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Objective: Caesarean section (CS) rates in Sri Lanka have escalated significantly, with projections indicating that over half of all births may involve CS by 2025. To address this rise and mitigate maternal morbidity, it is essential that CS procedures are medically justified. This study evaluates RobsApp®, a novel smartphone application designed to collect high-quality prospective data on CS rates based on the Robson classification. Methods: The study utilized RobsApp® for data collection in the Professorial Unit of De Soysa Hospital for Women (DSHW), Sri Lanka. Data were collected prospectively from 1,712 deliveries between April and October 2019. The analysis focused on CS rates across different Robson categories and the quality of the collected data, comparing them with previous data obtained using traditional methods. Results: The overall CS rate was 33.0%, with Robson category 5a accounting for most cases. Emergency CS constituted 49.6% of all procedures, with cardiotocograph (CTG) abnormalities being the leading indication. The quality of the data collected through RobsApp® met the standards recommended by the Robson guidance, as evidenced by the study's ability to accurately categorize deliveries and assess CS rates. Conclusions: RobsApp® has proven to be an effective tool for prospective data collection, aligning well with Robson guidelines and facilitating high-quality data gathering. The study reveals a rising trend in CS rates at DSHW, particularly for reasons beyond previous CS. The inclusion of demographic data and birth weight analysis in future studies will enhance comparisons and insights into reducing CS rates. Ethics: Ethical approval was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo (Ref – EC-19–024) which waived the need for individual consent. Study adhered to the Helsinki Declaration. [ABSTRACT FROM AUTHOR]

Background: In Sri Lanka, there is some evidence that the likelihood of breastfeeding initiation varies by exposure to Baby-Friendly Hospital Initiative [BFHI]-compliant care and mode of birth. Globally, there is some evidence that exposure to mother-baby skin-to-skin contact (BFHI Step 4) is lower in caesarean section births. Therefore, we aimed to determine how breastfeeding initiation varies by mode of birth in Sri Lanka, and the extent to which women's exposure to BFHI practices explains any associations found. Methods: A cross-sectional survey was conducted with women with a live baby across four government hospitals in Sri Lanka. Quantitative data were collected through participant interviews and extraction from medical records. Associations between BFHI practices, breastfeeding initiation, mode of birth, and women's characteristics were assessed using binary logistic regression analysis applied in mediation and moderated mediation models. Results: Women who received care compliant with Steps 4 and 6 of BFHI, regardless of their mode of birth, were more likely to initiate breastfeeding within the first hour after birth. BFHI Step 4 partially and completely mediated the effect of planned caesarean section and emergency caesarean section, respectively, on breastfeeding initiation within one hour of birth. Further, exposure to BFHI Step 6 partially mediated the effect of emergency caesarean section on breastfeeding initiation within one hour of birth. Women's age, pre-pregnancy BMI, parity status, and ethnic group significantly influenced the relationship between planned or emergency caesarean section, exposure to Step 4 or Step 6 of BFHI, and breastfeeding initiation within one hour of birth. Specifically, being primiparous strengthened the likelihood that having a planned caesarean section decreased women's exposure to BFHI Step 4; and having a pre-pregnancy BMI of 23–27.49 kg/m2 weakened the likelihood that planned caesarean section decreased exposure to BFHI Step 4. Conclusions: Improving compliance with mother-baby skin-to-skin contact (BFHI Step 4) and no supplementation (BFHI Step 6) is critical for Sri Lankan health services to support all women to establish breastfeeding initiation within one hour of birth, as these practices attenuate the negative effect of caesarean section on breastfeeding initiation. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim was to investigate feeding type at discharge; exclusively breastfeeding (EBF), mixed breastfeeding (MBF), and formula milk feeding (FMF), factors associated with feeding type, and changes in weight‐for‐age z‐score (ΔWAZ) in infants admitted to Danish neonatal units.Using data from the Danish National Quality Database for Births and the Danish Newborn Quality Database, we included 8639 mother‐infant dyads admitted ≥5 days between February 2019 and December 2021. We used logistic regression to investigate associations between maternal and infant factors and feeding type, and descriptive statistics to describe ΔWAZ and feeding type at discharge.Of all infants 59.1% were EBF, 16.9% MBF and 24.0% FMF at discharge. Gestational age <37 weeks, caesarean section, multiple births, small for gestational age, weeks at hospital, ≥6 h before skin‐to‐skin contact, and few weeks at hospital were associated with failure to EBF at discharge. Median (min–max) ΔWAZ in EBF, MBF and FMF infants was −0.44 (−4.78 to 4.88), −0.43 (−3.47 to 4.42) and −0.39 (−3.54 to 4.03), respectively. ΔWAZ was higher in EBF compared to FMF infants, p‐value 0.01, but no significant difference in ΔWAZ between MBF and FMF infants, p‐value 0.06.Danish newborn infants demonstrated satisfactory growth during admission to the neonatal unit, independent of feeding type at discharge. Rates of exclusively breastfeeding need improvement. [ABSTRACT FROM AUTHOR]

Background: Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique for Caesarean section. The Erector Spinae Plane Block is a relatively new fascial plane block that may be used to provide analgesia for numerous surgical procedures of the trunk. In recent years it is the fascial plane block that has accumulated the most enthusiasm and debate. Its use in Caesarean section has grown over the past three years. Objective: To determine the scope of literature published on ESPB in Caesarean sections and to identify deficits in the literature to guide future research. Methodology: This study was conducted using Arksey and O'Malley's framework for scoping reviews. This included a search of four databases searching for articles published between 2016 and 2022. Studies involving patients receiving ESPB as part of an analgesic strategy after a Caesarean section were included. Findings: Sixteen articles were included for final review. The most common primary outcomes measured were postoperative pain scores and analgesia consumption. Six ESPB studies recorded a statistically significant reduction in pain scores while three studies described a statistically significant reduction in postoperative analgesia consumption. Conclusion: The use of ESPB for Caesarean section is gaining momentum however insufficient evidence currently exists to support its widespread use. Further research is required to evaluate the potential benefits of ESPB in specific patient cohorts and in terms of its efficacy about multidimensional patient-centric outcomes. [ABSTRACT FROM AUTHOR]

Background & Objective: Obstructed labour during caesarean section makes foetal head delivery difficult for obstetricians. The present study was conducted with aim to evaluate maternal and fetal outcome in reversed breech extraction vs. head lifting method during caesarean section. Materials & Methods: This prospective case-control study was conducted from January to November 2022 at obstetrics departments of Basrah Maternity and Child Hospital, Iraq. A total of 88 women who met inclusion criteria were randomly divided into two groups reverse breech extraction and head lifting. The two groups were compared in terms of maternal and fetal outcomes. P<0.05 was considered statistically significant. Results: Reversed breech extraction and head lifting groups were not significantly different in terms of demographic and pregnancy related characteristics (P>0.05). However, reversed breech extraction group compared to head lifting group had significantly lower uterine artery injury (P=0.0001), uterine extension (P=0.0001), blood transfusion (P=0.003), operation time (P=0.0001), and postoperative HB level (P=0.026). Moreover, there was significant difference between reversed breech extraction and head lifting groups regarding birth weight (P=0.016), first and fifth minute APGAR score (P=0.051, P=0.002, respectively), and NICU admission (P=0.0001). Conclusion: Outcome of the study showed that reversed breech extraction method had significantly lower maternal and fetal risks. [ABSTRACT FROM AUTHOR]

Background: A Caesarean Section (CS) is a life saving procedure. It has a beneficial effect on maternal and child health as an alternative to difficult vaginal delivery. Adverse outcomes are postpartum hemorrhage (PPH), surgical site infection, puerperal sepsis, and maternal mortality, and fetal complications like neonatal sepsis, neonatal death, stillbirth, neonatal respiratory distress, a low Apgar score, and preterm birth. In past few decades a remarkable increase has been observed in delivery by caesarean section. This study aimed to find the indications of caesareansection in a private hospital. Method: A retrospective study was carried out for a period of six months at AMRI Hospital, Mukundapur, Kolkata. This includes 359 pregnant women, who underwent caesarean sections, both elective and emergency. Conclusion: Out of 359 pregnant women, 91% (328) were elective caesareans and 9% (31) were emergency caesarean sections. Previous caesarean section 16.15% (58) was found to be the most common indication of caesarean sections. A reduction of primary CS should be given priority. Following labor care guidelines, use of cardiotocography, partography, and patient education will contribute to the reduction of caesarean sections and related complications. [ABSTRACT FROM AUTHOR]

Cutaneous endometriosis is a rare manifestation of endometriosis, and few reports on its dermoscopic features have been published. In this case report, we present a 40‐year‐old female with cutaneous endometriosis arising in a caesarean scar, exhibiting unique and distinct dermoscopic features. The patient presented with a nodular, papillomatous growth in the right end of the scar, and dermoscopic examination revealed structureless red papillomatous projections, as well as nonpapillomatous areas with red dotted vessels surrounded by a white reticular network. A biopsy confirmed the diagnosis of endometriosis. To our knowledge, this is the first report of such dermoscopic features in cutaneous endometriosis arising in a caesarean scar. Our case report adds to the current limited knowledge of dermoscopic features of cutaneous endometriosis and may help in the diagnosis of this condition. [ABSTRACT FROM AUTHOR]

Modern obstetrics confronts a rise in caesarean sections (CS). Prevention of unnecessary primary CS is a global priority. Women face intense psychological and physiological challenges during childbirth. Fear and anxiety during labour reduce women’s self-confidence and empowerment. Yoga is a body-mind practice that lowers maternal fear and anxiety and helps relax pelvic floor muscles during labour. The study examined whether yoga practice in pregnancy influences CS rate in primiparous singleton pregnant women, labour pain intensity and epidural analgesia requests at delivery ward admission.We conducted a single-blind, randomised, controlled clinical trial comparing yoga to standard obstetric care in pregnancy. A total of 214 participants were randomised, 106 in yoga and 108 in controls. Weekly 90-min yoga classes were led by a certified yoga teacher’s supervision. Every pregnant woman in the interventional group completed 12 yoga sessions.Yoga group had a lower total CS due to less frequent In-labour CS (p=0.004) and a higher rate of spontaneous vaginal birth (p=0.009). They experienced less pain intensity during labour (p<0.001), and there was no difference in epidural analgesia requests.Engaging in yoga during pregnancy reduces the rate of In-labour CS, decreases discomfort and encourages spontaneous vaginal birth in primiparous singleton pregnant women. [ABSTRACT FROM AUTHOR]

Aim: Administration of phenylephrine can prevent oxytocin induced hypotension during caesarean section under spinal anesthesia. Our aim was to compare the effects of coadministration of two different doses of phenylephrine on oxytocin-induced hypotension during caesarean section under subarachnoid block. METHODS: 90 parturient undergoing caesarean section under spinal anesthesia were randomly divided into three groups. Group A received oxytocin 3U and normal saline. Group B received oxytocin 3U andphenylephrine 50 µg. Group C received oxytocin 3U and phenylephrine 75 µg. Study drug was administered IV over 5 min after baby delivery. The primary outcome was incidence of hypotension and secondary outcome were effect on HR and MAP. Results: The incidence of hypotension in the parturient in group Band A was significantly higher compared to group C.No of dose and total rescue vasopressor requirement were significantly lower in Group C compared to group A and B without any side effects. HR, SBP, DBP and MAP was higher in group C compared to group A and B. Conclusion: Co-administration of phenylephrine 75 µg with oxytocin 3U reduces the incidence of oxytocin-induced hypotension compared to phenylephrine 50 µg with oxytocin 3U during caesarean section under subarachnoid block(SAB). [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Impact Patient or Public Contribution To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next‐day discharge and home midwifery.This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post‐positivist philosophy.The work was conducted in South Australia, Australia between May and October 2019. Twenty‐three semi‐structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six‐phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.Four main themes and 11 sub‐themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.The health service and health providers were involved with the initiation and development of the research aims and design. [ABSTRACT FROM AUTHOR]

Background: The effect of caesarean section (CS) on breastfeeding initiation has been extensively studied, but its influence on exclusive breastfeeding practices remains inconclusive. Therefore, this study aims to investigate the impact of CS on exclusive breastfeeding using evidence from four countries in the Southeast Asian region. Methods: This cross-sectional study used secondary data obtained from the Demographic and Health Surveys (DHS) conducted between 2016 and 2022 in four countries within the Southeast Asian Region. We included information on the youngest children aged 0–5 months living with their mothers within the DHS datasets. The association between CS and exclusive breastfeeding was determined using a simple and multiple logistic regression models. Weight factors were taken into account in all analyses for the two-stage stratified cluster sampling design. Results: Among 3420 children, nearly half (49.1%, 95%CI: 47.0, 51.2) were exclusively breastfed. Children born by CS had lower odds of being exclusively breastfed, compared to children born vaginally (aOR = 0.68, 95%CI: 0.53, 0.88). Women who were married or living with a partner (aOR = 2.19, 95%CI: 1.33, 3.60), children born at a health facility (aOR = 1.31, 95%CI: 1.00, 1.71), and girl babies (aOR = 1.24, 95%CI: 1.05, 1.48) had higher odds of exclusive breastfeeding. Furthermore, residing in rural areas was associated with an increased likelihood of exclusive breastfeeding (aOR = 1.47, 95%CI: 1.20, 1.80). Maternal age, mother's education, parity, antenatal and postnatal care taken, and mass media exposure were not associated with exclusive breastfeeding. Conclusion: This study highlights a significant association between CS and reduced exclusive breastfeeding practices. The findings underscore the importance of providing adequate support and interventions to mothers who deliver by CS and their family members to ensure they can successfully achieve exclusive breastfeeding, particularly in a global context where CS rates are rising. [ABSTRACT FROM AUTHOR]

Background: The rate of caesarean section in Iran has significantly increased. The main reason cited by Iranian mothers for it is labor pain and fear of it. However, the experience of pain during childbirth has different meanings for mothers in various conditions. Therefore, this study aims to examine the components from the mothers' perspective that helped them manage pain in labor. The findings of this article may help prevent unnecessary medical interventions. Methods: The current article is one component of a mixed-method study conducted in Iran. Its primary objective was to develop protocols for maternity unit design to enhance maternal satisfaction, promote husbands' involvement, and improve pain management. The current study focuses on examining contextual components that are effective in managing pain among 25 mothers selected through stratified purposive sampling. Data collection from mothers who gave birth in four large hospitals in Iran was carried out through unstructured in-depth interviews. The data were analyzed using interpretative phenomenological analysis. Findings: The data show that two major environmental factors affect mothers' perception of pain and their ability to control it: (1) Internal and (2) External environments. The main components of the internal factor are identified as "Personal beliefs", "Self-confidence and lack of fear", and the external environment includes three subfactors: "Spatial environment", "Social environment", and "Interactive environment". The overall meaning attributed to pain caused by these factors determines how mothers can cope with it. Conclusion: In this study, self-confidence and a positive mindset were significant factors in managing pain during labor among this group of mothers. Furthermore, each mother's perception of pain was shaped by a combination of physical, social, and interactive influences. The research identified the importance of support during labor according to mothers' individual, subjective needs, while improving the physical environment, with a view to reducing interventions and promoting positive experiences for mothers and husbands. Consequently, enhancing internal resources and the birthing environment during labor which involve identifying the optimal blend of physical, mental, and emotional strategies tailored to the specific needs of mothers, can be considered to a potential reduction in the perceived intensity of pain in future. [ABSTRACT FROM AUTHOR]

Acute promyelocytic leukemia (APML), a rare disease encountered during pregnancy, is associated with high mortality secondary to consumptive coagulopathy and fatal bleeding diathesis. It usually presents as a medical emergency and warrants prompt diagnosis and treatment to improve maternal survival. This case report details a 19-year-old female with new onset APML who presented for emergency cesarean section because of respiratory distress and suspected placental abruption. Antifibrinolytics, which are commonly utilized to treat postpartum hemorrhage, were contraindicated because the patient was receiving all transretinoic acid (ATRA) therapy for APML. This case adds insight into the disease and its management along with anesthesia considerations for patients undergoing emergent caesarean delivery in the setting of acute disseminated intravascular coagulation and ATRA therapy. It also highlights the importance of a multidisciplinary team approach to plan for treatment and timing of delivery that balances the risk of disease progression and fetal wellbeing. Such multidisciplinary care and proper planning helped in attaining the best possible outcomes for both mother and baby. [ABSTRACT FROM AUTHOR]

Objectives: During caesarean section (CS), the urinary bladder is at risk of getting injured due to its proximity to the uterus. Globally, with an upward trend in the CS rates, there is an upsurge in the complications associated with CS. Evaluating the risk factors of bladder injury will help in patient counseling and treating team preparedness, recognition, and remedial surgery. Materials and Method: This case-control study was conducted from January 2006 to December 2020. Eighteen subjects who had bladder injuries during CS from January 2006 to December 2020 were included in the study as cases. Subjects who had caesarean section without bladder injury (BI) were enrolled as controls. Two controls for each case were enrolled. Thirty-six controls were chosen as subjects who had a caesarean section before and after the case. The proforma was filled out for both cases and controls, with information on their demographics, obstetric history, intraoperative problems, and hospital stay. The type, size, and site of BI and detection time were recorded. Result: During the study period, 80,488 deliveries were conducted of which 32,022 caesarean sections (39.7%) were performed. Eighteen patients had BIs at the time of caesarean sections. Incidence of BI during caesarean section was 0.056% (18/32,022). Previous caesarean section, dense adhesions, and difficulty in forming a bladder flap were statistically significant risk factors for BI. Conclusion: Previous caesarean section is the most important risk factor for urinary BI during CS. Early detection and good repair have excellent prognosis. [ABSTRACT FROM AUTHOR]

Background: Microbial colonisation in infants is initially dependent on the mother and is affected by the mode of delivery. Understanding these impacts is crucial as the early-life gut microbiota plays a vital role in immune development, metabolism, and overall health. Early-life infant gut microbiota is diverse among populations and geographic origins. However, in this context, only a few studies have explored the impact of the mode of delivery on the intestinal microbiome in children in Guangzhou, China. Therefore, this study aimed to investigate the influence of birth mode on the intestinal microbiota of healthy infants in Guangzhou, China. Methods: Faecal samples were collected once from 20 healthy full-term infants aged 1–6 months, delivered via either caesarean section (CS) or vaginal delivery (VD), post-enrolment. The intestinal microbiota were characterised using full-length 16S rRNA gene sequencing. Bacterial quantity and community composition were compared between the two groups. Results: No significant differences in gut bacterial diversity and richness were observed between the CS and VD groups. The Pseudomonadota phylum (44.15 ± 33.05% vs 15.62 ± 15.60%, p = 0.028) and Enterobacteriaceae family (44.00 ± 33.11% vs 15.31 ± 15.47%, p = 0.028) were more abundant in the CS group than in the VD group. The VD group exhibited a higher abundance of the Bacillota phylum (40.51 ± 32.77% vs 75.57 ± 27.83%, p = 0.019), Conclusions: The early stage of intestinal bacterial colonisation was altered in the CS group as compared with the VD group. Our findings provide evidence that CS has the potential to disrupt the maturation of intestinal microbial communities in infants by influencing the colonisation of specific microorganisms. Further comprehensive studies that consider geographical locations are necessary to elucidate the progression of microbiota in infants born via different delivery modes. PLAIN LANGUAGE SUMMARY: Microbial colonisation in infants is affected by the mode of delivery. Early-life infant gut microbiota is diverse among populations and geographic origins. Faecal samples were collected once from 20 healthy full-term infants aged 1–6 months that were delivered via either caesarean section (CS) or vaginal delivery (VD), and intestinal microbiota were compared between the two groups. No significant differences in gut bacterial diversity and richness were observed between the two groups; however, we did note that certain types of bacteria were more abundant in the CS group, while others were more abundant in the VD group. This suggests that CS may disturb intestinal microbial maturation in infants by affecting the colonisation of specific microorganisms. Further research is needed to fully understand this relationship. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease (COVID-19) pandemic, caesarean section (CS) has been the preferred deliver method for pregnant women with COVID-19 in order to limit the use of hospital beds and prevent morbidity among healthcare workers. Methods: To evaluate delivery methods used during the COVID-19 pandemic as well as the rates of adverse events and healthcare worker morbidity associated with caesarean deliveries. Methods: We investigated maternal and neonatal backgrounds, delivery methods, indications and complication rates among pregnant women with COVID-19 from December 2020 to August 2022 in Mie Prefecture, Japan. The predominant mutation period was classified as the pre-Delta, Delta and Omicron epoch. Results: Of the 1291 pregnant women with COVID-19, 59 delivered; 23 had a vaginal delivery and 36 underwent CS. Thirteen underwent CS with no medical indications other than mild COVID-19, all during the Omicron epoch. Neonatal complications occurred significantly more often in CS than in vaginal delivery. COVID-19 in healthcare workers was not attributable to the delivery process. Conclusion: The number of CS with no medical indications and neonatal complications related to CS increased during the COVID-19 pandemic. Although this study included centres that performed vaginal deliveries during COVID-19, there were no cases of COVID-19 in healthcare workers. It is possible that the number of CS and neonatal complications could have been reduced by establishing a system for vaginal delivery in pregnant women with recent-onset COVID-19, given that there were no cases of COVID-19 among the healthcare workers included in the study. PLAIN LANGUAGE SUMMARY: We evaluated the incidence of adverse events associated with caesarean section (CS) deliveries and the morbidity of health care workers, which increased during the coronavirus infection pandemic. Maternal and neonatal background, delivery methods, indications and complication rates of pregnant women with COVID-19 from December 2020 to August 2022 in Mie Prefecture were investigated by time of onset. Of the 1291 pregnant women with COVID-19, 59 delivered while affected; 23 underwent vaginal delivery and 36 CS. Of these, 13 who underwent CS in the omicron epoch had no medical indication other than mild COVID-19. Neonatal complications were significantly more common with CS than with vaginal delivery, and there was no occurrence of COVID-19 in healthcare workers. In this study, there were no cases of COVID-19 among health care workers; establishing a system to perform vaginal delivery for pregnant women with COVID-19 could have reduced the number of CS and neonatal complications. [ABSTRACT FROM AUTHOR]

Background: The trend of increasing caesarean section (CS) rates brings up questions related to subfertility. Research regarding the influence of CS on assisted reproduction techniques (ART) is conflicting. A potential mechanism behind CS-induced subfertility is intra uterine fluid resulting from a caesarean scar defect or niche. The vaginal microbiome has been repeatedly connected to negative ART outcomes, but it is unknown if the microbiome is changed in relation to a niche. Methods: This systematic review describes literature investigating the effect of a niche on live birth rates after assisted reproduction. Furthermore, studies investigating a difference in microbial composition in subfertile persons with a niche compared to no niche are evaluated. Pubmed, Embase and Web of Science were searched on March 2023 for comparative studies on both study questions. Inclusion criteria were i.e., English language, human-only studies, availability of the full article and presence of comparative pregnancy data on a niche. The quality of the included studies and their risk of bias were assessed using the Newcastle-Ottawa scale for cohort studies. The results were graphically displayed in a forest plot. Results: Six retrospective cohort studies could be included on fertility outcomes, with a total of 1083 persons with a niche and 3987 without a niche. The overall direction of effect shows a negative impact of a niche on the live birth rate (pooled aOR 0.58, 95% CI 0.48-0.69) with low-grade evidence. Three studies comparing the microbiome between persons with and without a CS could be identified. Conclusion: There is low-grade evidence to conclude that the presence of a niche reduces live birth rates when compared to persons without a niche. The theory that a caesarean has a negative impact on pregnancy outcomes because of dysbiosis promoted by the niche is interesting, but there is no sufficient literature about this. PLAIN LANGUAGE SUMMARY: The increasing number of caesarean deliveries has raised concerns about how it might affect a woman's ability to get pregnant afterwards. Some studies suggest that having a caesarean section (CS) could make it harder to conceive, particularly through in vitro fertilisation (IVF). The reason could be the scar or niche from a previous caesarean. This niche can cause fluid inside the uterus. We also know that the mix of bacteria in the vagina, called the vaginal microbiome, can affect a woman's chances of getting pregnant, especially with treatments like IVF. But we are not sure if having a caesarean affects the vaginal microbiome. To understand this better, van den Tweel's team looked at studies on whether having a niche from a caesarean affects a woman's chance of having a baby through IVF. They also looked at studies comparing the bacteria in the vagina of women who have had a caesarean with those who have not. They found that having a caesarean niche makes it harder for a woman to have a baby through IVF. However, the evidence from these studies is not very strong. We still do not know enough about whether having a caesarean niche affects the bacteria in the vagina. [ABSTRACT FROM AUTHOR]

This study explored the reasons underlying pregnant women's reluctance to undergo cesarean sections in Togo, despite its importance in reducing maternal and neonatal mortality. A total of 397 pregnant women who expressed hesitancy toward cesarean sections were enrolled during routine prenatal care visits at the country's largest hospital. They completed a questionnaire comprising 72 statements addressing potential reasons for hesitancy toward cesarean sections. Their responses were analyzed using factor analysis, and the effects of participants' demographic characteristics on scores for each factor were assessed using ANOVA. A seven-factor structure of motives was found: Fear of Death (endorsed by 92% of the sample); Regaining Autonomy Quickly (87%); Financial Concerns (74%); Fear of Stigmatization (73%); Fear of Unsupportive Reactions from Spouses and Relatives (72%); Prevention Through Spiritual Interventions (70%); and Perceived Health Risks for the Mother and Baby (40%). Scores on these factors were related to participants' sociodemographic characteristics. Effectively addressing the low uptake of cesarean section requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various obstacles to this life-saving care. [ABSTRACT FROM AUTHOR]

Abdominal wall endometriosis (AWE) is one of the rarest forms of endometriosis. Little is known about differences between umbilical AWE (U-AWE) and non-umbilical AWE (non-U-AWE) patients. This retrospective cohort study included patients treated for AWE at tertiary endometriosis centre between 2012 and 2020. Patients were divided into two groups – umbilical AWE and non-umbilical AWE. We identified 14 U-AWE and 45 non-U-AWE patients who mostly had lesions in caesarean section scar (38, 64.4%), rarely at other locations (7, 11.9%). Infertility rates for U-AWE patients and non-U-AWE patients were 57.1% and 17.8%, respectively. Concurrent or previous peritoneal endometriosis was noted in 85.7% of U-AWE and 24.4% of non-U- AWE patients. In addition, U-AWE patients and non-UAWE patients significantly differed in following: parity, number of previous caesarean sections, lesion size, prevalence of concurrent or previous deep infiltrating endometriosis, bleeding from abdominal wall, cyclic pain, continuous pain. Infertility and pelvic endometriosis were more prevalent in U-AWE patients. Our data suggests that U-AWE may be a specific marker for a patient highly prone to pelvic endometriosis and subsequent infertility. Findings suggests that clinician should consider comprehensive evaluation of U-AWE patients. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: A ten-group classification system of caesarean section was proposed by Michael Robson in 2001. It is helpful in comparing the rates of caesarean section between hospitals. The objective of this study was to determine the caesarean section rates to analyse trends of caesarean section and classify according to Robson's categories. Methods: This cross-sectional study was conducted from 2016 to 2022. A total of 3176 women who underwent caesarean section were grouped under Robson's ten-group classification system. Results: The most common group was Group 5 (All multiparous women with at least one previous uterine scar, with single cephalic pregnancy, ≥37 weeks gestation) followed by Group 2 (Nulliparous women, with single cephalic pregnancy, >37 weeks gestation who either had labour induced or were delivered by caesarean section before labour). Results were obtained for the specified period (from 2016 to 2022), and Group 5 contributes more to the total CS rates (45% in 2016, 46% in 2017, 46% in 2018, 57% in 2019, 49% in 2020, 52% in 2021, 54% in 2022), followed by Group 2 (20% in 2016, 17% in 2017, 18% in 2018, 19% in 2019, 26% in 2020, 24% in 2021, 24% in 2022). Conclusion: Pregnant women with prior uterine scars contribute more to caesarean section rates according to Robson's categories. Hence, strategies must be implemented to lower the primary caesarean section rates. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorders pose significant challenges in the anaesthetic management of elective caesarean section. This article explores the anaesthetic considerations for patients with PAS focusing on the optimal techniques to ensure maternal safety and surgical success. The analysis examines the advantages and disadvantages of general anaesthesia, neuraxial anaesthesia, and combined techniques to inform considerations of anaesthetic management in this high-risk population. [ABSTRACT FROM AUTHOR]

Abstract Objective The incidence of caesarean sections (CSs) has increased significantly in recent years, especially in developed countries. This study aimed to identify the factors that most influence the length of hospital stay (LOS) after a CS, using data from 9,900 women who underwent CS at the “Federico II” University Hospital of Naples between 2014 and 2021. Methods Various artificial intelligence models were employed to analyze the relationships between the LOS and a set of independent variables, including maternal and foetal characteristics. The analysis focused on identifying the model with the best predictive performance and specific comorbidities impacting LOS. Results A multiple linear regression model determined the highest R-value (0.815), indicating a strong correlation between the identified variables and LOS. Significant predictors of LOS included abnormal foetuses, cardiovascular disease, respiratory disorders, hypertension, haemorrhage, multiple births, preeclampsia, previous delivery complications, surgical complications, and preoperative LOS. In terms of classification models, the decision tree yielded the highest accuracy (75%). Conclusions The study concluded that certain comorbidities, such as cardiovascular disease and preeclampsia, significantly impact LOS following a CS. These findings can assist hospital management in optimizing resource allocation and reducing costs by focusing on the most influential factors.

Nathania Nathania,1 Jeffry Iman Gurnadi,2 Andi Rinaldi,1 Triana Rahmanita1 1Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Obstetrics and Gynecology, Cibabat District Hospital, Cimahi, IndonesiaCorrespondence: Nathania Nathania, Email nathania21004@mail.unpad.ac.idAbstract: Vasa previa is a condition where unprotected fetal vessels, neither by placenta nor umbilical cord, lie within the membranes over the internal cervical ostium and beneath the presenting part of the fetus. Due to this condition, the membranous vessels pose a higher risk of being compressed or ruptures and could lead to fetal demise, exsanguination, or even fetal death. In this case report, we reported a case of a 36-year-old woman, G3P2A0, at term gestation and oblique lie. Early prenatal diagnosis using transvaginal ultrasound could increase the survival rate of the fetus if followed by sufficient management after diagnosis. Caesarean birth is the safest mode of delivery even before the clinical signs or onset of labor occur.Keywords: vasa previa, early diagnosis, caesarean section

Introduction: Pain management after caesarean delivery is vital for the early recovery of the mother. In the absence of long-acting opioids, fascial plane blocks such as the Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane (TAP) block significantly prolong the duration of analgesia and increase maternal comfort. Aim: To compare the number of rescue analgesic boluses required in the 24-hour postoperative period between the QLB and TAP block groups. Materials and Methods: This study was a prospective, single-blind, randomised clinical trail conducted in the Department of Anaesthesiology at a teritary care teaching Hospital, Chennai, Tamil Nadu from March 2021 to March 2022 on 94 patients (47 in each group) scheduled for elective Lower Segment Caesarean Section (LSCS) and were randomised into two groups: Group T and Group Q. Patients in Group T received a TAP block, while patients in Group Q received a QLB. The primary outcome assessed was the number of rescue analgesic boluses used in 24 hours. Secondary outcomes assessed included the time to initial onset of pain, time to the first request for analgesia, total amount of rescue analgesic consumption for 24 hours, and postoperative pain scores. The Chi-square test and Fisher-Freeman-Halton Exact test were utilised to compare the categorical variables. Results: Mean rescue bolus doses were significantly lower in Group Q (1.0±0.6 doses) compared to Group T (2.5±0.6 doses) (p

Introduction: Cesarean section is one of the most prevalent surgical procedures in the world and Surgical Site Infections (SSI) are the most common complication following Cesarean section. This leads to greater patient dissatisfaction, longer hospital stays, and higher treatment costs. The aim of this retrospective study is to determine the prevalence of wound infection and the prevalence of bacterial isolates in post-Cesarean section and its sensitivity to variant antibiotics. Material and methods: Samples were collected from patients who had developed wound infection following cesarean section and cultured on blood, chocolate and chromatic agar. The isolated bacteria was identified by ordinary microbiology techniques. Results: Among 4,482 Cesarean section patients in Albaraa Hospital, the surgical site infections (SSI) rate was 2.94 %. Microorganisms isolated from these cases included Candida albicans at a rate of 0.11%. The remaining 2.83% were bacterial isolates, with 70.1% being gram-positive bacteria significantly higher than the 29.9% attributed to gram-negative bacteria (P = 0.01). The main bacteria isolates were Staphylococcus aureus (37.8%), Staphylococcus epidermidis (23.6%), Pseudomonas aeruginosa (11.4%), Klebsiella pneumonia (8.3%), Escherichia coli (5.3%) and Alpha hemolytic Streptococcus (3.8%) Conclusions: The SSI rate in this study was at the lower limit of the WHO predicted infection rate and the bacterial isolates were sensitive to many antibiotics. This result may be due to the pre, intra and postoperative prophylactic antibiotics administered to patients and other factors such as short hospital stay and staff training in aseptic techniques. This study recommends further assessment of SSI in alternative surgical procedures, and assess the efficiency of prophylactic antibiotics in alternative surgeries in Libya.

Samuel Omara,1 Musa Kasujja,1 Geoffrey Okot,1 Peter Okello,1 Maxwell Okello,1 Richard Mulumba,1 Justus Kafunjo Barageine2 1Department of Obstetrics and Gynecology, Kampala International University Western Campus, Bushenyi, Uganda; 2Department of Obstetrics and Gynecology, Makerere University/Mulago Hospital, Kampala, UgandaCorrespondence: Samuel Omara, Email samuelomara06@gmail.comBackground: Post-caesarean surgical site infections (PCSSIs) significantly impact maternal morbidity, mortality, and healthcare costs in low- and middle-income countries, particularly in sub-Saharan Africa, where preventive measures are often inadequate. Despite this burden, data on PCSSIs in this context are limited. This study aimed to evaluate the incidence and factors associated with PCSSIs at Mubende Regional Referral Hospital.Methods: This prospective cohort study included 204 women who underwent caesarean sections from July to September 2023. Data was collected and participants were monitored for up to 28 days post-delivery to identify occurrences of surgical site infections (SSIs). Statistical analysis was conducted using STATA, with significance defined as a p-value of < 0.05.Results: Most participants (63.2%) were aged 18– 35 years, with over 67% having a parity of ≤ 4. Preoperative antibiotics were administered to 77.5% of participants. Most surgeries (64.2%) lasted 1– 2 hours, and the overall incidence of surgical site infections (SSIs) was 16.18%. Significant risk factors associated with more than a twofold increase in SSI risk included unstable referral status (aRR = 2.02), obstructed labor (aRR = 2.97), chorioamnionitis (aRR = 2.73), and prolonged premature rupture of membranes (PROM) (aRR = 2.05). Prolonged labor increased SSI risk by 1.37-fold (aRR = 1.37), while receipt of preoperative antibiotics was linked to a reduced SSI risk (aRR = 0.77).Conclusion: The post-caesarean SSI rate at Mubende Regional Referral Hospital is notably high, with key risk factors including unstable referral status, obstructed labor, prolonged labor, chorioamnionitis, and prolonged premature rupture of membranes (PROM). Administering preoperative antibiotics 30 minutes to 1 hour prior to surgery is linked to a reduced risk of SSI.Keywords: caesarean section, surgical site infection, Uganda

Abstract Background Ensuring healthcare services are equipped to offer; emergency obstetric and newborn care (EmONC) is crucial for improving the quality of maternal and newborn care in low- and middle-income countries. We assessed the temporal trends of the availability and readiness of the healthcare system to provide EmONC in Burkina Faso. Methods We analyzed the data from three national health facilities surveys, conducted in 2014, 2016 and 2018, using the WHO Service Availability and Readiness Assessment tool. We performed multivariable linear regression models to examine the trends. Results Between 2014 and 2018, the percentage of healthcare facilities providing delivery service and blood transfusion significantly decreased (88.1% to 75.4% for delivery services and 67.3% to 50.2% for blood transfusion, p

Abstract Background Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda. Methods We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS. Results We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8–21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2–65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6–40), primiparity (AOR = 4.8, 95% CI: 1.1–21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5–12) were associated with EONS. Conclusions Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (> 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in > 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of >10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.