Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

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On demand caesarean section: What’s women’s attitude?

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i2.1448 ◽

1970 ◽

Vol 2 (2) ◽

pp. 12-15

Author(s):

Nira S Shrestha ◽

Sumita Pradhan

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Caesarean Delivery ◽

Mode Of Delivery ◽

University Teaching ◽

Normal Vaginal Delivery ◽

On Demand ◽

Assisted Delivery ◽

The Right

Objectives: To evaluate the knowledge and attitude of Nepalese women towards mode of delivery and caesarean on demand. Study design: Hospital based cross sectional descriptive study where 200 pregnant women after 37 completed weeks of gestation were recruited randomly and interviewed, and their answers were analyzed. Results: Of the 200 interviewed pregnant women, all of them knew about normal vaginal delivery and caesarean delivery, but only 30% knew about instrumentally assisted delivery and 9% had heard about painless labour. Vaginal delivery was the preferred mode in 93% and 7% preferred caesarean delivery. Only 35% of the interviewed women believed that women should have the right to demand a caesarean section Conclusion: Knowledge assessment of two hundred women regarding the mode of delivery clearly indicates the need for strengthening counseling aspect of antenatal care and awareness program regarding mode of delivery. In Nepal on demand caesarean section is not provided in the University Teaching Hospital. However one third of women still felt that women should have the right to choose caesarean section on demand. Key words: Attitude, mode of delivery, Caesarean on demand. doi:10.3126/njog.v2i2.1448 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 12 - 15

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Incidence and indications of LSCS among Doctors Community of Chattogram

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i2.56471 ◽

2021 ◽

Vol 20 (2) ◽

pp. 37-40

Author(s):

Adiba Malik ◽

Kamrun Nessa ◽

Yasmin Ara Begum ◽

M Jalal Uddin ◽

Aklima Sultana ◽

...

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Placenta Previa ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Fetal Distress ◽

Left Ventricular ◽

Subsequent Pregnancy ◽

Cross Sectional ◽

Lower Segment Caesarean Section

Background: Lower segment caesarean section (LSCS) is a surgical intervention, which is carried out to ensure the safety of mother and baby when vaginal delivery is not possible or when danger to mother and baby would be greater with vaginal delivery. This study is designed to identify indication of LSCS and detect complications if any among the respondents. Materials and methods: Cross sectional descriptive study where 95 female doctors of Chattogram were selected by convenient sampling without knowing their mode of delivery and if it is LSCS then indication of LSCS , maternal and neonatal complications were noted. Results: Age of the respondents at the time of interview were noted and most of them were between 31- 40 years 52 (55%), regarding income most of them between 100000 -200000 42(44%) most of the delivery occurred in the private clinics 92 (70%) regarding mode of delivery, LSCS was 92 (70%) vaginal delivery 40 (30%) regarding indications of LSCS most common was repeat caesarean section 27 (29%) and second common was LSCS due to maternal interest 18 (20%) and others were severe preeclampsia 10 (11%) fetal distress 08(09%) placenta previa, Diabetes with big baby, cephalopelvic disproportion, PROM with non progression of labour. PPH was the most common complication 05 (63%), next was paralytic ileus 02 (25%) and left ventricular failure 01 (12%). Common neonatal comoplications were low birth weight baby 904 (40%), prematurity 03 (30%) and birth asphyxia 03 (03%). Conclusion: LSCS is a major surgical procedure for delivery. Inspite of its low maternal morbidity and mortality due to improved surgical technique, modern aneasthetic skill and availability of blood and blood products, still it carries a slightly greater risk in subsequent pregnancy, so we should be rational in doing primary caesarean section. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 37-40

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Vaginal birth after caesarean section: why and how?

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175280 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5554

Author(s):

Vidyadhar B. Bangal ◽

Satyajit Gavhane ◽

Vishesha Yadav ◽

Kunal Aher ◽

Dhruval Bhavsar

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Vaginal Birth ◽

Maternal Complications ◽

History Of ◽

Spontaneous Onset ◽

Vaginal Birth After Caesarean

Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.

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Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

Obstetric Medicine ◽

10.1177/1753495x15625547 ◽

2016 ◽

Vol 9 (2) ◽

pp. 78-82

Author(s):

NM Murphy ◽

AS Khashan ◽

DI Broadhurst ◽

O Gilligan ◽

K O’Donoghue ◽

...

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

D Dimer ◽

In Pregnancy

Background To examine perinatal determinants of the antenatal levels of D-dimers. Methods Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. Results D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past ( P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women ( P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset ( P = 0.003) and induction of labour ( P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery ( P = 0.008) and instrumental vaginal delivery ( P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section ( P = 0.008). Discussion There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

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Prediction of Placenta Accreta Using Hyperglycosylated Human Chorionic Gonadotropin

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2020.22 ◽

2018 ◽

Vol 8 (2) ◽

pp. 142-146

Author(s):

Maad Mahdi Shalal ◽

Shaymaa Kadhim Jasim ◽

Huda Khalil Abd

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Chorionic Gonadotropin ◽

Gestational Age ◽

Human Chorionic Gonadotropin ◽

Placenta Accreta ◽

Placenta Previa ◽

Control Group ◽

Previous Caesarean Section ◽

Hyperglycosylated Human Chorionic Gonadotropin

Objectives: Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta. Materials and Methods: In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up. Results: Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy. Conclusions: The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

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A 3 year retrospective study of pregnancies complicated with placenta previa in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210003 ◽

2021 ◽

Author(s):

Vatsala Kamath ◽

Aparna C. Aravind ◽

Nishita Shettian

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Pregnant Women ◽

Neonatal Intensive Care ◽

Placenta Previa ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Multiple Pregnancy ◽

Age Group ◽

Tertiary Care Centre

Background: Placenta previa describes when a placenta is implanted partially or completely over the internal OS. About one third of the ante partum haemorrhage belongs to placenta previa. The incidence is increased beyond the age of 35 years, with high birth order pregnancies, prior caesarean deliveries and in multiple pregnancy. The aim of the study was to determine maternal and fetal outcome in pregnancies complicated with placenta previa.Methods: A 3 year retrospective study done in OBG department of A. J. Institute of Medical Sciences, Mangalore from January 2017- January 2020. All pregnant women who are diagnosed with placenta previa during regular antenatal care (ANC) follow up, at or after admission and during caesarean delivery are included in the study. Data were collected from the hospital records.Results: During the study period, there were 34 pregnant women with placenta previa. Maximum were in the age group of 31-35 years of age and 8.82 percentage were in the age group more than 35 years. Out of the study subjects,76.5 percentage were multigravidas and 50 percentage were giving history of prior one caesarean section. 29.4 percentage of study subjects had true placenta previa and 85.2 percentage underwent elective caesarean section. There were significantly higher number of babies required neonatal intensive care unit (NICU) admissions.Conclusions: An increase in the incidence of women with advanced maternal age, multiparity, prior caesarean deliveries contributes to a rise in the number of pregnancies complicated with placenta previa.

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Human Milk Virome Analysis: Changing Pattern Regarding Mode of Delivery, Birth Weight, and Lactational Stage

Nutrients ◽

10.3390/nu13061779 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1779

Author(s):

Meltem Dinleyici ◽

Vicente Pérez-Brocal ◽

Sertac Arslanoglu ◽

Ozge Aydemir ◽

Sibel Sevuk Ozumut ◽

...

Keyword(s):

Birth Weight ◽

Human Milk ◽

Vaginal Delivery ◽

Gestational Age ◽

Small For Gestational Age ◽

Mode Of Delivery ◽

Large For Gestational Age ◽

Delivery Mode ◽

Age Group ◽

Spontaneous Vaginal Delivery

The human milk (HM) microbiota is a significant source of microbes that colonize the infant gut early in life. The aim of this study was to compare transient and mature HM virome compositions, and also possible changes related to the mode of delivery, gestational age, and weight for gestational age. Overall, in the 81 samples analyzed in this study, reads matching bacteriophages accounted for 79.5% (mainly Podoviridae, Myoviridae, and Siphoviridae) of the reads, far more abundant than those classified as eukaryotic viruses (20.5%, mainly Herpesviridae). In the whole study group of transient human milk, the most abundant families were Podoviridae and Myoviridae. In mature human milk, Podoviridae decreased, and Siphoviridae became the most abundant family. Bacteriophages were predominant in transient HM samples (98.4% in the normal spontaneous vaginal delivery group, 92.1% in the premature group, 89.9% in the C-section group, and 68.3% in the large for gestational age group), except in the small for gestational age group (only ~45% bacteriophages in transient HM samples). Bacteriophages were also predominant in mature HM; however, they were lower in mature HM than in transient HM (71.7% in the normal spontaneous vaginal delivery group, 60.8% in the C-section group, 56% in the premature group, and 80.6% in the large for gestational age group). Bacteriophages still represented 45% of mature HM in the small for gestational age group. In the transient HM of the normal spontaneous vaginal delivery group, the most abundant family was Podoviridae; however, in mature HM, Podoviridae became less prominent than Siphoviridae. Myoviridae was predominant in both transient and mature HM in the premature group (all C-section), and Podoviridae was predominant in transient HM, while Siphoviridae and Herpesviridae were predominant in mature HM. In the small for gestational age group, the most abundant taxa in transient HM were the family Herpesviridae and a species of the genus Roseolovirus. Bacteriophages constituted the major component of the HM virome, and we showed changes regarding the lactation period, preterm birth, delivery mode, and birth weight. Early in life, the HM virome may influence the composition of an infant’s gut microbiome, which could have short- and long-term health implications. Further longitudinal mother–newborn pair studies are required to understand the effects of these variations on the composition of the HM and the infant gut virome.

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Preferences of pregnant women regarding mode of delivery: a questionnaire based study

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20174870 ◽

2017 ◽

Vol 3 (11) ◽

pp. 292 ◽

Cited By ~ 2

Author(s):

Poojan Dogra ◽

Reena Sharma

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Tertiary Care ◽

Mode Of Delivery ◽

Antenatal Clinic ◽

Tertiary Care Centre ◽

Term Outcome ◽

Long Term Outcome ◽

Knowledge And Attitude

Background: The rising rate of caesarean section is the subject of concern worldwide. The aim of our study was to know the knowledge, attitude and preferences of pregnant women towards the mode of delivery in a tertiary care centre and hence to see weather this is a contributing factor towards rinsing trend of caesarean delivery or not. Methods: This was a prospective questionnaire study conducted on 100 antenatal women in third trimester who attended the antenatal clinic in SLBS GMC Mandi at Nerchowk from 1st June, 2017 to 1st September 2017.The information regarding socio-demographic profile, obstetric history, knowledge and attitude statements towards vaginal delivery and caesarean section was collected and analysed.Results: Total of 100 women was interviewed in our study. Out of these, majority (85%) had received education up to High school and above. Majority of the women (90%) had the positive attitude towards vaginal delivery. The most frequently mentioned source of information about the mode of delivery was relatives and friends. Almost half of women agreed to the statement that vaginal delivery creates a more affectionate mother and baby relationship. Majority of women co-relate that caesarean section was associated with more complications and not good in long term outcome. Economic factors did not play an important role in deciding caesarean birth.Conclusions: Majority of pregnant women interviewed were interested to deliver vaginally, while some women were indecisive due to lack of knowledge and some due to apprehension of labor pains during vaginal delivery wanted to undergo a caesarean section. Appropriate counselling of pregnant women and their partners will help in changing their outlook and make them a better judge while choosing their preferences.

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Use of antenatal corticosteroids in Brazil: data analysis from the National Survey Nascer no Brasil

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2022/40/2020126 ◽

2022 ◽

Vol 40 ◽

Author(s):

Antônio José Ledo Alves da Cunha ◽

Karina Bilda de Castro Rezende ◽

Maria Elisabeth Lopes Moreira ◽

Silvana Granado Nogueira da Gama ◽

Maria do Carmo Leal

Keyword(s):

Data Analysis ◽

Pregnant Women ◽

Vaginal Delivery ◽

Gestational Age ◽

Maternal Education ◽

Mode Of Delivery ◽

Immune Deficiency Syndrome ◽

Antenatal Corticosteroids ◽

Maternal Complications ◽

Mortality And Morbidity

ABSTRACT Objective: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. Methods: Secondary data analysis from “Birth in Brazil”, a national hospital-based survey carried out in 2011–2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. Results: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26–34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks, the use of ANC was 23.9% in spontaneous deliveries, 20.6% in induced deliveries and 43.8% among those who did not go into labor. The variables vaginal delivery (OR 2.5; 95%CI 1.8–3.4) and living in the countryside were associated with not using ANC, and the occurrence of pre-eclampsia/eclampsia (OR 1.8; 95%CI 1.2–2.9) was associated with the use of ANC. Conclusions: The use of ANC among Brazilian pregnant women was low. Interventions to increase its use are necessary and can contribute to reduce neonatal mortality and morbidity. ANC should be promoted in pregnancies of less than 37 weeks, especially in cases of vaginal delivery and for those living in the countryside.

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An Evaluation of Birth Outcomes in Overweight and Obese Pregnant Women Who Exercised during Pregnancy

Sports ◽

10.3390/sports6040138 ◽

2018 ◽

Vol 6 (4) ◽

pp. 138 ◽

Cited By ~ 1

Author(s):

Palee Myrex ◽

Lorie Harper ◽

Sara Gould

Keyword(s):

Pregnant Women ◽

Weight Management ◽

Birth Outcomes ◽

Gestational Age ◽

Mode Of Delivery ◽

First Trimester ◽

Delivery Mode ◽

Obese Women ◽

Secondary Outcomes ◽

Exercise During Pregnancy

It is well established that exercise has numerous health benefits, especially in regard to weight management for the obese and overweight population. However, there is limited data to support the safety or effects of exercise in the obese and overweight pregnant population despite the fact that exercise and weight management in this demographic is particularly important. In an effort to establish the safety profile of exercise during pregnancy in this population, we tested the hypothesis that exercise would not result in adverse birth outcomes. We surveyed postpartum women with an average BMI of 34.7 regarding their participation in exercise during pregnancy. Our primary outcome of interest was small for gestational age (SGA). Secondary outcomes included gestational age at delivery, mode of delivery, head circumference, length and birthweight as compared to those who did not exercise. SGA occurred in 12.5% of women who exercised in the first trimester compared to 14.9% in those who did not exercise (p = 0.678). Similar results were seen for women who exercised in the second and third trimesters. Intensity of exercise did not alter these findings and the analysis of secondary outcomes also did not demonstrate a difference between the groups. In conclusion, overweight and obese women who reported exercising during pregnancy did not have a higher incidence of SGA infants. Exercise should not be discouraged in pregnant women due to obesity.

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