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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
 

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Embedding human rights into crypto isn’t optional, it’s foundational

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Embedding human rights into crypto isn’t optional, it’s foundational

Embedding human rights into crypto isn’t optional, it’s foundational

Embedding human rights into crypto systems is a necessity. Self-custody, privacy-by-default, and censorship-resistant personhood must be core design principles for any technology. The future of digital freedom depends on it.

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Three women charged under Terrorism Act after van driven into fence of defence factory

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Three women charged under Terrorism Act after van driven into fence of defence factory

Three women have been charged under the Terrorism Act after a van was driven into an external fence of a defence business in Edinburgh.

The incident happened at the Leonardo facility in Crewe Road North on Tuesday.

The three women – aged 31, 34 and 42 – who were earlier arrested under the Terrorism Act have been charged and are due to appear at Edinburgh Sheriff Court on Monday 21 July.

Police Scotland’s Counter Terrorism Unit are leading the investigation and enquiries are ongoing.

This breaking news story is being updated and more details will be published shortly.

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Can the Rangers’ offense be fixed? Five numbers that tell the story of Texas’ lineup woes

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Can the Rangers' offense be fixed? Five numbers that tell the story of Texas' lineup woes

Less than two years ago, the Texas Rangers rode a potent offense to the first World Series championship in franchise history. Since then — on paper, at least — that group has only improved. Established sluggers were brought in. Young, promising players accrued more seasoning. Core stars remained in their primes. And yet, over the course of 10 baseball months since hoisting the trophy on Nov. 1, 2023, the Rangers have fielded one of the sport’s worst offenses, a sobering reality that continues to vex team officials.

The circumstances of 2025 have only intensified the frustration.

The Rangers have received Cy Young-caliber production from a rejuvenated Jacob deGrom, who had compiled fewer than 200 innings over the last four years. Their rotation went into the All-Star break with the second-lowest ERA in the major leagues. Their bullpen, practically rebuilt over one offseason, ranked third. Their defense (16 outs above average) was elite, as was their baserunning (10.8 runs above average). But the Rangers, despite back-to-back wins over the first-place Detroit Tigers this weekend, find themselves only a game over .500, seven games out of first place and 2 1/2 games out of a playoff spot, because they can’t do the one thing they were expected to do best: hit.

Bret Boone, the former All-Star second baseman who was installed as the team’s hitting coach in early May, has been tasked with fixing that — but he is also realistic.

“I’m not gonna come in here and ‘abracadabra,'” he said, waving his right arm as if wielding a magic wand. “That’s the big misnomer about hitting. Hitting is really hard. The bottom line is — you can prepare as much as you want, but when you get in the box, it’s just you and that pitcher.”

Boone isn’t here for an overhaul. He’s here to encourage. To simplify. One of his prevailing messages to players, he said, has been to “watch the game” — to put away the tablet, come up to the dugout railing and see how opposing pitchers are attacking other hitters. Boone has emphasized the importance of approaching each game with a plan, whatever that might be. He has occasionally blocked off the indoor batting cage, worried that hitters of this generation swing too often. And he has encouraged conversation.

“That’s what great offenses do,” Boone said. “They’re constantly interacting.”

There might not be a more interesting team to watch ahead of the trade deadline. Rangers president of baseball operations Chris Young is not one to give up on a season, particularly with a team this talented. But one more rough patch might force him to, at least to an extent. Young would prefer to add, but it’s hard to envision a way to improve the lineup from outside.

He won’t find a better middle-infield combo than Corey Seager and Marcus Semien. Or a better outfield than Evan Carter, Wyatt Langford and Adolis García. Or a better designated hitter than Joc Pederson, who could return from a hand fracture before the end of this month. Or a better catching tandem than Jonah Heim and Kyle Higashioka. Or a better crop of corner infielders than Josh Smith, Josh Jung and Jake Burger, though Burger returned to the injured list with a quad strain earlier this week.

Any offensive improvement will probably come internally, signs of which emerged recently. The Rangers got Carter back from the bereavement list on July 4 and Langford back from the IL on July 5, making their lineup as close to whole as it has been all year. Over the ensuing week, they scored 53 runs in seven games heading into the All-Star break. Maybe it was a sign of things to come. Or, if recent history is any indication, a short burst of false promise.

Below is a look at five numbers that define the Rangers’ surprising offensive downturn.


1. Semien and Seager’s combined OPS on June 22: .671

The Rangers’ rise began in late November 2021, just before the sport shut down in the leadup to an ugly labor fight, when Semien and Seager secured contracts totaling $500 million. Their deals came within days of each other, ensuring they’d share a middle infield for years to come. And when the Rangers won it all in 2023, it was Semien and Seager hitting back-to-back at the top of the lineup, setting the tone for an offense that overwhelmed teams in October.

Some things haven’t changed: Semien and Seager are still the driving forces of this offense. For most of this year, though, that hasn’t been a positive thing.

As late as June 22, with the Rangers 78 games into their season, Semien and Seager had combined for a .229/.312/.359 slash line. Their combined OPS, .671, sat 44 points below the league average.

Semien, traditionally a slow starter, finished the month of May with the second-lowest slugging percentage among qualified hitters and at times batted ninth. Seager made two separate trips to the IL because of the same right hamstring strain and eventually fell out of whack, batting .188 in June. If the Rangers are looking for good news, though, it’s that Semien and Seager finally got going in the leadup to the All-Star break. From June 23 to July 13 — with Seager and Semien settling into the No. 2 and No. 3 spots, respectively — they slashed .313/.418/.592.

“We all want to be on at the same time,” Semien said. “It’ll never happen like that, but if Corey and I are on, this team goes.”


2. Texas’ slash line against fastballs: .236/.312/.372

One of the Rangers’ coaches recently recalled some of the most iconic homers from the team’s championship run — García’s grand slam in the American League Championship Series, and Seager’s blasts against Houston’s Cristian Javier and Arizona’s Paul Sewald.

They all had one thing in common: turning on high fastballs and pulverizing them.

The Rangers were one of the best fastball-hitting teams in 2023. That has been far from the case since. The Rangers slashed just .233/.315/.379 against four-seam fastballs in 2024, worse than every team except the Chicago White Sox, who lost a record 121 games. This year, it isn’t much better.

The Rangers’ slash line against four-seamers was only .236/.312/.372 heading into the All-Star break, good for a .684 OPS that ranked 27th in the majors. Burger (.473 OPS), Heim (.500), Pederson (.620) and García (.660) were especially vulnerable. Against four-seamers that were elevated, no team had a higher swing-and-miss percentage than Texas (55.5%).

Being in position to hit the fastball has been one of the points of emphasis from the hitting coaches in recent weeks. It doesn’t mean every hitter will look fastball first — approaches are individualistic and often alter based on matchups — but it does underscore the importance of narrowing the focus. Opposing pitchers are too good these days. Hitters can’t account for everything. And the best offenses are able to take something away from an opposing pitching staff. The 2023 team took away the fastball as an attack weapon. But the Rangers, in the words of one staffer, have been “stuck in between” ever since — late on velocity and off balance against spin.

It’s a tough way to live.


3. Rangers’ chase rate with RISP: 32.2%

When asked about the biggest difference between the 2023 offense and the 2025 version, Rangers manager Bruce Bochy mentioned the approach in run-scoring opportunities. The team from two years ago, he said, was much better at situational hitting with runners in scoring position. This team seems to chase too much in those situations.

The numbers bear that out.

The Rangers’ chase percentage with runners in scoring position was 32.2% coming out of the All-Star break, fourth worst in the major leagues. Their strikeout percentage, 23.7%, was fifth worst. Their slash line, .230/.304/.357, was down there with some of the worst teams in the sport. The Rangers’ lineup has some strikeout in it — with Burger, Jung and García at the top of that list — but team officials believe it should be much better adept at driving in runs.

Not being able to has led to some dramatic highs and lows. The Rangers have scored eight or more runs 13 times, including two instances over a 72-hour stretch in which they hung 16 runs on the Minnesota Twins. But there have also been 25 games in which they have been held to one or zero runs, third most in the major leagues.


4. Carter’s and Jung’s wOBA ranks since 2023: 205th and 264th

Entering the second half, 380 players had accumulated at least 300 plate appearances since the start of the 2024 season. Among them, Carter ranked 205th with a .308 weighted on-base average. Jung, with a .295 wOBA, ranked 264th.

Jung looked like a budding star at third base in 2023, making the All-Star team and finishing fourth in AL Rookie of the Year voting. Carter came up in September and surged throughout October. With those two and Langford, Texas’ draft pick at No. 4 earlier that summer, the Rangers had three young, controllable players they could surround with their long list of established stars. It seemed unfair, yet it hasn’t come close to panning out.

Carter struggled through the first two months of 2024, was diagnosed with a stress reaction in his back, couldn’t fully ramp back up, got shut down for good in August, didn’t look right the following spring training and started the 2025 season in Triple-A. Carter appeared in just 45 games in 2024. Jung played in only one more, after a wrist fracture held him out for most of the first four months.

Then came a stretch of 101 plate appearances this June during which Jung notched just 15 hits, 5 walks and 27 strikeouts. Eight of those strikeouts came over his last four games, when his chase rate jumped to 45.9% — 12 percentage points above his career average. A Rangers source described him as “defeated” and “lost.”

On the second day of July, Jung was optioned to Triple-A Round Rock.


5. Rangers’ wRC+ since 2023: 94

There might not be a better representation of the Rangers’ drop-off than weighted runs created plus, which attempts to quantify total offensive value by gathering every relevant statistic, assigning each its proper weight and synthesizing it all into one convenient, park- and league-adjusted metric. The league average is 100, with every tick above or below representing a percentage point better or worse than the rest of the sport at that time.

During the 2023 regular season, the Rangers put together 117 wRC+. In other words, their offense was 17% above league average. Only one team — the Atlanta Braves, another currently underperforming club — was better. From the start of the 2024 season to the start of the 2025 All-Star break, the Rangers compiled a 94 wRC+, putting them 6% below the league average. Only eight teams were worse.

Five every-day players from that 2023 team are still on the Rangers — not counting Carter, who didn’t come up until September — and all of them have seen their OPS drop by more than 100 points. Seager? 1.013 OPS in 2023, .856 OPS since. García? .836 in 2023, .681 since. Heim? .755 in 2023, .605 since. Semien? .826 in 2023, .693 since. Jung? .781 in 2023, .676 since.

For Young, it’s not just the individual performances but how they coalesce.

“What we had was just a really balanced approach and a collective mindset in terms of the way we were attacking the opposing pitcher,” Young, in his fifth season as the head of baseball operations, said of the 2023 offense. “We had other guys who could grind out at-bats. We had guys who could hit for average. We had guys who slugged. And I still think we have that in our lineup. It’s just, for whatever reason, a number of them have had bad years to start the season. When you have a couple guys having down years, you can survive. When you have a majority of them having down years, it’s magnified. And then guys start pressing and putting pressure on themselves, and it makes it even harder.”

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