Background Increasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications. Methods A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis. Results Maternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion Several reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth in order to prevent or diminish unnecessary cesarean births.

A historical cohort study was conducted to examine the pregnancy outcome in women aged 40 or older and determine the effect of age on low birth weight. The pregnancy outcomes of 789 mothers aged 40 years or older were analysed and compared with those of 20,852 mothers aged 20-34 years. There were differences in socioeconomic status and obstetric characteristics between the two groups. The older group had more medical and obstetric complications (diabetes mellitus, chronic hypertension, malpresentation, pregnancy-induced hypertension, placenta praevia, multiple pregnancies, pre-term labour, fetal distress, retained placenta, postpartum haemorrhage and endometritis), more adverse fetal outcomes (low birth weight, low Apgar scores and congenital anomalies) and a higher caesarean section rate. The multivariate logistic regression analysis confirmed that maternal age was an independent risk factor for low birth weight. These data will be useful in counselling patients about their expectations and the risk of adverse outcomes and in providing the appropriate necessary care.

PurposeTo validate the modified World Health Organization (WHO) classification in pregnant women with congenital and acquired heart diseases.Patients and methodsThe database of pregnant women with heart disease, who delivered at Songklanagarind Hospital between January 1995 and December 2016, was retrieved from the Statistical Unit, Department of Obstetrics and Gynecology, along with the Hospital Information System of Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University. Each patient was retrospectively classified according to the modified WHO classification of maternal cardiovascular risk. Comparison of maternal and fetal outcomes among the modified WHO classes were analyzed using the chi-square test or Fisher’s exact test and one-way ANOVA test. A p-value of <0.05 was considered statistically significant.ResultsA total of 331 cases were studied: 157 cases with congenital heart disease and 174 cases with acquired heart disease. There were 48, 173, 32 and 78 cases in the modified WHO class I, II, III and IV, respectively. Congestive heart failure was the most common complication. The overall maternal mortality rate was 3.6%, all of which were in the modified WHO class IV. Maternal cardiovascular events occurred in 24.2% of cases, increasing rates with higher modified WHO class: 4.2%, 15.0%, 25.0% and 56.4% in class I, II, III and IV, respectively (p<0.001). Adverse fetal outcomes including preterm delivery, low birth weight, small for gestational age and neonatal intensive care unit admission were also significantly increased in class III and IV (p<0.05).ConclusionThe modified WHO classification is useful not only for obtaining a cardiovascular risk assessment in pregnant women with heart disease but also for predicting adverse fetal outcomes. It must, therefore, be implemented into routine care service at all levels of health care systems.

The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.

The vacuum operator's experience was an independent risk factor for low Apgar scores. Improvement of the residency training program is mandatory.