Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section.

Uterine rupture is a rupture of the body or lower part of the uterus during pregnancy or delivery. Total of 98 cases with incomplete uterine rupture were classified as the incomplete uterine rupture group, 100 cases with a history of cesarean delivery without uterine rupture were classified as the non-ruptured uterus group, and controls were selected using a systematic sampling method. The maternal age ≥35 years were associated with 2.18 times higher odds of having an incomplete uterine rupture. The odd of having an incomplete uterine rupture was 3.744 times higher for a woman with delivery interval ≤36 months. Having pregnancy complication was associated with 3.961 times higher odds of having an incomplete uterine rupture. The neonatal weight was lighter in the incomplete uterine rupture group (P = 0.007). The number of preterm birth and transfer to the NICU were higher in the incomplete uterine rupture group (P ＜ 0.01). The operation time and the length of time in hospital were longer in the group with incomplete uterine rupture (P ＜ 0.01). Age ≥35 years, delivery interval ≤36 month, and pregnancy with complication were independent risk factors of incomplete rupture of the uterus secondary to previous cesarean section.

The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study.

Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.

Performance of Bakri balloon tamponade in controlling postpartum hemorrhage.

OBJECTIVE: Bakri balloon tamponade (BBT) is currently being used worldwide. This study aimed to explore the real-world performance of BBT for the treatment of postpartum hemorrhage (PPH). METHODS: A total of 279 women with PPH who failed to respond to first-line conservative management and received BBT were consecutively recruited, reflecting authentic settings. The maternal baseline clinical data, PPH management, and perinatal outcome were recorded. In addition, the perinatal outcomes of women with pre-BBT blood loss <1000 mL were compared to those with ≥1000 mL. Finally, the factors related to pre-BBT blood loss ≥1000 mL were analyzed by logistic regression. RESULTS: The mean gestational age of all recruited women was 39.03±1.98 weeks, with a primipara proportion of 68.82%, a vaginal delivery rate of 60.93%, a uterine atony rate of 74.91%, and placenta accreta rate of 53.05%. Perinatal outcomes showed a hemostasis success rate of 88.89%, a transvaginal BBT placement rate of 80.29%, and a blood transfusion rate of 65.95%. Compared to women with blood loss <1000 mL (33.33%), women with blood loss ≥1000 mL (66.67%) showed a lower proportion of gestational hypertension (P=0.026), cesarean section (P=0.024), a shorter time from delivery to insertion (P=0.037), and greater pre-BBT blood loss and blood transfusion (both P<0.001). Notably, there were no significant differences in hemostasis success rate (P=0.346) or post-BBT blood loss (P=0.907). Delivery mode and uterine atony were closely correlated with pre-BBT blood loss. CONCLUSIONS: BBT is effective in stopping PPH among women with massive blood loss in documented settings.

Effects of Antenatal Lifestyle Interventions in Pregnant Women with Normal Body Mass Index.

Background: We aimed to explore the effect of lifestyle interventions on improving lifestyle behaviors on gestational weight gain in pregnant women with normal body mass index (BMI). Methods: The study was conducted in Maternal and Child Health Hospital of Hubei Province (Wuhan, China) between June 2020 and April 2022. A total of 355 pregnant women (<12 weeks of pregnancy) were enrolled and finally completed the program. Participants were divided into the intervention and control groups. The intervention group received an individualized lifestyle intervention focusing on healthy lifestyle, like diet, exercise, and weight monitoring as four sessions at 16-18, 20-24, 28-30 and 34 weeks' gestation. Participants in the control group received routine antenatal care. The weight of both group was recorded from pregnancy until 6-8 weeks postpartum. Results: The participants in the intervention group with normal pre-pregnancy BMI (n = 178) had lower GWG, excessive GWG, hypertension, and neonate birth weight compared to the control group (n = 177, P<0.01). There were no statistically significant differences in the occurrence of gestational diabetes, premature labor, delivery mode, preterm birth, small for gestational age, macrosomia, number of neonates referred to the NICU, and postpartum weight retention. Conclusion: Even though lifestyle intervention in pregnant women with normal BMI has a relatively limited effect, attention should still be paid to reasonable weight gain during pregnancy and the potential long-term impact of the intervention remains to be assessed.

Bakri Balloon for Treatment of Postpartum Hemorrhage: A Real-World 2016-2020 Study in 279 Women from a Single Center.

BACKGROUND Postpartum hemorrhage (PPH) may be primary or secondary and is defined as the loss of 500 ml or more of blood within the first 24 h after birth. The Bakri balloon tamponade (BBT) is an intrauterine device used as an adjunctive treatment for refractory PPH. The aim of this study was to present the real-world experience from a single center on the effectiveness of the BBT for the treatment of PPH. MATERIAL AND METHODS This cohort study of 279 women was conducted in a real-world setting. Patients' characteristics and clinical outcomes between the BBT Success group and BBT Failure group were analyzed by t test or chi-square test. The primary outcome was the success rate of BBT. The secondary outcomes were the perinatal outcomes. RESULTS The success rate of BBT was 88.89% (248/279). A blood transfusion rate of 65.95% (184/279) was observed. After using the BBT, significant differences were observed in intervention (P<0.001), blood loss (P<0.001), indwelling time of BBT (P<0.001), and blood transfusion (P<0.001) between the Success group and Failure group. The Success group showed greater range of descent in blood loss (991.56.15±13.65 mL in Success group vs 816.23±7.57 mL in Failure group). Of the 31 women with BBT failure, 87.10% (27/31) received uterine artery embolization (UAE), 96.77% (30/31) received blood transfusion, and none required a hysterectomy. CONCLUSIONS The findings from this study from a single center in China supported those from previous studies showing that the BBT was an effective treatment to control PPH.

Analysis of Pregnancy Characteristics and Perinatal Outcome of Mediastinal Uterus in China.

Background: To analyze the complications and outcome of mediastinal uterine pregnancy, and put forward targeted prevention and treatment measures. Methods: A total of 248 pregnant women with mediastinal uterus treated were enrolled from Jan 2015 to Dec 2018 in the Maternal and Child Health Hospital of Hubei Province, China. The data, including complications of pregnancy, gestational weeks, mode of delivery, postpartum hemorrhage, placental condition and perinatal prognosis, were collected and analyzed. Results: There were 12 cases with abnormal fetal position in the previous cesarean section. The total number of cases with abnormal fetal position was 99(49.75%). For women with abnormal fetal position during mediastinal uterine pregnancy, there was a significant increase in the incidence of placental abruption (P<0.05). The average gestational age at termination of pregnancy was 37+5weeks. There were 55 cases (22.18%) of premature and 49 cases (19.75%) of premature rupture of membranes, including 29 cases of abnormal fetal position and premature rupture of membranes, mediastinal uterus preterm birth, premature rupture of membranes (P<0.05). There were 13 cases (5.24%) of postpartum hemorrhage, natural birth without neonatal asphyxia, five cases (2.02%) of neonatal asphyxia, preterm birth, and 51 cases (20.56%) of placental adhesion. Of these, 37 cases were cesarean, 13 were spontaneous production, and 71 were fetal umbilical cord winding. Conclusion: The pregnancy induced spontaneous abortion, premature delivery, premature rupture of membranes and abnormal fetal position in mediastinal uterus are significantly higher than normal pregnancy. The complications during delivery are significantly higher than in normal pregnant women.

Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term.

Labor induction is commonly used for achieving successful vaginal delivery. This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term. A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital. Basic clinical characteristics were collected. The main outcomes were vaginal delivery rate, cesarean section rate and forceps delivery rate. Obstetric and perinatal outcomes were also compared. Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h. A total of 845 eligible primipara women undergoing labor induction were recruited. Of them, 141 women were induced with dinoprostone (dinoprostone group, DG), and 704 with Cook's balloon (Cook's balloon group, CG). Groups were homogeneous except more women with premature rupture of membranes in DG, with gestational hypertension in CG (P<0.05). The vaginal delivery rate within 12 h was 1.98% and 16.52% in CG and DG respectively (P=0.0001). Besides, the vaginal delivery rate within 24 h was 37.62% and 52.26% in CG and DG respectively (P=0.0079). DG showed the lower rate of oxytocin augmentation, artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG (P<0.05). Multivariate regression analysis revealed that abortion history, oxytocin augmentation, artificial rupture of membrane, and obstetric analgesia were independent predictors for vaginal delivery within 24 h. In conclusion, dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.