Cesarean deliveries during labor linked to risks in future pregnancies

Published

2 months ago

December 16, 2024

admin

By Priyanjana Pramanik, MSc. Reviewed by Danielle Ellis, B.Sc. Dec 16 2024

Researchers suggest an association between cesarean sections during labor and recurrent preterm birth or mid-trimester loss in subsequent pregnancies, potentially due to cervical damage Study: Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. Image Credit: Oksana Shufrych/Shutterstock.com

In a recent perspective published in PLOS Medicine, researchers discussed the implications of cesarean section (C-section) deliveries during labor for preterm births in subsequent pregnancies. Rising rates of C-sections

C-section rates have risen steadily worldwide over the past decades. From 1990 to 2014, the global C-section rate rose by 12.4%. In England, the prevalence is even higher, with over one-third of women delivering by C-section.

Of these, approximately 24% are emergency procedures, and 5% take place when the cervix is fully dilated. In North America, full dilatation C-section rates have surged by 44% over the last decade.

Several factors contribute to this trend, including shifts in clinical and professional training practices, fears related to litigation, and evolving cultural and social expectations. While C-sections can be life-saving during pregnancy complications, their rising use, particularly in emergency settings, raises concerns about their long-term implications for maternal and fetal health. Future implications for pregnancies

Emergency procedures, especially those late in labor, have been linked to adverse outcomes in future pregnancies. Observational studies suggest a strong association between in-labor C-sections and increased risks of spontaneous preterm birth (sPTB) and mid-trimester pregnancy loss.

The risks are especially pronounced if cervix dilation is greater at the time of surgery, peaking when full dilation has taken place. For the majority of women who undergo an in-labor C-section, preterm birth risk in a future pregnancy remains low (less than 5%). However, women who experience preterm birth after an in-labor C-section are likelier to face recurrent preterm births in subsequent pregnancies.

In a recent analysis, researchers found that women who had an in-labor C-section and later experienced a preterm birth had a 2.7-fold higher risk of recurring sPTB than women with other preterm birth risk factors. When considering mid-trimester losses, the relative risk increased to 5.65. In this cohort, 54% of women who experienced preterm birth following an in-labor C-section went on to have a subsequent preterm delivery, a rate significantly higher than for other high-risk groups. Cervical damage is a key factor

The observed association between in-labor C-sections, sPTB, and mid-trimester loss may be explained by cervical damage during surgery. The cervix plays a central role in preventing premature labor. Surgical interventions during advanced labor stages often involve incisions close to or within cervical tissue, increasing the likelihood of trauma.

As labor progresses, the head of the fetus descends into the pelvis, making surgical delivery more challenging. This can result in a greater risk of cervical injury due to surgical extensions, sutures, or infection, compromising cervical integrity. Related StoriesAI-generated handoff notes: Study assesses safety and accuracy in emergency medicineNew insights into anti-seizure medications during pregnancyStudy identifies potential epigenetic biomarker for preeclampsia

Advanced imaging techniques, such as transvaginal ultrasound (TVUS), provide further insights into the role of cervical damage. Cesarean scars are often visible as disruptions in the uterine wall. Conventional interventions and alternative approaches

Standard interventions for preventing sPTB, such as transvaginal cerclage (TVC), are less effective among women with prior in-labor C-sections. In TVC, a suture is placed in the cervix during early pregnancy to reduce the risk of preterm labor. However, in women with previous in-labor C-sections, TVC failure rates are high.

A study found that these women were 10 times likelier to deliver before 30 weeks gestation than women with other risk factors. In the same analysis, 46% of the women with prior in-labor C-sections and TVC experienced either sPTB or mid-trimester loss.

For women with cervical damage from in-labor C-sections, transabdominal cerclage (TAC) may be an effective alternative. TAC bypasses damaged cervical tissue, offering better protection than TVC.

A retrospective cohort study found that TAC significantly reduced sPTB rates before 30 weeks compared to TVC (odds ratio 0.09). This suggests that TAC could be a valuable option for women with a history of in-labor C-sections, particularly those with recurrent preterm births. Conclusion

C-sections are the most common surgical procedure worldwide, impacting nearly one-quarter of women. The potential for cervical damage during in-labor C-sections and its implications for future pregnancies underscores the need for tailored management strategies. Clinicians and patients must recognize these risks and work together in shared decision-making to ensure better maternal and fetal outcomes.

The link between in-labor C-sections, mid-trimester losses, and sPTB highlights an emerging clinical problem. With the increasing prevalence of in-labor C-sections, there is an urgent need to address this issue through improved training in instrumental delivery and labor management. Further investigation is also needed to understand better the mechanisms driving cervical damage and to develop strategies for minimizing harm.

Improved imaging protocols could play a crucial role in identifying at-risk women and guiding treatment decisions. Additionally, evaluating the effectiveness of interventions, such as TAC, in preventing adverse outcomes could inform future clinical guidelines. Journal reference: Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. Van der Krogt, L., Shennan, A. PLOS Medicine (2024). doi: 10.1371/journal.pmed.1004497
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004497

World

Pope Francis has ‘initial, mild’ kidney problem and still in critical condition, says Vatican

Published

2 hours ago

February 23, 2025

admin

Pope Francis has 'initial, mild' kidney problem and still in critical condition, says Vatican

The Pope remains in a critical condition and is now showing an “initial, mild” kidney problem – but is “vigilant” and took part in Mass in hospital with those caring for him.

The Vatican statement said Francis hadn’t had any more “respiratory crises” since Saturday evening.

However, a problem with his kidneys has emerged, with blood tests showing “an initial, mild, renal insufficiency, which is currently under control”, according to the update.

The 88-year-old Pope is still having “high-flow oxygen therapy” into his nose, while his hemoglobin value has increased after being given blood transfusions on Saturday.

The Pope has been at Rome’s Gemelli hospital since 14 February and is being treated for double pneumonia and chronic bronchitis.

Sunday evening’s statement said he was “vigilant and well oriented”, but due to the complexity of his case the prognosis is “reserved”.

“During the morning, in the apartment set up on the 10th floor, he participated in the Holy Mass, together with those who are taking care of him during these days of hospitalization,” the update added.

On Sunday morning, the Vatican said the Pope had a “tranquil” night and confirmed he would not lead prayers for the second week running.

Instead, Francis, who has been Pope since 2013, prepared words to be read on his behalf at the recitation of the Angelus.

‘I ask you to pray for me’

The Pope’s message said: “I am confidently continuing my hospitalisation at the Gemelli Hospital, carrying on with the necessary treatment; and rest is also part of the therapy!

“I sincerely thank the doctors and health workers of this hospital for the attention they are showing me and the dedication with which they carry out their service among the sick.

“In recent days I have received many messages of affection, and I have been particularly struck by the letters and drawings from children.

“Thank you for this closeness, and for the prayers of comfort I have received from all over the world! I entrust you all to the intercession of Mary, and I ask you to pray for me.”

The message is understood to have been written in the last few days.

On Saturday night, the Vatican said the Pope was in a critical condition after a “prolonged respiratory crisis” that required a high flow of oxygen.

It said he’d had blood transfusions after tests revealed thrombocytopenia, which is associated with anaemia.

Millions around the world have been concerned about his increasingly frail health – and his condition has given rise to speculation over a possible resignation.

Faith is never lost but it feels optimism is fading

By Lisa Holland, Sky correspondent in Vatican City

It’s hard to imagine a Sunday in the Vatican City without the Pope. Every week – unless he’s travelling – he is a constant, appearing at the same Vatican windows to deliver his message.

Instead, his written words were distributed by Vatican officials. In his message, the Pope thanked his doctors and people around the world for their good wishes.

But it seems the upbeat message was written before the dramatic downturn in the Pope’s health, which has left him in a critical condition. The business and the events of the Church are continuing in his absence.

Faith is never lost but it feels like optimism is fading and we are living through the last days of Pope Francis.

In St Peter’s Square the sun shone – and a gentle light fell on the ancient stone of the basilica.
The beauty and pageantry of columns of deacons and visitors filing in for a special mass as part of the Catholic Church’s jubilee year sat awkwardly with the prognosis of the Pope’s ailing health.

The visitors and deacons who’d come from around the world to take part, and hoped to see the Pope, were left disappointed. Though they said they felt his presence. “It is what it is,” said one.

They know the Pope is an 88-year-old man who has spent the last few years assisted by a wheelchair and walking stick. Throughout his life he has been dogged by lung issues.

It leaves an almost philosophical mood ahead of what the coming days may bring.

Doctors said on Friday that he was “not out of danger” and was expected to remain in hospital for at least another week.

They also warned that while he did not have sepsis, there was always a risk the infection could spread in his body.

Sepsis is a complication of an infection that can lead to organ failure and death.

Pope Francis has a history of respiratory illness, having lost part of one of his lungs to pleurisy as a young man. He also had an acute case of pneumonia in 2023.

Environment

Volvo Penta set to show off its new BESS subsystem at bauma 2025

Published

4 hours ago

February 23, 2025

admin

Volvo Penta set to show off its new BESS subsystem at bauma 2025

Volvo Penta BESS subsystem to be Bauma highlight

Volvo Penta will debut its latest modular and scalable battery energy storage system (BESS) platform for the off-grid construction and mining industries at the bauma equipment show – here’s what you can expect.

Best-known for its marine engines and gensets, Volvo Penta is the power production arm of the Volvo Group, specializing in putting energy to work. Operating under the tagline, ‘Made to Move You’, Volvo Penta is headed to bauma 2025 with a plan to keep construction, port shipping, and mining operations moving productively and competitively throughout their transitions to battery and (in theory, at least) hydrogen power.

To that end, the company will show off a job site ready version of the scalable and modular BESS subsystem concept shown last year.

Volvo says its new, modular BESS subsystem will enable other OEMs and third party system integrators to seamlessly deploy electric power to meet the ever-exceeding energy needs in construction and mining.

Advertisement – scroll for more content

“Our modular and scalable battery-electric platform is designed to support the electrification ecosystem—combining high-performance drivelines with the crucial energy storage subsystems for efficient charging and operation in construction and mining,” says Hannes Norrgren, President of Volvo Penta Industrial. “We want to meaningfully collaborate with our customers on value-added customization that will enable them to stay productive, efficient, and future-ready.”

The Penta substation at bauma will be built around the company’s “Cube” battery pack, an energy-dense solution with a favorable C-rate designed to make it easy for BESS manufacturers to offer more compact job site solutions capable of charging and discharging energy with high levels of speed and efficiency, enabling both stationary and mobile BESS configurations that can change and grow to meet the evolving needs of a given asset fleet or project.

A Volvo Penta-developed DC/DC unit converts the voltage from the Cube battery packs (600 V) into lower voltage (24 V) for powering auxiliaries and portable offices.

Electrek’s Take

BESS concept packed with Penta Cube batteries; via Volvo.

Volvo Penta has always provided power. Historically that’s been from combustion, but the company is looking ahead, developing products that will bring energy to job sites, tractors, and more long after the last ICE engine shuts down.

SOURCE | IMAGES: Volvo Penta.

FTC: We use income earning auto affiliate links. More.

World

Exit poll may appear decisive – but path to coalition is not clear yet

Published

4 hours ago

February 23, 2025

admin

Exit poll may appear decisive - but path to coalition is not clear yet

Initial exit polls appear to confirm what we have known for weeks: that the conservative Christian Democrats (CDU) and their Bavarian sister party the Christian Social Union (CSU) have got the most votes in the federal election, with Friedrich Merz most likely to be the next chancellor.

While this result isn’t a surprise, it doesn’t mean the path to power will be easy.

First off, the CDU-CSU don’t have a majority so they need to try to build a coalition.

Their most obvious choices as partners are the third-place Social Democrats. A two-party coalition is preferred as it can avoid excess bickering but the SPD and CDU disagree on several key points including sending long-range Taurus cruise missiles to Ukraine.

Follow live: Germany’s election results

Forming a government can take months but Mr Merz is keen to speed up the process – aware of the pressing issues both at home and abroad.

One of those is the rise of the far right, with the Alternative for Germany (AfD) party celebrating historic results.

The initial results suggest that for the first time since the Second World War, a far-right party has got the second highest number of votes.

That could also cause serious issues for the next government.

As a result of Germany‘s Nazi history, mainstream parties have a long-running pact known as the “firewall” which says they will not work with the far right.

Even before the polls had closed, AfD leader Alice Weidel echoed Donald Trump and released a video statement urging people to “observe” the ballots being counted and to “protect democracy”.

Many of the AfD’s supporters have said not allowing the second most popular party into government is undemocratic, threatening to take to the streets.

The US vice president JD Vance also sparked outrage when he spoke out against the firewall at the recent Munich Security Conference and suggested the new Trump administration would be ready to work with the AfD.

Conversely, in the run-up to the election, hundreds of thousands of Germans have protested to demand that the firewall remains.

In January, Mr Merz caused controversy when a draft motion got through parliament with AfD support, he’s since vowed he will not go into government with them.

If he sticks to that pledge then he is likely to see right-wing demonstrations as well becoming a target of prominent AfD backers including Elon Musk.

The AfD’s result also cannot be ignored. While some of the vote may be a protest, the party has expanded its traditional base in the east to pick up support in the west.

Dissatisfaction over migration, the economy, rocketing prices and the war in Ukraine have all helped to grow its ranks as people feel ignored by mainstream parties.

Mr Merz has already tried to win back some of its voters by proposing tough migration reforms including permanent checks on the borders and potentially turning away some asylum seekers when they try to enter.

If he fails to deliver on these promises then the AfD will continue to make gains.

Other urgent to dos for the next government include sorting out Germany’s economy following two years of recession and restoring its position at the centre of the EU.

Ministers must also face up to the fact their traditional allies are no longer guaranteed.

The Trump administration appears to be ripping up the rule book when it comes to being a protector of Europe and its ongoing support for Ukraine.

If America steps back, as Europe’s largest power and Ukraine’s largest European backer, Germany will have to step up.

Again, that’s going to be a big challenge as its military needs to be transformed.

The final results are not even confirmed yet but whatever form it takes, the next government knows it has four years to fix Germany, if it fails then populists are highly likely to ride to power in 2029.