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Peled T, Saar N, Muraca GM, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Unintended Upper Uterine Wall Extensions at the Time of Cesarean Delivery: Risk Factors and Associated Adverse Maternal and Neonatal Outcomes. Am J Perinatol 2024. [PMID: 39227036 DOI: 10.1055/a-2408-7813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVE This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes. STUDY DESIGN A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used. RESULTS Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage. CONCLUSION Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. KEY POINTS · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..
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Affiliation(s)
- Tzuria Peled
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Noa Saar
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giulia M Muraca
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Gómez-Castellano M, Sabonet-Morente L, López-Zambrano MA, de Miguel-Luken V, Jiménez-López JS. Temporary clamping of the uterine arteries versus coventional technique for the prevention of postpartum hemorrage during cesarean section: a randomized controlled trial study. BMC Pregnancy Childbirth 2024; 24:608. [PMID: 39300367 DOI: 10.1186/s12884-024-06799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Cesarean sections are the most common abdominal surgical interventions worldwide, with increasing rates in both developed and developing countries. Postpartum (hemorrhage PPH) during cesarean sections can lead to maternal morbidity, prolonged hospital stays, and increased mortality rates. Although various non-surgical measures have been recommended for PPH prevention, surgical techniques such as uterine artery ligation and embolization have been used to manage PPH effectively. OBJECTIVE This study aimed to evaluate the effectiveness of a surgical technique based on the temporary bilateral clamping of uterine arteries to reduce blood loss during cesarean sections. METHODS A longitudinal prospective, randomized, controlled study was conducted with a preliminary population group of 180 patients at the University Hospital Regional de Málaga from November 2023 to January 2024. The study protocol was approved by the Ethics Committee of the Regional University Hospital of Malaga (protocol 1729-N-23 and registred with ISRCTN15307819|| http://www.isrctn.org/ , Date submitted 12 June 2023 ISRCTN 15307819). The patients were divided into two groups based on whether the clamping technique was applied during their cesarean sections. The study assessed hemoglobin levels before and after surgery, hospitalization durations, and the prevalence of anemia at discharge as the primary outcomes. RESULTS The patients who underwent the clamping technique demonstrated significant reductions in hemoglobin differences (0.80 g/dL) compared to the control group (1.42 g/dL). The technique also resulted in shorter hospital stays (3.02 days vs. 3.90 days) and a lower prevalence of anemia at discharge (76.2% vs. 60%). CONCLUSION Temporary clamping of uterine arteries during cesarean sections appears to be an effective measure for preventing postpartum hemorrhaging, reducing hospital stays, and decreasing the prevalence of anemia at discharge. Further research with larger sample sizes and standardized indications is warranted to confirm the benefits and potential broader applications of this technique. TRIAL REGISTRATION ISRCTN 15,307,819.
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Affiliation(s)
- Manuel Gómez-Castellano
- Medicine School, Malaga University, Málaga, 29071, Spain
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, Avd Arroyo de los Angeles S/N, Málaga, 29011, Spain
- Surgical Specialties, Biochemistry and Immunology Department, Málaga University, Málaga, 29071, Spain
- Biomedical Research Institute of Malaga (IBIMA) Research Group in Maternal-Fetal Medicine, Women's Diseases and Reproductive Health, Epigenetics, Málaga, 29071, Spain
| | - Lorena Sabonet-Morente
- Medicine School, Malaga University, Málaga, 29071, Spain.
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, Avd Arroyo de los Angeles S/N, Málaga, 29011, Spain.
- Surgical Specialties, Biochemistry and Immunology Department, Málaga University, Málaga, 29071, Spain.
- Biomedical Research Institute of Malaga (IBIMA) Research Group in Maternal-Fetal Medicine, Women's Diseases and Reproductive Health, Epigenetics, Málaga, 29071, Spain.
| | | | | | - Jesus Salvador Jiménez-López
- Medicine School, Malaga University, Málaga, 29071, Spain
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, Avd Arroyo de los Angeles S/N, Málaga, 29011, Spain
- Surgical Specialties, Biochemistry and Immunology Department, Málaga University, Málaga, 29071, Spain
- Biomedical Research Institute of Malaga (IBIMA) Research Group in Maternal-Fetal Medicine, Women's Diseases and Reproductive Health, Epigenetics, Málaga, 29071, Spain
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Huang Y, Jia J, Zhan J, Li B, Gu Q, Li Z. Porcine stomach surgical simulation model for cesarean section and cervical laceration suturing. BMC MEDICAL EDUCATION 2024; 24:1024. [PMID: 39294630 PMCID: PMC11411815 DOI: 10.1186/s12909-024-05936-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 08/20/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND Junior OB/GYN residents lack opportunities for fundamental surgical skills training of cesarean section, and most OB/GYN residents lack the experience of cervical laceration suturing due to its low incidence. METHODS A porcine stomach simulation model was designed for obstetrics surgical training. The surface of the stomach simulated the uterus, and the pylorus and cardia simulated the cervical canal. EXPERIENCE Materials are available from the nearby market. The total cost of the model is¥41. This model can be used in the training in uterus incision and repair of cesarean section and training in cervical laceration suturing. CONCLUSION The porcine stomach simulation model is pragmatic and realistic. They can be applied in the OB/GYN skill courses to introduce the fundamental obstetrics process to medical students and residents.
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Affiliation(s)
- Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China
| | - Jin Jia
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Jun Zhan
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China
| | - Bo Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiong Gu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China.
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Huang Y, Jia Z, Chen X, Wang Y, Zhou A, Zeng H, Xia W, Li Y, Xu S, Liu H. Association between mode of delivery and early neurodevelopment: A prospective birth cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05758-2. [PMID: 39245660 DOI: 10.1007/s00431-024-05758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
Previous research has assessed the effects of caesarean delivery (CD) on child neurodevelopment; however, whether the effects stem from the surgical procedure itself or its related medical conditions has not been conclusively determined. This study aimed to evaluate the associations among delivery mode, CD-related medical conditions and early childhood neurodevelopment. A total of 3829 maternal-infant pairs from a longitudinal birth cohort in Wuhan City, China, were included in the primary analysis. The neurodevelopment of the children was assessed by the Bayley Scales of Infant Development (BSID), the Conners Comprehensive Behaviour Rating Scale and the Chinese version of the Autism Behavior Checklist. Data on delivery mode and medical conditions were collected via medical records from the study hospital. Among the 3829 children for whom the BSID test was completed at two years of age, 50%, 27%, and 23% were delivered vaginally, by necessary CD, and by elective CD, respectively. Compared with vaginally delivered children, Necessary CD was associated with a 16.67% decrease in Mental Development Index (MDI) scores and a 13.37% decrease in Psychomotor Development Index (PDI) scores, while elective CD showed a 20.63% and 20.99% decrease after FDR correction, respectively. Similarly, among the 2448 children for whom the CBRS was completed, necessary CD was found to be associated with conduct disorders (adjusted β: 0.06; 95% CI: 0.02, 0.09), hyperactivity (adjusted β: 0.06; 95% CI: 0.02, 0.11), and hyperactivity index (adjusted β: 0.07; 95% CI: 0.03, 0.11), while elective CD was significantly associated with hyperactivity problem scores (adjusted β: 0.08, 95% CI: 0.03, 0.13). However, no significant association was found between CD and symptoms of autism in children, as assessed by the Autism Behavior Checklist (ABC). CONCLUSION This study suggested that the adverse impact of CD on child neurodevelopment stems from the procedure itself rather than CD-related medical conditions. It is important to minimize the use of CD when there is no medical necessity. WHAT IS KNOWN • Caesarean delivery (CD) may influence child neurodevelopment and other long-term outcomes. • In China, approximately one-quarter of CD are performed due to maternal request without medical indications. WHAT IS NEW • The negative impact of CD on the neurodevelopmental outcomes of children may be primarily attributed to the procedure itself, as opposed to related medical conditions. • In the absence of medical indications, unnecessary CD may have adverse impacts on children's neurodevelopment.
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Affiliation(s)
- Yun Huang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhenxian Jia
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xinmei Chen
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yin Wang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan, No. 100 Xianggang Road, Wuhan, 430016, Hubei, China
| | - Huaicai Zeng
- School of Public Health, Guilin Medical University, No. 20 Lequn Road, Guilin, 541199, China
| | - Wei Xia
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
- State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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Pilch A, Jekiełek M, Stach B, Zyznawska J, Klimek M. Impact of obstetric physiotherapy and transcutaneous electrical nerve stimulation (TENS) on pain management and gastrointestinal function following cesarean birth: A randomized controlled trial. Eur J Midwifery 2024; 8:EJM-8-50. [PMID: 39239326 PMCID: PMC11375754 DOI: 10.18332/ejm/191740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION The study aimed to compare the impact of the physiotherapeutic method combined with TENS and physiotherapy alone on post-cesarean pain levels and the time required for intestinal peristalsis recovery. The study was conducted at the Specialist Hospital in Kraków, from January to March 2020. METHODS The study was designed as a parallel randomized controlled trial (RCT). Participants were randomly assigned to one of three groups: TENS (n=52), nTENS (n=50) and control group (n=34), based on block randomization of 6. The allocation sequence was provided using a computer-generated random list. The participants were 136 postpartum primiparous women after cesarean birth, aged ≥18 years, having a healthy newborn, with no contradictions to TENS. The TENS group received a physiotherapeutic procedure involving a 20-minute exercise program plus a 40-minute session of TENS. The nTENS group received physiotherapeutic procedure alone, and the control group was under the routine care of midwives. The pain was assessed using the Numerical Rating Scale (NRS) at 6, 7, 12 and 24 hours after cesarean birth and twice during verticalization. RESULTS TENS and nTENS groups had decreased pain intensity immediately after the intervention compared to the control group (p=0.002, p=0.027, respectively). During the first stage of the verticalization, the smallest increase in pain was observed in the TENS (p=0.044 compared to nTENS, p=0.000 compared to the control group). Within the increase in the pain score, the intestinal peristalsis recovery time was longer. In both groups undergoing physical therapy, a shortened recovery time of intestinal peristalsis was demonstrated (p=0.000). CONCLUSIONS The proposed physiotherapy program, combined with TENS and instruction, proved effective in relieving post-cesarean pain and accelerating the time to first defecation and should be considered part of the standard patient management program in maternity units.
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Affiliation(s)
- Anna Pilch
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Jekiełek
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Stach
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Zyznawska
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Klimek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Kauffman E. Cesarean reduction efforts undercut by not attempting vaginal birth. Birth 2024; 51:471-474. [PMID: 38766955 DOI: 10.1111/birt.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
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Zalles LX, Le K, Jahandideh S, Wang J, Homer MV, Uhler ML, Hoyos LR, Devine K, Bruno-Gaston J. Impact of time interval from cesarean delivery to frozen embryo transfer on reproductive and neonatal outcomes. Fertil Steril 2024; 122:455-464. [PMID: 38663505 DOI: 10.1016/j.fertnstert.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To evaluate differences in reproductive and neonatal outcomes on the basis of the time interval from cesarean delivery to subsequent frozen embryo transfer (FET). DESIGN Retrospective cohort. SETTING Multicenter fertility practice. PATIENTS Women undergoing autologous elective single embryo transfer FET after prior cesarean delivery. INTERVENTION Time from prior cesarean delivery to subsequent FET. MAIN OUTCOME MEASURES live birth (LB). RESULTS A total of 6,556 autologous elective single embryo transfer FET cycles were included. Frozen embryo transfer cycles were divided into eight groups on the basis of the time interval from prior cesarean delivery to subsequent FET in months. A secondary analysis was then performed with time as a continuous variable. The proportion of LBs did not differ significantly across all time interval groups and over continuous time (range: 40.0%-45.6%). The mean gestational age at the time of delivery did not significantly differ as the time between prior cesarean delivery and subsequent FET increased (range: 37.3-38.4). When time was evaluated continuously, the proportion of preterm births was higher with a shorter time between cesarean delivery and subsequent FET. The mean birth weight ranged from 3,181-3,470g, with a statistically significant increase over time. However, the proportions of extremely low birth weight, very low birth weight, and low birth weight did not significantly differ. CONCLUSION There were no significant differences in reproductive outcomes on the basis of the time interval from cesarean delivery to FET, including LB. The proportion of preterm deliveries decreased with a longer time between cesarean delivery and FET. Differences in mean neonatal birth weight were not clinically significant because the proportion of low birth weight neonates was not significantly different over time. Although large, this sample cannot address all outcomes associated with short interpregnancy intervals, particularly rarer outcomes such as uterine rupture. When counseling patients, the timing of FET after cesarean delivery must be balanced against the risks of increasing maternal age on reproductive and neonatal outcomes.
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Affiliation(s)
- Laura X Zalles
- Shady Grove Fertility, Washington, D.C.; US Fertility, Rockville, Maryland.
| | - Kyle Le
- Cooper University Health Care, Camden, New Jersey
| | - Samad Jahandideh
- Shady Grove Fertility, Washington, D.C.; US Fertility, Rockville, Maryland
| | | | - Michael V Homer
- US Fertility, Rockville, Maryland; Reproductive Science Center, Los Gatos, California
| | - Meike L Uhler
- US Fertility, Rockville, Maryland; Fertility Centers of Illinois, Chicago, Illinois
| | - Luis R Hoyos
- US Fertility, Rockville, Maryland; IVF Florida Reproductive Associates, Margate, Florida
| | - Kate Devine
- Shady Grove Fertility, Washington, D.C.; US Fertility, Rockville, Maryland
| | - Janet Bruno-Gaston
- US Fertility, Rockville, Maryland; Shady Grove Fertility, Houston, Texas
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Verberkt C, Stegwee SI, Van der Voet LF, Van Baal WM, Kapiteijn K, Geomini PMAJ, Van Eekelen R, de Groot CJM, de Leeuw RA, Huirne JAF. Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study). Am J Obstet Gynecol 2024; 231:346.e1-346.e11. [PMID: 38154502 DOI: 10.1016/j.ajog.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The rising rate of cesarean deliveries has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecologic complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. OBJECTIVE We aimed to evaluate the effect of single-layer vs double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecologic, fertility, and obstetrical outcomes at the same follow-up. STUDY DESIGN A multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years old undergoing a first cesarean delivery were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate; with secondary outcomes, including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetrical and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). RESULTS Between 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830 of 1144 and 818 of 1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates; also there were no differences in pregnancy rate, need for fertility treatments, mode of delivery, or uterine ruptures in subsequent pregnancies. High rates of gynecologic symptoms, including spotting (30%-32%), dysmenorrhea (47%-49%), and sexual dysfunction (Female Sexual Function Index score, 23) are reported in both groups. CONCLUSION The study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecologic symptoms after a cesarean delivery should be discussed with patients.
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Affiliation(s)
- Carry Verberkt
- Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Sanne I Stegwee
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lucet F Van der Voet
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, The Netherlands
| | - W Marchien Van Baal
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | - Kitty Kapiteijn
- Department of Obstetrics and Gynecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Rik Van Eekelen
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert A de Leeuw
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
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Hendler I, Karram J, Litmanovich A, Navot S, Awad Khamaisa N, Jadaon J. The French Ambulatory Cesarean Section: Safety and Recovery Characteristics. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102606. [PMID: 38960281 DOI: 10.1016/j.jogc.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The French AmbUlatory Extraperitoneal Cesarean Section (FAUCS) is aimed at improving patients' birth experience and recovery. However, data are scarce regarding its maternal and neonatal safety. This study seeks to compare maternal and neonatal outcomes between FAUCS and conventional cesarean deliveries at term. METHODS This was a retrospective cohort study involving women who underwent scheduled cesarean deliveries at term. We compared a total of 810 cases using the FAUCS technique with 217 cases using conventional cesarean deliveries. Surgical complications, adverse neonatal events, and maternal recovery parameters were compared. RESULTS The incidence of overall surgical complications was comparable between the 2 groups, with rates of 1.97% for FAUCS and 1.85% for the conventional cesarean deliveries. The rates of specific complications such as bladder injury (0.1%), bowel injury (0.1%), blood transfusion (1.35%), and postpartum hemorrhage (1%) were consistent with existing literature. Neonatal outcomes, including neonatal acidemia and admission rates to the neonatal intensive care unit, were comparable between the groups and demonstrated favourable comparisons with previously reported data. Notably, women in the FAUCS group required less analgesia, with only 0.8% receiving morphine, as opposed to 38% in the control group. Furthermore, the FAUCS group demonstrated significantly quicker recovery, with 86% achieving autonomy and early discharge at their discretion within 48 hours after operation, in contrast to only 17% in the control group. CONCLUSIONS When performed by experienced practitioners, FAUCS proves to be a safe procedure, with no increased risk for maternal or neonatal complications. Its significant benefits in terms of enhancing maternal recovery are noteworthy.
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Affiliation(s)
- Israel Hendler
- Department of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Jawad Karram
- Department of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Adi Litmanovich
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sivan Navot
- Department of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nibal Awad Khamaisa
- Department of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jimmy Jadaon
- Department of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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10
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Muñoz-Saá LE, Sendra R, Carriles I, Sousa M, Turiel M, Ruiz-Zambrana Á, Chiva L. Maternal and Fetal Outcomes after Multiple Cesarean Deliveries. J Clin Med 2024; 13:4425. [PMID: 39124691 PMCID: PMC11313669 DOI: 10.3390/jcm13154425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Cesarean delivery (CD) is a common procedure, but it can be associated with some increasing risks as the number of previous CD increases. Although women undergoing multiple CDs is very unusual in Spain, our center serves pregnant women with a history of three or more previous CDs with some frequency. We aimed to assess whether women who undergo multiple CDs (≥4) have more risks than those who undergo a third CD. Material and Methods: A retrospective cohort study was conducted with 161 pregnant women who had undergone ≥ 2 previous CDs and were monitored during their next pregnancy. The primary endpoint was to evaluate the obstetric hemorrhage rate in the multiple CD group and compare it with that in the third CD group. Secondary outcomes regarding maternal and neonatal complications were also analyzed. Results: Hemorrhage (7% and 10%; p = 0.522) and transfusion (3% and 8%; p = 0.141) rates were similar in both groups. The risk of dehiscence of the uterine segment (6% and 24%; p < 0.006), as well as hysterectomy (0 and 6.6%, p = 0.019), difficult abdominal opening (49% and 82%; p = 0.001), peritoneal adhesions (3% and 22%; p < 0.001), and difficult bladder separation (36% and 73%; p < 0.001), was higher in the multiple CD group. No uterine rupture or maternal-neonatal mortality was observed in either of the groups. Conclusions: Since undergoing multiple CD is uncommon, our study may be the largest sample in our environment. Our findings suggest that despite the potential risks of undergoing multiple CDs, maternal and neonatal outcomes are overall favorable.
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Affiliation(s)
- Laura E. Muñoz-Saá
- Department of Obstetrics and Gynaecology, Clínica Universidad de Navarra, Marquesado de Sta. Marta St, 1, 28027 Madrid, Spain
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11
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Cobec IM, Rempen A, Anastasiu-Popov DM, Eftenoiu AE, Moatar AE, Vlad T, Sas I, Varzaru VB. How the Mode of Delivery Is Influenced by Patient's Opinions and Risk-Informed Consent in Women with a History of Caesarean Section? Is Vaginal Delivery a Real Option after Caesarean Section? J Clin Med 2024; 13:4393. [PMID: 39124660 PMCID: PMC11313181 DOI: 10.3390/jcm13154393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/09/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: In recent years, there has been a noticeable increase in the rates of caesarean section (CS), being one of the most commonly performed surgical procedures. For the following pregnancy, the previous CS represents the backbone of the risks and complications, such as uterine scar formation, uterine rupture, massive bleeding, and serious negative outcomes for both the mother and child. Our study followed patients with a history of CS from the birth planning prenatal check-up to delivery. Methods: We reviewed the records of 125 pregnant women with previous CS who presented in the third trimester for a prenatal check-up and completed our questionnaire from March 2021 to April 2022 in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. Results: Before the prenatal check-up, 74 patients (59.2%) preferred vaginal delivery (VD), while 51 (40.8%) preferred CS. After discussing birth planning with the obstetrician, 72 women (57.6%) decided upon VD, while 53 (42.4%) preferred CS. Ultimately, 78 (62.4%) of women gave birth through CS (either planned or by medical necessity) and 47 (37.6%) gave birth vaginally (either natural or per vacuum extraction). Conclusions: VD for patients with CS in their medical history is a real option. The patient must be well informed about the risks and benefits of the medical situation and should be empowered and supported on their chosen mode of delivery, which should be respected.
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Affiliation(s)
- Ionut Marcel Cobec
- ANAPATMOL Research Center, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, Klinikum Freudenstadt, 72250 Freudenstadt, Germany
| | - Andreas Rempen
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, 74523 Schwäbisch Hall, Germany
| | | | - Anca-Elena Eftenoiu
- Department of Medical Genetics, “Carol Davila” University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Aurica Elisabeta Moatar
- ANAPATMOL Research Center, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Clinic of Internal Medicine-Cardiology, Klinikum Freudenstadt, 72250 Freudenstadt, Germany
| | - Tania Vlad
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ioan Sas
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vlad Bogdan Varzaru
- ANAPATMOL Research Center, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, 74523 Schwäbisch Hall, Germany
- Doctoral School, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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12
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Bačić B, Hrgović Z, Cerovac A, Barčot O, Sabljić J, Markoski B, Leskur M. Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study. Z Geburtshilfe Neonatol 2024. [PMID: 39013437 DOI: 10.1055/a-2338-5802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
INTRODUCTION The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions. METHODS In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm. RESULTS No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04). CONCLUSION The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.
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Affiliation(s)
- Boris Bačić
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center, Split, Croatia
- University of Split, Medical School, Split, Croatia
| | - Zlatko Hrgović
- Gynecology, J.W.Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Ognjen Barčot
- Department of Surgery, Clinical Hospital Center Split, Split, Croatia
| | - Jelena Sabljić
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center, Split, Croatia
- University of Split, Medical School, Split, Croatia
| | - Blagoja Markoski
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center, Split, Croatia
- University of Split, Medical School, Split, Croatia
| | - Mateo Leskur
- University of Split, Medical School, Split, Croatia
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13
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Sun Q, Zhang D, Ai Q, Yue Y, Wang H, Tang L, Yi X, Wang S, Zheng Y. Human umbilical cord mesenchymal stem cells improve uterine incision healing after cesarean delivery in rats by modulating the TGF-β/Smad signaling pathway. Arch Gynecol Obstet 2024; 310:103-111. [PMID: 38342828 PMCID: PMC11169019 DOI: 10.1007/s00404-024-07381-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/07/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Although human umbilical cord-derived mesenchymal stem cells (HU-MSCs) have attracted increasing attention because of their pivotal functions in the process of wound healing, the underlying molecular mechanisms have been poorly understood. It has been shown that the TGF-β/Smad signaling pathway plays an important role in the process of scar formation. The present study focused on exploring whether HU-MSCs improve uterine incision healing after cesarean delivery in rats via the TGF-β/Smad signaling pathway. STUDY DESIGN Pregnant rats were randomly assigned to three groups, including the NP group, incision-injected group (HU-MSCs1 group), and tail vein-injected group (HU-MSCs2 group), and 30 days after cesarean section, sampling was carried out to further explore the specific mechanisms from tissue and protein levels. RESULTS HU-MSCs secretion could inhibit the fibrosis of scar tissue. We observed that the TGF-β induced expression of TGF-β1, Smad2, and Smad3 was attenuated upon HU-MSCs treatment in scar tissue, while the decrease in TGF-β3 expression was enhanced by HU-MSCs. Furthermore, HU-MSCs treatment accelerated wound healing and attenuated collagen deposition in a damaged uterine rat model, leading to the promoting of uterine incision scarring. In addition, the expression of alpha-smooth muscle actin (a-SMA) was enhanced by HU-MSCs treatment. CONCLUSION HU-MSCs transplantation promotes rat cesarean section uterine incision scar healing by modulating the TGF-β/Smad signaling pathway.
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Affiliation(s)
- Qing Sun
- Postgraduate Training Base of Shenyang Women's and Children's Hospital of Jinzhou Medical University, Shenyang, Liaoning, China
| | - Dan Zhang
- Shenyang Women's and Children's Hospital, No.87, Danan Street, Shenhe District, Shenyang, Liaoning, China.
| | - Qiuying Ai
- Liaoning Zhongtian Stem Cell and Regenerative Medicine Innovation Research Institute, Liaoning, China
| | - Yang Yue
- Shenyang Women's and Children's Hospital, No.87, Danan Street, Shenhe District, Shenyang, Liaoning, China
| | - Haijiao Wang
- Shenyang Women's and Children's Hospital, No.87, Danan Street, Shenhe District, Shenyang, Liaoning, China
| | - Le Tang
- Postgraduate Training Base of Shenyang Women's and Children's Hospital of Jinzhou Medical University, Shenyang, Liaoning, China
| | - Xiling Yi
- Shenyang Women's and Children's Hospital, No.87, Danan Street, Shenhe District, Shenyang, Liaoning, China
| | - Siyuan Wang
- Postgraduate Training Base of Shenyang Women's and Children's Hospital of Jinzhou Medical University, Shenyang, Liaoning, China
| | - Yang Zheng
- Shenyang Women's and Children's Hospital, No.87, Danan Street, Shenhe District, Shenyang, Liaoning, China
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14
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Tamir Yaniv R, Farladansky-Gershnabel S, Gluska H, Daykan Y, Shechter Maor G, Schonman R, Biron-Shental T. Cesarean Delivery Complicated by Peripartum Infection and Risk of Uterine Rupture During Subsequent Trial of Labor. J Womens Health (Larchmt) 2024; 33:986-990. [PMID: 38502835 DOI: 10.1089/jwh.2023.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Uterine rupture is a rare, but dangerous obstetric complication that can occur during trial of vaginal birth. Methods: The aim of this study was to evaluate the relationship between peripartum infection at the first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. We conducted a retrospective case-control study from March 2014 to October 2020 at a single academic medical center. The study group included women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who went through a successful vaginal birth after cesarean section (VBAC) without evidence of dehiscence or uterine rupture. We compared the rate of peripartum infection during the first cesarean delivery (CD) and other relevant variables, between the two groups. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful VBAC as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p = 0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk factor for uterine rupture at the subsequent trial of labor after CD (95% confidence interval, p = 0.034). Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery.
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Affiliation(s)
- Rina Tamir Yaniv
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | | | - Hadar Gluska
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Gil Shechter Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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15
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Smith GK, Ulin MA, Ganjineh BM, Urban AR, Fuller RR, Whitham MD. The Effect of Shift Timing on Cesarean Delivery Outcomes and Operative Noise Levels. Am J Perinatol 2024. [PMID: 38889763 DOI: 10.1055/s-0044-1787738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Intraoperative noise exposure has been associated with an increased risk of complications, communication errors, and stress among surgical team members. This study evaluates intraoperative noise levels in cesarean deliveries during different shift times, for example, night shifts, day shifts, and hand-off times between shifts. STUDY DESIGN This is a secondary analysis of a prospective observational study which measured volume in decibels, percentage of time above safe levels (>60 dB), startle noise events (events with rapid increase of decibel level above baseline noise), and peak levels (>75 dB) for cesarean deliveries during a 3-month preintervention and postintervention study. This secondary analysis of noise data evaluated whether there were differences in noise for cases occurring during day shifts (6:31 a.m.-4:59 p.m.), night shifts (6:01 p.m.-5:29 a.m.), and hand-off times (5:30 a.m.-6:30 a.m. and 5:00 p.m.-6:00 p.m.). Correlates and postoperative complications during the respective shifts were additionally analyzed. RESULTS Noise data were collected for a total of 312 cesarean deliveries; 203 occurred during the day shift, 94 during the night shift, and 15 during hand-off times. Median noise in decibels, median noise at various key intraoperative points, number of startle events, percentage of time above 60 dB, and above 75 dB had no significant differences throughout the various shift times. Significantly larger numbers of postpartum hemorrhages, unscheduled, urgent, and STAT cesarean deliveries occurred at hand-off times and on night shifts. CONCLUSION Noise levels during cesarean deliveries did not significantly vary when comparing night shifts, day shifts, and hand-off times, despite significantly higher numbers of urgent and STAT cases occurring overnight and during hand-off times. However, more than 60% of case time had noise levels exceeding those considered safe. This suggests that ambient background noise may be contributing more to overall noise levels rather than the specific clinical scenario at hand. KEY POINTS · Noise in cesarean delivery operating rooms frequently exceeded recommended levels.. · Noise in cesarean delivery operating rooms did not vary with shift type.. · Hand-off times had higher rates of urgent and STAT cesareans.. · Night shifts had higher rates of urgent and STAT cesareans..
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Affiliation(s)
- Gabrielle K Smith
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mara A Ulin
- Department of Obstetrics and Gynecology, Mount Sinai Hospital School of Medicine, Chicago, Illinois
| | - Brandon M Ganjineh
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Amanda R Urban
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert R Fuller
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Megan D Whitham
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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16
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Liu X, Chen HX, Chen B. Impact of combined propranolol and oxytocin on the process and outcomes of labor: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2024; 80:901-910. [PMID: 38436704 DOI: 10.1007/s00228-024-03659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To systematically review the impact of propranolol combined with oxytocin on the process and outcomes of labor. METHODS A comprehensive literature search was performed across multiple databases, including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database, PubMed, Embase, and the Cochrane Library. All publicly published randomized controlled trials (RCTs) of propranolol combined with oxytocin compared to the use of oxytocin alone in labor were collected. After screening the literature and extracting data, the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 recommended bias risk assessment tool was used to assess the quality of the included studies. A meta-analysis was conducted using RevMan 5.3 software, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to rate the quality of evidence for outcome measures. RESULTS Meta-analysis results showed that the group receiving propranolol combined with oxytocin was more capable of reducing the cesarean section rate (eight studies, 815 women, RR = 0.67, 95% CI (0.53, 0.86), P = 0.001) and shortening the duration of the latent phase (two studies, 206 women, MD = - 1.20, 95% CI (- 1.97, - 0.43), P = 0.002) and the duration of the active phase on day 1 (two studies, 296 women, MD = - 0.69, 95% CI (- 0.83, - 0.54), P < 0.00001), compared to the oxytocin monotherapy group. No significant difference was found between the two groups in terms of the 5-min Apgar score (five studies, 609 women, MD = - 0.05, 95% CI (- 0.14, 0.04), P = 0.32) and the rate of admissions to the Neonatal Intensive Care Unit (NICU) (three studies, 359 women, RR = 0.82, 95% CI (0.38, 1.79), P = 0.62). CONCLUSION The combined use of propranolol and oxytocin can significantly reduce the cesarean section rate, shorten the duration of the latent phase and the duration of the active phase on day 1, and is safe. However, due to the limitations, the conclusions of this article still need to be verified by large-sample, multicenter, rigorously designed high-quality clinical RCTs. TRIAL REGISTRATION Registration number is INPLASY202390107.
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Affiliation(s)
- Xia Liu
- Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, 646000, Sichuan, China
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, Sichuan, China
| | - Hai-Xu Chen
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, Sichuan, China
| | - Bo Chen
- Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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17
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Brinson AK, Jahnke HR, Rubin-Miller L, Henrich N, Peahl A, Shah N, Moss C. Digital health's influence on the association between birth preference and vaginal birth. Birth 2024. [PMID: 38804000 DOI: 10.1111/birt.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/27/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Women's preferred mode of birth during pregnancy is predictive of their actual mode of birth. Digital prenatal care services are a promising method for educating women on mode of birth to reduce elective cesareans. This study aimed to evaluate the influence of digital health on the association between birth preference and mode of birth. METHODS Data come from 5409 pregnant women enrolled in a digital platform for women's and family health. Multi-trajectory modeling identified trajectories of digital health usage throughout pregnancy. Adjusted logistic regression models tested associations between birth preferences and mode of birth. The modifying effect of digital health usage on the association between birth preference and mode of birth was assessed on the multiplicative scale. RESULTS Four distinct trajectories of digital service usage were identified and labeled as: (1) baseline users (52%): the reference group; (2) just-in timers (16%): high usage during the third trimester; (3) learners (26%): high educational resource usage (e.g., articles and classes) throughout pregnancy; and (4) super users (6%): high usage of both education and care resources throughout pregnancy. Overall, preferred mode of birth at enrollment was predictive of actual mode of birth; however, digital health usage moderated this association, whereby super users and learners who preferred a cesarean at enrollment were more likely to deliver vaginally, compared to baseline users who preferred a cesarean. CONCLUSION For the increasing proportion of women considering an elective cesarean, education through a prenatal digital health platform may help to encourage vaginal birth and reduce cesarean births.
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Affiliation(s)
- Alison K Brinson
- Department of Anthropology, UNC Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
- Maven Clinic, New York, New York, USA
| | | | | | | | - Alex Peahl
- Maven Clinic, New York, New York, USA
- University of Michigan-Obstetrics and Gynecology, Ann Arbor, Michigan, USA
| | - Neel Shah
- Maven Clinic, New York, New York, USA
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18
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Bačić B, Hrgović Z, Cerovac A, Barčot O, Sabljić J, Dumančić S, Markoski B, Leskur M. Extraperitoneal Cesarean Section after two Medial Laparotomies, Anus Prater, and Surgical Treatment of the Rectovaginal Fistula in a Patient with Crohn's Disease: A Case Report. Z Geburtshilfe Neonatol 2024; 228:192-195. [PMID: 38056597 DOI: 10.1055/a-2200-9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The aim of this case report is to show the advantages of the extraperitoneal cesarean section (ECS) approach in a pregnant patient with multiple previous abdominal transperitoneal colon surgeries and Crohn's disease. A pregnant nulliparous woman with Crohn's disease was admitted for delivery. After delivery, a large rupture and lesion of the rectum was observed. Suturing of the vagina, rectum and sphincter was performed by an abdominal surgeon. Because of a very large and irregularly shaped rectum rupture, the patient underwent infraumbilical medial laparotomy and sigmoidostomy. After 18 months, the patient started to experience vaginal discharge and Y-shaped rectovaginal fistula was confirmed. Surgical reconstruction was performed. The patient's second pregnancy began one year later. At 38 weeks of pregnancy, elective extraperitoneal cesarean section was performed. A healthy newborn was delivered. Follow-up showed full and fast recovery after the ECS. In cases of pregnant women who have had multiple colon surgeries, gynecology surgeons can choose to perform an ECS to avoid transperitoneal entrance into the abdomen. ECS avoids lysis of postoperative adhesions after repetitive gastrointestinal surgeries, the formation of new adhesions by lysis of the old adhesions, and most importantly, the possibility of colon or small intestine lesions during lysis of dense or firm adhesions.
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Affiliation(s)
- Boris Bačić
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center Split, Croatia
- University of Split, Medical School, Croatia
| | - Zlatko Hrgović
- Frauenklinik, J.W. Goethe Universität Frankfurt, Frankfurt am Main, Germany
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Ognjen Barčot
- Department of Surgery, Clinical Hospital Center Split, Split, Croatia
| | - Jelena Sabljić
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center Split, Croatia
- University of Split, Medical School, Croatia
| | - Stipe Dumančić
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center Split, Croatia
- University of Split, Medical School, Croatia
| | - Blagoja Markoski
- Clinic of Obstetrics and Gynecology, Clinical Hospital Center Split, Croatia
- University of Split, Medical School, Croatia
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Tremmel E, Starrach T, Buschmann C, Trillsch F, Kolben T, Mahner S, Burges A, Kost B, Ehmann L, Burgmann DM. Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series. Arch Gynecol Obstet 2024; 309:1227-1236. [PMID: 38078931 PMCID: PMC10894165 DOI: 10.1007/s00404-023-07290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/06/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. METHODS In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG-analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. RESULTS Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. CONCLUSION Treatment strategies were based on the patient's individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.
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Affiliation(s)
- E Tremmel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - C Buschmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - F Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - B Kost
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - L Ehmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - D M Burgmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Wang L, Zhao C, Zhang Q. Impact of cesarean scar defect on reproductive outcomes after assisted reproductive technology. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:313-320. [PMID: 38562032 PMCID: PMC11348694 DOI: 10.3724/zdxbyxb-2023-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/26/2023] [Indexed: 04/04/2024]
Abstract
In the last twenty years, the cesarean section rate has been rising in China, leading to an increased prevalence of cesarean scar defect (CSD) and secondary infertility. CSD decreases receptivity of endometrium, induces adenomyosis and endometriosis, disrupts uterine micro-environment and causes difficulties in embryo transplant operation as well as has further pregnancy complications. For women undergoing assisted reproductive technology (ART), CSD significantly reduces live birth rate, clinical pregnancy rate and embryo implantation rate. CSD can be effectively treated by hysteroscopic surgery, laparoscopic surgery and transvaginal surgery to increase the pregnancy rate. This article reviews the research progress on the impact of CSD on the reproductive outcomes of ART, the potential factors and related treatments, and provides a reference for the management of CSD patients undergoing ART.
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Affiliation(s)
- Ling Wang
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, China.
| | - Chenhan Zhao
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, China.
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou 310016, China.
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Rothman A, Ngene NC. Necrotising fasciitis presenting as a blister: A case report on improving early recognition of surgical site infection following caesarean delivery. Case Rep Womens Health 2024; 41:e00574. [PMID: 38178842 PMCID: PMC10764248 DOI: 10.1016/j.crwh.2023.e00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.
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Affiliation(s)
- Alison Rothman
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa
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Orovou E, Antoniou E. Voices of Women With Emergency Cesarean Section Experience: A Qualitative Approach. Cureus 2024; 16:e53429. [PMID: 38435160 PMCID: PMC10909072 DOI: 10.7759/cureus.53429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
The midwifery psychoeducation, relationship with the midwives, feelings from the surgery, and delivery expectations are major factors that affect the birth experiences of mothers following an emergency cesarean section. This study aimed to give voice to mothers to express the feelings they had before, during, and after an emergency cesarean section and primarily to express whether their expectations were met after the surgery. The research was conducted on mothers who gave birth through an emergency cesarean section in a public hospital by completing specific questionnaires. This study was carried out with 15 mothers. The data was collected through a semi-structured questionnaire form, including socio-demographic characteristics. From the research, four main themes and 11 sub-themes emerged. The main themes described are "midwifery psychoeducation," "relationship with the midwives," "feelings from the C-section," and "delivery expectations." The majority of women did not attend parenting preparation classes either because they did not consider it necessary or because they were unaware of their existence. The presence of a midwife remains valuable during the perinatal period for most mothers. However, feelings vary between fear, shock, terror, disappointment, pain, and in some cases happiness. In the majority of cases, emergency cesarean section did not meet the expectations of mothers, who described it as a violent and sudden experience. The results highlight the need to strengthen midwives in order to promote psychosocial education, support during childbirth, and counseling for traumatic experiences.
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Affiliation(s)
- Eirini Orovou
- Midwifery, University of Western Macedonia, Ptolemaida, GRC
- Midwifery, University of West Attica, Athens, GRC
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Ajmal S, Farrell T, Minisha F, Al Obaidly S, AlQubaisi M, Khenyab N, Ali N, Salama H, Pallivalappil AR, Al Dewik N, Al Rifai H. Maternal and neonatal outcomes associated with multiple repeat cesarean deliveries: A registry-based study from Qatar. Qatar Med J 2024; 2024:3. [PMID: 38264266 PMCID: PMC10801331 DOI: 10.5339/qmj.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs. METHODS This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death. RESULTS Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5th CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p = 0.015) and postpartum hemorrhage (7.5%, p = 0.010). 24% of babies in Group 5 were born preterm (p < 0.001). They also had a 3.5 times higher risk of having a surgical complication (RR = 3.5, 95% CI 1.6-7.6, p = 0.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR = 1.8, 95% CI 1.1-2.9, p = 0.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR = 1.7, 95% CI 1.3-2.2, p < 0.001), a higher risk of the baby getting admitted to NICU (RR = 1.3, 95% CI 1.0-1.6, p = 0.038), and developing RDS (RR = 1.5, 95% CI 1.2-2.0, p = 0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p < 0.001 for both). CONCLUSION Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups-consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.
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Affiliation(s)
- Shameena Ajmal
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar.
| | | | - Fathima Minisha
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar.
| | - Sawsan Al Obaidly
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar.
| | - Mai AlQubaisi
- Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Najat Khenyab
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar.
| | - Najah Ali
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar.
| | - Husam Salama
- Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Rouf Pallivalappil
- Department of Research, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar
| | - Nader Al Dewik
- Department of Research, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar
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Kim HJ, Lee HK, Jang JY, Lee KN, Suh DH, Kong HJ, Lee SH, Park JY. Immersive virtual reality simulation training for cesarean section: a randomized controlled trial. Int J Surg 2024; 110:194-201. [PMID: 37939117 PMCID: PMC10793750 DOI: 10.1097/js9.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Caesarean section (CS) is a complex surgical procedure that involves many steps and requires careful precision. Virtual reality (VR) simulation has emerged as a promising tool for medical education and training, providing a realistic and immersive environment for learners to practice clinical skills and decision-making. This study aimed to evaluate the educational effectiveness of a VR simulation program in training the management of patients with premature rupture of membranes (PROM) and CS. MATERIALS AND METHODS A two-arm parallel randomized controlled trial was conducted with 105 eligible participants randomly assigned to the VR group ( n =53) or the control group ( n =52) in a 1:1 ratio. The VR group received VR simulation training focused on PROM management and CS practice, while the control group watched a video presentation with narrative of clinical scenario and recording of CS. Both groups completed questionnaires assessing their prior experiences with VR, experience in managing patients with PROM and performing CS, as well as their confidence levels. These questionnaires were administered before and after the intervention, along with a mini-test quiz. RESULTS Baseline characteristics and previous experiences were comparable between the two groups. After the intervention, the VR group had higher confidence scores in all four aspects, including managing patients with PROM, performing CS as an operator, and understanding the indications and complications of CS, compared to the control group. The VR group also achieved significantly higher scores on the mini-test quiz [median (interquartile range), 42 (37-48) in the VR group; 36 (32-40) in the control group, P <0.001]. CONCLUSION VR simulation program can be an effective educational tool for improving participants' knowledge and confidence in managing patients with PROM and performing CS.
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Affiliation(s)
- Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Kyeong Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Yeon Jang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyoun-Joong Kong
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Yang J, Li X. A Qualitative Study on Postpartum Women Experienced Various Pain Throughout the Perinatal Period Based on the Thrive Model. Patient Prefer Adherence 2023; 17:3577-3587. [PMID: 38164225 PMCID: PMC10758158 DOI: 10.2147/ppa.s437901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Aim This study aims to thoroughly explore to comprehensively examine the diverse types and subjective experiences of pain in postpartum women throughout perinatal period, aiming to deepen understanding and support the development of precise pain management strategies in nursing care. Design A descriptive qualitative study. Methods Between August and November 2022, postpartum women attending outpatient clinics at a tertiary level A hospital were selected as participants. The study followed the framework of the THRIVE model and utilized a phenomenological method for qualitative research. In-depth semi-structured interviews were conducted with 21 postpartum women, and the data were analyzed using the Colaizzi 7-step analysis method. Results Thematic analysis revealed that different postpartum women exhibited diverse perceptions of their own pain experiences. Three themes were identified to describe the pain encountered by postpartum women: (1) Experiencing pain is complex (including experiencing multiple kinds of pain, individual differences in pain, and pain is variable), (2) Double perceptions of pain (negative effects of pain and positive energy for perceiving pain), and (3) Fighting pain requires active support (active outside support and construct a positive self-coping style). Conclusion This study provides a comprehensive overview of perinatal pain management in postpartum women, offering recommendations for accurate pain understanding and management. Healthcare professionals should be vigilant about maternal pain changes and individual experiences, implement targeted measures and support, aid in alleviating psychological burdens, boost maternal confidence in childbirth, and enhance postpartum quality of life. Patient or Public Contribution In this study, interviews were conducted in the hospital outpatient department, and the participants included in this study participated in the interviews to provide support for the implementation of this subject.
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Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Nursing, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xue Li
- Department of Nursing, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Song J, Cai R. Interaction between smoking during pregnancy and gestational diabetes mellitus and the risk of cesarean delivery: evidence from the National Vital Statistics System 2019. J Matern Fetal Neonatal Med 2023; 36:2259048. [PMID: 37766417 DOI: 10.1080/14767058.2023.2259048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To explore the interaction between smoking during pregnancy (SDP) and gestational diabetes mellitus (GDM) on the risk of cesarean delivery. METHODS This retrospective cohort study utilized data from the National Vital Statistics System (NVSS) 2019. The NVSS database provides data on births and deaths as well as maternal characteristics in the United States. The duration of follow-up was 38.74 ± 2.12 weeks. The outcome was the method of delivery, including vaginal and cesarean delivery. The multivariate logistic regression model was adopted to assess the associations of SDP and GDM with the method of delivery. The interaction between SDP and GDM was examined via calculating the relative excess risk of interaction (RERI), the attributable proportion of interaction (API) and the synergy index (S). Subgroup analyses were conducted based on age, race, prepregnancy body mass index (BMI), and primiparity. RESULTS The study included 3352615 puerperae. Compared with women who did not smoke during pregnancy, those who smoked during pregnancy had a significantly higher risk of cesarean delivery [odds ratio (OR)=1.07, 95% confidence intervals (CI): 1.05-1.10, p < 0.001]; women with GDM had a significantly greater risk of cesarean delivery than those without (OR = 1.31, 95%CI: 1.30-1.33, p < 0.001). In contrast to women who did not smoke during pregnancy and did not have GDM, those who smoked during pregnancy and had GDM exhibited an increased risk of a cesarean section (OR = 1.47, 95%CI: 1.40-1.54, p < 0.001). RERI was 0.08 (95%CI: 0.01-0.15), API was 0.06 (95%CI: 0.01-0.10), and S was 1.21 (95%CI: 1.04-1.40) suggested that there was an interaction between SDP and GDM, and it was a synergistic effect. There was a synergism between SDP and GDM in women of non-advanced age (RERI = 0.07, 95%CI: 0.001-0.15; API = 0.05, 95%CI: 0.003-0.10; S = 1.17, 95%CI: 1.001-1.36), in white women (RERI = 0.08, 95%CI: 0.004-0.16; API = 0.05, 95%CI: 0.01-0.10; S = 1.19, 95%CI: 1.02-1.39), in women who were overweight before pregnancy (RERI = 0.13, 95%CI: 0.05-0.21; API = 0.08, 95%CI: 0.04-0.13; S = 1.33, 95%CI: 1.14-1.55), and in primiparae (RERI = 0.20, 95%CI: 0.08-0.31; API = 0.12, 95%CI: 0.06-0.19; S = 1.50, 95%CI: 1.23-1.84). CONCLUSION SDP and GDM were associated with an increased risk of cesarean delivery, and a synergistic effect existed between SDP and GDM on the risk of cesarean delivery, especially in women of non-advanced age, white women, women who were overweight before pregnancy, and primiparae.
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Affiliation(s)
- Jie Song
- Department of Obstetrics and Gynecology, Ningxia People's Hospital, Yinchuan, Ningxia, P. R. China
| | - Ruiyu Cai
- Department of endocrinology, The Second Hospital of Jingzhou, Jingzhou, Hubei, P. R. China
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Yang X, Liu P, Yu W, Zhang Z. The mediating role of pregnancy-induced hypertension on pre-pregnancy body mass index and adverse neonatal outcomes in women with assisted reproductive technology. J Matern Fetal Neonatal Med 2023; 36:2289348. [PMID: 38057122 DOI: 10.1080/14767058.2023.2289348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To explore whether pregnancy-induced hypertension (PIH) mediates the association between pre-pregnancy body mass index (BMI) and adverse neonatal outcomes in women undergoing assisted reproductive technology (ART) for singleton pregnancies. METHODS This cohort study collected 79437 maternal data from the National Vital Statistics System (NVSS) between 2020 and 2021. Univariable and multivariable logistic regression models were applied to estimate the association between pre-pregnancy BMI and PIH in women receiving ART as well as the associations between pre-pregnancy BMI and PIH and adverse neonatal outcomes. The mediation effect of PIH on the association between pre-pregnancy BMI and adverse neonatal outcomes was estimated according to the total effect, natural direct effect, natural indirect effect, and percentage of mediation. RESULTS There were 25769 participants had adverse neonatal outcomes at the end of the follow-up. After adjusting for confounding factors, an increased risk of PIH in women receiving ART was identified in those with pre-pregnancy BMI ≥25 kg/m2 [odds ratio (OR)=1.92, 95% confidence interval (CI):1.84-2.01]. Pre-pregnancy BMI ≥25 kg/m2 was associated with an increased risk of adverse neonatal outcomes (OR = 1.26, 95%CI:1.22-1.30). Women with PIH had an increased risk of adverse neonatal outcomes (OR = 1.79, 95%CI:1.71-1.87). The percentage mediated by PIH in the association between pre-pregnancy BMI and adverse neonatal outcomes was 21.30%. CONCLUSION PIH partially mediated the association between pre-pregnancy BMI and adverse neonatal outcomes in women receiving ART, which recommends that women control weight before receiving ART.
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Affiliation(s)
- Xue Yang
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Pengyu Liu
- Medical unit, Troops 65739 PLA, Dandong, China
| | - Wenqian Yu
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhitao Zhang
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
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Kristbergsdottir H, Valdimarsdottir HB, Steingrimsdottir T, Sigurvinsdottir R, Skulason S, Lydsdottir LB, Jonsdottir SS, Olafsdottir H, Sigurdsson JF. The role of childhood adversity and prenatal mental health as psychosocial risk factors for adverse delivery and neonatal outcomes. Gen Hosp Psychiatry 2023; 85:229-235. [PMID: 37995481 DOI: 10.1016/j.genhosppsych.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/13/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Exposure to adverse childhood experiences (ACEs) is a significant predictor for physical and mental health problems later in life, especially during the perinatal period. Prenatal common mental disorders (PCMDs) are well-established as a risk for obstetric interventions but knowledge on combined effects of multiple psychosocial risk factors is sparse. We aim to examine a comprehensive model of ACEs and PCMDs as risk factors for poor delivery and neonatal outcomes. METHOD With structural equation modeling, we examined direct and indirect pathways between psychosocial risk and delivery and neonatal outcomes in a prospective cohort from pregnancy to birth in Iceland. RESULTS Exposure to ACEs increased risk of PCMDs [β = 0.538, p < .001, CI: 0.195-1.154] and preterm delivery [β = 0.768, p < .05, CI: 0.279-1.007)]. An indirect association was found between ACEs and increased risk of non-spontaneous delivery [β = 0.054, p < .05, CI: 0.004-0.152], mediated by PCMDs. Identical findings were observed for ACEs subcategories. CONCLUSION ACEs are strong predictors for mental health problems during pregnancy. Both ACEs and PCMDs diagnosis are associated with operative delivery interventions and neonatal outcomes. Findings underscore the importance of identifying high-risk women and interventions aimed at decreasing psychosocial risk during the prenatal period.
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Affiliation(s)
| | - Heiddis Bjork Valdimarsdottir
- Department of Psychology Reykjavik University, Iceland; Department of Population Health Science and Policy, Mount Sinai, School of Medicine, New York, USA.
| | - Thora Steingrimsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Obstetrics and Gynecology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | | | - Sigurgrimur Skulason
- Directorate of Education, Kopavogur, Iceland; Faculty of Psychology, University of Iceland, Reykjavik, Iceland.
| | | | | | - Halldora Olafsdottir
- Mental Health Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Jon Fridrik Sigurdsson
- Department of Psychology Reykjavik University, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Stanhope KK, Kapila P, Umerani A, Hossain A, Abu-Salah M, Singisetti V, Carter S, Boulet SL. Political representation and perinatal outcomes to Black, White, and Hispanic people in Georgia: a cross-sectional study. Ann Epidemiol 2023; 87:S1047-2797(23)00167-9. [PMID: 37689094 PMCID: PMC10842944 DOI: 10.1016/j.annepidem.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Our goal was to estimate differences in perinatal outcomes by racial differences in political representation, a measure of structural racism. METHODS We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n = 159) in 2022. We subtracted the percent of non-White elected officials from the percent of non-White residents to calculate the "representation difference," with greater positive values indicating a larger disparity. We linked this to data from 2020-2021 birth certificates (n = 238,795) on outcomes (preterm birth, <37 weeks, low birthweight birth <2500 g, birthweight, hypertensive disorders of pregnancy, cesarean delivery). We fit log binomial and linear models with generalized estimating equations, stratified by individual race/ethnicity and including individual and county covariates. RESULTS Median representation difference was 17.5% points (interquartile range: 17.2). A 25-percentile point increase in representation difference was associated with a greater risk of hypertensive disorders of pregnancy [White: adjusted risk ratio (RR): 1.12, 95% confidence interval (CI): (1.05, 1.2), Black: 1.06, 95% CI: (0.95, 1.17), other: 1.14, 95% CI: (1.0, 1.3), Hispanic: 1.19, 95% CI: (1.07, 1.32)] and lower mean birthweight for Black birthing people [adjusted beta -15.3, 95% CI: (-25.5, -7.4)]. CONCLUSIONS Parity in political representation may be associated with healthier environments.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Pari Kapila
- Emory College of Arts and Sciences, Atlanta, GA
| | | | | | | | | | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Eggen MB, Petrey J, Roberson P, Curnutte M, Jennings JC. An exploration of barriers to access to trial of labor and vaginal birth after cesarean in the United States: a scoping review. J Perinat Med 2023; 51:981-991. [PMID: 37067843 DOI: 10.1515/jpm-2022-0364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Increasing the number of vaginal birth after cesarean (VBAC) deliveries is one strategy to reduce the cesarean rate in the United States. Despite evidence of its safety, access to trial of labor after cesarean (TOLAC) and VBAC are limited by many clinical and non-clinical factors. We used a scoping review methodology to identify barriers to access of TOLAC and VBAC in the United States and extract potential leverage points from the literature. CONTENT We searched PubMed, Embase, Cochrane, and CINAHL for peer-reviewed, English-language studies published after 1990, focusing on access to TOLAC and/or VBAC in the United States. Themes and potential leverage points were mapped onto the Minority Health and Health Disparities Research Framework. The search yielded 21 peer-reviewed papers. SUMMARY Barriers varied across levels of influence and included factors related to restrictive clinical guidelines, provider reluctance, geographic disparities, and midwifery scopes of practice. While barriers varied in levels of influence, the majority were related to systemic and interpersonal factors. OUTLOOK Barriers to TOLAC and VBAC exist at many levels and are both clinical and non-clinical in nature. The existing body of literature can benefit from more research examining the impact of recent revisions to clinical guidelines related to VBAC as well as additional qualitative studies to more deeply understand the complexity of provider reluctance.
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Affiliation(s)
- Melissa B Eggen
- Department of Health Management and Systems Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, KY, USA
| | - Jessica Petrey
- Department of Health Management and Systems Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, KY, USA
| | - Paige Roberson
- Department of Health Management and Systems Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, KY, USA
| | - Mary Curnutte
- Department of Health Management and Systems Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, KY, USA
| | - J'Aime C Jennings
- Department of Health Management and Systems Sciences, University of Louisville, School of Public Health and Information Sciences, Louisville, KY, USA
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Mascarenhas Silva CH, Soares Laranjeira CL, Barros de Melo CS, Brandão LV, Oliveira GC, Brandão AHF, Nunes R. Perinatal complications of the maternal-Fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section: A retrospective study of clinical results associated with bioethical precepts. PLoS One 2023; 18:e0292846. [PMID: 37847716 PMCID: PMC10581477 DOI: 10.1371/journal.pone.0292846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
The obstetrics field is undergoing transformation and committing to ensuring the autonomy of pregnant women in decisions related to birth based on scientific information. The physiological process of birth typically results in vaginal delivery, but medicine has evolved to include obstetric surgeries that are safe and result in few perioperative complications, especially when cesarean section is performed from 39 weeks of gestational age. Thus, the question is whether clinicians should interfere with pregnant women's freedom to choose their mode of delivery by trying to persuade them to choose vaginal delivery. The objective was to analyze the perinatal complications of the maternal-fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section with respect to the bioethical precepts of autonomy, beneficence and nonmaleficence. In total, 2,507 women, including 1,807 (72.1%) with vaginal deliveries and 700 (27.9%) with cesarean deliveries, were analyzed between 2017 and 2020. There was no difference between the types of delivery in maternal readmission, death, admission to the intensive care unit, an Apgar score <7 in the 5th minute of life, maternal blood transfusion or comorbidities of the mothers or newborns. The elective cesarean section group showed less need for therapeutic uterotonics. In primigravidae, it was observed that elective cesarean section did not present a higher risk of complications than vaginal delivery. Therefore, this guarantees the autonomy and right of the individual to choose the mode of delivery.
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Affiliation(s)
- Carlos Henrique Mascarenhas Silva
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Obstetrics and Gynecology Unit, Mater Dei Health Network, Belo Horizonte, Brazil
| | - Cláudia Lourdes Soares Laranjeira
- Obstetrics and Gynecology Unit, Mater Dei Health Network, Belo Horizonte, Brazil
- Department of Women’s Health, School of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Augusto Henrique Fulgêncio Brandão
- Obstetrics and Gynecology Unit, Mater Dei Health Network, Belo Horizonte, Brazil
- Obstetrics and Gynecology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rui Nunes
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Jager F. An open dataset with electrohysterogram records of pregnancies ending in induced and cesarean section delivery. Sci Data 2023; 10:669. [PMID: 37783671 PMCID: PMC10545725 DOI: 10.1038/s41597-023-02581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023] Open
Abstract
The existing non-invasive automated preterm birth prediction methods rely on the use of uterine electrohysterogram (EHG) records coming from spontaneous preterm and term deliveries, and are indifferent to term induced and cesarean section deliveries. In order to enhance current publicly available pool of term EHG records, we developed a new EHG dataset, Induced Cesarean EHG DataSet (ICEHG DS), containing 126 30-minute EHG records, recorded early (23rd week), and/or later (31st week) during pregnancy, of those pregnancies that were expected to end in spontaneous term delivery, but ended in induced or cesarean section delivery. The records were collected at the University Medical Center Ljubljana, Ljubljana, Slovenia. The dataset includes 38 and 43, early and later, induced; 11 and 8, early and later, cesarean; and 13 and 13, early and later, induced and cesarean EHG records. This dataset enables better understanding of the underlying physiological mechanisms involved during pregnancies ending in induced and cesarean deliveries, and provides a robust and more realistic assessment of the performance of automated preterm birth prediction methods.
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Affiliation(s)
- Franc Jager
- Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000, Ljubljana, Slovenia.
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Abraham M, Ali N, Shivani Garapati SSL, Pandey P, Nair S, Swarna S, Chowdary DV, Aladeniyi F, Daing A, Abbas K. Delivery Methods in Twin Gestations: Evaluating Outcomes, Risk Factors, and the Paradigm Shift Towards Elective Cesarean Deliveries. Cureus 2023; 15:e46514. [PMID: 37927678 PMCID: PMC10625172 DOI: 10.7759/cureus.46514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
During the past decade, there has been a consistent rise in the number of twin births and the number of overall cesarean sections (CS) worldwide. This is owed to a variety of social, economic, educational, and scientific factors. More women are opting to advance their professional careers and gain financial stability before having children. Although this approach is understandable, a new set of challenges are faced as a result, the most important of which has been infertility due to advanced maternal age and the subsequent use of assisted fertility treatments, which have been noted to cause multiple gestations. Twin gestations are considered high-risk pregnancies and are associated with an amplitude of potential complications. Arguably, the biggest decision an obstetrician must make when dealing with this population is choosing the most appropriate mode of delivery. Given the lack of clear guidance pertaining to twin deliveries, CSs may often be perceived as safer and are often preferred over vaginal deliveries (VD). In this narrative review, we aimed to compare the outcomes of different delivery methods (CS versus VD) to investigate whether CS is truly superior to VD. Data were collected from the past two decades and analyzed based on the neonatal and maternal outcomes for each delivery mode. Our results indicate that planned VD is just as safe as CS, if not superior, in most uncomplicated twin pregnancies. Thus, it is best to advise and encourage healthy expecting twin carriers to undergo VD and explore any hesitations or fears they might have. Furthermore, a detailed guideline regarding twin delivery is essential to establish and better navigate twin deliveries, lower the rate of unnecessary CSs, and reduce overall twin gestation morbidity and mortality.
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Affiliation(s)
- Merin Abraham
- Internal Medicine, Kasturba Medical College, Manipal, Manipal, IND
| | - Noor Ali
- Obstetrics and Gynecology, Thumbay University Hospital, Ajman, ARE
- General Practice, Dubai Medical College, Dubai, ARE
| | | | - Priyanka Pandey
- Anatomical Sciences, Hind Institute of Medical Sciences, Sitapur, IND
| | - Shreya Nair
- Medicine, Krishna Institute of Medical Sciences, Karad, IND
| | - Sindhu Swarna
- Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | | | | | | | - Kiran Abbas
- Community Health Sciences, Aga Khan University, Karachi, PAK
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Medina G, González-Cortés FR, Sánchez-González A, Vázquez-Rodríguez JG, Ordoñez-González I, Jiménez-Arellano MP, García-Collinot G, Morales-Montalvo SI, Florez-Durante OI, Cruz-Domínguez MP, Colorado-Cruz MF, Zurita-Muñoz MA, Cruz-Arteaga G, Sánchez-Enriquez C, Jara LJ, Saavedra MÁ. The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients. Lupus 2023; 32:1409-1417. [PMID: 37840528 DOI: 10.1177/09612033231206446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed. OBJECTIVE To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups. METHODS Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values. RESULTS Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia. CONCLUSION The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.
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Affiliation(s)
- Gabriela Medina
- Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Antonio Sánchez-González
- Rheumatology Department, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan G Vázquez-Rodríguez
- Intensive Care Unit, Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - María P Jiménez-Arellano
- Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Grettel García-Collinot
- Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Oscar I Florez-Durante
- Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María P Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City, Mexico
- Direction of Education and Research, Hospital de Especialidades Centro Médico Nacional La Raza "Dr Antonio Fraga Mouret," Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Miguel A Zurita-Muñoz
- Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gilberto Cruz-Arteaga
- Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Luis J Jara
- Division of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Miguel Á Saavedra
- Research Division, Instituto Mexicano del Seguro Social, Hospital de Especialidades Centro Médico Nacional La Raza, Mexico City, Mexico
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Ramasauskaite D, Nassar A, Ubom AE, Nicholson W. FIGO good practice recommendations for cesarean delivery on maternal request: Challenges for medical staff and families. Int J Gynaecol Obstet 2023; 163 Suppl 2:10-20. [PMID: 37807587 DOI: 10.1002/ijgo.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Elective cesarean delivery on maternal request is a challenging topic of discussion for patients, their families, and clinicians. Efforts to reduce the rate of cesarean deliveries should include the proportion of cesarean deliveries at term that occur solely due to maternal request rather than a maternal or fetal indication. Additionally, clinicians should follow good clinical practice, which includes family counseling, discussions on the benefits and potential risks of elective cesarean delivery, timing of delivery, and ethical and legal considerations. Furthermore, there is the need for a sustained workforce of perinatal clinicians and staff trained in the appropriate technique and management of operative complications. This article reviews global rates of elective cesarean on maternal request and outlines FIGO's good practice recommendations for counseling expectant mothers and the conduct of elective cesarean versus vaginal delivery.
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Affiliation(s)
- Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Wanda Nicholson
- George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Vandenberghe G, Vercoutere A, Cuvellier N, Van Oost E, Leroy C, Goemaes R, Laubach M, Boulvain M, Daelemans C. Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study. BMC Pregnancy Childbirth 2023; 23:684. [PMID: 37736714 PMCID: PMC10515028 DOI: 10.1186/s12884-023-05984-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section. METHODS We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions. RESULTS Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001). CONCLUSIONS Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.
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Affiliation(s)
- Griet Vandenberghe
- Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - An Vercoutere
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
| | - Nadège Cuvellier
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Present Address: Department of Gynaecology and Obstetrics, Centre Hospitalier EpiCURA Site Ath, Ath, Belgium
| | - Elke Van Oost
- Department of Obstetrics, Ghent University Hospital, Vrouwenkliniek, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Present Address: Department of Obstetrics, AZ Maria Halle, Halle, Belgium
| | - Charlotte Leroy
- Centre d'Epidémiologie Périnatale (CEpiP) Clos Chapelle-Aux-Champs, 30 Bte, B1.30.04 1200, Brussels, Belgium
| | - Régine Goemaes
- Study Centre for Perinatal Epidemiology (SPE), Koning Albert II-Laan 35 Bus 29, 1030, Brussels, Belgium
| | - Monika Laubach
- Study Centre for Perinatal Epidemiology (SPE), Koning Albert II-Laan 35 Bus 29, 1030, Brussels, Belgium
- Service of Obstetrics and Prenatal Medecine, Universitair Ziekenhuis Brussel, Laarbeklaan 101, 1090, Brussels, Belgium
| | - Michel Boulvain
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Service of Obstetrics and Prenatal Medecine, Universitair Ziekenhuis Brussel, Laarbeklaan 101, 1090, Brussels, Belgium
| | - Caroline Daelemans
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles (ULB) Hôpital Universitaire de Bruxelles (H.U.B.), Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium
- Present Address: Obstetrics Division, Department of Woman, Child and Adolescent Medecine, Geneva University Hospitals, Boulevard de la Cluse, 30, 1205, Geneva, Switzerland
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Farid Mojtahedi M, Sepidarkish M, Almukhtar M, Eslami Y, Mohammadianamiri F, Behzad Moghadam K, Rouholamin S, Razavi M, Jafari Tadi M, Fazlollahpour-Naghibi A, Rostami Z, Rostami A, Rezaeinejad M. Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis. J Hosp Infect 2023; 139:82-92. [PMID: 37308061 DOI: 10.1016/j.jhin.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors. METHODS International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I2. RESULTS In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified. CONCLUSION An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.
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Affiliation(s)
- M Farid Mojtahedi
- Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | | | - Y Eslami
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - F Mohammadianamiri
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - S Rouholamin
- Department of Obstetrics and Gynaecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Razavi
- Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - A Fazlollahpour-Naghibi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Z Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - A Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - M Rezaeinejad
- Department of Obstetrics and Gynaecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Al-Bataineh R, Rawashdeh S, Lataifeh LN, Alzghoul SM, Al Sharie AH, Obeidat R, Altal OF. Cesarean scar ectopic partial molar pregnancy: A case report and a review of literature. Case Rep Womens Health 2023; 39:e00555. [PMID: 37868260 PMCID: PMC10587699 DOI: 10.1016/j.crwh.2023.e00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
A scar ectopic pregnancy exhibiting hydatidiform features is an extremely rare and clinically challenging entity. Delayed diagnosis and failure to treat such cases promptly can lead to devastating consequences. In this report, we present a case of cesarean scar ectopic partial molar pregnancy in a 37-year-old woman who presented with complaints of vaginal discharge with streaks of blood and lower abdominal pain. Diagnostic laparoscopy revealed an abnormal mass of brown soft tissue in the anterior wall of the uterus, measuring 13.0 × 9.0 × 2.0 cm, raising suspicion (in the context of elevated serum human chorionic gonadotropin levels) of a scar ectopic pregnancy. Open laparotomy was performed, and the scar ectopic mass was successfully removed. The histologic examination of the tissue revealed a partial hydatidiform mole. The patient experienced a full recovery postoperatively, with serum human chorionic gonadotropin levels gradually declining to normal values. This report is unique in its presentation of the clinicopathological features of cesarean scar ectopic molar pregnancy and the successful management of the condition.
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Affiliation(s)
- Rania Al-Bataineh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | | | - Leen N. Lataifeh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Saja M. Alzghoul
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Ahmed H. Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Rawan Obeidat
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Omar F. Altal
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
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Socha MW, Flis W, Pietrus M, Wartęga M. Risk of Cesarean Delivery after Vaginal Inserts with Prostaglandin Analogs and Single-Balloon Catheter Used for Cervical Ripening and Induction of Labor. Biomedicines 2023; 11:2125. [PMID: 37626622 PMCID: PMC10452585 DOI: 10.3390/biomedicines11082125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Induction of labor is currently the most frequently performed procedure in modern obstetrics, referring to more than one in five women, and it is postulated that the percentage of labor induction will increase. (2) Methods: In total, 2935 patients in uncomplicated full-term pregnancy fulfilled the study inclusion criteria and underwent induction of labor. Pregnant women were divided into three groups: IOL with Dinoprostone, Misoprostol vaginal suppositories, and Foley catheter. Outcomes, including cesarean section rates, time to delivery, and cesarean section indications, were analyzed. (3) Results: There was statistically significantly more cesarean sections within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p < 0.0001). The percentage of patients who had a cesarean section due to clinically diagnosed threatened fetal asphyxia was 63% in the Dinoprostone group, 81.3% in the Misoprostol group, and 55.3% in the Foley catheter group. There were statistically significantly more cesarean deliveries due to nonreassuring fetal heart rate patterns within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p = 0.0031 and p = 0.0363). (4) Conclusions: Misoprostol may cause a more turbulent and violent course of labor, with a higher rate of increased incidence of nonreassuring fetal heart rate patterns and cesarean deliveries. The use of a Dinoprostone vaginal insert or Foley catheter may provide longer labor, although still within 48 h, with a lower risk of cesarean section caused by nonreassuring fetal heart rate patterns.
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Affiliation(s)
- Maciej W. Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert’s Hospital in Gdańsk, Copernicus Healthcare Entity, 80-462 Gdańsk, Poland
| | - Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert’s Hospital in Gdańsk, Copernicus Healthcare Entity, 80-462 Gdańsk, Poland
| | - Miłosz Pietrus
- Department of Gynecology and Oncology, Jagiellonian University Medical College, 31-501 Kraków, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
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Brar BK, Bober MB, Gough E, Hashmi SS, Hecht JT, Dujmusic L, Little ME, Modaff P, Pauli RM, Rodriguez-Buritica DF, Serna ME, Smid C, Legare JM, Hoover-Fong JE. Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia. Genet Med 2023; 25:100845. [PMID: 37061874 DOI: 10.1016/j.gim.2023.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023] Open
Abstract
PURPOSE Pregnancies affected by maternal or fetal achondroplasia present unique challenges. The optimal route of delivery in fetuses with achondroplasia has not been established. Our objective was to determine whether the route of delivery affects postnatal achondroplasia-related surgical burden. METHODS We conducted a secondary analysis of Achondroplasia Natural History Study (CLARITY), which is a multicenter natural history cohort study of patients with achondroplasia. Achondroplasia-related surgical morbidity, which we defined as the need for one or more postnatal achondroplasia-related surgeries, was assessed in relation to the route of delivery and whether the mother also had achondroplasia. Rate of each individual surgery type (otolaryngology, brain, foramen magnum, spine, and extremity) was also assessed in relation to the route of delivery. RESULTS Eight hundred fifty-seven patients with achondroplasia with known route of delivery and known maternal stature were included. Three hundred sixty (42%) patients were delivered vaginally, and 497 (58%) patients were delivered by a cesarean delivery. There was no difference in the odds of requiring any postnatal achondroplasia-related surgery in those with achondroplasia who were delivered vaginally compared with those delivered by cesarean birth (odds ratio 0.95, 95% CI = 0.68-1.34, P = .80). No difference was present in the odds of requiring any postnatal achondroplasia-related surgery when route of delivery was compared for fetuses born to 761 average stature mothers (odds ratio 1.05, 95% CI = 0.74-1.51, P = .78). There was also no difference in the odds of requiring each of the individual achondroplasia-related surgeries by route of delivery, including cervicomedullary decompression. CONCLUSION Our study suggests that it is reasonable for average stature patients carrying a fetus with achondroplasia to undergo a trial of labor in the absence of routine obstetric contraindications.
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Affiliation(s)
- Bobby K Brar
- Division of Maternal - Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD; Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD.
| | | | - Ethan Gough
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | | | - Lorena Dujmusic
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mary E Little
- Nemours/A.I. duPont Hospital for Children, Wilmington, DE
| | - Peggy Modaff
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Richard M Pauli
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Maria E Serna
- McGovern Medical School, University of Texas Health, Houston, TX
| | - Cory Smid
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Janet M Legare
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Julie E Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD
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41
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Piva VMR, Voget V, Nucci LB. Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil. BMC Pregnancy Childbirth 2023; 23:455. [PMID: 37340447 DOI: 10.1186/s12884-023-05768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
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Affiliation(s)
- Veridiana Monteiro Ramos Piva
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
| | - Verena Voget
- Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
| | - Luciana Bertoldi Nucci
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
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Albzea W, Almonayea L, Aljassar M, Atmeh M, Al Sadder K, AlQattan Y, Alhajaji R, AlNadwi H, Alnami I, Alhajaji F. Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1065. [PMID: 37374268 PMCID: PMC10302920 DOI: 10.3390/medicina59061065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in pregnant women who were scheduled for elective CS. Methods: We systemically searched 4 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception until 10 March 2023. We included randomized controlled trials (RCTs) comparing melatonin and placebo for postoperative outcomes in CS patients. For risk of bias assessment, we used the Cochrane Risk of Bias 2 tool. Continuous variables were pooled as mean difference (MD), and categorical variables were pooled as a risk ratio (RR) with a 95% confidence interval (CI). Results: We included 7 studies with a total of 754 pregnant women scheduled for CS. The melatonin group had a lower pain score (MD = -1.23, 95% CI [-1.94, -0.51], p < 0.001) and longer time to first analgesic request (MD = 60.41 min, 95% CI [45.47, 75.36], p < 0.001) than the placebo group. No difference was found regarding hemoglobin levels, heart rate, mean arterial pressure, total blood loss, or adverse events. Conclusions: Preoperative melatonin may reduce postoperative pain in CS patients without side effects. This research offers a safe and affordable pain management method for this population, which has clinical consequences. Further research is needed to validate these findings and determine the best melatonin dosage and timing.
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Affiliation(s)
- Wardah Albzea
- Faculty of Medicine, Alexandria University, Alexandria 21544, Egypt
| | - Lolwa Almonayea
- Kuwait Institute for Medical Specializations, Kuwait City 12050, Kuwait
| | - Marah Aljassar
- Kuwait Institute for Medical Specializations, Kuwait City 12050, Kuwait
| | - Mousa Atmeh
- Department of Hemto-Oncology, Royal Medical Services, Amman 11855, Jordan
| | - Khaled Al Sadder
- Department of General Surgery, Ministry of Health, Kuwait City 12009, Kuwait
| | - Yousef AlQattan
- Kuwait Institute for Medical Specializations, Kuwait City 12050, Kuwait
| | - Raghad Alhajaji
- Department of Family Medicine, Almagrah Primary Health Care, Ministry of Health, Makkah 11176, Saudi Arabia
| | - Hiba AlNadwi
- King Abdullah Medical City, Makkah 57657, Saudi Arabia
| | - Inaam Alnami
- Senior Registerar Family Medicine, Internal Medicine Department, Security Forces Hospital Program, Makkah 14799, Saudi Arabia
| | - Fatima Alhajaji
- College of Medicine, Umm Alqura University, Makkah 57483, Saudi Arabia
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43
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Vashi CA, Vijay N, Bhalerao A, Shetty A. Obstetrics Outcomes in Women Undergoing Second-Stage Cesarean Section: A Cross-Sectional Study. Cureus 2023; 15:e39911. [PMID: 37404394 PMCID: PMC10317200 DOI: 10.7759/cureus.39911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Background Cesarean section (CS) involves the delivery of the fetus through incisions in the abdomen or uterine walls which is an alternative to vaginal delivery. In the majority of women, second-stage CS is performed without even attempting assisted vaginal delivery. This leads to difficulty for obstetricians for whether to perform an immediate CS or attempt a difficult vaginal birth as the effective method of delivery as CS are linked with higher morbidities which further increase when a CS is performed in the second stage. Hence, the present study was performed to find out obstetrics results in women undergoing second-stage CS. Method A cross-sectional study was conducted in the Department of Obstetrics and Gynecology of a tertiary care center attached to a medical college to study obstetric outcomes in women undergoing second-stage CS from January 2021 to December 2022 on 54 postnatal women who underwent second-stage CS. Results The mean age was 26.7 ± 3.9 years ranging between 19 and 35 years involving a majority of primiparity women. Maximum patients were having gestational age between 39 and 40 weeks and had spontaneous labor. The main indication of second-stage CS was non-reassuring fetal status and the method of delivery mainly involved for the deeply impacted head was the modified patwardhan technique in which if the head is embedded deeply in the pelvis in the OP position the anterior shoulder is delivered first followed by the same side leg then opposite side leg followed by the arm is gently delivered. Baby's trunk, legs, and buttocks are moved out by pulling them carefully and gently. And lastly, the head of the infant is finally moved out. The intra-operative complications mainly found were an extension of uterine angle and the post-operative complication was post-partum hemorrhage (PPH). The most common neonatal complication was the requirement for neonatal intensive care unit (NICU) admission. In conclusion, the present study reported a hospital range between seven and 14 days in comparison to other studies that reported hospital stays between three and 15 days. Conclusion In conclusion, higher maternal and fetal morbidities were associated with CS performed at full dilation of the cervix. The most common maternal complication seen was an injury to uterine vessels along with PPH however neonatal complications included the requirement of NICU monitoring. As there are no appropriate guidelines for the same, formulation of guidelines for performing CS at full dilation is required.
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Affiliation(s)
- Charmy A Vashi
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Nikita Vijay
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Anuja Bhalerao
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Anushree Shetty
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
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Ulfa Y, Maruyama N, Igarashi Y, Horiuchi S. Early initiation of breastfeeding up to six months among mothers after cesarean section or vaginal birth: A scoping review. Heliyon 2023; 9:e16235. [PMID: 37292274 PMCID: PMC10245156 DOI: 10.1016/j.heliyon.2023.e16235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
Background Early initiation of breastfeeding is important for establishing continued breastfeeding. However, previous research report that cesarean section (C-section) may hinder early initiation of breastfeeding. Despite this, there is currently a lack of literature that examines the rates of breastfeeding after both cesarean section and vaginal birth globally. Research aims The objective of this scoping review was to systematically assess the available literature on the rate of early initiation of breastfeeding within the first hour and exclusive breastfeeding up to 6 months after C-section and vaginal birth, as well as any other factors associated with initiation and exclusive breastfeeding. Methods We adhered to the PRISMA extension guidelines for scoping reviews in conducting our review. In August 2022, we carried out an electronic database search on CINALH, PubMed, EMBASE, and Cochrane Library, and also manually searched the reference list. Results A total of 55 articles were included in the scoping review. The majority of these studies found that mothers who delivered vaginally had higher rates of breastfeeding compared to those who underwent a C-section, at various time points such as breastfeeding initiation, hospital discharge, one month, three months, and six months postpartum. Notably, there was a significant difference in the rate of early initiation of breastfeeding between the two groups. However, at 3 and 6 months after delivery the gap of exclusive breastfeeding rate between C-section and vaginal delivery is narrow. Breastfeeding education, health care providers support, and mother and baby bonding are other factors associate with initiation and exclusive breastfeeding. Conclusions The rate of breastfeeding initiation after C-section has remained low to date. This is due in part to insufficient knowledge about and support for breastfeeding from healthcare providers.
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Affiliation(s)
- Yunefit Ulfa
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- National Research and Innovation Agency, Jakarta, Indonesia
| | - Naoko Maruyama
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yumiko Igarashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Barinov SV, Di Renzo GC, Tsibizova VI, Shifman EМ, Leont'eva NN, Arbuzov AB. Detoxification treatment in Gynecology using a modified molded sorbent. Best Pract Res Clin Obstet Gynaecol 2023:102346. [PMID: 37225639 DOI: 10.1016/j.bpobgyn.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
Postpartum endometritis is a common complication of cesarean section, the progression of which often leads to the loss of the uterus and the patient's fertility. We evaluated a detoxification therapy for treating patients with postpartum endometritis using an intrauterine application of a modified molded sorbent containing polyvinylpyrrolidone. A retrospective, controlled study included 124 patients with postpartum endometritis. The study group, n = 63, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial therapy in combination with the intrauterine application of a molded modified sorbent containing polyvinylpyrrolidone (FSMP) for 24 h daily for 5 days. The control group, n = 61, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial treatment only. The uterine cavity was infected by coccal flora (Enterococcus faecalis (26.6%), Staphylococcus spp. (21.3%), E. faecium (14.3%), and Gram-negative Escherichia coli (9.6%). A combination of these microorganisms was present in 40.5% of crops. Antibiotic resistance was detected in 53.6%-68.3% of the cases. In the study group, we observed: a faster and higher decrease in neutrophils (p < 0.05); a lower uterine concentration of pro-inflammatory cytokines: interleukin-1 beta (IL-1β) and tumor necrosis factor α (TNFα) - 4.0 and 3.2 times, respectively, compared with the control group (p < 0.05); and a significant decrease in the uterus volume and cavity (M-echo). Using a newly modified sorbent associated with antibiotic treatment in patients with postpartum endometritis, compared with antibiotics alone, we showed a sharp reduction of inflammatory parameters, residual microorganism growth, and faster uterine volume involution. Moreover, the frequency of hysterectomy decreased by 14.4 times.
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russian Federation.
| | - G C Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Wayne State University Medical School and Perinatal Research Branch, NIH-NICHD, Detroit, MI, 48201, USA; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy; Department of Obstetrics, Gynecology and Perinatal Medicine of the Clinical Institute of Children's Health Named After N.F. Filatov, I.M. Sechenov First State Medical University Under Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - V I Tsibizova
- Institute of Perinatology and Pediatrics, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.
| | - E М Shifman
- Department of Anesthesiology and Сritical Care of Moscow Regional M.V. Vladimirsky Moscow`s Regional Research Clinical Institute, Moscow, Russian Federation.
| | - N N Leont'eva
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
| | - A B Arbuzov
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
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Hersh AR, Bullard KA, Garg B, Arora M, Mischkot BF, Caughey AB. Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non-Medically Indicated Induction of Labor at 39 Weeks. JAMA Netw Open 2023; 6:e239167. [PMID: 37093603 PMCID: PMC10126869 DOI: 10.1001/jamanetworkopen.2023.9167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Importance Non-medically indicated induction of labor has been demonstrated to potentially improve some obstetric outcomes, such as decreasing cesarean birth. It has been reported that rates of cesarean birth and other obstetric outcomes vary among hospitals with different characteristics. Objective To assess whether obstetric outcomes differ between nulliparous individuals with low-risk pregnancies managed with non-medically indicated induction of labor compared with expectant management in different types of hospitals. Design, Setting, and Participants This retrospective cohort study included non-medically indicated induction of labor at 39 weeks' gestation compared with expectant management of singleton, nonanomalous, births in nulliparous women with low-risk pregnancies in California between January 1, 2007, and December 31, 2011. The initial analysis of these data was performed in 2021. Outcomes were assessed by 3 hospital characteristics: location (urban vs rural), obstetric volume, and teaching (academic vs community) status. Volume was categorized based on the average number of births per year and grouped into low (<1200 births per year), medium (1200-2399 births per year), and high (≥2400 births per year). Births with previous or planned cesarean delivery were excluded, and non-medically indicated induction of labor was defined as induction of labor without a specific medical indication. Testing with χ2 and multivariable logistic regression analyses was used for statistical comparisons with a cutoff level of P = .01. Exposure Non-medically indicated induction of labor at 39 weeks' gestation. Main Outcomes and Measures The primary outcome was cesarean birth, and numerous secondary perinatal outcomes were also assessed. Results There were 455 044 births included in this study. When stratified by hospital variables, a number of sociodemographic characteristics were significantly different, such as race and ethnicity, age, body mass index, and insurance type. The adjusted odds ratios (aORs) of cesarean birth were significantly lower in all settings with induction of labor except for low-volume hospitals, in which there was no significant difference (aOR, 0.95; 95% CI, 0.82-1.09). Chorioamnionitis and postpartum hemorrhage were lower with induction of labor among nearly every hospital when stratified by hospital characteristics. Neonatal outcomes were improved in all settings with induction of labor compared with expectant management. Conclusions and Relevance These findings suggest that non-medically indicated induction of labor may be associated with a lower rate of cesarean births and some maternal and neonatal adverse outcomes in a range of hospital settings.
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Affiliation(s)
- Alyssa R Hersh
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
| | - Kimberley A Bullard
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
| | - Bharti Garg
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
| | - Megha Arora
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
| | - Brooke F Mischkot
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland
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Braga A, Sun SY, Zaconeta ACM, Junior AT, Luz AG, Osanan G, Duarte G, Ramos JGL, Wender MCO, Nomura RMY, Francisco RPV, Borges VTM, Mattar R. Increase in cesarean sections in Brazil - a call to reflection. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:109-112. [PMID: 37105193 PMCID: PMC10166644 DOI: 10.1055/s-0043-1768454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
- Department of Maternal Child, Fluminense Federal University, Niterói, RJ, Brazil
- Vassouras University, Vassouras, RJ, Brazil
| | - Sue Yazaki Sun
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Alberto Trapani Junior
- Departamento de Ginecologia e Obstetrícia, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Gabriel Osanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - José Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Celeste Osório Wender
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roseli Mieko Yamamoto Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Rosiane Mattar
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Abstract
Long-standing health disparities in maternal reproductive health, infant morbidity and mortality, and long-term developmental outcomes are rooted in a foundation of structural racism. Social determinants of health profoundly affect reproductive health outcomes of Black and Hispanic women disproportionately; they have higher rates of death during pregnancy and preterm birth. Their infants are also more likely to be cared for in poorer quality neonatal intensive care units (NICUs), receive poorer quality of NICU care, and are less likely to be referred to an appropriate high-risk NICU follow-up program. Interventions that mitigate the impact of racism will help to eliminate health disparities.
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Affiliation(s)
- Yvette R Johnson
- Texas Christian University, Burnett School of Medicine, Cook Children's Medical Center, N.E.S.T. Developmental Follow-up Clinic, 1500 Cooper Street, Fort Worth, TX 76104, USA.
| | - Charleta Guillory
- Baylor College of Medicine, Texas Children's Hospital, Section of Neonatology, 6621 Fannin, Houston, TX 77030, USA
| | - Sonia Imaizumi
- Newtown Square, MultiPlan.com, 18 Campus Boulevard, Suite 200, Newtown Square, PA 19073, USA
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Adesina OO, Brunson A, Fisch SC, Yu B, Mahajan A, Willen SM, Keegan THM, Wun T. Pregnancy outcomes in women with sickle cell disease in California. Am J Hematol 2023; 98:440-448. [PMID: 36594168 PMCID: PMC9942937 DOI: 10.1002/ajh.26818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991-2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD-adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at-risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5-36.1 vs. 12.4 [CI: 12.1-12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6-682.2] vs. 6.1 [CI: 2.3-8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79-2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD-modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.
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Affiliation(s)
- Oyebimpe O. Adesina
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Samantha C. Fisch
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Bo Yu
- Department of Obstetrics & Gynecology, Stanford University School of Medicine; Stanford Maternal & Child Health Research Institute, Stanford, CA
| | - Anjlee Mahajan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Shaina M. Willen
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- UC Davis Clinical and Translational Science Center, University of California, Davis, CA
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50
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Chen SW, Shorten A, Yeh CC, Kao CH, Lu YY, Hu HW. An innovative web-based decision-aid about birth after cesarean for shared decision making in Taiwan: study protocol for a randomized control trial. Trials 2023; 24:103. [PMID: 36759893 PMCID: PMC9910264 DOI: 10.1186/s13063-023-07103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. This study aims to develop and evaluate a web-based decision-aid with communication support tools, to increase shared decision making (SDM) about birth after caesarean. METHODS A quantitative approach will be adopted using a randomized pre-test and post-test experimental design in a medical centre in northern Taiwan. The web-based decision aid consists of five sections. Section 1 provides a two-part video to introduce SDM and how to participate in SDM. Section 2 presents an overview of functions and features of the birth decision-aid. Section 3 presents relevant VBAC information, including definitions, benefits and risks, and an artificial intelligence (AI) calculator for rate and likelihood of VBAC success. Section 4 presents the information regarding elective repeat caesarean delivery (ERCD), involving definitions, benefits, and risks. Section 5 comprises four steps of decision making to meet women's values and preferences. Pregnant women who have had one previous caesarean and are eligible for VBAC, will be recruited at 14-16 weeks. Participants will complete a baseline survey prior to random allocation to either the control group (usual care) or intervention group (usual care plus an AI-decision aid). A follow up survey at 35-38 weeks will measure change in decisional conflict, knowledge, birth mode preference, and decision-aid acceptability. Actual birth outcomes and satisfaction will be assessed one month after birth. DISCUSSION The innovative web-based decision-aid with support tools will help to promote pregnant women's decision-making engagement and communication with their providers and improve opportunities for supportive communication about VBAC SDM in Taiwan. Linking web-based AI data analysis into the medical record will also be assessed for feasibility during implementation in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT05091944), Registered on October 24, 2021.
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Affiliation(s)
- Shu Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Allison Shorten
- grid.265892.20000000106344187School of Nursing, University of Alabama at Birmingham, Birmingham, USA
| | - Chang Ching Yeh
- grid.278247.c0000 0004 0604 5314Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien Huei Kao
- grid.412146.40000 0004 0573 0416Department of Nursing-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu Ying Lu
- grid.412146.40000 0004 0573 0416School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsiang Wei Hu
- grid.64523.360000 0004 0532 3255Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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