A single dose of 20 mg intravenous HBB is effective and safe in shortening the duration of the first stage of labor without any adverse effects on fetus and mother.

In this observational study, we investigated the maternal and perinatal complications of caesarean delivery performed in the second stage compared with the first stage of labour at a tertiary hospital in İstanbul. This study was performed from June 2008 to July 2011. Primary maternal outcomes measured included intraoperative surgical complications, surgery duration, need for blood transfusion, endometritis, requirement for hysterectomy, unintended extension and length of hospital stay. Neonatal outcomes included a 5 min Apgar score ≤ 3, admission to a neonatal intensive care unit, fetal injury, septicaemia and neonatal death. In total, 3,817 caesarean deliveries were available for analysis; 3,519 were performed in the first stage, and 298 in the second stage. Caesarean deliveries performed in the second stage were associated with increased intraoperative complications, unintended extensions, need for blood transfusion, higher rates of endometritis and requirement for hysterectomy and were, therefore, associated with longer operation time and hospital stay. Neonatal complications included a significantly low Apgar score at 5 min, increased neonatal death, admission to the neonatal intensive care unit, septicaemia and fetal injury (all p < 0.05). Caesarean deliveries performed in the second stage of labour were associated with higher rates of maternal and neonatal complications, particularly in women who had undergone previous caesarean delivery.

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Objectives: To compare maternal and neonatal outcomes concerning emergency or planned cesarean deliveries in pregnancies complicated by placenta previa (PP), and to evaluate factors related to blood transfusion requirement. Methods: Three hundred sixty-three women with PP with (n = 80) and without (n = 283) placenta accreta spectrum (PAS) who delivered between May 2016 and May 2021 were retrospectively reviewed. The patients were allocated to two main groups as PAS and non-PAS and into two subgroups as emergency cesarean delivery (ECD) and planned cesarean delivery (PCD). Results: One hundred twenty-eight deliveries were emergency and 155 were planned in non-PAS group. In PAS group 38 patients were delivered urgently and 42 were delivered as planned. General anesthesia was preferred more frequently in emergency cases. Gestational age, birth weight, and the 1 st and 5 th minute APGAR scores of the infants were significantly lower and neonatal intensive care unit (ICU) admission was significantly higher in the ECD cases (p < 0.001) in both PAS and non-PAS groups. The total amount of blood and blood product transfused (p = 0.005), length of hospital stay (p = 0.022) were higher in the ECD cases and adult ICU admission was significantly higher in the ECD cases in non-PAS group (p = 0.016). In multilinear regression analysis, the need for blood transfusion was found to increase with the number of previous cesarean sections, ECD, PP with PAS, general anesthesia, and uterine artery ligation. Conclusions: In placenta previa, which is an obstetric condition associated with serious maternal and neonatal morbidity and mortality, adverse maternal and neonatal outcomes increase in cases of emergency cesarean delivery.

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The purpose of this study was to compare postoperative pain and neuropathy after primary caesarean sections with either blunt or sharp fascial expansions. A total of 123 women undergoing primary caesarean sections were included in the study. The sharp group had 61 patients, and the blunt group had 62. In the sharp group, the fascia was incised sharply and extended using scissors. In blunt group, the fascia was bluntly opened by lateral finger-pulling. The primary outcome was postoperative pain. The long-term chronic pain scores were significantly lower in the blunt group during mobilisation (p = .012 and p = .022). Neuropathy was significantly more prevalent in the sharp group at both 1 and 3 months postoperatively (p = .043 and p = .016, respectively). The odds ratio (OR) and 95%CI for postoperative neuropathy at 1 and 3 months were as follows; OR 3.71, 95%CI 0.97-14.24 and OR 5.67, 95%CI 1.18-27.08, respectively. The OR for postoperative pain after 3 months was 3.26 (95%CI 1.09-9.73). The prevelance of postsurgical neuropathy and chronic pain at 3 months were significantly lower in the blunt group. Blunt fascial opening reduces the complication rate of postoperative pain and neuropathy after caesarean sections. Impact statement What is already known on this subject? The anatomic relationship of the abdominal fascia and the anterior abdominal wall nerves is a known fact. The fascia during caesarean sections can be opened by either a sharp or blunt extension. Data on the isolated impact of different fascial incisions on postoperative pain is limited. What do the results of this study add? The postoperative pain scores on the incision area are lower in the bluntly opened group compared to the sharp fascial incision group. By extending the fascia bluntly, a decrease in trauma and damage to nerves was observed. What are the implications of these findings for clinical practice and/or future research? The lateral extension of the fascia during caesarean sections must be done cautiously to prevent temporary damage to nerves and vessels. The blunt opening of the fascia by lateral finger pulling might be a preferred method over the sharp approach that uses scissors. We included only primary caesarean cases, however, comparisons of blunt and sharp fascial incisions in patients with more than one abdominal surgery should be explored in future studies.