The aim of this multicenter retrospective cohort study was to examine the impact of maternal age on perinatal outcomes in multiparas, stratified according to maternal age in one- and two-year increments. The analysis involved 302,484 multiparas who delivered between the years 2003 and 2021 in four university-affiliated obstetrics departments. Maternal age was considered both as a continuous variable and in two-year intervals, as compared with a comparison group of parturients aged 25–30 years. The study focused on cesarean delivery and neonatal intensive care unit (NICU) admission as primary outcomes. The findings revealed that cesarean delivery rates increased as maternal age advanced, with rates ranging from 6.7% among 25–30 year olds, rising continuously from 13.5% to 19.9% between the age strata of 31 and 42, to exceeding 20% among those aged ≥ 43 years (p < 0.01 for each stratum when compared to 25–30 year old group). Similarly, NICU admission rates rose from 2.7% in the comparison group to 6% in parturients aged 45–46 years (p < 0.01 for each stratum when compared to 25–30 year old group). The study highlights the association between incrementally advanced maternal age and increased rates of maternal and neonatal complications, necessitating global awareness of these implications for family planning decisions and maternal care.

OBJECTIVE: To evaluate the risk of uterine rupture and other major labor complications in a trial of labor after cesarean delivery (TOLAC) in grandmultiparous women. METHODS: A retrospective descriptive study of 64,345 births in three hospitals between the years 1999 and 2009. The study group included 1,922 deliveries of women in their sixth or higher birth with one previous cesarean delivery. RESULTS: The risk for uterine rupture was 0.3% (six cases) (95% confidence interval [CI] 0.11–0.68); of these, two cases ended in hysterectomy. There were another four hysterectomies not attributable to uterine rupture (a total risk of 0.3%). Neither induction nor augmentation of labor increased the risk for uterine rupture. Trial of labor after cesarean delivery in the first labor after prior cesarean delivery conferred a higher risk for hysterectomy (1% compared with 0.1%; P=.019). In the presence of shoulder dystocia (n=20), the risk of uterine rupture was 10% (two cases) compared with 0.2% when shoulder dystocia did not occur (P=.002; odds ratio 52.7, 95% CI 9–306). CONCLUSION: Grandmultiparous women with one previous cesarean delivery can be offered TOLAC. Labor induction is not contraindicated in such women. LEVEL OF EVIDENCE: III

Research using artificial intelligence (AI) in medicine is expected to significantly influence the practice of medicine and the delivery of health care in the near future. However, for successful deployment, the results must be transported across health care facilities. We present a cross-facilities application of an AI model that predicts the need for an emergency caesarean during birth. The transported model showed benefit; however, there can be challenges associated with interfacility variation in reporting practices.

(1) Background: Progesterone-only pills (POP) are widely used contraceptives. About 40% of women taking these pills report vaginal bleeding/spotting; 25% find this a reason for cessation. To date, no effective remedy has been described. We aimed to examine the therapeutic approaches offered by health providers. (2) Methods: A prospective questionnaire-based study of women experiencing vaginal bleeding due to POP, comparing the effectiveness of prescribed therapies. Women were recruited through social networks, and subsequently divided into groups according to the treatment offered: (1) POP with norethisterone (n = 36); (2) double dose POP (n = 19); (3) single dose POP (continuing initial treatment, n = 57); and (4) different POP formula (n = 8). Women rated bleeding quantity and frequency at four intervals, at weeks 0, 2, 4, and 6. (3) Results: Women who added 5 mg norethisterone acetate reported a significant decrease in bleeding frequency compared to the other groups, observed after 2, 4, and 6 weeks (p-values 0.019, 0.002, and 0.002, respectively). Women also reported an overall decrease in combined bleeding quantity and frequency (p-values 0.028, 0.003, and 0.005, respectively). There was no difference in the rate of side effects among groups. (4) Conclusions: Adding 5 mg norethisterone acetate (Primolut-nor) to progesterone-only pills significantly reduces bleeding and spotting associated with POP contraception.