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OBJECTIVE: This study aimed to systematically review the worldwide second-stage cesarean delivery rate concerning pre–second-stage cesarean delivery and assisted vaginal birth rates. DATA SOURCES: PubMed, Medline Ovid, EBSCOhost, Embase, Scopus, and Google Scholar were queried from inception to February 2023, with the following terms: “full dilatation,” “second stage,” and “cesarean,” with their word variations. Furthermore, an additional cohort of 353,434 cases from our recently published study was included. STUDY ELIGIBILITY CRITERIA: Only original studies that provided sufficient information on the number of pre–second-stage cesarean deliveries, second-stage cesarean deliveries, and vaginal births were included for the calculation of different modes of delivery. Systemic reviews, meta-analyses, or case reports were excluded. METHODS: Study identification and data extraction were independently performed by 2 authors. Selected studies were categorized on the basis of parity, study period, and geographic regions for comparison. RESULTS: A total of 25 studies were included. The overall pre–second-stage cesarean delivery rate, the second-stage cesarean delivery rate, and the second-stage cesarean delivery–to–assisted vaginal birth ratio were 17.94%, 2.65%, and 0.19, respectively. Only 5 studies described singleton, term, cephalic presenting pregnancies of nulliparous women, and their second-stage cesarean delivery rates were significantly higher than those studies with cohorts of all parity groups (4.50% vs 0.83%; P

Abstract Background Uterine compression suture is an important conservative surgical technique in managing atonic postpartum hemorrhage. In this study, we aim to evaluate the subsequent menstrual, fertility and psychological outcomes after uterine compression sutures. Methods This was a prospective cohort study between 2009 and 2022 conducted in a tertiary obstetric unit (6000 deliveries per year) in Hong Kong SAR. Women with primary postpartum hemorrhage successfully treated with uterine compression sutures were followed-up in postnatal clinic for two years after delivery. Data on menstrual pattern were collected during each visit. Psychological impact after uterine compression suture was assessed using a standardized questionnaire. Subsequent pregnancies were identified by territory-wide computer registry and telephone interviews. Women with postpartum hemorrhage treated with uterotonic agents only were chosen as controls. Results In our cohort (n = 80), 87.9% of women had return of menses within six months after delivery. Regular monthly cycle was observed in 95.6% of women. Majority of women reported similar menstrual flow (75%), menstrual days (85.3%) and no change in dysmenorrhea status (88.2%) as compared before. Among eight (11.8%) women who reported hypomenorrhea after uterine compression sutures, two cases of Asherman’s syndrome were diagnosed. Among 23 subsequent pregnancies (16 livebirths), no significant differences in outcome were observed except more omental or bowel adhesions (37.5% vs. 8.8%, p = 0.007), recurrence of hemorrhage (68.8% vs. 7.5%, p

Objective: To examine the efficacy of uterine artery ligation (UAL) with or without subsequent haemostatic procedures in management of postpartum haemorrhage (PPH) during Caesarean section. Methods: Women who underwent UAL with or without subsequent haemostatic procedures were compared in terms of maternal demographics, antenatal risk factors, delivery details, causes of PPH, sequence of treatment modalities used, and short-term complications. Results: A total of 173 women underwent UAL with or without subsequent haemostatic procedures. The success rate of haemostasis was 96.5% (167/173) after UAL with or without subsequent haemostatic procedures; it was 81.5% (141/173) after UAL alone. Multivariate analysis revealed that women with prior PPH had a higher risk for haemostasis failure after UAL alone (adjusted odds ratio [aOR]=10.35, p=0.027), whereas women with placenta praevia had a lower risk for haemostasis failure after UAL alone (aOR=0.05, p=0.001). Compared with UAL alone, UAL followed by haemostatic procedures resulted in a higher risk of postoperative complications including haemorrhagic shock (p=0.012), disseminated intravascular coagulopathy (p<0.001), and intensive care unit admission (p<0.001). There were five cases of bowel injury and one case of pelvic vessel injury. Conclusion: UAL is an effective and safe first-line surgical procedure for management of PPH during Caesarean section, especially for women with placenta praevia. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors for adverse pregnancy outcomes among women with pre-gestational diabetes. Methods: We retrospectively reviewed medical records of women with pre-gestational diabetes who attended the Tuen Mun Hospital between 1 January 2012 and 30 December 2022 for antenatal care and delivery. Composite adverse early perinatal outcomes included spontaneous fetal loss before 24 weeks and congenital malformations. Composite adverse maternal outcomes included pre-eclampsia and Caesarean section. Composite adverse neonatal outcomes included preterm delivery <37 weeks, small and large for gestational age, shoulder dystocia, hypoglycaemia, Apgar score <7 at 5 minutes, arterial cord blood pH <7.0, admission to a neonatal intensive care unit, stillbirth, and death within 28 days of life. Factors associated with adverse pregnancy outcomes were identified. Results: Among 245 women included in analysis, there were 10 spontaneous pregnancy losses before 24 weeks, four stillbirths, and 41 congenital malformations, which resulted in four terminations of pregnancy. The glycated haemoglobin (HbA1c) level at the first antenatal visit was a predictor for composite adverse early perinatal outcomes (adjusted odds ratio [aOR]=1.27, p=0.013). The rate of congenital anomaly increased threefold from 10% when the HbA1c level was <5.6% to 37.1% when the HbA1c level was >9.1% (p=0.003). Predictors for composite adverse maternal outcomes were a pre-pregnancy body mass index =25 kg/m2 (aOR=2.04, p=0.033) and chronic hypertension (aOR=3.59, p=0.009), whereas the predictor for composite adverse neonatal outcomes were the HbA1c level before delivery (aOR=1.57, p=0.025). Pre-pregnancy medical care was associated with a lower maternal HbA1c level at the first antenatal visit (6.8% vs 8.2%, p=0.002) and earlier gestational age at the first antenatal visit (8 vs 12 weeks, p<0.001), compared with no pre-pregnancy medical care. Conclusion: Maternal glycaemic control and body mass index are the major modifiable risk factors for adverse pregnancy outcomes in women with pre-gestational diabetes. Pre-pregnancy medical care should emphasise lowering the HbA1c level and bodyweight at early pregnancy to avoid adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare treatment outcomes of a levonorgestrel-releasing intrauterine system (LNGIUS) or oral progestogens in women with non-atypical endometrial hyperplasia (EH). Additionally, the predictors for EH non-regression were determined. Methods: Medical records of women diagnosed with non-atypical EH between April 2016 and March 2022 at Tuen Mun Hospital were retrieved. These patients were offered LNG-IUS as the first-line option or oral progestogens if they refused or had LNG-IUS contraindications such as submucosal fibroid distorting endometrial cavity. The rate of EH non-regression at 12 months and the rate of EH relapse at 24 and 36 months between groups were compared. Univariate and multivariate analyses were conducted to identify predictors for EH non-regression. Results: The median follow-up duration was 24 months for the LNG-IUS group and 19 months for the oral progestogens group. The rate of EH regression at 12 months was higher in the LNG-IUS group (93.9% vs 71.2%, p<0.001). The rate of EH relapse was higher in the oral progestogens group at 24 months (21.1% vs 1.1%, p=0.003) and 36 months (33.3% vs 2.3%, p=0.014). The incidence of hysterectomy for treatment failure was higher in the oral progestogens group (13.7% vs 4.2%, p=0.005). No EH relapse occurred in either group after 36 months posttreatment. Predictors for EH non-regression were postmenopausal status (odds ratio=5.80, p=0.022) and oral progestogens treatment (odds ratio=7.51, p<0.001). Conclusion: In women with non-atypical EH, treatment with LNG-IUS leads to a higher regression rate at 12 months, a lower relapse rate within 36 months, and a lower rate of hysterectomy due to treatment failure, compared with treatment with oral progestogens. Postmenopausal status and treatment with oral progestogens are risk factors for treatment failure. Regular endometrial surveillance should be provided to women at risk. Hysterectomy is recommended for postmenopausal women. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patients' pain scores and satisfaction with hysteroscopic morcellation service in two hospitals in Hong Kong. Methods: Medical records of women who underwent hysteroscopic morcellation as a day procedure using the Intrauterine Bigatti Shaver between 1 November 2018 and 31 October 2022 at Tuen Mun Hospital or Pok Oi Hospital were retrospectively reviewed. Results: 242 patients who underwent hysteroscopic morcellation were included. The mean patient age was 54.1 years. Postmenopausal bleeding was the commonest presenting symptom (48.8%), followed by abnormal menstrual bleeding (42.6%). 43.8% of patients had one lesion; 87.2% of patients had endometrial polyps. There were 523 endometrial polyps and 29 myomas; 99.4% of endometrial polyps and 79.3% of myomas were removed. The complete resection rate was higher for patients with endometrial polyps than for patients with myomas (98.7% vs 77.8%, p<0.001). Most patients reported mild pain intraoperatively (57.4%), immediately after the procedure (72.3%), and upon discharge (95.0%). 98.8% of patients were satisfied with the procedure; 94.2% would undergo the same operation again if clinically indicated; and 95.5% would recommend this procedure to others. Premenopausal women reported more pain immediately after the procedure (2 vs 1, p=0.020) and upon discharge (0 vs 0, p=0.040) than postmenopausal women. Patients with an operative time of >20 minutes reported more pain immediately after the procedure (3 vs 1, p=0.007) than patients with an operative time of =20 minutes. Conclusion: Almost all patients were satisfied with hysteroscopic morcellation. Most patients experienced only mild pain during and immediately after the procedure and upon discharge. Premenopausal status and operative time of >20 minutes were associated with higher pain scores. Further optimisation of pain-relief methods should be considered. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to identify risk factors for placental abruption and evaluate maternal and fetal outcomes of patients with placental abruption in a tertiary hospital in Hong Kong. Methods: Medical records of patients with placental abruption treated at the Tuen Mun Hospital between January 2017 and December 2021 were retrospectively reviewed. Data retrieved included patient demographics, alcohol/substance abuse and smoking status, obstetric history, antenatal characteristics, body mass index at first antenatal visit, clinical presentation, intrapartum events, complications, and maternal and perinatal outcomes. Each patient was matched with a control who delivered just before the patient. Results: Of 22 990 deliveries and 23 230 live births, there were 86 placental abruption cases; the incidence was 0.37%. After adjusting for confounders, the risk factor for placental abruption was a history of antepartum haemorrhage. Compared with controls, patients with placental abruption had higher rates of caesarean sections (91.9% vs 23.3%, p<0.001), postpartum haemorrhage (62.8% vs 15.1%, p<0.001), uterine atony (31.4% vs 3.5%, p<0.001), blood transfusion (25.6% vs 3.5%, p<0.001), and disseminated intravascular coagulopathy (7.0% vs 0%, p=0.029). Compared with controls, neonates complicated with placental abruption had lower Apgar score at 1 minute (7 vs 8, p<0.001), higher preterm birth rate (64.0% vs 9.3%, p<0.001), lower birth weight (2296.4 g vs 3088.8 g, p<0.001), and more perinatal morbidities. Patients with a Couvelaire uterus had higher rates of uterine atony (56.3% vs 27.0%, p=0.026), postpartum haemorrhage (93.8% vs 61.9%, p=0.014), disseminated intravascular coagulopathy (25.0% vs 3.2%, p=0.014), blood transfusion (68.8% vs 17.5%, p<0.001), and secondary intervention (25.0% vs 1.6%, p=0.005). Neonates born from patients with a Couvelaire uterus had higher rates of acidosis (umbilical cord blood pH <7.1) [53.3% vs 5.8%, p<0.001], lower Apgar score at 1 minute (25.0% vs 4.8%, p=0.028), and hypoxic-ischaemic encephalopathy (12.5% vs 0%, p=0.039). Conclusion: Clinicians should be vigilant for placental abruption in patients with antepartum haemorrhage, especially in high-risk patients with a history of placental abruption, hypertension, or pre-eclampsia. Early and consistent antenatal care is imperative to identify those with risk factors. Proper education and timely preventive management should be provided to improve maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]