Secondary syphilis in the third trimester of pregnancy.

Syphilis infections discovered late in pregnancy, as in this case, may not be treated long enough for delivery. The Japanese guidelines should be revised because they do not describe the mode of delivery for pregnant women infected with syphilis.

Prevalence of Surgical Site Infection (SSI) and Its Association With Vitamin D Deficiency.

BACKGROUND AND AIM: Surgical site infections (SSIs) are one of the significant complications detected after surgical procedures. Recent studies have highlighted the antimicrobial, wound-healing, and immunological properties of vitamin D. Therefore, this study examined the association between levels of preoperative vitamin D and SSI occurrence in Saudi Arabia. METHODS: We conducted this retrospective observational study among patients who underwent surgery at King Faisal Medical Complex, Saudi Arabia. We included data from patients who underwent surgery between January 2021 and October 2023 in the study. If vitamin D concentrations were not measured at admission, patients were excluded from the final analysis. The researchers performed statistical analysis using the computer program Statistical Package for Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY). The significant level was considered when the p-value was less than 0.05. RESULTS: The study included 130 patients with a mean (SD) age of 26.98 (9.3) years. Most patients were females (n = 92, 70.8%), had diabetes mellitus disease (n = 121, 93.1%), had a vitamin D deficiency (<30 ng/dl) (n = 106, 81.5%), and underwent cesarean section (n = 80, 61.5%). The mean (SD) vitamin D level among patients was 19.9 (9.7) ng/dl, and the mean (SD) hemoglobin level was almost normal (12.30 (2.1) g/dl). Out of 40.8% (n = 53) of patients, the most detected pathogenic bacteria was Escherichia coli, followed by Staphylococcus aureus (n = 11, 44%, and n = 7, 25%, respectively). Furthermore, vitamin D deficiency significantly impacted positive SSI; patients with insufficient levels had a higher infection rate compared to those with sufficient levels (n = 58, 54.7% vs. n = 7, 29.2%, p-value = 0.024). A longer surgery duration did not increase the risk of SSI (p-value = 0.047). Patients with class 3 wounds were more prone to SSI than those with class 2 wounds (n = 12, 100% vs. n = 53, 44.9%, p-value<0.001). CONCLUSION: This study provides important evidence supporting the relationship between vitamin D deficiency and SSI incidence. Patients with lower levels of vitamin D reported a higher incidence of SSIs. Healthcare providers should pay attention to the high prevalence of vitamin D deficiency among patients undergoing surgery. Screening for vitamin D deficiency and implementing convenient interventions to optimize vitamin D levels could help reduce the incidence of SSIs. Further research with larger sample sizes, more diverse populations, and different surgery types is necessary to validate these findings and explore additional factors influencing SSI development.

Urgent Cesarean Section in a Patient on Venovenous Extracorporeal Membrane Oxygenation.

A G7P6 40-year-old female at 20 weeks gestation, with a history of polysubstance use disorder and hepatitis C, presented to the emergency department with severe shortness of breath and hypoxia requiring intubation. After a thorough workup, she was diagnosed with aspiration pneumonitis and was treated with a course of antibiotics. After progressing well, she was soon extubated and transferred to a subacute rehabilitation facility (SAR). There, she acutely decompensated, requiring readmission, reintubation, and venovenous extracorporeal membrane oxygenation (ECMO) cannulation. After a brief period of improvement, the patient became increasingly unstable with hypotension, anemia, and downtrending fibrinogen. Bedside imaging indicated a possible placental abruption. After extensive discussion among the care teams and patient's healthcare proxy, an urgent cesarean section was performed. Although the fetus was determined to be nonviable, the patient tolerated the procedure well and was eventually decannulated from ECMO and transferred to a SAR.

Outcome of subsequent pregnancies in women with prior uterine rupture.

OBJECTIVE: To report maternal and neonatal outcomes of subsequent pregnancies in a series of women with a prior uterine rupture. METHODS: The records of all 103,542 deliveries (22,286 by cesarean section) performed in a single tertiary medical center from 2009 to 2021 were reviewed. Women with a prior uterine rupture, defined as a separation of the entire thickness of the uterine wall, with extrusion of fetal parts and intra-amniotic contents into the peritoneal cavity documented in the operative report of the previous cesarean delivery or laparotomy, were identified for inclusion in the study. RESULTS: The cohort included 38 women with 50 pregnancies (50 neonates). Women had been scheduled for elective cesarean delivery at early term. Mean gestational age at delivery was 36 + 4 weeks (±5 days). In 7 pregnancies (14 %), spontaneous labor occurred before the scheduled cesarean delivery (at 36 + 6, 35 + 4, 35 + 3, 34 + 6, 34 + 3, 32 + 6 and 31 + 0 gestational weeks). A recurrent uterine scar rupture was found in 4 pregnancies (8 %), and uterine scar dehiscence, in 2 pregnancies (4 %), all identified during elective repeat cesarean delivery. In none of these cases was there a clinical suspicion beforehand; all had good maternal and neonatal outcomes. One parturient with placenta previa-accreta had a planned cesarean hysterectomy. CONCLUSION: Women with prior uterine rupture have good maternal and neonatal outcomes in subsequent pregnancies when managed at a tertiary medical center, with planned elective term cesarean delivery, or even earlier, at the onset of spontaneous preterm labor.

Progesterone Analysis in Canine Breeding Management.

Progesterone is a worthwhile addition to the clinical assessment of cycle stage for breeding, elective cesarian delivery, and reproductive management in the bitch if reliably measured. Clinical decisions based on systemic progesterone concentrations also require the rapid return of results. Most commercially accessible analyses capable of returning results within a day still rely primarily on immunoassays of one kind or another. Point-of-care instruments utilizing similar technology have been developed more recently to enable results to be generated in-house. Repeated monitoring of progesterone on whatever platform can be useful if consistent collection and analysis protocols ensure acceptable precision, accuracy, and repeatability.

Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review.

INTRODUCTION: In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas. METHODS: Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools. RESULTS: Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals. CONCLUSIONS: Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.

The effect of acupressure on postpartum fatigue in women delivering by caesarean section: A randomized controlled study.

AIM: The aim of this study was to determine the effect of acupressure on postpartum fatigue in women who gave birth by cesarean section. METHOD: This study is a randomized controlled experimental study. The study was conducted between August 2021 and January 2022 in the maternity wards of hospitals in Turkey. Multiparous women who gave birth by cesarean section were randomly assigned to acupressure (n = 60) and control (n = 62) groups. Acupressure was applied to the acupressure group for a total of four sessions on the points of LI4, ST36, and SP6, for an average of 15 min for each session. The application sessions continued for 48 h after the cesarean section. The data were collected with a Descriptive Information Form and the VAS-F. RESULTS: It was determined that the mean posttest score of the fatigue dimension of the VAS-F was found to be significantly lower in the acupressure group (p = 0.023). Additionally, in the acupressure group, while the differences between the pretest and posttest results of the both fatigue and energy dimensions of the VAS-F were statistically highly significant in the acupressure group (p = 0.000), only the difference in the energy dimension was found to be statistically significant in the control group (p = 0.016). CONCLUSIONS: As a result, acupressure was found to be effective in reducing postpartum fatigue in women who gave birth by cesarean section, and its usability for healthcare professionals was demonstrated.

Peripartum Complications as Risk Factors for Postpartum Psychosis: A Systemic Review.

The aim of this research paper is to conduct a systematic review of periparturient complications as risk factors of postpartum psychosis. The investigation of risk factors for maternal psychosis following childbirth is complicated by the risk of confounding by a previous psychiatric history; therefore, this systematic review focuses on labor complications as risk factors among women without any previous psychiatric hospitalizations or diagnoses. Articles were collected and analyzed from the PubMed, MEDLINE, and Cochrane Review Library databases, as well as Clinicaltrials.gov, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article abstracts and article titles of the identified publications were screened independently by all seven authors, and studies were selected if they met the following inclusion criteria: patients were diagnosed with postpartum psychosis per the guidelines in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), DSM-IV or World Health Organization's ICD-10 Classification of Mental and Behavioral Disorders; patients presented with no prior psychiatric diagnoses, hospitalizations or history; and the study evaluated the association of periparturient complications to first-onset postpartum psychosis, excluding narrative reviews, systematic reviews, or meta-analyses. Fifteen case-control, cohort, and case report studies, with thousands of patients, were selected to investigate the correlation between perinatal complications and first-onset post-partum psychosis. Obstetric complications during childbirth significantly predisposed for postpartum psychosis in certain individual studies but did not reveal an association in others. More studies must be implemented to elaborate on this limited scope.

Association between prenatal provision of lipid-based nutrient supplements and caesarean delivery: Findings from a randomised controlled trial in Malawi.

In populations with a high prevalence of childhood and adolescent undernutrition, supplementation during pregnancy aiming at improving maternal nutritional status and preventing fetal growth restriction might theoretically lead to cephalopelvic disproportion and delivery complications. We investigated whether the prenatal provision of small-quantity lipid-based nutrient supplements (SQ-LNS) was associated with an increased risk of caesarean section (CS) or other delivery complications. Pregnant Malawian women were randomised to receive daily i) iron-folic acid (IFA) capsule (control), ii) multiple micronutrient (MMN) capsule of 18 micronutrients (second control), or iii) SQ-LNS with similar micronutrients as MMN, plus four minerals and macronutrients contributing 118 kcal. We analysed the associations of SQ-LNS, CS, and other delivery complications using log-binomial regressions. Among 1391 women enrolled, 1255 had delivery information available. The incidence of CS and delivery complications was 6.3% and 8.2%, respectively. The incidence of CS was 4.0%, 6.0%, and 8.9% (p = 0.017) in the IFA, MMN, and LNS groups, respectively. Compared to the IFA group, the relative risk (95% confidence interval) of CS was 2.2 (1.3-3.8) (p = 0.006) in the LNS group and 1.5 (0.8-2.7) (p = 0.200) in the MMN group. We found no significant differences for other delivery complications. Provision of SQ-LNS to pregnant women may have increased the incidence of CS. The baseline rate was, however, lower than recommended. It is unclear if the higher CS incidence in the SQ-LNS group resulted from increased obstetric needs or more active health seeking and a better supply of services. Trial registered at clinicaltrials.gov, NCT01239693.

Retained Placenta and Postpartum Hemorrhage: A Case Report and Review of Literature.

The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman. According to the American Pregnancy Association, a retained placenta is diagnosed if the placenta is not delivered within 30 minutes following delivery of the fetus. Retained placenta can be caused by placenta accreta, increta, or percreta. There are several complications of a retained placenta, including postpartum hemorrhage, which can lead to maternal death if not treated promptly. We report the case of a 32-year-old female, gravida 4 para 3, who was diagnosed with a retained placenta after delivering at term (39 weeks gestation). The retained placenta was complicated by postpartum hemorrhage and was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin, carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. Sharp curettage was also used with ultrasound to confirm that the uterus was empty, followed by one more suction curettage to remove any products of conception that were scraped off with sharp curettage. Vaginal bleeding was significantly reduced; minor bleeding was noted from a first-degree vaginal laceration, which was repaired by suture. The patient recovered from surgery and was discharged on postpartum day 3 with her neonate in stable condition. In conclusion, this case highlights that retained placenta is a serious obstetric complication that can cause life-threatening postpartum hemorrhage. More data are needed to define the period of time correlating with the greatest chance of encountering a retained placenta in order to improve obstetric care and reduce maternal morbidity and mortality. Future research should consider challenging the current definition of retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood bank to prevent catastrophic postpartum hemorrhage.

Can Fetal Heart Lie? Intrapartum CTG Changes in COVID-19 Mothers.

Background: COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome. Methods: A case-control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication. Results: COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities. Conclusions: The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-022-01663-6.

Utero-cutaneous fistula following cesarean section: A case report.

Utero-cutaneous fistula is a rare pathology. It mostly occurs consecutively to surgical intervention such as Cesarean section. Blood discharge from the cesarean scar during menstruation is a quasi-pathognomonic feature. Imaging modalities, particularly with the injection of contrast material through the cutaneous fistulous opening, confirm the diagnosis. The management is mainly surgical. We report the case of a utero-cutaneous fistula in a 27-year-old lady, with systemic lupus erythematosus. She presented seven months after her third cesarean section with pain and blood discharge from the cutaneous scar during menstruation for four months. A pelvic CT scan with the injection of the contrast material through the cutaneous fistulous opening confirmed the diagnosis of utero-cutaneous fistula. Surgical management was successful.

Insulin treatment of patients with gestational diabetes: does dosage play a role?

BACKGROUND AND OBJECTIVE: In nonpregnant patients high insulin requirements are associated with hypoglycemia and weight gain but not with improvement in glucose control. The effect of insulin requirement on maternal and neonatal outcomes in gestational diabetes mellitus (GDM) is yet unknown. METHODS: We conducted a retrospective cohort study of maternal and neonatal outcomes of pregnancy according to insulin requirements in women with GDM who were followed and delivered at the Yitzhak Shamir Medical Center between 2006 and 2016. The daily insulin dose in units per body weight was divided into quartiles and analyses were performed to compare the lowest, highest, and two middle quartiles. The primary outcome was a composite of any of the following: cesarean-section (CS), preeclampsia, macrosomia and large for gestational age (LGA) birth weight, neonatal intensive care unit admission, need for phototherapy, and neonatal hypoglycemia. RESULTS: Women were divided according to their insulin requirements as follows: 79 (24.8%) women who needed <0.13 IU/kg/day of insulin (insulin-sensitive group), 160 (50%) women who needed 0.14-0.42 IU/kg/day of insulin (comparison-group), and the rest who needed >0.43 IU/kg/day of insulin (insulin resistant group). There were no differences in the composite outcome between the groups (64.6, 61.3, and 69.6% for the insulin sensitive-, comparison- and resistant- groups, respectively, p = .44). Women in the insulin-resistant group had higher fasting glucose levels in the first trimester (91, 98 and 102 mg/dL for women in the insulin sensitive-, comparison- and insulin-resistant groups, respectively; p = .01). Women in the insulin-sensitive group had significantly better glycemic control (fasting glucose levels ≤90 mg/dL and 1-hour and 2-hour postprandial glucose levels ≤140 mg/dL and ≤120 mg/dL for more than 80% of measurements) than those in the insulin-resistant group (70.3 versus 29.9%; p < .001). The rate of CS was significantly higher in the insulin-resistant group (42.3 versus 24.1%; p = .03), but the rate of LGA birth weight was surprisingly higher in the insulin-sensitive group (29.5 versus 16.7%, p = .04). After controlling for confounders, women in the insulin-sensitive group had a decreased risk for CS in relation to the comparison group (OR = 0.46, 95%CI 0.23-0.9, p = .025). CONCLUSION: We found no association between insulin requirements and adverse composite outcome in women with GDM. However, those with higher insulin requirements have poorer glucose control and higher rates of CS than those with lower insulin requirements. Larger studies are needed to inquire short- and long-term outcomes of insulin requirements on fetal and maternal outcomes.

Combined hereditary thrombophilias are responsible for poor placental vascularization development and low molecular weight heparins (LMWH) prevent adverse pregnancy outcomes in these patients.

BACKGROUND: Even though thrombophilias are associated with negative pregnancy outcomes (PO), there is not a consensus of when thrombophilias should be screened for, or how they affect placental vascularization during pregnancy. Therefore, the main aim of this study was to discover inherited thrombophilias (IHT) in the first trimester in women with otherwise no indications for thrombophilia screening, based on their vascularization parameters. LMWH treatment in improvement of placental vascularization and PO was also assessed. Finally, the classification of thrombophilias based on observed obstetric risks was proposed. METHODS: Women were included in study based on their poor gestational sac and later utero-placental juncture vascularization signal and screening for inherited thrombophilias. LMWH were then initiated and Resistance index of Uterine artery (RIAU) was followed alongside PO (preterm birth, preeclampsia, placental abruption, intrauterine growth reduction). Study group consisted of women with combined inherited thrombophilias. Control group consisted of patients with inherited thrombophilias who have received LMWH therapy since pregnancy beginning. FINDINGS: Out of 219 women, 93 had IHT, and 43 had combined IHT. All pregnancies both in both groups ended up with live births. Vaginal birth was more present in the control group (p < .001), and all women in study group delivered by CS. Premature birth was present in 8.4% of patients in control group, and in 32.55% of the patients in the study (p < .001). PE wasn't noted, and only 1 case of PA in control group. In the control group, 6.5% patients had IUGR, and 32.55% in the study group (p < .05). Based on RIAU and PO, thrombophilia categories were established: S (severe), MO (moderate), MI (mild) and L (low). Higher risk thrombophilias had higher RIAU later in the pregnancy, earlier pregnancy termination and Intrauterine Growth Reduction (IUGR). CONCLUSIONS: Thrombophilias should be considered and screened when poor vascularization is noted early in the pregnancy with Doppler sonography. Intervention with LMWH prevents adverse PO in these patients.

El impacto de la dosis de bupivacaína epidural en los escalofríos en la cesárea: un ensayo aleatorizado / The impact of epidural bupivacaine dose on shivering in cesarean section: a randomized trial

Objetivo: El objetivo de este estudio fue investigar la relación entre la dosis intratecal de bupivacaína hiperbárica y la incidencia y severidad de los escalofríos postespinales en parturientas sometidas a cesárea. Material y métodos: Cien mujeres embarazadas a término que se sometieron a una cesárea electiva se distribuyeron aleatoriamente en dos grupos iguales de acuerdo con la dosis de bupivacaína administrada para la anestesia espinal. El grupo de bupivacaína de dosis baja (grupo LB) y el grupo de bupivacaína de dosis alta (grupo HB) recibieron 8 mg y 10 mg de bupivacaína respectivamente. La incidencia y la gravedad de los escalofríos se registraron como resultados primarios. Otras mediciones fueron la frecuencia cardiaca, la presión arterial media, la temperatura de la membrana timpánica y el nivel de bloqueo sensorial. Resultados: El nivel de bloqueo espinal fue mayor en el grupo HB en comparación con el grupo LB (p = 0,02). La incidencia de escalofríos intraoperatorios fue de 15 (30 %) en el grupo HB y de 10 (20 %) en el grupo LB (p = 0,032), mientras que las puntuaciones de escalofríos no fueron significativas. La incidencia de escalofríos postoperatorios fue de 16 (32 %) en el grupo HB y de11 (22 %) en el grupo LB (p = 0,043). Las temperaturas intraoperatorias de la membrana timpánica mostraron una reducción muy significativa con respecto a la línea de base (p < 0,0001), mientras que los valores postoperatorios no mostraron diferencias significativas con respecto a la línea de base. Conclusiones: El nivel de bloqueo espinal más que la dosis de bupivacaína intratecal afecta la incidencia de escalofríos. A niveles bajos de bloqueo espinal, la incidencia de escalofríos disminuye sin efecto sobre el grado de escalofríos.(AU)

Objective: The aim of this study was to investigate the relationship between the intrathecal dose of hyperbaric bupivacaine and the incidence and severity of post spinal shivering in parturients undergoing cesarean section. Material and methods: A hundred full term pregnant ladies undergoing elective cesarian section were randomized into two equal groups according to bupivacaine dose given for spinal anesthesia. low dose bupivacaine group (LB group) and high dose bupivacaine group (HB group) received 8 mg and 10mg bupivacaine respectively. The incidence and severity of shivering were recorded as primary outcomes. Other measurements were heart rate, mean arterial blood pressure, tympanic membrane temperature, sensory block level. Results: The level of spinal block was higher in HB group compared with LB group (p = 0.02). The incidence of intra-operative shivering was 15 (30 %) in HB group and 10 (20 %) in LB group (p = 0.032) while the shivering scores were not significant. The incidence of postoperative shivering was 16 (32 %) in HB group and 11 (22 %) in LB group (p = 0.043). Intra-operative tympanic membrane temperatures showed a highly significant reduction from the baseline (p < 0.0001) while postoperative values showed no significant difference from the baseline. Conclusions: The level of the spinal block rather than the dose of intrathecal bupivacaine affects the incidence of shivering. At low levels of the spinal block the incidence of shivering is decreased with no effect on the degree of shivering.(AU)

Health Implications of Increased Cesarean Section Rates.

INTRODUCTION: The health implications of Caesarean section are a significant factor in evaluating the use of Caesarean section as a method of completing childbirth. The increased rate of Cesarean section augmenting in a statistical way the health implications of the use of Cesarean section as a way of operative technique of childbirth finalization. AIM: To investigate the incidence of health implications on mother and child after Cesarian section in comparison to vaginal delivery. METHODS: In our study, which was conducted as a retrospective-prospective and targeted study, the observed research period is from 2007 to 2019. The data sources are: medical histories, birth protocols and neonatal medical histories. Group A: represents the number of surveyed patients with a Cesarean section in a one-year period (2018) in General Hospital "Prim.dr A. Nakas". Group B: represents a control group of the same number of patients born by Caesarean section in 2007 in General Hospital "Prim.dr A.Nakas" with all parameters and variables detected in the research group. Evaluation of the examinee's findings includes: anamnestic data, sonographic data, gynecological finding, colposcopic finding. PAPA test, HPV typing and laboratory findings due to the extensiveness of the study. RESULTS: A comparison of the number of Caesarean sections in BiH before and now shows a statistically significant increase from about 6 caesareans per year to almost 21 Cesarean section per year (p<0.05). This increase led to a statistically significant decrease in perinatal mortality from 30 per thousand per year to only 6 per thousand per year (p<0.05). Complications after Cesarean section during both observed periods are dominated by subjective problems, followed by early complications after Cesarean section. According to the types of complications after Caesarean section, hemorrhages were the most numerous during both examined years, with 1 case of other complications and without a statistically significant difference between the observed years. There were no statistically significant differences in the duration of hospitalization, although in 2007 somewhat longer stay in the hospital after Caesarean section was recorded. CONCLUSION: Our study has shown that one of the most visible trends in modern perinatology is a significant increase in number of Cesarean sections. This is the basis of long-term side effects of Caesarean section, the frequency of which correlates with the increase in this surgical procedure.

Sentidos do Nascer: exposição interativa para a mudança de cultura sobre o parto e nascimento no Brasil / Sentidos del Nacer - exposición interactiva para el cambio de cultura sobre el parto y el nacimiento en Brasil / Senses of Birth: An interactive and provocative exhibition to change the culture about childbirth in Brazil

A exposição Sentidos do Nascer (SDN) é uma ação de educomunicação inovadora que visa contribuir para mudança de cultura sobre o parto e nascimento no Brasil, incentivar o parto normal e apoiar a redução das elevadas taxas de cesarianas desnecessárias. Trata-se de uma exposição imersiva e interativa que articula linguagens e técnicas para sensibilizar o grande público e instigá-lo, de forma lúdica, a conhecer mais e se posicionar criticamente sobre a temática. Este artigo descreve as estratégias e dispositivos desenvolvidos para sensibilização e envolvimento do público no debate sobre o modelo assistencial ao parto e nascimento, bem como a metodologia utilizada para avaliar os efeitos e mudanças no conhecimento e percepção dos visitantes. Houve considerável mudança de opinião e percepção e ampliação do conhecimento sobre o parto e nascimento, revelando o potencial dessa estratégia em saúde.(AU)

La exposición "Sentidos del nacer" es una acción de educomunicación innovadora cuyo objetivo es contribuir con el cambio de cultura sobre el parto y el nacimiento en Brasil, incentivar el parto normal y dar apoyo a la reducción de los elevados índices de cesárea innecesarias. Se trata de una exposición de inmersión e interactiva que articula lenguajes y técnicas para sensibilizar al gran público e instigarlo, de forma lúdica, para que conozca más y se posicione críticamente sobre la temática. Este artículo describe las estrategias y dispositivos desarrollados para la sensibilización y el envolvimiento del público en el debate sobre el modelo asistencial al parto y al nacimiento, así como la metodología utilizada para evaluar los efectos y cambios en el conocimiento y percepción de los visitantes. Hubo un considerable cambio de opinión, percepción y ampliación del conocimiento sobre el parto y el nacimiento, revelando el potencial de esta estrategia de salud.(AU)

The Senses of Birth exhibit is an innovative educommunication action that seeks to contribute to a change in culture regarding childbirth in Brazil, giving incentive to normal childbirth and making a case for the reduction of unnecessary cesarean (C-section) rates. It is an immersive and interactive exhibition that articulates languages and techniques to raise awareness and instigate the general public, in a playful manner, to increase knowledge and promote a critical position on the subject. The article describes the strategies and devices used to raise the public´s awareness and involvement in the debate concerning childbirth care, as well as analyzes the effects and changes in the visitor´s knowledge and perception about childbirth. The results show considerable changes in opinion and perception favoring normal childbirth and an increase in knowledge related to forms of childbirth care and best practices, revealing the potential of this educational health strategy.(AU)

Maternal request for cesarian birth without medical indication in a group of healthy women: A qualitative study in Jordan.

OBJECTIVE: To explore women's reasons for requesting an elective cesarian birth without medical indication and to describe the factors that affect their decision to choose a cesarian birth. DESIGN: A descriptive qualitative content analysis approach was used for the gathering and analysis of data. Interviews were held with 35 first-time mothers. The participants were recruited by using a purposive sampling method. Interviews were begun with the same question which sked about women's reasons for requesting cesarian birth without medical indication. Other questions were used to facilitate the interview and elicit the factors that led this group of first-time Jordanian mothers to choose a cesarian birth. SETTING: A private hospital in Amman, the capital of Jordan, was selected as the location for the data gathering process. Data collection and analysis were conducted concurrently and interviews were discontinued when data saturation was reached. PARTICIPANTS: The participants consisted of 35 first-time mothers recruited by using a purposive sampling method. FINDINGS: Socio-demographic, economic status, and childbirth culture played an important role in influencing women's requests for an elective cesarian. Women made their decision based on the lived negative experience of other women and were driven and supported by their social network. Five themes that reflected the reasons for elective cesarian birth without medical indication were identified: (1) fear of vaginal birth process, (2) concerns about future sexual life, (3) need for humanized birth, (4) personal reasons, and (5) decision-making process. CONCLUSIONS AND IMPLICATIONS: The women's reasons for choosing cesarian birth without medical indication and the factors influencing the women's decision-making process were complex and interrelated and reflect a lack of appropriate informed choice about elective cesarian. The findings therefore suggest that healthcare policy makers need to attend to the reasons and the factors that influence women's decision-making about cesarian birth in order to promote the trend of women having a vaginal birth. Evidence-based knowledge and strategies to reduce elective caesareans should be disseminated to healthcare providers in maternity settings. Future explorations of this issue should address obstetricians' and midwives' views and attitudes about cesarian birth without medical indication.

Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct obstruction.

AIM: To study any possible association of congenital nasolacrimal duct obstruction (CNLDO) with mode of delivery, birth weight and gestational age. METHODS: We retrospectively reviewed charts of all patients (n=2591) under the age of 3y who were born between April 2015 and May 2017 and were examined at the Ophthalmology Clinic of Emsey Hospital Istanbul, Turkey. We identified patients (n=105) who were diagnosed as CNLDO. The mode of delivery, birth weight and gestational age along with any adverse event during or after delivery or any other health history were determined. Birth statistical data were obtained from the hospital's medical records database. RESULTS: Gestational age of babies who were born via cesarean section (CS) was lower than gestational age of babies who were born via normal spontaneous vaginal delivery (NSVD; P=0.002). Babies who were born via CS were found to have 3.75 times higher risk of developing NLDO when compared to babies who were born via NSVD (OR=3.754). CONCLUSION: There is a possible association between CS and CNLDO.