=3). In vaginal deliveries, 54.7% (n=99) had prolonged labor, 71.8% (n=130) had received labor induction and 7.7% (n=14) had a history of instrumental intervention. A statistically significant relationship was found between clavicular fracture and prolonged labor, labor induction, increased birth weight, and low Apgar scores (p<0.001). While 21 infants (11.4%) had cephalohematoma, 8 infants (4.3%) presented with symptoms of OBP. Although high birth weight, prolonged labor, and ventouse delivery are the already known major risk factors for neonatal clavicular fractures, induced vaginal delivery has been defined as a new and important risk factor. Induction of labor should be decided when the benefits of immediate delivery outweigh the risks of continuing the pregnancy for fetal and maternal health. [ABSTRACT FROM AUTHOR]

Our systematic review highlights that multiparametric PAI score assessment is a consistent tool with high sensitivity and specificity for prenatal prediction for placenta accreta spectrum (PAS) in high‐risk population with anterior placenta previa or low‐lying placenta and prior cesarean deliveries. A systematic search was conducted on November 1, 2022, of MEDLINE via PubMed, Scopus, Web of Science Core Collection, Cochrane Library, and Google Scholar to identify relevant studies (PROSPERO ID # CRD42022368211). A total of 11 articles met our inclusion criteria, representing the data of a total of 1,044 cases. Women with PAS had an increased mean PAI total score, compared to those without PAS. Limitations of the PAI are most studies were conducted in developing countries in high‐risk population which limit the global generalizability of findings. Heterogeneity of reported data did not allow to perform meta‐analysis. [ABSTRACT FROM AUTHOR]

Thrombotic microangiopathy (TMA) is characterized by thrombocytopenia, microangiopathic hemolytic anemia and target organ damage. Pregnancy is associated with several forms of TMA, including preeclampsia (PE), HELLP syndrome, thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). When HUS is secondary to a deregulation of the alternative complement pathway, it is known as atypical HUS (aHUS). Differential diagnosis is challenging, as these forms share clinical characteristics. However, early diagnosis is crucial for a specific treatment to be established and improve prognosis. We present the case of a 43 year-old primiparous woman admitted to hospital for an urgent C-section at 33 gestational weeks due to a diagnosis of severe preeclampsia and fetal distress. In the immediate postpartum, the patient developed acute liver failure and anuric renal failure in the context of the HELLP syndrome, anemia, thrombocytopenia, arterial hypertension (HTN) and neurological deficit. TMA study and differential diagnosis confirmed pregnancy-associated aHUS. Treatment with eculizumab was initiated, with good response and progressive improvement of clinical and analytical parameters. aHUS is a rare multifactorial disease that used to be associated with high mortality rates before the advent of eculizumab. Due to challenging diagnosis, the clinical laboratory plays a major role in the differential diagnosis and management of the disease. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of additional local infiltration of dexamethasone and lidocaine among post-cesarean parturient underwent spinal anesthesia compared to the control group. Materials and Methods: This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between June and November 2022. Singleton pregnant women who underwent cesarean delivery were randomized into 3 groups: dexamethasone (D), lidocaine (L), and control groups (C). Before skin closure, D, L and C group received infiltration of 16 mg of dexamethasone, 2% lidocaine with adrenaline and none, respectively. A visual analog scale (VAS, 0-10) was used for the evaluation of post-cesarean pain at two, four, six, eight, twelve, and twenty-four hours. VAS, demographic, and obstetric data were collected for analysis. Additional opioid was recorded for secondary outcome. Results: A total of 279 participants were recruited and divided into 3 groups. Half of the participants (151/279) were nulliparity. Other demographics were similar. Subjects in the D group had lower moderate to severe pain after 6 hours onwards and less additional opioid requirement compared to the C and L groups significantly. Subjects in the L group had lower moderate to severe pain than the C group at 4 hours after surgery. Postoperative complications were comparable among the groups. Conclusion: Local dexamethasone infiltration could reduce and prolong post-cesarean pain relief within 24 hours after cesarean delivery. [ABSTRACT FROM AUTHOR]

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background & Objective: To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound with the findings during a cesarean section (C/S) of pregnant women with a history of previous C/S. Materials & Methods: This cross-sectional study was performed on 40 pregnant women referred to Izadi Obstetrics and Gynecology Hospital in Qom. All the women underwent transvaginal ultrasound followed by C/S within a maximum of one week later. Also, an expert gynecologist classified LUS thickness into four grades in the operation room. Results: The mean age of women was 31.58 ± 4.56 years, and the mean thickness of the LUS was 2.17 ± 0.51 cm. Moreover, 57.5% of the women have graded I of LUS based on intraoperative findings. Results indicated that the mean thickness of the LUS measured by ultrasound significantly differed between the three grades detected by the gynecologist (P=0.04). However, there were no significant differences between maternal age, gestational age, parity, and time of last C/S among women with different LUS grades (P=0.05). Transvaginal ultrasound could be helpful in evaluating the risk of scar dehiscence and uterine rupture among women with LUS grades I and II with a history of previous C/S. Conclusion: Transvaginal Ultrasonography, Lower Uterine Segment Thickness, Cesarean Section. [ABSTRACT FROM AUTHOR]

Background & Objective: Placenta Accreta Spectrum (PAS) is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean delivery, which is increasing without medical indication. This study was conducted with aim to explore the risk factors of PAS, clinical outcomes of affected patients, and strategies to minimize maternal morbidity and mortality. Materials & Methods: A total of 142 women who had undergone at least one cesarean delivery in the past were included. Among them, 85 women had placenta accreta spectrum (PAS) in their current pregnancy (group 1), while 57 did not have PAS (group 2). The information regarding their demographics and previous gynecological history, including placenta previa were collected. P<0.05 was considered statistically significant. Results: The risk of placenta accreta spectrum (PAS) is significantly higher in cases where there has been a previous cesarean delivery and placenta previa (p<0.05). There were no significant differences between past elective or emergent cesarean delivery (p>0.05). PAS was associated with more emergent cesarean deliveries (p<0.001) and hysterectomies (p<0.001). Moreover, 97% of patients with history of placenta previa developed PAS (p<0.001). Most of the patients who underwent hysterectomy had PAS and placenta previa (p<0.001). There was no significant correlation between previous hysteroscopies and curettages and a higher risk of PAS (p>0.05). Conclusion: Women with previous cesarean delivery are significantly at risk of placenta accreta in their future pregnancies. Pregnant women should avoid insisting on elective cesarean delivery without medical indication. Planned cesarean delivery could reduce the maternal complications. [ABSTRACT FROM AUTHOR]

Background & Objective: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage. Materials & Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section, was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocin therapy, and the incidence of adverse effects were recorded. Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.). Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration. [ABSTRACT FROM AUTHOR]

Background/Aim: Constipation can occur after abdominal procedures. In this study, we investigated whether early mobilization after abdominal surgery is effective for treating constipation. Methods: We conducted a systematic review of studies implementing early and planned mobilization after abdominal surgical procedures. We extracted studies published from 2012-2022 from six electronic databases: PubMed, Google Scholar, Science Direct, Cochrane, TürkMedline, and Ulakbim. The data were collected by two reviewers following a pre-designed subtraction form. We made use of narrative synthesis when presenting our results. Results: We examined 10 articles that satisfied the inclusion criteria; patients underwent a cesarean section in four studies, bariatric surgery (gastric bypass) in one study, liver resection in one study, radical cystectomy in two studies, cholecystectomy in one study, and a kidney transplant in one study. The studies were characterized by differences in the early mobilization programs applied to patients after abdominal surgery. In two of the studies, the patients were mobilized accordingly to daily step goals; in five studies only early stimulation and walking attempts were utilized. In three of the studies, the patients were mobilized within the scope of mobilization programs prepared in detail after surgery, and the targets were determined in terms of distance walked. All of the studies stipulated that physical activity should gradually increase over time. Conclusion: Early and planned mobilization programs applied after surgery had positive effects on first gas/first stool output time, the severity of abdominal distension, the occurrence of nausea/vomiting, and the onset of oral intake. [ABSTRACT FROM AUTHOR]

(1) Background: Pulmonary hypertension (PH) increases pulmonary vascular resistance and right ventricular (RV) afterload. Assessment of RV systolic function in PH using RV fractional area change (RV FAC) as a marker directly correlates with mortality and the need for extracorporeal membrane oxygenation (ECMO). However, few studies have assessed neurodevelopmental outcomes. We hypothesize that cardiac RV systolic dysfunction with lower RV FAC is associated with worse neurodevelopmental impairment (NI). (2) Methods: Retrospective study of 42 subjects with PH to evaluate neurodevelopmental outcomes in the first two years of life based on (i) subjective assessment of RV systolic function and (ii) RV FAC, a specific echocardiographic marker for RV function. (3) Results: Subjects from the initial study cohort (n = 135) with PH who had long-term follow-up were divided into RV dysfunction (study, n = 20) and non-RV dysfunction (control, n = 22) groups. RV FAC in the study vs. control group (0.18 vs. 0.25) was lower (p = 0.00017). There was no statistically significant difference in NI either with RV dysfunction or lower RV FAC. Although not significant, RV dysfunction was associated with longer mean duration of mechanical ventilation, time on ECMO, and length of stay. In the initial cohort (135), mortality was 16.3% and the percentage of NI was 62%. (4) Conclusions: Neonatal pulmonary hypertension is associated with a high degree of neurodevelopment impairment. Early RV systolic dysfunction, as identified by RV FAC, was not an optimal predictive biomarker for infants with PH and neurodevelopmental impairment. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean section it is the most frequently applied surgical application. Every surgical procedure creates an inflammation. Neutrophil to lymphocyte ratio (NLR), which can be easily obtained from complete blood count, is used as subclinical systemic inflammatory markers. In this study, our aim is to understand the effect of the duration of the cesarean section on subclinical inflammation by looking at the neutrophil/lymphocyte ratio and the effect of this period on blood loss and postoperative recovery Methods: We included a total of 188 operations between the ages of 18-45 in our study and created 2 groups according to the duration of the cesarean section. When grouped as short (0-39 min) and long (≥40 min) according to the operation time, NOL change was higher in the group with longer operation duration, but no significant difference was found in both groups. Similarly, although the decrease in hemoglobin was higher in the group with a long operation time, no significant difference was found. No difference was observed between the two groups in terms of wound healing on the postoperative 10th day. When we look at our other parameters, we found a significant relationship between those whose cesarean section ended within 40 minutes and those who had their first cesarean section. Results: As a result of our study, we could not detect a significant difference in the duration of the cesarean section operations performed in our clinic on the postoperative parameters. Conclusion: Although supportive studies are needed, it shows that the surgical rules of cesarean section operate correctly under optimal conditions. [ABSTRACT FROM AUTHOR]

Introduction: Scar endometriosis is a type of rare endometriosis that develops following obstetric or gynecological surgeries. The aim of our study is to share our clinical experiences regarding scar endometriosis, which is becoming more common due to increasing cesarean operations, and to contribute to the literature on this subject. Methods: A total of 32 patients who underwent surgery due to scar endometriosis participated in our study. The patients' demographic and clinical characteristics, size and location of the lesion determined by imaging methods and histopathological results were recorded and analyzed. Results: The mean age of the patients was 34.81±6.52 years, with 46.9% having undergone one cesarean section and 53.1% having undergone two or more cesarean sections. Scar endometriosis involving subcutaneous and fascial tissue was determined to be 43.7% in the right corner, 28.1% in the left corner, 9.4% in the midline, and 18.8% within the rectus muscle. The time elapsed between cesarean section and the onset of symptoms was found to be statistically significantly shorter in patients who had undergone two or more cesarean sections compared to those with only one previous cesarean section (p=0.015). Conclusion: Scar endometriosis is a painful condition for which clear success in medical treatment has not yet been demonstrated, and surgical intervention is often required. Given the higher frequency of occurrence at the corners of cesarean section incisions, we recommend the careful washing of these corners. Further immunohistochemical studies are needed to achieve success in medical treatment, and histopathological analysis should be fully elucidated. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to evaluate the effect of volar locking plate (VLP) removal on functional scores. Methods: In this retrospective study, between January 2019 and January 2024, medical records of our institution were reviewed and patients who underwent VLP removal were included in the study. Demographic characteristics of the patients, follow-up time until VLP removal and reasons of VLP removal were evaluated from medical records. Preoperative and postoperative 3rd month Disabilities of Arm, Shoulder and Hand (DASH) scores were evaluated. Soong classification was performed on lateral wrist radiographs. Results: Thirty-eight patients (24 male, 14 female) patients were included in the study. The mean age of all patients was 51.23±15.6 years. The mean time from VLP fixation to implant removal was 17.42±12.42 months. Patients who underwent implant removal were evaluated according to the Soong classification. 18 of the patients (%47.36) were grade 0, 16 of the patients (%42.1) were grade 1 and 4 of the patients (%10.54) were grade 2. The most common removal reason was patient request (n=26, %68.42). Preoperative mean DASH score was 19.1 and postoperative 3rd month mean DASH score was 8.2. There was a significant difference between preoperative and postoperative 3rd month DASH scores. (p<0.001) When patients were asked whether they would choose to implant removed again if they were in the same situation, %94.7 of the patients stated that they would choose implant removal again compared to those with only one previous cesarean section (p=0.015). Conclusion: VLP removal provided significant improvement in the patients' functional outcomes. The most common reason for VLP removal was patient request. [ABSTRACT FROM AUTHOR]

Background and Aims: A ping pong fracture is a rare depressed skull fracture (DSF) observed in infants. It occurs due to the inward buckling of the calvarium, creating a cup‐like shape. Trauma during childbirth, particularly from instrumental delivery or the application of pressure by physicians or midwives during challenging deliveries, is the primary cause. This study aimed to investigate the epidemiologic characteristics associated with DSF in newborns and to identify the main factors related to its incidence and the type of hematoma involved. Methods: This is a retrospective case‐control analysis of all newborns delivered with DSF at King Abdulla University Hospital in Jordan between January 2008 and December 2020. The medical records were reviewed, and clinical data were collected and analyzed. Results: Out of 42,955 live births delivered at King Abdulla University Hospital, 13 cases of DSF were observed, giving an incidence of 3.0 in 10,000 live births. All cases were delivered at full term. Of the 13 cases, nine cases were associated with the use of instrumental delivery. Seven of those nine cases were delivered vaginally, while the other two cases required cesarean section following unsuccessful instrumental delivery. Four cases were spontaneous, with no history of trauma or instrument use, and delivered by cesarean section. Only 3 of the 13 cases required neurosurgical elevation of DSF. The outcome was excellent in all cases, both cosmetically and neurologically. Conclusion: Ping‐pong skull fractures are seen in newborns infrequently in the Jordanian population, with an incidence of 0.03%. Most of the cases have resulted from difficult deliveries though spontaneous fractures can be encountered rarely. The treatment is usually conservative with spontaneous resolution. The overall prognosis is excellent both neurologically and cosmically. [ABSTRACT FROM AUTHOR]

Aim: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID‐19 epidemics' fifth wave. Design: A cross‐sectional study. Methods: This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction. Results: The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC‐19S (14.7 ± 7.5), WHO‐5 (67.5 ± 13.0) and BSS‐R (28.6 ± 7.3). Sixty‐five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well‐being score < 50, fear of COVID‐19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]