OBJECTIVE: This study aimed to compare plasma concentrations of anesthetic drugs administered during Cesarean section with low Apgar score in neonates deliveried under general anesthesia and analyze associated risk factors.
METHODS: Data from 76 neonates undergoing Cesarean section under general anesthesia with blood concentrations of anesthetic drugs were analyzed. A low Apgar score was defined as ≤ 7. Perioperative maternal and neonatal data were collected and analyzed. Neonates were divided into a control group (Group CON, n = 65) and a low Apgar score group (Group LAS, n = 11) based on Apgar score.
RESULTS: There were no significant differences in the plasma concentrations of anesthetic drugs in maternal artery, umbilical vein or umbilical artery blood between the two groups. Risk factors for neonatal low Apgar scores during Cesarean section under general anesthesia were premature delivery (aOR 10.2, 95% CI = 1.8-56.9) and preoperative fetal distress (aOR 9.6, 95% CI = 1.3-69.0). The prediction model was: probability = 1/(e‑Y), Y= -4.607 + 2.318× (premature delivery) + 2.261× (fetal distress) (yes = 1, no = 0). The Hosmer-Lemeshow test showed χ²= 9.587, P = 0.213, and the area under the curve (AUC) was 0.850 (0.670 ~ 1.000). With a cutoff value of 0.695, sensitivity and specificity were 81.8% and 87.7%, respectively.
CONCLUSIONS: There was no correlation between blood concentration of general anesthetic drugs and Apgar score or occurrence of neonatal low Apgar scores. Premature delivery and preoperative fetal distress were identified as independent risk factors for neonatal low Apgar scores after Cesarean section under general anesthesia.

Meconium-stained amniotic fluid (MSAF) presents a complex medical scenario with significant implications for maternal and neonatal health. This case report explores the intricacies surrounding MSAF, focusing on its diagnosis, treatment, and the associated meconium aspiration syndrome (MAS). The report emphasizes the critical role of antibiotic prophylaxis in lower segment cesarean sections (LSCS) in balancing infection prevention in the mother with neonatal considerations. Additionally, it highlights personalized pain management and post-operative care regimens, contributing to a comprehensive strategy for maternal and neonatal well-being. A 27-year-old primigravida (primi) underwent a cesarean section due to the presence of meconium in the amniotic fluid, indicating fetal distress. The report meticulously documents vital signs, laboratory findings, and the timeline of events. The case report underscores the importance of diagnosing and treating MAS, offering valuable insights into management strategies and their impact on maternal and neonatal health. This case report emphasizes the critical role of antibiotic prophylaxis in LSCS to prevent maternal infection while considering neonatal well-being. The personalized pain management approach and post-operative care regimens contribute significantly to a comprehensive strategy for maternal and neonatal well-being. The findings provide valuable insights into diagnosing and treating MAS, highlighting the importance of timely intervention in similar clinical scenarios.

OBJECTIVE: Snoring frequently occurs among pregnant women, particularly in the later stages of pregnancy. It often signals obstructive sleep apnea (OSA), which could potentially affect pregnancy outcomes negatively. Hence, our study aimed to investigate how snoring influences the likelihood of pregnancy complications and fetal outcomes in a cohort of expectant mothers.
METHODS: We enrolled pregnant women in their second and third trimesters and had them fill out a questionnaire concerning sleep-related symptoms such as snoring, excessive daytime sleepiness, and frequency of nighttime awakenings, along with anthropometric measurements. Subsequently, the participants were divided into snorers and non-snorers, and the occurrence of pregnancy complications and fetal outcomes was monitored.
RESULTS: The study enrolled a total of 212 pregnant women, among whom 35 were identified as snorers and 177 as non-snorers during mid to late pregnancy. This indicated a snoring prevalence of 16.5% in our sample. Significant differences were noted between the two groups regarding the occurrence of oligohydramnios (11.43% vs. 2.82%, p = 0.044) and fetal distress (28.57% vs. 8.47%, p = 0.003). Logistic regression analyses revealed that snoring was independently associated with fetal distress (odds ratio [OR] = 4.99, 95% confidence interval [CI] 1.88-13.23, p = 0.001).
CONCLUSIONS: Our findings suggest that habitual snoring was the independent risk factor fetal distress after adjusting for potential confounders, indicating that habitual snoring may have a detrimental effect during mid to late pregnancy.

In clinical practice, scar dehiscence following a previous cesarean section is a serious worry that necessitates close consideration of a number of contributing factors. We present the case of a 29-year-old gravida six, para three, who presented at 36 weeks of gestation with scar tenderness and abdominal discomfort at the site of her previous cesarean section scar. Despite a clear cardiovascular and respiratory examination, the lower-segment scar was notably thin at 1.2 mm, raising concerns for scar rupture. An emergency lower-segment cesarean section revealed a 4 x 2 cm scar dehiscence. The patient was counseled on the risks of future pregnancies and advised to consider tubal ligation. Early complications of cesarean delivery include wound hematoma, infection, and cesarean scar dehiscence (CSD), while long-term issues involve morbid adherent placentae and intra-abdominal adhesions. Short inter-pregnancy intervals and multiple cesarean deliveries are significant risk factors for CSD due to inadequate myometrial healing. Diagnostic imaging, particularly ultrasonography, is crucial for monitoring scar thickness and planning the timing of delivery. Management may involve conservative resuturing or hysterectomy in cases of severe infection or abscess formation. Early detection through vigilant prenatal care and monitoring, coupled with a multidisciplinary approach, can optimize maternal and fetal outcomes. Enhanced education for healthcare providers and expectant mothers, along with technological advancements, are key to improving the management of this complex obstetric dilemma.

BACKGROUND: Prior evidence showed that placental dysfunction triggers spontaneous preterm or term births, and intrapartum fetal compromise, often requiring urgent delivery and exposing both fetus and mother to significant risks. Predicting spontaneous labor onset and intrapartum fetal compromise could improve obstetric management and outcomes, but this is currently difficult, particularly in low-risk population.
OBJECTIVE: The objective of this study is to examine whether placental dysfunction assessed at 36 weeks by the soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, associates with interval to spontaneous onset of labor and intrapartum fetal compromise requiring cesarean delivery, in a routinely examined population.
METHODS: Retrospective analysis of prospectively collected data of women with singleton pregnancies undergoing routine assessment at 35+0-36+6 weeks\' gestation at King\'s College Hospital (London, England). Using a General Linear Model the study examined outcomes related to the sFlt-1/PlGF ratio including the time interval from testing to spontaneous onset of labor, and the subsequent rate of fetal compromise requiring cesarean delivery. Patients undergoing induction of labor, and prelabour cesarean deliveries were excluded from the study.. Competing risks regression and Cox regression models were used to estimate the cumulative incidence and risk of the outcomes of interest RESULTS: In the screened population of 45,375 patients, 23,831 (52.5%) had spontaneous onset of labor and were included in the analysis. Cases with sFlt-1/PlGF ratio ˃50 vs. ≤50 delivered about one week earlier (39.2 vs. 40.0 weeks; p˂0.001). General linear model showed that greater sFlt-1/PlGF ratio associated with earlier spontaneous onset of labor (p<0.001), particularly in multiparous women A significant effects on sFlt-1/PlGF ratio values was, as expected, observed for those cases who developed preeclampsia and in women of advanced age.Cumulative incidence for spontaneous onset of labor was significantly higher in cases with sFlt-1/PlGF ˃50 vs. ≤50. Cox regression showed that the risk of spontaneous onset of labor increased with sFlt-1/PlGF ˃50 (hazard ratio [HR] 1.424; 95% CI 1.253-1.618; p˂0.001) and, as expected, the risk was mitigated over time from s-Flt-1/PlGF measurement to spontaneous labour onset (p˂0.001). Cases with vs. without intrapartum fetal compromise had higher mean sFlt-1/PlGF ratio (21.79 vs. 17.67; p˂0.001). Qualitative addition of fetal compromise to the general linear model showed higher sFlt-1/PlGF ratio in cases with, compared to those without, fetal compromise (p=0.014). Competing risks regression showed a positive dose-response effect for fetal compromise with increasing sFlt-1/PlGF ratios (p˂0.001). Above and below the optimal cut-off of 50 the quoted cumulative incidences were 6.7% vs. 4.7%, respectively (p<0.001). The effect of the sFlt-1/PlGF ratio remained significant even after adjusting for preeclampsia, which is a well-known major risk factor for fetal compromise. Finally, the proportion of cases with intrapartum fetal compromise having sFlt-1/PlGF ratio >50 decreased from 35% to 0% with advancing gestation.
CONCLUSIONS: This study shows that increased sFlt1/PLGF ratio at 36 weeks associates with earlier gestational age at spontaneous onset of labor and higher rates of intrapartum fetal compromise. There are two major implications: sFlt1-/PLGF ratio ˃50 indicates imminent labor onset with about 40% mean risk increase and immediate clinical translation for term pregnancies monitoring. Additionally raising sFlt1-/PLGF ratios increase the risk of intrapartum fetal compromise, though outcome variability indicates reassessment within multi-marker models.

OBJECTIVE: This study aimed to investigate umbilical artery N-terminal proBrain natriuretic peptide (NT-proBNP) in fetuses delivered by cesarean section due to fetal distress in term pregnancies.
METHODS: This prospective case-control study was conducted at the Antalya Training and Research Hospital Obstetric Department, Turkiye. A total of 140 pregnant women, 70 underwent elective cesarean sections between weeks 37 and 40 of gestation (Group 1, the control group) and 70 underwent cesarean sections due to fetal distress (Group 2, the study group), were included. The participants\' sociodemographic and obstetric data and fetal umbilical blood NT-proBNP levels were recorded in a database.
RESULTS: Age, body mass index, gestational age, prenatal diagnostic tests, fetal anatomical scanning, and baby gender ratios were comparable between the groups (p>0.05), while statistically significant differences were observed in terms of gravidity (3.0 vs. 1.0, p≤0.001) and parity numbers (2 vs. 0, p≤0.001), baby height (50.36±0.88 vs. 49.80±0.86, p≤0.001) and weight (3422.43±409.16 vs. 3239.86±293.74, p=0.003), 1-min Apgar (9.0±0.1 vs. 8.5±1.3, p≤0.001) and 5-min Apgar (10.0±0.1 vs. 9.8±0.4, p=0.026) scores, umbilical artery pH (7.32±0.05 vs. 7.25±0.07, p≤0.001), umbilical artery base deficit (-2.48±1.23 vs. -4.36±1.09. p≤0.001), and NT-proBNP levels [8.77 (7.72-9.39) vs. 12.35 (9.69-12.92), p<0.001].
CONCLUSIONS: This study showed that NT-proBNP can be used as an important marker in the diagnosis of fetal distress. Prospective studies with more participants are now needed to confirm the accuracy of our results.

UNASSIGNED: Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD.
UNASSIGNED: In a randomized double-blinded clinical trial, a total of 208 low-risk subjects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23.
UNASSIGNED: The mean age of mothers was 28.98±5.6 years and 120 cases were primigravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than placebo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR=2.83%, 95%CI of 1-8.24).
UNASSIGNED: The results showed that SC can effectively decrease the rate of emergency CS and FD during labor.

The umbilical cord (UC) is vital to maintain blood circulation between the mother and the growing fetus, which is sometimes disrupted. The umbilical artery thrombosis (UAT) is an infrequent complication of pregnancy that can lead to extreme perinatal outcomes, ranging from intrauterine growth restriction stillbirth to neonatal death. The prenatal diagnosis of UAT is essential and sometimes challenging to detect in clinical practice. Once it is detected, the emergent delivery through a cesarean section is considered after the steroidal lung maturity of the fetus. We report a primigravida diagnosed with this rare pregnancy complication, the UAT at delivery, along with the nuchal cord and abnormally coiled UC. The patient had an uneventful course of pregnancy except for the premature rupture of membranes and continuous fetal distress in the second stage of labor. As the labor progression was optimal, and prioritizing the patient\'s desire, she was vigilantly observed under the premise of continuous electronic fetal monitoring (EFM) to facilitate any emergency, ultimately resulting in the spontaneous vaginal delivery of an alive and healthy baby boy. The fetal distress detected through EFM is an indicator of several stressors predisposing the fetus to some unknown danger that carries an increased risk of perinatal mortality. Based on our experience, it is suggested that radiologists should routinely conduct UC sonographic studies on regular antenatal scans; obstetricians should also have a brief and precise awareness of the critical lifesaving sonographic parameters to measure. The UAT, nuchal cord, and abnormal UC coiling, as found in our case, are all rare factors and related to some extent of fetal morbidity and mortality; once such complications are prenatally suspected, one should manage it through close monitoring and timely decision of appropriate delivery time.

Obesity, characterized by an excess of adipose tissue, has become a significant global health issue. The prevalence of obesity has increased markedly in recent decades worldwide, with a sharp rise also observed in developing countries, particularly in urban areas. Addressing obesity during pregnancy is crucial for several reasons and presents challenges for specialists in obstetrics and gynecology.
OBJECTIVE: The aim of the present study was to investigate the correlation between obesity and its implications for childbirth.
METHODS: We conducted a retrospective study involving 1513 patients, grouped into normal-weight, overweight, and obese categories using corrected BMI values. We performed comparative analyses to explore the association between BMI and various outcomes: the method of delivery, the Apgar score at birth, the incidence of fetal distress, fetal birth weight, the presence of pregnancy-associated pathologies, and the occurrence of postpartum hemorrhage. Descriptive statistical analysis was utilized to characterize the demographic and clinical features of the patients and newborns.
RESULTS: By examining variables such as the occurrence of fetal distress during labor, the Apgar score at delivery, and the mode of delivery, we identified an association between increasing BMI and complications during labor and delivery. The results indicate that a higher BMI is linked with increased complications and variations in the mode of delivery.
CONCLUSIONS: Obesity is the most common health issue among women of reproductive age and requires long-term care. It can contribute to numerous pregnancy-associated pathologies and affect both mother and child during labor and delivery. Obesity is associated with lower Apgar scores, the increased incidence of fetal distress, and a higher rate of cesarean section deliveries. Although the absolute risk of serious complications for mother, fetus, and newborn is low among women with obesity, adopting healthy eating and exercise behaviors prior to pregnancy, ideally, or as early in pregnancy as possible, can help minimize excessive weight gain during pregnancy.

BACKGROUND: The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS.
METHODS: We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1-10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS.
RESULTS: We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58).
CONCLUSIONS: Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.