Academic literature on the topic 'Obesity Cesarean Section Baghdad'

Aim: to determine the effectiveness of women's self-care instructions on their post cesarean section care in Baghdadteaching hospital.Methodology: The present study used quasi-experimental study design in maternity words in Baghdad teachinghospital. The sample was collected and follow up for the period (15) January 2014 until 15 May 2014 Nonprobability(purposive sample) of (100) women post cesarean section divided in to two groups (50) women postcesarean section considered as a study group, and another (50) women post cesarean section considered as thecontrol one, A questionnaire designed as a tool to collect data fit the purpose of the study a questionnaire includedemographic variables, Reproductive variables, instructions self-care post cesarean Wound care, a pilot study wascarried out to test the reliability, As for reliability of questionnaire has been displayed by a group of experts invarious medical specialties and nursing.Result: The study presents significant differences in implementation of instructional program for self-carepost cesarean between study and control groups on wound, there is significant differences in washing handbefore & after any procedure, Don't put ointment or cream on the wound, don't raise the dressing to see operationimmediately unless done by medical staff (P=0.000). Also significant differences are found in perineal care &urinary system post cesarean in washing hand before & after using bathroom, wash perineum area water warmwater contains a antiseptics from front of the pubic bone to the anus, place sanitary pads from front to back toprotect the inner surface from contamination, do not hold on the urine when feel the desire to urinate,practice kegel exercises 2-3 times per day, Do not have sexual intercourse during the first 6 weeks, preferred touse the western bathroom (P= 0.000).Recommendations: The study recommended the possibility of providing an educational overlap of self-careafter a cesarean delivery for all pregnant women attending antenatal care centers, primary health, constructionand application of the overlap of the mothers of the educational process to be holding them in the hospital toincrease their knowledge of self-care after a cesarean section

Aim of the study: To evaluate the causes of primary cesarean section in Abu Ghraib general hospital with the intention to reduce cesarean section rate. Patients and methods: A descriptive study done prospectively in Abo Ghraib general hospital in Baghdad, Iraq during the period from first of January till 30th of June 2021, there were 2799 of deliveries (beyond 28 weeks of gestation), 466 of them delivered by cesarean section. The study included all cesarean sections that collected from labor ward, general and private sector. Results: The most common primary Cs (57.4%) was found in age group between (21-30) years old, then (31.4%)) in age ?20 years, (9.9 %) in age between (31-40) years, and only (1.3%) in group of age >40 years. the most common indication was fetal distress in 65 (29.1%), then FTP in 57 (25.6%), then malpresentation in 27 (12.1%) and the least cause was preeclampsia and rupture uterus in 4 (1.8 %) for each cause. Conclusion: The most common causes of primary cesarean section in Abo Ghraib general hospital was fetal distress this may be due to low hospital resources.

Objective: To find out how commonly infections occur in cesarean section skin wound in post operative period and what factors are commonly encountered in these patients. Design: Descriptive Case Series. Setting: Obs & Gynae Deptt., Nishtar Hospital Multan (NHM). Duration of Study: Six Months. Subjects and Methodology: 121 patients undergoing cesarean section due to various reasons were enrolled in this research. These subjects were followed till 30 days of the procedure and examined through this interval for presence/absence of wound infection . These patients were evaluated for the presence of anemia, PIH/ pre-eclampsia, DM , PROM, obesity & type of cesarean section. Results: Age range was 18 to 45 yrs & Mean calculated i.e 28.289±2.74 years, mean gestational age 37.983±1.75 weeks, mean BMI 26.281±1.47 Kg/m2 and mean parity was 1.545±1.17. Post cesarean wound infection was seen in 9.9% patients. Factors leading to post-cesarean section wound infection were anemia found in 16.7%, diabetes mellitus in 16.7%, PROM in 16.7%, hypertension in 25%, obesity in 75%, emergency caesarean section in 75% and elective caesarean section in 25% were noted. Conclusion: Identification of causative factors of cesarean section wound infection, their correction and modification may help reduce wound infection rates among postoperative patients leading to reduction in maternal morbidity. Keywords: Cesarean section, Wound infection, Factors leading to wound infection.

Background: Overweight, obesity, and morbid obesity in the mother are associated with adverse obstetrics well as neonatal outcome. Aim of this study was to assess the prevalence of overweight and obesity, and the impact of body mass index (BMI) on maternal and neonatal outcome.Methods: This is a retrospective study from January 2018 to September 2018 on 180 women with singleton term pregnancies. Maternal and neonatal outcomes at delivery were noted.Results: In present study, 3 (1.66%) pregnant women were underweight, 57 (31.66%) pregnant women had normal BMI, 71 (39.44%) pregnant women were overweight while 49 (27.22%) pregnant women were obese. Gestational weight gain was less than 8 kgs in 40 (22.22%) pregnant women, weight gain was 8-15.9 kgs in 132 (73.33%) pregnant women while weight gain was more than 16 kgs in 8 (4.44%) pregnant women. Out of 3 underweight women, 1 delivered by cesarean section and 2 had normal delivery, out of 57 women with normal BMI, 21 delivered by cesarean section and 36 had normal delivery, out of 71 overweight women, 47 delivered by cesarean section and 34 had normal delivery while out of 49 obese women, 38 delivered by cesarean section and 11 had normal delivery. PET and GDM was seen in 9 (7.5%) women each while macrosomia were seen in 5 (4.16%) women.Conclusions: Increased association was seen with maternal obesity and adverse outcome of pregnancy like PIH, GDM, cesarean section.

как показывает статистика, в современном мире значительно выросла частота родоразрешения путем операции кесарева сечения. Также отмечена явная тенденция увеличения числа беременных женщин с ожирением, что осложняет послеоперационный период. Само по себе ожирение уже достигло масштабов пандемии и неуклонно продолжает расти. Мы провели клинико-лабораторное исследование на 93 беременных женщинах, родоразрешение у которых произведено путем кесарева сечения и сделали выводы о взаимосвязи ожирения и нарушением гомеостаза. Исследование проводилось на 12,3,5 сутки после абдоминального родоразрешения. В ходе исследования выявили взаимосвязь между степенью ожирения и нарушением гомеокинеза. Полученные данные обрабатывали методом вариационной статистики с использованием критерия t Стьюдента. statistics show that in the modern world, the frequency of delivery by caesarean section has increased significantly. There is also a clear trend towards an increase in the number of obese pregnant women, which complicates the postoperative period. Obesity itself has already reached pandemic proportions and continues to grow steadily. We conducted a clinical and laboratory study on 93 pregnant women whose delivery was performed by cesarean section and drew conclusions about the relationship between obesity and homeostasis disorders. The study was conducted on 12, 3, 5 days after abdominal delivery. The study revealed a relationship between the degree of obesity and a violation of homeokinesis. The obtained data were processed by the method of variational statistics using the Student's t criterion.

The objective: to analyze cesarean section in women with gestational diabetes mellitus and obesity and to improve them to prevent complications for the mother and newborn.Materials and methods. The course of pregnancy, indications for cesarean section, surgical technique, perinatal complications, and the state of the postpartum period for 2020-2024 were analyzed according to the medical documentation of the Municipal non-profit enterprise of the Kharkiv Regional Council «Regional Clinical Hospital». The results of the examination and opera-tive delivery of 110 primiparous pregnant women are presented. They were divided into the fol-lowing clinical groups: the main group consisted of 32 pregnant women (29.1%) with GDM and obesity, the first comparison group consisted of 30 pregnant women (27.3%) with GDM, the second comparison group consisted of 28 pregnant women (25.4%) with obesity, and 20 preg-nant women (18.2%) who did not have extragenital pathology formed the control group.A general clinical examination and ultrasound examination of the fetoplacental complex were performed. The newborn’s condition was assessed using the Apgar score and by measuring the acid-base status of the umbilical cord blood. Results. When analyzing medical documentation, it was found that the number of pregnant women with obesity almost doubled from 16.5% in 2021 to 31% in 2022, which could be influ-enced by the beginning of the war, stress, being pregnant in a combat zone, psycho-emotional factors, and eating disorders. The number of patients with GDM also changed towards an in-crease in frequency from 30.7% in 2021 to 37.8% - in 2023, obesity could play an important role in this process. Based on the cesarean section technique from the clinical protocol of the Ministry of Health of Ukraine «Caesarean section»; and the NICE Guideline «Cesarea section»; proposed to supplement it with some points in women with GDM with obesity. When comparing the results of childbirth, it was determined that in the examined women, the most frequent indications for cesarean section (CS) were macrosomia, fetopathy, weakness of labor ac-tivity, ineffective induction of labor activity, and fetal distress. To prevent complications of CS in pregnant women with GDM and obesity, it was proposed to improve the protocol of the operation by finalizing some of its stages, taking into account the features of the existing extragenital pathology.Conclusions. The increase in extragenital pathology, especially during the war, among which the frequency of endocrine diseases increased, led to a rise in the frequency of operative delivery. Improving the technique of cesarean section in women with obesity and gestational diabetes mel-litus will contribute to the reduction of complications in the postoperative period on the part of the mother, perinatal morbidity, and mortality.Keywords: gestational diabetes mellitus, obesity, cesarean section.

Lower urinary tract symptoms are common during pregnancy and shortly after it ( puerperium period ). Those symptoms usually classified into filling symptoms like urinary frequency, urgency, nocturia, and dysuria. And voiding symptoms which consist of: straining, hesitancy, post void dribbling and weak stream. Over the last decades many researcher were alert to urinary incontinence and it is possible association with childbirth type, cesarean section versus vaginal delivery. The objective of this study is to estimate the effect of cesarean section procedure on lower urinary tract function in long term. The study was conducted at Al-Imamain Al-Kadhmain medical city, Baghdad-Iraq. During the period from (August 2020) to (January 2021). Retrospective cohort study design was chosen. Target population was women with history of previous cesarean section for at least 6 months ago. Data were collected by using structured questionnaire form. 176 women were included. The analysis of data was carried out by using Microsoft excel 2013. This study went with most of the previous researcher findings as it appears that lower urinary tract symptoms (LUTS) have generally low incidence among women with cesarean section. But this study showed a possible effect of multiple cesarean sections on LUTS development , namely pervious three , which can be explained by their higher percentage in our study sample ( about 20% ) as Iraqi families have a tendency to have more children . In conclusion; this study concluded that LUTS have low frequency post caesarean section apart from the possible effect of multiple cesarean sections on LUTS development, namely pervious three .In general cesarean section could be protective against LUTS in comparison to normal vaginal delivery.

We examined the relationship between cesarean section (C-section) and the risk of overweight and obesity in children in grade 6 (mean age, 11.92 years; standard deviation = 0.34). Data from phase I through phase III of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Children with complete data from 1991 through 2004 were included in this study (n = 917). Multiple logistic regression analyses were used to adjust for potential confounding and to evaluate the association of C-section and childhood overweight and obesity. Compared to children delivered vaginally, children delivered by C-section had approximately twice the likelihood of being overweight (odds ratio (OR) = 1.86, 95 % confidence interval (CI) = 1.27–2.73) or obese (OR = 1.87, 95 % CI = 1.19–2.95). However, when examined according to sex, males delivered by C-section had an increased risk for being overweight (OR = 1.78, 95 % CI = 1.01–3.12) and obese (OR = 2.58, 95 % CI = 1.36–4.88), while females had an increased risk only for being overweight (OR = 1.99, 95 % CI = 1.17–3.39). Conclusion: C-section was associated with an increased risk of overweight and obesity in children in grade 6, but the relationship differed according to gender. Further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight.

Orientador: Eliana Martorano Amaral<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-11-27T12:22:22Z (GMT). No. of bitstreams: 1 Conceicao_ElizandraRosado_M.pdf: 4391047 bytes, checksum: c515837bc9825b7b68306fceca492dc9 (MD5) Previous issue date: 2010<br>Resumo: Introdução: A epidemia de obesidade, observada mundialmente, pode justificar parte do aumento das taxas de cesárea em maternidades públicas do Brasil. Objetivo: Avaliar associação entre peso materno e tipo de parto em um serviço público universitário. Métodos: Trata-se de um estudo de coorte retrospectiva. Foram estudados os dados de 376 partos ocorridos entre janeiro de 2006 e junho de 2008 em uma maternidade pública. Esta amostra foi selecionada de 7026 registros eletrônicos de partos, após aplicados os critérios de exclusão: preenchimento incompleto de peso e altura maternos na primeira e última consultas de pré-natal ou no parto, início do acompanhamento pré-natal após 16 semanas de gestação, gestação gemelar, óbito fetal anteparto, e indicação eletiva de cesárea (malformação fetal, doença materna, iteratividade, feto em apresentação anômala). Foram analisados os riscos de cesárea segundo categorias de peso pelo índice de massa corpórea (IMC) materno no início do pré-natal, no parto e segundo a mudança de categoria de peso pela curva de Atalah. Os dados, originalmente armazenados em arquivo SQL Server, foram transferidos para um programa Excel e analisados utilizando-se o pacote estatístico SAS versão 9.03. Aplicaram-se os testes qui-quadrado e exato de Fisher para análise bivariada e foram calculadas as razões de risco brutas e ajustadas com intervalo de confiança 95% controlando-se por idade, paridade, presença de cesárea prévia, tabagismo, uso de ocitocina, hipertensão, diabetes, analgesia no trabalho de parto, rotura prematura de membranas, líquido meconial e peso do RN. Resultados: Dos 376 partos selecionados, 75 (20%) gestantes eram obesas, 102 (27,1%) tinham sobrepeso e as restantes tinham peso normal no início do pré-natal. Deste total, 126 (33,5%) foram cesáreas. Na análise bivariada, a obesidade no início da gestação se associou a maior idade, paridade, cesárea prévia, hipertensão, diabetes, parto cesárea e peso do recém-nascido ? 3500 g, mas não a menor Apgar ou prematuridade. Houve aumento de risco de cesárea nas obesas, em relação às gestantes de baixo peso ou normal, baseado na análise pelos IMC inicial (RR=1,55; 1,12 - 2,13) e final da gestação (RR=1,44; 0,94 - 2,22), mas não observado pela mudança de categoria na curva de Atalah. Na análise multivariada, observou-se diminuição de risco de cesárea entre adolescentes e aumento em mulheres com cesárea prévia, nulíparas, e nas com recém-nascido (RN) de peso ? 3500 g. Em adição, o IMC final da gestação, mas não o inicial, também contribuiu para o aumento do risco (RR =1,16; 1,07 - 1,99). Nas obesas, a maior indicação de cesárea foi falha de indução/distócia funcional, enquanto nas de peso normal predominaram as cesáreas por desproporção céfalo-pélvica/ macrossomia/ deflexão e sofrimento fetal. Conclusões: Estar obesa ao final da gestação, ser nulípara, ter cesárea prévia e RN com peso ? 3500 g aumentaram o risco de cesárea, mas ser adolescente reduziu. Medidas de controle de ganho de peso podem contribuir para a redução dos partos cirúrgicos<br>Abstract: Introduction: The increase in obesity observed throughout the world may explain the rise on cesarean rates. Objective: To evaluate the association between maternal obesity and type of delivery in a public university service. Methods: This is a retrospective cohort study. Data from 376 deliveries from a public hospital occurred between January 2006 and June 2008 were analyzed. They sample was selected from 7,026 electronic birth registries, after applying the exclusion criteria: incomplete filling of maternal height and weight at the first and last prenatal visit or the time of delivery, initiation of prenatal care after 16 weeks of gestation, twin pregnancy, antepartum fetal death, elective elective caesarean section (fetal malformation, maternal disease, repeat cesarean, fetus anomalous presentation). The C-section risk was analyzed according to the body mass index (BMI) in the beginning (initial) and the last 15 days before delivery, or at delivery (final), and the change on category at the Atalah's curve. Data stored in SQL Server file was transferred to Excel, analyzed by statistical package SAS version 9.03. The Chi square and Fisher Exact tests were applied for a bivariate analysis and the crude risk ratio was calculated and adjusted with 95% confidence interval, controlled by age, parity, presence of previous caesarean section, smoking, use of oxytocin, hypertension, diabetes, analgesia during labor, premature rupture of membranes, meconium and newborn (NB) weight. Results: Among the 376 births, 75 (20%) women were obese, 102 (27.1%) were overweight and the remaining had normal weight at the beginning of prenatal care, with 33.5% delivering by cesarean sections. In the crude analysis, obesity in the beginning of pregnancy was associated with older age, parity, previous cesarean section, hypertension, diabetes, cesarean delivery and newborn weight ? 3,500 g, but not with low Apgar score or prematurity. There was increased risk of cesarean delivery in obese women in relation to those of low or normal weight (RR) based on initial BMI (RR = 1.55, 1.12 to 2.13) and final BMI (RR = 1.44, 0.94 to 2.22), not observed by on the Atalah's curve categories. The adjusted analysis showed lower risk of cesarean delivery among teenagers and higher in women with previous cesarean section, nulliparous women and with NB weight ? 3500 g. In addition, the final, but not the initial BMI, also contributed to the increased risk (RR = 1.16, 1.07 to 1.99). Among obese women, the main reason for cesarean section was failure induction/ functional dystocia, whereas in the normal or low weight women predominated cesarean by cephalopelvic disproportion/ macrossomia/ deflected presentation and fetal distress. Conclusions: Being overweight at the end of pregnancy, nulliparity, previous cesarean and NB weighing ? 3500 g increased the risk of cesarean delivery, but being a teenager reduced the risk. Measures to control weight gain can contribute to the reduction of surgical deliveries<br>Mestrado<br>Tocoginecologia<br>Mestre em Tocoginecologia

La Communauté française décide en concertation avec la Région bruxelloise et la Région wallonne, de financer un Centre d’Epidémiologie Périnatale (CEpiP). Les Communautés et Régions chargent le CEpiP de les assister dans la vérification, le remplissage et la correction des certificats concernant les naissances à partir du 1er janvier 2008. Le CEpiP est également chargé d’encoder les certificats bruxellois, les certificats wallons étant toujours encodés par un sous-traitant.<p>Un problème souvent rencontré dans l’analyse des certificats de naissance est la présence de données manquantes. Des informations manquaient sur 64.0% des certificats bruxellois de janvier 2008 (situation de base). Le renforcement de l’enregistrement par le CEpiP durant l’année 2008 est lié à une diminution des informations manquantes sur les certificats initiaux (à la sortie des maternités et services d’état civil) après la première et la deuxième année d’enregistrement :20,8% et 19,5% des naissances en décembre 2008 et 2009 respectivement. Le taux résiduel de données manquantes après correction grâce aux listes envoyées aux maternités et services d’Etat civil est faible. En particulier, la nationalité d’origine des parents était souvent manquante, jusqu’à 35% à Bruxelles (données non publiées), et ce taux est passé à 2.6% en 2008 et 0.1% en 2009. Certaines données manquantes ne sont pas distribuées de façon équivalente selon la nationalité de la mère, même après correction. Les mères d’origine sub-saharienne ont les taux de remplissage les moins élevés. Enfin, le taux de mort-nés a augmenté par rapport aux données de 2007, au profit des mort-nés avant l’âge de 28 semaines, et suggère une amélioration de l’enregistrement suite au renforcement de l’information.<p>Les données concernant l’indice de masse corporelle des patientes sont donc relevées depuis 2009 pour l’ensemble des mères qui accouchent en Belgique. L’obésité maternelle et l’immigration sont en augmentation en Belgique, et ont été rarement étudiées au travers d’études de population sur les certificats de naissance. Des études ont pourtant montré que ces mères étaient à risque de complications périnatales, comme la césarienne ou la mortalité périnatale. L’obésité et l’immigration ont en commun le fait qu’elles recouvrent des réalités médicales, sociales et relationnelles face au personnel soignant, qui les mettent à risque de complications périnatales.<p>Des différences en termes de complications obstétricales et néonatales entre populations immigrantes et autochtones ont été observées en Belgique et dans d’autres pays, mais elles sont encore mal comprises. <p>Dans un premier travail d’analyse, nous avons évalué les taux de mortalité périnatale chez les mères immigrantes, en fonction du fait qu’elles étaient naturalisées ou non.<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères immigrantes (8.6‰) que non-immigrantes (6.4‰).<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères non naturalisées (10.3‰) que chez les mères naturalisées (6.1‰).<p>Le taux de mortalité périnatale varie selon l’origine des mères, mais dans chaque sous-groupe étudié, les mères non naturalisées ont un taux plus élevé de mortalité périnatale.<p><p>Des études ont successivement montré davantage, ou moins de césariennes chez les mères immigrantes. Peu de facteurs confondants étaient généralement pris en compte. Dans un second travail d’analyse, nous avons comparé les taux de césarienne dans plusieurs sous-groupes de nationalités.<p>Les taux de césarienne varient selon les sous-groupes de nationalités. Les mères originaires d’Afrique sub-saharienne ont un odds ratio ajusté pour la césarienne de 2.06 (1.62-2.63) en comparaison aux mères belges. L’odds ratio ajusté n’est plus statistiquement significatif après introduction des variables anthropométriques dans le modèle multivariable pour les mères d’Europe de l’Est, et après introduction des interventions médicales pour les mères du Maghreb.<p><p>Peu d’études ont analysé la relation entre l’obésité maternelle et les complications néonatales, et la plupart de ces études n’ont pas ajusté leurs résultats pour plusieurs variables confondantes. Nous avons eu pour but dans un troisième travail d’analyse d’étudier la relation entre l’obésité maternelle et les paramètres néonatals, en tenant compte du type de travail (induit ou spontané) et du type d’accouchement (césarienne ou voie basse). Les enfants de mères obèses ont un excès de 38% d’admission en centre néonatal après ajustement pour toutes les caractéristiques du modèle multivariable (intervalle de confiance à 95% :1.22-1.56) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 45% (1.21-1.73) et 34% (1.10-1.63) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 18% (0.86-1.63) et non statistiquement significatif.<p>Les enfants de mères obèses ont un excès de 31% de taux d’Apgar à 1 minute inférieur à 7, après ajustement pour toutes les caractéristiques du modèle mutivariable (1.15-1.49) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 26% (1.04-1.52) et 38% (1.12-1.69) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 50% (0.96-2.36) et non statistiquement significatif.<p><p>In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region and the French Community to check birth certificates. A problem repeatedly reported in birth certificate data is the presence of missing data. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status. Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6‰ in 2007 to 8.2‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.<p>Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰). In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. <p>Our second objective was to provide insight into the differential effect of immigration on cesarean section rates, using Robson classification. Cesarean section rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from Sub-Saharan Africa with a term, singleton infant in cephalic position, without previous cesarean section, appear to carry the highest burden.<p>If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the last study, after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and <p><br>Doctorat en Sciences médicales<br>info:eu-repo/semantics/nonPublished

OBJECTIVES: The effect of body mass index (BMI) was assessed on unplanned cesarean section (CS) rate and its indications among healthy, nulliparous women without other risk factors for CS. METHOD: A cross sectional study was performed on 1649 healthy, nulliparous women at term who were admitted in spontaneous labor and delivered at Boston Medical Center between Jan 1st 2008 and Dec 31st 2012. The demographics and outcomes were compared by using a logistic regression analyses. RESULT: There were no statistically significant differences in unplanned CS rates between the three BMI groups (19% in normal weight, 24% in overweight, and 21% in obese women, p=0.1). Compared with normal weight women the crude odds ratio for overweight women was 1.34 (95%CI 1.03-1.76) and for obese women 1.04 (95%CI 0.84-1.54). A multivariate logistic regression analysis was used to adjust for maternal age, birth weight, race and augmentation of labor. The adjusted ORs were 1.073 (95%CI 0.781-1.473) for obese and 1.291 (95%CI 0.978-1.705) for overweight women. Obese women had a higher rate of CS for non-reassuring fetal status (56%, p= 0.01) compared to overweight (46.5%) and normal weight women (37%). CONCLUSION: high maternal BMI per se does not appear to be an independent risk factor for unplanned CS in healthy nulliparous women presenting at term with a singleton pregnancy in spontaneous labor.

Venous thromboembolism (VT is a major cause of maternal mortality and severe morbidity. Pharmacological and non-pharmacological methods of prophylaxis are therefore often used for women considered to be a risk including women who have given birth by cesarean section. The risk is potentially increased in women with a personal or family history of VTE, women with genetic or acquired thrombophilia, and another risk factors like sickle cell disease, inflammatory bowel disease, active cancer, obesity, preeclampsia·and SARS COVID 19 infection. However, a specific score in obstetrics has not yet been well defined. Recommendations from major society guidelines for post-cesarean section (C/S) thromboprophylaxis differ greatly; the safety and efficacy of drug prophylaxis - mainly low molecular weight heparins - has been demonstrated, but large scale randomized trials of currently-used interventions should be conducted. The purpose of this chapter is to discuss the indications and contraindications for VTE prophylaxis in cesarean sections, prophylaxis regimens and potential adverse events.

The 2020 edition of the Institute of Health Statistics in Portugal provides information on the health of pregnant women, childbirth and newborns. In 2022, there were 829,807 births in Portugal, 36% of which involved instrumental delivery by cesarean section. Regarding simple deliveries, 93.2% of the parturients had a pregnancy lasting between 37 and 41 weeks (PORDATA, 2023) and the mean age of pregnant women was 32.2 years. The birth rate in Portugal has been decreasing and maternal age has been increasing, with 97.4% of pregnancies occurring between the ages of 30 and 34 (PORDATA, 2023).

Venous thromboembolism complicates 1–2 of every 1000 deliveries. It may manifest as deep vein thrombosis or pulmonary embolism. Pregnancy-associated venous thromboembolism is an important major cause of maternal morbidity and mortality. Prophylaxis and therapy in pregnancy are complicated by the need to take both fetal and maternal well-being into consideration. Risk factors for venous thromboembolism during pregnancy or the puerperium are multiple. They include, but are not limited to, thrombophilia, multiparity, orthopedic injuries, medical comorbidities, prior venous thromboembolism, smoking, gross varicose veins, age, if older than 35, obesity, multiple pregnancy, preeclampsia, cesarean section, prolonged labor, instrumental vaginal delivery, stillbirth, preterm birth, postpartum hemorrhage, hyperemesis gravidarum, ovarian hyperstimulation syndrome, immobility, long periods of hospitalization, and long haul travel. This chapter is a clinical guide that covers prophylaxis and therapy of pregnancy-associated venous thromboembolism, based on evidence-based research and consensus opinion.

Formally recognized by O’Sullivan and Mahan in 1964, gestational diabetes mellitus (GDM) is defined as any degree of hyperglycaemia recognized for the first time in the pregnancy, including type 2 diabetes mellitus diagnosed during pregnancy, as well as true GDM which develops in pregnancy. GDM is currently the most prevalent medical complication during gestation, affecting approximately 15% of pregnancies worldwide. Important risk factors for GDM include being obese, advanced maternal age and having a family history of diabetes mellitus. Expectant mothers with GDM face the risk of developing gestational hypertension, pre-eclampsia, and necessitating cesarean section for pregnancy termination. Moreover, GDM amplifies the likelihood of complications such as cardiovascular disease, obesity, and abnormal carbohydrate metabolism, consequently increasing the chances of type 2 diabetes (T2D) development in both the mother and the child. Pregnancy itself places stress on the body’s insulin production and utilization, and some women are unable to produce enough insulin to overcome the insulin resistance caused by pregnancy hormones. While gestational diabetes usually resolves after pregnancy, the experience of insulin resistance during pregnancy can unmask an underlying predisposition to insulin resistance, which is a key factor in the development of T2D.