Search

Post-dural puncture headache (PDPH) is a debilitating complication of neuraxial anesthesia, particularly prevalent in obstetric patients, usually characterized by a postural headache. PDPH is hypothesized to result from cerebrospinal fluid leakage through a dural puncture, triggering symptoms like neck stiffness and subjective hearing changes. While conservative measures are common for treatment, more refractory cases may require invasive interventions such as an epidural blood patch (EBP). Recent studies have shown promise in using nebulized dexmedetomidine (nDEX) for PDPH, offering a non-invasive alternative to EBP. Two case presentations illustrate the efficacy of nDEX in resolving PDPH symptoms rapidly and completely. These cases underscore the need for exploring novel therapeutic options, especially in obstetric patients where safe and prompt relief is essential for maternal and newborn well-being. While the EBP remains the gold standard, its limitations of accessibility and invasiveness highlight the significance of investigating alternatives like nDEX. [ABSTRACT FROM AUTHOR]

This randomized controlled intervention study aims to determine the effect of an abdominal binder on pain, bleeding, and breastfeeding success after cesarean delivery. The study was conducted with women who underwent cesarean section and were followed-up for the first 48 hours at the obstetrics clinic of a state hospital in Türkiye between September 2020-March 2021. The study was completed with a total of 128 women who met the inclusion criteria (Intervention (IG):64, Control (CG):64). Data were collected using a “Socio-demographic Form” and “Postpartum Follow-up Form.” Statistical significance was defined as p < .05. The IG showed significantly lower pain scores in both the abdominal area (uterine involution) and cesarean incision compared to the CG (p < .001), (respectively, IG:0.19 ± 0.58 vs. CG:1.33 ± 1.16; IG:0.23 ± 0.61 vs. CG:0.75 ± 1.26). The amount of puerperal bleeding was significantly lower in the IG (p < .001) (IG:327.65 ± 112.61 mL vs. CG:402.61 ± 157.45 mL), and their hemoglobin and hematocrit values were significantly higher (p < .05) (Hemoglobin, IG:11.00 ± 0.78 g/dL vs. CG:10.62 ± 0.90 g/dL; Hematocrit, IG:34.54 ± 1.79 percent vs. CG:33.51 ± 2.56 percent). The breastfeeding success scores were significantly higher in the IG (p < .001) (IG:9.97 ± 0.17 vs. CG:9.81 ± 0.43). These data demonstrate that the abdominal binder is beneficial and applicable for reducing pain, bleeding, and for improving breastfeeding success in the first 48 hours after cesarean delivery. [ABSTRACT FROM AUTHOR]

• Different Level of care did not impact the Decision-to-delivery interval. • Rates of appropriate indications were higher in the level-2 than level-1 hospitals. • Code red CD indications and level-2 were associated with worse perinatal outcome. Code red cesarean delivery (CD) is performed in the presence of an impending danger to maternal or fetal life. The indications, times, and procedures in this setting remain ambiguous. The aim of this study was to evaluate in a cohort of code red CD the impact of the level of care of Obstetric Units, indications, and decision to delivery interval CD on maternal and perinatal outcomes. This was a multicenter retrospective study conducted at four maternal units (two level-2 University Hospitals and two level-1 Community Hospitals) on a cohort of women who underwent code red CD between 2018 and 2021. An independent team of experts performed retrospective audits to assess the appropriateness of indications. A cohort of 168 code red CDs were included. The most frequent indications were severely abnormal fetal heart rate patterns (41.7 %) and sentinel events (38.1 %). Decision to delivery interval (DDI) was similar between different level of care (20.7 vs 21.4 min, p = 0.66) and didn't affect adverse perinatal outcome. Rates of appropriate indications were higher in the level-2 than level-1 hospitals (80.2 % vs 65 %, p = 0.036), with worse adverse perinatal outcome in the former than the latter (43.4 % vs 21.1 %, p = 0.002). At multivariate analysis, worse perinatal outcomes were independently associated with indications for code red CD (P = 0.01) and level-2 units (P = 0.005). Level-1 hospitals guarantee a promptness of response comparable to that of level-2 centers in dealing with emergency in CD, however with lower rates of appropriate indications. Indications for code red CD but not DDI are associated with worse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate maternal and neonatal outcomes in subsequent pregnancies of women with a history of placenta accreta spectrum (PAS) compared with women without history of PAS. Study Design A retrospective cohort study conducted at a single tertiary center between March 2011 and January 2022. We compared women with a history of PAS who had uterine preservation surgery and a subsequent pregnancy, to a control group matched in a 1:5 ratio. The primary outcome was the occurrence of a composite adverse outcome (CAO) including any of the following: uterine dehiscence, uterine rupture, blood transfusion, hysterectomy, neonatal intensive care unit admission, and neonatal mechanical ventilation. Multivariable logistic regression was performed to evaluate associations with the CAO. Results During the study period, 287 (1.1%) women were diagnosed with PAS and delivered after 25 weeks of gestation. Of these, 32 (11.1%) women had a subsequent pregnancy that reached viability. These 32 women were matched to 139 controls. There were no significant differences in the baseline characteristics between the study and control groups. Compared with controls, the proportion of CAO was significantly higher in women with previous PAS pregnancy (40.6 vs. 19.4%, p = 0.019). In a multivariable logistic regression analysis, previous PAS (adjusted odds ratio [aOR] = 3.31, 95% confidence interval [CI] = 1.09–10.02, p = 0.034) and earlier gestational age at delivery (aOR = 3.53, 95% CI = 2.27–5.49, p < 0.001) were independently associated with CAOs. Conclusion A history of PAS in a previous pregnancy is associated with increased risk of CAOs in subsequent pregnancies. Key Points The uterine-preserving approach for PAS delivery is gaining more attention and popularity in recent years. Women with a previous pregnancy with PAS had higher rates of CAOs in subsequent pregnancies. Previous PAS pregnancy is an independent factor associated with adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective Intraoperative noise exposure has been associated with an increased risk of complications, communication errors, and stress among surgical team members. This study evaluates intraoperative noise levels in cesarean deliveries during different shift times, for example, night shifts, day shifts, and hand-off times between shifts. Study Design This is a secondary analysis of a prospective observational study which measured volume in decibels, percentage of time above safe levels (>60 dB), startle noise events (events with rapid increase of decibel level above baseline noise), and peak levels (>75 dB) for cesarean deliveries during a 3-month preintervention and postintervention study. This secondary analysis of noise data evaluated whether there were differences in noise for cases occurring during day shifts (6:31 a.m.–4:59 p.m.), night shifts (6:01 p.m.–5:29 a.m.), and hand-off times (5:30 a.m.–6:30 a.m. and 5:00 p.m.–6:00 p.m.). Correlates and postoperative complications during the respective shifts were additionally analyzed. Results Noise data were collected for a total of 312 cesarean deliveries; 203 occurred during the day shift, 94 during the night shift, and 15 during hand-off times. Median noise in decibels, median noise at various key intraoperative points, number of startle events, percentage of time above 60 dB, and above 75 dB had no significant differences throughout the various shift times. Significantly larger numbers of postpartum hemorrhages, unscheduled, urgent, and STAT cesarean deliveries occurred at hand-off times and on night shifts. Conclusion Noise levels during cesarean deliveries did not significantly vary when comparing night shifts, day shifts, and hand-off times, despite significantly higher numbers of urgent and STAT cases occurring overnight and during hand-off times. However, more than 60% of case time had noise levels exceeding those considered safe. This suggests that ambient background noise may be contributing more to overall noise levels rather than the specific clinical scenario at hand. Key Points Noise in cesarean delivery operating rooms frequently exceeded recommended levels. Noise in cesarean delivery operating rooms did not vary with shift type. Hand-off times had higher rates of urgent and STAT cesareans. Night shifts had higher rates of urgent and STAT cesareans. [ABSTRACT FROM AUTHOR]

Objective We aimed to examine rates of induction of labor at 39 weeks and cesarean delivery before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial stratified by body mass index (BMI; kg/m 2) category. Study Design This was a repeated cross-sectional analysis of publicly available U.S. birth certificate data from 2015 to 2021. We limited analyses to nulliparous individuals with a singleton pregnancy, cephalic presentation, without chronic hypertension, diabetes (gestational or pregestational), and fetal anomaly who delivered between 39 and 42 weeks' gestation. The pre-ARRIVE period spanned from August 2016 to July 2018 and the post-ARRIVE period spanned from January 2019 to December 2020. The dissemination period of the ARRIVE trial was from August 2018 to December 2018. Our co-primary outcomes were induction at 39 weeks and cesarean delivery. Our secondary outcomes were overall induction of labor and preeclampsia. We conducted an interrupted time series analysis after stratifying by prepregnancy BMI (<40 or ≥40). Negative binomial regression was used to calculate adjusted incident rate ratios with 95% confidence intervals. Results Of 2,122,267 individuals that were included, 2,051,050 had BMI <40 and 71,217 had BMI ≥40. In individuals with BMI <40, the post-ARRIVE period compared to the pre-ARRIVE period was associated with an increased rate of induction of labor at 39 weeks, a decreased rate of cesarean delivery, and an increased rate of overall induction of labor. In individuals with BMI ≥40, the post-ARRIVE period compared to the pre-ARRIVE period was associated with an increased rate of induction of labor at 39 weeks, an increased rate of overall induction of labor and a decreased rate of preeclampsia; however, the decrease in the rate of cesarean delivery was not significant. Conclusion An increase in induction of labor at 39 weeks' gestation in individuals with BMI ≥40 was not associated with a decrease in the cesarean delivery rate. Key Points The ARRIVE trial increased 39-week labor inductions in BMI <40 and ≥40. BMI <40 had fewer cesareans; BMI ≥40 showed no significant decrease. Offering labor induction is reasonable as cesarean rates didn't increase. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]). Study Design We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor. Patient characteristics were abstracted. The primary outcome was rate of VD. Secondary outcome was factors associated with VD. Secondary analysis performed including only primiparous patients. Bivariate statistics and logistic regression were used to analyze data. Results Of 229 patients with ESPEC, 184 (80%) were candidates for labor. Of those, 74 (40%) underwent prelabor cesarean delivery (CD). Among the 110 remaining patients who attempted VD, 47 (43%) were successful. No significant differences in characteristics between VD and CD patients were found on bivariate analysis. In regression models, BMI ≥ 40 was associated with increased odds of CD (adjusted odds ratio [aOR]: 2.83, 95% confidence interval [CI]: 1.01, 7.95), whereas private insurance was associated with reduced odds of CD (aOR: 0.37, 95% CI: 0.16, 0.86). In planned secondary analysis of primiparous patients, 101/123 (82%) were candidates for labor. Of those, 29 underwent prelabor CD. The VD rate among primiparous patients attempting labor was 40% (29/72). In this subgroup, private insurance was associated with VD (71 vs. 46%, p = 0.03). In regression models, only private insurance remained associated with CD (aOR: 0.30, 95% CI: 0.10, 0.92). Conclusion Patients with ESPEC who attempted VD were successful less than half of the time, with similar rates among the subset of primiparous patients. BMI ≥ 40 was associated with increased odds of CD, whereas private insurance was associated with reduced odds of CD. These data may aid providers in counseling patients with ESPEC on the likelihood of successful VD. Key Points Only 43% of ESPEC patients who attempted VD were successful. Subset of primiparous patients w/ESPEC had similar VD rate. BMI ≥40 kg/m 2 in ESPEC patients was associated with increased odds of CD. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to compare the cost and effectiveness of three strategies for screening and/or treating bacterial vaginosis (BV) during pregnancy prior to delivery: (1) the current standard of care was neither test nor treat for BV (Treat None); (2) test all patients for BV at 36 weeks' gestation; treat if positive (Test Treat); and (3) treat all patients undergoing cesarean delivery with intravenous metronidazole at time of surgery (Treat All Cesarean). Effectiveness was defined as avoidance of postpartum surgical site infection (SSI). Study Design A decision analytic cost–effectiveness model was designed from a third-party payer perspective using clinical and cost estimates obtained from the literature, American College of Surgeons National Surgical Quality Improvement Program participant use file (2005–2019), 2019 National Vital Statistics, Medicare costs, and wholesale drug costs. Cost estimates were inflated to 2020 U.S. dollars. For this study, effectiveness was defined as avoidance of postpartum SSIs. Results The base case analysis that is the current standard of care of not routinely testing and treating patients for BV (Treat None) was the most expensive and least effective strategy, with a mean cost of $59.16 and infection rate of 3.71%. Empirically treating all patients for BV without testing (Treat All Cesarean) was the most effective and the least expensive strategy, with a mean cost of $53.50 and an infection rate of 2.75%. Testing all patients for BV and treating those positive for BV (Test Treat) was also relatively inexpensive and effective, with an infection rate of 2.94% and mean cost of $57.05. Compared with Treat None, we would expect the Treat All Cesarean strategy to reduce the infection rate by 26%. Conclusion These findings suggest that treating pregnant patients with intravenous metronidazole at time of cesarean delivery could be an effective and cost-saving strategy. Testing and treating for BV could also be considered a reasonable strategy, as it has the added benefit of preserving antibiotic stewardship. In no analysis was the standard of care strategy of neither testing nor treating for BV before delivery the preferred strategy. Key Points BV colonization may increase surgical site infection risk after cesarean section. Treatment of BV before or during delivery may be cost-saving strategies as treatment could prevent costs associated with infection. Further study is needed to best balance the risk of surgical site infection with antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) is a relatively new obstetric condition which, until recently, was poorly understood. The true incidence is unknown because of the poor quality and heterogeneous diagnostic criteria. Classification systems have attempted to provide clarity on how to grade and diagnose PAS, but these are no longer reflective of our current understanding of PAS. This is particularly true for placenta percreta, which referred to extrauterine disease, as recent studies have demonstrated that placental villi associated with PAS have minimal potential to invade beyond the uterine serosa. It is accepted that PAS is a direct consequence of previous iatrogenic uterine injury, most commonly a previous cesarean section. Here, we "look back to look forwards"—starting with the primary predisposing factor for PAS, an iatrogenic uterine injury and subsequent wound healing. We then consider the evolution of definitions and diagnostic criteria of PAS from its first description over a century ago to current classifications. Finally, we discuss why modifications to the current classifications are needed to allow accurate diagnosis of this rare but life‐threatening complication, while avoiding overdiagnosis and potential patient harm. Synopsis: Current clinical grading systems for placenta accreta spectrum do not reflect current understanding of etiology and warrant updating as overdiagnosis is becoming a serious problem. [ABSTRACT FROM AUTHOR]

The puerperium refers to the 6–8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends a cesarean delivery rate of 5–15%, which is thought to be within the range that can reduce infant morbidity and mortality. Various investigations have shown that those poor newborn outcomes are influenced by a variety of maternal and fetal factors and are more prevalent in emergencies than planned cesarean deliveries. Ethiopia is one of the five nations that account for 50% of all neonatal fatalities worldwide. Sub-Saharan African countries account for 38% of all infant deaths worldwide. Aim: To know the determinants of adverse early neonatal outcomes after emergency cesarean delivery. Method and material: A multicenter case-control study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 318 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. The measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05. Results: Maternal age over 35, the presence of danger signs during pregnancy, and non-reassuring fetal heart rate were significantly associated with increased risk of adverse fetal outcomes following emergency cesarean section. Women aged over 35 were 3.6 times more likely to experience adverse fetal outcomes compared to younger women (AOR: 3.6, 95% CI: 1.1, 9.7). Women with danger signs during pregnancy were 3.5 times more likely to have adverse fetal outcomes compared to those without (AOR = 3.5, 95% CI: 2.4, 36). Similarly, cases with non-reassuring fetal heart rate were associated with a 5.2 times higher risk of adverse newborn outcomes (AOR = 5.2, 95% CI: 1.1, 26). Conclusion: This study identified advanced maternal age (over 35 years old), pregnancy complications, and non-reassuring fetal heart rate as significant risk factors for adverse neonatal outcomes following emergency cesarean section. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To compare adverse neonatal outcomes between trial of vaginal delivery and upfront cesarean delivery for singleton infants born at 24 to 28 weeks of gestation.This is a retrospective cohort study that was conducted at a university‐affiliated tertiary medical center between 2011 and 2022, involving singleton pregnancies delivered between 240/7 and 276/7 weeks of gestation. Participants were divided into two groups based on their intended mode of delivery: a trial of labor (TOL) group and an upfront cesarean delivery (CD) group. The primary outcome was defined as neonatal death. The secondary outcome was defined as any of the following: intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, neonatal sepsis, periventricular leukomalacia, disseminated intravascular coagulation, umbilical cord arterial PH <7.1, or use of postpartum mechanical ventilation. Analyses were performed using an intention‐to‐treat approach.Overall, 199 patients were enrolled, with 64 in the TOL group and 135 in the upfront CD group. Neonatal deaths occurred in 48 cases (24.2%) across the entire cohort, with no significant difference between the TOL (18.8%) and upfront CD (26.7%) groups (P = 0.223). Rates of other composite adverse outcome were comparable between the groups (26.6% vs. 31.9%, P = 0.448), respectively. A sub‐analysis comparing patients with pre‐existing contraindications for vaginal delivery, without maternal or fetal indications for delivery, to those in the TOL group who experienced spontaneous onset of labor showed no differences in primary or secondary outcomes between the groups.We found no difference in adverse neonatal outcomes between TOL and upfront CD for singletons born at 24–28 weeks gestation. [ABSTRACT FROM AUTHOR]

To describe maternal and perinatal outcomes in patients with BMI ≥30 kg/m2 by BMI class and gestational weight gain.Retrospective review of singleton pregnancies with pre-pregnancy BMI ≥30 kg/m2 who received care at our institution between January 1, 2016 and December 31, 2021. Patients were divided into three categories based on BMI (kg/m2): Class I (BMI 30.0–34.9), Class II (BMI 35–39.9), and Class III (BMI≥40) obesity. For gestational weight gain analysis, pregnancies were stratified into three groups: <11 pounds, 11–20 pounds, and >20 pounds. Maternal demographics and outcomes were compared using chi-square analysis, analysis of variance, nonparametric tests, and multivariable regression analysis.Of 641 patients included, 299 (46.6 %) were in Class I, 209 (32.6 %) in Class II, and 133 (20.7 %) in Class III. Readmission within 6 weeks postpartum, the only outcome found to have a significant difference between BMI categories, was higher in the Class III group (p=0.01). One hundred sixty-two (25.3 %) patients gained <11 pounds, 164 (25.6 %) gained 11–20 pounds, and 313 (48.8 %) gained ≥20 pounds. Greater gestational weight gain was associated with increased rates of cesarean delivery (p<0.001), higher quantitative blood loss (p=0.006), longer length of hospitalization (p=0.03), and higher birthweights (p<0.001).This represents a unique and actionable opportunity for clinicians to counsel and support their patients in adhering to optimal weight gain targets throughout their pregnancy. Future studies are needed to determine the optimal gestational weight gain recommendations for obese patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate if placement of transverse cesarean skin incision above or below the overhanging pannus is associated with wound morbidity in morbidly obese patients. Study Design: We identified a cohort of patients with body mass index (BMI) ≥40 kg/m2 undergoing cesarean delivery at a single center from 2017-2020 with complete postpartum records. Data was abstracted after institutional review board exemption, and patients were grouped by low transverse or high transverse skin incision. The primary outcome was a composite of wound infection, fascial dehiscence, incisional hernia, therapeutic wound vacuum, and reoperation. Secondary outcomes included the individual components of the composite, blood transfusion, operative time, and immediate neonatal outcome. T test and χ2 were used for continuous and categorical comparisons. Logistic regression was used to compute adjusted odds ratios for categorical outcomes and linear regression to compare operative times adjusting for factors associated with wound complications and surgical duration respectively. Results: 328 patients met inclusion criteria: 65 with high transverse (infraumbilical and supraumbilical) and 263 with low transverse (Pfannenstiel) incision. 11% of patients had wound morbidity; high transverse incision was associated with 3.64-fold increased odds of composite wound morbidity (23.1% vs 8%, aOR 3.64, 95% CI 1.52-8.70) and 5.73-fold increased odds of wound infection (13.8% vs. 4.9%, aOR 5.73, 95% CI 1.83-17.96). Time from skin incision to delivery was 1.87 min longer (11.09 vs 14.98 min, β = 1.87, 95% CI 0.17-4.61). There was no significant difference in neonatal outcomes, non-low transverse hysterotomy, or total operative time. Conclusion: High transverse skin incision for cesarean delivery was strongly associated with increased wound morbidity in morbidly obese patients. KEY POINTS: Outcomes after cesarean delivery were assessed for 328 patients with morbid obesity. High transverse skin incision for cesarean delivery was associated with increased wound morbidity and wound infection. Prospective studies will be needed to determine if skin incision placement causes wound morbidity. [ABSTRACT FROM AUTHOR]

Objective: A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. Methods: In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. Results: After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p =.48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p =.21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. Conclusion: This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. Trial registration: The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199). [ABSTRACT FROM AUTHOR]

Objective: It is currently unknown whether adjunctive azithromycin prophylaxis at the time of non-elective cesarean has differential effects on neonatal outcomes in the context of prematurity. The objective of this study was to compare whether neonatal outcomes differ in term and preterm infants exposed to adjunctive azithromycin prophylaxis before non-elective cesarean delivery. Study Design: A planned secondary analysis of a multi-center randomized controlled trial that enrolled women with singleton pregnancies ≥24 weeks gestation undergoing non-elective cesarean delivery (during labor or ≥4 h after membrane rupture). Women received standard antibiotic prophylaxis and were randomized to either adjunctive azithromycin (500 mg) or placebo. The primary composite outcome was neonatal death, suspected or confirmed neonatal sepsis, and serious neonatal morbidities (NEC, PVL, IVH, BPD). Secondary outcomes included NICU admission, neonatal readmission, culture positive infections and prevalence of resistant organisms. Odds ratios (OR) for the effect of azithromycin versus placebo were compared between gestational age strata (preterm [less than 37 weeks] versus term [37 weeks or greater]). Tests of interaction examined homogeneity of treatment effect with gestational age. Results: The analysis includes 2,013 infants, 226 preterm (11.2%) and 1,787 term. Mean gestational ages were 34 and 39.5 weeks, respectively. Within term and preterm strata, maternal and delivery characteristics were similar between the azithromycin and placebo groups. There was no difference in the odds of composite neonatal outcome between those exposed to azithromycin versus placebo in preterm neonates (OR 0.82, 95% CI 0.48-1.41) and in term neonates (OR 1.06, 95% CI 0.77-1.46), with no difference between gestational age strata (p = 0.42). Analysis of secondary outcomes also revealed no differences in treatment effects within or between gestational age strata. Conclusion: Exposure to adjunctive azithromycin antibiotic prophylaxis for non-elective cesarean delivery does not increase neonatal morbidity or mortality in term or preterm infants. Clinical Trial Registration: , NCT 01235546 [ABSTRACT FROM AUTHOR]

Objective: Elective induction of labor versus expectant management at 39 weeks gestation in low-risk nulliparous patients was shown in the ARRIVE randomized trial of over 6000 patients to decrease risks of cesarean delivery without significant change in the composite perinatal outcome. We aimed to pragmatically analyze the effect of offering elective induction of labor (eIOL) to all low-risk patients. Methods: Retrospective cohort study of low-risk nulliparous and multiparous patients delivering live, non-anomalous singletons at a single center at greater than or equal to 39 0/7 weeks gestational age. Those with prior or planned cesarean delivery, ruptured membranes, medical comorbidities, or contraindications to vaginal delivery were excluded. Patients were categorized as before (pre-eIOL; 1/2012–3/2014) or after (post-eIOL; 3/2019–12/2021) an institution-wide policy offering eIOL at 39 0/7 weeks. Births occurring April 2014 to December 2018 were allocated to a separate cohort (during-eIOL) given increased exposure to eIOL as our center recruited participants for the ARRIVE trial. The primary outcome was cesarean birth. Secondary outcomes included select maternal (e.g. chorioamnionitis, operative delivery, postpartum hemorrhage) and neonatal morbidities (e.g. birthweight, small- and large-for gestational age, hypoglycemia). Characteristics and outcomes were compared between the pre and during-eIOL, and pre and post-eIOL groups; adjusted OR (95% CI) were calculated using multivariable regression. Subgroup analysis by parity was planned. Results: Of 10,758 patients analyzed, 2521 (23.4%) were pre-eIOL, 5410 (50.3%) during-eIOL, and 2827 (26.3%) post-eIOL. Groups differed with respect to labor type, age, race/ethnicity, marital and payor status, and gestational age at care entry. Post-eIOL was associated with lower odds of cesarean compared to pre-eIOL (aOR 0.83 [95% CI 0.72–0.96]), which was even lower among those specifically undergoing labor induction (aOR 0.58 [0.48–0.70]. During-eIOL was also associated with lower odds of cesarean compared to pre-eIOL (aOR 0.79 [0.69–0.90]). Both during and post-eIOL groups were associated with higher odds of chorioamnionitis, operative delivery, and hemorrhage compared to pre-eIOL. However, only among post-eIOL were there fewer neonates weighing ≥4000 g, large-for-gestational age infants, and neonatal hypoglycemia compared to pre-IOL. Conclusion: An institutional policy offering eIOL at 39 0/7 to low-risk patients was associated with a lower cesarean birth rate, lower birthweights and lower neonatal hypoglycemia, and an increased risk of chorioamnionitis and hemorrhage. [ABSTRACT FROM AUTHOR]

Objective Our objective was to examine the association between sonographic estimated fetal weight (EFW) and obstetrical and neonatal outcomes in women with neonatal macrosomia. Study Design This study, conducted at a tertiary university-affiliated hospital from 2017 to 2021, compared obstetrical and neonatal outcomes between two groups of women who delivered macrosomic newborns (actual birth weight ≥ 4,000 g): (1) those with EFW ≥ 3,800 g (suspected impending macrosomia) and (2) those with EFW < 3,800 g (unsuspected impending macrosomia). Results During the study period, 854 women with neonatal macrosomia attempted vaginal delivery. Only 9.2% had a sonographic EFW ≥ 4,000 g. Among women with EFW ≥3,800 g (n = 317) compared with EFW < 3,800 g (n = 537), the cesarean delivery (CD) rate was higher (17.0 vs. 10.5%, p = 0.004) and the operative delivery rate was lower (3.2 vs. 0.6%, p = 0.015). Among primiparous women, the CD rate was higher among those with EFW ≥ 3,800 versus <3,800 g (37.3 vs. 23.2%, p = 0.033). EFW ≥3,800 g was associated with CD, regardless of predelivery body mass index, parity, diabetes mellitus, maximal fetal weight at previous deliveries, actual birth weight, and labor induction (p = 0.014). EFW ≥3,800 g and diabetes mellitus were independent predictors of CD. Among women with EFW ≥3,800 g and diabetes mellitus, the risk of CD was double that of those without diabetes and with EFW ≥ 3,800 g (31.4% vs. 15.2%, p = 0.02), although their actual birth weights were similar. Obstetrical and neonatal outcomes were similar between those with sonographic EFW ≥3,800 and < 3,800 g. Conclusion Larger EFW increased CD risk among pregnancies with actual neonatal macrosomia. Antenatally suspected macrosomia might alter labor management due to concerns for potential complications, especially when associated with primiparity, diabetes mellitus, or maternal obesity. The increase in the CD rate did not show an association with improved maternal and neonatal outcomes. Key Points Antenatally suspected macrosomia might alter labor management due to concerns about complications. Larger EFW increased cesarean delivery risk among pregnancies with actual neonatal macrosomia. The increase in the cesarean delivery rate was not associated with improved outcomes. [ABSTRACT FROM AUTHOR]

Objective: With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity. Methods: A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes. Results: The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18–1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16–1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09–1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69–0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31–0.93, among mild cases only). A dose–response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11–1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31–3.19, for severe cases). Conclusions: Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose–response manner and when diagnosed during the second trimester. Synopsis: Hyperemesis gravidarum is associated with preterm birth in a dose–response manner, low birth weight, and cesarean delivery, especially when diagnosed in the second trimester. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate the effects of epidural analgesia (EA) administered at cervical dilatation of 1 cm on multiparae who underwent vaginal delivery. Methods: This propensity score‐matched retrospective cohort research was conducted between 2021 and 2022. All the singleton multiparae who had previous successful vaginal deliveries and epidural analgesia during this delivery were screened for eligibility. The primary outcome was the effect of EA on the duration of labor. The main secondary outcomes included the incidence of cesarean delivery and umbilical arterial pH. Results: This study incorporated 686 multiparae who were divided into two cohorts: EA 1 (cervical dilatation = 1 cm, n = 166) and EA 2 (cervical dilatation >1 cm, n = 520). In the propensity score‐matched cohort (including 164 women in each group), there were no statistically significant differences in the incidence of cesarean delivery (4 [2.4%] vs 4 [2.4%], P = 1.000), umbilical arterial pH (7.28 ± 0.06 vs 7.28 ± 0.07, P = 0.550) and other secondary outcomes between the two groups. Based on a comparative assessment of the women who delivered vaginally to the Kaplan–Meier curves and propensity score‐matching (including 160 women in each group), there was no statistical significance in the duration of the first, second and third stages of labor (log rank P, P = 0.811; P = 0.413; P = 0.773, respectively). Conclusion: Initiation of epidural analgesia at cervical dilatation of 1 cm in multiparae did not cause adverse effects with regard to the duration of labor, increased cesarean deliveries, and bad neonatal outcomes. Synopsis: Administration of epidural analgesia at 1 cm cervical dilatation did not cause adverse effects on multiparae. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound view of the interlaminar structure is likely to be associated with difficult spinal anesthesia (DSA), and a poor ultrasound view which cannot show the anterior and posterior complex predicts a difficult spinal technique. As our target site is the posterior complex, this study aimed to assess whether the ratio of posterior complex length to depth measured by ultrasound can predict DSA in cesarean delivery. Methods: Four anesthesiologists with 1–2 years of experience located and marked the puncture interspace using a traditional surface landmark. Subsequently, the ultrasound examiner located and measured the marked interspace via an oblique parasagittal ultrasound scan. The anesthesiologists, who were blinded to the ultrasound results, performed spinal anesthesia using a 25-gauge Whitacre spinal needle. The total number of attempts, including skin punctures and needle passes, was recorded and the DSA was defined as 10 unsuccessful attempts. A multivariable logistic regression analysis was used to determine the independent predictors, and receiver operating characteristic curves were constructed to evaluate the performance of the ratio of posterior complex length to depth for predicting DSA. Results: A total of 397 cesarean delivery parturients with successfully measured posterior complex were included in the analysis. DSA occurred in 64 parturients (16.1%). Reduced length [odds ratio (OR) = 0.010, 95% confidence interval (CI), 0.002–0.062, P < 0.001] and increased depth [OR = 6.127, 95% CI, 2.671–14.056, P < 0.001] of the posterior complex were independently predictive of DSA compared with body mass index, abdominal circumference, and palpable surface landmarks. The ratio of posterior complex length to depth for predicting DSA had an area under the curve of 0.86 (95% CI, 0.82–0.90). The optimal cutoff was 0.23, with a sensitivity of 86% (95% CI, 74–93%) and specificity of 72% (95% CI, 67–77%). Conclusion: The ratio of posterior complex length to depth measured by ultrasound demonstrated a considerable accuracy in predicting DSA for inexperienced anesthesiologists. A higher ratio at ultrasound is an indication to evaluate the optimal puncture body position and interspace in the clinic practice. Clinical trial registration: ChiCTR2200065171 https://www.chictr.org.cn/showproj.html?proj=180855 [ABSTRACT FROM AUTHOR]

Women who undergo cesarean delivery have reported experiencing mood distress related to the surgery and postoperative pain. Heart rate variability biofeedback (HRVB) training is known to have positive effects on mental health, but its effects on women undergoing cesarean delivery have not yet been determined. This study evaluated the effects of an HRVB training intervention on stress, anxiety, and depression in women undergoing cesarean delivery. We hypothesized that 10 sessions of HRVB training could cumulatively improve emotion regulation in participants. This study was designed as a double-blinded randomized controlled trial involving a total of 86 enrolled women who were then divided into two groups: intervention and control. During their hospitalization, the intervention group underwent HRVB training daily, while both groups received standard perinatal care. Heart rate variability (HRV) was assessed using root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), high-frequency power (HF) and low-frequency power (LF). HRV parameters, stress, anxiety, and depression were evaluated at baseline and on the fifth day after childbirth. Intention-to-treat (ITT) analyses examined change over time between groups. Although no significant effects were found for the RMSSD and HF, a significant increase was observed in SDNN (F = 13.43, p = < 0.001, ƞ2 = 0.14), and LF at post-assessment (F = 4.26, p =.04, ƞ2 = 0.05) compared to the control group. Except for the depression variable, stress (F = 6.11, p =.02, ƞ2 = 0.07) and anxiety (F = 8.78, p =.004, ƞ2 = 0.10) significantly decreased compared to the control group on the fifth postpartum day. Furthermore, post-hoc analysis showed that HRVB was more effective in decreasing mild to severe depressive symptoms (F = 7.60, p =.001, ƞ2 = 0.27). The intervention program successfully decreased self-perceived stress and anxiety in the postpartum period and relieved symptoms in more severely depressed participants. Our findings suggest that this program is suitable and beneficial for application in women during the early postpartum period following cesarean delivery. [ABSTRACT FROM AUTHOR]

Purpose: To identify potential risk factors for bladder injury during cesarean section (CS). Methods: We conducted an observational case–control study from 2009 to 2024 at our Tertiary Care Hospital, matching each bladder injury case with four controls. Additionally, a systematic review and meta-analysis of the literature was performed using MEDLINE, CINAHL, and Scopus, from inception to 2024; eligible studies were case–control studies assessing risk factors for bladder injury during CS. Random-effects regression with the restricted maximum likelihood method was employed for the meta-analysis. Results: We identified 23 cases of bladder injury out of 15,260 CSs at our hospital, resulting in a rate of 0.15%. Women with bladder injuries were significantly older (p = 0.022), with 47.8% having a history of previous CS, while no significant differences were observed between groups regarding prior abdominal surgery, endometriosis, or body mass index. The systematic review included four case–control studies, whose data were meta-analyzed with our patients, identifying several significant predictors: adhesions (OR 18.6, 95% CI 8.86–39.0), repeated CS (OR 3.25, 95% CI 2.02–5.23), emergent procedures (OR 3.15, 95% CI 1.71–5.80), failed vaginal birth after cesarean (OR 4.74, 95% CI 2.18–10.3), second stage of labor (OR 2.78, 95% CI 1.80–4.29), and macrosomia (OR 2.64, 95% CI 1.25–5.57). Conclusions: Key risk factors for cesarean bladder injury include prior CSs, adhesions, second stage of labor, macrosomia, failed VBAC, and emergent procedures. Identifying these risk factors is critical for preoperative assessment and counseling, allowing for better surgical planning and improved outcomes. [ABSTRACT FROM AUTHOR]

Purpose of the Review: Cesarean delivery is one of the most common surgical procedures performed worldwide. Approximately 28–78% of the patients have reported experiencing severe pain after Cesarean delivery, which is associated with adverse outcomes. Current analgesic management strategies employ a one-size-fits-all approach, which may not be suitable for all post-Cesarean patients. Our ongoing research and the purpose of this review are focusing on preoperative risk assessment to identify patients at risk of severe pain or needing higher doses of opioid or other analgesics. Recent Findings: Recent clinical investigations have found that by utilizing the demographic and psychological evaluations, screening tests, quantitative sensory testing, and assessment of response to local anesthetic infiltration, clinicians were potentially able to stratify the risks for severe post-cesarean pain. Several modalities demonstrated significant correlations with pain outcomes, although most of these correlations were weak to modest. Since consensus statement regarding predicting post-CD pain control are still lacking, these correlations can be clinically helpful. Summary: It is possible to identify patients at high risk of developing severe acute pain after cesarean section by preoperative demographic data, screening questionnaires, or other tools. Further studies are needed to identify additional variables or screening tools for more accurate prediction and investigate whether personalized analgesic regimens can lead to improved analgesic outcomes. [ABSTRACT FROM AUTHOR]

Objectives: One particularly effective method of long-acting, reversible, and reasonably priced contraception for spacing out pregnancies is the intrauterine device (IUD), especially in areas with poor access to medical facilities. Alongside contraceptive implants, IUDs are known to offer high satisfaction rates among users. For postpartum contraception, IUD insertion immediately after placental delivery, following either vaginal or abdominal delivery, is considered feasible. Additionally, insertion within 48 hours of delivery is also a viable option. To compare the post-placental insertion (PPIUD) of an IUD among women who had a cesarean birth against those who planned for interval IUD installation 6 weeks postpartum in terms of expulsion rate and patient compliance. Materials and Methods: This randomized controlled trial involved 97 patients who were recruited from an outpatient clinic and received the intervention of IUD insertion. It was carried out at the Tertiary Care Hospital’s Obstetrics and Gynecology Department at Ain Shams University Maternity Hospital from July 2022 to March 2024. Results: There were no statistically significant difference between the studied groups regarding age, body mass index, parity and history of previous IUD use. None of the cases in either group experienced failed insertion or perforation during insertion. Pelvic pain, dyspareunia and abnormal bleeding in month-6 follow-up were significantly less frequent in PPIUD group. None of the cases in either group experienced perforation, pelvic inflammatory disease or pregnancy in month-6 follow-up. IUD removal, expulsion and failure by month-6 were nonsignificantly more frequent in PPIUD group. Also, there were no statistically significant difference between the study groups regarding baseline and month-6 hemoglobin. Hemoglobin significantly less reduced in PPIUD. Patient satisfaction in month-6 was significantly higher in PPIUD group. Conclusion: PPIUD of the IUD following cesarean delivery is a safe, simple, efficient, and practical method of contraception that can replace delayed IUD insertion because of its immediate and sustained contraceptive benefit, patient comfort, convenience, and lower incidence of side effects. As such, it qualifies for popularization as a first-line contraceptive agent in eligible patients. [ABSTRACT FROM AUTHOR]

Henry Kaggwa,1 Edemaga Deogratious,2 Billy Richard Ndiwalana,1 Henry Luweesi,2 Paul Kaduyu1 1Department of Obstetrics and Gynecology, Mengo Hospital, Kampala, Uganda; 2Department of Surgery, Mengo Hospital, Kampala, UgandaCorrespondence: Henry Kaggwa, Email kaggwahenry027@gmail.comAbstract: Uterine rupture is defined as the complete division of all three layers of the uterus: the endometrium, myometrium, and perimetrium. Uterine rupture due to trauma often results from high-impact blunt abdominal trauma such as motor vehicle accidents, falls and domestic violence, and it is most common in the third trimester. Prompt diagnosis is necessary to treat this emergency, given its quick onset and progression, to prevent potentially life-threatening complications to the mother and fetus, notably fetal death, which commonly occurs in such cases. Here, we present a case of a 33-year-old female, Gravida 3 Para 2+0, with two previous uterine scars who sustained a traumatic uterine rupture at gestation of 18 weeks due to blunt abdominal trauma after a bathroom fall. The uterine rupture was surgically repaired, allowing continuation of pregnancy and delivery of a live baby 20 weeks later. We demonstrate a timely multidisciplinary approach to managing a pregnant trauma patient by surgical and obstetric teams to optimize outcomes for both the fetus and the mother.Keywords: blunt abdominal trauma, uterine rupture, pregnancy, cesarean delivery

Abstract Major congenital anomalies (MCAs) are a public health concern. However, studies on obstetric outcomes in pregnancies complicated by MCAs are scarce, emphasizing the need for research to enhance management strategies. This study aimed to investigate the impact of MCAs on fetal presentation and delivery mode in the United Arab Emirates. The analysis was based on a cohort of single live births in the Mutaba’ah study (2017–2023). Univariable and multivariable regression models assessed the associations between MCAs and obstetric outcomes, adjusting for maternal and neonatal characteristics. For any and single MCAs, significant associations with breech presentation were detected in women below 35 years (AOR = 2.7, 95% CI: 1.5-5.0; AOR = 2.5, 95% CI: 1.3–4.8) and among term deliveries (AOR = 2.5, 95% CI: 1.4–4.3; AOR = 2.4, 95% CI: 1.3–4.3). These associations remained significant in young (

Abstract The long-term effects of cesarean delivery (CD) on child health and development remain controversial. This study aimed to investigate these effects using an outcome-wide approach in a Japanese context, where perinatal mortality rates are among the world’s lowest. We analyzed data from 2,114 children in a nationwide Japanese birth cohort, linking the 21st Century Longitudinal Survey of Newborns with the Perinatal Research Network database. We examined associations between CD and various health and developmental outcomes up to 9 years of age, including hospitalizations, obesity, and developmental milestones. After adjusting for potential confounders, CD was not significantly associated with most outcomes, including all-cause hospitalization (adjusted risk ratio 1.25, 95% CI 0.997–1.56), obesity at 5.5 and 9 years, and various developmental milestones. Subgroup analyses for multiple births and preterm infants showed some differences in point estimates, but were limited by small sample sizes. CD was not significantly associated with adverse long-term child health or developmental outcomes in this Japanese cohort. These findings provide reassurance regarding CD safety when medically indicated in advanced perinatal care settings. Further research with larger samples and longer follow-up is needed, especially for specific subgroups.

Abstract Background Intravenous fluid administration and prophylactic vasopressor infusion are the primary methods for preventing spinal anesthesia-induced hypotension during cesarean delivery. However, evidence regarding the impact of different volumes of crystalloid solution on the phenylephrine infusion dosage for preventing this hypotension remains inconclusive. This study aimed to determine the effect of two IV fluid infusion rates (10 or 20 mL/kg/h) on phenylephrine requirement for preventing spinal anesthesia-induced hypotension. Methods Eighty healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. Participants were randomly assigned to receive either 10 mL/kg/h (group 10) or 20 mL/kg/h (group 20) of lactated Ringer’s solution. The first patient in each group received 0.5 µg/kg/min of phenylephrine infusion immediately after intrathecal injection. The phenylephrine dose in subsequent patients was adjusted by increments or decrements of 0.05 µg/kg/min based on the previous patient’s response. The ED50 of phenylephrine infusion for preventing spinal-induced hypotension for cesarean delivery was estimated using a modified up-down sequential analysis, with probit analysis applied as a backup sensitivity analysis. Results The ED50 values for preventing spinal anesthesia-induced hypotension were 0.30 µg/kg/min (95% CI, 0.29–0.32 µg/kg/min) for group 10, and 0.19 µg/kg/min (95% CI, 0.16–0.22 µg/kg/min) for group 20, respectively. The estimated relative potency for phenylephrine in group 10 compared to group 20 was 1.52 (95%CI, 1.24–1.97), showing a significant difference in the ED50 values between the two groups. Conclusion This study found that a higher crystalloid co-loading rate significantly reduces prophylactic phenylephrine requirement for preventing spinal anesthesia induced hypotension. Trials registration https://www.chictr.org.cn/showproj.html?proj=125918 (Trial number: ChiCTR2100048002).

Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia. Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor analgesia and were converted to cesarean delivery at Beijing Tiantan Hospital. According to the anesthesia method of cesarean section, the participants were divided into the epidural anesthesia(EA) group and the subarachnoid anesthesia(SA) group. That were aimed to compare the effects of the two anesthesia methods on the mother and fetus perioperatively. Results Compared with women in the epidural anesthesia group, women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale (VAS) scores, frequency (%)[VAS scores 0-3: 5(25%) vs. 14(70%); VAS scores 4-6: 12(60%) vs. 6(30%); and VAS scores 7-10: 3(15%) vs. 6(30%)], and higher perioperative complication rate. There was nonsignificance difference in perio- perative maternal bleeding, neonatal Apgar score, and neonatal umbilical artery blood gas analysis between the two groups. Conclusions In women with epidural analgesia undergoing cesarean section, the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia. The anesthesiologist must pay attention to prevent complications in the perioperative period.

Abstract Background It is recommended that postpartum women undergo early oral feeding (EOF) after cesarean section (CS). However, the optimal early time for oral feeding after CS is unclear. We performed a meta-analysis to assess whether EOF within two hours is superior to delayed oral feeding (DOF) after CS. Methods The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched from inception to February 2024 for randomized controlled trials comparing EOF versus DOF after CS. Primary outcomes included the time to normal bowel function. The secondary outcomes included postoperative complications, the time to ambulation after surgery, the time to removal of the catheter, the time to start of a regular diet, the length of hospital stay and patient satisfaction. Results Data from 8 studies involving a total of 2572 women were obtained. EOF within two hours was significantly associated with shorter durations of return bowel movement (WMD, − 2.41, 95% CI, − 3.80–− 1.02; p

Abstract Background Ankylosing Spondylitis (AS) is a systemic chronic rheumatic disease characterized by involvement of the axial skeletal and sacroiliac joints. Although this disease is not rare amongst women of reproductive age, data regarding pregnancy outcomes have demonstrated conflicting results. We therefore aimed to compare pregnancy and perinatal outcomes between women who suffered from AS to those who did not. Methods A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Included in the study were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. Women with an ICD-9 diagnosis of AS before or during pregnancy were compared to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups using multivariate logistic regression models adjusting for potential confounders. Results A total of 9,096,788 women were inclusion in the analysis. Amongst them, 383 women (3.8/100,000) had a diagnosis of AS and the rest were controls. Women with AS, compared to those without, were more likely to be older; Caucasian; from higher income quartiles; suffer from thyroid disorders, and have multiple pregnancies (p

Abstract Background Anaphylactic cardiovascular collapse is complicated by aortocaval compression during pregnancy, exacerbated by neuraxial anesthesia. Despite recommendations to administer perioperative antibiotics before anesthesia, common practice in Japan involves administering them after anesthesia induction. We report a case of possible antibiotics-induced anaphylaxis just before anesthesia for cesarean delivery. Case presentation A 24-year-old woman at 37 weeks of gestation presented for a scheduled repeat cesarean under spinal anesthesia. After starting administration of cefazolin prior to anesthesia, she developed anaphylactic symptoms. Hypotension refractory to adrenaline necessitated conversion to an emergency cesarean section under general anesthesia. A neonate was delivered with favorable Apgar scores. Post-delivery, the mother’s hemodynamics stabilized significantly. Elevated plasma tryptase confirmed anaphylaxis. Both mother and infant were discharged without further complications. Conclusions This case emphasizes the importance of administering prophylactic antibiotic before anesthesia in mitigating severity of shock induced by anaphylaxis and the crucial role of prompt emergency cesarean in achieving successful outcomes.