Special Issues

Special Issue Title: Caesarean Section Today - “Caesarology in the 21st Century”

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· Deadline for manuscript submissions: 30 April 2021

Special Issue Editor

Guest Editor

Prof. Dubravko Habek

Clinical Department of Obstetrics and Gynecology, Sveti Duh University Hospital, Catholic University of Croatia Zagreb, Croatia

Website | E-Mail1 | E-Mail2

Interests: Operative and emergency obstetrics; Pelveoperineology;  Forensic gynecology and obstetrics; Deontology; Surgery; Medicohistoriography

Prof. Vesna Elvedi Gasparovic

Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia


Interests: High risk pregnancy; emergency obstetrics; forensic obstetrics

Special Issue Information

Dear Colleagues,

Caesarean Section (CS) is a major surgical procedure that should be performed according to medically obstetric (>90%) and nonobstetrics (<10%) indications with 80% emergency and 20% elective CS. The relationship between elective CS and urgent CS has become inverted, as has the relationship between the existence of nonobstetricc indications and real obstetric indications in extremely high >30% CSs where they are performed.

CS has remained a clinically justified procedure as a life-saving surgical procedure for mother and/or baby but recently it has become a fashionable procedure as a consequence of various non-medical indications. Non–medical indicated CS has become a public health, epidemiologic, perinatal, pediatric, juristic, and deontological problem worldwide as it burdens the healthcare system and is beyond the reach of good clinical practice. Generally known, with increased rates of CS, incidence of previal and/or morbid invasive malplacentation in nulliparous increases from 5% to 67% in pregnant women with >4 CSs, while surgery, especially unplanned laparotomy and hysterectomy, as well as hemorrhagic obstetric shock, are direct predictors of severe maternal morbidity and mortality. Today, when CS has become the most common obstetric operation, even more common than episiotomy, any clinical evaluation of this procedure is worth publishing: repeaed CS, vaginal birth after CS, evaluation of CSs techniques, CS in twin pregnancies, ethical dilemas in CS etc.

Prof. Dubravko Habek and Prof. Vesna Elvedi Gasparovic

Guest Editor


Manuscript Submission Information

Manuscripts should be submitted online at https://ceog.imrpress.org by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Clinical and Experimental Obstetrics & Gynecology is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1250. We normally offer a discount about 30% (APC: $850) to all contributors invited by the Editor-in-Chief, Guest Editor (GE) and Editorial board member. Submitted papers should be well formatted and use good English.


Caesarean section; good clinical practice; operative techniques and outcome

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Planned Papers

Title: The influence of Cesarean SEction on future female fertility
Authors: Johannes Ott

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Obstetrics philosophy of extraperitoneal cesarean section and possible placental percretism into urinary bladder
Dubravko Habek
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (5): 995-996.   DOI: 10.31083/j.ceog4805159
Abstract75)   HTML5)    PDF(pc) (218KB)(19)       Save
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The impact of Cesarean section on female fertility: a narrative review
Lorenz Hinterleitner, Herbert Kiss, Johannes Ott
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (4): 781-786.   DOI: 10.31083/j.ceog4804125
Abstract174)   HTML29)    PDF(pc) (113KB)(106)       Save

Objective: The mode of giving birth has changed over the years. In 1990, approximately 10% of women delivered by Cesarean section (CS), whereas this procedure is performed daily in obstetrics today. When a surgical intervention performed, it is necessary to consider special risks and complications, including long-term effects. Mechanism: This review focuses on fertility after CS. Evidence suggests that many women who aim to have subsequent children have difficulties becoming pregnant after they have delivered by CS. Findings: There are several causes for subfertility/infertility after CS, including post-Cesarean niches, intraabdominal adhesions, and the preference for a smaller family size, among others. Conclusion: This review provides an overview of the available literature, which supports the conclusion that CS is associated with decreased odds of subsequent pregnancy and live birth.
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Less is more—a minimal approach technique for Cesarean Section
Dragan Belci, Gian Carlo Di Renzo, Davor Zoričić, Andrea Tinelli, Antonio Malvasi, Michael Stark
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 478-482.   DOI: 10.31083/j.ceog.2021.03.2422
Abstract245)   HTML18)    PDF(pc) (106KB)(81)       Save

Background: The various techniques for performing a Cesarean Section (CS) have a long history. There are numerous surgical variations based on personal or local tradition, but these are not based on evidence and often have different outcomes on maternal and newborn health. Many modifications of the CS technique have been utilized in order to improve outcome with variable results both positive and negative. Several CS laparotomic methods have been developed but no consensus has been reached on the most optimal approach as related to safety and morbidity. Methods: The minimalistic approach of the Stark Cesarean Section (SCS) is compared to other methods thorugh an evaluation of the studies published in the last 20 years comparing this technique with others, the systematic reviews and the personal experience of the authors. Results and Discussion: The abdominal incision done at the Stark Cesarean Section differs from the Pfannenstiel incision by its location being above the arcuate line eliminating the need to separate the fascia from the recti muscles. The muscle separations being away from the pubic bone and the iliohypogastric and ilioinguinal nerves eliminates the risk of damage. This unique surgical approach is a logical, fast and simple one that eliminates unnecessary operative steps saving time and reducing complications. After fifteen years of experience and thousands of SCS performed at our departments, we may conclude that this method has several advantages over other surgical methods as related to short and long-term outcomes, including chronic/neuropathic pain and quality of life.
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Frequency of cesarean section in pregnant women with risk factors for preeclampsia: prospective cohort study
Lejla Kamerić, Anis Cerovac, Mirzeta Rizvanović, Alen Kamerić, Mahira Jahić, Dubravko Habek
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 561-566.   DOI: 10.31083/j.ceog.2021.03.2369
Abstract208)   HTML7)    PDF(pc) (427KB)(64)       Save

Background: Preeclampsia is a disorder of pregnancy associated with new-onset hypertension after the 20th week of gestation. The aim of this study is to examine frequency of cesarean delivery in pregnant women with risk for developing preeclampsia compared with pregnant women with normal pregnancy. Methods: The prospective study included 240 pregnant women. The experimental group had 120 pregnant women with preeclampsia risk factors. The control group had 120 pregnant women with no pregnancy risk factors. The method of delivery completion was analyzed. Results: In the experimental group, 88 (73.3%) pregnant women completed delivery vaginally, by cesarean section in 32 (26.7%). In the control group of vaginally deliveries were 105 (87.5%), by cesarean section 15 (12.5%). The difference in the frequency of method of delivery between the experimental and control groups is not random (p = 0.009). The chance of completing a delivery by cesarean section 2.54 times is higher in the experimental than in the control group. In the control group, it was found that the RI of uterine arteries in women who delivered by cesarean section was statistically significantly higher than in vaginal delivery (p = 0.038). Conclusion: Cesarean section is the most commonly used surgical procedure to complete delivery in pregnant womens with risk factors for preeclampsia, which confirmed our study.
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Do women in Slovenia prefer vaginal birth after prior caesarean and what hinders its successful outcome? A single institution retrospective analysis
Faris Mujezinović, Veronika Anzeljc, Monika Sobočan, Iztok Takač
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 607-614.   DOI: 10.31083/j.ceog.2021.03.2439
Abstract115)   HTML8)    PDF(pc) (457KB)(87)       Save

Background: To analyze the mode of delivery and the outcome of a trial of labor in women with one prior caesarean birth. Methods: We extracted from the national database our hospital's information on women with a prior caesarean section from January 2014 to July 2019. They were then divided into groups that either opted for a trial of labor or repeat caesarean section. We further focused on the trial of labor group and divided them in two subgroups of either a vaginal delivery or repeat caesarean section. Results: 796 women with one prior caesarean section were identified and 201 (25.3%) opted for a trial of labor. Successful vaginal delivery was achieved in 84.1% of women that opted for a trial of labor. Women pregnant for the third time or greater delivered vaginally at a higher rate (24.3% vs 10.7%). More women who had labor induced with a Foley catheter ended in caesarean section (8.1% vs 17.9%). There was one uterine rupture without further complications. Failed trial of labor was caused by the lack of persistence (14.3%) and arrest of labor (50.0%). Conclusion: Improved counselling is needed for those women who choose a trial of labor. The rate of successful vaginal delivery following a trail of labor is high, but could be improved with more conservative management during the first stage of labor.
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Caesarean sections and outcomes of labor induction after the introduction of a new intravaginal device: retrospective analysis
Veronika Anzeljc, Faris Mujezinović
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 615-627.   DOI: 10.31083/j.ceog.2021.03.2440
Abstract115)   HTML7)    PDF(pc) (197KB)(71)       Save

Background: To evaluate the outcomes and process of labour induction following the introduction of a new vaginal device with slow releasing dinoprostone (Propess). Methods: Data were collected on the indications for labour induction, the process of induction and delivery, and the outcomes of delivery for 171 term pregnancies between 1 January 2020 and 31 August 2020. Excluded from this study were patients with preterm delivery, multiple pregnancies, or pre-labour rupture of membranes. Data for the standard dinoprostone medication (PG) and Propess groups was analysed and compared. Results: Of the 93 women (54.4% of total) induced in the PG group, 55 (59.1%) received Prostin tablets, 17 (18.3%) received 1 mg of Prostin gel, and 21 (22.6%) received 2 mg of Prostin gel. Seventy eight women (45.6%) received the new intravaginal device (Propess group). The five most frequent indications for labour induction were post-term pregnancy (53, 31.0%), GDM (42, 24.6%), oligohydramnios (30, 17.5%), IUGR (21, 12.3%), and hypertensive disease (20, 11.7%). The Bishop scores were unfavourable in the majority of cases (119, 69.6%). The length of induction was less than 24 hours in 134 women (78.4%). Oxytocin was used more frequently (p = 0.001) in the Propess group and these women underwent more frequent caesarean section (20.5% vs 12.9%, p = 0.31). The status of babies was good in both groups. Conclusion: Introduction of the Propess device to mainstream medical practice has led to rapid implementation and resulted in improved workflow and positive outcomes for both the baby and mother.
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Perinatal outcome in twins. A hospital based comparative study at a single third-level care centre in Croatia
Dino Pavoković, Vesna Elveđi Gašparović, Tvrtko Tupek, Analena Gregorić, Ana Tikvica Luetić, Dubravko Habek
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 631-636.   DOI: 10.31083/j.ceog.2021.03.2450
Abstract120)   HTML5)    PDF(pc) (180KB)(47)       Save

Background: The goal of our study is to explore the association of assisted reproductive technology (ART) as contributing factor for obstetric complications and perinatal outcome in twin pregnancies during a 14-year period at a single tertiary centre. Methods: We collected the data (from maternal and neonatal medical records) from 731 twin pregnancies; 192 conceived by ART and 539 twin pregnancies conceived naturally during a 14-year period. Results: Pregnancy complications in twin pregnancies mainly included preterm premature rupture of membranes, gestational diabetes mellitus, and preeclampsia. Higher occurrence of placenta praevia in the ART group was the only perinatal risk related to twin pregnancies in the ART group as compared to those conceived naturally. Over 71% of ART twins were delivered by caesarean section, which is considerably increased as compared to non-ART twins (P = 0.042). Neonatal complications in both groups mainly included low Apgar score in the 1st minute, low birth weight and admission to NICU, and the incidences of these complications were comparable between the groups. Conclusion: Our results indicated that ART procedures were not followed by adverse obstetric and perinatal outcome in twin pregnancy delivered at single tertiary centre, except for the slightly higher risk of placenta praevia.
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Caesarean section between doctrine to heresis. Medicoethical and deontological view of caesarology: an opinion
Dubravko Habek, Matija Prka, Anto Čartolovni, Anis Cerovac, Domagoj Dokozić
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 1-4.   DOI: 10.31083/j.ceog.2021.01.2305
Abstract415)   HTML132)    PDF(pc) (165KB)(361)       Save

Increasing the incidence of caesarean section is not in line with professional and deontological guidelines. Elective cesarean section prevents primordial prevention of chronic cardiovascular, gastrointestinal, imunological, endocrinological morbidity by peripartal programming. Elective non-medical indicated caesarean section is not a procedure that respects deontological, clinical etics, scientific and professional principles. It is like an unacceptable surgery outside the scope of medical ethics. Clientelism in high-risk clinical obstetric medicine is not a professional and deontologically correct category: a physician should not be a provider on request of healthy pregnant women with the potential to have a medically incorrect procedure and complications associated with it and to put a healthy pregnant/maternity and child status in the patient's status. The financial, social, political and cultural components must not outweigh good clinical practice and the moral principles of medicine.
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