Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.

The relationship of the application of guided imagery therapy techniques towards pain intensity of maternal post caesarian section operation in postnatal care at the maternity hospital in the city of Padang

Background: Most of the maternity mothers experience discomfort disorders due to the pain felt by the mother after caesarean section surgery. The pain causes disruption of the mother’s activities after giving birth, the mother has difficulty breastfeeding her baby, and has difficulty doing physical activities. The pain results from surgical wounds on the abdominal wall and uterine wall of the mother. The pain experienced by each mother is different, ranging from low pain levels to severe pain levels.Methods: This type of comparative analytic research with a cross sectional study approach with one group pretest and posttest design. As many as 30 samples of post caesarean section delivery mothers were taken by purposive sampling technique. Marginal homogeneity test was used for research analysis.Results: The study showed that there was a decrease in the level of post-partum labor pain before and after the intervention of guided imagery therapy. Before the intervention, most of the respondents (46.7%) had moderate pain levels (4-6), after giving the intervention some respondents (43.3%) had mild pain levels. Statistical test showed a significant relationship with a significance value of 0.000 (p value <0.05).Conclusions: Giving guided imagery therapy to post caesarean section delivery mothers is able to reduce the level of pain that the mother experiences without causing additional risk for the mother. This therapy provides a sense of comfort and relaxation for the mother through the imagination generated by the mother in her mind so that it diverts and reduces the pain that the mother is experiencing.

Administration of antenatal corticosteroids for singleton preterm birth in China, 2017 to 2018

Background The administration of antenatal corticosteroids (ACS) to women who are at risk of preterm birth has been proven to reduce not only the mortality, but also the major morbidities of the preterm infants. The rate of ACS and the risk factors associated with ACS use in Chinese population is unclear. This study aimed to investigate the rate of ACS use and the associated perinatal factors in the tertiary maternal centers of China. Methods Data for this retrospective observational study came from a clinical database of preterm infants established by REIN-EPIQ trial. All infants born at <34 weeks of gestation and admitted to 18 tertiary maternal centers in China from 2017 to 2018 were enrolled. Any dose of dexamethasone was given prior to preterm delivery was recorded and the associated perinatal factors were analyzed. Results The rate of ACS exposure in this population was 71.2% (range 20.2% – 92%) and the ACS use in these 18 maternal centers varied from 20.2–92.0% in this period. ACS exposure was higher among women with preeclampsia, caesarean section delivery, antibiotic treatment and who delivered infants with lower gestational age and small for gestational age. ACS use was highest in the 28-31 weeks gestational age group, and lowest in the under 26 weeks of gestational age group (x2=65.478, P < 0.001). ACS exposure was associated with lower odds of bronchopulmonary dysplasia or death (OR, 0.778; 95% CI 0.661 to 0.916) and invasive respiration requirement (OR, 0.668; 95% CI 0.585 to 0.762) in this population. Conclusion The ACS exposure was variable among maternity hospitals and quality improvement of ACS administration is warranted.

Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu

Background Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. Methods This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. Results Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). Conclusion Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

Critical COVID-19 in a 24-week pregnant woman with 32 days of invasive mechanical ventilation before delivery of fetus: a case of successful collaborative multidisciplinary care

We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.

An Experience Survey Report on Post Caesarean Complications among Young Women

Aim: To assess the post caesarean complications among young women through a survey study. Background: Caesarean section delivery has many adverse effects in the post natal period and later including pain, muscle weakness, reduced endurance, adverse reactions from anaesthesia and difficulty in breast feeding. There are several studies reported the health-related complications following caesarean section. However it is not been fully understood the various complications and its reasons. Design: An explorative cross sectional survey study. Method: participants were identified based on the inclusion criteria. Information on caesarean section delivery related complications and experience were gathered. Conclusion: The complications following the caesarean survey may increase the risk of physical difficulties, incidence of lower back pain, reduced abdominal strength, and difficulty in selfcare activities. Keywords: caesarean delivery, complications, child labour, Postpartum period pain.

Cost of Deliveries among Health Insurance (HI) Enrollees and Out-of-Pocket (OOP) Payers Accessing Maternal Healthcare Services in a Tertiary Health Institution in Southwest Nigeria

Maternal Mortality Is Currently High And Remains One Of The Most Important Public Health Problems In Developing Countries. This Study Determined The Cost Of Vaginal And Caesarean Section Deliveries Among Health Insurance (HI) Enrollees And Out-Of-Pocket (OOP) Payers. A Comparative Cross-Sectional Study Was Carried Out Among 380 Women {(133 Vaginal And 57 Caesarean Section Deliveries Among Each Of HI Enrollees And OOP Payers)} Who Accessed Delivery Services In A Tertiary Health Institution In Southwest Nigeria Using A Systematic Random Sampling Technique. Data Was Gathered Using An Interviewer-Administered Semi-Structured Questionnaire And Analyzed Using IBM SPSS Version 23. P-Value <0.05 Was Taken As Significant. The Overall Mean Age Of Respondents In This Study Was 36.5 ± 4.7years Among The Vaginal Delivery Respondents And 35.8 ± 3.6 Years Among Caesarean Section Delivery Respondents. The Mean Total Cost Of Vaginal Delivery For HI Enrollees {₦14,238.5 ± 4,809.0 ($34.5 ± 12.7)} Is Lesser Than For OOP Payers {₦37,928.5 ± 19,813.0 ($99.8 ± 52.1)}. Furthermore, The Mean Total Cost Of Caesarean Section Delivery For HI Enrollees {₦14,238.5 ± 4,809.0 ($34.5 ± 12.7)} Is Lesser Than For OOP Payers (₦37,928.5 ± 19,813.0 ($99.8 ± 52.1}. 94.1% Of The Non-Insurance Enrollees Were Willing To Join Health Insurance Scheme. It Was Concluded That The Total Cost Of Vaginal And Caesarean Section Deliveries Is Lower Among The Health Insurance Enrollees Than The Out-Of-Pocket Payers. Therefore, Intervention To Increase Awareness On Health Insurance Is Recommended.

Early-life oxytocin attenuates the social deficits induced by caesarean-section delivery in the mouse

The oxytocin (OXT) system has been strongly implicated in the regulation of social behaviour and anxiety, potentially contributing to the aetiology of a wide range of neuropathologies. Birth by Caesarean-section (C-section) results in alterations in microbiota diversity in early-life, alterations in brain development and has recently been associated with long-term social and anxiety-like behaviour deficits. In this study, we assessed whether OXT intervention in the early postnatal period could reverse C-section-mediated effects on behaviour, and physiology in early life and adulthood. Following C-section or per vaginum birth, pups were administered with OXT (0.2 or 2 μg/20 μl; s.c.) or saline daily from postnatal days 1–5. We demonstrate that early postnatal OXT treatment has long-lasting effects reversing many of the effects of C-section on mouse behaviour and physiology. In early-life, high-dose OXT administration attenuated C-section-mediated maternal attachment impairments. In adulthood, low-dose OXT restored social memory deficits, some aspects of anxiety-like behaviour, and improved gastrointestinal transit. Furthermore, as a consequence of OXT intervention in early life, OXT plasma levels were increased in adulthood, and dysregulation of the immune response in C-section animals was attenuated by both doses of OXT treatment. These findings indicate that there is an early developmental window sensitive to manipulations of the OXT system that can prevent lifelong behavioural and physiological impairments associated with mode of birth.

Association between migration status and caesarean section delivery based on a modified Robson classification in China

Background China has one of the highest caesarean section (C-Section) rates in the world. In recent years, China has been experiencing a massive flow of migration due to rapid urbanization. In this study, we aimed to differentiate the rates of C-Section between migrants and residents, and explore any possible factors which may moderate the association between migrant status and C-Section rates. Methods We conducted a retrospective cohort study in Shanghai, China. All deliveries were classified using the modified Robson Classification. The association between women’s migrant status and C-Section rates was assessed using the Poisson regression of sandwich estimation, after adjusting for possible factors. Results Of the 40,621 women included in the study, 66.9% were residents and 33.1% were internal migrants. The rate of C-Section in migrants was lower than that of residents in all subjects (39.9 and 47.7%) and in group 1 subjects (based on the Robson Classification) using a modified Robson Classification. There was an association between migrant status and caesarean delivery on maternal request that was statistically significant (RR = 0.664, p < 0.001), but the association was weakened after adjusting for such factors as maternal age at delivery (aRR = 0.774, p = 0.02), ethnicity (aRR = 0.753, p < 0.001), health insurance (aRR = 0.755, p < 0.001), and occupation (aRR = 0.747, p = 0.004), but had no significant changes when adjusting for health conditions (aRR = 0.668, p = 0.001) and all considering variables (aRR = 0.697, p = 0.002). In group 1 subjects, the effect of migrant status on maternal requested intrapartum C-Section was also statistically significant (RR = 0.742, p = 0.004). Conclusion C-Section rates are lower among migrant women than residents, especially on maternal request. The medical practitioners should further reinforce the management of elective C-Section in resident women.