Predictors of caesarean section - a cross-sectional study in Hungary.

PURPOSE: The aim of this study was to analyse the factors associated with caesarean section (CS) at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary. STUDY DESIGN: Data collection was based on self-administered questionnaire and medical records related to the deliveries in the year of 2014. Maternal age, education level, marital status, pre-gestational body mass index (BMI), infertility treatment, previous CS, gestational diabetes mellitus (GDM), pre-pregnancy hypertension and pregnancy-induced hypertension (HT/PIH) were examined. The participation rate was 67.3%, multiple pregnancies and questionnaires with missing data were excluded (n = 1493). Univariate and multivariate comparisons were performed. RESULTS: There were 1125 (45.4%) CSs out of 2479 deliveries. CS rate: 40.0%. Underweight 109 (7.1%), normal 921 (60.2%), overweight 320 (20.9%) obese 181 (11.8%). HT/PIH: 7.6% (n = 117), GDM: 10.1% (n = 155). The odds of CS were significantly higher among obese mothers (OR: 1.81) compared with the normal weight group. Increasing maternal age (OR: 0.97) and being underweight (OR: 0.59) significantly decreased, previous CS (OR: 12.19), infertility treatment (OR: 1.91) and HT/PIH (OR: 1.87) significantly increased the probability of CS. CONCLUSIONS: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.

Efficacy of anchoring the four-arm transvaginal mesh to the mid-urethra vs original surgery as a surgical correction for stress urine incontinence in coexisting anterior vaginal prolapse grades II and III: study protocol for a randomized controlled trial.

BACKGROUND: The prevalence of obesity with aging is escalating alarmingly; and pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh has been employed with increasing popularity in the treatment of POP and is usually highly effective in controlling the principal symptoms of prolapse. However, studies have reported that mesh operations provide fairly unfavorable SUI cure rates. Therefore, additional anti-incontinence surgical strategies are increasingly being scrutinized to achieve better postoperative continence without any significant side-effects for patients with both POP and SUI. We hypothesize that the modification with the fixing of the mesh to the mid-urethra is superior to the original transvaginal mesh operation (TVM) with regard to anti-incontinence. METHODS: One hundred and thirty patients diagnosed with POP-Q II-III and concomitant SUI requiring surgical treatment will be included in this prospective, randomized, double-blind, controlled clinical trial. Patients will be randomly allocated to receive either original TVM (TVM group, n = 65) or modified TVM surgery (mTVM group, n = 65). As the primary outcome parameter, we will evaluate the objective SUI and POP cure rates. Secondary endpoints include postoperative morbidity as assessed with the International Urogynaecological Association classification and subjective prolapse and incontinence cure rates reported by questionnaires. DISCUSSION: Recognizing the importance of an additional surgical procedure for anti-incontinence management, we aim to investigate whether a stabilizing suturing of the mesh to the mid-urethra delivers superior SUI correction compared to the original prosthesis surgery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02935803. Registered on 20 May 2016.

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013.

OBJECTIVE: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. METHODS: A retrospective analysis of 26,416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. RESULTS: Of the 26,416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. CONCLUSIONS: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.