UNASSIGNED: Nonspecific presentations during pregnancy can mask early signs and symptoms of upper abdominal tumours, making the preoperative diagnosis of upper abdominal tumours difficult. Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare exocrine tumour of the pancreas, and SPN in combination with preeclampsia during pregnancy is even rarer.
METHODS: In this paper, we report a case of SPN combined with preeclampsia during pregnancy and sudden rupture of a giant retroperitoneal SPN during a caesarean section, which resulted in life-threatening intra-abdominal haemorrhage. After exclusion of obstetric factors, a rapid response team was activated, multidisciplinary treatment (MDT) was carried out, and the patient was treated promptly and appropriately by resection of the giant retroperitoneal tumour, partial resection of the body and tail of the pancreas, and abdominal drainage.
UNASSIGNED: To our knowledge, this is the first reported case of SPN combined with preeclampsia during pregnancy, and a rapid and timely MDT could have ensured the patient\'s life.
CONCLUSIONS: When dealing with a pregnant woman with an acute abdomen, the obstetrician should communicate fully with the woman to ensure that the most likely diagnosis is obtained. In the event of an unexpected accident during a caesarean section, it is important to remain calm, activate the Rapid Response Team and seek an MDT to ensure the life of the mother.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.

BACKGROUND: Postpartum urinary retention is a common complication following caesarean section, with significant implications for patient comfort and recovery. Combined spinal and epidural anaesthesia is frequently employed for caesarean section, but postpartum urinary retention remains a clinical concern despite its benefits. This study aimed to investigate the effectiveness of hydromorphone hydrochloride combined with bupivacaine for combined spinal and epidural anaesthesia in reducing postpartum urinary retention.
METHODS: A retrospective analysis was conducted on patients who received combined spinal and epidural anaesthesia for caesarean section. The control group received bupivacaine, whereas the hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia (HB) group received hydromorphone hydrochloride combined with bupivacaine. Data on demographics, anaesthesia, operative characteristics, postoperative urinary retention and adverse events were collected and analysed.
RESULTS: The study enrolled 105 patients, with a control group (n = 51) receiving bupivacaine spinal-epidural anaesthesia and an observation group (n = 54) receiving hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia. The incidence of postoperative urinary retention was significantly lower in the HB group than in the control group (3.70% vs. 17.65%, p = 0.044). Furthermore, the HB group exhibited a shorter time to first voiding after anaesthesia (5.72 ± 1.26 h vs. 6.28 ± 1.35 h, p = 0.029), lower peak postvoid residual volume (168.57 ± 25.09 mL vs. 180.43 ± 30.21 mL, p = 0.032), decreased need for postoperative catheterisation (5.56% vs. 21.57%, p = 0.034) and shorter duration of urinary catheterisation (10.92 ± 2.61 h vs. 12.04 ± 2.87 h, p = 0.039) than the control group. Correlation analysis supported a negative correlation between hydromorphone supplementation and parameters related to postoperative urinary retention. Multivariate regression analysis demonstrated a significant association between the duration of urinary catheterisation and the use of hydromorphone with the occurrence of postoperative urinary retention, providing further insights into the multifactorial nature of this postoperative complication.
CONCLUSIONS: The addition of hydromorphone hydrochloride to bupivacaine for combined spinal and epidural anaesthesia was associated with a reduced incidence of postpartum urinary retention and improved postoperative voiding parameters, without significantly increasing the risk of adverse events.

UNASSIGNED: Microbial colonisation in infants is initially dependent on the mother and is affected by the mode of delivery. Understanding these impacts is crucial as the early-life gut microbiota plays a vital role in immune development, metabolism, and overall health. Early-life infant gut microbiota is diverse among populations and geographic origins. However, in this context, only a few studies have explored the impact of the mode of delivery on the intestinal microbiome in children in Guangzhou, China. Therefore, this study aimed to investigate the influence of birth mode on the intestinal microbiota of healthy infants in Guangzhou, China.
UNASSIGNED: Faecal samples were collected once from 20 healthy full-term infants aged 1-6 months, delivered via either caesarean section (CS) or vaginal delivery (VD), post-enrolment. The intestinal microbiota were characterised using full-length 16S rRNA gene sequencing. Bacterial quantity and community composition were compared between the two groups.
UNASSIGNED: No significant differences in gut bacterial diversity and richness were observed between the CS and VD groups. The Pseudomonadota phylum (44.15 ± 33.05% vs 15.62 ± 15.60%, p = 0.028) and Enterobacteriaceae family (44.00 ± 33.11% vs 15.31 ± 15.47%, p = 0.028) were more abundant in the CS group than in the VD group. The VD group exhibited a higher abundance of the Bacillota phylum (40.51 ± 32.77% vs 75.57 ± 27.83%, p = 0.019).
UNASSIGNED: The early stage of intestinal bacterial colonisation was altered in the CS group as compared with the VD group. Our findings provide evidence that CS has the potential to disrupt the maturation of intestinal microbial communities in infants by influencing the colonisation of specific microorganisms. Further comprehensive studies that consider geographical locations are necessary to elucidate the progression of microbiota in infants born via different delivery modes.
Microbial colonisation in infants is affected by the mode of delivery. Early-life infant gut microbiota is diverse among populations and geographic origins. Faecal samples were collected once from 20 healthy full-term infants aged 1–6 months that were delivered via either caesarean section (CS) or vaginal delivery (VD), and intestinal microbiota were compared between the two groups. No significant differences in gut bacterial diversity and richness were observed between the two groups; however, we did note that certain types of bacteria were more abundant in the CS group, while others were more abundant in the VD group. This suggests that CS may disturb intestinal microbial maturation in infants by affecting the colonisation of specific microorganisms. Further research is needed to fully understand this relationship.

Pregnant women with severe osteogenesis imperfecta (OI) are uncommon, and there are limited data regarding anaesthesia for caesarean section in these high-risk individuals. The presence of anatomical and physiological abnormalities can pose technical challenges for the anaesthetist. This report describes the successful implementation of epidural anaesthesia in a parturient with severe OI. To our knowledge, this is the first documented use of ultrasound-assisted neuraxial anaesthesia and wrist blood pressure monitoring in such patients undergoing caesarean section. Understanding the pathophysiological changes associated with OI is crucial for ensuring safe administration of anaesthesia to these women.

Pregnancies following previous caesarean section (CS) are associated with higher incidence of infections, postpartum haemorrhage and obstetric complications. The present study aimed to explore the effect of previous CS on reproductive, maternal and neonatal outcomes in women who underwent assisted reproductive techniques (ART). A systematic review and meta-analysis were conducted to assess reproductive and pregnancy outcomes following ART in women with and without a previous CS. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Eligible language articles written in English, published up to October 2023, were identified in Medline, Google Scholar and Science Direct databases. The quality of the included studies was assessed using the Newcastle Ottawa Scale. A total of 19 articles, reporting on 13 different outcomes met the inclusion criteria. It was revealed that women with previous CS had 9% lower clinical pregnancy rates, 13% lower live birth rates, 11% lower implantation rates and 28% lower multiple pregnancy rates compared with women who had prior natural vaginal deliveries. Additionally, previous CS was associated with an 8-fold higher risk of difficult embryo transfers. No significant differences were noted in ectopic pregnancy rates, miscarriage rates or biochemical pregnancy rates. The present systematic review and meta-analysis demonstrated that previous CS is associated with decreased prospects of clinical pregnancy, live birth and successful embryo implantation during ART. The findings of the present study underscored the need to counsel women with prior CS regarding its potential impact on ART outcomes.

Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean section and splenectomy for splenic rupture has not been previously reported. This case report describes a case of multiple venous thromboses after caesarean section and splenectomy for traumatic splenic rupture in late pregnancy. A 34-year-old G3P1 female presented with abdominal trauma at 33+1 weeks of gestation. After diagnosis of splenic rupture, she underwent an emergency caesarean section and splenectomy. Multiple venous thromboses developed during the recovery period. The patient eventually recovered after anticoagulation therapy with low-molecular-weight heparin and warfarin. These findings suggest that in patients that have had a caesarean section and a splenectomy, which together might further increase the risk of venous thrombosis, any abdominal pain should be thoroughly investigated and thrombosis should be ruled out, including the possibility of multiple venous thromboses. Anticoagulant therapy could be extended after the surgery.

The accurate assessment of wound healing post-caesarean section, especially in twin pregnancies, remains a pivotal concern in obstetrics, given its implications for maternal health and recovery. Traditional methods, including conventional abdominal ultrasonography (CU), have been challenged by the advent of transvaginal ultrasonography (TU), offering potentially enhanced sensitivity and specificity. This meta-analysis directly compares the efficacy of TU and CU in evaluating wound healing and scar formation, crucial for optimizing postoperative care. Results indicate that TU is associated with significantly better outcomes in wound healing, demonstrated by lower REEDA scores (SMD = -20.56, 95% CI: [-27.34.20, -13.77], p < 0.01), and in scar formation reduction, evidenced by lower Manchester Scar Scale scores (SMD = -25.18, 95% CI: [-29.98, -20.39], p < 0.01). These findings underscore the potential of integrating TU into routine post-caesarean evaluation protocols to enhance care quality and patient recovery.

BACKGROUND: Women undergoing caesarean section (CS) experience difficulties when preparing for discharge, and readiness for hospital discharge (RHD) may depend on individual characteristics.
OBJECTIVE: To explore the status of RHD in women with CS, identify the latent classes of RHD, and analyse predictors from a bio-psycho-social perspective.
METHODS: A sample of 410 women with CS completed the following questionnaires on demographic and obstetric characteristics: Readiness for Hospital Discharge Study-New Mother Form (RHDS-NMF), Parents\' Postnatal Sense of Security (PPSS), Quality of Discharge Teaching Scale (OB-QDTS), and Postpartum Support Questionnaire (PSQ). Latent profile analysis was used to identify the latent classes of RHD. Multiple logistic regression analysis was used to analyse the predictors.
RESULTS: In total, 96.6 % of women with CS reported discharge ready, and the score of RHDS-NMF was 136.09 ± 25.59. Three latent classes were identified as Low RHD (16.1 %), Moderate RHD (41.7 %), and High RHD (42.2 %). Primiparas (OR = 2.867 / 1.773; P = 0.012 / 0.033), emergency CS (OR = 3.134 / 2.470; P = 0.006 / 0.002), lower levels of PPSS (OR = 0.909 / 0.942; P = 0.009 / 0.013) and OB-ODTS (OR = 0.948 / 0.975; P < 0.001) were associated with Moderate and Low RHD. Lower PSQ predicted a higher probability of Low RHD (OR = 0.955; P = 0.038).
CONCLUSIONS: The perception of RHD by women in the study was inaccurate, with more than half not being classified as High RHD. Healthcare professionals can anticipate interventions for maternal well-being based on the characteristics of the different RHD classes.

UNASSIGNED: The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD.
UNASSIGNED: We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models.
UNASSIGNED: A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%).The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively.
UNASSIGNED: Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023389265.