Search Results (97)

Background and Objectives: Early mother–newborn skin-to-skin contact (SSC) after birth is widely recommended to support neonatal physiological stabilization, including thermoregulation. Under routine clinical practice, however, SSC may be brief or interrupted, and its effectiveness in maintaining neonatal body temperature under such conditions is less well described. This study aimed to evaluate early neonatal temperature changes under routine post-birth care practices that included brief SSC followed by separation for incubation care. Materials and Methods: This retrospective cohort study included 620 term mother–infant dyads delivered at a single regional teaching hospital. Newborns were managed according to routine clinical practice and were allocated to either a brief early SSC group or a control group without SSC. SSC duration differed by mode of delivery (approximately 10 min after cesarean section and 20 min after vaginal birth). Infant body temperature was recorded at predefined time points from birth through early incubation care. Associations between temperature changes and clinical factors, including mode of delivery, gestational age, parity, and birth weight, were analyzed. Results: No significant difference was observed between the SSC and control groups in overall changes in infant body temperature from birth to the beginning of incubation care (p = 0.245). After one hour of incubation, mean body temperature was comparable between groups (p = 0.357). Within the SSC group, infant body temperature decreased significantly during the SSC period (change from birth: −0.68 °C ± 0.35 °C; p < 0.001). At the start of incubation care, a significantly lower proportion of infants in the SSC group (22%) had body temperatures below 36.5 °C compared to the control group (32%) (p = 0.018). Multivariable analysis identified mode of delivery, reflecting differences in post-birth care routines and SSC duration, as the only factor independently associated with temperature changes during SSC. Conclusions: Under routine clinical conditions, brief and interrupted SSC was associated with transient reductions in neonatal body temperature; however, brief SSC was associated with a lower proportion of hypothermia compared with immediate incubation care, suggesting that even short periods of SSC may support early neonatal thermoregulation. Full article

Background and Objectives: Despite the development of medicine, there is no clearly established scheme for the prediction of intra-amniotic infection (IAI). In this study, evaluation of some predictors of IAI confirmed in histopathological examination was performed. Materials and Methods: The study population included 70 patients all giving birth by cesarean section divided into two groups: study (n = 34) consisting of patients with histologically confirmed IAI and control (n = 36) without IAI. Biological material included the mother’s venous blood to determine C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT) concentrations; vaginal discharge to determine IL-6; cervical canal swabs to perform cultures for bacteria and fungi and polymerase chain reaction (PCR) for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis; amniotic fluid to perform cultures for aerobic and anaerobic bacteria and PCR for atypical pathogens, and to determine glucose, IL-6, and PCT concentrations; umbilical cord blood to determine PCT, CRP, Il-6 and blood culture. A fragment of the placenta and fetal membranes was taken for histopathological assessment of the inflammatory infiltrate. Results: Mothers’ serum CRP assessments as well as serum PCT assessments are of poor diagnostic value in the prediction of IAI confirmed in histopathological examination. Conclusions: The best predictive values of IAI confirmed in histopathological examination were amniotic fluid glucose and vaginal fluid IL-6 determinations. Full article

Background: The increasing number of cesarean deliveries worldwide has led to a growing population of women eligible for vaginal birth after cesarean (VBAC). limited evidence exists regarding the natural progression of labor among secundiparous women experiencing their first vaginal delivery. Evidence regarding labor progression among women attempting VBAC remains inconclusive and with conflicting results. Clarifying these differences is essential for optimizing intrapartum management. Our objective was to compare the progression rate of the active phase of labor between secundiparous womne at their first VBAC and primiparous women who delivered vaginally. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated medical center (January 2011–January 2021). Included were term singleton pregnancies in spontaneous labor resulting in vaginal delivery. Exclusion criteria included induction, augmentation, and operative vaginal delivery. Results: Among 13,983 primiparous and 736 VBAC patients, the VBAC group was older, used epidural more frequently, and had higher neonatal birth weight. The cervical dilatation rate during the active phase was faster in VBAC patients (3.26 vs. 2.85 cm/h, p = 0.011), with a shorter second stage (77.8 vs. 86.6 min, p < 0.001). The rate of prolonged second stage was higher in the primiparous group (9.5% vs. 7.1%, p = 0.029). In a multivariable analysis examining the association between VBAC and prolonged second stage, VBAC was found to be inversely associated with prolonged second stage (OR 0.541, 95% CI 0.388–0.753, p = 0.001). Conclusions: When compared to primiparous women, women at their first VBAC had significantly shorter active phase and increased progression rate as well as a shorter second stage of labor. Full article

Background and Objectives: Extremely preterm infants (<28 weeks’ gestation) face high risks of morbidity and mortality, and the optimal mode of delivery for this population is debated. This retrospective study evaluated the impact of delivery mode (vaginal vs. cesarean section) on neonatal outcomes in extremely preterm infants. Materials and Methods: Ninety-two singleton births at 22 + 0 to 25 + 6 weeks of gestation were analyzed. Primary endpoints were survival to discharge; intraventricular hemorrhage (IVH); necrotizing enterocolitis (NEC); and arterial umbilical cord pH. Secondary endpoints included APGAR scores; preterm premature rupture of membranes (PPROMs); and pathological vaginal microbial colonization. Results: Survival to discharge did not differ significantly between vaginal delivery (84.8%) and cesarean section (93.5%) (p = 0.140). No significant differences were observed for NEC, APGAR scores, or umbilical arterial cord pH. IVH occurred more often after vaginal birth (47.8% vs. 30.4%, p = 0.080). In multivariable analysis, male sex was significantly associated with adverse outcome (p = 0.041); while PPROM showed a borderline association (p = 0.079). Complete antenatal corticosteroid administration was more frequent in the cesarean group (p = 0.021) and represented a relevant confounder. Conclusions: Delivery mode had no significant effect on survival in this cohort, though IVH tended to occur more frequently after vaginal birth. Male sex and complete antenatal corticosteroid exposure were key determinants of neonatal outcome. Prospective studies are needed to establish evidence-based recommendations. Full article

Background/Objectives: Twin pregnancies have long been of interest to the scientific community. Particular attention has been paid to factors influencing the postnatal condition of newborns. However, findings related to this issue, obtained in various centres, remain inconclusive. Methods: Data from 845 pairs of twins born between 1990 and 2017 at the University Centre of Obstetrics and Gynecology in the Wroclaw Medical University were analyzed. The postnatal condition was assessed based on the Apgar score at the 5th minute after birth. The Apgar scores were categorized into three groups: 8–10 indicated a good condition, 4–7 moderate, and 0–3 poor. Pregnancies with unknown chorionicity and amnionicity, monochorionic and monoamniotic pregnancies, still births, and cases with fetal defects were excluded from the study (126 cases). Finally, data of 719 pairs of twins were included. Results: Twins with a birth weight difference of less than 15% were more likely to receive a good Apgar score compared to those with a greater weight discrepancy (p < 0.001). The second-born twin was more likely to receive a good Apgar score compared to the first-born (p < 0.001). A higher proportion of twins delivered by cesarean section received a good Apgar score compared to those delivered vaginally (p < 0.001). The method of conception, chorionicity, amnionicity and being the smaller or bigger twin in the pair did not significantly affect the perinatal outcomes. Conclusions: Delivery method, birth order, and weight discrepancy play a key role in postnatal condition of twins, highlighting the importance of understanding these factors to optimize the management of twin pregnancies. Full article

Background and Objectives: Vernix caseosa peritonitis (VCP) is rare. Nonspecific symptoms of acute abdomen during early puerperium make preoperative diagnosis of VCP challenging. We aimed to identify risk factors, early diagnosis and treatment options, and the association between the timing and severity of VCP diagnosis and maternal outcomes. Materials and Methods: We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed according to the PRISMA guidelines. The search items included: ‘vernix caseosa peritonitis, ‘vernix caseosa granuloma, ‘maternal meconium peritonitis’, ‘maternal meconium granuloma’, ‘vernix caseosa’, ‘peritonitis’, ‘pregnancy’, ‘puerperium’, ‘postpartum’, and ‘gravid’. Additional studies were extracted by reviewing the reference lists of retrieved studies. Demographic, clinical, obstetric, diagnostic, and treatment parameters, and outcomes were collected. Results: Out of 55 published VCP case reports, 46 were available. Most involved term pregnancies (84.8%) and were delivered by Cesarean section (CS) (87%), with no difference in parity distribution (χ²(2) = 1.1875, p = 0.5523) or fetal sex (m: f = 53.3%: 46.7%). Common symptoms included abdominal pain and fever over 38 °C, while dyspnea or tachypnea was unexpectedly frequent (23.9%/15.2%). The interval from delivery to surgery ranged from 4 to 13 days (average 8 days), with no difference between CS and vaginal deliveries. Preoperative VCP was diagnosed in only 4.3% of cases, and intraoperative diagnosis occurred in 60.9%. Intraoperative microbiology and histopathology (vernix components) were positive in 6.5% and 89.1%, respectively. The birth weight was normal (3656 ± 509 g), with no maternal or neonatal deaths. Conclusions: VCP primarily develops in term pregnancies delivered by CS, without other risk factors. Despite extremely low preoperative and unexpectedly low intraoperative diagnosis and treatment delay of several days, there is no maternal or fetal mortality. The time to symptom onset is similar between women who delivered vaginally and those who had a CS. All women with VCP after vaginal delivery had previous deliveries. Abdominal pain with a fever over 38 °C and dyspnea or tachypnea in the early puerperium suggests VCP. Surgical lavage is the primary treatment, while corticosteroids have been reported to be beneficial in several cases, and antibiotics seem to have a limited role. Full article

Background: Cesarean section (CS) is a critical surgical procedure in obstetrics but is increasingly overused worldwide. Vietnam has seen rising CS rates, especially in urban tertiary hospitals, with limited standardized analysis to guide interventions. This study assesses CS rates at Tu Du Hospital using the WHO-endorsed Robson 10-Group Classification System. Methods: A cross-sectional descriptive study was conducted over one month in 2017 at Tu Du Hospital, a major obstetrics referral center in southern Vietnam. All women who delivered during this period were classified into Robson’s 10 groups based on parity, gestational age, labor onset, presentation, fetal number, and prior CS. CS rates and group-specific contributions were analyzed. Results: Among 5287 deliveries, the overall CS rate was 42.6%. Group 5 (previous CS) contributed 29.7% of all CSs, followed by Group 2 (nulliparous, induced/pre-labor CS, 26.2%) and Group 1 (nulliparous, spontaneous labor, 12.8%). Failed induction, fetal distress, and cephalopelvic disproportion were common indications. Only 22% of eligible women in Group 5 were offered a trial of labor after cesarean (TOLAC), although the success rate for vaginal birth after cesarean (VBAC) was 67%, indicating underutilization of this option. Conclusions: This study provides rare Robson-based evidence from Vietnam, identifying key target groups for intervention. The findings support expanded use of VBAC and more stringent criteria for induction. Future research should explore behavioral and systemic drivers of high CS rates to guide national policy. Full article

IgG Fc binding protein (FcGBP) is a mucin-like protein that binds strongly to IgG and IgG–antigen complexes in intestinal mucus. FcGBP presence and its altered expression levels in meconium accumulating in the fetal intestine and amniotic fluid flowing in the intestine may provide new knowledge of the mechanisms responsible for the immune adaptation of the fetus to extrauterine life. FcGBP concentrations were measured by ELISA in the first-pass meconium and amniotic fluid samples collected from 120 healthy neonates delivered by either vaginal birth (n = 35) or cesarean section (n = 85) at 36 to 41 weeks gestation. The meconium FcGBP concentrations (405.78 ± 145.22 ng/g) decreased (r = −0.241, p = 0.007) over the course of 36 to 41 weeks gestation, but there were no significant changes (p > 0.05) in the amniotic fluid FcGBP (135.70 ± 35.83 ng/mL) in the same period. Both meconium and amniotic fluid FcGBP concentrations were higher (p < 0.05) in neonates delivered by cesarean section. Decreases in the meconium FcGBP concentrations correlated (r = −0.37, p = 0.027) with the gestational age in neonates delivered by vaginal birth but not in those delivered by cesarean section (p > 0.05). No association was found between the FcGBP concentrations in meconium and amniotic fluid and the birth weight (p > 0.05). With the development of the mucosal immune system in the fetal intestine over the course of the third trimester of gestation, the meconium FcGBP concentrations decrease. Increased FcGBP concentrations measured in the meconium and amniotic fluid of neonates delivered by cesarean section may possibly indicate altered intestinal mucosal function. Intrauterine growth is not associated with the intestinal mucosal barrier maturation involving FcGBP. Full article

Background/Objectives: Recent changes in obstetric practices and population demographics have prompted a re-evaluation of labor patterns. This study aimed to characterize labor patterns in a Greek pregnant population using ultrasound and compare them with established labor curves. Methods: A prospective cohort study was conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, over a two-year period (December 2022 to June 2024). Transabdominal ultrasound was used to determine the fetal head position and transperineal ultrasound was used to measure angle of progression (AoP) and head–perineum distance (HPD) during labor. Maternal and labor characteristics, including body mass index (BMI), parity, labor duration, and mode of delivery, were recorded. Statistical analysis included mixed linear models to assess the relationship between AoP, HPD, and cervical dilatation. Results: In total, 500 parturients were included in this study. Women entered the active phase of labor approximately 5 h before delivery, with AoP increasing sharply and HPD decreasing rapidly at this point. Cesarean section (CS) cases showed a slower increase in AoP compared to vaginal deliveries (VDs), with CS cases having a mean AoP of 117.9° (95% CI: 111.6–124.2°) at full dilation, compared to 133.4° (95% CI: 130.6–136.2°) in VD. HPD values declined more slowly in CS cases, with a mean HPD of 45.1 mm (95% CI: 40.6–49.6 mm) at full dilation, compared to 36.4 mm (95% CI: 34.3–38.5 mm) in VD. Epidural analgesia was associated with steeper increases in AoP and decreases in HPD in the final 2.5 h before delivery, while oxytocin administration accelerated these changes in the last 3–4 h. The mean time to delivery was 3.19 h (95% CI: 2.80–3.59 h) when AoP reached 125° and 3.92 h when HPD was 40 mm (95% CI: 3.53–4.30 h). BMI in women who gave birth via CS was significantly higher compared to VD (32.03 vs. 29.94 kg/m², p-value: 0.008), and the total duration of labor was shorter in VD compared to CS and operative vaginal delivery (OVD) (8 h vs. 15 h, p-value < 0.001 and 8 h vs. 12 h, p-value < 0.001, respectively). Birthweight was also lower in VD compared to CS (3103.09 g vs. 3267.88 g, p-value: 0.05). Conclusions: This study provides the first ultrasonographic characterization of labor patterns in a Greek population, highlighting the utility of ultrasound in objectively assessing labor progression. Full article

Background/Objectives: Cesarean delivery often leads to delayed breastfeeding initiation, potentially affecting infant health compared with vaginal delivery. This prospective observational study (conducted between August 2022 and January 2024) comparatively evaluates the impact of delivery method—vaginal, planned cesarean, and emergency cesarean—on breastfeeding initiation and continuation and examines the maternal factors influencing these outcomes. Materials and Methods: We enrolled 338 mother–infant pairs at a tertiary university hospital. Breastfeeding effectiveness was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at birth and at one, three, and six months postpartum. Rates of breastfeeding continuation and formula supplementation were documented through structured interviews. Results: The mothers who delivered vaginally had a significantly higher rate of breastfeeding within one hour after birth (85.5%) compared with planned (57.9%) and emergency cesarean sections (64.9%) (p < 0.001). Baseline BBAT scores were higher for vaginal births but converged across the groups by one month postpartum (p > 0.05). At six months, breastfeeding continuation rates remained high (94.4–95.2%) irrespective of delivery method. Conclusions: Delivery method exerts a transient effect on breastfeeding initiation. With lactation support, the mothers delivering by cesarean section achieved comparable breastfeeding outcomes within the first month postpartum. These findings reinforce the importance of Baby-Friendly Hospital Initiative (BFHI) practices, including immediate skin-to-skin contact, effective pain management, and lactation counseling, in ensuring equitable breastfeeding outcomes. Full article

Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women’s Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99–7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10–6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025–20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21–40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38–17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13–3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes. Full article

Background and Objectives: For many patients, the induction-to-delivery interval is shorter with Propess than with Prostin E2. However, some patients also require Prostin E2 to sufficiently boost their dinoprostone levels to achieve cervical change and vaginal delivery. In this study, we compared the efficacy of different timings of Prostin E2 administration after Propess use. Materials and Methods: This single-institution retrospective cohort study was conducted between January 2020 and August 2023. The inclusion criterion was an unfavorable cervix (Bishop score ≤ 6) after Propess use for 8 h. We divided the patients into three groups based on the addition of Prostin E2 at the 8th (group 1), 12th (group 2), and 24th (group 3) hour after Propess insertion. The primary outcome was the cesarean section rate. The secondary outcomes were the induction-to-birth interval, Bishop score at 24 h, neonatal outcomes, and the predictors of labor induction duration. Results: A total of 63 patients were analyzed across three groups based on the timing of Prostin E2 administration (8, 12, and 24 h). The gestational age differed significantly between groups (p < 0.001), with the highest age being observed in the 24 h group. The 8 h group had the shortest induction-to-birth interval (p < 0.001) and the highest Bishop scores after 24 h of Propess use (p < 0.001). Blood loss was lowest in the 12 h group (p = 0.027). No significant differences were found in relation to the mode of birth, tachysystole, neonatal birth weight, or Apgar scores. A multivariable analysis identified gestational age (β = 3.33; p = 0.015) and Bishop score after 24 h of PGE2 (β = −1.99; p < 0.001) as being independent predictors of labor duration. Conclusions: administering Prostin E2 to patients who had a poor response after Propess use was safe; additionally, adding it at the 8th hour after Propess initiation could result in a shorter induction-to-birth interval. Full article

Background/Objectives: Using healthcare vouchers mitigates the financial burdens of low-income individuals, therefore enhancing mothers’ satisfaction and encouraging service utilization. In Yemen, reducing financial barriers results in marked improvement in reproductive health services utilization for mothers and their newborns. Such financial strain can be addressed through reproductive health vouchers, which reduce out-of-pocket expenses of family planning, pregnancy, birth, postnatal care and neonatal care. This study compares the Safe Motherhood and Family Planning Voucher Program in the Lahj governorate to the non-voucher program in the Abyan governorate in terms of enhancement of reproductive healthcare accessibility and use. Methods: This facility-based, quantitative, comparative, cross-sectional study was conducted in the Lahj governorate, which supports the Safe Motherhood and Family Planning Voucher Program, and the Abyan governorate, which does not. Results: The voucher-supported program has greatly improved mothers’ satisfaction, access, and use of all reproductive health services by covering transportation, covering lodging during hospitalization, and providing free reproductive treatments. Compared to Abyan mothers, Lahj governorate mothers more frequently used rental vehicles (paid for by the voucher program) and free reproductive health services (p-value < 0.001). Lahj governorate mothers (who used the vouchers) used family planning, prenatal care, facility-based delivery, home delivery by competent birth staff, cesarean section, postnatal care, and neonatal care more frequently than Abyan governorate mothers. A health institution which supported the Safe Motherhood and Family Planning Voucher Program (SMHFPVP) provided prenatal care (98.5%), competent birth services (99.0%), and modern contraceptive use (92.3%)—oral contraceptive pills, implants, injectables, contraceptive patches, vaginal rings, and intrauterine devices—for mothers who were interviewed and attended the targeted HFs in the Lahj governorate, compared with (77.6%), (80.3%), and (67.8%), respectively, for mothers in Abyan governorate who were not supported by the SMHFPVP. This study demonstrates substantially higher satisfaction levels among voucher-using mothers in the Lahj governorate compared to those in the Abyan governorate, across all satisfaction domains and overall satisfaction scores. Conclusions: This study found that women without access to maternal health vouchers experienced worse prenatal, natal, and postnatal care and were less satisfied with healthcare services compared with women who used vouchers. Full article

Although Cesarean section (C-section) delivery is often a necessary medical intervention, it also increases the risk of the infant developing chronic inflammatory, metabolic, and neurodevelopmental disorders. The association of C-section with the development of these conditions is thought to be partially mediated by the effects of the C-section on the infant’s microbiome development and subsequent immune regulation. C-section-delivered infants acquire a different set of microbes compared with infants who are vaginally delivered. “Vaginal seeding” exposes C-section-delivered infants to the maternal vaginal microbiome directly after birth, partly replicating the microbial exposures they would have received during a vaginal delivery. Studies have shown that vaginal seeding at birth partially restores the infant microbiome towards that of a vaginally delivered infant. More recently, preliminary studies have shown a potential benefit of vaginal seeding on health outcomes. Here, we examine the evidence from observational studies and randomized controlled trials that have evaluated microbiome restoration after C-section, and we discuss new research assessing the potential impact of vaginal seeding on immune, metabolic, and neurodevelopmental outcomes and the underlying mechanisms. Collectively, we review the potential health benefits, safety risks, regulatory implications, and future directions for the use of vaginal seeding in infants delivered by C-section. Full article

Cesarean sections (CSs) are essential in certain medical contexts but, when overused, can carry risks for both the mother and child. In the unique multilingual landscape of Luxembourg, this study explores whether non-medical factors—such as the language spoken—affect CS rates. Through a survey conducted with women in Luxembourg, we first applied statistical methods to investigate the influence of various social and linguistic parameters on CS. Additionally, we explored how these factors relate to the feelings of happiness and respect women experience during childbirth. Subsequently, we employed four machine learning models to predict CS based on the survey data. Our findings reveal that women who speak Spanish have a statistically higher likelihood of undergoing a CS than women that do not report speaking that language. Furthermore, those who had CS report feeling less happy and respected compared to those with vaginal births. With both limited and augmented data, our models achieve an average accuracy of approximately 81% in predicting CS. While this study serves as an initial exploration into the social aspects of childbirth, it underscores the need for larger-scale studies to deepen our understanding and to inform policy-makers and health practitioners that support women during their pregnancies and births. This preliminary research advocates for further investigation to address this complex social issue comprehensively. Full article