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Abstract Background The decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria. Methods We conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021. Results Out of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059). Conclusion This study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications.

Background/Aims: A Cochrane review reported that epidural analgesia had no effect on the risk of emergency caesarean section; there was a discrepancy between these findings and the author's clinical observations, prompting the author to evaluate labour outcomes for women with and without epidural analgesia. The aim was to establish whether the author's clinical observations were supported by data. Methods: A retrospective review of the outcomes of 200 labours with and without epidural analgesia was carried out, limited to women the author had personally cared for. A subsequent trust-wide analysis of labours was conducted to explore wider trends in analgesia and emergency caesarean section. Results: In the personal review, epidural analgesia was associated with a more than two-fold increase in risk of emergency caesarean section, regardless of the underlying obstetric risk factors (from 14.7% to 36.4%). A similar trend was found across the trust. Conclusions: Epidural analgesia in labour is associated with increased risk of an emergency caesarean section. Potential reasons for the discrepancy with the Cochrane review findings include differences in anaesthetic practice, timing and dilation at the time of receiving epidural analgesia, and evidence that women taking part in a randomised controlled trial experience better outcomes than those receiving routine care. [ABSTRACT FROM AUTHOR]

Background: Conjoined twins (CT), which used to be historically defined as "monstrous human" and previously so-called Siamese twins in the early eighteenth century, are one of the very rare congenital malformations with an uncertain etiology and complex yet remain inconclusively debatable regarding its pathophysiological mechanisms of fusion and fission theories. Among all types of CT, parasitic CT, especially the pygopagus sub-type, is exceedingly rarer. To the best of the authors' knowledge, no parasitic CT had been reported in Papua, and this is the first finding in South Papua. Case Report: Herein, a 30-year-old multigravida female with 37th-week gestation, previous twice spontaneous miscarriage, and non-adequate antenatal care history is presented with a chief complaint of painful construction and greenish fluid leakage from the vagina, with an examination that showed a cephalic presentation with a "peculiar" big mass at the upper uterus and complete cervical dilation toward second-stage inpartu. Vaginal delivery was performed with a complication of obstructed labor due to uncommon dystocia with a suspected "big mass" below the fetal buttocks and intrapartum dead. Intrapartum transabdominal ultrasound demonstrates a gross anatomically like an organ inside a fluid-filled mass with unidentified parts, leading to a suspected type of congenital malformation at the baby's sacral region. Emergency C-section was done with findings of parasitic pygopagus CT, showing an attachment of a large irregular fluid-filled mass-like incomplete twin (parasite) with palpable soft tissue and bony structure inside to the buttocks of a male autosite twin, and an additional third leg which happened to be an under-developed lower extremity with a sacrum-like structure. Conclusions: An obstetrician's routine ANC and critical radiological evaluation will increase the odds of identifying CT or other congenital malformations to provide better delivery planning or further management. Increasing maternal health knowledge in society, improving medical skills and knowledge levels for health providers, and advancing supporting facilities and specialists are future strategies for managing and preventing such cases in low-middle-income countries. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post‐caesarean section ultrasound‐guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post‐operative analgesia use, and admission length.We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post‐operative 24 h, total dose used during admission, and opiates prescribed on discharge.Ninety‐six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m2, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.Surgical TAP blocks did not prolong surgical time or decrease post‐operative analgesia use or admission length in patients having undergone emergency caesarean. Patient‐tailored multimodal analgesia is encouraged, although more research is needed. [ABSTRACT FROM AUTHOR]

Background: The decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria. Methods: We conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021. Results: Out of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059). Conclusion: This study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications. [ABSTRACT FROM AUTHOR]

Objective: This study investigated prospective relationships between the perception of threat to one's own life or to that of one's infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CBPTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample. Methods: Study samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at =1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed. Results: Globally, mothers were significantly more likely to perceive their infant's life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05. Conclusion: The type of perceived threat differently influences maternal CBPTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool. [ABSTRACT FROM AUTHOR]

Background: The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD. Material and methods: We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models. Results: A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%). The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively. Conclusion: Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of surgical site wound infection and factors responsible for it following emergency Caesarean section performed in, PNS Shifa Hospital Karachi. Study Design: Cross Sectional study. Setting: Department of Obstetrics and Gynecology, PNS Shifa Hospital Karachi. Period: 4th July 2021 to 4th January 2022. Methods: Three hundred eleven women with term pregnancy undergoing emergency Caesarean section for maternal or foetal indications were included in this study. Wound inspection for signs of infection was done every day. Factors responsible of causing wound infection were noted from the discharge card. All the information was recorded on a preformed questionnaire. Results: 62(19.94%) of 311 women experienced surgical site wound infections in which prolonged duration of rupture of membranes was the commonest factors i.e. 51.6% (32/62), prolong duration of labor before operation 29%(18/62) and excessive volume of intra operative blood loss 29% (18/62). Conclusion: It is concluded there is a need to adopt specific preventative measures to decrease the frequency of identified factors so that the frequency of wound infection after the emergency caesarean section can be controlled with decreasing maternal morbidity and reduce hospital stays and thus, reducing the cost of treatment. [ABSTRACT FROM AUTHOR]

ObjectiveThis study investigated prospective relationships between the perception of threat to one’s own life or to that of one’s infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample.MethodsStudy samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed.ResultsGlobally, mothers were significantly more likely to perceive their infant’s life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p

Abstract Background Emergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas. Methods Data on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation. Results Primary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P

Background: Maternity hospitals everywhere are seeing a rise in the trend of Caesarean deliveries, the indications for which are varied and could be maternal, fetal or fetomaternal. The objective of the study was to find out the factors associated with the indications for emergency Caesarean sections. Methodology: Retrospective case-control study conducted in Kasturba Medical College Hospital, Attavar and Govt. Lady Goschen Hospital, Mangalore, among women who underwent caesarean sections as cases, and equal number of age matched women who underwent normal deliveries as controls, a total sample size of 70, during the study period 12th April 2016 to 22nd April 2016. A questionnaire was used to collect details including the social- demographic details, antenatal history, and indications for caesarean section. Results: The study showed that 37.1% of women who underwent emergency LSCS were ≤25 years, 34.3% were between 26-30 years, and 28.6% were ≥31 years. Regarding occupation 88.6%of our cases did non strenuous work whereas 11.4% did strenuous work(manual labourer). 20% of our cases were vegetarians and 80% consumed a mixed diet. 71.4% cases were primigravids and 28.6% were non primis. Regarding antenatal visits 85.7% who underwent emergency LSCS made regular antenatal visits and 14.3% were irregular. Conclusion: Among the women that underwent full term vaginal delivery (FTVD), it was observed that they did moderate physical work. Older women (above 30 years) were observed to have undergone emergency LSCS rather than vaginal deliveries. It was seen that most of the women who had a full-term vaginal delivery consumed a mixed diet. Those who underwent emergency LSCS were observed to be mostly primigravida and primipara.

Apgar scoring of 97 puppies from 18 litters delivered either by medical induction (Group I, n=9) or emergency caesarean section (Group II, n=9) was carried out. A total of 54 and 43 puppies were delivered in group I and II, respectively and their Apgar scores measured at 5min and one hour after birth. The mean ± SE Apgar scores measured at 5min of birth in group I and group II were 3.96 ± 0.38 and 4.84 ± 0.39, respectively. The mean ± SE Apgar scores of puppies at one hour of birth in group I and group II were 6.09 ± 0.31and 6.93 ± 0.33, respectively. Apgar scores at different time periods did not vary significantly between groups but varied significantly within the group. The association between Apgar score at one hour and survivability of puppies at 24 h of birth was analysed. The puppy mortality rate was significantly (p0.05) between different Apgar scores of puppies within group II.

Background: Emergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas. Methods: Data on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation. Results: Primary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05). Conclusions: The DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting. [ABSTRACT FROM AUTHOR]

Abstract Background General anesthesia in pregnant women can be associated with significant maternal and fetal morbidity. Emergency caesarean section can be performed by converting labor epidural analgesia to surgical anesthesia by injecting high-dose short-acting local anesthetics through the epidural catheter. The effectiveness and the delay to obtain surgical anesthesia depends upon the protocol used. Data indicate that alkalinization of local anesthetics may shorten their onset of action and increase their effectiveness. This study investigates whether alkalinization of adrenalized lidocaine could increase the efficacy and decrease the delay of onset of surgical anesthesia via an indwelling epidural catheter, thus decreasing the necessity to resort to general anesthesia for emergency caesarean deliveries. Methods This study will be a bicentric, double-blind, randomized, controlled trial with two parallel groups of 66 women who require emergency caesarian deliveries and who have been receiving epidural labor analgesia. The number of subjects in groups will be unbalanced with a 2:1 ratio of experimental:control. In both groups, all eligible patients will have had an epidural catheter placed for labor analgesia with levobupicaine or ropivacaine. Patient randomization will occur when the decision is made by the surgeon that an emergency caesarean delivery is indicated. Surgical anesthesia will be obtained by injecting 20 mL of 2% lidocaine with epinephrine 1:200,000, or 10 mL 2% lidocaine with epinephrine 1:200,000 plus 2 mL sodium bicarbonate 4.2% (total of 12 mL). The primary outcome will be the rate of conversion to general anesthesia for failure of the epidural to provide adequate analgesia. This study will be powered to detect a 50% reduction in the incidence of general anesthesia, from 80 to 40%, with a confidence ratio of 90%. Discussion Sodium bicarbonate could be used to avoid general anesthesia for emergency caesarean deliveries by providing reliable and effective surgical anesthesia in women with pre-existing labor epidural catheters is promising. This randomized controlled trial seeks to determine the optimal local anesthetic mixture for converting epidural analgesia to surgical anesthesia for emergency caesarean sections. This may decrease the need for general anesthesia for emergency caesarian section, shorten the time to fetal extraction, and improve safety and patient satisfaction. Trial registration ClinicalTrials.gov NCT05313256. Registered on 6 April 2022

Purpose: An emergency caesarean section (CS) has more complications than a planned CS. The arrest of labour is a major indication for an emergency CS. This study aimed to develop a prediction model for the arrest of labour to be used in regular check-ups at 36 or 37 gestational weeks for primiparas. Methods: This was a retrospective cohort study conducted at a single institution in Japan using data from January 2007 to December 2013. Primiparas attending regular check-ups during 36 or 37 gestational weeks, with live single foetuses in a cephalic presentation were included. The outcome was the incidence of labour arrest. Candidate predictors included 25 maternal and foetal findings. We developed a prediction model using logistic regression analysis with stepwise selection. A score was assigned to each predictor of the final model based on their respective β coefficients. Results: A total of 739 women were included in the analysis. Arrest of labour was diagnosed in 47 women (6.4%), and all of them delivered by emergency CS. The predictors in the final model were a Bishop score ≤ 1, maternal height ≤ 154 cm, foetal biparietal diameter ≥ 91 mm, pre-pregnancy weight ≥ 54 kg, maternal haemoglobin concentration ≥ 11.0 g/dl, and amniotic fluid index ≥ 13. The area under the receiver operating characteristic curve was 0.783. Conclusion: We have developed the first model to predict arrested labour before its onset. Although this model requires validation using external samples, it will help clinicians and pregnant women to control gestational conditions and make decisions regarding planned CS. [ABSTRACT FROM AUTHOR]

Apgar scoring of 97 puppies from 18 litters delivered either by medical induction (Group I, n=9) or emergency caesarean section (Group II, n=9) was carried out. A total of 54 and 43 puppies were delivered in group I and II, respectively and their Apgar scores measured at 5min and one hour after birth. The mean ± SE Apgar scores measured at 5min of birth in group I and group II were 3.96 ± 0.38 and 4.84 ± 0.39, respectively. The mean ± SE Apgar scores of puppies at one hour of birth in group I and group II were 6.09 ± 0.31and 6.93 ± 0.33, respectively. Apgar scores at different time periods did not vary significantly between groups but varied significantly within the group. The association between Apgar score at one hour and survivability of puppies at 24 h of birth was analysed. The puppy mortality rate was significantly (p<0.01) higher (63.64 per cent) among those which scored 0-3 than other Apgar scores in group I. The puppy mortality rate and survival rate did not vary significantly (p>0.05) between different Apgar scores of puppies within group II. [ABSTRACT FROM AUTHOR]

Background: General anesthesia in pregnant women can be associated with significant maternal and fetal morbidity. Emergency caesarean section can be performed by converting labor epidural analgesia to surgical anesthesia by injecting high-dose short-acting local anesthetics through the epidural catheter. The effectiveness and the delay to obtain surgical anesthesia depends upon the protocol used. Data indicate that alkalinization of local anesthetics may shorten their onset of action and increase their effectiveness. This study investigates whether alkalinization of adrenalized lidocaine could increase the efficacy and decrease the delay of onset of surgical anesthesia via an indwelling epidural catheter, thus decreasing the necessity to resort to general anesthesia for emergency caesarean deliveries. Methods: This study will be a bicentric, double-blind, randomized, controlled trial with two parallel groups of 66 women who require emergency caesarian deliveries and who have been receiving epidural labor analgesia. The number of subjects in groups will be unbalanced with a 2:1 ratio of experimental:control. In both groups, all eligible patients will have had an epidural catheter placed for labor analgesia with levobupicaine or ropivacaine. Patient randomization will occur when the decision is made by the surgeon that an emergency caesarean delivery is indicated. Surgical anesthesia will be obtained by injecting 20 mL of 2% lidocaine with epinephrine 1:200,000, or 10 mL 2% lidocaine with epinephrine 1:200,000 plus 2 mL sodium bicarbonate 4.2% (total of 12 mL). The primary outcome will be the rate of conversion to general anesthesia for failure of the epidural to provide adequate analgesia. This study will be powered to detect a 50% reduction in the incidence of general anesthesia, from 80 to 40%, with a confidence ratio of 90%. Discussion: Sodium bicarbonate could be used to avoid general anesthesia for emergency caesarean deliveries by providing reliable and effective surgical anesthesia in women with pre-existing labor epidural catheters is promising. This randomized controlled trial seeks to determine the optimal local anesthetic mixture for converting epidural analgesia to surgical anesthesia for emergency caesarean sections. This may decrease the need for general anesthesia for emergency caesarian section, shorten the time to fetal extraction, and improve safety and patient satisfaction. Trial registration: ClinicalTrials.gov NCT05313256. Registered on 6 April 2022 [ABSTRACT FROM AUTHOR]

• Four risk factors are associated with difficult fetal extraction in emergency CS. • Difficult fetal extraction causes maternal blood loss, low Apgar score and low umbilical artery pH. • This article suggests a definition of difficult fetal extraction. This study aimed to assess risk factors for difficult fetal extraction in emergency caesarean sections, focusing on top-up epidural anesthesia compared to spinal anesthesia. Additionally, this study addressed consequences of difficult fetal extraction on neonatal and maternal morbidity. This retrospective registry-based cohort study included 2,332 of 2,892 emergency caesarean sections performed with local anesthesia during 2010–2017. Main outcomes were analyzed by crude and multiple adjusted logistic regression providing odds ratios. Difficult fetal extraction was found in 14.9% of emergency caesarean sections. Risk-factors for difficult fetal extraction included top-up epidural anesthesia (aOR:1.37[95 %CI 1.04–1.81]), high pre-pregnancy BMI (aOR:1.41[95 %CI 1.05–1.89]), deep fetal descent (ischial spine: aOR:2.53[95 %CI 1.89–3.39], pelvic floor: aOR:3.11[95 %CI 1.32–7.33]), and anterior placental position (aOR:1.37[95 %CI 1.06–1.77]). Difficult fetal extraction was associated with increased risk of low umbilical artery pH 7.00–7.09 (aOR:3.50[95 %CI 1.98–6.15]) pH ≤ 6.99 (aOR:4.20[95 %CI 1.61–10.91]), five-minute Apgar score ≤ 6 (aOR:3.41[95 %CI 1.49–7.83]) and maternal blood loss (501–1,000 ml: aOR:1.65[95 %CI 1.27–2.16], 1,001–1,500 ml: aOR:3.24[95 %CI 2.24–4.67], 1,501–2,000 ml: aOR:3.94[95 %CI 2.24–6.94] and ≥ 2001 ml: aOR:2.76[95 %CI 1.12–6.82]). This study identified four risk factors for difficult fetal extraction in emergency caesarean section: top-up epidural anesthesia, high maternal BMI, deep fetal descent and anterior placental position. Additionally, difficult fetal extraction was associated with poor neonatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

For more than 60 years the Confidential Enquiry into Maternal Deaths triennial reports and later reports from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have helped build a picture of maternity care within the UK highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner. [ABSTRACT FROM AUTHOR]

Unplanned/emergency caesarean section (CS) can lead to an increased risk of increased risk of adverse maternal and perinatal outcomes. This prospective observational study was conducted in a tertiary centre in South India to determine the factors associated with increased risk of unplanned/emergency CS among women with placenta previa (PP). Primary outcome was the unplanned CS defined as emergency CS performed, prior to the scheduled date of delivery, for profuse vaginal bleeding or onset of labour pains. Obstetric morbidity and maternal–foetal outcomes were also compared between major and minor degree of PP. Major degree PP (OR 3.56; 95% CI: 1.73–7.32), first episode of bleeding at less than 29 weeks of gestation (OR 6.25; 95% CI: 2.14–18.24), and the haemoglobin level at admission (OR: 0.72; 95% CI: 0.57–0.91) were found to be associated with higher odd for undergoing unplanned CS. Identifying these women at high risk of unplanned CS, especially in limited resource setting, helps for a timely and early referral to tertiary centres with expertise to manage complications along with facilities for blood transfusion and interventional radiology can help to optimise maternal and perinatal outcomes. What is already known on this subject? With increasing numbers of caesarean sections (CSs) and assisted reproductive techniques, the rate of PP is constantly on the rise. Unplanned CS is associated with increased risk of adverse maternal and perinatal complications. What do the results of this study add? Nearly, 40% among those who underwent CS were unplanned. Major degree placenta previa (PP) (OR 3.56; 95% CI: 1.73–7.32), first episode of bleeding at less than 29 weeks of gestation (OR 6.25; 95% CI: 2.14–18.24), and the haemoglobin level at admission (OR: 0.72; 95% CI: 0.57–0.91) were found to be associated with higher odd for undergoing unplanned CS. What are the implications of these findings for clinical practice and/or further research? Identifying women with PP at high risk of unplanned CS, especially in limited resource setting, helps for a timely and early referral to tertiary centres with expertise to manage complications, facilities for blood transfusion and interventional radiology, which optimise maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Emergency caesarean sections (EmCS), particularly those performed in the second stage of labour, have been associated with a risk of subsequent preterm birth. More worrying is that the risk of sPTB recurrence appears to be high in women who have had a second stage EmCS and a subsequent sPTB. However, there is a paucity of evidence regarding the risk of recurrence in women who have had a prior term EmCS at any stage of labour followed by a sPTB. This study aims to investigate the relationship between all term in labour EmCS and the risk of recurrent spontaneous preterm birth (sPTB).Study Design: This is an observational, retrospective cohort study conducted at St Thomas' Hospital, a tertiary-level maternity hospital in London, United Kingdom. 259 women were included; 59 women with a term in labour EmCS preceding a sPTB (EmCS group) and 200 women with a prior sPTB only (control group). The initial EmCS was further categorised into first stage (FS)-EmCS or second stage (SS)-EmCS. Primary outcome was sPTB in Pregnancy C < 37 weeks' gestation. Secondary outcomes included sPTB < 34 weeks' and < 24 weeks' gestation.Results: 54% (32/59) of the EmCS group had a recurrent sPTB < 37 weeks compared to 20% (40/200) of the control women (p < 0.0001) with a relative risk of 2.71 [95%CI 1.87-3.87]). Of women who had a SS-EmCS and a subsequent PTB, 61.9% (13/21) had a further sPTB (RR 3.0 [95%CI, 1.8-4.5] compared to control women). In addition, there is nearly a 6-fold increased risk of a recurrent sPTB or midtrimester loss < 24 weeks' gestation in these women (RR 5.65 [95%CI2.6-12.0]).Conclusions: In women who have had a previous sPTB in which a term in labour EmCS is a risk factor, the risk of a further sPTB is much higher than in those women where a prior sPTB is the sole risk factor. Furthermore, EmCS at both the first and second stage of labour are associated with a increased risk of recurrent sPTB. Further work should ascertain which women who have had a prior term EmCS are at risk of sPTB and recurrence, and how best to identify and treat them. [ABSTRACT FROM AUTHOR]

Objective(s): To understand current practice, expertise and training requirements for management of an impacted fetal head (IFH) at caesarean section (CS) in the UK, and whether a clinical trial of techniques to manage an IFH is acceptable.Study Design: Five hundred and thirty-eight online surveys were completed by obstetricians (n = 206), obstetric anaesthetists (n = 38), midwives (n = 35) and parents (n = 259). Data was collected on incidences of CS and IFH, current use of techniques, and acceptability of a clinical trial to manage an IFH from health care professionals. Information on incidences of CS and recollection of an IFH, acceptability of techniques, and likelihood of taking part in a clinical trial were sought from parents.Results: The most common technique used by obstetricians (84%) and midwives (69%) was the 'push technique'. Eighty-seven percent of health care professionals would be willing to participate in a clinical trial, with 89% confirming that results would guide their clinical practice. Most parents expressed reluctance regarding participation in a clinical trial during labour (62%), due to preferring a doctor to adopt the technique they felt most comfortable with (63%).Conclusion(s): Given the lack of national guidance on appropriate techniques, no formal training, and no consensus on best practice for the management of an IFH during emergency CS, it is perhaps not surprising that the majority of heath care professionals would be willing to participate in a clinical trial, where results will guide their clinical practice. The future development of clinical trials, involving relevant stakeholders in the design of such trials, is crucial to improve upon the guidance and training provided to staff who may encounter an IFH. [ABSTRACT FROM AUTHOR]

General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes. [ABSTRACT FROM AUTHOR]

Successful management of a pregnant patient with complex congenital heart disease is a challenge for anesthesiologists, requiring thorough knowledge of the impact of pregnancy on the cardiac lesion. Hearing and speech impaired patients pose a barrier to effective communication between the patient and the doctors, thus increasing the anxiety and risk of complications. Here, we present a case of a hearing and speech impaired woman with the rare and dangerous Eisenmenger's syndrome, presenting for an emergency cesarean section (CS).

Dilated cardiomyopathy (DCM) is a rare condition in pregnancy and has an established grave prognosis as such. Anesthetic management of pregnant patients with dilated cardiomyopathy is quite challenging either because of preexisting DCM or the risk of precipitating sudden cardiac failure. Pregnancy in patients with preexisting DCM can further flare-up disease and can be life- threatening, especially in patients who land up in an emergency when there is less time to optimize the patient's condition. The anesthesiologist thus must have knowledge of its causes, pathophysiology, clinical features, and various anesthetic modalities available. The present case report illustrates the successful management of a parturient with preexisting DCM undergoing emergency caesarean section. It is very important that patients with DCM should have regular follow-up so that timely intervention can be done about the mode of delivery for the safety of both mother and child.

Abstract Background Given the sudden and unexpected nature of an emergency caesarean section (EmCS) coupled with an increased risk of psychological distress, it is particularly important to understand the psychosocial outcomes for women. The aim of this systematic literature review was to identify, collate and examine the evidence surrounding women’s psychosocial outcomes of EmCS worldwide. Methods The electronic databases of EMBASE, PubMed, Scopus, and PsycINFO were searched between November 2017 and March 2018. To ensure articles were reflective of original and recently published research, the search criteria included peer-reviewed research articles published within the last 20 years (1998 to 2018). All study designs were included if they incorporated an examination of women’s psychosocial outcomes after EmCS. Due to inherent heterogeneity of study data, extraction and synthesis of both qualitative and quantitative data pertaining to key psychosocial outcomes were organised into coherent themes and analysis was attempted. Results In total 17,189 articles were identified. Of these, 208 full text articles were assessed for eligibility. One hundred forty-nine articles were further excluded, resulting in the inclusion of 66 articles in the current systematic literature review. While meta-analyses were not possible due to the nature of the heterogeneity, key psychosocial outcomes identified that were negatively impacted by EmCS included post-traumatic stress, health-related quality of life, experiences, infant-feeding, satisfaction, and self-esteem. Post-traumatic stress was one of the most commonly examined psychosocial outcomes, with a strong consensus that EmCS contributes to both symptoms and diagnosis. Conclusions EmCS was found to negatively impact several psychosocial outcomes for women in particular post-traumatic stress. While investment in technologies and clinical practice to minimise the number of EmCSs is crucial, further investigations are needed to develop effective strategies to prepare and support women who experience this type of birth.

• Pregestational obesity significantly increased the risk of caesarean deliveries in general, and elective and emergency. • The population attributable risk analysis suggested that 32% of the total caesarean deliveries may be due to pregestational obesity. • These results highlight the importance of reducing the rates of obesity among women of childbearing age, preventing excessive gestational weight gain and promoting the recovery of a normal nutritional status after delivery, so women can start a new pregnancy with a better nutritional status. To evaluate whether pregestational obesity is associated with the risk of caesarean section in pregnant women living in a country in an advanced stage of the obstetric transition. Retrospective cohort study. Data were collected from prenatal and hospital records. Pregestational obesity was defined as: body mass index, [weight(k)/height (m2)] ≥30, and caesarean sections were categorized as elective, emergency, or non-emergency/medically necessary. Biodemographic and sociodemographic characteristics, obstetric and perinatal pathologies, and maternal anthropometric variables were assessed. Chi-square and t-tests were used to compare qualitative and quantitative variables, respectively. Simple and adjusted generalized linear models were used to evaluate the association between pregestational obesity and caesarean delivery. Finally, population attributable risk was calculated. Data analysis was performed using STATA.v.14.0. 2309 pregnant women with a singleton pregnancy who gave birth at a public hospital in the Metropolitan Region of Santiago, Chile in 2015. The prevalence of pregestational obesity was 21.4%, and the incidence of caesarean deliveries was 34.8% (33% of which corresponded to elective, 46% to emergency, and 21% to non-emergency/medically necessary caesarean deliveries). Pregestational obesity increased the risk of caesarean delivery (aRR = 1.46; 95%CI. [1.19–1.79] as well as the risk of elective (aRR = 1.74; 95%CI. [1.23–2.45]) and emergency caesarean delivery (aRR = 1.44; 95%CI. [1.03–2.00]). The population attributable risk of pregestational obesity for caesarean section was 32%. Given the significant association between pregestational obesity and caesarean delivery, it is necessary to develop strategies to decrease obesity among women of childbearing age in order to decrease obstetric intervention. [ABSTRACT FROM AUTHOR]

PICO question In pregnant bitches due to whelp, is elective caesarean section more effective than vaginal delivery to improve puppy survival? Clinical bottom line Category of research question The category of the research question is regarding the incidence of puppy mortalities as a result of vaginal delivery, emergency caesarean section and elective caesarean section. The number and type of study designs reviewed Two retrospective articles were reviewed and critically appraised; one retrospective study with high single canine breed bias and one study on different canine breeds but limited support in directly answering the PICO question. Strength of evidence The studies selected both had strong uses of experimental designs but together provided weak evidence to determine a definitive answer to the PICO question. Outcomes reported The outcomes from both retrospective studies suggests that the mortality rates of newborn puppies can be reduced if pregnant bitches are scheduled ahead for elective caesareans, in comparison to undergoing an emergency caesarean section when complications develop, particularly in breeds with higher risks of dystocia. Therefore, there is some evidence to support that it may be advantageous to consider the breed, age and overall health of the bitch during pregnancy to determine whether elective caesarean sections, for the safe delivery of puppies, should be considered. Conclusion There are currently insufficient studies, literatures and evidence in veterinary medicine for caesarean sections to become a routine procedure in first opinion practices. Future prospective studies should be conducted and include the optimum anaesthetic protocols with the lowest associated risks for the pregnant bitch and puppies. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Introduction: Spinal anaesthesia is an accepted technique in obstetric surgery but often associated with hypotension and nasal congestion. Phenylephrine, α1 agonist has been tried earlier in managing such adverse situations by parenteral route. Aim: To compare the effect of prophylactic phenylephrine nasal drop versus normal saline as nasal drop in the prevention of hypotension and nasal congestion during spinal anaesthesia in emergency Lower Uterine Caesarean Section (LUCS). Materials and Methods: A prospective randomised double blinded study was conducted on 90 parturient over a period of five months. Patients were randomised into Group A (n=46) phenylephrine (3 μg/kg) nasal drop (10%) and Group B (n=44) received normal saline nasal drop apart from all other standard pre-anaesthetic medications. Blood pressure was measured and nasal congestion recorded every two minutes in the first five minutes and then every five minutes until 30 minutes after spinal anaesthesia. Numerical variables were analysed using independent student’s t-test. Results: The incidence of hypotension was significantly prevented for those participants with prophylactic phenylephrine (p

Recent studies have suggested an association between Pulmonary Arterial Hypertension (PAH) and thyroid disease. This combination is however rare during pregnancy. Here is a case of uncontrolled hyperthyroidism with severe PAH presenting during the third trimester. Due to impeding fetal distress patient was taken for delivery via caesarean section. Under a cover of Propylthiouracil (PTU) and beta blockers, epidural anaesthesia was given to avoid substantial hemodynamic variations which may induce sudden right ventricular insufficiency. Uneventful intraoperative and postoperative course ensured good maternal outcome.

Background and Aims: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. Methods: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score

Acute myocardial infarction (AMI) during pregnancy is rare emergency, having potential risk for adverse fetomaternal outcomes. AMI accounts for 5.6% of the people under 40 years and females being only 0.7%. During pregnancy incidence is 1:10,000 to 1:30,000. During entire pregnancy, third trimester is the period where AMI is more common. Till 2005 around 230-250 AMI during pregnancy are reported in literature since 1920, but none is reported of AMI during labour. High index of suspicion and early diagnosis is a keystone for favourable fetomaternal outcome along with multidisciplinary team approach during management of parturient with AMI. We report a case of 28 year old parturient (G3P2L2 with 37weeks of gestation) admitted in active labour with breathlessness, chest pain diagnosed with AMI. She was posted for labour analgesia and converted into emergency caesarean section because of foetal distress. [ABSTRACT FROM AUTHOR]

Puprose: An emergency caesarean section is a potentially life-threatening situation both for the mother and the newborn. Non-technical skills can be improved by simulation training and are necessary to manage this urgent situation successfully. The objective of this study was to investigate, if training of emergency caesarean section can be transferred into daily work to improve the outcome parameters pH an APGAR of the newborn. Methods: In this pre-post study, 141 professionals took part in a training for emergency caesarean section. Participants received a questionnaire, based on the tools "Training Evaluation Inventory" and "Transfer Climate Questionnaire" 1 year after training. Outcome data of the newborn were collected from the hospitals information system. Results: Except the scale "extinction", Cronbach's alpha was higher than 0.62. All scales were rated lower than 2.02 on a 5-point Likert Scale (1 = fullest approval; 5 = complete rejection). "Negative reinforcement" was rated with 2.87 (SD 0.73). There were no significant differences in outcome data prior. The questionnaire fulfils criteria for application except the scale "extinction". Conclusion: The presented training course was perceived as useful by the professionals and attitudes toward training were positive; the content was positively reinforced in practice 1 year after training. Parameters of the newborn did not change. It is conceivable that other outcome parameters (e.g. posttraumatic stress disorder) are addressed by the training. The development of relevant outcome parameters for the quality of emergency sections needs further investigation. [ABSTRACT FROM AUTHOR]

The objective of the study was to compare maternal and neonatal adverse outcomes between elective caesarean section (ElCS) and emergency caesarean section (EmCS) for singleton-term breech presentation. This study included women with singleton breech presentation who underwent ElCS or EmCS at term during 2007-2015 at Siriraj Hospital (Thailand). Complete data were collected for 2178 pregnant women. Of those, 1322 (60.7%) women underwent EmCS, and 856 (39.3%) delivered by ElCS. Maternal and perinatal morbidity were compared. There was no maternal or perinatal death in either group. Maternal morbidity was comparable between groups, except for longer hospital stay in the EmCS group (p = .047). One-minute Apgar score was significantly lower in the EmCS group (p = .040). There was no significant difference in 5-min Apgar score between groups. No significant difference was observed for serious maternal and neonatal morbidity between women who underwent ElCS versus those who underwent EmCS for singleton-term breech presentation.IMPACT STATEMENTWhat is already known on this subject? Emergency caesarean section (EmCS) is generally known to be associated with a higher risk of maternal and neonatal complications than elective caesarean section (ElCS).What do the results of this study add? In singleton-term breech presentation, EmCS in tertiary care setting was not associated with an increase in serious maternal and neonatal morbidity compared with EICS. Cord prolapse as an indication for emergency caesarean section was significantly associated with adverse outcomes while advanced cervical dilation ≥7 cm or low foetal station ≥+1 did not have an impact on maternal and neonatal complications.What are the implications of these findings for clinical practice and/or further research? Mean gestational age in both the ElCS and EmCS groups was approximately 38 weeks and 5 d; there were no neonatal cases with respiratory distress syndrome. Our findings suggest further prospective study in planned caesarean section scheduled for 38-39 weeks in patients with term breech presentation. The results of such a study could yield lower rates of both EmCS and potential adverse outcomes. [ABSTRACT FROM AUTHOR]

Maternity and neonatal departments must be prepared for the delivery of babies from COVID-19 positive women. We describe a guideline developed at the North Middlesex University Hospital maternity unit, for multidisciplinary team members attending an emergency caesarean section of mothers with confirmed or suspected COVID-19. Anticipated staff actions and personal protective equipment were considered to optimise staff safety and reduce transmission of SARS-CoV-2. We recommend units generate individualised guidance suitable to their settings. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anaesthesia is an accepted technique in obstetric surgery but often associated with hypotension and nasal congestion. Phenylephrine, α1 agonist has been tried earlier in managing such adverse situations by parenteral route. Aim: To compare the effect of prophylactic phenylephrine nasal drop versus normal saline as nasal drop in the prevention of hypotension and nasal congestion during spinal anaesthesia in emergency Lower Uterine Caesarean Section (LUCS). Materials and Methods: A prospective randomised double blinded study was conducted on 90 parturient over a period of five months. Patients were randomised into Group A (n=46) phenylephrine (3 μg/kg) nasal drop (10%) and Group B (n=44) received normal saline nasal drop apart from all other standard pre-anaesthetic medications. Blood pressure was measured and nasal congestion recorded every two minutes in the first five minutes and then every five minutes until 30 minutes after spinal anaesthesia. Numerical variables were analysed using independent student's t-test. Results: The incidence of hypotension was significantly prevented for those participants with prophylactic phenylephrine (p<0.001) compared to the normal saline group. Systolic and diastolic blood pressures parameters after administration of spinal anaesthesia were maintained well in the phenylephrine group as compared to the normal saline group at various time intervals. Moreover, there were no incidences of nasal congestion among the parturient in the phenylephrine arm. Conclusion: Prophylactic phenylephrine nasal drop remarkably reduced the incidence of spinal anaesthesia induced hypotension and nasal congestion compared to normal saline treated group. Such approach can be recommended in emergency LUCS provided more robust data are generated from large multicentric studies. [ABSTRACT FROM AUTHOR]

Abstract Background Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania. Methods This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant. Results A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40–120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5thminute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63–1.64) and hospital stay (OR: 1.02; 95% 0.63–1.64). Conclusions Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the urgency of caesarean section in order to prevent maternal and neonatal morbidity and mortality.

A too-high gestational weight gain, in combination with steadily increasing obesity rates among women of reproductive age, represents an enormous obstetrical problem, as obesity and high gestational weight gain are associated with enhanced fetal growth, low vital parameters, and increased cesarean section rates. This medical record-based study investigates the association patterns between too-low as well as too-high gestational weight gain, according to the 2009 Institute of Medicine (IOM) guidelines, and fetal growth, as well as birth mode and pregnancy outcome. The data of 11,755 singleton births that had taken place between 2010 and 2020 at the Public Clinic Donaustadt in Vienna, Austria, were analyzed. Birth weight, birth length, head circumference, APGAR scores, and pH values of the arterial umbilical cord blood described fetal growth as well as the vital parameters after birth. Gestational weight gain was classified as too low, recommended, or too high according to the different weight status categories of the IOM guidelines. Birth weight, birth length, and head circumference of the newborn were significantly increased ( p < 0.001) among underweight, normal-weight, and overweight women who gained more weight than recommended. Among obese women, only birthweight was significantly ( p < 0.001) higher among women who gained more weight than recommended. Furthermore, a too-high gestational weight gain was significantly associated with an increased risk of macrosomia and emergency cesarean sections among underweight, normal-weight, and overweight women, but not among obese ones. Obese and morbidly obese women experiencing excessive gestational weight gain showed no significantly increased risk of macrosomia or emergency cesarean section. However, among obese mothers, a too-low gestational weight gain reduced the risk of emergency cesarean sections significantly ( p = 0.010). Consequently, the IOM recommendations for gestational weight gain fit only partly for pregnant women in Austria. In the case of obese and morbidly obese women, new guidelines for optimal pregnancy weight gain should be considered.

Background: Given the sudden and unexpected nature of an emergency caesarean section (EmCS) coupled with an increased risk of psychological distress, it is particularly important to understand the psychosocial outcomes for women. The aim of this systematic literature review was to identify, collate and examine the evidence surrounding women's psychosocial outcomes of EmCS worldwide.Methods: The electronic databases of EMBASE, PubMed, Scopus, and PsycINFO were searched between November 2017 and March 2018. To ensure articles were reflective of original and recently published research, the search criteria included peer-reviewed research articles published within the last 20 years (1998 to 2018). All study designs were included if they incorporated an examination of women's psychosocial outcomes after EmCS. Due to inherent heterogeneity of study data, extraction and synthesis of both qualitative and quantitative data pertaining to key psychosocial outcomes were organised into coherent themes and analysis was attempted.Results: In total 17,189 articles were identified. Of these, 208 full text articles were assessed for eligibility. One hundred forty-nine articles were further excluded, resulting in the inclusion of 66 articles in the current systematic literature review. While meta-analyses were not possible due to the nature of the heterogeneity, key psychosocial outcomes identified that were negatively impacted by EmCS included post-traumatic stress, health-related quality of life, experiences, infant-feeding, satisfaction, and self-esteem. Post-traumatic stress was one of the most commonly examined psychosocial outcomes, with a strong consensus that EmCS contributes to both symptoms and diagnosis.Conclusions: EmCS was found to negatively impact several psychosocial outcomes for women in particular post-traumatic stress. While investment in technologies and clinical practice to minimise the number of EmCSs is crucial, further investigations are needed to develop effective strategies to prepare and support women who experience this type of birth. [ABSTRACT FROM AUTHOR]

Rationale: Sleep duration is critical to growth, learning, and immune function development in infancy. Strategies to ensure that national recommendations for sleep duration in infants are met require knowledge of perinatal factors that affect infant sleep.Objectives: To investigate the mechanistic pathways linking maternal education and infant sleep.Methods: An observational study was conducted on 619 infants whose mothers were enrolled at the Edmonton site of the CHILD birth cohort. Infant sleep duration at three months was assessed using the Brief Infant Sleep Questionnaire. Maternal education was collected via maternal report. Prenatal and postnatal depression scores were obtained from the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Birth records and maternal report were the source of covariate measures. Mediation analysis (PROCESS v3.0) was used to examine the indirect effects of maternal education on infant sleep duration mediated through prenatal depression and birth mode.Measurements and Main Results: At three months of age, infants slept on average 14.1 h. Lower maternal education and prenatal depression were associated with significantly shorter infant sleep duration. Emergency cesarean section birth was associated with 1-hour shorter sleep duration at three months compared to vaginal birth [without intrapartum antibiotic prophylaxis] (β: -0.99 h; 95% CI: -1.51, -0.48). Thirty percent of the effect of lower maternal education on infant total sleep duration was mediated sequentially through prenatal depression and birth mode (Total Indirect Effects: -0.12, 95% CI: -0.22, -0.03, p < 0.05).Conclusions: Prenatal depression and birth mode sequentially mediate the effect of maternal education on infant sleep duration. [ABSTRACT FROM AUTHOR]

Background: In Norway and other European countries, women are less satisfied with the postnatal care they receive than with the antenatal and birthing care. Postnatal care in Norway is changing, with the number of nights in hospital being reduced, including for women who have undergone a caesarean section. Objective: To investigate women's perceptions of the physical health care they received in the maternity ward following an emergency caesarean section. Method: Qualitative study involving a convenience sample consisting of ten women who had given birth by emergency caesarean section. We conducted semi-structured, individual interviews and analysed the data using systematic text condensation. Results: The analysis highlighted four themes: the post-surgery experiences of new mothers, perceptions of continuity and midwifery presence, the importance of knowledge and good information, and the value of a partner's presence. Conclusion: The study shows that women who had given birth by emergency caesarean section felt that they received poor physical health care in the maternity ward. [ABSTRACT FROM AUTHOR]

Background: Little empirical research examines relationships among delivery mode, other childbirth-related factors, maternal characteristics, and child psychosocial development. Objective: The aim of this study is to explore the developmental trajectories of toddlers' emotional and behavioral problems and the predictive role of psycho-social, childbirth, and maternal characteristics. Method: Participants were 258 mothers and their children who took part in a longitudinal study from birth till the age of 30 months. Self-report instruments were used for the assessment of mothers' infant rearing attitudes, the quality of relationship with the partner, maternal emotional distress, and maternal self-efficacy. The Child Behavior Checklist (1½–5) was used for the assessment of children's behavioral and emotional problems. Results: Latent class analysis for emotional and behavioral problems ended in 3-class solutions. In regard to emotional problems, 83% of children were classified as having a stable low, 11% an increasing, and 6% a decreasing level of emotional problems. In regard to behavioral problems, 86% of children showed a stable low, 5% an increasing, and 9% a stable high level of behavioral problems. Children's gender in combination with maternal education and maternal infant rearing attitudes predict children's membership in the increasing and decreasing emotional problem classes. Children's gender and maternal age in combination with emergency caesarean section, the quality of the relationship with the partner, and maternal self-efficacy explain children's membership in the classes of high and increasing behavioral problems. Conclusions: A combination of such factors as emergency caesarean section, child's gender, maternal age and level of education, maternal infant rearing attitudes, maternal self-efficacy, and inter-parental relationships predict developmental trajectories of emotional and behavioral problems in toddlers. [ABSTRACT FROM AUTHOR]