Factors infl uencing delivery in women with multiple fetus pregnancy.

OBJECTIVE: This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. MATERIALS AND METHODS: Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022. RESULTS: Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. CONCLUSION: Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

Pelvic floor muscle injuries in women with a history of Caesarean section.

OBJECTIVE: The aim of the paper is to determine the prevalence of levator ani muscle injuries and identify risk factors among women undergoing vaginal birth after Caesarean section (VBAC) compared to those with elective repeat Caesarean section (ERCS). MATERIAL AND METHODS: This prospective observational comparative study was conducted at the 2nd Clinic of Gynaecology and Obstetrics of FM CU and UN Bratislava. Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor. RESULTS: A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury. CONCLUSION: In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of ​​the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). Text in PDF www.elis.sk Keywords: pelvic floor, levator ani muscle avulsion, vaginal birth after Caesarean section.