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Sample records for caesarean section cohort

  1. Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort

    Rodrigo M. Carrillo-Larco

    2015-06-01

    Full Text Available Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity, and central obesity (waist circumference at the age 5 (first follow-up and 7 (second follow-up years. The exposure of interests was delivery by Caesarean section. Relative risks (RR and 95% confidence intervals (95% CI were calculated using multivariable models adjusted for child-related (e.g., birth weight and family-related (e.g., maternal nutritional status variables. Results. At baseline, mean age was 11.7 (± 3.5 months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74] than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]. Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.

  2. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study

    Hansen, Anne Kirkeby; Wisborg, Kirsten; Uldbjerg, Niels;

    2007-01-01

    tachypnoea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation). RESULTS: 2687 infants were delivered by...... 39 weeks' gestation (1.9, 1.2 to 3.0). The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios: a fivefold increase was found at 37 weeks (5.0, 1.6 to16.0). These results remained essentially unchanged after exclusion of pregnancies complicated by...... diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation. CONCLUSION: Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity...

  3. Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study

    Dunn, Clare Newton; Zhang, Qianpian; Sia, Josh Tjunrong; Assam, Pryseley Nkouibert; Tagore, Shephali; Sng, Ban Leong

    2016-01-01

    Background and Aims: A decision-to-delivery interval (DDI) of 30 min for category-one caesarean section (CS) deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (‘crash’) CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation) DDI was 9.4 (3.2) min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9%) of women had general anaesthesia (GA) for category-one CS. Of those who had an epidural catheter already in situ (34.4%), 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA). Conclusions: Our ‘crash’ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9%) of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA. PMID:27601736

  4. Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study

    Clare Newton Dunn

    2016-01-01

    Full Text Available Background and Aims: A decision-to-delivery interval (DDI of 30 min for category-one caesarean section (CS deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (′crash′ CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation DDI was 9.4 (3.2 min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9% of women had general anaesthesia (GA for category-one CS. Of those who had an epidural catheter already in situ (34.4%, 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA. Conclusions: Our ′crash′ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9% of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA.

  5. Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study.

    O'Neill, Sinéad M; Curran, Eileen A; Dalman, Christina; Kenny, Louise C; Kearney, Patricia M; Clarke, Gerard; Cryan, John F; Dinan, Timothy G; Khashan, Ali S

    2016-05-01

    Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (χ(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment. PMID:26615187

  6. Perimortem caesarean section.

    Parry, Richard; Asmussen, Tilo; Smith, Jason E

    2016-03-01

    This review describes a simple approach to perimortem caesarean section (PMCS) that can be used by a doctor in the resuscitation room or prehospital environment when faced with a mother of more than 20 weeks gestation in cardiac arrest. It explores the indications for and contraindications to the procedure, the physiological rationale behind it, equipment needed, technical aspects of the procedure and reviews recent literature on maternal and fetal outcomes. Like other uncommon procedures such as emergency department thoracotomy, rehearsal and preparation for a PMCS is essential to give both mother and baby the best chance of survival. PMID:25714106

  7. Neonatology and the caesarean section.

    Zanini, R; Minghetti, D

    2012-10-01

    The origins of the use of the Caesarean section date far back in human history. Traces of this procedure can be found in Greek mythology and in the history of Ancient Rome. Many documents about the history of religion make reference to a delivery from the abdomen. PMID:22958012

  8. Infertility and preterm delivery, birthweight, and Caesarean section: a study within the Danish National Birth Cohort

    Basso, Olga; Baird, Donna D.

    2003-01-01

    , longitudinal studies enrolling couples irrespective of infertility treatment. METHODS: We used data from the Danish National Birth Cohort: 55 906 singleton live births from women who reported their waiting time to pregnancy (TTP) and other covariates in an interview during the 2nd trimester of pregnancy....... RESULTS: A TTP >1 year was associated with an increased risk of all outcomes studied, including preterm birth [odds ratios and 95% confidence intervals were 1.5 (1.2, 1.8) among primiparas and 1.9 (1.5, 2.4) among multiparas]. Odds ratios for preterm remained elevated after adjustment for covariates....... Among couples with a TTP >1 year, infertility treatment was associated with added risk only among multiparas. CONCLUSION: Infertile women are at higher risk of adverse birth outcomes even if they conceive without treatment. With >10% of babies born to infertile couples, it is important to consider this...

  9. Thromboprophylaxis for women undergoing caesarean section.

    Kennedy, C

    2012-02-01

    Thromboprophylaxis for women undergoing caesarean section (CS) was introduced in the hospital in 1995. This study audited the use of tinzaparin prophylaxis in a nested cohort of women who screened negative for diabetes mellitus at 28 weeks gestation. All the women had their weight measured and BMI calculated at the first antenatal visit. Of the 284 women, 68 (24%) had a CS and all received tinzaparin. Of the 68, however, 94% received a dose lower than recommended. Compliance with prophylaxis was complete but compliance with the recommended dosage was suboptimal, which may result in venous thromboembolism after CS despite thromboprophylaxis.

  10. Psychiatric illness in women requesting caesarean section

    Sydsjö, Gunilla; Möller, Louise; Lilliecreutz, Caroline; Bladh, Marie; Andolf, E; Josefsson, Ann

    2014-01-01

    Objective To compare psychiatric in-and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period. Design Prospective, population-based register study. Setting Sweden. Sample Women giving birth for the first time between 2002 and 2004 (n = 64 834). Methods Women giving birth by caesarean section on maternal request (n = 1009) were compared with all ot...

  11. [Caesarean section in the context of free policy in Benin].

    Mahieu, Céline

    2016-01-01

    Caesarean section was well appreciated by most beneficiaries. However, an audit of caesarean sections would ensure compliance with the principles of free care and better management of women at all levels of the health system.. PMID:27531438

  12. Methods of achieving and maintaining an appropriate caesarean section rate.

    Robson, Michael

    2013-04-01

    Caesarean section rates continue to increase worldwide. The appropriate caesarean section rate remains a topic of debate among women and professionals. Evidence-based medicine has not provided an answer and depends on interpretation of the literature. Overall caesarean section rates are unhelpful, and caesarean section rates should not be judged in isolation from other outcomes and epidemiological characteristics. Better understanding of caesarean section rates, their consequences and their benefits will improve care, and enable learning between delivery units nationally and internationally. To achieve and maintain an appropriate caesarean section rate requires a Multidisciplinary Quality Assurance Programme in each delivery unit, recognising caesarean section rates as one of many factors that determine quality. Women will always choose the type of delivery that seems safest to them and their babies. Professionals need to monitor the quality of their practice continuously in a standardised way to ensure that women can make the right choice.

  13. Intervention for postpartum infections following caesarean section

    Hyldig, Nana; Bille, Camilla; Kruse, Marie; Bøgeskov, Renee Anita; Jørgensen, Jan Stener

    2012-01-01

    The purpose of this study is to examine the effect on wound healing using Negative Pressure Wound Therapy (NPWT) compared with conventional wound treatment in women, who experience spontaneous dehiscence or reoperation for postoperative infection after caesarean section (CS). In addition the study seeks to elucidate the health economic cost and consequences of this type of infection and treatment.Background: Obesity is an increasing problem in the health care system. Today more than 12% of al...

  14. Emergency caesarean section in low risk nulliparous women

    Haerskjold, Ann; Hegaard, H K; Kjaergaard, H

    2012-01-01

    The rising incidence of caesarean section (CS), including emergency caesarean section (ECS) in nulliparas is of concern. Previous CS may have implications for future pregnancies and deliveries. This article describes the prevalence and indications for ECS in a cohort of low risk nulliparas and...... association between risk factors and indications for ECS. Smoking during pregnancy (OR 2.33; CI 1.18-4.61) and BMI ≥ 30 (OR 2.87, CI 1.34-6.16) were associated with increased risk of ECS due to SFD. Birth weight (BW) ≥ 4,000 (OR 2.95; CI 1.92-4.53) and smoking cessation during pregnancy (OR 2.02; CI 1...

  15. Rising caesarean section rate: a matter of concern?

    Sanjivani A. Wanjari

    2014-06-01

    Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate. Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%. Other leading indications were foetal distress (9.36%, CPD (7.69%, PROM (7.31%, postdate pregnancy (6.62%, hypertensive disorders of pregnancy (6.0%. Conclusions: Some of the measures that can reduce caesarean section rate can be 1 reduction in primary caesarean sections 2 giving the option of VBAC to women with one prior caesarean section 3 use of foetal heart tracings and scalp blood sampling for foetal monitoring 4 judicious use of oxytocin and plotting of the partogram for every labour. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 728-731

  16. Asthma at 8 years of age in children born by caesarean section.

    Roduit, C.; Scholtens, S.; Jongste, de, J.C.; Wijga, A H; Gerritsen, J.; Postma, D. S.; Brunekreef, B; Hoekstra, M.O.; Aalberse, R; Smit, H. A.

    2009-01-01

    BACKGROUND: Caesarean section might be a risk factor for asthma because of delayed microbial colonisation, but the association remains controversial. A study was undertaken to investigate prospectively whether children born by caesarean section are more at risk of having asthma in childhood and sensitisation at the age of 8 years, taking into account the allergic status of the parents. METHODS: 2917 children who participated in a birth cohort study were followed for 8 years. The definition of...

  17. INDICATIONS FOR CAESAREAN SECTION IN NULLIPAROUS AND MULTIPAROUS WOMEN

    Sheela

    2014-12-01

    Full Text Available INTRODUCTION: Within few years’ number of caesarean sections increased dramatically in our hospital. This study was done to find out whether increasing the number of caesarean sections were due to improving patients transportation and maternal and child welfare program or it was due to caesarean section were performed for improper indication. METHOD AND MATERIAL: It is a retrograded study conducted on the bases of caesarean section performed in Bundelkhand Medical college associated hospital from October 2013 to September 2014. 1536 caesarean section were performed of this 1104 (71.87% were nulliparous and 432 (23.43% were multiparous. During this period only 5 cases of rupture uterus were reported. All are multiparous women with no history of previous section. RESULT: The most common indication of caesarean section among nulliparous women (23.43% was cephalo-pelvic disproportion with other complications like fetal distress, premature rupture membrane, PIH, mal-presentation. Among multiparous women the most common indication for caesarean section was previous caesarean section with Cephalo-pelvic disproportion (26.62% CONCLUSION: In our hospital majority of caesarean sections were compulsory for maternal and fetal wellbeing. Minority of cases there may be difference of opinion or error of judgment. But attempts should be made to decrease even these minorities of cases by critical evaluation of decision to perform caesarean section especially in nulliparous women. First caesarean section itself an indication for subsequent caesarean section but in these cases also presence of other risk factors should identified and if possible careful trial of labour should perform.

  18. Fear of childbirth and emergency caesarean section in low-risk nulliparous women

    Jespersen, Cecilie; Hegaard, Hanne Kristine; Schroll, Anne-Mette;

    2014-01-01

    OBJECTIVE: To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN: A prospective cohort study of low-risk nulliparous women at term. SETTING: Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION: A total of 2598 nulliparous women in...... recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Risk of emergency caesarean section in women who feared childbirth. RESULTS: FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated with...... emergency caesarean section: adjusted OR = 0.81 (95% CI: 0.48-1.36) and OR = 0.97 (95% CI: 0.55-1.71), respectively. CONCLUSION: In this prospective observational study, women with FOC did not have an increased risk of emergency caesarean section compared to women with no such fear....

  19. Intervention for Postpartum Infections following Caesarean Section

    Hyldig, Nana; Bille, Camilla; Kruse, Marie;

    Purpose: To examine the effect on wound healing, using Negative Pressure Wound Therapy (NPWT) compared with standard wound dressings in women, who experience spontaneous dehiscence or reoperation due to infection or hematoma after caesarean section. In addition, an analysis of the health economic...... cost and consequences of NPWT is planned. Methods: A randomized controlled trial. The study will be performed at two large obstetrical units in Denmark. Data will be collected prospectively. We expect to include 50 women, of whom two-thirds will be randomized to NPWT. The primary endpoint is the...... treatment for one change with NPWT to be cost effective. Concussion: The preliminary results indicate that NPWT reduce the risk of re-rupture significantly. The benefit of the treatment is expected to be twofold: a) A reduction in health care costs (inpatient bed days and readmissions) b) An increase in the...

  20. Effective education to decrease elective caesarean section

    Objective: To examine the effect of education on deciding about natural delivery in women opting for elective caesarean section. Methods: The quasi-experimental study was carried out between January and March 2012 and comprised a sample of 200 women in their third trimester of pregnancy attending women's clinics of Imam Ali Hospital, Zahedan, Iran, with the intention of having elective caesarean section. The subjects were voluntarily classified into three groups: one group received an educational package; the other had educational package along with group discussion, and the last one without any intervention was considered the control group. Post-test was conducted a month after intervention. Data were analysed using Kruskal Wallis, and logistic regression tests. Results: Group A represented the controls and had 100 (50%) women; Group B with the educational package had 40 (20%), while there were 60 (30%) women in Group C who had exposure to the educational package as well as group discussion. There were significant changes in behaviour in Group B and C (p <0.01) but no change among the controls in Group A. In Group C, 25 (42%) women decided to go for natural delivery, while 1 (2.5%) woman had a change of opinion in Group B. Four (4%) women in the control Group A had ultimately natural delivery, but they were all emergency cases. Conclusion: The two educational methods increased model construct scores, including awareness, attitude, perceived behaviour control, subjective norms and behavioural intention. Nevertheless, educational package in conjunction with group discussion was more effective in influencing the choice towards natural delivery. (author)

  1. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

  2. Adhesive bowel strangulation after caesarean section, the rare puerperal complication.

    Záhumenský, J; Zmrhalová, B; Sottner, O; Maxová, K; Brtnická, H; Horák, J; Binder, T; Halaska, M

    2010-01-01

    Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication. PMID:20359439

  3. Caesarean section scar ectopic pregnancy following postcoital contraception.

    Fabunmi, Laura; Perks, Nigel

    2002-07-01

    This is believed to be the first reported case of an ectopic pregnancy following failed progestogen-only emergency contraception. The ectopic pregnancy was at the site of a previous caesarean section scar and was managed conservatively. PMID:16259837

  4. Techniques and materials for skin closure in caesarean section

    Mackeen, A Dhanya; Berghella, Vincenzo; Larsen, Mie-Louise

    2012-01-01

    Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples....... A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women....

  5. Preference for Institutional Delivery and Caesarean Sections in Bangladesh

    Kamal, S M Mostafa

    2013-01-01

    In Bangladesh, preference for place of delivery and socioeconomic factors associated with caesarean section are not well-understood. This paper examines the socioeconomic correlates of preference for institutional delivery and caesarean sections in Bangladesh. The study used data from the nationally-representative 2007 Bangladesh Demographic and Health Survey. Both bivariate and multivariate binary logistic regression models were constructed to assess the effect of sociodemographic factors on...

  6. Challenges in the Caesarean Section of a Severely Kyphotic Parturient

    Manisha Chhetry; Basudeb Banerjee; Shanti Subedi; Narayan Bahadur Gharti Chhetri; Yogendra Gupta

    2016-01-01

    Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilate...

  7. Scar endometriosis following caesarean section: a rare case report

    Manisha Sharma; Ruchira Nautiyal; Jaya Chaturvedi; Surbhi Bhargava

    2015-01-01

    Endometriosis is presence of functioning endometrial tissue (glands and stroma) outside the uterine cavity. Endometriosis can sometimes occur in previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynaecological surgeries. We present here a case report of a patient who developed scar endometriosis following a caesarean section which was dealt adequately in the subsequent caesarean section. [Int J Reprod Contracept Obstet Gynecol 2015...

  8. Stress, sleep quality and unplanned Caesarean section in pregnant women.

    Ko, Yi-Li; Lin, Pi-Chu; Chen, Shu-Chuan

    2015-10-01

    This study examines the relationship among prenatal maternal stress, sleep quality and unplanned Caesarean delivery. For this research, we adopted a prospective survey design and a sample of 200 women in the early stages of labour. The findings were as follows: (i) 11.5% of the participants underwent unplanned Caesarean sections; (ii) based on a Pittsburg Sleep Quality Index split point of 5, approximately 90.5% of the participants experienced poor sleep quality; and (iii) the odds ratio for primiparas undergoing an unplanned Caesarean section was 4.183 times that for multiparas (95% confidence interval (CI) = 1.177 to 14.864), indicating a statistically significant difference. The results also showed that stress was a significant factor related to unplanned Caesarean sections; a 1-point increase on the Pregnancy Stress Rating Scale was associated with a 1.033-fold higher probability of undergoing an unplanned Caesarean section (95% CI = 1.002 to 1.065). Furthermore, prenatal stress was a significant variable that can be used to predict unplanned Caesarean deliveries. PMID:24754483

  9. Caesarean section survey in Galway--1973 through 1987.

    Bolaji, I I; Meehan, F P

    1993-01-01

    We review the trend, indications and maternal mortality with caesarean section at University College Hospital Galway from 1973 to 1987. The caesarean section rate (CSR) rose from 6.06% in 1973 to 10.18% in 1987, primary sections from 3.58% to 6.51% and repeat sections from 2.49% to 3.67% during the same interval. The four major indications for section were cephalopelvic disproportion, foetal distress, previous section and malpresentations. Lower segment caesarean section was the commonest operation and a slight increase in the classical operation was noted due to an increased intervention in prematurity. The maternal mortality rate was 11.2/10,000 in the 15-year period and the complications leading to death were ultimately ascribable to primary postpartum haemorrhage. Strategies for reduction in the CSR are discussed. PMID:8449255

  10. Caesarean section in Ancient Greek mythology.

    Lurie, Samuel

    2015-01-01

    The narrative of caesarean birth appears on several occasions in Greek mythology: in the birth of Dionysus is the God of the grape harvest and winemaking and wine; in the birth of Asclepius the God of medicine and healing; and in the birth of Adonis the God of beauty and desire. It is possible, however not obligatory, that it was not solely a fantasy but also reflected a contemporary medical practice. PMID:26203550

  11. Challenges in the Caesarean Section of a Severely Kyphotic Parturient.

    Chhetry, Manisha; Banerjee, Basudeb; Subedi, Shanti; Gharti Chhetri, Narayan Bahadur; Gupta, Yogendra

    2016-01-01

    Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful. PMID:27066281

  12. Challenges in the Caesarean Section of a Severely Kyphotic Parturient

    Manisha Chhetry

    2016-01-01

    Full Text Available Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.

  13. Oral microflora in infants delivered vaginally and by caesarean section

    Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron;

    2011-01-01

    International Journal of Paediatric Dentistry 2011 Background. Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. Aim. To...

  14. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    Kristensen, Kim; Fisker, Niels; Haerskjold, Ann;

    2015-01-01

    BACKGROUND AND OBJECTIVE:: Hospitalization for respiratory syncytial virus (RSV) infection and asthma share common determinants, and meta-analyses indicate that children delivered by caesarean section (CS) are at increased risk of asthma. We aimed to investigate whether birth by CS is associated ...

  15. Evidence-based surgical techniques for caesarean section

    Aabakke, Anna J M; Secher, Niels Jørgen; Krebs, Lone

    2014-01-01

    Caesarean section (CS) is a common surgical procedure, and in Denmark 21% of deliveries is by CS. There is an increasing amount of scientific evidence to support the different surgical techniques used at CS. This article reviews the literature regarding CS techniques. There is still a lack of evi...

  16. Ectopic Pregnancy in caesarean section scar: A case report

    Rajarshi Aich, MBBS

    2015-12-01

    Full Text Available We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition.

  17. Ectopic pregnancy in a Caesarean section scar: a case study

    Piotr Niziurski

    2013-08-01

    Full Text Available Implantation of a pregnancy in a scar after Caesarean section is one of the rarest locations of ectopic pregnancies. A diagnosis and/or treatment which is too late may lead to a uterine rupture, the necessity to remove the uterus and a significant increase in morbidity among mothers. The study presents a diagnostically difficult case of a 29-year-old woman, who was diagnosed with pregnancy in its seventh week, located in a scar after a Caesarean section, with highly increased values of human chorionic gonadotropin (β-HCG concentration in blood serum. The pregnancy was removed and the wound was stitched during laparotomy, without a need to remove the uterus.

  18. Prolonged labour as indication for emergency caesarean section

    Maaløe, N; Sørensen, Bjarke Lund; Onesmo, R;

    2012-01-01

    OBJECTIVE: To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. DESIGN: A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. SETTING: Two Tanzanian rural mission hospitals....... Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. CONCLUSION: The lack of use and awareness of evidence-based guidelines led to misinterpretation of....... POPULATION: Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. METHODS: Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what...

  19. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    O' Connell, AnnaMarie [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); Donoghue, Veronica B. [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); National Maternity Hospital, Radiology Department, Dublin (Ireland)

    2007-05-15

    Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury. To demonstrate that the CML may occur following simple lower segment caesarean section (LSCS). A review of 22 years of an obstetric practice that delivers 8,500 babies per year. We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML. We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed. (orig.)

  20. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    Kirti N Saxena

    2008-01-01

    A twenty year old parturient with short stature presented to the hospital in early labour. An elective lower segment caesarean section(LSCS was planned in view of cephalopelvic disproportion. She had papers which suggested that she had been diagnosed as a case of achondroplasia though details were not available. Combined spinal epidural(CSE anaesthesia was planned in the patient in view of the death of her first baby following caesarean section under general anaesthesia. Repeatedly dry taps were achieved on attempting dural puncture. Dural puncture was abandoned and an 18 G epidural catheter was threaded via the Tuohy needle. Sensory block till T 6 was achieved with 6ml of local anaesthetic solution. The patient was stable during the intraoperative and postoperative period.

  1. Third caesarean section in patient with myasthenia gravis

    A Pizzo; R De Dominici; I Borrielli; FV Ardita; I Lo Monaco; E Sturlese

    2012-01-01

    Myasthenia gravis(MG) is an autoimmune neuromuscular disease, characterised by muscle weakness and fatigability of the voluntary muscles, it affects young women in the second and third decade of life.We report a case of30 years old multigravida woman with myasthenia gravis submitted to third iterative caesarean section with no adverse neonatal and maternal outcome. The course myathenia is highly variable and unpredictable during gestation and can change in subsequent pregnancies.Delivery specially, through caesarean section is very stressful and may cause severe myasthenic crisis.Although pregnancy and delivery represent particular events, that require more attention in these patients, they are not associated, in most cases, with higher risks of complications compared to normal pregnancy, delivery and postpartum period.According our experiences, in the management of myasthenic pregnant woman is necessary cooperation in a multidisciplinary team between obstetricians, neurologist, anaesthetist, and neonatologist for ensure an optimum outcome.

  2. Caesarean Section, Vaginal Delivery and Post Natal Depression

    MH Baghianimoghadam; D Shodjaee zadeh; AH Aminian

    2009-01-01

    "nBackground: Depression is a kind of sorrow that decreases the level of juiciness. Most studies have maintained that psy­chological risk factors have the most profound effect on the development of postnatal depression (PND). We compared the postnatal depression among the women with elective caesarean and vaginal delivery. "nMethods: This cross- sectional study was carried out on 120 women 1-4 months after their delivery. Samples were divided in two groups (60 mothe...

  3. Caesarean section in a parturient with a spinal cord stimulator.

    Sommerfield, D

    2010-01-01

    A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.

  4. Fetal circulation during epidural analgesia for caesarean section.

    Lindblad, A; Marsál, K; Vernersson, E; Renck, H

    1984-01-01

    Fetal blood flow was examined during epidural analgesia in six women with uncomplicated pregnancies undergoing elective caesarean section. A non-invasive, ultrasonic technique was used to measure blood flow in the fetal descending aorta and intra-abdominal part of the umbilical vein before induction of analgesia with etidocaine and bupivacaine and 15 and 30 minutes afterwards. No appreciable change in fetal blood flow was observed.

  5. Assessment of competence for caesarean section with global rating scale

    Objective: To establish as reliable and valid the nine-point global rating scale for assessing residents' independent performance of Caesarean Section. Methods: The validation study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan University Hospital, from April to December 2008, and comprised 15 residents during 40 Caesarean Sections over 9 months. Independently two evaluators rated each procedure and the difficulty of each case. Results: The observations per faculty ranged from 1-8 (mean 4.07+- 2.56). The Year 4 residents were observed the most i.e. 32 (40%), followed by Year 3, 30 (37.5%); Year 2; 14 (17.5%); and Year 1, 4 (5%). Mean time required for observation of the surgery was 43.81+-14.28 (range: 20-90) with a mode of 45 min. Mean aggregate rating on all items showed gradual progression with the year of residency. The assessment tool had an internal consistency reliability (Cronbach's alpha) of 0.9097 with low inter-rater reliability. Conclusion: The evaluation tool was found to be reliable and valid for evaluating a resident's competence for performing Caesarean Section. Training of the assessors is required for a better inter-rater agreement. (author)

  6. Predictors of post-caesarean section pain and analgesic consumption

    Luana Buhagiar

    2011-01-01

    Full Text Available Background: Ideally, the intensity of postoperative pain should be predicted so as to customize analgesia. The objective of this study was to investigate whether preoperative electrical and pressure pain assessment can predict post-caesarean section pain and analgesic requirement. Materials and Methods: A total of 65 subjects scheduled for elective caesarean section, who gave written informed consent, were studied. Preoperatively, PainMatcher® was used to evaluate electrical pain threshold, while manual PainTest™ FPN 100 Algometer and digital PainTest™ FPX 25 Algometer determined pressure pain threshold and tolerance. Postoperatively, numerical rating scales were used to assess pain at regular time intervals. Patients received intramuscular pethidine (100mg, 6 hourly, rectal diclofenac (100mg, 12 hourly, and oral paracetamol (1g, p.r.n. for pain relief. Statistical analysis was conducted using PASW Statistics 18 software. Results: Preoperative electrical pain threshold correlated significantly with post-caesarean pain scores at 6 and 24 hours (r = -0.26, P < 0.02; r = -0.23, P < 0.04, respectively, and with the quantity of paracetamol consumed by the patient within 48 hours of surgery (r = -0.33, P < 0.005. Preoperative pressure pain tolerance measured by PainTest™ FPX 25 Algometer was significantly correlated with pain scores 6 hours postsurgery (r = -0.21, P < 0.05. Pain scores 6 hours post-caesarean section correlated significantly with anesthesia--general or spinal (F = 4.22, v 1 = 1, v 2 = 63, P < 0.05. Conclusions: The predictive methods proposed may aid in identifying patients at greater risk for postoperative pain. Electrical pain threshold could be useful in personalizing the postoperative analgesic protocol.

  7. South African mothers' coping with an unplanned Caesarean section.

    van Reenen, Samantha; van Rensburg, Esmé

    2015-01-01

    In this study, researchers explored mothers' coping strategies in dealing with birth by unplanned Caesarean section. Mothers' experiences of a traumatic birth could be influenced by perceived strengths when coping with the stress related to the incident. Coping strategies resulted in reassessment of the birth process and were associated with a more positive and memorable experience. In-depth interviews with 10 women explored their lived experiences of childbirth. Data were analyzed thematically. Phenomenological theory served as a framework for the structuring, organizing, and categorizing of data. Mothers described several factors and coping strategies that they perceived to be effective in reducing the impact of their traumatic birth experiences. PMID:24313379

  8. Clinical study of primary caesarean section in multiparous women in a tertiary care hospital

    Rupal Samal; Pallavee Palai; Seetesh Ghose

    2016-01-01

    Background: The objective of this study was to find the incidence and indications of primary caesarean section in parous women and evaluate the maternal and perinatal outcomes there from. Methods: Prospective study of primary caesarean sections in parous women at our institute from June 2013 to May 2014 was done. Age, indications and the maternal as well as perinatal outcomes were analyzed. Data was expressed as number and percentage. Results: Out of 1124 caesarean deliveries, 68 primar...

  9. Evaluating trial of scar in patients with a history of caesarean section

    Aliya Islam

    2011-01-01

    Full Text Available Aims: To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar. Patients and Methods : The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose. Results : The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required with syntocinon infusion. 60 patients were induced with prostaglandin E 2 vaginal tablet. Conclusion : This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.

  10. VBAC Scoring: Successful vaginal delivery in previous one caesarean section in induced labour

    Objective: To develop a scoring system for the prediction of successful vaginal birth after caesarean section, following induction of labour with intra-vaginal E2 gel (Glandin). Methods: The cross-sectional study was conducted from January 2010 to August 2011, at the Pakistan Institute of Medical Sciences in Islamabad. Trial of labour in previous one caesarean section, undergoing induction with intra-vaginal E2 gel, was attempted in 100 women. They were scored according to six variables; maternal age; gestation; indications of previous caesarean; history of vaginal birth either before or after the previous caesarean; Bishop score and body mass index. Multivariate and univariate logistic regression analysis was used to develop the scoring system. Results: Of the total, 67 (67%) women delivered vaginally, while 33 (33%) ended in repeat caesarean delivery. Among the subjects, 55 (55%) women had no history of vaginal delivery either before or after previous caesarean section; 15 (15%) had history of vaginal births both before and after the previous caesarean; while 30 (30%) had vaginal delivery only after the previous caesarean section. Rates of successful vaginal birth after caesarean increased from 38% in women having a score of 0-3 to 58% in patients scoring 4-6. Among those having a score of 7-9 and 10-12, the success rates were 71% and 86% respectively. Conclusion: Increasing scores correlated with the increasing probability of vaginal birth after caesarean undergoing induction of labour. The admission VBAC scoring system is useful in counselling women with previous caesarean for the option of induction of labour or repeat caesarean delivery. (author)

  11. Management of pregnancy with previous lower segment caesarean section in Modern obstetric practice

    Rajita Jani; Devangi Munshi

    2013-01-01

    Objective: In today’s obstetric practice we encounter increasing number of post caesarean pregnancies because of rise in primary caesarean due to multi factorial reasons. There is increasing concern by obstetricians for managing these cases for medical and legal point of view. Present study was undertaken to decide appropriate mode of delivery and to conduct the proper management of patients with previous lower segment caesarean section.Study design: This is a prospective study carried out on...

  12. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

    McMorrow, R C N

    2011-05-01

    Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial.

  13. Is a planned caesarean section in women with cardiac disease beneficial?

    Ruys, Titia P. E.; Roos-Hesselink, Jolien W.; Pijuan-Domenech, Antonia; Vasario, Elena; Gaisin, Ilshat R.; Iung, Bernard; Freeman, Leisa J.; Gordon, Elaine P.; Pieper, Petronella G.; Hall, Roger; Boersma, Eric; Johnson, Mark R.

    2015-01-01

    Objectives In the general population, planned caesarean section is thought to be safer in high-risk situations as it avoids the greater risk of an emergency caesarean section. Only limited data exist on the optimal mode of delivery in women with structural heart disease. We investigated the relation

  14. MATERNAL AND FOETAL OUTCOME OF VAGINAL BIRTH AFTER CAESAREAN SECTION

    Thulasi

    2016-04-01

    Full Text Available OBJECTIVES OF THE STUDY 1. To identify maternal and foetal factors responsible for the success or the failure of VBAC. 2. To study maternal and perinatal outcome while giving a trial of scar. METHOD OF COLLECTION OF DATA Study was conducted at P K Das Institute of Medical Sciences hospital. 50 cases obtained during the period of January 2013 to December 2013 were studied. Inclusion Criteria 1. Multigravida with previous one lower segment caesarean section at term in early labour. 2. Singleton pregnancy. 3. Cephalic presentation. 4. Who are willing for VBAC. 5. Well-informed subjects. Exclusion Criteria 1. Known classical scar and 2 or >caesarean sections. 2. Unknown uterine scar. 3. Multiple gestation. 4. Malpresentations. 5. Cephalopelvic disproportion. 6. Subjects with medical complication/obstetric risk factors. Cases are monitored with a partogram and continuous foetal monitor. METHODOLOGY Informed consent is taken after explaining the risks, benefits and potential complications in patients’ own language while giving a trial of scar. After the exclusion criteria, patients selected for VBAC is given a trial of scar. 1. Maternal monitoring of blood pressure and pulse rate every 15 minutes is done. 2. Continuous foetal monitoring in the active phase of labour. 3. Contraction stress test will be done in the active phase of labour. Uterine contractions are monitored every 30 minutes. Partogram is used to ensure adequate progress with respect to descent of the head, cervical dilatation, moulding and caput. 4. Pelvic examination every one hour to assess the progress of labour. 5. If labour has to be induced, done with great care particularly with prostaglandins – PGE 2 gel. Progress of labour should be assessed by a senior obstetrician, particularly in an unfavourable cervix. 6. Cross-matched blood is kept ready and a good intravenous line is established. 7. Oxytocin may be used with caution, as in any labour, for induction or augmentation. 8

  15. STUDY OF OBSTETRIC AND FETAL OUTCOME OF PREGNANCY IN PREVIOUS CAESAREAN SECTION

    Gurpreet Kaur

    2015-09-01

    Full Text Available Previous caesarean section sparks an area of controversy in Obstetrics. The management of women with previous caesarean section regarding the mode of delivery whether to opt for repeat caesarean section or vaginal delivery, is an area of debate. Very often the decision on management is not made on Principle of sound reasoning and many who choose the elective repeat caesarean section do so to circumvent the anxious moment that arise during conduct ion of labour. AIMS AND OBJECTIVE: To determine the maternal and fetal outcome in relation to type of delivery . MATERIALS AND METHOD S: A 18 month prospective observational study was conducted where in 150 patients who had a term pregnancy with a history of prior LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients in the present pregnancy were analyzed by Z test. RESULTS: Out of the 150 subjects 78 ( 52% were in age group of 26 - 30 years, 106 ( 70.67% patients belonged to the urban population, 116 ( 77.33% were booked patie nts, 107 ( 71.33% were housewives, 122 ( 81.33% belonged to middle class and 22 ( 14.67% were from high socio economic status. 67 ( 44.67% were second gravid, 112 ( 74.67% were para 1. Out of total 134 patients 29 ( 21.64% had elective caesarean section and 5 ( 3 .73% patients came as emergency admission and underwent caesarean section. Out of 134 patients, with one previous caesarean section. 32 had spontaneous onset of labour. Out of which 20 ( 68.97% had vaginal delivery and 9 ( 31.03% had repeat caesarean section. 13 patients had augmentation, 11 ( 84.62% had vaginal delivery and 2 ( 15.38% had caesarean section. In 58 patients labour was induced 29 ( 50% had section. 14 patients out of 50 who had previous 2 caesarean section only 1 ( 7.69% patient had spontane ous onset of labour and had caesarean section. 3 ( 92.86% patients had elective caesarean section. There were only 2 patients with previous 3 caesarean

  16. An observational study on extraperitoneal caesarean section in present era

    Sudhanshu Sekhara Nanda

    2014-06-01

    Full Text Available Background: This study was designed to find out the maternal and perinatal outcome in cases of extraperitoneal caesarean section. Total 100 women undergoing extraperitoneal cesarean section were included in the study. Methods: A detailed history taking, examination done and intra and post-operative parameters as per protocols were noted. Results: Success rate of extra peritoneal CS was 79.63%, Time taken from incision to delivery was and #8804;5 minutes in 60% cases, time taken from incision to closure was between 31-45 min in 67% cases, blood loss and #8804;500 ml in 58% cases, return of bowel function between 5-8 hours in 52%, mobilization within 24 hours in 52%, neonatal one minute APGAR score and #8805;7 in 90.91%. Conclusions: Extraperitoneal cesarean section can be applied as a surgical form of infection prophylaxis. Since it possesses a rational basis for the avoidance of serious post-operative pelvic infectious complications, this operation deserves reconsideration in the modern era. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 724-727

  17. Attitude of pregnant women in south western Nigeria towards caesarean section as a method of birth

    Adenike Funmilola Faremi

    2014-06-01

    Full Text Available Background: Choice of the method of birth is an essential decision for pregnant women and the spouse. This choice is sometimes based on a number of factors. This study assesses knowledge of pregnant women about caesarean section, their attitude towards it and level of acceptance of the methods of birth among women. Methods: This descriptive study was carried out in a government owned hospital in south western Nigeria. Respondents were selected using accidental sampling techniques. Questionnaire whose validity and reliability has been previously ascertained was the instrument used for data collection. Data generated was analysed using SPSS. Results: Results show that 17.1% of the women have good knowledge of caesarean section as a method of birth. Majority of the respondents agreed that vaginal delivery creates more mother-baby relationship than caesarean section. 69.5% of the respondents agreed that caesarean section is preferable to vaginal delivery as the pain in vaginal delivery is usually unpleasant, 66.0% disagreed that babies born through caesarean section are more healthy than their other counterpart that are born through vaginal delivery. Only 6.9% accept caesarean section. Conclusions: Mothers should therefore be educated on the process involved in caesarean birth and the advantage of this method of birth over other birth method. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 709-714

  18. Patterns of caesarean-section delivery in Addis Ababa, Ethiopia

    Mashalla, Yohana J.S.; Thupayagale-Tshweneagae, Gloria

    2016-01-01

    Setting The study was conducted in Addis Ababa, the capital city of Ethiopia. Specifically, it was conducted in all healthcare facilities offering maternity and obstetric services. Objective The objective of the study was to explore the patterns of caesarean-section (CS) delivery in Addis Ababa. Methods A cross-sectional survey was carried out between December 2013 and January 2014. The population for the study were women aged between 15 and 19 years of age who had given birth in the last 1–3 years before the date of data collection. The Census and Survey Processing System software was used for data capturing and analysing both descriptive and inferential statistics using Statistical Package for Social Sciences version 20.0. Results Amongst the 835 women who delivered at health facilities, 19.2% had given birth by CS. The prevalence of CS based on medical indication was 91.3%. However, 6.9% of CS performed had no medical indication. Private health facilities performed more CSs than public health facilities, 41.1% and 11.7% respectfully. CS was high amongst women of higher socio-economic standing. Conclusion Overall, CS deliveries rate in Ethiopia is above the rate recommended by the World Health Organisation. Because socio-economic factors influence CS delivery, governments should play a key role in regulating performance of CSs in private institutions.

  19. Rate and indications of elective and emergency caesarean section; a study in a tertiary care hospital of peshawar

    The study was conducted to determine the rate and clinical indications for emergency and elective caesarean section. Methods: This was a cross-sectional descriptive study conducted from December 2010 to January 2011 in Gynaecology unit-A of Lady Reading Hospital Peshawar. Consecutive patients who gave birth in the hospital during the study period were included in the study. There were a total of 966 patients. Mode of delivery and basic demographics of the patients who underwent elective and emergency caesarean section were noted down. Clinical indications were recorded. Results: Out of 966 patients, 210 underwent caesarean section. Therefore, the rate of caesarean section was 21.7 per 100. Among those 78% (n=164) were emergency caesarean sections and others were elective caesarean sections. Top six indicators for caesarean sections were foetal distress 17.1 % (n=36), obstructive labour/failure to progress 16.1% (n=34), previous caesarean section 15.2% (n=32), breech presentation 9.5% (n=20), cephalopelvic disproportion 6.1% (n=13), failed induction 5.7% (n=12) and pregnancy induced hypertension (PIH) 5.7% (n=12). Conclusion: The rate of caesarean section was only slightly higher than recommended by the WHO. Most of caesarean sections were emergency caesarean sections. (author)

  20. Decisions to Perform Emergency Caesarean Sections at a University Hospital

    Pillai, Silja A.; Vaidyanathan, Gowri; Al-Shukri, Maryam; Al-Dughaishi, Tamima R.; Tazneem, Shahila; Khan, Durdana; El-Tayeb, Saniya; Mathew, Mariam

    2016-01-01

    Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings. PMID:26909212

  1. International variation in caesarean section rates and maternal obesity.

    O'Dwyer, V; Layte, R; O'Connor, C; Farah, N; Kennelly, M M; Turner, M J

    2013-07-01

    This study examined variations in caesarean section (CS) rates associated with a woman's birthplace and differences in maternal adiposity. Women were enrolled in the 1st trimester. Maternal adiposity was assessed by body mass index (BMI) and bioelectrical impedance analysis (BIA). Irish women were compared with women born in the 14 countries who joined the European Union (EU) before 2004 (EU 14), and with those born in 12 countries who joined following enlargement (EU 12). Of the 2,811 women enrolled, 2,235 women were born in Ireland, 100 in EU 14 countries and 476 in EU 12 countries. Based on a BMI > 29.9 kg/m(2), maternal obesity was higher in Irish (19.8%; n = 443) and EU 14 women (19.0%; n = 19) compared with EU 12 women (9.5%; n = 45), p < 0.001. BIA of maternal body composition confirmed increased adiposity in both the Irish and EU 14 women. Variations in emergency CS rates in primigravidas based on the woman's birthplace were associated with maternal adiposity and induction of labour, both modifiable risk factors for CS. We recommend, therefore, that induction of labour in obese primigravidas should be undertaken only in carefully considered clinical circumstances. Our findings also suggest economic development in Europe may drive an increase in the CS rates mediated through increased levels of maternal obesity and, therefore, public health interventions should focus on optimising a woman's prepregnancy weight. PMID:23815198

  2. Service Quality of Delivered Care from the Perception of Women with Caesarean Section and Normal Delivery

    Jafar S Tabrizi; Samira Askari; Zahra Fardiazar; Hossein Koshavar; Kamal Gholipour

    2014-01-01

    Background: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. Methods: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 – (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women‟s...

  3. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

    Souza, JP; Betran, AP; Dumont, A; de Mucio, B.; Gibbs Pickens, CM; Deneux-Tharaux, C.; Ortiz-Panozo, E; Sullivan, E; Ota, E.; Togoobaatar, G; Carroli, G; Knight, H; Zhang, J.; Cecatti, JG; Vogel, JP

    2015-01-01

    ObjectiveTo generate a global reference for caesarean section (CS) rates at health facilities. DesignCross-sectional study. SettingHealth facilities from 43 countries. Population/SampleThirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10045875 women giving birth from 43 countries for model testing. MethodsWe hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. The...

  4. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study.

    De Nardo, P; Gentilotti, E; Nguhuni, B; Vairo, F; Chaula, Z; Nicastri, E; Nassoro, M M; Bevilacqua, N; Ismail, A; Savoldi, A; Zumla, A; Ippolito, G

    2016-08-01

    Few data are available on the determinants and characteristics of post-caesarean section (CS) surgical site infections (SSIs) in resource-limited settings. We conducted a prospective observational cohort study to evaluate the rates, determinants, and microbiological characteristics of post-CS SSI at the Dodoma Regional Referral Hospital (DRRH) Gynaecology and Obstetrics Department in Tanzania. Spanning a three-month period, all pregnant women who underwent CS were enrolled and followed up for 30 days. SSI following CS occurred in 224 (48%) women. Only 10 (2.1%) women received pre-incision antibiotic prophylaxis. Urgent intervention is needed to prevent and control infections and contain the rising rate of post-CS SSI at the DRRH. PMID:27125664

  5. Caesarean section in a patient with varicella: Anaesthesia considerations and clinical relevance

    Nandini M Dave

    2007-01-01

    Full Text Available A primigravida with chicken pox was posted for an emergency caesarean section. General anaesthesia was administered. Key issues in anaesthesia management and the clinical implications are discussed.

  6. Comparison of peritoneal closure versus non-closure during caesarean section

    In modern obstetrics caesarean sections are commonly used and in all caesarean sections either peritoneal closure is done or not. This cases series was conducted to record outcomes in our setup. Methods: Cases of caesarean sections were followed for adhesions and non-adhesions in peritoneal closure and non-closure cases from 1st January to December 2011 at DHQ Hospital Haripur. In non-peritoneal closure cases adhesions were marked as compare to non-adhesions in eritoneal closure cases. Results: Sixty-five cases of peritoneal closure and 30 cases of non-peritoneal closure were followed up. There were more cases of adhesions in non-closure group (p<0.05). Conclusion: Peritoneal closure is beneficial in routine caesarean sections. (author)

  7. Maternal height as a risk factor for Caesarean section due to failure to progress in labour.

    McGuinness, B J; Trivedi, A N

    1999-05-01

    We examined for a regional sample of the New Zealand population, the relationship between maternal height and an increased risk of emergency Caesarean section due to arrested labour, to identify a height below which the risk of Caesarean section increases markedly and to quantify the risk of a Caesarean section for a range of maternal heights. The data of nulliparous singleton pregnancies over the period 1994-1998 was sorted into 2 study groups, one resulting in emergency Caesarean section for arrested labour and the other a group of women who had normal vaginal delivery requiring no intervention. The means and standard deviations of these 2 groups were found and 99% confidence intervals calculated. They were analysed for statistical difference and then a logistical regression calculation tried to identify a height at which the risk of a Caesarean section increased suddenly. There were 81 women in the Caesarean section group and 997 in the normal vaginal delivery group. Mean heights and confidence intervals were 161.0 cm (158.9-163.1) and 164.6 cm (164.0-165.2) respectively. There was a statistically significant difference between these means (plogistic regression analysis showed that risk of Caesarean section increased gradually with decreasing height, and even then did not reach more than 30% risk until a height of less than 140 cm. Low maternal height was associated with increased risk of Caesarean section due to labour arrest. Because the likelihood of having a normal vaginal delivery was still very good (>80 %) at modest degrees of short stature, this risk factor alone is unlikely to affect management. However the combination of other risk factors with maternal height may be of clinical use. PMID:10755767

  8. Use of a computerised maternity information system to improve clinical effectiveness: thromboprophylaxis at caesarean section

    Taylor, G.; Mckenzie, C.; Mires, G.

    2000-01-01

    An audit of the introduction of a protocol for thromboprophylaxis at caesarean section revealed over treatment of low risk women and the under treatment of high risk women. A routine computer generated risk assessment profile was introduced as part of a maternity information system. Reaudit showed a significant improvement in adherence to the thromboprophylaxis protocol in all risk groups.


Keywords: thromboprophylaxis; caesarean section; computerised assessment

  9. Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

    Aliya Islam; Ambreen Ehsan

    2011-01-01

    Background : A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim : The aim of this study...

  10. Double balloon device compared to oxytocin for induction of labour after previous caesarean section

    José García-Adanez; Irene Diez-Itza; Miren Arrue Gabilondo; Estefanía Rodríguez Ferradas; Izaskun Lasa Alvarado

    2013-01-01

    Objective: To assess cervical changes, duration of oxytocin infusion, mode of delivery and complications after cervical ripening using a double balloon device in women with a previous caesarean section. Methods: Longitudinal study including 80 women with a previous caesarean section, no previous vaginal delivery and an unfavourable cervix (Bishop score < 4). Two groups were established: a double balloon device was used with 32 women (exposed) and not with the others (non-exposed) (48). Stati...

  11. After surgery: the effects of life-saving caesarean sections in Burkina Faso

    Filippi, Véronique; Ganaba, Rasmané; Calvert, Clara; Murray, Susan F.; Storeng, Katerini T.

    2015-01-01

    Background In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso. Methods We conducted a 4 year ...

  12. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial)

    Stutchfield, Peter Roy; Whitaker, Rhiannon; Gliddon, Angela E; Hobson, Lucie; Kotecha, Sailesh; Doull, Iolo J M

    2013-01-01

    Objectives To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. Design A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). Setting Four UK study centres from the original trial. Participants 862 participants from the four largest recruiti...

  13. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section.

    Higgins, Mary F

    2013-11-01

    Placenta accreta, morbid adherence to the uterus to the myometrium, is commonest in association with placenta previa in women previously delivered by caesarean section (CS). It has become proportionally a greater cause of major maternal morbidity and mortality as the frequency of other serious obstetric complications has declined. The aim of this study was to examine the incidence of placenta accreta in the context of a rising caesarean delivery rate.

  14. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

    Bamigboye, Anthony A; Hofmeyr, G Justus

    2014-01-01

    Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the ...

  15. An audit of caesarean sections for very low birth weight babies.

    Khalifeh, A

    2012-02-01

    This study reviewed caesarean sections for very low birth weight babies in a tertiary referral maternity hospital. Maternal and neonatal complications were recorded and classified according to uterine incision type. We reviewed medical records of 89 women over a period of 2 years. The indication for the caesarean section influenced the type of uterine incision made (p = 0.004). Women who had antepartum haemorrhage were more likely to need a vertical incision. There was also a higher incidence of vertical incisions for gestations <28 weeks (p = 0.029). Surprisingly, when the computerised discharge summaries were reviewed retrospectively, all the vertical uterine incisions were recorded as lower segment caesarean sections. This would have a clinical impact on those women in future pregnancies, especially in a highly mobile population.

  16. The respiratory consequences of early-term birth and delivery by caesarean sections.

    Kotecha, Sarah J; Gallacher, David J; Kotecha, Sailesh

    2016-06-01

    In England and Wales, 19% of live births in 2012 were at 37-38 weeks' gestation, equating to nearly 140 000 early-term births each year. Since caesarean sections (CS) are often performed at early-term gestations, this accounts for some of the increased proportion of the early-term births. Infants born early-term are at an increased risk of neonatal respiratory morbidity particularly if they are delivered by caesarean section. The long term lung function data are limited but available data suggest that early-term delivery is associated with respiratory morbidity in childhood. CS also appears to be associated with increased neonatal morbidity and future development of respiratory symptoms. However, future studies need to confirm the independent effects of caesarean sections and early-term deliveries particularly for long term outcomes as both are likely to affect the respiratory system differently. PMID:26810083

  17. Caesarean section on maternal request in north-eastern Nigeria: Women’s knowledge, perception and attitude

    Bukar M

    2014-03-01

    Full Text Available Background: Caesarean delivery is the most widely performed major obstetric surgery globally and the incidence is rising. Aim: To document the views of pregnant women in two tertiary institutions in Nigeria towards caesarean delivery on maternal request. Methods: A cross-sectional study of pregnant women who attended the antenatal clinics of the University of Maiduguri Teaching Hospital and Federal Medical Centre, Yola from August to October 2009. Results: A total of 254 women were interviewed. The age ranged from 18-43 years with a mean of 28.56+5.60 years. The mean parity was 2.71+1.96. Majority, 204 (80.3% respondents were aware of caesarean delivery with 90 (44.1% of the information obtained from friends. Sixteen (6.3% believed that having caesarean section was due to failure of reproductive function of a woman, with 106 (41.7% citing destiny as reason for caesarean delivery. Most, 226 (89.0%, would not request for caesarean section. The commonest reason for caesarean section on maternal request was avoidance of labour pain, 16 (57.1%. Education (2 =33.561, P=0.000 and occupation (2 =26.205, P=0.003 had influence on knowledge of caesarean delivery. Education however, had no influence on maternal request for caesarean delivery (2 =5.810, P=0.121. Although majority (2 =2.589, P=0.000 would prefer vaginal delivery, none of the respondents would decline caesarean delivery if indicated. Conclusion: The knowledge, perception and attitude toward caesarean delivery are encouraging. The low number of maternal request for caesarean will serve as a benchmark for the future especially with the increasing penchant for smaller family sizes among the urban educated elites.

  18. Anaesthetic Management of Two Patients with Pompe Disease for Caesarean Section

    I. J. J. Dons-Sinke

    2014-01-01

    Full Text Available The introduction of enzyme replacement therapy and the resultant stabilisation or improvement in mobility and respiratory muscle function afforded to patients with late-onset Pompe may lead to an increased number of Pompe patients prepared to accept the challenges of parenthood. In this case report, we describe our anaesthetic management of two patients with Pompe disease for a caesarean section.

  19. Trends in Caesarean Section Use from 1955-1999 in a Regional Perinatology Centre

    Hájek, Z.; Reissigová, Jindra; Haaková, L.; Kolařík, D.; Binder, T.; Živný, J.

    2001-01-01

    Roč. 7, č. 2 (2001), s. 55-58. ISSN 1505-0580 R&D Projects: GA MZd NH4837 Institutional research plan: AV0Z1030915 Keywords : caesarean sections * increasing frequency * indications Subject RIV: BB - Applied Statistics, Operational Research

  20. Bioethical considerations: Caesarean section at the request of the patient and autonomy

    Rogelio González Pérez

    2012-01-01

    A doctor who has to perform an on demand Caesarean section instead of a vaginal birth, without any medical need, must analyze several ethical elements to accept this request. To review and reflect on the principles of medical ethic can guide the physician to prioritize a medical-based decision, ensuring the best result possible for the mother and for the unborn child.

  1. Elective caesarean section and respiratory morbidity in the term and near-term neonate

    Hansen, Anne Kirkeby; Wisborg, Kirsten; Uldbjerg, Niels;

    2007-01-01

    AIM: The aim of this review was to assess the relationship between delivery by elective caesarean section and respiratory morbidity in the term and near-term neonate. METHODS: Searches were made in the MEDLINE database, EMBASE, Cochrane database and Web of Science to identify peer-reviewed studie...

  2. Prediction of successful trial of labour in patients with a previous caesarean section

    Objective: To determine the prediction rate of success in trial of labour after one previous caesarean section. Methods: The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Cantonment General Hospital, Rawalpindi, from January 1, 2012 to January 31, 2013, and comprised women with one previous Caesarean section and with single alive foetus at 37-41 weeks of gestation. Women with more than one Caesarean section, unknown site of uterine scar, bony pelvic deformity, placenta previa, intra-uterine growth restriction, deep transverse arrest in previous labour and non-reassuring foetal status at the time of admission were excluded. Intrapartum risk assessment included Bishop score at admission, rate of cervical dilatation and scar tenderness. SPSS 21 was used for statistical analysis. Results: Out of a total of 95 women, the trial was successful in 68 (71.6%). Estimated foetal weight and number of prior vaginal deliveries had a high predictive value for successful trial of labour after Caesarean section. Estimated foetal weight had an odds ratio of 0.46 (p<0.001), while number of prior vaginal deliveries had an odds ratio of 0.85 with (p=0.010). Other factors found to be predictive of successful trial included Bishop score at the time of admission (p<0.037) and rate of cervical dilatation in the first stage of labour (p<0.021). Conclusion: History of prior vaginal deliveries, higher Bishop score at the time of admission, rapid rate of cervical dilatation and lower estimated foetal weight were predictive of a successful trial of labour after Caesarean section. (author)

  3. Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

    Zaman Shakila

    2010-01-01

    Full Text Available Abstract Background Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. Methods This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. Results The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees and from the patient's perspective was 79 US$ (5278 rupees. The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees and 204 US$ (13678 rupees from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74% of households had a monthly income of less than 149 US$ (10000 rupees. Conclusion The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare.

  4. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

    Fyfe Elaine M

    2012-10-01

    Full Text Available Abstract Background Increasing rates of postpartum haemorrhage in developed countries over the past two decades are not explained by corresponding changes in risk factors and conjecture has been raised that maternal obesity may be responsible. Few studies investigating risk factors for PPH have included BMI or investigated PPH risk among nulliparous women. The aim of this study was to determine in a cohort of nulliparous women delivering at term whether overweight and obesity are independent risk factors for major postpartum haemorrhage (PPH ≥1000ml after vaginal and caesarean section delivery. Methods The study population was nulliparous singleton pregnancies delivered at term at National Women’s Hospital, Auckland, New Zealand from 2006 to 2009 (N=11,363. Multivariable logistic regression was adjusted for risk factors for major PPH. Results There were 7238 (63.7% women of normal BMI, 2631 (23.2% overweight and 1494 (13.1% obese. Overall, PPH rates were increased in overweight and obese compared with normal-weight women (n=255 [9.7%], n=233 [15.6%], n=524 [7.2%], p Conclusion Nulliparous obese women have a twofold increase in risk of major PPH compared to women with normal BMI regardless of mode of delivery. Higher rates of PPH among obese women are not attributable to their higher rates of caesarean delivery. Obesity is an important high risk factor for PPH, and the risk following vaginal delivery is emphasised. We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women.

  5. User fee exemptions and equity in access to caesarean sections: an analysis of patient survey data in Mali

    El-Khoury Marianne

    2012-08-01

    Full Text Available Abstract Introduction Little rigorous evidence exists on how health service utilization varies across socioeconomic groups after a user fee exemption policy has been implemented, and the evidence that does exist is mixed. In this paper, we estimate the distribution of caesarean section deliveries across socioeconomic groups following Mali’s implementation of a fee exemption policy for caesareans in 2005. Methods We conducted a patient survey in 2010 to collect socioeconomic data from 2,477 women who had caesareans in a representative sample of 25 facilities across all regions of Mali. We used these data along with data from the most recent Demographic and Health Survey to construct a wealth index and classify women into population-based wealth groupings. We compared the wealth distribution of women delivering via caesarean section to that of a nationally representative sample of women giving birth. Results We found that wealthier women make up a disproportionate share of those having free caesareans, five years after implementation of the fee exemption policy. Women in the richest two quintiles accounted for 58 percent of all caesareans, while women in the poorest two quintiles accounted for 27 percent of all caesareans. Fewer women in the poorest two-fifths of the population are receiving caesareans than what we would expect given their share in the population of women giving birth. Conclusions While fee exemptions remove important financial barriers to accessing priority maternal health services, they are insufficient to ensure equal access among wealth groups.

  6. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    Shubhra Goel; Cat Nguyen Burkat

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner’s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles des...

  7. Management of pregnancy with previous lower segment caesarean section in Modern obstetric practice

    Rajita Jani

    2013-07-01

    Full Text Available Objective: In today’s obstetric practice we encounter increasing number of post caesarean pregnancies because of rise in primary caesarean due to multi factorial reasons. There is increasing concern by obstetricians for managing these cases for medical and legal point of view. Present study was undertaken to decide appropriate mode of delivery and to conduct the proper management of patients with previous lower segment caesarean section.Study design: This is a prospective study carried out on 50 women with previous lower segment caesarean section. From December 2010 to December 2012 at private hospital Ahmedabad. Patient enrolled in study are with previous lower segment caesarean section (classical CS, Inverted T incision other medical complications (Hypertension, diabetes mellitus, anemia, heart disease, cardiac disease patients excluded. Patients were evaluated thoroughly by history and examination and mode of delivery was decided. Informed consent was taken of the patients who were fit for VBAC (Vaginal Birth after caesarean section. Women who were given trial ofVBAC, they progressed into labour spontaneously.Labour was constantly supervised by competent staff and meticulously monitored by cardiotocography.Results and discussion: Out of 50 cases, 40 (80% patients had history of previous 1 cesarean section, 8(16% patients had history of previous 2 cesarean section and 2 (4% had history of previous 3 cesarean section. Number of previous cesarean section has an important effect on outcome of labour as number of previous cesarean section increases, a repeat LSCS increases. Amongst 8 (16% patients with history of previous 2 LSCS and 2(4% patients with previous 3 LSCS, repeat LSCS was done in all 10 patients as there is no policy to give trial in patients of previous two or more caesarean sections. In present study, out of 40 patients with history of previous 1 cesarean section, in 20 patients repeat LSCS was done without giving trial

  8. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    Shubhra Goel

    2011-01-01

    Full Text Available This is a rare case of persistent Horner′s syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI/magnetic resonance angiography (MRA of head, neck, and chest were unremarkable. Medline search using terms Horner′s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner′s syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner′s syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner′s syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  9. The Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Region, Mali).

    Ravit, Marion; Philibert, Aline; Tourigny, Caroline; Traore, Mamadou; Coulibaly, Aliou; Dumont, Alexandre; Fournier, Pierre

    2015-08-01

    The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. Household socioeconomic status was assessed using a wealth index constructed with a principal component analysis. The factors significantly associated with expenses were determined using multivariate linear regression analyses. Women in the Kayes region spent on average 77,017 FCFA (163 USD) for a caesarean episode in EmONC, of which 70 % was for treatment. Despite the caesarean fee exemption, 91 % of the women still paid for their treatment. The largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. Near-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. Although abolishing fees of EmONC in Mali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. There are still barriers to EmONC access for women of the lowest socio-economic group. These included direct expenses for drugs prescription, treatment and indirect expenses for transport and food. PMID:25874875

  10. Cervical tourniquet in case of uncontrollable haemorrhage during caesarean section owing to a placenta accreta.

    Huijgen, Q C A; Gijsen, A F; Hink, E; Van Kesteren, P J M

    2013-01-01

    This case report describes a 38-year-old woman in whom a primary caesarean section for placenta previa was complicated by postpartum haemorrhage due to a placenta accreta. Despite tamponade with a Bakri balloon and placement of a B-Lynch suture, the amount of blood loss could not be effectively reduced. The blood loss was eventually minimised by the placement of a Penrose drain around the cervix as a cervical tourniquet. We think that a cervical tourniquet is an effective method of stopping haemorrhage during caesarean section, as shown in this case report, and we consider this technique to be a valuable addition to several existing methods through which fertility is preserved by preventing emergency hysterectomy. PMID:23608864

  11. ANESTHETIC MANAGEMENT OF AN ANEMIC PARTURIENT WITH SEVERE KYPHOSCOLIOSIS AND BILATERAL POLIOMYELITIS FOR EMERGENCY CAESAREAN SECTION

    Sujay

    2014-05-01

    Full Text Available Anesthesia for emergency caesarean section for a pregnant patient with severe dorsolumbar kyphoscoliosis and severe anemia is associated with potential risks for both mother and the fetus due to alterations in maternal physiology and the pathological changes associated with kyphoscoliosis. In an emergency situation, the anesthesiologist has to quickly choose the anesthetic technique depending on the cardiopulmonary status of the patient and feasibility. We present a case of a 20 year old parturient in labour with severe kyphoscoliosis and severe anemia who was posted for emergency caesarean section. In view of severe anemia, anticipated technical difficulties with central neuraxial blocks and emergency situation, she was administered general anesthesia (GA with uneventful recovery.

  12. Vaginal prostaglandin gel to induce labour in women with one previous caesarean section.

    Agnew, G

    2012-02-01

    This retrospective study reviewed the mode of delivery when vaginal prostaglandins were used to induce labour in women with a single previous lower segment caesarean section. Over a 4-year period, PGE 2 gel was used cautiously in low doses in 54 women. Induction with PGE 2 gel was associated with an overall vaginal birth after caesarean section (VBAC) rate of 74%, which compared favourably with the 74% VBAC rate in women who went into spontaneous labour (n = 1969). There were no adverse outcomes recorded after the prostaglandin inductions but the number reported are too small to draw any conclusions about the risks, such as uterine rupture. We report our results because they may be helpful in assessing the chances of a successful VBAC in the uncommon clinical circumstances where prostaglandin induction is being considered.

  13. Anaesthetic Management of Caesarean Section in a Patient with Large Mediastinal Mass

    Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with anterior and middle mediastinal masses are recognized to be at risk for cardiorespiratory compromise. Likewise, pregnancy has a widely known constellation of potential complications that confront the anaesthesiologist. The combination of both (pregnancy and mediastinal mass) in a single patient presents an unusual anaesthetic challenge. Caesarean sections are usually the mode of delivery, therefore, the cardio-respiratory stability is very important. The following is the report of a 31 weeks pregnant patient with a large, symptomatic anterior and middle mediastinal mass, who required anaesthesia for emergency caesarean section. The anaesthetic management entailed Combined Spinal and Epidural (CSE) technique with safe feto-maternal outcome. (author)

  14. Anaesthetic management of caesarean section in a patient with large mediastinal mass.

    Kashif, Sanum; Saleem, Jodat

    2015-02-01

    Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with anterior and middle mediastinal masses are recognized to be at risk for cardiorespiratory compromise. Likewise, pregnancy has a widely known constellation of potential complications that confront the anaesthesiologist. The combination of both (pregnancy and mediastinal mass) in a single patient presents an unusual anaesthetic challenge. Caesarean sections are usually the mode of delivery, therefore, the cardio-respiratory stability is very important. The following is the report of a 31 weeks pregnant patient with a large, symptomatic anterior and middle mediastinal mass, who required anaesthesia for emergency caesarean section. The anaesthetic management entailed Combined Spinal and Epidural (CSE) technique with safe feto-maternal outcome. PMID:25703761

  15. Short and long term effects of caesarean section and vaginal delivery

    Larsson, Christina

    2010-01-01

    The aim of this thesis was to study short and long term effects after caesarean section (CS) and vaginal delivery. We also studied the difficulty in estimating blood loss at delivery and birth experience estimated nine months after delivery. In Study I blood loss during delivery was measured in two ways, visually, according to the routine of the hospital, and with a laboratory method, the alkaline hematin method. The visual estimation tended to over-estimate the bleeding. ...

  16. What is the optimal caesarean section rate? An outcome based study of existing variation.

    Joffe, M.; Chapple, J; Paterson, C.; Beard, R. W.

    1994-01-01

    STUDY OBJECTIVE--To investigate the consequences of different levels of caesarean section (CS) rate in terms of fetal and maternal outcomes. DESIGN--Comparison of outcome variables between four categories of maternity units stratified according to CS rates. Data were collected concurrently. SETTINGS--All 17 maternity units in one health region. SUBJECTS--Data for the perinatal mortality analysis: all 221,867 deliveries in 1983-87 (excluding severe malformations) (1462 deaths); maternity infor...

  17. CORONIS - International study of caesarean section surgical techniques: the follow-up study.

    Abalos, E.; Oyarzun, E; Addo, V; Sharma, JB; Matthews, J.; Oyieke, J.; Masood, SN; El Sheikh, MA; Brocklehurst, P; Farrell, B; Gray, S.; Hardy, P.; N. Jamieson; Juszczak, E; Spark, P

    2013-01-01

    BACKGROUND: The CORONIS Trial was a 2×2×2×2×2 non-regular, fractional, factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes, the primary outcome being a composite of maternal death or infectious morbidity. The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies. Such outcomes include those related to subsequent pregnancy: mode of delivery; abnormal placentation (e....

  18. Bioethical considerations: Caesarean section at the request of the patient and autonomy

    Rogelio González Pérez

    2012-04-01

    Full Text Available A doctor who has to perform an on demand Caesarean section instead of a vaginal birth, without any medical need, must analyze several ethical elements to accept this request. To review and reflect on the principles of medical ethic can guide the physician to prioritize a medical-based decision, ensuring the best result possible for the mother and for the unborn child.

  19. Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

    Madhu Gupta; Shalini Subramanian; Preeti Adlakha

    2013-01-01

    A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE) anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate th...

  20. Birth after emergency caesarean section: Women’s perspectives on the factors influencing their decision making

    Hughes, Laura Jane

    2016-01-01

    The study explored the decisions women made in relation to mode of birth following a previous emergency lower segment caesarean section (emLSCS), particularly focusing on what different factors influenced women to choose a particular mode of birth and what they described as the rationale underpinning that decision. Participants were recruited from a population of students and staff within the School of Human and Health Sciences at a university in the north of England. Sixteen individuals...

  1. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT

    Wendy Chaboyer; Vinah Anderson; Joan Webster; Anne Sneddon; Lukman Thalib; Gillespie, Brigid M

    2014-01-01

    Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a defi...

  2. Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

    Madhu Gupta

    2013-01-01

    Full Text Available A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

  3. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial

    2007-10-01

    Full Text Available Abstract Background Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision. Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are: • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum (pelvic and parietal • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis or further operative procedures; or blood transfusion. The sample size required is 15,000 women in total; at least 7,586 women

  4. LIVE CONJOINED TWIN BABIES DELIVERED BY CAESAREAN SECTION: A CASE REPORT

    Biswas

    2014-07-01

    Full Text Available Conjoined twins, commonly referred to as Siamese twins, are babies connected physically to each other. Depending upon the point of connection, there are different types of conjoined twins. A targeted sonographic examination at midpregnancy can diagnose the entity in most cases. Fetal prognosis depends on the period of gestation at delivery, birth weight, extent of organ sharing by the fetuses and possibility of surgical separation. Viable conjoined twins should be delivered by caesarean section. Here we present a case of thoracopagus twin pregnancy where the fetuses were born alive by C Section but expired soon after delivery probably because of extreme prematurity and low birth weight

  5. Influence of anesthesia techniques of caesarean section on memory, perception and speech

    Volkov O.O.

    2014-06-01

    Full Text Available In obstetrics postoperative cognitive dysfunctions may take place after caesarean section and vaginal delivery with poor results both for mother and child. The goal was to study influence of anesthesia techniques following caesarian section on memory, perception and speech. Having agreed with local ethics committee and obtained informed consent depending on anesthesia method, pregnant women were divided into 2 groups: 1st group (n=31 had spinal anesthesia, 2nd group (n=34 – total intravenous anesthesia. Spinal anesthesia: 1.8-2.2 mLs of hyperbaric 0.5% bupivacaine. ТIVА: Thiopental sodium (4 mgs kg-1, succinylcholine (1-1.5 mgs kg-1. Phentanyl (10-5-3 µgs kg-1 hour and Diazepam (10 mgs were used after newborn extraction. We used Luria’s test for memory assessment, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers". Control points: 1 - before the surgery, 2 - in 24h after the caesarian section, 3 - on day 3 after surgery, 4 - at discharge from hospital (5-7th day. The study showed that initially decreased memory level in expectant mothers regressed along with the time after caesarean section. Memory is restored in 3 days after surgery regardless of anesthesia techniques. In spinal anesthesia on 5-7th postoperative day memory level exceeds that of used in total intravenous anesthesia. The perception and speech do not depend on the term of postoperative period. Anesthesia technique does not influence perception and speech restoration after caesarean sections.

  6. National Variation in Caesarean Section Rates: A Cross Sectional Study in Ireland

    Sinnott, Sarah-Jo; Brick, Aoife; Layte, Richard; Cunningham, Nathan; Turner, Michael J.

    2016-01-01

    Objective Internationally, caesarean section (CS) rates are rising. However, mean rates of CS across providers obscure extremes of CS provision. We aimed to quantify variation between all maternity units in Ireland. Methods Two national databases, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women delivering singleton births weighing ≥500g. We used multilevel models to examine variation between hospitals in Ireland for elective and emergency CS, adjusted for individual level sociodemographic, clinical and organisational variables. Analyses were subsequently stratified for nullipara and multipara with and without prior CS. Results The national CS rate was 25.6% (range 18.2% ─ 35.1%). This was highest in multipara with prior CS at 86.1% (range 6.9% ─ 100%). The proportion of variation in CS that was attributable to the hospital of birth was 11.1% (95% CI, 6.0 ─ 19.4) for elective CS and 2.9% (95% CI, 1.4 ─ 5.6) for emergency CS, after adjustment. Stratifying across parity group, variation between hospitals was greatest for multipara with prior CS. Both types of CS were predicted by increasing age, prior history of miscarriage or stillbirth, prior CS, antenatal complications and private model of care. Conclusion The proportion of variation attributable to the hospital was higher for elective CS than emergency CS suggesting that variation is more likely influenced by antenatal decision making than intrapartum decision making. Multipara with prior CS were particularly subject to variability, highlighting a need for consensus on appropriate care in this group. PMID:27280848

  7. GOAL ORIENTED ANAESTHETIC MANAGEMENT FOR CAESAREAN SECTION IN A PARTURIENT WITH PITUITARY TUMOUR

    Sushma

    2015-03-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anesthesia for Pregnancy with pituitary tumours is a challenge to an Anesthesiologist , requires careful preoperative assessment and meticulous perioperative management to achieve optimal safety of mother and fetus. There are very limited studies in literature to guide the anaesthetic management of such patients. Here we report the successful Anaesthetic management of a parturient with pituitary tumour with epilepsy posted for emergency caesarean section. PRESENTATION, DIAGNOSIS, MANAGEMENT: A 25 year young woman, G2P1L1, a known epileptic, diagnosed with pituitary macroadenoma presented at 40 weeks of gestation with severe Oligohydramnios (AFI - 4cm was posted for an emergency caesarean section. Following consultation with the obstetrician, neonato logist and the neurosurgeon the decision was made to proceed with caesarean section under general anesthesia. Rapid sequence induction and intubation was performed with inj Thiopentone sodium and inj Rocuronium and was maintained with Isoflurane, titrated to maintain the stability of mean arterial pressure until extraction. A live 4. 25kgs male child was born with Apgar scores of 8 and 9 at 1 and 5 mins respectively. Following extraction 10U run as infusion in Ringers lactate. Intraoperative analgesia was a dministered after extraction. Dexmedetomedine infusion was used. Postoperative period was uneventful. DISCUSSION & CONCLUSION: Management of obstetric patients with pituitary tumour is complex, requiring knowledge of the physiological effects of pregnancy on tumour size and labour on intracranial pressure. General anesthesia combined with multimodal balanced analgesia is associated with a favorable outcome. General anaesthesia using Thiopentone, Fentanyl, Dexmedetomedine and titrated dose of Isoflurane was used in our case were found to be safe with adequate hemodynamic stability and postoperative pain control. A team approach involving the Anaesthethesiologist

  8. Anaesthetic management for caesarean section in a case of previously operated with residual pituitary tumour

    Prerana N Shah

    2011-01-01

    Full Text Available Successful anaesthetic management for caesarean section in a case with previous pituitary tumour resection, with residual tumour, is reported. The pituitary gland undergoes global hyperplasia during pregnancy. Functional pituitary tumours may exhibit symptomatic enlargement during pregnancy. Growth hormone secreting tumour is associated with acromegaly which has associated anaesthetic implications of difficult airway, systemic hypertension, and diabetes and electrolyte imbalance. Intracranial space occupying lesions can increase intra cranial pressure and compromise cerebral perfusion or cause herniation. We report management of this case.

  9. Cervical tourniquet in case of uncontrollable haemorrhage during caesarean section owing to a placenta accreta

    Huijgen, Q C A; Gijsen, A F; Hink, E; Van Kesteren, P J M

    2013-01-01

    This case report describes a 38-year-old woman in whom a primary caesarean section for placenta previa was complicated by postpartum haemorrhage due to a placenta accreta. Despite tamponade with a Bakri balloon and placement of a B-Lynch suture, the amount of blood loss could not be effectively reduced. The blood loss was eventually minimised by the placement of a Penrose drain around the cervix as a cervical tourniquet. We think that a cervical tourniquet is an effective method of stopping h...

  10. Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

    Aliya Islam

    2011-03-01

    Full Text Available Background: A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim: The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section. Materials and Methods: Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating, using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results. Results: It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in

  11. Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

    Aliya Islam

    2011-01-01

    Full Text Available Background : A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim : The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section. Materials and Methods : Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating, using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results. Results : It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in

  12. Anaesthetic management for emergency caesarean section in a patient with an untreated recently diagnosed phaeochromocytoma

    Anil Agarwal

    2011-01-01

    Full Text Available Phaeochromocytoma is a rare cause of hypertension during pregnancy with potentially fatal consequences. If not detected and treated early in pregnancy, it is catastrophic for both the mother and the baby. Management requires close co-ordination between the obstetrician, anaesthesiologist, paediatrician and the endocrinologist. Perioperative management for an emergency caesarean section in a parturient with untreated phaeochromocytoma is an anaesthetic challenge and no standard recommendations have been reported till date. In this case report, we present anaesthetic management in such a case with successful maternal and foetal outcome.

  13. Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England

    Marshall, Joyce; Spiby, Helen; McCormick, Felicia

    2015-01-01

    Background Caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ was a facilitative initiative developed to promote opportunities for normal birth and reduce Caesarean section rates in England. Objective To evaluate the ‘Focus on Normal Birth and Reduc...

  14. Comparison of ephedrine versus fluid preload in prevention of hypotension after spinal anaesthesia for caesarean section

    Objective: To compare the effect of crystalloid preload versus prophylactic ephedrine on blood pressure after spinal anesthesia for elective caesarean section. Study Design: Randomized control trails (RCT). Place and Duration of Study: The study was carried out at Combined Military Hospital Peshawar, which is a tertiary care hospital from January 2007 to January 2008. Methodology: One hundred patients fulfilling the inclusion criteria were selected for this study and randomly divided into two groups of 50 each. Patients of group A were preloaded with Hartman's solution 15ml/kg body weight. Patients in group B received prophylactic intravenous ephedrine 0.25mg/kg body weight just before administration of spinal anesthesia. Blood pressure was recorded before and 03 minutes after administration of spinal anesthesia. Results: The mean age in group A was 25.54 +- 3.06 years and in group B was 25.34+-2.94 years. In group A, there were 6(12%) patients with no/mild hypotension 10(20%) patients of moderate while 34(68%) patients had severe hypotension. In group B 24(48%) patients had no/mild hypotension. Ten (20%) patients had moderate while 16(32%) patients had severe hypotension (p=0.001). Conclusion: Prophylactic administration of ephedrine is better than crystalloid preload in prevention of significant hypotension in spinal anesthesia for elective caesarean section. (author)

  15. Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature.

    Stevens, Jeni; Schmied, Virginia; Burns, Elaine; Dahlen, Hannah

    2014-10-01

    The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress. PMID:24720501

  16. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

    McMorrow, R C N

    2012-02-01

    BACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)Caesarean section. The addition of TAP block with bupivacaine 2 mg kg(-1) to spinal morphine did not further improve analgesia.

  17. Caesarean delivery and risk of developing asthma in the offspring

    Werner, Anette; Ramlau-Hansen, Cecilia Høst; Jeppesen, Simone K;

    2007-01-01

    AIM: To evaluate the association between caesarean section and risk of developing asthma. METHOD: We evaluated this association in a Danish cohort, comprising of 11,147 mothers and their babies of which 7119 mother-child pairs were included in the analyses. The mothers' reported asthma data on...... their children were linked to hospitalization records on mode of delivery. RESULTS: The adjusted odds ratio for developing asthma was 1.11 (95% CI, 0.88-1.39) for caesarean sections versus vaginal births. CONCLUSION: We found no evidence that children being delivered by caesarean section have an...

  18. Multidisciplinary team training reduces the decision-to-delivery interval for emergency Caesarean section

    Fuhrmann, Lone; Pedersen, T H; Atke, A;

    2015-01-01

    BACKGROUND: Emergency Caesarean section is performed when the life of the pregnant woman and/or the foetus is considered at risk. A 30-min standard for the decision-to-delivery interval (DDI) is a common practice and is supported by national organisations including The Danish Society of Obstetrics...... study aims to evaluate the effect of a simulation-based team training programme on the proportion of ECSs achieved within a 30-min time frame. METHOD: We performed an interventional before-and-after study. We evaluated a total of one hundred 30-min ECSs before and after the intervention. The primary...... outcome of interest was the proportion of 30-min ECSs achieved within a 30-min time frame. RESULTS: A total of 20 team training courses were held during May/June 2013. These courses trained 239 of 252 team members (comprised of: 36 obstetricians, 45 scrub nurses, 83 midwives, 38 anaesthesiologists, 37...

  19. Effect of phenylephrine vs. ephedrine on frontal lobe oxygenation during caesarean section with spinal anesthesia

    Foss, Visti T; Christensen, Robin; Rokamp, Kim Z;

    2014-01-01

    phenylephrine reduced ScO2 (-8.6 ± 2.8%; p = 0.005) with a 10.7% difference in ScO2between groups (p = 0.0106). Also maternal heart rate was maintained with ephedrine (+3 ± 3 bpm) but decreased with phenylephrine (-11 ± 3 bpm); difference 14 bpm (p = 0.0053), but no significant difference in mean arterial...... pressure (p = 0.1904) or CO (p = 0.0683) was observed between groups. The two drugs also elicited an equal increase in fetal heart rate (by 19 ± 3 vs. 18 ± 3 bpm; p = 0.744). CONCLUSION: In the choice between phenylephrine and ephedrine for maintenance of blood pressure during caesarean section with spinal...

  20. Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

    Tadrous, R

    2012-02-01

    Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.

  1. Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

    Tadrous, R

    2011-07-01

    Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.

  2. The half-life and exposure of Cefuroxime varied in newborn infants after a Caesarean section

    Zachariassen, G; Hyldig, N; Joergensen, J S;

    2016-01-01

    AIM: No information was available on how fast intravenous cefuroxime administered to pregnant women before a Caesarean section was cleared in newborn infants. This study investigated the drug's half-life and the exposure of healthy newborn infants after their mothers received the drug. METHODS......: Healthy mothers received a single dose of cefuroxime 15 to 60 minutes before skin incision. One blood sample was drawn from the umbilical cord and two blood samples were drawn from the infant after delivery. Total plasma cefuroxime (μg/ml) was measured using high-pressure liquid chromatography. RESULTS......: Cefuroxime was given to 22 mothers, including two who had twins. The concentration of cefuroxime varied significantly among infants (p<0.001), while the rate of decline did not (p=0.24). The median cefuroxime half-life was 3.5 hours (range 2.9-5.5), which was approximately three times longer than in normal...

  3. Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section

    The uteroplacental blood flow was measured before and during epidural anaesthesia for caesarean section in 11 woman. The blood flow was measured with dynamic placental scintigraphy. After an i.v. injection of indium-113m chloride, the gamma radiation over the placenta was recorded with a computer-linked scintillation camera. The uteroplacental blood flow could be calculated from the isotope accumulation curve. The anaesthesia was performed with bupivacaine plain 0.5%, 18-22 ml and a preload of a balanced electrolyte solution 10 ml/kg b.w. was given. The placental blood flow decreased in eight patients and increased in three with a median change of -21%, not being statistically significant. No correlation between maternal blood pressure and placental blood flow was found. (author)

  4. Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section

    Skjoeldebrand, A.; Eklund, J.; Johansson, H.; Lunell, N.-O.; Nylund, L.; Sarby, B.; Thornstroem, S. (Departments of Anaesthesiology, Obstetrics and Gynaecology and Medical Physics, Karolinska Institute at Huddinge University Hospital, Stockholm (Sweden))

    1990-01-01

    The uteroplacental blood flow was measured before and during epidural anaesthesia for caesarean section in 11 woman. The blood flow was measured with dynamic placental scintigraphy. After an i.v. injection of indium-113m chloride, the gamma radiation over the placenta was recorded with a computer-linked scintillation camera. The uteroplacental blood flow could be calculated from the isotope accumulation curve. The anaesthesia was performed with bupivacaine plain 0.5%, 18-22 ml and a preload of a balanced electrolyte solution 10 ml/kg b.w. was given. The placental blood flow decreased in eight patients and increased in three with a median change of -21%, not being statistically significant. No correlation between maternal blood pressure and placental blood flow was found. (author).

  5. 6. Pattern of antimicrobial use in caesarean section in a tertiary care hospital in rural south India

    J. Heethal

    2010-05-01

    Full Text Available Use of antimicrobials in caesarean section has become an accepted practice to minimize the incidence of post operative complications. Not many studies are available in India regarding the use of antimicrobial in caesarean section, hence this study. The study aims at finding the pattern of use of antimicrobial prophylaxis in caesarean section and also the frequency of post operative morbidity. This study is a retrospective case series analysis which included seventy five patients undergoing caesarean section admitted to the obstetrics and gynaecology department of Sri R.L.Jalappa hospital and research centre. Relevant information on each patient was collected according to the proforma designed for the study. Antimicrobial used, their dose dosage schedule were recorded. Investigations like pus, blood and urine culture and sensitivity was recorded for patients with post operative complications. Change of antimicrobial following culture sensitivity report was noted. In our analysis, most of the patients came from low socioeconomic status. We observed the use of third generation cephalosporin like ceftriaxone or cefotaxime and metronidazole in most of the patients. Two drugs or three drug combinations were used which commonly included third generation cephalosporin and metronidazole with gentamicin being added in three drug combinations. Thirty patients had post operative complications which included wound infection, urinary tract infection and fever. E. coli were the common organism isolated which was resistant to third generation cephalosporin and sensitive to amikacin. In conclusion, periodic surveillance of antimicrobial prophylaxis is essential to detect the emergence of antibiotic resistance.

  6. Study of adequacy of informed consent in caesarean section in a tertiary care, teaching and research institute of Northern India

    Latika

    2015-06-01

    Conclusions: Majority of the caesarean sections were performed due to some emergency indications. It was found that overall patients were well informed about the procedure and the related consequences. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 780-784

  7. The effect of distant reiki on pain in women after elective Caesarean section: a double-blinded randomised controlled trial

    vanderVaart, Sondra; Berger, Howard; Tam, Carolyn; Goh, Y. Ingrid; Gijsen, Violette M G J; de Wildt, Saskia N.; Taddio, Anna; Koren, Gideon

    2011-01-01

    Introduction Approximately 25% of all babies in North America are delivered via Caesarean section (C-section). Though a common surgical procedure, C-section recovery can be painful. Opioids, specifically codeine, are commonly used to ease pain; however, its active metabolite, morphine, passes into breast milk, and may produce unwanted side effects in neonates; therefore, alternatives to opioids are being sought. Reiki is an ancient Japanese form of healing where practitioners transfer healing...

  8. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend.

    Unterscheider, J

    2011-08-01

    To audit caesarean sections performed at full cervical dilatation over a three year period in a tertiary referral centre in Ireland. To evaluate (i) the rate of caesarean deliveries in the second stage of labour, (ii) the indication for delivery and (iii) the associated fetal and maternal morbidity in this cohort of women.

  9. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis

    Wang, Hong-Yan; Jiang, Qing; Shi, Hao; Xu, Yun-Qing; Shi, Ai-Chao; Sun, Yuan-Li; Li, Jian; Ning, Qin; Shen, Guan-Xin

    2016-01-01

    Several studies have reported a positive association between caesarean section for expeditious pregnancy termination and perinatal outcomes in acute fatty liver of pregnancy (AFLP); however, the risks remain unclear and independent studies have reported conflicting findings. In this meta-analysis, we aimed to confirm the relationship between caesarean section and perinatal outcomes in AFLP. The PubMed, Embase, and China National Knowledge Infrastructure databases were searched (until July 17, 2015) for observational clinical studies focusing on the association between caesarean section and perinatal outcomes in AFLP. Data were extracted and processed independently by 2 authors. We also compared caesarean section with vaginal delivery to further investigate this relationship. We observed that 2 of the 3 primary outcomes in caesarean section exhibited positive effects—the maternal mortality rate was 44% lower (relative risk [RR], 0.56 [0.41–0.76]) and perinatal mortality rate was also reduced (RR, 0.52 [0.38–0.71]), compared to those for vaginal delivery. We did not find any associations between caesarean section and perinatal outcomes in AFLP in terms of neonatal mortality type and maternal multiple organ complications. These findings emphasise the significant prognostic value and clinical implications of caesarean section in AFLP, and suggest that the adverse outcomes should be reduced. PMID:27387594

  10. Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section.

    Sagoo, Balvinder; Ng, Ka Ying Bonnie; Ghaleb, G; Brown, Heather

    2015-01-01

    We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid) in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery. PMID:26380133

  11. Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section

    Balvinder Sagoo

    2015-01-01

    Full Text Available We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.

  12. The risk of caesarean section in obese women analysed by parity.

    O'Dwyer, Vicky

    2012-02-01

    OBJECTIVE: This study looked at the association between caesarean section (CS) and Body Mass Index (BMI) in primigravidas compared with multigravidas. STUDY DESIGN: We enrolled women at their convenience, in the first trimester after an ultrasound examination confirmed an ongoing pregnancy. Weight and height were measured digitally and BMI calculated. After delivery, clinical details were again collected from the Hospital\\'s computerised database. RESULTS: Of the 2000 women enrolled, there were 50.4% (n=1008) primigravidas and 49.6% (n=992) multigravidas. Of the 2000 8.5% were delivered by elective CS and 13.4% were delivered by emergency CS giving an overall rate of 21.9%. The overall CS rate was 30.1% in obese women compared with 19.2% in the normal BMI category (p<0.001). In primigravidas the increase in CS rate in obese women was due to an increase in emergency CS (p<0.005) and in multigravidas the increase was due to an increase in elective CS (p<0.01). In obese primigravidas 20.6% had an emergency section for fetal distress. In obese multigravidas 17.2% had a repeat elective CS. CONCLUSION: The influence of maternal obesity on the increase in CS rates is different in primigravidas compared with multigravidas.

  13. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.

    Sheehan, Sharon R

    2012-02-01

    OBJECTIVE: Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. STUDY DESIGN: We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. RESULTS: The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85-95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest-55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4h, but only 122 clinicians (40%) used this. CONCLUSIONS

  14. Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.

    Lundgren, Ingela

    2015-02-05

    BackgroundThe number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.MethodsThe bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, `Effective Public Health Practice Project¿. The primary outcome measure was VBAC rates.Results238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.ConclusionsThis systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that

  15. Decisions to Perform Emergency Caesarean Sections at a University Hospital; Do obstetricians agree?

    Gowri Vaidyanathan

    2016-02-01

    Full Text Available Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40% and dystocia (32%. There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.

  16. Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial

    Sng, Ban Leong; Kwok, Sarah Carol; Mathur, Deepak; Ithnin, Farida; Newton-Dunn, Clare; Assam, Pryseley Nkouibert; Sultana, Rehena; Sia, Alex Tiong Heng

    2016-01-01

    Background and Aims: Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. Methods: A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction. Results: One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia. Conclusion: There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period. PMID:27053782

  17. Is vaginal delivery or caesarean section the safer mode of delivery in patients with adult congenital heart disease?

    Asfour, Victoria; Murphy, Michael O; Attia, Rizwan

    2013-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is vaginal delivery or caesarean section (CS) the safer mode of delivery in patients with adult congenital heart disease? Of the 119 studies, 13 papers represented the best evidence on the topic. Recommendations are based on 29 262 patients. Those having undergone successful corrective or palliative cardiac surgery for congenital heart disease, in addition to patients with unop...

  18. Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section

    Barfod, Mette Nelun; Christensen, Lisa Bøge; Twetman, Svante Henrik Agardh;

    2012-01-01

    -section). MATERIALS AND METHODS: The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final...

  19. Caesarean-sections in the Press: the said and the not said.

    Tatiana Augustinho Rocha

    2006-04-01

    Full Text Available This paper aimed at knowing the cultural caesarean representations present in magazines addressed to the laic public. One of the attributions of the nurse is health education. The press is source of informal education. So, the nurse must provide women with subsidies so that they can make decisions with autonomy and knowledge, demystifying or incrementing what is thought about the surgical delivery. Upon analyzing editions of Revista Crescer, two themes have arisen: the “said” and the “not said” about caesarean. Regarding the “said” category, the articles appraise pathologies in the gestation and their inter-occurrences with explicit association between pathologies and the caesarean; the magazine searched for the adequacy of the woman to the hospital routine and softened the caesarean consequences. As to the “not said” category, the magazine did not emphasize the control and prevention of the complications that are inherent to pregnancy and, somehow, led women to opt for the caesarean as the safest mode of delivery.

  20. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia

    Seyedeh Masoumeh Hosseini Valami

    2015-01-01

    Full Text Available Background and Aims: Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Methods: Fifty parturients were randomly divided into two equal groups. Patients in the first group received alfentanil 10 μg/kg and in the second group received placebo intravenously 1 min before induction of anaesthesia for elective caesarean section. Haemodynamic parameters and bispectral index system (BIS in mothers, peripheral capillary oxygen saturation (SpO 2 and Apgar score in the newborn were assessed. Results: Changes in systolic blood pressure were significant at 1, 5 and 10 min after intubation between two groups. Changes in diastolic blood pressure were significantly less in alfentanil group, 1 min after induction of anaesthesia and 1 min after endotracheal intubation. Mean heart rate at 1 min after induction and at 1 and 5 min after intubation also reduced significantly in this group. Conclusion: Alfentanil use was associated with decreases or minimal increases in maternal systolic and diastolic blood pressures and heart rate after endotracheal intubation.

  1. Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

    Oshodi Yussuf A

    2010-09-01

    Full Text Available Abstract Background Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies. Methods Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s of blood transfused and duration of hospital stay was extracted and the data analysed. Results There were 1056 deliveries out of which 327 (31% were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6% were transfused to 41 patients. Amongst those transfused, twenty-six (54% were booked and 31 (75.6% had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood and cephalo-pelvic disproportion (8 patients with 13 units. Conclusion Even though a large number of units of blood was reserved and made available in the theatre at

  2. INTRATHECAL CLONIDINE AS AN ADJUVANT WITH HYPERBARIC BUPIVACAINE FOR CAESAREAN SECTION

    Sunil

    2014-06-01

    Full Text Available BACKGROUND: Intrathecal adjuvants has gained popularity with the aim of prolonging the duration of block, quality of block and decreased resource utilization compared with general anaesthesia. However they are not free from side effects. We evaluated the effect of addition of intrathecal clonidine (45 micgm to hyperbaric bupivacaine on perioperative and neonatal outcome following lower segment caesarean section. Study period: January –July 2012. METHODS: 60 female Patients undergoing elective cesarean section (LSCS were randomly allocated to two groups of 30 each to receive intrathecally either 10 mg hyperbaric bupivacaine alone(group B or 45 µg of clonidine (group C, added to 10 mg hyperbaric bupivacaine. The onset time to reach T 6 sensory and Bromage 3 motor level, the regression time for L1 sensory and Bromage 0 motor block, Sedation scores, hemodynamic changes, APGAR score and side effects were recorded. RESULTS: Onset of bromage 3 motor block and time to reach T 6 sensory dermatome level was statistically similar between group B and group C. The time for regression of sensory block to L1 dermatome was increased by addition of clonidine (p <0.001 B vs. C. The duration of postoperative analgesia was 164.42±24.64 min in group B and 260.71±38.46 min in group C which was statistically significant. (P<0.001. New born apgar score shows that addition of clonidine is safe for new borns. CONCLUSION: Addition of 45 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal and neonatal side effects.

  3. Protocol for a randomised controlled trial of fetal scalp blood lactate measurement to reduce caesarean sections during labour: the Flamingo trial [ACTRN12611000172909

    East, Christine E.; Stefan C. Kane; Davey, Mary-Ann; Kamlin, C. Omar; Brennecke, Shaun P.; ,

    2015-01-01

    Background The rate of caesarean sections around the world is rising each year, reaching epidemic proportions. Although many caesarean sections are performed for concerns about fetal welfare on the basis of abnormal cardiotocography, the majority of babies are shown to be well at birth, meaning that the operation, with its inherent short and long term risks, could have been avoided without compromising the baby’s health. Previously, fetal scalp blood sampling for pH estimation was performed i...

  4. The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005

    Hagen Terje P

    2011-10-01

    Full Text Available Abstract Background There has been a marked increase in the number of Caesarean sections in many countries during the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased by about 260% (adjusted for inflation. Methods The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included. Results The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p Conclusion The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.

  5. The Effect of Music Therapy on Pain The Level of Postoperative Patients' with Caesarean Section at Islamic Hospital A.Yani, Surabaya

    Nanik Handayani

    2015-01-01

    Pain is the most common effects in patients after undergoing surgery of Caesarean section. Pain management using pharmacological and non pharmacological management, one of non-pharmacological management is using music therapy The purpose of this study was to analyze the effect of music therapy on pain level of postoperative patients' with Caesarean section. The type of study is analytic with True Experimental type with Pre Post Test Control Group Design done by Random Allocation. The study po...

  6. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review.

    Salvatore Gizzo

    Full Text Available The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.

  7. Utilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China

    Huang Kun

    2012-04-01

    Full Text Available Abstract Background Antenatal ultrasound scan is a widely accepted component of antenatal care. Studies have looked at the relationship between ultrasound scanning and caesarean section (CS in certain groups of women in China. However, there are limited data on the utilization of antenatal ultrasound scanning in the general population, including its association with CS. The purpose of this study is to describe the utilization of antenatal ultrasound screening in rural Eastern China and to explore the association between antenatal ultrasound scan and uptake of CS. Methods Based on a cluster randomized sample, a total of 2326 women with childbirth participated in the study. A household survey was conducted to collect socio-economic information, obstetric history and utilization of maternal health services. Results Coverage of antenatal care was 96.8% (2251/2326. During antenatal care, 96.1% (2164/2251 women received ultrasound screening and the reported average number was 2.55. 46.8% women received at least 3 ultrasound scans and the maximum number reached 11. The CS rate was found to be 54.8% (1275/2326. After adjusting for socio-demographic and clinical variables, it showed a statistically significant association between antenatal ultrasound scans and uptake of CS by multivariate logistic regression model. High husband education level, high maternal age, having previous adverse pregnant outcome and pregnancy complications during the index pregnancy were also found to be risk factors of choosing a CS. Conclusions A high use of antenatal ultrasound scan in rural Eastern China is found and is influenced by socio-demographic and clinical factors. Evidence-based guidelines for antenatal ultrasound scans need to be developed and disseminated to clinicians including physicians, nurses and sonographers. Guidance about the appropriate use of ultrasound scans should also be shared with women in order to discourage unreasonable expectations and demands. It

  8. Caesarean Section: Could Different Transverse Abdominal Incision Techniques Influence Postpartum Pain and Subsequent Quality of Life? A Systematic Review

    Gizzo, Salvatore; Andrisani, Alessandra; Noventa, Marco; Di Gangi, Stefania; Quaranta, Michela; Cosmi, Erich; D’Antona, Donato; Nardelli, Giovanni Battista; Ambrosini, Guido

    2015-01-01

    The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon’s experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: “acute pain”, “chronic pain”, “Pfannenstiel incision”, “Misgav-Ladach”, “Joel Cohen incision”, in combination with “Caesarean Section”, “abdominal incision”, “numbness”, “neuropathic pain” and “nerve entrapment”. Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required. PMID:25646621

  9. A cross sectional study of rate, indications and complications of primary caesarean section

    Mahima Jain

    2016-06-01

    Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of the present study from 1st April 2014 to 31st March 2015. While primary cesarean section rate is 55.8%, more in primipara as compared to multipara. The malpresentation was the major indication in primary cesarean section, in both primipara and multipara women in our community, while APH is still a major problem of the multiparity. Anemia, malpresentation, eclampsia and preeclampsia were more common antenatal complications in primipara while APH was antenatal complication in multiparity. Malpresentation (34.3% was the commonest indication for cesarean section in both the groups. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1814-1819

  10. Laparoscopic excision of rudimentary horn pregnancy in a patient with previous caesarean section.

    Jihong, Lu; Siow, Anthony; Chern, Bernard

    2009-03-01

    A rudimentary uterine horn is extremely rare and often difficult to diagnose. The frequency of this pathology is approximately 1:100,000. The diagnosis is sometimes elusive even at surgery. We present a case report of pregnancy in a rudimentary horn in the patient with one caesarean and one normal vaginal delivery, and we successfully conduct a removal of the rudimentary horn pregnancy laparoscopically. PMID:18629528

  11. Observational study comparing non-invasive blood pressure measurement at the arm and ankle during caesarean section.

    Drake, M J P; Hill, J S

    2013-05-01

    Upper-arm non-invasive blood pressure measurement during caesarean section can be uncomfortable and unreliable because of movement artefact in the conscious parturient. We aimed to determine whether ankle blood pressure measurement could be used instead in this patient group by comparing concurrent arm and ankle blood pressure measured throughout elective caesarean section under regional anaesthesia in 64 term parturients. Bland-Altman analysis of mean difference (95% limits of agreement [range]) between the ankle and arm was 11.2 (-20.3 to +42.7 [-67 to +102]) mmHg for systolic arterial pressure, -0.5 (-21.0 to +19.9 [-44 to +91]) mmHg for mean arterial pressure and -3.8 (-25.3 to +17.8 [-41 to +94]) mmHg for diastolic arterial pressure. Although ankle blood pressure measurement is well tolerated and allows greater mobility of the arms than measurement from the arm, the degree of discrepancy between the two sites is unacceptable to allow routine use of ankle blood pressure measurement, especially for systolic arterial pressure. However, ankle blood pressure measurement may be a useful alternative in situations where arm blood pressure measurement is difficult or impossible. PMID:23480469

  12. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT

    Wendy Chaboyer

    2014-09-01

    Full Text Available Obese women undergoing caesarean section (CS are at increased risk of surgical site infection (SSI. Negative Pressure Wound Therapy (NPWT is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing and 46 women received standard care (Comfeel Plus® dressing. All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68; for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79. A sample size of 784 (392 per group would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.

  13. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta

    Aim: To report experience of prophylactic occlusion balloon catheters (POBCs) in both internal iliac arteries before caesarean section, with or without embolization, to preserve the uterus and reduce haemorrhage. Methods and materials: Twenty-seven women diagnosed with morbidly adherent placenta (MAP) and with suspected placenta percreta underwent POBC placement before caesarean section. The balloons were inflated immediately after delivery of the baby. The patients' case notes were reviewed retrospectively for histological grading of MAP, blood loss, transfusion, requirement of uterine artery embolization (UAE), or hysterectomy, radiation dose, and infant or maternal morbidity and mortality. Results: MAP was confirmed histologically as percreta in 17, accreta in eight, and increta in two women. Mean blood loss was 1.92 l (range 0.5–12 l). Postpartum haemorrhage (PPH) occurred in nine patients. Eight were referred for UAE, which was successful in six. Immediate peri-partum hysterectomy was performed in one patient. Three women in total required hysterectomy, two after recurrent haemorrhage after UAE. No foetal morbidity or mortality occurred. No maternal mortality occurred. There was one case of iliac artery thrombosis, which resolved with conservative therapy. Conclusion: POBC, with or without UAE, contributes to reduction of blood loss and preservation of the uterus in women with MAP. - Highlights: • Management of morbidly adherent placenta requires a multidisciplinary team approach. • Prophylactic occlusion balloon catheters reduce blood loss and help avoid hysterectomy. • Protocols ensure correct management of placenta percreta patients and minimise risk

  14. Objective Structured Assessment of Technical Skill in assessing technical competence to carry out caesarean section with increasing seniority.

    Landau, Alex; Reid, Wendy; Watson, Andrew; McKenzie, Clare

    2013-04-01

    Since the incorporation of workplace-based assessment within the specialty training programme in obstetrics and gynaecology, the assessment of technical competence to carry out caesarean section has been undertaken by the Objective Structured Assessment of Technical Skill tool. This requirement has been formalised in the Matrix of Educational Progression, ensuring that the tool must assess trainees' technical competence in caesarean section procedures of varying levels of complexity throughout training. Trainee feedback suggests that the effectiveness of the tool diminishes as the seniority of the trainee increases, with technical competence assessed less effectively in more complex procedures. This seems to be a result of the generic design of the tool and insufficient training on the part of assessors. Both of these are due to be addressed within a division of the Objective Structured Assessment of Technical Skill tool into explicitly formative and summative assessments of technical skill, following a General Medical Council-led consultation on the future of workplace-based assessment. PMID:23062591

  15. Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta

    Aim: To determine the efficacy and safety of caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation (UAE) for the treatment of patients with placenta accreta. Materials and methods: This retrospective study involved 42 patients with placenta accreta. All patients underwent caesarean section combined with temporary aortic balloon occlusion followed by UAE through the right femoral approach. Results: All patients were confirmed to have placenta praevia and accreta, including five patients with placenta percreta, at the time of delivery. The technical success rate of the combined treatment was 97.6% (41/42). Forty-one patients underwent successful caesarean section with conservation of the uterus. Hysterectomy was required in one (3.1%) patient. The amount of blood loss and blood transfusion, and the operation time were was 586 ± 355 ml, 422 ± 83 ml and 65.5 ± 10.6 minutes, respectively. The mean postoperative hospital stay, occlusion time and fetal radiation dose were 5.5 ± 2.6 days, 22.4 ± 7.2 minutes and 4.2 ± 2.9 mGy, respectively. There were no significant changes before and 7 days after the endovascular procedure in creatinine levels (56.8 ± 13.8 μmol/l versus 63.4 ± 16.7 μmol/l, p = 0.09) or urea nitrogen (6.3 ± 2.5 μmol/l versus 7.4 ± 3.8 μmol/l, p = 0.17). There were no access-site complications after the endovascular procedure and no complications related to the intervention during follow-up. Conclusion: Temporary aortic balloon occlusion followed by UAE can effectively control postpartum haemorrhage during placental dissection, and reduce transfusion requirements, hysterectomy rate, and operation time in patients with placenta accreta. -- Highlights: •Aortic balloon occlusion can overcome the collateral flow from other arteries. •UAE can effectively manage secondary postpartum haemorrhage. •The aortic balloon can rapidly and easily insert. •The mean

  16. A COMPARATIVE STUDY OF ANALGESIC EFFICACY OF INTRATHECAL CLONIDINE WITH BUPIVACAINE & BUPIVACAINE ALONE IN ELECTIVE CAESAREAN SECTION

    Chethanananda

    2014-03-01

    Full Text Available : Spinal anaesthesia in caesarean section has many advantages in that it is simpler to perform, provides a more certain endpoint& has a higher degree of success than epidural anaesthesia as it provides more profound block than epidural anaesthesia. As the dose of local anaesthetics used with spinal anaesthesia is small, there is little chance of maternal toxicity & placental transfer of drugs. Bupivacaine 0.5% is the most popular drug used for spinal anaesthesia in caesarean section. Many adjuvant drugs are added intrathecally along with Bupivacaine to increase the duration and intensity of analgesia. Intrathecal Clonidine (an α2 agonist is being extensively evaluated as an alternative to neuraxial opioid along with local anaesthetic agents. We evaluated the efficacy of clonidine added to 0.5% bupivacaine in prolonging the analgesia produced by intrathecal bupivacaine in parturients undergoing elective lower segment caesarean section (LSCS. 60 parturients between 20-30 years of age weighing 50-70 Kgs belonging to ASA (American Society of Anaesthesiologists grading I & II were prospectively randomised to two groups. 30 parturients of Group B (control group received 2.0 ml of 0.5% hyperbaric bupivacaine intrathecally alone and 30 parturients of Group BC received 1.75 ml of 0.5% hyperbaric bupivacaine +0.25 ml (37.5mcg of preservative free clonidine. The time taken for onset of sensory and motor blockade duration of postoperative analgesia and the duration of motor blockade were noted. The mean time of onset of sensory blockade in Group B was 57.16±9.9 seconds and Group BC was 62.8±6.80 seconds (p < 0.05. The meantime taken for onset motor block was 66.00±5.15 seconds in Group B and 81.33±8.89 seconds in Group BC (p = 0.000 with the grade of motor blockade was similar in both groups. The mean duration of analgesia was 152.77±11.79 minutes in B group and 288.16±16.73 in BC group (p = 0.000. The mean duration of motor blockade was 93.33±8

  17. EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION: A RANDOMIZED CASE CONTROL PROSPECTIVE STUDY

    Tullika

    2014-03-01

    Full Text Available : INTRODUCTION: To reduce maternal mortality and morbidity caused by bleeding, it is important to reduce the amount of bleeding during and after lower segment caesarean section (LSCS. Tranexamic acid helps to reduce bleeding during and after LSCS. OBJECTIVES: To study the efficacy and safety of Tranexamic acid in reducing blood loss during and after Lower segment Caesarean Section (LSCS. METHODS: A randomized case controlled prospective study was conducted on 200 women undergoing lower segment cesarean section. Hundreds of them that were given tranexamic acid immediately before LSCS were compared to hundred others to whom tranexamic acid was not given. Blood loss was collected and measured during the two periods, from plancental delivery to end of LSCS and second from end of LSCS to two hours postpartum. RESULTS: Tranexamic acid significantly reduced the quantity of blood loss from placental delivery to end of LSCS, 202.25ml in the study group vs392.20 ml in the control group (p<0.001; from the end of LSCS, to 2 hours postpartum 3.80ml in the study group versus 112.25ml in the control group (p<0.001; In totality, it significantly reduced the quantity of blood loss from placental delivery to two hours postpartum i.e. 27.05ml in the study group versus 510.45ml in the control group (p < 0.001. No complications or side effects were noted. CONCLUSION: Tranexamic acid significantly reduced the amount of blood loss during and after LSCS. Tranexamic acid can be used prophylactically; moreover it is safer and effective in women undergoing LSCS.

  18. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section: a randomised controlled trial.

    Bonnal, A; Dehon, A; Nagot, N; Macioce, V; Nogue, E; Morau, E

    2016-05-01

    We assessed the effectiveness of early patient-controlled oral analgesia compared with parenteral analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine analgesia. The woman having patient-controlled oral analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral analgesia minus parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral analgesia. More women used morphine in the patient-controlled oral analgesia group (22 (58%)) than in the parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral analgesia. Pruritus was more frequent in the patient-controlled oral analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral analgesia is non-inferior to standard parenteral analgesia for pain management, and can be one of the steps of an enhanced recovery process. PMID:26931110

  19. Using a Caesarean Section Classification System based on characteristics of the population as a way of monitoring obstetric practice

    Milanez Helaine M

    2010-06-01

    Full Text Available Abstract Objective to compare the distribution of caesarean rates in the Robson's 10 groups classification in order to see if any change occurred after the implementation of an audit and feedback intervention. Design: cross sectional, before and after an audit and feedback study. Setting: a university hospital in Brazil. Methods clinical records of all births during two three months-periods were evaluated. Each case of CS was classified into one of ten mutually exclusive categories according to obstetric characteristics. The proportion of CS in each group was compared in both periods. Results total number of deliveries and the high rate of CS were similar in both periods. Group 3 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, spontaneous labour accounted for the largest proportion of deliveries, 28.5 and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, ≥ 37 weeks, spontaneous labour was the second largest one, while Group 5 (previous caesarean section, single, cephalic, and ≥ 37 weeks was the third but the largest contributor to CS, accounting for 16.6 and 14.9% among all deliveries in both periods. Groups 2 (nulliparous, single, cephalic, ≥ 37 weeks, induction or CS before labour and 4 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, induction or CS before labour were less prevalent, however had higher rates of CS. Only in Group 10 (All single, cephalic, ≤ 36 weeks, including previous CS, there was a significant decrease of CS rate from 70.5 to 42.6% between periods. Conclusion Robson's classification did not identify any significant change in the pattern of CS rates with the audit and feedback process, but showed to be useful for comparing trends among similar obstetric populations.

  20. Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan

    Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

    2016-01-01

    Background The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. Methods In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. Results After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03–0.25) in women’s awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women’s preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22–0.85); P>0.001). Conclusions The results of this study

  1. Carbetocin in comparison with oxytocin in several dosing regimens for the prevention of uterine atony after elective caesarean section in the Netherlands

    Holleboom, C. A. G.; van Eyck, J.; Koenen, S. V.; Kreuwel, I. A. M.; Bergwerff, F.; Creutzberg, E. C.; Bruinse, H. W.

    2013-01-01

    Purpose The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication. Methods Eac

  2. The Effect of Musical Therapy on Postoperative Pain after Caesarean Section

    Ali Sizlan

    2009-04-01

    Full Text Available AIM: We reasoned that addition of musicotherapy -a simple and convenient method with no adverse effects- in the preoperative period would have favorable effects pertaining to postoperative pain. METHODS: One hundred patients, between the ages of 20-40 years, who were undergoing elective caesarean delivery under general anaesthesia, were enrolled. The patients were randomly allocated into two groups (with 50 patients in each and in group 1, patients listened to music through a headphone for one hour immediately before surgery whereas in group 2, patients did not listen to any music during the same period. The anaesthetic technique was standardized. All neonates were also assessed and Apgar scores were recorded. In the postanaesthesia care unit, patients were connected to i.v.-PCA device when they were able to respond to commands. The patient’s level of satisfaction with perioperative care was assessed by a 10-cm visual analogue scale and the severity of postoperative pain was assessed with VAS. RESULTS: Postoperative tramadol consumption, total amount of tramadol consumption, additional analgesic use and all VAS values were lower in group 1 (p<0.05. Apgar scores were significantly greater in group 1. CONCLUSION: We imply that music therapy given before surgery decreases postoperative pain and analgesic requirement. [TAF Prev Med Bull 2009; 8(2.000: 107-112

  3. Modest Rise in Caesarean Section from 2000-2010: The Dutch Experience

    Zhao, Yanjun; Zhang, Jun; Hukkelhoven, Chantal; Offerhaus, Pien; Zwart, Joost; de Jonge, Ank; Geerts, Caroline

    2016-01-01

    Background The caesarean delivery (CD) rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is attributable to the relative stability of the Dutch CD rate. Methods A total of 1,935,959 women from the nationwide Perinatal Registry of the Netherlands were included. Women were categorized into ten groups based on the modified CD classification scheme. Trends of CD rates in each group were described. Results The overall CD rate increased slightly from 14.0% in 2000–2001 to 16.7% in 2010. Fetal, early and late neonatal mortality rates decreased by 40–50% from 0.53%, 0.21%, 0.04% in 2000–2001 to 0.29%, 0.12%, 0.02% in 2010, respectively. During this period, the prevalence of non-vertex presentation decreased from 6.7% to 5.3%, even though the CD rate in this group was high. The nulliparous women with spontaneous onset of labor at term and a singleton child in vertex presentation had a CD rate of 9.9%, and 64.7% of multiparous women with at least one previous uterine scar and a singleton child in vertex presentation had a trial of labor and the success rate of vaginal delivery was 45.9%. Conclusions The Dutch experience indicates that external cephalic version for breech presentation, keeping the CD rate low in nulliparous women and encouraging a trial of labor in multiparous women with a previous scar, could help to keep the overall CD rate steady. PMID:27192534

  4. Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants.

    Kangas-Saarela, T; Koivisto, M; Jouppila, R; Jouppila, P; Hollmén, A

    1989-05-01

    Thirty-one neonates delivered by elective caesarean section were evaluated at the ages of 3 h, 1 day, 2 days and 4-5 days using Scanlon's Early Neonatal Neurobehavioural Scale and tests for orientation. Thirteen of the mothers received general anaesthesia and 18 epidural anaesthesia. All the mothers were healthy and not in labour. All the neonates weighed 2500 g or more and had Apgar scores of 7 or more at 1, 5 and 15 min. The neonates delivered with epidural anaesthesia scored significantly lower on rooting at the age of 3 h than those delivered with general anaesthesia, but the latter scored significantly lower on habituation to sound and orientation to both animate and inanimate visual stimuli. General anaesthesia seemed to depress the infants' interactive processes (orientation items), and their ability to make an appropriate response to repetitive stimuli (habituation) more than did epidural anaesthesia, indicating greater global depression. This depression was short-lived, however, and there were no differences between the groups on any of the parameters after 24 h. PMID:2718708

  5. Increasing Trend in Caesarean Section Delivery in India: Role of Medicalisation of Maternal Health

    Sancheeta Ghosh

    2010-01-01

    The paper tries to throw light on the current trends in c-section delivery in India. In developed and developing countries, including India, increasing use of medical technologies during childbirth is a matter of concern. It is evident that the development and application of reproductive technologies is creating contradictory possibilities for women. With the increasing numbers of institutionalised births in India, the trend of c-section delivery is also sharply rising. The objectives of the ...

  6. Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

    Murphy, Deirdre J

    2012-02-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

  7. Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

    Murphy, Deirdre J

    2009-01-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

  8. Intramuscular adrenaline does not reduce the incidence of respiratory distress and hypoglycaemia in neonates delivered by elective caesarean section at term

    Pedersen, Pernille; Avlund, O L; Pedersen, B L; Pryds, Ole

    2008-01-01

    AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...... respiratory distress and hypoglycaemia was 14% among infants treated with adrenaline compared with 7% in those who received saline injection (p = 0.048). CONCLUSION: Intramuscular injection of 30 microg adrenaline does not reduce the incidence of respiratory distress or hypoglycaemia after elective caesarean...... assigned to intramuscular treatment with saline (0.30 ml) or 30 microg adrenaline (0.30 ml) immediately after birth. The primary endpoint was referral to the neonatal ward because of respiratory distress or a blood glucose level <1.8 mmol/l measured 2 h after birth. The first 50 infants were monitored with...

  9. ADVANTAGE OF NON-CLOSURE OF THE PERITONEUM AT CAESAREAN SECTION

    Narayan

    2016-01-01

    OBJECTIVE To determine advantage of non-closure of peritoneum at LSCS over of closure of peritoneum with regard to postoperative complications. STUDY DESIGN Prospective randomized controlled trial. SETTING Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Tripura. SUBJECTS AND METHODS Three hundreds term pregnant women undergoing first cesarean section were divided into 2 groups (N = 150). Group I: Non-closure of both visceral ...

  10. CHARACTERIZATION OF THE MATERNAL AND NEONATAL ADVERSE OUTCOMES AFTER CAESAREAN SECTION IN THE CLÍNICA DE MATERNIDAD RAFAEL CALVO

    Rubio-Hoyos Sandra M

    2015-01-01

    Full Text Available Introduction: the World Health Organization (WHO recommends that the incidence of cesarean must not exceed 15%; however, its use has increased in the last two decades, which implies a public health problem. Objective: to characterize the maternal and neonatal adverse outcomes of caesarean in the Clínica Maternidad Rafael Calvo (CMRC,Cartagena-Colombia. Methodology: a descriptive cross-sectional study, where after cesarean maternal and neonatal adverse outcomes were characterized. Results: 1.804 cesarean sections (46.5% and 2.073 vaginal deliveries (53.5% were performed. The most common indications for cesarean section were before cesarean (35.5%, cephalo pelvic disproportion (30.6% and oligoamnios (10.8%. The most common adverse maternal outcomes were bleeding requiring transfusion (9.17%, surgical wound hematoma (3.28% and admission to ICU (1.5%. The most common adverse neonatal outcomes were APGAR <7 per minute (21.3%, transient tachypnea of the newborn (9.6% and Apgar <7 at 5 ‘(4.3%. Prenatal care (PNC was protective factor for uterine bleeding requiring transfusion (OR crude 0.54, CI 0.38 to 0.76, OR adjusted 0.53 IC 0.38 to 0.76, uterine bleeding which required hysterectomy (OR crude 0.20, CI 0.01 to 0.72, OR adjusted 0.11, IC: 0.11 to 0.72, obstetric shock (OR crude 0.06, IC: 0.00 to 0.55 ,OR adjusted 0.04, CI 0.04 to 0.38 and destination (rooming (OR 0.66, IC 0.49 to 0.90, APGAR <7 at 1 ‘( OR 0.78 IC 0.44 to 0.72, Apgar <7 at 5 ‘(adjusted OR 0.48, IC 0.28 to 0.82 and the presence of respiratory distress (OR crude 0,28 IC, 0.15 to 0.51; OR adjusted 0.53, IC 0.28 to 0.98 Conclusions: the proportion of cesarean sections performed in the CMRC (46.5% is above 15% recommended by WHO. Cesarean section leads to increased maternal and fetal morbidity. The CNP acted as a protective factor against the occurrence of adverse maternal and neonatal outcomes. Rev.cienc.biomed. 2015;6(2:241-250 KEYWORDS Cesarean; Obstetric; Hemorrhage.

  11. Recurarization in a successfully managed case of posterior reversible encephalopathy syndrome (PRES) for emergency caesarean section.

    Parikh, Suchita; Tavri, Snehlata; Mohite, Shubha

    2016-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic syndrome of headache, visual changes, altered mental status and seizures with radiologic findings of posterior cerebral white matter edema. It is seen in hypertensive encephalopathy, renal failure, and autoimmune disorders or in patients on immunosuppressants. We report a case of 24-year-old primigravida who presented at term with sudden onset hypertension, neurological deficits, and an episode of the visual blackout. Magnetic resonance imaging showed features suggestive of PRES. She was posted for emergency lower segment cesarean section. General anesthesia was administered and blood pressure managed with antihypertensives. Postoperatively, she developed acute respiratory depression after prophylactic administration of injection magnesium sulfate. This case highlights that good clinical acumen along with early neuroimaging helps in prompt diagnosis, treatment and prevention of long-term neurological sequelae in PRES and the anesthetic implications of administering magnesium sulfate in the immediate post neuromuscular block reversal phase. PMID:27212776

  12. COMPARATIVE EVALUATION OF INTRATHECAL BUPIVACAINE-FENTANYL AND BUPIVACAINE - CLONIDINE FOR CAESAREAN SECTION IN PREGNANCY INDUCED HYPERTENSION

    Tripti

    2014-09-01

    Full Text Available BACKGROUND: Pain free postoperative period and early ambulation are the need of the day for mothers and their neonates for early initiation of breast feeding. It is moral responsibility of Anaesthesiologist to provide a safe and pain free postoperative period with use of various techniques and drug combinations. Spinal anaesthesia has been widely used for caesarean section in normalas well as preeclamptic parturients and has been found to be efficaciousand safe. The present study aimed to compare the analgesic efficacy and side effect profile of intrathecal Bupivacaine with Fentanyl and Bupivacaine with Clonidine in cesarean section of parturients with pregnancy induced hypertension (PIH. METHODS: 50 full term parturients with pregnancy induced hypertension scheduled for cesarean section were randomized into 2 groups of 25 each. GROUP BF (Bupivacaine with Fentanyl received 7.5mg of 0.5% hyperbaric Bupivacaine and 20µg Fentanyl intrathecally. GROUP BC (Bupivacaine with Clonidine received 7.5mg of 0.5% hyperbaric Bupivacaine and 60µg clonidine intrathecally. RESULTS: Patients in group BC showed long lasting analgesia compared to group BF (p value<0.05. Both the groups had satisfactory analgesia with hemodynamic stability, however the incidence of hypotension and vasopressor requirement was more in group BC compared to BF. Incidence of pruritus was exceptionally seen in group BF, however more patients were sedated and complained of dry mouth in group BC. Both the groups had comparable APGAR scores with no adverse neonatal effects. CONCLUSION: We conclude use of intrathecal clonidine 60µg and Fentanyl 20µg both provide excellent sensory and motor blockage with lower dose of bupivacaine. Both drugs improved intraoperative analgesia and prolonged the duration of effective analgesia without any adverse effect on neonate neurobehaviour. Fairly good analgesia with less sedation and better haemodynamic stability is observed with 20μg fentanyl

  13. A randomised controlled trial of opioid only versus combined opioid and non-steroidal anti inflammatory analgesics for pain relief in the first 48 hours after Caesarean section

    Natalia Adamou

    2014-01-01

    Full Text Available Background: Post-Caesarean section pain is complex in nature, requiring a combination of pharmacological and non-pharmacological methods. Effective management of postoperative pain will reduce postoperative morbidity, hospital stay and cost. The objective of this study was to compare the clinical effectiveness and adverse effects of a combination of non-selective cyclooxygenase (COX inhibitor (Diclofenac sodium 50 mg and opioid (Pentazocine 60 mg to opiod only (Pentazocine 60 mg for pain management after Caesarean section (CS at Aminu Kano Teaching Hospital (AKTH. Materials and Methods: This was a randomised double-blind controlled study conducted at AKTH, Kano, Nigeria. A total of 166 patients scheduled to undergo either emergency or elective Caesarean section were studied. Group I received a combination of COX inhibitor and opiod while Group II received opiod only for pain management after CS. Results: The average age of the patients was 28.35 years (SD ± 6.426 in the group I and 26.9(SD ± 6.133 in group II. The mean parity was 3.27(SD ± 2.67 and 2.75(SD ± 2.14 while the mean gestational age at admission was 37.68(SD ± 2.69 and 38.18(SD ± 2.63 weeks in the first and second groups, respectively. Comparison of the level of pain experienced and patients satisfaction during the first 48 hours postoperatively revealed that the level of pain was statistically significantly less and patient′s satisfaction significantly better in group I compared to group II (P-value 0.00001. Conclusion: The use of combined compared to single agent analgesia is safe, significantly reduced pain and improved patient satisfaction after a caesarian section (CS.

  14. The pregnant woman and the good Samaritan: can a woman have a duty to undergo a caesarean section?

    Scott, R

    2000-01-01

    Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal right to do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery--however great the burden--is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the 'maternal-fetal conflict' begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should 'give way' to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of 'general conduct.' Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and

  15. A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004

    Ronsmans Carine

    2007-08-01

    Full Text Available Abstract Background Bangladesh is committed to the fifth Millennium Development Goal (MDG-5 target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC. Methods We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics. Results Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18% compared with the richest urban women with secondary or higher education (99%. Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas, and caesarean sections trebled (from 2% to 6%, but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services. Conclusion Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a

  16. A RANDOMIZED CLINICAL STUDY TO EVALUATE THE EFFECT OF INTRAVENOUS MAGNESIUM SULPHATE FOR POSTOPERATIVE PAIN RELIEF IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION

    Jitendra

    2015-09-01

    Full Text Available BACKGROUND : In this randomized, double - blind, prospective study, we have evaluated the effect of i.v. infusion of magnesium sulphate during spinal anaesthesia, for postoperative pain relief in patients undergoing lower segment caesarean section. AIM : A comparative evaluation of intravenous magnesium sulphate for prevention of postoperative pain relief in lower segment caesarean section under spinal anaesthesia” . METHODS AND MATERIAL S : 60 female patients of ASA grade I and II of the age group 20 - 40 yrs., posted for lower segment caesarean section under spinal anaesthesia were selected after pre anaesthetic fitness. Randomly patient were divided into two groups (n=30 patients each group NS, and group MS to receive 100ml of 0.9% Normal saline and Magnesium sulphate 50mg kg - 1 in 100ml of 0.9% Normal saline respectively to be given over 15 min, 60min after performing spinal anaesthesia. After surgery, rescue analgesia in form of inj. tramadol 100 mg i.v was provided for the patients. The Postoperative pain scores, Rescue analgesic consumption, and incidences of sedation, shivering, dysrhythmia, bradycardia, and hypotension evaluated immediately after surgery, and at 30 min, 1, 2, 3, hrs. After surgery. STATISTICAL ANALYSIS: Results were expressed as mean and standard deviation. P value of <0.05 was considered statistically significant. RESULTS: IV Magnesium sulphate 50 mg kg - 1 bolus significantly prolonged duration of analgesia, superior quality of analgesia ( L ower VAS and significant reduction in postoperative analgesic requirement than normal saline under spinal anaesthesia. No significant hemodynamic and respiratory instability occurred with Magnesium Sulphate use. CONCLUSION: I.V. magnesium sulphate administration during spinal anaesthesia improves postoperative analge sia without any notable complications.

  17. Should the visceral peritoneum at the bladder flap closed at caesarean sections a post partum sonographic and clinical assessment?

    Malvasi, A; Tinelli, A; M. Guido; Zizza, Antonella; Farine, D.; Stark, M.

    2010-01-01

    Objective. To compare cesarean section (CS) using open or closed visceral peritoneum of the bladder flap (BF) in relation to fluid collection in vesico-uterine space (VUS) by ultrasound (US) and clinical outcome. Material and methods. A prospective cohort of repeat CS in 474 in advanced first and second stage of labor was studied. All women underwent a Misgav Ladach CS, in local combined anesthesia. These were divided into two groups by surgical management of the BF at the time of CS: Group I...

  18. 'What about the Mother?' : Rising Caesarean Section Rates and their Association with Maternal Near-Miss Morbidity and Death in a Low-Resource Setting

    Litorp, Helena

    2015-01-01

    In recent decades, there has been a seemingly inexhaustible rise in the use of caesarean section (CS) worldwide. The overall aim with this thesis is to explore the effects of and reasons for an increase in the CS rate at a university hospital in Dar es Salaam, Tanzania. In Study I, we analysed time trends in CS rates and maternal and perinatal outcomes between 2000 and 2011 among different obstetric groups. In Study II, we documented the occurrence and panorama of maternal ‘near-miss’ morbidi...

  19. Comparison of colloid (polygeline) over crystalloid (lactated ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia

    Objective: To assess efficacy of colloid (Polygeline) over crystalloid (Lactated Ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia. Study design: Randomized control trial. Settings: The study was conducted in department of Anesthesiology and Intensive care Combined Military Hospital Peshawar over a period of 6 months from 01 March 2007 to 31 August 2007. Material and Methods: One hundred patients fulfilling the inclusion criteria were selected for study and divided into two groups of 50 each. Group A was given 500 ml Polygeline as preloading solution while group B received 1 liter of Ringer's Lactate as preloading solution just before administration of spinal anaesthesia. Heart rate and systolic blood pressure were recorded at 01 min, 05 mins, 10 mins, 15 mins, 20 mins, 30 mins and 45 mins after the performance of spinal block. Dose of ephedrine given to treat hypotension after the block was also recorded. Results: There was significant difference in terms of heart rate and systolic arterial pressure 1 and 5 minutes after block between both the groups. There was also significant difference in terms of dose of ephedrine between both the groups. Conclusion: Polygeline is more effective than Ringer's Lactate as preloading fluid in preventing hypotension for caesarean section under spinal anaesthesia. (author)

  20. The Effect of Music Therapy on Pain The Level of Postoperative Patients' with Caesarean Section at Islamic Hospital A.Yani, Surabaya

    Nanik Handayani

    2015-11-01

    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Pain is the most common effects in patients after undergoing surgery of Caesarean section. Pain management using pharmacological and non pharmacological management, one of non-pharmacological management is using music therapy The purpose of this study was to analyze the effect of music therapy on pain level of postoperative patients' with Caesarean section. The type of study is analytic with True Experimental type with Pre Post Test Control Group Design done by Random Allocation. The study population is post-operative Caesarean section mothers who are hospitalized in Surabaya Islamic Hospital Surabaya Jl. A Yani since May 2011. The Sample are some populations above mentioned with amount of 24 respondents, 12 respondents as a control and 12 respondents were given music therapy. The Sampling technique uses Consecutive Sampling. Independent variable is music therapy and dependent variable is pain level. The instrument used to measure the independent variables is a check sheet lists while the dependent variable is Descriptive Pain Intensity Scale. To analyze the changes of pain level in the control group and the treatment used Paired T Test, the result showed that values of ρ is 0.166 or (ρ > 0.05, so there is no significant change of pain level on a pre test and post test control group, whereas in treatment group obtained value of ρ is 0.000 or (ρ < 0.05, so there is a significant change of pain level on a pre test and post test. To analyze differences of pain

  1. Asthma and atopy in children born by caesarean section: effect modification by family history of allergies – a population based cross-sectional study

    Kolokotroni Ourania

    2012-11-01

    Full Text Available Abstract Background Studies on the association of birth by caesarean section (C/S and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies. Methods Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents’ responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models. Results After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71, asthma diagnosis (OR 1.41, 95% CI 1.09-1.83 and be atopic (OR 1.67, 95% CI 1.08-2.60. There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06 but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00, no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11. Conclusions Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.

  2. Las cesáreas en México: tendencias, niveles y factores asociados Caesarean sections in Mexico: tendencies, levels and associated factors

    Esteban Puentes-Rosas

    2004-02-01

    ón precisa de las razones para llevarla a cabo y el monitoreo de los porcentajes individuales de cesáreas entre los obstetras de los hospitalesOBJECTIVE: To describe the rate of caesarean sections in Mexico in the last 10 years and evaluate its relationship with several socioeconomic variables, type of health care services, and specialists' availability. MATERIAL AND METHODS: The Ministry of Health's register of births was used as source of information. The dependent variable was the type of delivery (vaginal or caesarean. The independent variables were: gross domestic product, human development index, illiteracy percentage among women, social exclusion index and, gynecology and obstetrics specialists supply. Correlations between variables were evaluated using Pearson's parametric test and Spearman range test. A lineal multiple regression was used to model the national caesarean data of 1999. RESULTS: National caesarean percentage increased in the last 10 years at an annual rate of 1%. It was considerably higher in social security institutions and the private sector. Caesareans percentages in 1999 were slightly above 35%. The highest values were those of the private sector with 53%, followed by social security institutions, with 38.2%. The variables more strongly associated with C sections were GDP, specialists' availability and human development index. CONCLUSIONS: It seems reasonable to advocate for a widespread descent in caesarean sections in Mexico. Important declines in certain contexts have been witnessed by implementing measures such as a second opinion before any C-section, a precise definition of the reasons for using it, and the monitoring of individual caesarean percentage among hospital obstetricians.

  3. Temporal Changes of Protein Composition in Breast Milk of Chinese Urban Mothers and Impact of Caesarean Section Delivery

    Affolter, Michael; Garcia-Rodenas, Clara L.; Vinyes-Pares, Gerard; Jenni, Rosemarie; Roggero, Iris; Avanti-Nigro, Ornella; de Castro, Carlos Antonio; Zhao, Ai; Zhang, Yumei; Wang, Peiyu; Thakkar, Sagar K.; Favre, Laurent

    2016-01-01

    Human breast milk (BM) protein composition may be impacted by lactation stage or factors related to geographical location. The present study aimed at assessing the temporal changes of BM major proteins over lactation stages and the impact of mode of delivery on immune factors, in a large cohort of urban mothers in China. 450 BM samples, collected in three Chinese cities, covering 8 months of lactation were analyzed for α-lactalbumin, lactoferrin, serum albumin, total caseins, immunoglobulins (IgA, IgM and IgG) and transforming growth factor (TGF) β1 and β2 content by microfluidic chip- or ELISA-based quantitative methods. Concentrations and changes over lactation were aligned with previous reports. α-lactalbumin, lactoferrin, IgA, IgM and TGF-β1 contents followed similar variations characterized by highest concentrations in early lactation that rapidly decreased before remaining stable up to end of lactation. TGF-β2 content displayed same early dynamics before increasing again. Total caseins followed a different pattern, showing initial increase before decreasing back to starting values. Serum albumin and IgG levels appeared stable throughout lactation. In conclusion, BM content in major proteins of urban mothers in China was comparable with previous studies carried out in other parts of the world and C-section delivery had only very limited impact on BM immune factors. PMID:27548208

  4. Temporal Changes of Protein Composition in Breast Milk of Chinese Urban Mothers and Impact of Caesarean Section Delivery

    Michael Affolter

    2016-08-01

    Full Text Available Human breast milk (BM protein composition may be impacted by lactation stage or factors related to geographical location. The present study aimed at assessing the temporal changes of BM major proteins over lactation stages and the impact of mode of delivery on immune factors, in a large cohort of urban mothers in China. 450 BM samples, collected in three Chinese cities, covering 8 months of lactation were analyzed for α-lactalbumin, lactoferrin, serum albumin, total caseins, immunoglobulins (IgA, IgM and IgG and transforming growth factor (TGF β1 and β2 content by microfluidic chip- or ELISA-based quantitative methods. Concentrations and changes over lactation were aligned with previous reports. α-lactalbumin, lactoferrin, IgA, IgM and TGF-β1 contents followed similar variations characterized by highest concentrations in early lactation that rapidly decreased before remaining stable up to end of lactation. TGF-β2 content displayed same early dynamics before increasing again. Total caseins followed a different pattern, showing initial increase before decreasing back to starting values. Serum albumin and IgG levels appeared stable throughout lactation. In conclusion, BM content in major proteins of urban mothers in China was comparable with previous studies carried out in other parts of the world and C-section delivery had only very limited impact on BM immune factors.

  5. Delivery times for caesarean section at Queen Elizabeth Central Hospital, Blantyre, Malawi: is a 30-minute 'informed to start of operative delivery time' achievable?

    O'Regan, M

    2003-08-01

    A timesheet questionnaire was used to assess the time it took from informing the anaesthetist about a case to the start of operative delivery in 78 consecutive patients undergoing caesarean section. Median (IQR [range]) times for grade-1 cases (immediate threat to the life of the mother or fetus) and grade-2 cases (fetal or maternal compromise without immediate threat to life) were 20 (17-35 [6-75]) min and 41 (27-60 [17-136]) min, respectively. Delays occurred in all the component time intervals examined. The primary avoidable delay was the patient's late arrival in theatre. Many significant delays were apparently not perceived by the anaesthetist. In nine (69%) grade-1 cases, the 30-min target decreed by the Association of Anaesthetists of Great Britain & Ireland and the Obstetric Anaesthetists' Association was achieved. PMID:12859467

  6. Successful Delivery of Twin Pregnancy in Class U3b/C2/V1 Uterus by Bilateral Caesarean Section after Spontaneous Conception

    Yasmine El-Masry

    2015-01-01

    Full Text Available A case of a 19-year-old female with class U3b/C2/V1 uterus conceived a twin pregnancy with a fetus in each horn after spontaneous conception. She referred to our department with presentation of premature rupture of membranes, with a history of cesarean delivery of a single full term living fetus a year and a half before this delivery. Examination revealed two completely separate uterine horns with a fetus in each horn, two distinct externally rounded cervices, and a single vagina with a short nonobstructing vaginal septum in the upper part of the vagina. And as the appropriate mode of delivery is still unclear, each case should be managed as the condition requires, and in our case urgent bilateral caesarean sections were performed.

  7. Intramuscular adrenaline does not reduce the incidence of respiratory distress and hypoglycaemia in neonates delivered by elective caesarean section at term

    Pedersen, Pernille; Avlund, O L; Pedersen, B L;

    2008-01-01

    AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...... assigned to intramuscular treatment with saline (0.30 ml) or 30 microg adrenaline (0.30 ml) immediately after birth. The primary endpoint was referral to the neonatal ward because of respiratory distress or a blood glucose level ... with pulse oximetry to disclose potential side effects. RESULTS: Pulse-oximetry recordings revealed a modest systemic effect by intramuscular adrenaline as the heart rate and the haemoglobin oxygen saturation were significantly higher in infants who received adrenaline. In contrast, the incidence...

  8. Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron.

    Tan, T

    2012-02-01

    BACKGROUND: The incidence of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine may be 60-100%, and is a common cause of maternal dissatisfaction. Ondansetron has been shown to reduce pruritus but the effect is short-lived. The objective of this randomized double-blind trial was to evaluate the anti-pruritic efficacy of granisetron compared with ondansetron. METHODS: Eighty ASA I or II women undergoing elective caesarean section received spinal anaesthesia with 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 microg and preservative-free morphine 150 microg. After delivery of the baby and clamping of the umbilical cord, they were randomised to receive granisetron 3mg i.v. (group G) or ondansetron 8 mg i.v. (group O). RESULTS: The two groups were similar for age, gestational age, height and weight. According to visual analogue pruritus scores, patients in group G experienced less pruritus at 8h (P=0.003) and 24h (P=0.01). Fewer patients in group G (n=8) than group O (n=18) required rescue anti-pruritic medication (P=0.03). Satisfaction scores were also higher in group G than in group O (P=0.03). There was no difference in overall incidence of pruritus, nausea and vomiting, and visual analogue pain scores between the two groups. CONCLUSIONS: Administration of granisetron 3mg i.v. reduces the severity of pruritus and the use of rescue anti-pruritic medication, and improves satisfaction but does not reduce the overall incidence of pruritus in women who have received subarachnoid morphine 150 microg compared to ondansetron 8 mg i.v.

  9. THE EFFECTS OF ANTIBIOTIC PROPHYLAXIS ON INFECTIOUS COMPLICATIONS AFTER CAESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL IN A TERTIARY HOSPITAL OF EASTERN INDIA

    Shelley

    2013-04-01

    Full Text Available ABSTRACT: CONTEXT: Infectious complications after caesarean deliveries are an important and substantial cause of maternal morbidity and inc rease in the hospital stay and cost of treatment. Routine prophylaxis with antibiotics may reduce this risk. AIMS: To determine whether prophylactic antibiotic administration using ceftriaxone at the time of caesarean section significantly reduces maternal and neonatal infectious complications . SETTINGS AND DESIGN: The study was conducted in a tertiary teaching hospi tal of eastern India during March 2011 to October 2011. It was a prospective, double-b lind randomised placebo-controlled trial. METHODS AND MATERIAL: After exclusion due to different reasons, 288 patien ts were enrolled in study group and received prophylactic inje ction ceftriaxone. 293 patients were enrolled in control group who received placebo. Patie nts were randomly selected according to computerized randomization protocol. Postpartum infect ious complications were recorded, as were the duration of hospital stay and neonatal compl ications. STATISTICAL ANALYSIS USED: Analysis of statistical data was done by using stat istical software Open Epi, 8version 2.3.1. RESULTS: Wound indurations, discharge, erythema were 2.43% a nd 5.80% in study and control group respectively and it was statistically significa nt with p value 0.043 (RR=0.419, 95% confidence interval [CI] 0.405. Endomyometritis was more in control group (1.04% vs. 3.75% with p value 0.036 and RR=0.279 and CMLE OR= 0.272. No significant relationship with neonatal morbidities was found. Maternal stay in ho spital was significantly more with p=0.01 in control group. CONCLUSIONS: Antibiotic prophylaxis prior to skin incision of caes arean sections resulted in better maternal outcome when i nfectious morbidity and postoperative hospital stay were concerned, without influencing th e neonatal outcome.

  10. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G quince, 27G quince and 27G whitacre spinal needles

    To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used. (author)

  11. Clinical analysis of 39 cases of ectopic pregnancy in caesarean section scar%剖宫产疤痕部位妊娠39例诊治分析

    赵松兰; 刘晓健; 李飞; 于红凤

    2011-01-01

    Objective To study the clinical characteristics, early diagnosis and effective treatment of pregnancy in caesarean section scar. Methods 39 cases of pregnancy in caesarean section scar treated in Jiangsu University Attached People's Hospital were retrospectively analyzed. Results All of the patients had undergone caesarean section at least once before pregnancy in caesarean scar, and they suffered vaginal bleeding of different severity after menolipsis. Pregnancy in caesarean section scar was suspicious by B-ultrasonography. There were 5 cases of hysterectomy, 15 cases of methotrexate chemotherapy, 6 cases of intervention and methotrexate chemotherapy, 6 cases of intervention, wedge resection of scar lesions in lower uterine segment and uterus neoplasty, and 7 cases of intervention, methotrexate chemotherapy, wedge resection of scar lesions in lower uterine segment and uterus neoplasty. Conclusion Once pregnancy in caesarean section scar is diagnosed, it should be interrupted in time so as to reduce the harmfulness of adverse pregnancy. Personalized treatment should be provided for different patients.%目的 探讨剖宫产疤痕部位妊娠的临床特点、早期诊断及适当的治疗方法.方法 分析就诊于江苏大学附属人民医院的39例剖宫产疤痕部位妊娠患者的临床资料及治疗结果.结果 39例患者均有剖宫产史,并都有不同程度停经后阴道流血史;患者经彩超检查显示有剖宫产疤痕部位妊娠可能.39例中有5例行子宫全切除术,15例行甲氨蝶呤化疗,6例行介入+甲氨蝶呤化疗,6例行介入+子宫下段疤痕病灶楔形切除术+子宫修补术,7例行介入+甲氨蝶呤化疗+子宫下段疤痕病灶楔形切除术+子宫修补术.结论 剖宫产疤痕部位妊娠的诊断一旦确认,应及时中止妊娠,从而降低不良妊娠带来的危害;并且要根据患者的具体情况给予个性化治疗.

  12. Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score.

    Arpino, Bruno; Cannas, Massimo

    2016-05-30

    This article focuses on the implementation of propensity score matching for clustered data. Different approaches to reduce bias due to cluster-level confounders are considered and compared using Monte Carlo simulations. We investigated methods that exploit the clustered structure of the data in two ways: in the estimation of the propensity score model (through the inclusion of fixed or random effects) or in the implementation of the matching algorithm. In addition to a pure within-cluster matching, we also assessed the performance of a new approach, 'preferential' within-cluster matching. This approach first searches for control units to be matched to treated units within the same cluster. If matching is not possible within-cluster, then the algorithm searches in other clusters. All considered approaches successfully reduced the bias due to the omission of a cluster-level confounder. The preferential within-cluster matching approach, combining the advantages of within-cluster and between-cluster matching, showed a relatively good performance both in the presence of big and small clusters, and it was often the best method. An important advantage of this approach is that it reduces the number of unmatched units as compared with a pure within-cluster matching. We applied these methods to the estimation of the effect of caesarean section on the Apgar score using birth register data. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26833893

  13. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section--pilot study. ISRCTN 40302163.

    Murphy, Deirdre J

    2012-02-01

    OBJECTIVE: To compare the blood loss at elective lower segment caesarean section with administration of oxytocin 5IU bolus versus oxytocin 5IU bolus and oxytocin 30IU infusion and to establish whether a large multi-centre trial is feasible. STUDY DESIGN: Women booked for an elective caesarean section were recruited to a pilot randomised controlled trial and randomised to either oxytocin 5IU bolus and placebo infusion or oxytocin 5IU bolus and oxytocin 30IU infusion. We wished to establish whether the study design was feasible and acceptable and to establish sample size estimates for a definitive multi-centre trial. The outcome measures were total estimated blood loss at caesarean section and in the immediate postpartum period and the need for an additional uterotonic agent. RESULTS: A total of 115 women were randomised and 110 were suitable for analysis (5 protocol violations). Despite strict exclusion criteria 84% of the target population were considered eligible for study participation and of those approached only 15% declined to participate and 11% delivered prior to the planned date. The total mean estimated blood loss was lower in the oxytocin infusion arm compared to placebo (567 ml versus 624 ml) and fewer women had a major haemorrhage (>1000 ml, 14% versus 17%) or required an additional uterotonic agent (5% versus 11%). A sample size of 1500 in each arm would be required to demonstrate a 3% absolute reduction in major haemorrhage (from baseline 10%) with >80% power. CONCLUSION: An additional oxytocin infusion at elective caesarean section may reduce blood loss and warrants evaluation in a large multi-centre trial.

  14. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort

    Laursen, M; Johansen, C; Hedegaard, M

    2009-01-01

    emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth. RESULTS: Fear of childbirth in early (16 weeks, 6 +/- 29 days) and late (31 weeks, 4 +/- 21 days) pregnancy was associated with emergency caesarean section: OR, 1.......72-1.23). CONCLUSIONS: Fear of childbirth during pregnancy was associated with dystocia and emergency caesarean section but not with fetal distress.......OBJECTIVES: To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress. DESIGN: Prospective cohort study. SETTING: Danish National Birth Cohort. POPULATION: A total of 25 297 healthy...

  15. Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study

    Mazzoni, Agustina; Althabe, Fernando; Gutierrez, Laura; Gibbons, Luz; Liu, Nancy H; Bonotti, Ana María; Izbizky, Gustavo H.; Ferrary, Marta; Viergue, Nora; Vigil, Silvia I.; Zalazar Denett, Gabriela; Belizán, José M

    2016-01-01

    Background Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. Methods A prospective cohort study was conducted in two pub...

  16. A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it.

    Ana Pilar Betrán

    Full Text Available BACKGROUND: Caesarean sections (CS rates continue to increase worldwide without a clear understanding of the main drivers and consequences. The lack of a standardized internationally-accepted classification system to monitor and compare CS rates is one of the barriers to a better understanding of this trend. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation and number of fetuses and does not involve the indication for CS. This classification has become very popular over the last years in many countries. We conducted a systematic review to synthesize the experience of users on the implementation of this classification and proposed adaptations. METHODS: Four electronic databases were searched. A three-step thematic synthesis approach and a qualitative metasummary method were used. RESULTS: 232 unique reports were identified, 97 were selected for full-text evaluation and 73 were included. These publications reported on the use of Robson's classification in over 33 million women from 31 countries. According to users, the main strengths of the classification are its simplicity, robustness, reliability and flexibility. However, missing data, misclassification of women and lack of definition or consensus on core variables of the classification are challenges. To improve the classification for local use and to decrease heterogeneity within groups, several subdivisions in each of the 10 groups have been proposed. Group 5 (women with previous CS received the largest number of suggestions. CONCLUSIONS: The use of the Robson classification is increasing rapidly and spontaneously worldwide. Despite some limitations, this classification is easy to implement and interpret. Several suggested modifications could be useful to help facilities and countries as they work towards its implementation.

  17. Pre-operative ondansetron vs. metoclopramide for prevention of post-operative nausea and vomiting in elective lower-segment caesarean section under spinal anaesthesia

    Vasantha Kumar J

    2014-02-01

    Full Text Available Background: The problem of nausea and vomiting is a very old but a less thought of problem. Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of post-operative nausea and vomiting (PONV. Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS under spinal anaesthesia. Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were divided randomly into 2 groups of 50 each. Group I received IV metoclopramide 10mg and Group II received IV. Ondansetron 4mg. Anaesthetic management was standardized. The incidence of vomiting and retching as number of episodes was studied. Nausea was graded depending on the severity and data derived. Results: The mean age, weight and duration of surgery was not significantly different when compared group-1 parturiants with group-2. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreased (p<0.05 in Ondansetron group when compared to metoclopramide group as postoperative time progresses. Conclusions: Injection ondansetron 4mg provided decrease in the incidence of PONV than metoclopramide as the side effects with these drugs were minimal. [Int J Res Med Sci 2014; 2(1.000: 175-179

  18. Impact of caesarean section on mode of delivery, pregnancy-induced and pregnancy-associated disorders, and complications in the subsequent pregnancy in Germany

    Jacob, Louis

    2016-06-01

    Full Text Available Objectives: To analyze the impact of caesarean section (CS on mode of delivery, pregnancy-induced and pregnancy-associated disorders, as well as complications in the subsequent pregnancy within German gynecological practices.Methods: 1,801 women with CS and 1,801 matched women with vaginal delivery (VD from the IMS Disease Analyzer database were included. The impact of previous CS on the mode of delivery and pregnancy-associated disorders as well as complications prior to or during birth in the subsequent pregnancy were analyzed. Cox regressions were used to determine the influence of CS with regard to these outcomes.Results: Medical abortion and single spontaneous delivery were significantly less frequent in women with a history of CS compared to VD (OR equal to 0.52 and 0.04 respectively, whereas CS after CS was the significantly more common mode of delivery (79.0% versus 9.3%, OR=36.47. Gestational hypertension without significant proteinuria, gestational hypertension with significant proteinuria, and polyhydramnios were more frequent in women with CS than in women with VD (OR equal to 6.80, 1.71, and 2.29. Hemorrhage and maternal care for known or suspected disproportion were more common in the CS group than in the VD group (OR equal to 1.34 and 3.75. Prolonged pregnancy, preterm labor, abnormalities arising from forces of labor, and perineal laceration during delivery were significantly less frequent in women with CS than in women with VD (OR between 0.32 and 0.75, whereas long labor was more common (OR=2.09.Conclusion: Women with CS were more likely to undergo further CS and to develop major pregnancy-associated diseases in the following pregnancy compared to women with VD.

  19. Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review.

    Sonja Melman

    Full Text Available There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS rates.Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery.The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1 suspected fetal distress (frequency 17%, adherence 46%, 2 non-progressive labour (frequency 12%, CS performed too early in over 75%, 3 continuous support during labour (frequency 88%, adherence 37% and 4 previous CS (frequency 12%, with adequate counselling in 15%.We identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide.

  20. 剖宫产子宫切除术相关情况分析%The Analysis of Cesarean Hysterectomy during Caesarean Section

    李湛

    2014-01-01

    Objective To investigate the related factors of cesarean hysterectomy during caesarean section. Methods From January 2003 to December 2012,a total of 14 601 women had delivery at department of obstetrical and gynecology in Bei-jing Chaoyang Hospital,among whom 7 178 momen received cesarean section,13 cases received cesarean hysterectomy during cesarean section,the general information,postpartum blood lossing,postoperative complications,and prognosis of mother and infant were analyzed retrospectively. Results Among 7 178 momen who received cesarean section during past 10 years,there were totally 13 cases who received cesarean hysterectomy,the incidence was 0. 18% ,10 cases received total hysterectomy,3 cases received subtotal hysterectomy. The indications of operation include placental factor(9 cases),hemorrhage and dissemi-nated intravascular coagulation(3 cases),and uterine atony(1 case). The postpartum hemorrhage was 600 to 12 600 ml(av-erage 3 800 ml). The postpartum hemorrhage,post - operative hospitalization duration,the proportion of cases with postopera-tive complications,and the proportion of cases who were transferred to ICU after operation of cases whose quantity of blood lossing≤1 500 ml when making the hysterectomy decision were significantly less than those of cases whose quantity of blood lossing >1 500 ml when making the hysterectomy decision(P 1500 ml 者产后出血量、术后住院日减少,术后并发症发生率及转 ICU 比例降低(P <0.05)。2例产妇分别于孕20周及孕24周因瘢痕子宫胎盘因素大量出血急诊行剖宫产术终止妊娠,其余11例进入围生期。13例产妇均治愈出院;11例围生儿中,早产儿7例,胎死宫内2例,新生儿重度窒息1例家属放弃抢救后死亡,轻度窒息1例。结论剖宫产子宫切除术胎盘因素是主要手术指征,剖宫产术中各种止血措施无效时应及时切除子宫。

  1. Analysis of the current status and related factors of caesarean section in Zhangjiagang%张家港市剖宫产现状与相关因素分析

    查建梅; 褚光萍

    2014-01-01

    Objective To analyze the current status and influencing factors of caesarean section in Zhangjiagang and to provide evidence for controlling caesarean section .Methods Retrospective study was conducted to understand the situation of caesarean section and the changes of caesarean section indications in Zhangjiagang from 2008 to 2012 with the monitoring data of delivery in maternal and child health annual report and questionnaires allocated randomly to pregnant women and medical staff .Results The rate of caesarean section in Zhangjiagang was always high, however, the high rate of caesarean section did not reduce prenatal mortality rate (r=0.500, P>0.05).The first 6 indications for cesarean section were social factors , scar uterus , intrauterine fetal distress , cephalopelvic disproportion , premature rupture of fetal membranes and umbilical cord around neck .Of all these factors , social factors came first .Survey among pregnant women showed significant differences between women with different delivery modes in the aspect of cognition on benefit of vaginal delivery (χ2 =15.225, P<0.01), support of family members on vaginal delivery (χ2 =73.569, P<0.01), mastering of nutrition knowledge during pregnancy (χ2 =11.367,P<0.05) and participating in natural delivery course (χ2 =13.300,P<0.01).Survey among medical staff showed that little understanding of long-term harm of caesarean section and social factors resulted in high rate of caesarean section .Conclusion The rate of caesarean section in Zhangjiagang has been at a relative high level .We should put more emphasis on health education among pregnant women, improving professional quality of medical staff and seeking for governmental support and social participation to reduce the rate of caesarean section so as to protect maternal and infant health .%目的:分析张家港市剖宫产现状及其影响因素,提出相关控制措施。方法采用张家港市2008至2012年的妇幼卫生年报分娩情况监测

  2. SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study

    Melman Sonja

    2013-01-01

    Full Text Available Abstract Background Caesarean section (CS rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives. Methods An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals with regard to effectiveness, experiences, and costs. Discussion This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow

  3. The right to informed choice. A study and opinion poll of women who were or were not given the option of a sterilisation with their caesarean section.

    Douwe A Verkuyl

    Full Text Available BACKGROUND: In The Netherlands, caesarean sections (CSs are rarely combined with tubal occlusion (TO, partly because discussing CS/TO near delivery is considered unethical and earlier hypothetical counselling--i.e. suppose you happen to need a CS--is rare. This results in more unintended pregnancies and is inconsistent with informed choice. We explored whether TO should indeed not be made routinely available to eligible women. METHODS AND FINDINGS: A questionnaire was mailed to 515 Para ≥2 who underwent in the past ≥1 CS. 498 (96.7% responded. They were on average 35.3 years old, had 2.5 children, had undergone 1.6 CSs, and 3.3 years had passed since their index delivery, either a CS (393 or vaginal birth (105 after a previous CS. 87% of the 498 believed that pregnant mothers with ≥1 children should be routinely counselled about CS/TO. Indeed, 58% and 85% respectively, thought women/couples expecting their second or third child should still be given the TO option days before delivery, if omitted earlier. Counselled women, 138/498 (27.8%, were far more often satisfied than those without CS/TO option. 33/393 had a CS/TO. None indicated regret in the questionnaire. Another 119 also would have elected a CS/TO if given that option. Therefore, 152 (38.7% of 393 Para ≥2 had or would have liked a concurrent TO. 118/119 wrote they still regretted missing this opportunity. The exception's husband had had a vasectomy. 100/119 were good TO candidates: they were ≥28 years when they delivered an apparently healthy baby of ≥37 weeks. The current contraceptive use of these 100 suggests that this group will have at least 8 unintended pregnancies before age 50. CONCLUSION: The experiences and opinions of previous potential candidates for a CS/TO do not support the reluctance of Dutch obstetricians to counsel pregnant Para ≥1 about the TO option for a (potential CS.

  4. The DiAMOND trial protocol: a randomised controlled trial of two decision aids for mode of delivery among women with a previous caesarean section [ISRCTN84367722

    Montgomery Alan A

    2004-12-01

    Full Text Available Abstract Background Caesarean section (CS has become an increasingly common method of delivery worldwide, rising in the UK from 9% of deliveries in 1980 to over 21% 2001. This increase, and the question of whether CS should be available to women on request, has been the subject of considerable debate, and national reports and guidelines have specifically highlighted the importance of patient choice in the decision making process. For women who have already experienced CS, the UK National Institute of Clinical Excellence recommends that the decision should consider maternal preferences and priorities in addition to general discussion of the overall risks and benefits of CS. Decision aids for many different medical treatment and screening decisions have been developed and evaluated, but there is relatively little evidence for the use of decision aids for choice of mode of delivery among women with a previous CS. The aim of the study is to evaluate two interventions to assist decision making about mode of delivery among pregnant women with one previous CS. Methods/design Women with one previous CS are recruited to the trial during their booking visit at approximately 12–20 weeks' gestation in participating maternity units in Bristol, Weston and Dundee. Using central randomisation, women are allocated to one of three arms: information programme and website; decision analysis; usual care. Both interventions are computer-based, and are designed to provide women with detailed information about the potential outcomes for both mother and baby of planned vaginal delivery, planned CS and emergency CS. The decision analysis intervention additionally provides a recommended 'preferred option' based on maximised expected utility. There are two primary outcomes (decisional conflict and actual mode of delivery, and five secondary outcomes (anxiety, knowledge, perceptions of shared decision making; satisfaction with decision making process, proportion of women

  5. 术中应用保温措施防止剖宫产产妇寒颤%Intraoperative body-temperature maintenance to prevent shivering during Caesarean section

    陈少娟; 郭雅梅; 赖梅; 黄素娟; 张莹

    2010-01-01

    目的 探讨术中应用积极的保温措施对防止剖宫产产妇低体温寒颤的影响.方法 选取拟行剖宫产产妇100例,随机分为保温组和对照组,每组50例.对照组术中按传统护理常规进行护理,保温组采用多种积极的综合保温措施.结果 低体温寒颤发生率对照组为60%,保温组16%,两组比较差异有显著性(P<0.05).结论 术中采取积极有效的保温措施有助于预防剖宫产产妇低体温寒颤的发生.%Objective To explore the effect of aggressive intraoperative body-temperature maintenance on prevention of hypothermia-induced shivering in puerperas during Caesarean section.Methods 100 puerperas undergoing Caesarean section were randomly assigned to receive routine intraoperaive nursing (50 puerperas, control group)or various aggressive approachs for body-temperature maintenance (50 puerperas, study group). Results The rate of hypothermia-induced shivering differed significantly between the control group and the study group (60% vs. 16%, P< 0.05). Conclusions Aggressive intraoperative body-temperature maintenance is helpful for preventing the occurrence of hypothermia-induced shivering in puerperas undergoing Caesarean section.

  6. Nursing Experience and Comprehensive Nursing Intervention after Caesarean Section%剖腹产术后的护理体会和综合护理干预

    陈启蓉

    2015-01-01

    Objective To explore the cesarean section postoperative application of the method and the ef ect of comprehensive nursing intervention.Methods Selection in February of 2012 ~ 2013 in our hospital in February 2013 underwent cesarean section of maternal as the research object, were randomly divided into observation group and control group, 60 cases;Postoperative nursing were given conventional cesarean section and comprehensive nursing intervention measures; The indicators on two groups of maternal satisfaction with care and comparison.Results Observation group, the incidence of postpartum hemorrhage and maternal postpartum depression were significantly lower than control group ( <0.05), maternal breastfeeding rate of observation group was obviously higher than that of control group ( <0.05); In addition, the observation group of maternal care (98.33%) of total satisfaction is significantly higher than the control group (68.33%). Two groups of data dif er significantly ( <0.05).Conclusion Implement comprehensive nursing intervention for caesarean section maternal postoperative ef ect significantly, can reduce maternal postpartum hemor hage, postpartum depression, and pain, increase the rate of breastfeeding, while increasing maternal satisfaction of nursing.%目的探究在剖腹产术后应用综合护理干预的方法及效果。方法选取2012年2月~2013年2月我院收治的120例行剖腹产术的孕产妇作为研究对象,随机分为观察组与对照组,各60例;分别给予常规剖腹产术后护理与综合护理干预措施;对两组孕产妇各项指标以及对护理的满意度进行比较。结果观察组产妇产后出血与产后忧郁症的发生率均明显低于对照组(<0.05),观察组产妇母乳喂养率明显高于对照组(<0.05);另外,观察组产妇对护理的总满意度(98.33%)明显高于对照组(68.33%);两组数据差异显著(<0.05)。结论对剖腹产术后产妇实施综合护理干预效果显著,能

  7. 控制剖宫产率对高龄初产母婴结局影响的研究%Pregnancy outcomes in advanced maternal age pregnancies after taking measures to reduc-ing caesarean section rate

    曹冬如; 张小燕; 包狄

    2015-01-01

    Objective To compare pregnancy outcomes in advanced maternal age pregnancies after taking measures to reducing caesarean section rate. Method A total of 1062 pregnant women aged 35 years or older who gave birth in beijing haidian district maternal and children healthcare hospital from 2013 to 2014 were retrospectively studied. 490 Pregnant women aged 35 years and over delivered in 2014 were included in study group and those 572 patients delivered in 2013 were included in the control group. Pregnant complications,delivery mode,postpartum hemorrhage rate,neonatal asphyxia rate were compared in both groups. Result ①No statistically significant difference was ob-served in the frequency of premature rupture of membrane,gestational diabetes mellitus, placenta previa,uterine my-oma,hypertensive disorders, preterm birth, or macrosomia in both groups;②The caesarean section rate in study group was statistically significantly lower than that in the control group(51. 63%vs 68. 88%,P0. 05). Conclusion With the measures of strengthening prenatal and intrapartum care, it is possible to reducing the caesarean section rate in advanced maternal aged pregnancies.%目的:探讨采取控制剖宫产率相关措施对高龄初产妇母婴结局的影响。方法回顾性分析1062例高龄初产孕产妇临床资料,2014年分娩的490例高龄初产妇作为研究组,2013年分娩的高龄初产妇572例作为对照组,比较两组妊娠并发症、分娩方式、产后出血率、新生儿窒息率。结果①两组胎膜早破、妊娠期糖尿病、前置胎盘、子宫肌瘤、妊娠期高血压疾病、早产、巨大儿发生率差异无显著性(P>0.05);②研究组和对照组剖宫产率分别为51.63%、68.88%,两者比较差异有显著性(P0.05)。结论综合孕期和产时管理,将高龄初产孕妇剖宫产率控制在较合理的水平是可能的。

  8. 异丙酚对剖宫产术硬膜外麻醉后寒战的疗效观察%Clinical effect of propofol in the treatment of shivering after epidural anesthesia during caesarean section

    潘桂芳

    2015-01-01

    目的:研究异丙酚对剖宫产术硬膜外麻醉后寒战的疗效。方法将剖宫产术硬膜外麻醉后出现寒战的产妇随机分为A、B、C三组。三组产妇采取相同硬膜外麻醉及体温护理措施。A组产妇给予异丙酚治疗,B组产妇给予右美托咪定治疗,C组产妇给予等量生理盐水。比较围术期三组产妇生理指标及抗寒战效果。结果三组产妇围术期各时刻平均动脉压、心率及血氧饱和度比较无显著差异(P>0.05),寒战不同分级分布亦无显著差异(P>0.05);A组产妇抗寒战治疗有效率高于B组(P<0.05),且寒战持续时间明显短于B组(P<0.01)。结论对于剖宫产术硬膜外麻醉后寒战,异丙酚具有与右美托咪定相近的安全性,但其抗寒战效果及起效时间优于右美托咪定。%ObjectiveTo explore the clinical effect of propofol in the treatment of shivering after epidural anesthesia during caesarean section.MethodThe parturients who were shivering after epidural anesthesia during caesarean section were randomly divided into A, B, C group. All parturients were taken the same epidural anesthesia and temperature nursing care. Parturients in group A were taken propofol, parturients in group B were taken dexmedetomidine, parturients in group C were taken same volume of saline, the physiologic index during caesarean section and the clinical effect for the shivering were compared among the three groups.ResultThere were no signiifcant differences at the MAP, HR and SpO2 among the three groups (P>0.05), and it didn't showed signiifcant difference at shivering in different grade distribution among the three groups (P>0.05). The total effective rate in group A was higher than group B (P>0.05), and shiver lasting time in group A was obiviously shorter than group B (P<0.01).ConclusionPropofol is safe for parturients with shivering after epidural anesthesia during caesarean section as same as dexmedetomidine, and

  9. 陈皮汤和枳术汤对剖宫产后排气的影响观察%Clinical effect of dried orange peel soup and Zhizhu soup in promoting exhaust after caesarean section

    沈少云

    2015-01-01

    目的 观察陈皮汤和枳术汤在剖宫产术后的助排气临床效果.方法 选取我院120例剖宫产术后产妇平均分为三组,其中分别服用陈皮汤、枳术汤的归为观察组,未服用的归为对照组.对比三组产妇自诉首次排气、排便时间,观察腹胀程度.结果 记录三组剖宫产术后排气时间和排便时间数据,观察组对比对照组在产妇术后排气时间、排便时间的差异有统计学意义(P<0.05),但两组观察组之间在排气时间、排便时间对比差异无统计学意义(P>0.05);三组腹胀程度均为不明显.服用枳术汤的观察组对促剖宫产后排气效果稍优.结论 服用枳术汤有利于剖宫产术后产妇胃肠道功能恢复,明显缩短肛门排气、排便时间,帮助产妇更快恢复正常饮食,利于产妇恢复,利于母乳喂养.%Objective To observe the clinical effect of dried orange peel soup and Zhizhu soup in promoting exhaust after caesarean section.Methods 120 puerperae who had underwent caesarean section in our hospital were selected and randomly divided into three groups.Group A took dried orange peel soup,group B took Zhizhu soup,group C as a control.Compared the time of first exhaust,defecation of three groups,observed abdominal distension degree.Results The time of first exhaust,defecation of group A,B were shorter than those of group C (P<0.05),while there were no statistically significant differences in the time of first exhaust,defecation between group A and B (P>0.05).There was no obvious abdominal distension in three groups.Zhizhu soup had better effect in promoting exhaust after caesarean section.Conclusions Zhizhu soup is helpful to the recovery of gastrointestinal function in puerperae who have underwent caesarean section,which can significantly shorten anus exhaust and defecation time,helps puerperae to return to normal diet as soon as possible,is helpful to body rehabilitation and breastfeeding.

  10. Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005

    Kidanto Hussein L

    2009-07-01

    Full Text Available Abstract Background Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS and low birth weight deliveries (LBWT at Muhimbili National Hospital in Tanzania. Methods We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value Results The proportion of teenage mothers (12–19 years progressively decreased over time while that of 30–34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6–1.8] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71–0.82. The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30–34 years age group had no impact on this. Conclusion The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.

  11. Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis.

    Sinéad M O'Neill

    Full Text Available OBJECTIVE: To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery. DESIGN: Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th 2011, using a detailed search-strategy and cross-checking of reference lists. STUDY SELECTION: Cohort, case-control and cross-sectional studies examining the association between previous caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality. DATA SYNTHESIS: 11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually. CONCLUSIONS: Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE, providing women the right to request a caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment

  12. 咪达唑仑对剖宫产术初产妇情绪和记忆的影响%Emotion and memory effects of midazolam on primipara undergoing caesarean section

    谭菁瑜; 董庆龙; 欧阳葆怡

    2007-01-01

    目的 探讨咪达唑仑对剖宫产手术产妇情绪和记忆的影响.方法 72例择期剖宫产术产妇随机分成4组,Ⅰ、Ⅱ和Ⅲ组麻醉前30 min分别肌注咪达唑仑0.05、0.06和0.07 mg/kg,Ⅳ组肌注生理盐水1.5 ml,同时肌肉注射阿托品0.01 mg/kg.于注药前和注药后30 min进行焦虑视觉类比试验(AVAT)、状态焦虑问卷(SAI)测试及Ramsay镇静水平评估.将麻醉准备到手术结束过程分为5阶段,每项告知产妇,记录剖宫产术后4 h产妇能准确回忆的项目.结果 注药后30 min时,Ⅰ~Ⅲ组AVAT分别下降36.4%、43.2%和43.1%;SAI分别下降20.9%、24.8%和26.9%,均获得Ramsay 2~4级镇静水平.Ⅰ~Ⅲ组和Ⅳ组比较记忆保留组间差异均有统计学意义(P均<0.01).Ⅰ~Ⅲ组以遗忘静脉穿刺过程的居多,4组产妇对椎管内麻醉穿刺和新生儿娩出后性别识别两过程全部记忆完觋整.结论 剖宫产手术前给予咪达唑仑0.05~0.07 mg/kg,对产妇有良好的镇静和抗焦虑作用,对外显记忆有一定程度的影响,其中对信息量小和关注程度低的信息能产生顺行性遗忘作用,能保留信息量大和关注程度高的信息的完整记忆.%Objective To investigate the emotion and memory effects of midazolam as a premedication on primipara undergoing caesarean section. Methods Seventy-two primiparous women scheduled for elective caesarean section were randomly divided into four groups. In group Ⅰ,Ⅱand Ⅲ,intramuscular midazolam 0.05 mg/kg,0.06 mg/kg and 0.07 mg/kg were given respectively. The primiparae in group Ⅳ were given intramuscular normal saline 1.5 ml. Anxiety vision analogy test(AVAT) , state anxiety index testing(SAIT) and Ramsay score were evaluated before and 30 min after injection of above drugs. The primiparae were informed when several stages of anesthesia and surgery began. Four hours after the caesarean section they would recall those stages. Accurate remembrance was recorded. Results Thirty minutes

  13. A comparative study of the antibiotic utilization during the normal and caesarean section deliveries at Jawaharlal Nehru institute of medical sciences hospital, Imphal, Manipur, India

    Joychandra Singh Oinam

    2016-06-01

    Conclusions: Pregnancy is just a natural process (not a disease or a medical condition and external intervention should occur only for sound medical conditions C section delivery cannot replace normal delivery in terms of low maternal mortality and neonatal morbidity and less cost. Prescribing antibiotics to mother of normal delivery may also be avoided if the complete sterilization process during and after the delivery is assured. [Int J Basic Clin Pharmacol 2016; 5(3.000: 794-797

  14. 小剂量硫酸镁预防剖宫产术中寒战发生的临床观察%Clinical Observation of Low Dosage Magnesium Sulfate in Preventing Shivering in Caesarean Section

    王新妃

    2012-01-01

    Objective: To observe the effects of low dosage magnesium sulfate in preventing shivering in caesarean section. Method : Totally 60 patients scheduled for caesarean section with ASA grade Ⅰ-Ⅱ were enrolled and randomly divided into the magnesium sulfate group and the control group with 30 cases in each group. 25% magnesium sulfate with the dosage of 10 mg·kg-1 was intravenously administered ( lasting for 2 minutes ) in the magnesium sulfate group, while the same amount of normal saline was injected in the control group. Incidence and severity of shivering were observed in the both groups, Apgar scores in the first and 5th minute after the neonate expulsion were recorded, and the changes in BP and heart rate of the parturients during the operation were observed. Result: The severity of shivering in the magnesium sulfate group was lower than that in the control group,while there was no statistical significance in the incidence of shivering between the two groups( 23. 3% vs 40. 0% ). The heart rate in the magnesium sulfate group after the neonate expulsion was slower than that in the control group ( 87 ± 9 vs 96 ± 6, P<0. 05 ), however, there was no statistical significance in Apgar scores in the first and 5th min after the neonate expulsion and the neural adaptation in the 15th min between the two groups. Conclusion: Low dosage magnesium sulfate( 10 mg·kg-1 )is safe and effective in reducing the severity of shivering.%目的:观察小剂量硫酸镁预防剖宫产术中寒战发生的临床效果.方法:选择择期剖宫产,ASA分级 I~Ⅱ级患者60例.随机分成硫酸镁组和对照组各30例,麻醉平面固定后,硫酸镁组静脉缓慢注射25%硫酸镁10 mg·kg-1(2 min),对照组给予相同剂量的0.9%氯化钠注射液.观察两组寒战发生率和寒战程度,并记录新生儿娩出后1 min和5 min时的Apgar评分,监测产妇术中血压和心率的变化.结果:硫酸镁组寒战反应程度低于对照组(P<0.05),两组寒战发

  15. A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

    Madhuri Alwani

    2014-06-01

    Methods: In a double-blind randomized controlled trial, 200 pregnant women who had cesarean sections were assigned into two groups: to receive either oxytocin intramuscularly or misoprostol rectally after spinal anesthesia. Results: There was no significant difference between the two groups about change in postpartum hemoglobin, need for blood transfusion and incidence of PPH. We also did not observe any significant difference in any side effects. Conclusions: Misoprostol may be considered as an alternative for oxytocin in low resource clinical settings. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 512-515

  16. Nurse competence between three generational nurse cohorts: A cross-sectional study.

    Meretoja, Riitta; Numminen, Olivia; Isoaho, Hannu; Leino-Kilpi, Helena

    2015-08-01

    Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care. PMID:24689751

  17. Effects of Sufentanil on Shivering after Caesarean Section%舒芬太尼对剖腹产寒颤的影响

    张惠珍; 于振峰

    2014-01-01

    目的观察舒芬太尼用于剖宫产术中寒颤的变化情况。方法选择200例行剖宫产患者,随机分为A、B两组(n=100)。A组在术中胎儿安全取出后给予舒芬太尼0.2 ug/Kg而B组在术中未做任何处理,比较两组术中寒战情况。结果 A组100例产妇中有5例发生轻度寒战而没有重度寒颤发生者,寒颤发生率约为5%;B组100例产妇中有轻度寒颤38例,重度寒颤22例,寒颤发生率为60%,两组比较,A组寒颤发生显著低于B组(<0.01)。结论舒芬太尼可明显减少患者术中寒颤的发生及严重程度,减少并发症的发生,使患者更加舒适,进而配合医生尽快完成手术,值得临床推广应用。%Objective To observe the changes of sufentanil for cesarean section in the shivering. Methods 200 cases of cesarean section patients, randomly divided into A, B two group (n=100). A group in the operation safety after take out the fetal given sufentanil 0.2ug/kg and group B in patients without any treatment, the two groups were compared intraoperative shivering. Results 5 patients had mild chil s and no severe chil s occurred in A group 100 cases of maternal, shivering occurrence rate is about 5%; 100 cases in group B were slightly shivering in 38 cases, 22 cases of severe chil s, chil s, the incidence rate was 60%, the two groups, A group was significantly lower than that in B group (shivering during <0.01). Conclusion Sufentanil can obviously reduce and the severity of shivering during operation in patients, reduce the incidence of complications, make the patient more comfortable, and cooperate with the doctor as soon as possible to complete the operation, it is worthy of clinical application.

  18. Adult Lifespan Cognitive Variability in the Cross-Sectional Cam-CAN Cohort

    Emma Green; Shafto, Meredith A.; Fiona E Matthews; Cam-CAN,; White, Simon R.

    2015-01-01

    This study examines variability across the age span in cognitive performance in a cross-sectional, population-based, adult lifespan cohort from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) study (n = 2680). A key question we highlight is whether using measures that are designed to detect age-related cognitive pathology may not be sensitive to, or reflective of, individual variability among younger adults. We present three issues that contribute to the debate for and against age-...

  19. A cross sectional study of two independent cohorts identifies serum biomarkers for facioscapulohumeral muscular dystrophy (FSHD).

    Petek, Lisa M; Rickard, Amanda M; Budech, Christopher; Poliachik, Sandra L; Shaw, Dennis; Ferguson, Mark R; Tawil, Rabi; Friedman, Seth D; Miller, Daniel G

    2016-07-01

    Measuring the severity and progression of facioscapulohumeral muscular dystrophy (FSHD) is particularly challenging because muscle weakness progresses over long periods of time and can be sporadic. Biomarkers are essential for measuring disease burden and testing treatment strategies. We utilized the sensitive, specific, high-throughput SomaLogic proteomics platform of 1129 proteins to identify proteins with levels that correlate with FSHD severity in a cross-sectional study of two independent cohorts. We discovered biomarkers that correlate with clinical severity and disease burden measured by magnetic resonance imaging. Sixty-eight proteins in the Rochester cohort (n = 48) and 51 proteins in the Seattle cohort (n = 30) had significantly different levels in FSHD-affected individuals when compared with controls (p-value ≤ .005). A subset of these varied by at least 1.5 fold and four biomarkers were significantly elevated in both cohorts. Levels of creatine kinase MM and MB isoforms, carbonic anhydrase III, and troponin I type 2 reliably predicted the disease state and correlated with disease severity. Other novel biomarkers were also discovered that may reveal mechanisms of disease pathology. Assessing the levels of these biomarkers during clinical trials may add significance to other measures of quantifying disease progression or regression. PMID:27185459

  20. Intervention for postpartum infections following caesarean section

    Hyldig, Nana; Bille, Camilla; Kruse, Marie;

    2012-01-01

    seeks to elucidate the health economic cost and consequences of this type of infection and treatment. Background: Obesity is an increasing problem in the health care system. Today more than 12% of all pregnant women in Denmark are obese (BMI >30). There is a significant association between obesity in...... pregnant women and the risk of CS. Obesity is associated with an increased risk of postoperative complications such as wound infection, spontaneously dehiscence or reoperation due to infection and prolonged wound healing. Postoperative complications lead to higher costs in the health care sector, including...... time of health professionals, prolonged hospitalization, medications, blood samples and -cultures, reoperations and visits to the general practitioner. Complications may also lead to productivity losses and reduced quality of life. At Odense University Hospital (OUH), Denmark, the conventional...

  1. Evaluation of the perceived quality regarding pain management after obstetric surgery in female undergoing caesarean operation

    Isabel Mª García Sánchez

    2004-01-01

    Appropriate pain management is closely related to the patient wellbeing, which is a main objective in any nursing intervention. This study is aimed to analyse the satisfaction of females undergoing caesarean, focusing on the effectiveness of the analgesic protocol used at Reanimation Ward as well as on identifying factors affecting the perception of pain.Methodology: Cross-sectional study including female admitted in a Reanimation ward of a University hospital after caesarean. A multiple choi...

  2. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    ,

    2014-01-01

    Louise Kenny and colleagues conduct a population-based cohort study in Denmark to assess the likelihood of stillbirth, miscarriage, and ectopic pregnancy following cesarean section compared to women who gave birth by vaginal delivery.

  3. Ningbo thyroid dysfunction prevalence study: a cross-sectional survey in an employees-cohort

    MAO Yu-shan; LIU Zhi-min; CHEN Chang-xi; ZHU Zhong-wei; HONG Zhong-li

    2010-01-01

    Background The prevalence and the spectrum of thyroid dysfunction in the mainland of China are not adequately understood. We performed a population-based study to determine the prevalence of major thyroid dysfunctions including overt and subclinical hyper- and hypothyroidism in a stable cohort.Methods All active and retired employees aged 20 years and older (11 067) of Sinopec Zhenhai Refining & Chemical Company in Ningbo participated in the cross-sectional survey with a questionnaire and blood samples. Results A total of 10 405 individuals attended for screening. Using biochemical definitions 95.5% were euthyroid. The prevalence of former diagnosed hyperthyroidism was 1.1% in females and 0.4% in males, hypothyroidism 1.7% and 0.3%, and thyroid surgery 1.2% and 0.3%, respectively. In both sex the prevalence increased with age. Twenty-four percent of individuals with thyroid surgery or medications had abnormal thyroid-stimulating hormone (TSH) levels. In individuals without a history of thyroid disease, the prevalence of pathological TSH values in females and males were TSH ≥10 mU/L 0.60% and 0.29%; TSH 4.8-9.9 mU/L 5.71 % and 2.25%; TSH <0.3 mU/L 0.87% and 0.41 %, respectively. Overt hyper- and hypothyroidism were uncommon (0.2%, 0.3%, respectively). The prevalence of subclinical hyper- and hypothyroidism was 0.4% and 3.4%, respectively. Subclinical hypothyroidism was more common in females (male 2.4% vs. female 5.8%, P<0.001) and with increasing age (P<0.001).Conclusions The prevalence of thyroid dysfunction is 4.5% in the cohort. Among individuals with thyroid medications or surgery, only 75.7% were within the normal range of TSH. These results indicate that thyroid dysfunction is common in Chinese adults.

  4. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  5. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  6. Intrapartum caesarean rates differ significantly between ethnic groups--relationship to induction.

    Ismail, Khadijah I

    2012-01-31

    OBJECTIVE: Given international variation in obstetric practices and outcomes, comparison of labour outcomes in different ethnic groups could provide important information regarding the underlying reasons for rising caesarean delivery rates. Increasing numbers of women from Eastern European countries are now delivering in Irish maternity hospitals. We compared labour outcomes between Irish and Eastern European (EE) women in a large tertiary referral center. STUDY DESIGN: This was a prospective consecutive cohort study encompassing a single calendar year. The cohort comprised 5550 Irish and 867 EE women delivered in a single institution in 2009. Women who had multiple pregnancies, breech presentation, and elective or pre-labour caesarean sections (CS) were excluded. Data obtained from birth registers included maternal age, nationality, parity, gestation, onset of labour, mode of delivery and birth weight. RESULTS: The overall intrapartum CS rate was 11.4% and was significantly higher in Irish compared to EE women (11.8% vs. 8.8%; p=0.008). The proportion of primiparas was lower in Irish compared to EE women (44.8% vs. 63.6%; p<0.0001). The intrapartum CS rate was almost doubled in Irish compared to EE primiparas (20.7% vs. 11.0%; p<0.0001). Analysis of primiparas according to labour onset revealed a higher intrapartum CS rate in Irish primiparas in both spontaneous (13.5% vs. 7.2%; p<0.0001) and induced labour (29.5% vs. 19.3%; p=0.005). Irish women were older with 19.7% of primiparas aged more than 35, compared to 1.6% of EE women (p<0.0001). The primigravid CS rate in Irish women was significantly higher in women aged 35 years or older compared women aged less than 35 (30.6% vs. 18.3%; p<0.0001) consistent in both spontaneous and induced labour. The primiparous induction rate was 45.4% in Irish women compared to 32% in EE women, and more Irish women were induced before 41 weeks gestation. CONCLUSION: The results highlight that primigravid intrapartum CS rates were

  7. Adult Lifespan Cognitive Variability in the Cross-Sectional Cam-CAN Cohort

    Emma Green

    2015-12-01

    Full Text Available This study examines variability across the age span in cognitive performance in a cross-sectional, population-based, adult lifespan cohort from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN study (n = 2680. A key question we highlight is whether using measures that are designed to detect age-related cognitive pathology may not be sensitive to, or reflective of, individual variability among younger adults. We present three issues that contribute to the debate for and against age-related increases in variability. Firstly, the need to formally define measures of central tendency and measures of variability. Secondly, in addition to the commonly addressed location-confounding (adjusting for covariates there may exist changes in measures of variability due to confounder sub-groups. Finally, that increases in spread may be a result of floor or ceiling effects; where the measure is not sensitive enough at all ages. From the Cam-CAN study, a large population-based dataset, we demonstrate the existence of variability-confounding for the immediate episodic memory task; and show that increasing variance with age in our general cognitive measures is driven by a ceiling effect in younger age groups.

  8. Adult Lifespan Cognitive Variability in the Cross-Sectional Cam-CAN Cohort.

    Green, Emma; Shafto, Meredith A; Matthews, Fiona E; White, Simon R

    2015-12-01

    This study examines variability across the age span in cognitive performance in a cross-sectional, population-based, adult lifespan cohort from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) study (n = 2680). A key question we highlight is whether using measures that are designed to detect age-related cognitive pathology may not be sensitive to, or reflective of, individual variability among younger adults. We present three issues that contribute to the debate for and against age-related increases in variability. Firstly, the need to formally define measures of central tendency and measures of variability. Secondly, in addition to the commonly addressed location-confounding (adjusting for covariates) there may exist changes in measures of variability due to confounder sub-groups. Finally, that increases in spread may be a result of floor or ceiling effects; where the measure is not sensitive enough at all ages. From the Cam-CAN study, a large population-based dataset, we demonstrate the existence of variability-confounding for the immediate episodic memory task; and show that increasing variance with age in our general cognitive measures is driven by a ceiling effect in younger age groups. PMID:26690191

  9. Pregnancy in uterus didelphys delivered by caesarean delivery: case report

    Sneha S. Rao

    2016-07-01

    Full Text Available Uterus didelphys represents a uterine malformation where the uterus is present as paired organ. There is presence of double uterine bodies with two separate cervices and often a double or septate vagina. Women with congenital malformations of uterus usually have higher incidence of complications during pregnancy and delivery. We report the case in our institute of a pregnancy in the left sided body of a didelphys uterus delivered by caesarean section. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2434-2437

  10. The Impact of Caesarean Delivery on Paracetamol and Ketorolac Pharmacokinetics: A Paired Analysis

    Aida Kulo

    2012-01-01

    Full Text Available Pharmacokinetics is a first, but essential step to improve population-tailored postoperative analgesia, also after Caesarean delivery. We therefore aimed to quantify the impact of caesarean delivery on the pharmacokinetics of intravenous (iv paracetamol (2 g, single dose and iv ketorolac tromethamine (30 mg, single dose in 2 cohorts eachof 8 women at caesarean delivery and to compare these findings with postpartum to quantify intrapatient changes. We documented a higher median paracetamol clearance at delivery when compared to 10–15 weeks postpartum (11.7 to 6.4 L/h⋅m2, P<0.01, even after correction for weight-related changes. Similar conclusions were drawn for ketorolac: median clearance was higher at delivery with a subsequent decrease (2.03 to 1.43 L/h⋅m2, P<0.05 in postpartum (17–23 weeks. These differences likely reflect pregnancy- and caesarean-delivery-related changes in drug disposition. Moreover, postpartum paracetamol clearance was significantly lower when compared to estimates published in healthy young volunteers (6.4  versus  9.6 L/h⋅m2, while this was not the case for ketorolac (1.43  versus  1.48 L/h⋅m2. This suggests that postpartum is another specific status in young women that merits focused, compound-specific pharmacokinetic evaluation.

  11. CDKAL1-related single nucleotide polymorphisms are associated with insulin resistance in a cross-sectional cohort of Greek children.

    Mathias Rask-Andersen

    Full Text Available Five novel loci recently found to be associated with body mass in two GWAS of East Asian populations were evaluated in two cohorts of Swedish and Greek children and adolescents. These loci are located within, or in the proximity of: CDKAL1, PCSK1, GP2, PAX6 and KLF9. No association with body mass has previously been reported for these loci in GWAS performed on European populations. The single nucleotide polymorphisms (SNPs with the strongest association at each loci in the East Asian GWAS were genotyped in two cohorts, one obesity case control cohort of Swedish children and adolescents consisting of 496 cases and 520 controls and one cross-sectional cohort of 2293 nine-to-thirteen year old Greek children and adolescents. SNPs were surveyed for association with body mass and other phenotypic traits commonly associated with obesity, including adipose tissue distribution, insulin resistance and daily caloric intake. No association with body mass was found in either cohort. However, among the Greek children, association with insulin resistance could be observed for the two CDKAL1-related SNPs: rs9356744 (β = 0.018, p = 0.014 and rs2206734 (β = 0.024, p = 0.001. CDKAL1-related variants have previously been associated with type 2 diabetes and insulin response. This study reports association of CDKAL1-related SNPs with insulin resistance, a clinical marker related to type 2 diabetes in a cross-sectional cohort of Greek children and adolescents of European descent.

  12. Workplace determinants of social capital: cross-sectional and longitudinal evidence from a Finnish cohort study.

    Tuula Oksanen

    Full Text Available OBJECTIVE: To examine which contextual features of the workplace are associated with social capital. METHODS: This is a cohort study of 43,167 employees in 3090 Finnish public sector workplaces who responded to a survey of individual workplace social capital in 2000-02 (response rate 68%. We used ecometrics approach to estimate social capital of work units. Features of the workplace were work unit's demographic and employment patterns and size, obtained from employers' administrative records. We used multilevel-multinomial logistic regression models to examine cross-sectionally whether these features were associated with social capital between individuals and work units. Fixed effects models were used for longitudinal analyses in a subsample of 12,108 individuals to examine the effects of changes in workplace characteristics on changes in social capital between 2000 and 2004. RESULTS: After adjustment for individual characteristics, an increase in work unit size reduced the odds of high levels of individual workplace social capital (odds ratio 0.94, 95% confidence interval 0.91-0.98 per 30-person-year increase. A 20% increase in the proportion of manual and male employees reduced the odds of high levels of social capital by 8% and 23%, respectively. A 30% increase in temporary employees and a 20% increase in employee turnover were associated with 11% (95% confidence interval 1.04-1.17 and 24% (95% confidence interval 1.18-1.30 higher odds of having high levels of social capital respectively. Results from fixed effects models within individuals, adjusted for time-varying covariates, and from social capital of the work units yielded consistent results. CONCLUSIONS: These findings suggest that workplace social capital is contextually patterned. Workplace demographic and employment patterns as well as the size of the work unit are important in understanding variations in workplace social capital between individuals and workplaces.

  13. Association of Group B Streptococcus Colonization and Bovine Exposure: A Prospective Cross-Sectional Cohort Study

    Manning, Shannon D.; Springman, A. Cody; Million, Amber D.; Milton, Nicole R.; McNamara, Sara E.; Somsel, Patricia A.; Bartlett, Paul; Davies, H. Dele

    2010-01-01

    Background While Group B Streptococcus (GBS) human colonization and infection has long been suspected as originating from cows, several investigators have suggested that ongoing interspecies GBS transmission is unlikely due to genotyping data demonstrating that human and bovine-derived GBS strains represent mostly distinct populations. The possibility of ongoing transmission between humans and their livestock has not been systematically examined. Methodology/Principal Findings To examine ongoing interspecies transmission, we conducted a prospective cross-sectional cohort study of 68 families and their livestock. Stool specimens were collected from 154 people and 115 livestock; GBS was detected in 19 (12.3%) humans and 2 (1.7%) animals (bovine and sheep). Application of multilocus sequence typing (MLST) identified 8 sequence types (STs or clones), with STs 1 and 23 predominating. There were 11 families in which two members submitted stools and at least one had GBS colonization. In 3 of these families, both members (consisting of couples) were colonized, yielding a co-colonization rate of 27% (95% CI: 7%–61%). Two of these couples had strains with identical MLST, capsule (cps) genotype, susceptibility, and RAPD profiles. One couple co-colonized with ST-1 (cps5) strains also had a bovine colonized with the identical strain type. On multivariate analysis of questionnaire data, cattle exposure was a predictor of GBS colonization, with each unit increase in days of cattle exposure increasing the odds of colonization by 20% (P = 0.02). These results support interspecies transmission with additional evidence for transmission provided by the epidemiological association with cattle exposure. Conclusions/Significance Although GBS uncommonly colonizes livestock stools, increased frequency of cattle exposure was significantly associated with human colonization and one couple shared the same GBS strains as their bovine suggesting intraspecies transmission. These results

  14. Patterns and Associated Factors of Caesarean Delivery Intention among Expectant Mothers in China: Implications from the Implementation of China’s New National Two-Child Policy

    Wang, Lianlian; Xu, Xianglong; Baker, Philip; Tong, Chao; Zhang, Lei; Qi, Hongbo; Zhao, Yong

    2016-01-01

    Objective: This study explores the basic demographic characteristics of expectant mothers in the context of their intentions regarding mode of delivery, in particular, the preference for caesarean delivery, and analyzes the social and psychological factors that influence delivery preference. Method: A cross-sectional survey of pregnant women was conducted during June to August in 2015. This study adopted a stratified sampling method, and 16 representative hospitals in five provinces of China were included. Results: 1755 and 590 of expectant mothers in their first and second pregnancies, respectively, were enrolled in this study. 354 (15.10%) intended to deliver by caesarean section and 585 (24.95%) participants were uncertain prior to delivery. 156 (8.89%) of expectant mothers in their first pregnancy and 198 (33.56%) expectant mothers in their second pregnancy intended to deliver by caesarean section. Ordinal logistic regression analysis found that nationality, parity, trimester of pregnancy, and advanced maternal age were factors associated with intention to deliver by caesarean (ordered logistic regression/three-level caesarean delivery intention criterion; odds ratios p < 0.05). Conclusions: 8.89% of first pregnancy expectant mothers and 33.56% of second pregnancy expectant mothers intended to deliver by caesarean section. Any intervention program to reduce the rate of Caesarean delivery should focus on the Han population, older pregnant women, and expectant mothers in their second pregnancy, at an early gestation. PMID:27399752

  15. Spontaneous coronary artery dissection in pregnancy requiring emergency caesarean delivery followed by coronary artery bypass grafting.

    Weinberg, L; Ong, M; Tan, C O; McDonnell, N J; Lo, C; Chiam, E

    2013-03-01

    Spontaneous coronary artery dissection is a rare and often fatal condition of pregnancy. The long-term morbidity is unknown, but a small cohort of patients develop severe ventricular dysfunction as a consequence. We describe a 37-week gestation parturient who presented with cardiogenic shock secondary to spontaneous left main coronary artery dissection. Despite rapid diagnosis, stabilisation with an intra-aortic balloon pump and prompt transfer to a tertiary centre for emergency caesarean delivery and coronary artery bypass grafting, the patient developed a severe postoperative dilated ischaemic cardiomyopathy. There is little information about the long-term outcomes and the specific anaesthesia management of combined emergency caesarean delivery and cardiac surgery in pregnancy for spontaneous coronary artery dissection. Therefore, we outline our multidisciplinary management of this critically ill pregnant woman. PMID:23530793

  16. First trimester caesarean scar ectopic pregnancy evaluation using MRI

    Aim: To determine the features of caesarean scar ectopic pregnancy (CSP) by using magnetic resonance imaging (MRI) in the first trimester. Materials and methods: Thirty-nine women with CSP in the first trimester were initially selected and underwent transvaginal ultrasound and MRI examinations. Thirty-five patients with CSP were finally included in this study. Results: The CSPs were categorized into three groups: type I, in which a thin-walled diverticulum is present at the caesarean section scar (CSS) defect and the gestational sac (GS) is embedded in the diverticulum; type II, in which a thin-walled diverticulum is present at the CSS defect and the GS is partially embedded in the diverticulum; type III, in which a niche is present in the CSS defect and the GS is mainly embedded in the isthmus. Types I, II, and III CSP occurred in 40, 46, and 14% of the women, respectively. There was no significant difference between the three types in the minimum thickness of the CSS defect. In types I and II, there was a positive correlation in the maximum inlet diameter of the CSS defect and the approximate area of the GS. Conclusion: Using MRI, most CSPs present as a diverticulum at the CSS defect, and the CSS defect becomes weaker with the growth of the GS. MRI showed detailed features of the CSP

  17. Cesarean Section Birth

    Full Text Available ... you will experience the miracle of birth during a live Internet broadcast from Shawnee Mission Medical Center ... hour, operating surgeon Dr. Leah Ridgway will perform a caesarean section delivery while Dr. Reagan Wittek will ...

  18. Application effect comparison of pentazocine for intravenous analgesia and epidural analgesia after caesarean section%喷他佐辛在剖宫产术后静脉镇痛与硬膜外镇痛中的应用效果比较

    罗新萍; 尹新武; 罗芳; 周生智

    2015-01-01

    Objective To compare the application effect of pentazocine on patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) after caesarean section. Methods 120 patients who needed postoperative analgesia after caesarean section in our hospital from November 2013 to April 2014 were selected and evenly divided into PCIA group and PCEA group in random.In PCEA group,90 mg pentazocine,215 mg ropivacaine,5 mg tropisetron,and normal saline were mixed to 100 ml,while in PCIA group,90 mg pentazocine,2 mg propacetamol,5 mg tropisetron,and normal saline were mixed to 100 ml.Fifteen minutes before the end of surgery,disposable patient-controlled analgesia pump (PCA) was connected in both groups.The mode of LCP referred to 5 ml load dosage,2 ml con-tinuous infusion dosage,and 2 ml self-controlled bolus for 15 set minutes.Scores of analgesia and sedation 6 h,12 h,24 h,36 h,and 48 h after surgery were observed.The adverse reactions like nausea,vomiting,respiratory depression,retention of urine after surgery,postoperative pump dropping,and numbness of lower limb were also observed in order to know pa-tient’s satisfaction. Results There was no significant difference about score of analgesia between the two groups (P>0.05).Within 24-hour application of PCA pump,there was significant difference in Ramsay sedation score between the two groups (P0.05)。在自控镇痛泵使用24 h内,两组Ramsay镇静评分差异有统计学意义(P<0.05)。 PICA组患者对镇痛泵的满意度为95%,高于PCEA组的85%,差异有统计学意义(P<0.05)。结论喷他佐辛用于剖宫产PCEA和PCIA镇痛效果相当,但PCIA还具有携带方便、操作简单等优点,可避免留置硬膜外导管可能发生的并发症,患者的满意度较高,PICA更适合剖宫产手术,值得推广。

  19. Delivery outcomes for nulliparous women at the extremes of maternal age - a cohort study.

    Vaughan, DA

    2013-06-12

    OBJECTIVE: To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes. DESIGN: Retrospective cohort study. SETTING: Urban maternity hospital in Ireland. POPULATION: A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011. METHODS: The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18-19 years, 20-34 years, 35-39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section. RESULTS: Compared with maternal age 20-34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33-2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06-1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07-2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34-0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67-3.94). CONCLUSIONS: Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.

  20. Workplace Determinants of Social Capital: Cross-Sectional and Longitudinal Evidence from a Finnish Cohort Study

    Tuula Oksanen; Ichiro Kawachi; Anne Kouvonen; Soshi Takao; Etsuji Suzuki; Marianna Virtanen; Jaana Pentti; Mika Kivimäki; Jussi Vahtera

    2013-01-01

    OBJECTIVE: To examine which contextual features of the workplace are associated with social capital. METHODS: This is a cohort study of 43,167 employees in 3090 Finnish public sector workplaces who responded to a survey of individual workplace social capital in 2000-02 (response rate 68%). We used ecometrics approach to estimate social capital of work units. Features of the workplace were work unit's demographic and employment patterns and size, obtained from employers' administrative records...

  1. Morbidity of caesarean delivery: a comparative study between early and advanced stages of labour in an Indian tertiary care center

    Amrutha Ramachandran

    2013-08-01

    Methods: A retrospective analysis of 131 women with singleton term pregnancies who underwent emergency caesarean section. The study was done in a tertiary care teaching hospital in India. In this study advanced labour was defined as one with cervical dilatation 8 cm or more at the time of caesarean section. The primary outcome variables were a maternal composite morbidity and a neonatal composite morbidity. Categorical data were compared using chi square test or Fischer’s exact test. Results: 73 women (56% underwent caesarean delivery in the early labour and 58(44% in advanced labour. 12/73 (16.4% patients in early stage of labour had at least one maternal complication (Composite maternal morbidity compared to 18/58 (31% women who had caesarean in advanced stage (p = 0.048. Seven patients out of 73 in the early labour and 14/58 in the advanced labour (p = 0.024 had at least one neonatal complication (Composite neonatal morbidity. Conclusions: The morbidity of primary caesarean sections done in the advanced stage of labour is associated with increased maternal and neonatal morbidity compared to that done in the early stage. A larger study will be needed to establish the inference. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 646-650

  2. Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia

    Berlac, P A; Rasmussen, Yvonne Hovmann

    2005-01-01

    BACKGROUND: Spinal anaesthesia-induced maternal hypotension is common during elective caesarean section. This study evaluated whether cerebral near-infrared spectroscopy predicts maternal hypotension, defined as a 25% reduction in systolic blood pressure or heart rate or presentation of clinical...... symptoms. METHOD: Thirty-eight ASA I-II parturients scheduled for elective caesarean section with spinal anaesthesia were monitored by near-infrared spectroscopy for changes in cerebral oxygenation (ScO(2)) with the recordings blinded to the anaesthesiologist. RESULTS: There was a 5% decrease in ScO(2......-infrared spectroscopy to predict hypotension was 1.00, with a specificity 0.85 and a predictability of 0.91. CONCLUSION: The results demonstrate a relationship between ScO(2) and impending hypotension during low-dose spinal anaesthesia for elective caesarean section. We suggest that immediate measures are taken to...

  3. Midwife-led Care Model for Reducing Caesarean Rate: A Novel Concept for Worldwide Birth units where Standard Obstetric Care Still Dominates

    Hong Zhou

    2012-01-01

    Full Text Available Caesarean rate has been increasing year by year in China and other countries in the world. In fact, caesarean section is associated with increased risk of maternal mortality and serious foetal pulmonary morbidity. To reduce caesarean rate, obstetricians in physician-based birth units get used to take early intervention for any delay in labour progress that could cause dystocia. However, standard obstetric care enhanced by obstetric power has not consistently been shown to reduce rate of caesarean delivery. Other than physician-based model, midwife-led model of care is aiming to promote normal birth by use of midwives’ skills as well as continuous support rather than augmentation of labour through excessive medical treatment. Midwife-led care model is novel to worldwide birth units where standard obstetric care still dominates. It has made some headway in efforts to reduce caesarean rate. The fact that standard obstetric care of childbirth have not consistently reduced rate of caesarean delivery encourages us for creating the hypotheses that midwife-led care model satisfying puerpera with care and support could minimise unnecessary obstetric intervention and facilitate vaginal birth, and finally reduces caesarean rate. This hypothesis, if confirmed, might have the potential to be disseminated elsewhere in the world, where most women still take standard obstetric care. Moreover, it has political implications for the national health-care policymaking.

  4. Prelabor Cesarean Section and Risk of Childhood Type 1 Diabetes A Nationwide Register-based Cohort Study

    Clausen, Tine Dalsgaard; Bergholt, Thomas; Eriksson, Frank;

    2016-01-01

    BACKGROUND: Unfavorable conditions associated with cesarean section may influence the risk of type 1 diabetes in offspring, but results from studies are conflicting. We aimed to evaluate the association between prelabor cesarean section and risk of childhood type 1 diabetes. METHODS: A Danish...... nationwide cohort study followed all singletons born during 1982-2010. Five national registers provided information on mode of delivery, outcome, and confounders. The risk of childhood type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 1,760,336 singletons...... contributed 20,436,684 person-years, during which 4,400 were diagnosed with childhood type 1 diabetes. RESULTS: The hazard ratio for childhood type 1 diabetes was increased in children delivered by prelabor cesarean section compared with vaginal delivery when adjusted for year of birth, parity, sex, parental...

  5. Pyoderma Gangrenosum in Two Successive Pregnancies Complicating Caesarean Wound

    Sapna Vinit Amin

    2014-01-01

    Full Text Available Pyoderma gangrenosum (PG is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing.

  6. A case of spontaneous tubal pregnancy with caesarean scar pregnancy

    Zhu, Jie; Shen, Yue-Ying; ZHAO, YU-QING; Lin, Ru; Fang, Fang

    2014-01-01

    Tubal pregnancy with caesarean scar pregnancy is rare. Early, accurate diagnosis and treatment for this kind of ectopic pregnancy can lead to a decrease of maternal morbidity and mortality. Here, we report a rare case of spontaneous tubal pregnancy co-existing with caesarean scar pregnancy. After timely emergency laparoscopy and curettage, the patient was cured.

  7. Effects of Cesarean Section on Infant Health in China:Matched Prospective Cohort Study

    2007-01-01

    Objective To compare the medical outcomes of infants delivered by cesarean section with those of infants delivered vaginally.Methods A total of 301 healthy women with cesarean section and a matched control group of 301 women delivered vaginally were identified at three district-level hospitals in Shanghai from May 2001 to February 2003.Two groups were matched according to their medical indications Tor cesarean section.Their infants were assessed at delivery,1 month,6 month and 1 year after birth.Results The incidence of neonatal complications and infant morbidities at all measurement occasions did not differ significantly between groups.Rehospitalization was found to be more likely among infants delivered by cesarean section in the first month after birth.However,there was no difference between two groups in the incidence of rehospitalization in the first year after birth. Cesarean section was also associated with a higher risk of infant diarrhea (adjusted relative risk=1.25,95% CI:1.01,1.56).Conclusion Infants did not have health benefits from cesarean section if the pregnancy was at low risk.

  8. Clinical Efficacy Comparion of Ropivacaine and Levobupivacaine for Combined Spinal-Epidural Anesthesia(CSEA) on Caesarean Section%罗哌卡因与布比卡因用于腰硬联合麻醉剖宫产的临床效果对比

    谢伟

    2011-01-01

    目的:探讨罗哌卡因与布比卡因用于腰硬联合麻醉剖宫产的临床效果.方法:采用随机双盲对照试验设计,将60 例择期行腰硬膜联合麻醉剖宫产产妇按照1:1 的比例随机分为罗哌卡因组和布比卡因组.罗哌卡因组:0.75% 罗哌卡因2ml,布比卡因组:0.75% 布比卡因2ml 用脑脊液稀释到3ml 注药2ml.结果:两组最高感觉阻滞平面、到达最高阻滞平面时间、感觉恢复时间、麻醉效果无显著性差异(P>0.05),罗哌卡因组感觉起效时间、运动阻滞起效时间明显晚于布比卡因组(P<0.05),运动恢复时间明显快于布比卡因组(P<0.05);罗哌卡因组低血压、心动过缓、恶心呕吐和头晕均少于布比卡因组,其中低血压有显著性差异(P<0.05).结论:与布比卡因比较,罗哌卡因麻醉效能相似,但运动恢复更快,利于早期下床活动,且不良反应少,更适用于腰硬联合麻醉剖宫产.%Objective: To investigation the of ropivacaine and levobupivacaine for combined spinal-epidural anesthesia(CSEA) on caesarean section.Methods: Use randomized double-blind controlled trial design,sixty primiparae schedualed for caesarean section were divided into ropivacaine group and bupivacaine group in 1:1 proportion.Ropivacaine group: 0.75% ropivacaine 2ml, bupivacaine group: 0.75% bupivacaine 2ml was diluted to 3ml with cerebrospinal fluid,injection 2ml.Results: There were no significant difference on the highest sensory block plane, reach the maximum block plane time, sensory recovery time, anesthesia effect in the two groups (P> 0.05), sensory onset time, motor block onset time of ropivacaine group was significantly later than that of bupivacaine group (P<0.05), motor recovery was significantly faster than the bupivacaine group (P<0.05); the cases of hypotension, bradycardia, nausea, vomiting and dizziness in ropivacaine group were less than the bupivacaine group, the hypotension cases has significantly differences (P<0

  9. Multimorbidity: Epidemiology and Risk Factors in the Golestan Cohort Study, Iran: A Cross-Sectional Analysis.

    Ahmadi, Batoul; Alimohammadian, Masoomeh; Yaseri, Mehdi; Majidi, Azam; Boreiri, Majid; Islami, Farhad; Poustchi, Hossein; Derakhshan, Mohammad H; Feizesani, Akabar; Pourshams, Akram; Abnet, Christian C; Brennan, Paul; Dawsey, Sanford M; Kamangar, Farin; Boffetta, Paolo; Sadjadi, Alireza; Malekzadeh, Reza

    2016-02-01

    Advances in medicine and health policy have resulted in growing of older population, with a concurrent rise in multimorbidity, particularly in Iran, as a country transitioning to a western lifestyle, and in which the percent of the population over the age of 60 years is increasing. This study aims to assess multimorbidity and the associated risk factors in Iran. We used data from 50,045 participants (age 40-75 y) in the Golestan Cohort Study, including data on demographics, lifestyle habits, socioeconomic status, and anthropometric indices. Multimorbidity was defined as the presence of 2 or more out of 8 self-reported chronic conditions, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, gastroesophageal reflux disease, tuberculosis, and cancer. Multivariate logistic regression models were used to examine the associations between multiple different factors and the risk factors. Multimorbidity prevalence was 19.4%, with the most common chronic diseases being gastroesophageal reflux disease (76.7%), cardiovascular diseases (72.7%), diabetes (25.3%), and chronic obstructive pulmonary disease (21.9%). The odds of multimorbidity was 2.56-fold higher at the age of >60 years compared with that at <50 years (P < 0.001), and 2.11-fold higher in women than in men (P < 0.001). Other factors associated with higher risk of multimorbidity included non-Turkmen ethnicity, low education, unemployment, low socioeconomic status, physical inactivity, overweight, obesity, former smoking, opium and alcohol use, and poor oral health. Apart from advanced age and female sex, the most important potentially modifiable lifestyle factors, including excess body weight and opium use, and opium user, are associated with multimorbidity. Policies aiming at controlling multimorbidity will require a multidimensional approach to reduce modifiable risk factors in the younger population in developing countries alongside

  10. A cross-sectional analysis of pet-specific immunoglobulin E sensitization and allergic symptomatology and household pet keeping in a birth cohort population

    Ezell, Jerel M.; Wegienka, Ganesa; Havstad, Suzanne; Ownby, Dennis R.; Johnson, Christine C; Zoratti, Edward M

    2013-01-01

    It is unknown whether family members with detectable specific immunoglobulin E (sIgE) and/or allergic symptoms to pets are more or less likely to reside in a household with pets. We cross-sectionally investigated potential relationships between family members' allergic sensitization and symptoms to dogs and cats and current household pet-keeping practices, using birth cohort data. Blood samples taken from children enrolled in a birth cohort and their biological mothers and fathers, when the c...

  11. Study of patient satisfaction and self-expressed problems after emergency caesarean delivery under subarachnoid block

    V R Hemanth Kumar

    2014-01-01

    Full Text Available Background and Aims: Subarachnoid block is one of the common modes of anaesthesia opted for emergency caesarean section, if the maternal and foetal conditions are favourable. Various factors influence the quality of care administered during the procedure. This questionnaire based study was undertaken to look for self-expressed problems in peri-operative period in patients undergoing emergency caesarean surgery under subarachnoid block. Methods: All the parturients who underwent emergency caesarean section under subarachnoid block during 6 months period were distributed a questionnaire in post-operative period. They were encouraged to fill and return the form within 15 days. Patient satisfaction and the self-expressed problems were analysed at the end of 6 months. Results: One hundred and seventy five out of 220 parturients responded. 58.3% of them said that they were explained about the anaesthesia prior to surgery and 85.3% overall remained anxious. With people around them, 93.1% of them felt comfortable and 91.4% expressed that they were made comfortable inside the theatre. The self-expressed problems were shivering (43.4%, breathlessness (21.7%, pain (20%, post-operative headache (15.4% and backache (19.4%. Parturients who heard their babies cry was 85.1%. After their babies were shown after delivery, 77.1% mothers slept well; 86.9% fed their babies within 4 h of delivery. Conclusion: Pre-operative communication in emergency caesarean section by health personnel did not reduce the anxiety level, which shows that communication was ineffective. Intra-operative psychological support like making the patient comfortable, showing baby to mother and early breast feeding improve bonding between child and mother and essentially contribute to patient satisfaction.

  12. 应用LiDCOrapid监测缩宫素所致产妇血流动力学变化的临床观察%The application of LiDCOrapid system in observation of oxytocin induced-hemodynamic changes in obstetric patients undergoing caesarean section

    段庆芳; 肖玮; 张希峣; 王天龙

    2015-01-01

    目的 探讨LiDCOrapid提供的血流动力学指标能否在剖宫产手术患者中及时、有效地反映缩宫素引起的血流动力学改变.方法 选择美国麻醉医师协会(ASA)分级Ⅰ级,择期剖宫产手术20例,患者入室后应用LiDCOrapid指套、袖带建立无创血压监测(continuous noninvasive arterial blood pressure measurement,CNAP).记录患者入室、胎儿娩出、给予缩宫素后即刻、给药后每间隔10s记录至给药后180 s时患者的血流动力学指标:收缩压(systolic blood pressure,SBP)、舒张压(diastolicblood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、心排血量(cardiac output,CO)、每搏量(stroke volume,SV).记录患者缩宫素相关副作用.结果 给予缩宫素后,LiDCOrapid记录到患者HR、CO、SV增高,同时SBP、DBP、MAP下降,这与国外应用LiDCOplus建立有创动脉压监测所得血流动力学变化趋势一致.以胎儿娩出时血流动力学指标为基础值,SBP、DBP、MAP、HR、CO、SV均于给药后40 s~60 s达峰,达峰时相对基础值百分比分别为(89±12)%、(73±14)%、(81±12)%、(116±12)%、(174±35)%、(150±27)%,差异有统计学意义(P<0.01).结论 LiDCOrapid与LiDCOplus比较,二者具有一致性,均可及时、有效地反映剖宫产手术中缩宫素引起的快速血流动力学变化.健康产妇给予10单位负荷剂量缩宫素后,SBP、DBP、MAP下降,而HR、CO、SV升高.%Objective To validate whether the application of LiDCOrapid system could provide timely and effective monitoring in oxytocin-induced hemodynamic changes in obstetric patients undergoing caesarean section.Methods Twenty ASA Ⅰ obstetric patients undergoing elective caesarean section were set the continuous noninvasive arterial blood pressure measurement (CNAP) using the LiDCOrapid monitor in operating room.The real-time hemodynamic parameters,including systolic blood pressure (SBP),diastolic blood pressure (DBP

  13. Effect of Planned Early Recommended Ambulation Technique on Selected Post caesarean Biophysiological Health Parameters

    Jyoti V. Dube

    2014-01-01

    Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative

  14. Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV

    Mehta Shruti H

    2010-05-01

    Full Text Available Abstract Background Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV infection and with obstructive lung diseases (OLD. Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs. Methods Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea. Results Of 974 participants, 835 (86% were current smokers and 288 (29.6% were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70 was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively. COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively. Conclusions While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

  15. Perspectives of cesarean section in buffaloes

    G N Purohit; Mitesh Gaur; Amit Kumar; Chandra Shekher; Swati Ruhil

    2013-01-01

    Cesarean section in buffaloes is an emergency operative procedure being performed prinicipally for uncorrectable uterine torsions and for delivery of fetal monsters. Left paramedian (lateral and parallel to the milk vein) and oblique ventrolateral (above arcus cruralis) are the two common operative sites used for buffalo caesarean section. Although many anesthetic combinations including intravenous and inhalation anesthetic procedures have been experimented in the buffalo species yet most caesarean sections in buffaloes are satisfactorily performed in right lateral recumbency under mild sedation and local infiltration analgesia or paravertebral nerve blocks. The history, indications, anesthesia, operative procedures, post operative complications and future fertility following caesarean section in buffalo are described.

  16. Reduced risk of malaria parasitemia following household screening and treatment: a cross-sectional and longitudinal cohort study.

    Catherine G Sutcliffe

    Full Text Available BACKGROUND: In regions of declining malaria transmission, new strategies for control are needed to reduce transmission and achieve elimination. Artemisinin-combination therapy (ACT is active against immature gametocytes and can reduce the risk of transmission. We sought to determine whether household screening and treatment of infected individuals provides protection against infection for household members. METHODOLOGY/PRINCIPAL FINDINGS: The study was conducted in two areas in Southern Province, Zambia in 2007 and 2008/2009. To determine the impact of proactive case detection, households were randomly selected either to join a longitudinal cohort, in which participants were repeatedly screened throughout the year and those infected treated with artemether-lumefantrine, or a cross-sectional survey, in which participants were visited only once. Cross-sectional surveys were conducted throughout the year. The prevalence of RDT positivity was compared between the longitudinal and cross-sectional households at baseline and during follow-up using multilevel logistic regression. In the 2007 study area, 174 and 156 participants enrolled in the cross-sectional and longitudinal groups, respectively. In the 2008/2009 study area, 917 and 234 participants enrolled in the cross-sectional and longitudinal groups, respectively. In both study areas, participants and households in the longitudinal and cross-sectional groups were similar on demographic characteristics and prevalence of RDT positivity at baseline (2007: OR = 0.97; 95% CI:0.46, 2.03 | 2008/2009: OR = 1.28; 95% CI:0.44, 3.79. After baseline, the prevalence of RDT positivity was significantly lower in longitudinal compared to cross-sectional households in both study areas (2007: OR = 0.44; 95% CI:0.20, 0.96 | 2008/2009: OR = 0.16; 95% CI:0.05, 0.55. CONCLUSIONS/SIGNIFICANCE: Proactive case detection, consisting of screening household members with an RDT and treating those positive with

  17. Caesarean section in a case of systemic lupus erythematosus

    Varsha Vyas; Deepika Shukla; Surekha Patil; Shubha Mohite

    2014-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear an...

  18. Determinants of Caesarean Risk Factor in Northern Region of Bangladesh: A Multivariate Analysis.

    Mostafizur Rahman

    2014-01-01

    Full Text Available Caesarean section (c-section rates have been increasing dramatically in the past decades around the world. This increase has been attributed to multiple factors such as maternal, socio-demographic and institutional fac-tors. Therefore, this study examines the impact of maternal, socio-demographic and relevant characteristics on caesar-ean delivery in the northern region of Bangladesh.This study is based on a total of 1142 delivery cases from four private hospitals and four public hospitals during the period of January to March 2010. The study was carried out using a cross-sectional design where data were collected by simple random sampling. In order to data analysis, first, an initial bivariate analysis was performed by the chi-square and Fisher exact test. Secondly, the risk factors which are associated with c-section identify by logistic re-gression model. Finally, a stepwise regression analysis was carried out to isolate the most influential risk factors.Among the 17 risk factors, nine were found significantly associated with type of delivery. Eight of the risk factors i.e. previous c-section, pregnancy-induced swollen of leg, prolonged labour, maternal education status, mater-nal age more than 25 years, low birth order, length of baby more than 45cm and irregular intake of a balanced diet remained independently significant for caesarean delivery. The value of P<0.05 was considered statistically significant. Maternal complications were found to be more significant in public hospitals than in private ones and conversely for the demographic characteristics.The findings of this study suggested that the above factors may influence the health-seeking behaviour of women in the northern region of Bangladesh.

  19. Effect of bupivicaine to subarachnoid at different specific gravity on CSEA for caesarean section%蛛网膜下腔给予不同比重布比卡因腰-硬联合麻醉在剖宫产术中的效果比较

    黄东林; 韩娜娜

    2012-01-01

    [目的]观察比较不同比重布比卡因腰-硬联合麻醉临床应用于剖宫产术的效果、并发症和安全性.[方法]选择ASA Ⅰ~Ⅱ级择期选取腰麻-硬膜外联合阻滞麻醉(CSEA)的产妇150例,随机分为3组.L组50例产妇为轻比重组,腰麻药为0.75%布比卡因2 mL+无菌注射用水1 mL;Ⅰ组50例产妇为等比重组,腰麻药为0.75%布比卡因2mL+生理盐水1 mL;H组50例产妇为重比重组,腰麻药为0.75%布比卡因2mL+ 10%葡萄糖1 mL.硬膜外导管向头侧置管3 ~4 cm,阻滞不完全者由硬膜外导管注入2%利多卡因联合麻醉.比较分析3组患者麻醉效果,术中不良反应及神经系统并发症的差异.[结果]3组患者麻醉从麻醉效果来看,起效时间及达到最高阻滞平面的时间,H组均小于其他两组,差异有显著性意义(P<0.05),L组起效时间最长,出现阻滞不完全,需追加2%利多卡因的例数较多,差异有显著性意义(P<0.05).H组最高平面维持时间大于其他两组,差异有显著性意义(P<0.05),但术中仰卧位综合征及术后神经系统并发症的发生均高于其他两组,差异有显著性意义(P<0.05).[结论]3种不同比重腰麻液中,0.5%等比重布比卡因用于CSEA剖宫产术效果确切,神经系统并发症少,安全可靠.%[Objective] Evaluating the effectiveness and complications by using bupivicaine at different specific gravity on CSEA for caesarean section. [ Methods ] 150 parturient (ASA I ~ II ) were randomly divided into three groups: L group with 0. 75% bupivicaine 2 mL and water for injection 1 mL as spinal fluid; I group with 0. 75% bupivicaine 2 mL and normal saline 1 mL; H group with 0. 75% bupivicaine 2 mL and 10% glucose 1 mL. 2% lidocaine was supplemented via fcpi-dural catheter if necessary. [Results] The onset time and the duration of reaching the height level of group H is shorter than the other. ( P < 0. 05). There was more incomplete block in group L (P<0.05 ). The

  20. Psychosocial Factors for Women Requesting Cesarean Section

    Yajuan Zhao; Shuangyun Chen

    2013-01-01

    Background: Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors, there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. The psychosocial factors for requesting cesarean section were analyzed in our study. Methods: A self-made questionnaire and the State-Trait Anxiety Inventory (STAI) and Self-rating Depression Scale (SDS) were ...

  1. Caesarean birth: consumption, safety, order, and good mothering.

    Bryant, Joanne; Porter, Maree; Tracy, Sally K; Sullivan, Elizabeth A

    2007-09-01

    This article draws on qualitative data to explore the beliefs through which decisions about caesarean birth are made and to consider how these might contribute to the increasing rate of caesarean birth. A total of 36 interviews were conducted in Australia, including 12 hospital-based midwives, 6 obstetricians, and 18 women who had experienced caesarean birth within the 2 years prior to the research interview. Data reveal a belief derived from the pervasive discourse of neo-liberalism that women are self-governing autonomous subjects in their birth experience, with entitlement to the consumption of birthing information and services, as guided by obstetricians. Feeding into this belief are coexisting discourses that serve to organise 'free choice' in terms of safe/unsafe, order/disorder, life/death; and with ontological meanings, by structuring women's mothering identities as good/bad. The neo-liberal obligation to manage risk and pursue success for both mothers and babies means that women (and others) are obliged to choose what is set up as the most obvious and sensible option: safe, ordered caesareans. The structuring of discourses in this way shows how caesareans can be positioned as a preferential means of birth. PMID:17590252

  2. Anaemia and Iron Homeostasis in a Cohort of HIV-Infected Patients: A Cross-Sectional Study in Ghana

    Christian Obirikorang

    2016-01-01

    Full Text Available Aim. We determined the prevalence of anaemia and evaluated markers of iron homeostasis in a cohort of HIV patients. Methods. A comparative cross-sectional study on 319 participants was carried out at the Tamale Teaching Hospital from July 2013 to December 2013, 219 patients on HAART (designated On-HAART and 100 HAART-naive patients. Data gathered include sociodemography, clinical history, and selected laboratory assays. Results. Prevalence of anaemia was 23.8%. On-HAART participants had higher CD4/CD3 lymphocyte counts, Hb, HCT/PCV, MCV, MCH, iron, ferritin, and TSAT (P<0.05. Hb, iron, ferritin, and TSAT decreased from grade 1 to grade 3 anaemia and CD4/CD3 lymphocyte count was lowest in grade 3 anaemia (P<0.05. Iron (P=0.0072 decreased with disease severity whilst transferrin (P=0.0143 and TIBC (P=0.0143 increased with disease severity. Seventy-six (23.8% participants fulfilled the criteria for anaemia, 86 (26.9% for iron deficiency, 41 (12.8% for iron deficiency anaemia, and 17 (5.3% for iron overload. The frequency of anaemia was higher amongst participants not on HAART (OR 2.6 for grade 1 anaemia; OR 3.0 for grade 3 anaemia. Conclusion. In this study population, HIV-associated anaemia is common and is related to HAART status and disease progression. HIV itself is the most important cause of anaemia and treatment of HIV should be a priority compared to iron supplementation.

  3. Metabolic syndrome, sarcopenia and role of sex and age: cross-sectional analysis of Kashiwa cohort study.

    Shinya Ishii

    Full Text Available Recent epidemiological evidence suggests that effects of cardiovascular risk factors may vary depending on sex and age. In this study, we assessed the associations of metabolic syndrome (MetS with sarcopenia and its components in older adults, and examined whether the associations vary by sex and age. We also tested if any one of the MetS components could explain the associations. We conducted a cross-sectional analysis of the baseline data from the cohort study conducted in Kashiwa city, Chiba, Japan in 2012 which included 1971 functionally-independent, community-dwelling Japanese adults aged 65 years or older (977 men, 994 women. Sarcopenia was defined based on appendicular skeletal muscle mass, grip strength and usual gait speed. MetS was defined based on the National Cholesterol Education Program's Adult Treatment Panel-III criteria. The prevalence of sarcopenia was 14.2% in men and 22.1% in women, while the prevalence of MetS was 43.6% in men and 28.9% in women. After adjustment for potential confounders, MetS was positively associated with sarcopenia in men aged 65 to 74 years (odds ratio 5.5; 95% confidence interval 1.9-15.9 but not in older men or women. Among the sarcopenia components, MetS was associated with lower muscle mass and grip strength, particularly in men aged 65 to 74 years. The associations of MetS with sarcopenia and its components were mainly driven by abdominal obesity regardless of sex or age. In conclusion, MetS is positively associated with sarcopenia in older men. The association is modified by sex and age, but abdominal obesity is the main contributor to the association across sex and age.

  4. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births

    Khajehei M

    2009-01-01

    Full Text Available Background and Objective: We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births. Materials and Methods: This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum. Results: The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi group was 40 days and in the caesarean section (C/S group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%, sexual dissatisfaction (65%, and vaginal looseness (55%. In the C/S group, the most common problems were vaginal dryness (85%, sexual dissatisfaction (60%, and decreased libido (35%. There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant. Conclusion: Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women′s sexual life and try to improve their quality of life after delivery.

  5. Increase in caesarean deliveries after the Australian Private Health Insurance Incentive policy reforms.

    Kristjana Einarsdóttir

    Full Text Available BACKGROUND: The Australian Private Health Insurance Incentive (PHII policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA. METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3 decrease in public birth rates, a 51% (45.1 to 56.4 increase in private birth rates, a 5% (-5.3 to -5.1 and 8% (-8.9 to -7.9 decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1 increase in caesarean sections with labour and 10% (8.0 to 11.7 increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5, but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1. CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

  6. Impact of visual acuity on developing literacy at age 4–5 years: a cohort-nested cross-sectional study

    Bruce, Alison; Fairley, Lesley; Chambers, Bette; Wright, John; Sheldon, Trevor A

    2016-01-01

    OBJECTIVES: To estimate the prevalence of poor vision in children aged 4-5 years and determine the impact of visual acuity on literacy. DESIGN: Cross-sectional study linking clinical, epidemiological and education data. SETTING: Schools located in the city of Bradford, UK. PARTICIPANTS: Prevalence was determined for 11 186 children participating in the Bradford school vision screening programme. Data linkage was undertaken for 5836 Born in Bradford (BiB) birth cohort study children participat...

  7. Self-Reported Speech Problems in Adolescents and Young Adults with 22q11.2 Deletion Syndrome: A Cross-Sectional Cohort Study

    Spruijt, Nicole E.; Vorstman, Jacob AS; Kon, Moshe; Mink van der Molen, Aebele B.

    2014-01-01

    Background Speech problems are a common clinical feature of the 22q11.2 deletion syndrome. The objectives of this study were to inventory the speech history and current self-reported speech rating of adolescents and young adults, and examine the possible variables influencing the current speech ratings, including cleft palate, surgery, speech and language therapy, intelligence quotient, and age at assessment. Methods In this cross-sectional cohort study, 50 adolescents and young adults with t...

  8. At what price? A cost-effectiveness analysis comparing trial of labour after previous Caesarean versus elective repeat Caesarean delivery.

    Fawsitt, Christopher G

    2013-01-01

    Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.

  9. Preoperative administration of cephalosporins for elective caesarean delivery

    Bogavac Mirjana

    2010-01-01

    Full Text Available Introduction. Antibiotic prophylaxis means administration of antibiotics in prevention of infections. Objective. To investigate the efficacy of a single dose preoperative administration of ceftriaxone and cefazolin in the prevention of intra- and postoperative infections in the parturients without high risk of inflammation. Methods. The first group of 45 pregnant and 4 non-pregnant women were preoperatively administered ceftriaxone in a dose of 2 g, i.v., 10 minutes before the planned surgery. The second group of 45 pregnant and 4 non-pregnant women were preoperatively administered cefazolin in a dose of 2 g i.v., 10 minutes before the planned surgery. The concentrations of antibiotics were estimated immediately and 6 hours following the operation, as well as in the amniotic fluid and umbilical cord in the group of pregnant women. The estimation of antibiotic concentration was done by the method of liquid chromatography. Results. The mean concentrations of antibiotics in the patients following the elective caesarean section were as follows: ceftriaxone - 22.7 μg/l. vs cefazolin - 44.8 μg/l. Six hours later, the concentration of antibiotic decreased, but the concentration of cefazolin was still over the MIC for sensitive bacteria. The mean concentrations of antibiotics following gynaecological surgery in the non-pregnant patients were as follows: ceftriaxone - 12.0 μg/l vs cefazolin - 30.1 μg/l. Six hours later, the concentration of antibiotic decreased. Conclusion. It is most optimal to administer a single-dose of the first generation cephalosporins-cefazolin-immediately following the clamping of the umbilical cord as well as in preoperative prophylaxis in gynaecological operations.

  10. Clinical Analysis of 45 Cases of Caesarean Scar Pregnancy

    Hong SHI; Ai-hua FANG; Qin-fang CHEN

    2008-01-01

    Objective To summarize the clinical characteristics of caesarean scar pregnancy and to investigate its treatment.Methods Clinical case records of 45 cases of caesarean scar pregnancy from June 2003 to September 2007 were reviewed.The characteristics and management of cases were analyzed.Results The women's average age was 32.8±5.1 years.All cases had amenorrhoea.and 27 cases had vaginal bleeding from spotting to morderate.Seven cases were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before dilation and curettage(D & C).In case of massive bleeding,caesarean scar pregnancy was diagnosed after D & C.Bleeding was controlled and uterus was conserved in 6 cases,and 1 case underwent hysterectomy because of uncontrollable bleeding.The remaining 38 cases had ultrasound scan,which indicated scar pregnancy before primary treatment.Eight cases were primarily treated with dilation and curettage,in which only 2 cases had slight bleeding in the operation and no further treatment.Nineteen cases were primarily treated with dilation and curettage after uterine artery embolization.in which 17 cases needed no further treatment and had no complications.The success rate was 89.4%(17/19).Eleven cases were primarity treated with trichosanthin 1.2 mg intramuscular.No one encountered massive bleeding,but 7 cases of these 11 cases needed extra treatment.Conclusion Caesarean scar pregnancy must be cautious of,especially in cases of inevitable miscarriage.Dilation and curettage followed uterine artery embolization can be used as the primary treatment for caesarean scar pregnancy.

  11. Objectively measured physical activity and sedentary time:cross-sectional and prospective associations with adiposity in the Millennium Cohort Study

    Griffiths, Lucy J; Sera, Francesco; Cortina-Borja, Mario; Law, Catherine; Ness, Andy R.; Dezateux, Carol

    2016-01-01

    OBJECTIVE: To examine whether physical activity (PA) and sedentary time (ST) in primary school-aged children are associated with adiposity at the start of secondary school, and whether these associations differ by sex or ethnic group.DESIGN: Nationally representative prospective cohort study.SETTING: Children born across the UK, between 2000 and 2002.PARTICIPANTS: 6497 singleton children.OUTCOME MEASURES: Measures of adiposity (body mass index (BMI), fat mass index (FMI) and fat free mass ind...

  12. COMPARISION BE T WEEN METOCLOPRAMIDE AND ONDANSETRON FOR PREVENTION OF NAUSEA AND VOMITING IN CAESAREAN DELIVERY UNDER SPINAL ANAESTHESIA

    Upendra Singh

    2015-09-01

    Full Text Available AIM OF STUDY : To evaluate the anti - emetic efficacy of bolus doses of metoclopramide and ondansetron in preventing nausea and vomiting in caesarean section under spinal anaesthesia. METHODS: Sixty patients of ASA - Ī and ĪĪ undergoing elective caesarean section were randomly divided into 2 groups of 30 each. Group A (n=30 received IV metoclopramide 10mg and Group B (n=30 received IV ondansetron 4mg, 30 minutes prior to spinal anaesthesia. Anaesthetic management was standardized and incidence o f nausea , retching and vomiting was compared between the two groups. RESULTS: The maternal characteristics regarding age, weight and gestational period were not significantly different between the two groups. There was also no statistically significant (p> 0.05 difference of anti - emetic effects (N ausea, vomiting between the two studied drugs. CONCLUSION: No single intervention is available to completely eliminate nausea and vomiting. Metoclopramide is as effective as ondansetron in preventing the incidence of nausea and vomiting in caesarean delivery under spinal anaesthesia.

  13. Ultrasound-guided Transversus Abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomized trial.

    Michel Chandon

    Full Text Available OBJECTIVE: To compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane (TAP block versus Continuous Wound Infusion (CWI with levobupivacaine after caesarean delivery. METHODS: We recruited parturients undergoing elective caesareans for this multicenter study. Following written informed consent, they received a spinal anaesthetic without intrathecal morphine for their caesarean section. The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block (levobupivicaine = 150 mg or a CWI through an elastomeric pump for 48 hours (levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter. Every woman received regular analgesics along with oral morphine if required. The primary outcome was comparison of the 48-hour area under the curve (AUC pain scores. Secondary outcomes included morphine consumption, adverse events, and persistent pain one month postoperatively. RESULTS: Recruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group. By then, 36 patients with TAP and 29 with CWI had completed the study. AUC of pain at rest and during mobilization were not significantly different: 50 [22.5-80] in TAP versus 50 [27.5-130] in CWI (P = 0.4 and 190 [130-240] versus 160 [112.5-247.5] (P = 0.5, respectively. Morphine consumption (0 [0-20] mg in the TAP group and 10 [0-32.5] mg in the CWI group (P = 0.09 and persistent pain at one month were similar in both groups (respectively 29.6% and 26.6% (P = 0.73. CONCLUSION: In cases of morphine-free spinal anesthesia for cesarean delivery, no difference between TAP block and CWI for postoperative analgesia was suggested. TAP block may induce seizures in this specific context. Consequently, such a technique after a caesarean section cannot be recommended. TRIAL REGISTRATION: ClinicalTrials.gov NCT01151943.

  14. Medida da espessura do segmento uterino inferior em gestantes com cesárea prévia: análise da reprodutibilidade intra- e interobservador por ultra-sonografia bi- e tridimensional Lower uterine segment thickness measurement in pregnant women with previous caesarean section: intra- and interobserver reliability analysis using bi- and tridimensional ultrasonography

    Daniela de Abreu Barra

    2008-03-01

    interferir na conduta do obstetra ou antecipar o parto, foi feito por medidas bidimensionais abdominais da espessura total.PURPOSE: to compare the intra and interobserver reproducibility of the total thickness measurement of the inferior uterine segment (IUS, through the abdominal route, and of the muscle layer measurement, through the vaginal route, using bi and tridimensional ultrasonography. METHODS: the IUS thickness measurement of 30 women, between the 36th and 39th weeks of gestation with previous caesarean section, done by two observers, was studied. Abdominal ultrasonography with the patient in both supine and lithotomy position was performed. In the sagittal section, the IUS was identified and four bidimensional images and two tridimensional blocks of the total thickness were collected through the abdominal route, and the same for the muscle layer, through the vaginal route. Tridimensional acquisitions were manipulated in the multiplanar mode. The time was measured with a chronometer. Reproducibility was evaluated by the computation of the absolute difference between measurements, the ratio of differences smaller than 1 mm, the intraclass coefficient (ICC, and the Bland and Altman's concordance limits. RESULTS: the average bidimensional measurement of IUS thickness was 7.4 mm through the abdominal and 2.7 mm through the vaginal route, and the tridimensional measurement was 6.9 mm through the abdominal and 5.1 mm through the vaginal route. Intra- and interobserver reproducibility of vaginal versus abdominal route: smaller absolute difference (0.2-0.4 mm versus 0.8-1.5 mm, greater ratio of differences (85.8-97.8% versus 48.7-72,8%, with p0.05[A1] and similar lower concordance limits (-38 to 3.4 versus -3.6 to 4 mm for tridimensional ultrasonography and ICC (0.6-0.9 versus 0.7-0.9. CONCLUSIONS: from the above, we came to the conclusion that the measurement of the IUS muscle layer, through the vaginal route using tridimensional ultrasonography is more reproducible

  15. Acute Chest Syndrome in Sickle Cell Disease Patients Post Caesarean Delivery

    YM Zhang

    2016-02-01

    Full Text Available Sickle cell disease (SCD is the most common inherited disease worldwide and is associated with anaemia and intermittent painful crisis. Pregnant women who are affected are known to have increased maternal and fetal mortality and morbidity. Acute chest syndrome (ACS is an uncommon but serious complication in pregnant women with SCD that can lead to death. We present two cases of patients with SCD, both of whom had severe ACS within 24 hours post Caesarean section. By accurate diagnosis and appropriate management by a multidisciplinary team, both mothers and fetuses had excellent outcomes. It is suggested that prompt recognition of ACS in a pregnant woman with SCD and collaborative medical and obstetric management are essential to optimize maternal and fetal outcomes.

  16. Perceived Health After Kidney Transplantation : A Cross-sectional Comparison of Long-term and Short-term Cohorts

    Schulz, T.; Niesing, J.; van der Heide, J. J. Homan; Westerhuis, R.; Ploeg, R. J.; Ranchor, A. V.

    2013-01-01

    Although increased longevity of grafts has led to a growing number of long-term kidney transplant recipients, knowledge about the perceived health of these patients remains limited. A cross-sectional sample of 609 patients (60% response) was stratified into a short-term (1 and 8 and .05). Furthermor

  17. Cross-sectional and longitudinal comparisons of metabolic profiles between vegetarian and non-vegetarian subjects: a matched cohort study.

    Chiu, Yen-Feng; Hsu, Chih-Cheng; Chiu, Tina H T; Lee, Chun-Yi; Liu, Ting-Ting; Tsao, Chwen Keng; Chuang, Su-Chun; Hsiung, Chao A

    2015-10-28

    Several previous cross-sectional studies have shown that vegetarians have a better metabolic profile than non-vegetarians, suggesting that a vegetarian dietary pattern may help prevent chronic degenerative diseases. However, longitudinal studies on the impact of vegetarian diets on metabolic traits are scarce. We studied how several sub-types of vegetarian diets affect metabolic traits, including waist circumference, BMI, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, total cholesterol (TC), HDL, LDL, TAG and TC:HDL ratio, through both cross-sectional and longitudinal study designs. The study used the MJ Health Screening database, with data collected from 1994 to 2008 in Taiwan, which included 4415 lacto-ovo-vegetarians, 1855 lacto-vegetarians and 1913 vegans; each vegetarian was matched with five non-vegetarians based on age, sex and study site. In the longitudinal follow-up, each additional year of vegan diet lowered the risk of obesity by 7 % (95 % CI 0·88, 0·99), whereas each additional year of lacto-vegetarian diet lowered the risk of elevated SBP by 8 % (95 % CI 0·85, 0·99) and elevated glucose by 7 % (95 % CI 0·87, 0·99), and each additional year of ovo-lacto-vegetarian diet increased abnormal HDL by 7 % (95 % CI 1·03, 1·12), compared with non-vegetarians. In the cross-sectional comparisons, all sub-types of vegetarians had lower likelihoods of abnormalities compared with non-vegetarians on all metabolic traits (P<0·001 for all comparisons), except for HDL and TAG. The better metabolic profile in vegetarians is partially attributable to lower BMI. With proper management of TAG and HDL, along with caution about the intake of refined carbohydrates and fructose, a plant-based diet may benefit all aspects of the metabolic profile. PMID:26355190

  18. A cross-sectional analysis of pet-specific immunoglobulin E sensitization and allergic symptomatology and household pet keeping in a birth cohort population.

    Ezell, Jerel M; Wegienka, Ganesa; Havstad, Suzanne; Ownby, Dennis R; Johnson, Christine C; Zoratti, Edward M

    2013-01-01

    It is unknown whether family members with detectable specific immunoglobulin E (sIgE) and/or allergic symptoms to pets are more or less likely to reside in a household with pets. We cross-sectionally investigated potential relationships between family members' allergic sensitization and symptoms to dogs and cats and current household pet-keeping practices, using birth cohort data. Blood samples taken from children enrolled in a birth cohort and their biological mothers and fathers, when the children were aged 18 years, were assessed for sIgE to dog and cat allergens. Interviews assessed subjects' self-reported pet exposure symptoms, current household pet-keeping practices, and socioeconomic characteristics. Overall, household dog or cat keeping was not associated with sIgE to these animals and/or self-reported allergic symptoms in the presence of these animals, even after controlling for factors such as education and household income. In subgroup analyses, current household dog keeping among dog-symptomatic teens (n = 40) was significantly lower than among teens who were not dog symptomatic (n = 289), at 48.8 and 61.1%, respectively (p = 0.036). Current household cat keeping was significantly lower among cat-symptomatic mothers (n = 27) compared with mothers who were not cat symptomatic (n = 120), at 24.3 and 37.0%, respectively (p = 0.015). However, when considering those who were both sensitized and reported symptoms, only the mother and cat-keeping associations persisted (p = 0.049). When cat-sensitized mothers report allergic symptoms to cats, these pets may be less likely to be kept in homes. Elevated dog and cat allergen sIgE does not appear to be associated with the keeping of these pets. PMID:24169057

  19. Inverse association of plasma IL-13 and inflammatory chemokines with lung function impairment in stable COPD: a cross-sectional cohort study

    Choi Augustine MK

    2007-09-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a heterogeneous syndrome characterized by varying degrees of airflow limitation and diffusion impairment. There is increasing evidence to suggest that COPD is also characterized by systemic inflammation. The primary goal of this study was to identify soluble proteins in plasma that associate with the severity of airflow limitation in a COPD cohort with stable disease. A secondary goal was to assess whether unique markers associate with diffusion impairment, based on diffusion capacity of carbon monoxide (DLCO, independent of the forced expiratory volume in 1 second (FEV1. Methods A cross sectional study of 73 COPD subjects was performed in order to examine the association of 25 different plasma proteins with the severity of lung function impairment, as defined by the baseline measurements of the % predicted FEV1 and the % predicted DLCO. Plasma protein concentrations were assayed using multiplexed immunobead-based cytokine profiling. Associations between lung function and protein concentrations were adjusted for age, gender, pack years smoking history, current smoking, inhaled corticosteroid use, systemic corticosteroid use and statin use. Results Plasma concentrations of CCL2/monocyte chemoattractant protein-1 (CCL2/MCP-1, CCL4/macrophage inflammatory protein-1β (CCL4/MIP -1β, CCL11/eotaxin, and interleukin-13 (IL-13 were inversely associated with the % FEV1. Plasma concentrations of soluble Fas were associated with the % DLCO, whereas CXCL9/monokine induced by interferon-γ (CXCL9/Mig, granulocyte- colony stimulating factor (G-CSF and IL-13 showed inverse relationships with the % DLCO. Conclusion Systemic inflammation in a COPD cohort is characterized by cytokines implicated in inflammatory cell recruitment and airway remodeling. Plasma concentrations of IL-13 and chemoattractants for monocytes, T lymphocytes, and eosinophils show associations with increasing severity of

  20. Metallothionein MT2A A-5G Polymorphism as a Risk Factor for Chronic Kidney Disease and Diabetes: Cross-Sectional and Cohort Studies.

    Hattori, Yuta; Naito, Mariko; Satoh, Masahiko; Nakatochi, Masahiro; Naito, Hisao; Kato, Masashi; Takagi, Sahoko; Matsunaga, Takashi; Seiki, Toshio; Sasakabe, Tae; Suma, Shino; Kawai, Sayo; Okada, Rieko; Hishida, Asahi; Hamajima, Nobuyuki; Wakai, Kenji

    2016-07-01

    Metallothioneins (MTs) are proteins that protect cells from toxic agents such as heavy metal ions or reactive oxygen species. MT2A A-5G is a single nucleotide polymorphism in the promoter region of the MT2A gene, and the minor G allele results in lower transcription efficiency. We aimed to elucidate associations between MT2A A-5G and risks of 2 diseases potentially related to lowered MT expression, chronic kidney disease (CKD), and diabetes mellitus (DM), in a community-dwelling population. Study subjects were Nagoya city residents participating in the Japan Multi-Institutional Collaborative Cohort Study (J-MICC) Daiko Study, comprised 749 men and 2,025 women, aged 39-75 years. CKD (>stage 3) and DM were defined by standard guidelines. Associations were evaluated using logistic regression models with adjustments for age, sex and potential confounders in a cross-sectional study, and verified in a 5-year longitudinal study. Odds ratios (OR [95% confidence interval]) were calculated relative to the AA genotype. Serum MT (I + II), Cd and zinc levels were also determined by genotype. The OR of the GG genotype for CKD risk was 3.98 (1.50, 10.58) in the cross-sectional study and 5.17 (1.39, 19.28) in the longitudinal study. The OR of the GA genotype for DM was 1.86 (1.26, 2.75) in the cross-sectional study and 2.03 (1.19, 3.46) in the longitudinal study. MT2A A-5G may be associated with CKD and DM risks. This polymorphism is a promising target for evaluations of CKD and DM risks with possible involvement of low-dose chronic exposure to environmental pollutants. PMID:27122239

  1. Polychlorinated biphenyls, glycaemia and diabetes in a population living in a highly polychlorinated biphenyls-polluted area in northern Italy: a cross-sectional and cohort study

    Claudia Zani

    2013-05-01

    Full Text Available Background. Polychlorinated biphenyls (PCBs have been found to be associated with diabetes in some, but not all, studies performed so far. The aim of this study was to assess the association between PCB serum levels and glycaemia and diabetes in people living in Brescia, a highly industrialised PCB-polluted town in Northern Italy. Design and Methods. 527 subjects were enrolled in a cross-sectional population-based study: they were interviewed face-to-face in 2003 and also provided a blood sample under fasting conditions. The concentration of 24 PCB congeners was determined using gas-chromatography (GC/MS. Subsequently, all subjects were included in a follow-up (cohort study. According to the Local Health Authority health-care database, subjects were considered to be diabetic if they had diabetes at interview time (prevalent cases or during a 7-year follow-up (incident cases. Results. A total of 53 subjects (10.0% were diabetics: 28 had dia- betes at enrolment and other 25 developed the disease subsequently. Diabetes frequency increased according to the serum concentrations of total PCBs and single PCB congeners, but no association was found when estimates were adjusted for education, body mass index, age and gender by logistic regression analysis. Accordingly, glycaemia increased with PCB serum levels, but no association was observed when multiple regression analysis, including confounding factors, was performed. Conclusions. This study does not support the hypothesis that PCB environmental exposure is strictly associated with diabetes or glycaemia.

  2. Post Caesarean Sagittal Sinus Thrombosis after Spinal Anaesthesia: A Case Report

    Gaurav Tomar; Neeraj Narang; TC Kriplani; Ashish Sethi

    2010-01-01

    Central venous thrombosis, although rare, is a recognized cause of puerperium stroke. We present a case of successfully managed sagittal sinus thrombosis (SST) developed in a parturient after Caesarean delivery under spinal anaesthesia.

  3. Nested Cohort

    NestedCohort is an R software package for fitting Kaplan-Meier and Cox Models to estimate standardized survival and attributable risks for studies where covariates of interest are observed on only a sample of the cohort.

  4. Cohort Coefficients

    Kristensen, Gustav

    2013-01-01

    Cohorts are the aggregate of individuals who experience the same event within the same time interval. Cohorts can be based on people born in a given year, for example in 1940 or within a span of years, e.g. born in 1940-1944. The year of birth is here the defining event for cohorts. The health di...

  5. High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort.

    Salgado, Eva; Bes-Rastrollo, Maira; de Irala, Jokin; Carmona, Loreto; Gómez-Reino, Juan J

    2015-09-01

    Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis. We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case-control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease. The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25-75: 2.63-4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1-2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case-control study. High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research. PMID:26376372

  6. High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort

    Salgado, Eva; Bes-Rastrollo, Maira; de Irala, Jokin; Carmona, Loreto; Gómez-Reino, Juan J.

    2015-01-01

    Abstract Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis. We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case–control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease. The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25–75: 2.63–4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1–2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case–control study. High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research. PMID:26376372

  7. Serum uric acid concentrations in meat eaters, fish eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort.

    Julie A Schmidt

    Full Text Available INTRODUCTION: Circulating concentrations of uric acid may be affected by dietary components such as meat, fish and dairy products, but only a few studies have compared uric acid concentrations among individuals who exclude some or all of these foods from their diet. The aim of this study was to investigate differences in serum uric acid concentrations between meat eaters, fish eaters, vegetarians and vegans. SUBJECTS AND METHODS: A sample of 670 men and 1,023 women (424 meat eaters, 425 fish eaters, 422 vegetarians and 422 vegans, matched on age and sex from the European Prospective Investigation into Cancer and Nutrition Oxford cohort were included in this cross-sectional analysis. Diet was assessed using a semi-quantitative food frequency questionnaire and serum concentrations of uric acid were measured. Mean concentrations of uric acid by diet group were calculated after adjusting for age, body mass index, calcium and alcohol intake. RESULTS: In both men and women, serum uric acid concentrations differed significantly by diet group (p<0.0001 and p = 0.01, respectively. The differences between diet groups were most pronounced in men; vegans had the highest concentration (340, 95% confidence interval 329-351 µmol/l, followed by meat eaters (315, 306-324 µmol/l, fish eaters (309, 300-318 µmol/l and vegetarians (303, 294-312 µmol/l. In women, serum uric acid concentrations were slightly higher in vegans (241, 234-247 µmol/l than in meat eaters (237, 231-242 µmol/l and lower in vegetarians (230, 224-236 µmol/l and fish eaters (227, 221-233 µmol/l. CONCLUSION: Individuals consuming a vegan diet had the highest serum concentrations of uric acid compared to meat eaters, fish eaters and vegetarians, especially in men. Vegetarians and individuals who eat fish but not meat had the lowest concentrations of serum uric acid.

  8. What characterises women who eat potatoes? A cross-sectional study among 74,208 women in the Norwegian Women and Cancer cohort

    Lene A. Åsli

    2015-02-01

    Full Text Available Background: Studies of potato consumption have shown that age, region, socioeconomic status, and household structure are important determinants. Objective: This study aims to map which factors influence potato consumption among women in the Norwegian Women and Cancer (NOWAC study. Design: A cross-sectional study using a postal questionnaire among 74,208 NOWAC participants aged 41–70. Results: Results showed that 56% of the women ate at least two potatoes a day. A north–south gradient in potato consumption was observed in logistic regression models (OR: 3.41, 95% CI: 3.19–3.64 for the north compared to the capital. Women in households with children had lower odds of high potato consumption than women living only with a partner, and women who lived alone had the lowest odds of all (OR: 0.39, 95% CI: 0.37–0.41. Smokers had higher odds of high potato consumption, while diabetics had lower odds. The odds of high potato consumption were greater among older women, and among those with lower income and education. In a sub-cohort, women who were dieting had lower odds of high potato consumption. Consumption of different foods varied in the low versus the high potato consumption group, with largest effect for fish and pasta/rice. The groups had similar nutrient densities. Conclusions: In addition to lifestyle and socioeconomic factors, health-related factors like smoking and diabetes were found to influence potato consumption. The high potato consumption group had an especially high consumption of fish and a low consumption of pasta/rice, though the nutrient density in the groups was similar.

  9. Road Traffic and Railway Noise Exposures and Adiposity in Adults: A Cross-Sectional Analysis of the Danish Diet, Cancer, and Health Cohort

    Christensen, Jeppe Schultz; Raaschou-Nielsen, Ole; Tjønneland, Anne; Overvad, Kim; Nordsborg, Rikke B.; Ketzel, Matthias; Sørensen, Thorkild IA; Sørensen, Mette

    2015-01-01

    Background Traffic noise has been associated with cardiovascular and metabolic disorders. Potential modes of action are through stress and sleep disturbance, which may lead to endocrine dysregulation and overweight. Objectives We aimed to investigate the relationship between residential traffic and railway noise and adiposity. Methods In this cross-sectional study of 57,053 middle-aged people, height, weight, waist circumference, and bioelectrical impedance were measured at enrollment (1993–1997). Body mass index (BMI), body fat mass index (BFMI), and lean body mass index (LBMI) were calculated. Residential exposure to road and railway traffic noise exposure was calculated using the Nordic prediction method. Associations between traffic noise and anthropometric measures at enrollment were analyzed using general linear models and logistic regression adjusted for demographic and lifestyle factors. Results Linear regression models adjusted for age, sex, and socioeconomic factors showed that 5-year mean road traffic noise exposure preceding enrollment was associated with a 0.35-cm wider waist circumference (95% CI: 0.21, 0.50) and a 0.18-point higher BMI (95% CI: 0.12, 0.23) per 10 dB. Small, significant increases were also found for BFMI and LBMI. All associations followed linear exposure–response relationships. Exposure to railway noise was not linearly associated with adiposity measures. However, exposure > 60 dB was associated with a 0.71-cm wider waist circumference (95% CI: 0.23, 1.19) and a 0.19-point higher BMI (95% CI: 0.0072, 0.37) compared with unexposed participants (0–20 dB). Conclusions The present study finds positive associations between residential exposure to road traffic and railway noise and adiposity. Citation Christensen JS, Raaschou-Nielsen O, Tjønneland A, Overvad K, Nordsborg RB, Ketzel M, Sørensen TI, Sørensen M. 2016. Road traffic and railway noise exposures and adiposity in adults: a cross-sectional analysis of the Danish Diet

  10. The Ontario Mother and Infant Study (TOMIS III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year

    Landy Christine

    2009-04-01

    Full Text Available Abstract Background The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge. Methods and design The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings. Discussion The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to

  11. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development

    Vervoort, A.J.M.W.; Uittenbogaard, L.B.; Hehenkamp, W.J.K.; Brölmann, H.A.M.; Mol, B.W.J.; Huirne, J.A.F.

    2015-01-01

    Caesarean section (CS) results in the occurrence of the phenomenon ‘niche’. A ‘niche’ describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6–12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation. PMID:26409016

  12. Fine needle aspiration cytology diagnosis of caesarean scar endometriosis with histopathological correlation: a case report

    Sandeep P. Kumar

    2015-06-01

    Full Text Available Endometriosis is defined as the presence of endometrial tissue outside the endometrium or myometrium. It occurs in 8-15% of women of reproductive age group with abdominal wall endometriosis accounting for only 0.5-1% of all pelvic endometriosis. We present a case of a 25 year old lady who presented with a mass in the anterior abdominal wall over a previous caesarean section scar. Endometriosis was diagnosed on Fine Needle Aspiration Cytology (FNAC based on the findings of monolayered sheets of endometrial cells, few spindle shaped stromal cells and hemosiderin laden macrophages in the background. Histopathological examination confirmed the cytological diagnosis. Endometriosis in scar tissue is a rare disease which might be difficult to diagnose and should always be considered in evaluation of painful abdominal masses in women. Fine needle aspiration cytology is economical, fast and accurate method to make the diagnosis of scar endometriosis and to plan better surgical approach. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 921-923

  13. Hormone replacement therapy use and plasma levels of sex hormones in the Norwegian Women and Cancer Postgenome Cohort – a cross-sectional analysis

    Olsen Karina S

    2008-01-01

    Full Text Available Abstract Background Hormone replacement therapy use (HRT is associated with increased breast cancer risk. Our primary objective was to explore hormone levels in plasma according to HRT use, body mass index (BMI and menopausal status. A secondary objective was to validate self-reported questionnaire information on menstruation and HRT use in the Norwegian Women and Cancer postgenome cohort (NOWAC. Methods We conducted a cross-sectional study of sex hormone levels among 445 women aged 48–62 who answered an eight-page questionnaire in 2004 and agreed to donate a blood sample. The samples were drawn at the women's local general physician's offices in the spring of 2005 and sent by mail to NOWAC, Tromsø, together with a two-page questionnaire. Plasma levels of sex hormones and Sex Hormone Binding Globulin (SHBG were measured by immunometry. 20 samples were excluded, leaving 425 hormone measurements. Results 20% of postmenopausal women were HRT users. The plasma levels of estradiol (E2 increased with an increased E2 dose, and use of systemic E2-containing HRT suppressed the level of Follicle Stimulating Hormone (FSH. SHBG levels increased mainly among users of oral E2 preparations. Vaginal E2 application did not influence hormone levels. There was no difference in BMI between HRT users and non-users. Increased BMI was associated with increased E2 and decreased FSH and SHBG levels among non-users. Menopausal status defined by the two-page questionnaire showed 92% sensitivity (95% CI 89–96% and 73% specificity (95% CI 64–82%, while the eight-page questionnaire showed 88% sensitivity (95% CI 84–92% and 87% specificity (95% CI 80–94%. Current HRT use showed 100% specificity and 88% of the HRT-users had plasma E2 levels above the 95% CI of non-users. Conclusion Users of systemic E2-containing HRT preparations have plasma E2 and FSH levels comparable to premenopausal women. BMI has an influence on hormone levels among non-users. NOWAC

  14. On the motivations and career orientations of self-initiated and conventional expatriates employed in the Saudi Arabian banking industry: a two scale contextual validation and an inter-cohort cross-sectional investiagation and controls

    Alshahrani, Saeed Turki

    2015-01-01

    peer-reviewed cross-sectional inter-cohort study explores the dominant motivational factors and career orientations among conventional (CE) and self-initiated (SE) expatriates. Quantitative data was obtained from a sample of 344 SEs and 74 CEs working in the banking sector in Saudi Arabia. Firstly, a principal components analysis (PCA) was conducted to validate a pull-push model of motivations governing the decision to expatriate and a career anchors model. Secondly, six mot...

  15. COMPARISON OF TWO DOSES OF OXYTOCIN FOR THE PREVENTION OF POSTPARTUM UTERINE ATONY IN PARTURIENTS UNDERGOING EMERGENCY CAESAREAN DELIVERY: A RANDOMIZED DOUBLE BLIND STUDY

    Fayaz Ahmad

    2016-04-01

    Full Text Available BACKGROUND The optimal dose of oxytocin at Caesarean section is unclear. Oxytocin may cause adverse cardiovascular effects including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomized double-blind trial. METHODS 80 patients undergoing emergency Caesarean section received an IV bolus of either 2 or 5 units (u of oxytocin after delivery, followed by an oxytocin infusion of 10 uh-1 . All patients received spinal anaesthesia with mean arterial pressure maintained by injection ephedrine. We compared changes in Heart Rate (HR, Mean Arterial Pressure (MAP, blood loss, uterine tone, the need for additional uterotonic drugs and antiemetics. RESULTS There was a greater increase in mean (SD HR in patients who received 5u of oxytocin [32 (17 beats min-1 ] than in those who received 2 u [24 (13 beats min-1 ] (P=0.015. There was a larger decrease in MAP in patients who received 5 u [13 (15 mmHg] than in those who received 2 u [6 (10 mmHg] (P=0.030. The frequency of nausea and antiemetic use was higher after 5 u (32.5% than 2 u (5% (P=0.003. There were no differences in blood loss, uterine tone or requests for additional uterotonic drugs (17.5% in both groups. CONCLUSIONS In emergency Caesarean section, a 2 u bolus of oxytocin results in less haemodynamic change than 5 u with less nausea and no difference in the need for additional uterotonics.

  16. Anesthesia for caesarean section in a gravida with peripartum cardiomyopathy combined with acute heart failure: a case report%围产期心肌病合并急性心力衰竭剖宫产麻醉处理1例

    曾鸿; 李晓曦; 赵文秋; 冯新恒; 郭向阳

    2012-01-01

    SUMMARY Peripartum cardiomyopathy ( PPCM) is a rare but serious form of cardiac failure affecting women in the last month of pregnancy or early puerperium within six months. Clinical presentation of PPCM is similar to that of idiopathic dilated cardiomyopathy, and maternal mortality is high. An 18 year-old pri-migravida was admitted to our hospital at the end of forty-one weeks of gestation. She was diagnosed with PPCM complicated with heart failure. Preoperative optimization was done with a view to managing left ventricular failure. Continuous epidural anesthesia in the sitting position with lidocaine was used for cesare-an section. The baby was delivered successfully. Intravenous furosemide 20 mg, morphine 10 mg, cedi-lanid 0.4 mg were given. Nitroglycerin and milinone infusions continued throughout the surgery titrated to the hemodynamics. The patient received inotropic agents, dieresis, vasodilators and anticoagulants post-operatively. Both the mother and the baby were discharged safely 9 days after operation.

  17. Parity and the Risk of Diabetes Mellitus among Chinese Women: A Cross-Sectional Evidence from the Tongji-Dongfeng Cohort Study

    Tian, Yaohua; Shen, Lijun; Jing WU; Chen, Weihong; Yuan, Jing; Yang, Handong; Wang, Youjie; Liang, Yuan; Wu, Tangchun

    2014-01-01

    Objectives Little is known about the long-term health impact of pregnancy on women. The objective of this study was to examine the association between parity and the risk of diabetes among a population of Chinese women. Study design A total of 14,196 women (aged ≥45 years) from the Dongfeng-Tongji Cohort study who had experienced at least one live birth completed baseline questionnaires, medical examinations, and provided baseline blood samples. Participants were categorized into four groups ...

  18. Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study

    Turkeshi, Eralda; Zelenukha, Dmitry; Vaes, Bert; Andreeva, Elena; Frolova, Elena; Degryse, Jean-Marie

    2015-01-01

    Background: Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units. Aims: This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium. Methods: Spirograms from two population-based coho...

  19. Conventional laparotomy for management of caesarean scar ectopic pregnancy: a case report

    Nilesh C. Mhaske

    2015-10-01

    Full Text Available Increase in the rates of caesarean deliveries has led to a concurrent rise in the number of caesarean scar ectopic pregnancies (CSEP. With recent advances, diagnosis can be made at an early gestational age, hence facilitating a prompt intervention. With the varied treatment options available, choosing the right one may possess a clinical dilemma. However, in a low resource setting, conventional laparotomy may be the only option feasible. A case of CSEP managed with laparotomy is presented. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1581-1584

  20. Tendencias de cesáreas en relación con factores no clínicos en un centro de educación para el parto en la Ciudad de México Trends in caesarean sections associated with non-clinical factors in a Birthing Educational Center in Mexico City

    Lourdes Campero

    2007-04-01

    Full Text Available OBJETIVOS: Describir las tendencias de la operación cesárea (OC asociadas con factores no clínicos en mujeres que asistieron al Centro de Educación para el Parto (CEPAPAR en la Ciudad de México. MATERIAL Y MÉTODOS: Se analizó información de 992 nacimientos de 847 mujeres, ocurridos entre 1988 y 2000. Se utilizó el método de regresión lineal para identificar el comportamiento de factores no clínicos con respecto a la tendencia de OC. RESULTADOS: La incidencia global de OC fue de 32.8%, con 8% de incremento promedio anual. El porcentaje de OC se mantuvo por debajo de 30% hasta 1994; durante los siguientes años se incrementó hasta 40%. Al analizar la tendencia de OC en relación con factores no clínicos se encontró que, a lo largo del periodo 1988-2000, el aumento en la incidencia de la OC fue mayor en nacimientos sin instructora presente, entre mujeres primigestas y en hospitales grandes (con más de 50 camas. CONCLUSIONES: Los resultados muestran que el aumento en la incidencia de OC está asociado a factores no clínicos, como el tamaño del hospital y la presencia de una instructora. Un modelo de apoyo a mujeres, que cuente con asesoría, información y presencia de una instructora durante el trabajo de parto, puede contribuir a disminuir el riesgo de tener una OC innecesaria en poblaciones como la estudiada.OBJECTIVES: To describe the trends in caesarian sections (CS associated with non-clinical factors in women who attended a birthing educational facility, also known as 'Centro de Educación,' (CEPAPAR in Mexico City. METHODS: Data from 992 births of 847 women that occurred from 1988-2000 were analyzed using linear regression to identify the association between non-clinical factors and time-trends in CS. RESULTS: The overall incidence of CS was 32.8%, with an 8% average annual increase. Until 1994 the percentage of CS remained relatively steady at 30%, increasing to 40% in subsequent years. In analyzing trends in CS and their

  1. Nocturnal haemoglobin oxygen desaturation in urban and rural East African paediatric cohorts with and without sickle cell anaemia: a cross-sectional study

    L'Esperance, V.S.; Ekong, T.; Cox, S E; Makani, J.; Newton, C R; Soka, D.; Komba, A.; Kirkham, F. J.; Hill, C. M.

    2016-01-01

    Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94-100)%); p

  2. LIVE CONJOINED TWIN BABIES DELIVERED BY CAESAREAN SECTION: A CASE REPORT

    Biswas,, S.; Rout; Mukhopadhyay,

    2014-01-01

    Conjoined twins, commonly referred to as Siamese twins, are babies connected physically to each other. Depending upon the point of connection, there are different types of conjoined twins. A targeted sonographic examination at midpregnancy can diagnose the entity in most cases. Fetal prognosis depends on the period of gestation at delivery, birth weight, extent of organ sharing by the fetuses and possibility of surgical separation. Viable conjoined twins should be delivere...

  3. [Case report: patient with needle phobia for caesarean section - not quite as in a textbook …].

    Hillermann, Thomas; Breitenstein, Chantal; Soll, Cristina

    2015-06-01

    In a 20-year old parturient general anesthesia is induced by inhalation and without venous access because of severe needle phobia. This article discusses risks associated with inhalational induction of anesthesia in this special situation. It deals with needle phobia, an anxiety disorder belonging to the group of blood-injury-injection phobia. This psychic illness can cause severe problems for the anaesthetic management in acute or in elective situations. PMID:26147408

  4. Effect of high-volume systematic local infiltration analgesia in Caesarean section

    Larsen, Katrine Rose; Kristensen, B B; Rasmussen, Marianne A.; Rasmussen, Y H; Weber, T; Kristensen, Bent; Kehlet, H

    2015-01-01

    endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation. RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the...... found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed. CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no...

  5. Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study

    Knight-Agarwal, Catherine R; Davey, Rachel; Cochrane, Tom

    2016-01-01

    Objective To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. Methods A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m2); normal weight (19–24 kg/m2); overweight (25–29 kg/m2); obese class I (30–34 kg/m2); obese class II (35–39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. Results Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). Conclusions Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless

  6. Birth cohorts

    Andersen, Anne-Marie Nybo; Madsen, Mia

    2009-01-01

    ; provides practical guidance on how to set-up and maintain birth cohorts for completing family-based studies in life course epidemiology; describes how to undertake appropriate statistical analyses of family-based studies and correctly interpret results from these analyses; and provides examples that...

  7. Risk factors for venous thromboembolism in 1.3 million pregnancies: a nationwide prospective cohort.

    Rie Adser Virkus

    Full Text Available OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders was retrieved from national registries. The diagnosis of venous thromboembolism was confirmed through medical charts. We calculated adjusted incidence rates per 10,000 women years and used Poisson regression to estimate effects during pregnancy and the puerperal period. RESULTS: We studied 1,297,037 pregnancies and related puerperal periods, during which there were 748 venous thromboembolisms. The incidence rate for venous thromboembolism during a pregnancy with and without hospitalization for hyperemesis was 15.2/10,000 yr and 6.3/10,000 yr, respectively, (adjusted rate ratio: 2.5 (95%-confidence interval; 1.4-4.5. The incidence rate among women with multiple pregnancies was 18.2/10,000 yr and 6.3/10,000 yr in singletons (adjusted rate ratio: 2.8 (1.9-4.2. Increased risk was found with hospitalization during pregnancy or the puerperal period with incidence rates of 42.1/10.000 and 54.7/10.000, respectively, (rate ratios: 12.2 (8.7-17 and 5.9 (4.0-8.8. Women hospitalized with infections during pregnancy had incidence rates of 25.9/10,000 yr and 29.3/10,000 yr during pregnancy and the puerperal period, respectively, and of 62.7/10,000 yr if hospitalized with infection in the puerperal period. Puerperal venous thromboembolism was associated with hospitalization for preeclampsia and intrauterine growth restriction/fetal death with incidence rates of 45.8/10,000 yr and 18.3/10,000 yr, respectively (rate ratio: 5.0 (3.1-7.8 and 1.9 (0.9-4.4. Additionally puerperal venous thromboembolism was associated with obesity, elective and acute caesarean sections and major postpartum bleeding with incidence rates of 25.5/10,000 yr, 23.2/10,000 yr, 34.0/10,000 yr and 20

  8. Nocturnal haemoglobin oxygen desaturation in urban and rural East African paediatric cohorts with and without sickle cell anaemia: a cross-sectional study.

    L'Esperance, V S; Ekong, T; Cox, S E; Makani, J; Newton, C R; Soka, D; Komba, A; Kirkham, F J; Hill, C M

    2016-04-01

    Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94-100)%); pnight-time SpO2 compared with rural Kenyan children with SCA. Possible explanations include differences in the prevalence of obstructive sleep apnoea or asthma, alterations in the oxyhaemoglobin desaturation curve or cardiovascular compromise, for example, to shunting at atrial or pulmonary level secondary to increased pulmonary artery pressure. The fact that non-SCA siblings in the urban area are also affected suggests that environmental exposures, for example, air pollution, nutrition or physical exercise, may play a role. Further studies should determine aetiology and clinical relevance for the SCA phenotype in children resident in Africa. PMID:26699539

  9. Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Healthy Ageing (MELSHA: cross-sectional analysis of prevalence and risk factors

    Browning Colette

    2010-06-01

    Full Text Available Abstract Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community. Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA, collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000 in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk. Results Self-reported medication side effects were reported by approximately 6.7% (67/1000 of the entire baseline MELSHA cohort, and by 8.5% (65/761 of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors. Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

  10. Impact of the adipokine adiponectin and the hepatokine fetuin-A on the development of type 2 diabetes: prospective cohort- and cross-sectional phenotyping studies.

    Norbert Stefan

    Full Text Available BACKGROUND: Among adipokines and hepatokines, adiponectin and fetuin-A were consistently found to predict the incidence of type 2 diabetes, both by regulating insulin sensitivity. OBJECTIVE: To determine to what extent circulating adiponectin and fetuin-A are independently associated with incident type 2 diabetes in humans, and the major mechanisms involved. METHODS: Relationships with incident diabetes were tested in two cohort studies: within the European Prospective Investigation into Cancer and Nutrition (EPIC-Potsdam study (628 cases and the Nurses' Health Study (NHS; 470 cases. Relationships with body fat compartments, insulin sensitivity and insulin secretion were studied in the Tübingen Lifestyle Intervention Program (TULIP; N = 358. RESULTS: Circulating adiponectin and fetuin-A, independently of several confounders and of each other, associated with risk of diabetes in EPIC-Potsdam (RR for 1 SD: adiponectin: 0.45 [95% CI 0.37-0.54], fetuin-A: 1.18 [1.05-1.32] and the NHS (0.51 [0.42-0.62], 1.35 [1.16-1.58]. Obesity measures considerably attenuated the association of adiponectin, but not of fetuin-A. Subjects with low adiponectin and concomitantly high fetuin-A had the highest risk. Whereas both proteins were independently (both p<1.8×10(-7 associated with insulin sensitivity, circulating fetuin-A (r = -0.37, p = 0.0004, but not adiponectin, associated with insulin secretion in subjects with impaired glucose tolerance. CONCLUSIONS: We provide novel information that adiponectin and fetuin-A independently of each other associate with the diabetes risk. Furthermore, we suggest that they are involved in the development of type 2 diabetes via different mechanisms, possibly by mediating effects of their source tissues, expanded adipose tissue and nonalcoholic fatty liver.

  11. Effort-reward imbalance at work and risk of sleep disturbances. Cross-sectional and prospective results from the Danish Work Environment Cohort Study

    Rugulies, Reiner; Norborg, Malene; Sørensen, Tilde Sand;

    2009-01-01

    gender-stratified, multivariate logistic and linear regression analyses, adjusted for numerous covariates. RESULTS: Cross-sectionally, a 1 S.D. increase in the ERI ratio was associated with sleep disturbances among both men [odds ratio (OR)=1.65, 95% confidence interval (CI)=1.20-2.27] and women (OR=1...... disturbances in the Danish workforce. Among women, an association between ERI and sleep disturbances was restricted to the cross-sectional sample. Improving psychosocial working conditions might reduce the risk of sleep disturbances and subsequently also help to prevent clinical disorders related to sleep...

  12. Gestational obesity as a determinant of general anesthesia technique for caesarean delivery: a case report.

    Navarro Vargas, José Ricardo; Aldana Díaz, José Luis; Eslava Schamalbach, Javier H.

    2010-01-01

    Background. The incidence of obesity has undergone a dramatic increase around the world during the last few years. Such epidemic behavior has been associated with obstetric patient’s frequent presentation of different stages of obesity when undergoing anesthetic procedure. Obesity in pregnant women involves the risk of adverse maternal and fetal outcomes. Hypertension and preeclampsia, diabetes, fetal macrosomia, caesarean delivery, difficult airway management and neuroaxial techniques are mo...

  13. Appropriate waist circumference cut points for identifying insulin resistance in black youth: a cross sectional analysis of the 1986 Jamaica birth cohort

    Tulloch-Reid Marshall K

    2010-12-01

    Full Text Available Abstract Background While the International Diabetes Federation (IDF has ethnic specific waist circumference (WC cut-points for the metabolic syndrome for Asian populations it is not known whether the cut-points for black populations should differ from those for European populations. We examined the validity of IDF WC cut points for identifying insulin resistance (IR, the underlying cause of the metabolic syndrome, in predominantly black, young Jamaican adults. Methods Participants from a 1986 birth cohort were evaluated between 2005 and 2007 when they were 18-20 years old. Trained observers took anthropometric measurements and collected a fasting blood sample. IR was assessed using the homeostasis model assessment computer programme (HOMA-IR. Sex specific quartiles for IR were generated using HOMA-IR values and participants in the highest quartile were classified as "insulin resistant". Receiver operator characteristic (ROC curves were used to estimate the best WC to identify insulin resistance. The sensitivity and specificity of these values were compared with the IDF recommended WC cut-points. Results Data from 707 participants (315 males; 392females were analysed. In both sexes those with IR were more obese, had higher mean systolic blood pressure, glucose and triglycerides and lower mean HDL cholesterol. The WC was a good predictor of IR with an ROC area under the curve (95% CI of 0.71(0.64,0.79 for men and 0.72(0.65,0.79 for women. Using the Youden Index (J the best WC cut point for identifying IR in male participants was 82 cm (sensitivity 45%, specificity 93%, J 0.38 while the standard cut point of 94 cm had a sensitivity of 14% and specificity of 98% (J 0.12. In the female participants 82 cm was also a good cut point for identifying IR (sensitivity 52%, specificity 87%, J 0.39 and was similar to the standard IDF 80 cm cut point (sensitivity 53%, specificity 82%, J 0.35. Conclusions The WC that identified IR in young black men is lower

  14. Cohort Profile

    Jespersen, Sanne; Hønge, Bo Langhoff; Oliveira, Inés;

    2014-01-01

    The West African country Guinea-Bissau is home to the world’s highest prevalence of HIV-2, and its HIV-1 prevalence is rising. Other chronic viral infections like human T-lymphotropic virus type 1 (HTLV-1) and hepatitis B virus are common as well. The Bissau HIV Cohort was started in 2007 to gain...... new insights into the overall effect of introducing antiretroviral treatment in a treatment-naı ̈ve population with concomitant infection with three retroviruses (HIV-1, HIV-2 and HTLV-1) and tuberculosis. The cohort includes patients from the HIV clinic at Hospital Nacional Sima ̃ o Mendes, the main...... hos- pital in Bissau, the capital of the country. From July 2007 to June 2013, 3762 HIV-infected patients (69% HIV-1, 18% HIV-2, 11% HIV-1/2 and 2% HIV type unknown) were included in the world’s largest single-centre HIV-2 cohort. Demographic and clinical data are col- lected at baseline and every 6...

  15. Antiviral Resistance and Correlates of Virologic Failure in the first Cohort of HIV-Infected Children Gaining Access to Structured Antiretroviral Therapy in Lima, Peru: A Cross-Sectional Analysis

    Rath Barbara A

    2013-01-01

    Full Text Available Abstract Background The impact of extended use of ART in developing countries has been enormous. A thorough understanding of all factors contributing to the success of antiretroviral therapy is required. The current study aims to investigate the value of cross-sectional drug resistance monitoring using DNA and RNA oligonucleotide ligation assays (OLA in treatment cohorts in low-resource settings. The study was conducted in the first cohort of children gaining access to structured ART in Peru. Methods Between 2002–5, 46 eligible children started the standard regimen of AZT, 3TC and NFV Patients had a median age of 5.6 years (range: 0.7-14y, a median viral load of 1.7·105 RNA/ml (range: 2.1·103 – 1.2·106, and a median CD4-count of 232 cells/μL (range: 1–1591. Of these, 20 patients were classified as CDC clinical category C and 31/46 as CDC immune category 3. At the time of cross-sectional analysis in 2005, adherence questionnaires were administered. DNA OLAs and RNA OLAs were performed from frozen PBMC and plasma, RNA genotyping from dried blood spots. Results During the first year of ART, 44% of children experienced virologic failure, with an additional 9% failing by the end of the second year. Virologic failure was significantly associated with the number of resistance mutations detected by DNA-OLA (p Conclusions Advanced immunosuppression at baseline and previous exposures to unsupervised brief cycles of ART significantly impaired treatment outcomes at a time when structured ART was finally introduced in his cohort. Brief maternal exposures to with AZT +/− NVP for the prevention of mother-to-child transmission did not affect treatment outcomes in this group of children. DNA-OLA from frozen PBMC provided a highly specific tool to detect archived drug resistance. RNA consensus genotyping from dried blood spots and RNA-OLA from plasma consistently detected drug resistance mutations, but merely in association with virologic failure.

  16. Prospective cohort study on effect of elective cesarean section on physical and intellectual development in children%社会因素剖宫产儿体格与智力发育的前瞻性队列研究

    刘达美; 赵勇; 关蕴良; 李廷玉; 李少芳; 刘永芳; 张勇; 刘平

    2009-01-01

    目的:探讨社会因素剖宫产对儿童体格与智力发育的影响.方法:采用前瞻性队列研究,确定社会因素剖宫产和顺产产妇队列(社会因素剖宫产组68例、顺产组65例),分别于出生时、18月龄、24月龄、30月龄、36月龄、42月龄时体格检查,24月龄时智力测验(采用Gesell评分).结果:两队列均衡性较好(P>0.05),两组儿童在身高、体重、头围以及智力发育方面差异均无统计学意义.结论:社会因素剖宫产对42月龄以下的儿童体格发育未见显著性影响,社会因素剖宫产智力发育并不优于顺产,远期影响仍需扩大样本量以及继续随访研究.%To explore the effect of elective cesarean section on physical and intellectual development in children. Methods: Using the prospective cohort study, a 133 newborn sample composed by 68 newborns delivered by cesarean section and 65 newborns by spontaneous delivery in a county of Chongqing was established from March to May, 2002. Physical development index such as length, head circumference and body weight were measured at birth and on the 18, 24, 30, 36 and 42-month-old, respectively. Intel-lectual development was tested by Gesell mark at 2 years old. Results: The factors had equilibrium in two cohorts (P>0. 05) . There had no significant difference of weight, height or length, head circumference and Intellectual development between the two groups. Conclusion: There's no significant effect of cesarean section on physical growth of children below 4 years old. Intellectual development of the children de-livered by cesarean section is no better than that of spontaneous delivery. Forward affect needs more samples and continual follow-up.

  17. Which tinnitus-related characteristics affect current health-related quality of life and depression? A cross-sectional cohort study.

    Weidt, Steffi; Delsignore, Aba; Meyer, Martin; Rufer, Michael; Peter, Nicole; Drabe, Natalie; Kleinjung, Tobias

    2016-03-30

    Tinnitus is sometimes associated with lower health-related quality of life (HRQoL) and depressive symptoms. However, only limited evidence exists identifying which tinnitus characteristics are responsible for these associations. The aim of this cross-sectional study was to assess associations between tinnitus, HRQoL, depressive symptoms, subjective tinnitus loudness and audiometrically assessed tinnitus characteristics (e.g., hearing threshold). Two hundred and eight outpatients reporting tinnitus completed questionnaires on tinnitus (Tinnitus Handicap Inventory, THI), HRQoL (World-Health-Organisation Quality of Life Short Form Survey, WHOQOL-BREF), and depressive symptoms (Beck Depression Inventory, BDI), and underwent audiometry. Patients with higher THI scores exhibited significantly lower HRQoL, and higher depression scores. THI total-score, THI subscales, and subjective tinnitus loudness explained significant variance of WHOQOL-BREF and BDI. Audiometrically measured features were not associated with WHOQOL-BREF or BDI. Overall, we confirmed findings that different features of tinnitus are associated with HRQoL and depressive symptoms but not with audiometrically assessed tinnitus characteristics. Consequently, physicians should evaluate THI total score, its sub-scores, and subjective tinnitus loudness to reliably and quickly identify patients who potentially suffer from depressive symptoms or significantly lower HRQoL. Supporting these patients early might help to prevent the development of reactive depressive symptoms and impairment of HRQoL. PMID:26850646

  18. Relationship of obesity to physical activity, domestic activities, and sedentary behaviours: cross-sectional findings from a national cohort of over 70,000 Thai adults

    Bain Chris

    2011-10-01

    Full Text Available Abstract Background Patterns of physical activity (PA, domestic activity and sedentary behaviours are changing rapidly in Asia. Little is known about their relationship with obesity in this context. This study investigates in detail the relationship between obesity, physical activity, domestic activity and sedentary behaviours in a Thai population. Methods 74,981 adult students aged 20-50 from all regions of Thailand attending the Sukhothai Thammathirat Open University in 2005-2006 completed a self-administered questionnaire, including providing appropriate self-reported data on height, weight and PA. We conducted cross-sectional analyses of the relationship between obesity, defined according to Asian criteria (Body Mass Index (BMI ≥25, and measures of physical activity and sedentary behaviours (exercise-related PA; leisure-related computer use and television watching ("screen-time"; housework and gardening; and sitting-time adjusted for age, sex, income and education and compared according to a range of personal characteristics. Results Overall, 15.6% of participants were obese, with a substantially greater prevalence in men (22.4% than women (9.9%. Inverse associations between being obese and total weekly sessions of exercise-related PA were observed in men, with a significantly weaker association seen in women (p(interaction Conclusions Domestic activities and sedentary behaviours are important in relation to obesity in Thailand, independent of exercise-related physical activity. In this setting, programs to prevent and treat obesity through increasing general physical activity need to consider overall energy expenditure and address a wide range of low-intensity high-volume activities in order to be effective.

  19. Smoking water-pipe, chewing nass, and prevalence of heart disease – A cross-sectional analysis of baseline data from the Golestan Cohort Study, Iran

    Islami, Farhad; Pourshams, Akram; Vedanthan, Rajesh; Poustchi, Hossein; Kamangar, Farin; Golozar, Asieh; Etemadi, Arash; Khademi, Hooman; Freedman, Neal D.; Merat, Shahin; Garg, Vaani; Fuster, Valentin; Wakefield, Jon; Dawsey, Sanford M.; Pharoah, Paul; Brennan, Paul; Abnet, Christian C.; Malekzadeh, Reza; Boffetta, Paolo

    2013-01-01

    Objective Water-pipe and smokeless tobacco use have been associated with several adverse health outcomes. However, little information is available on the association between water-pipe use and heart disease (HD). Therefore, we investigated the association of smoking water-pipe and chewing nass (a mixture of tobacco, lime, and ash) with prevalent HD. Design Cross-sectional study. Setting Baseline data (collected in 2004–2008) from a prospective population-based study in Golestan Province, Iran. Participants 50,045 residents of Golestan (40–75 years old; 42.4% male). Main outcome measures ORs and 95% CIs from multivariate logistic regression models for the association of water-pipe and nass use with HD prevalence. Results A total of 3051 (6.1%) participants reported a history of HD, and 525 (1.1%) and 3726 (7.5%) reported ever water-pipe or nass use, respectively. Heavy water-pipe smoking was significantly associated with HD prevalence (highest level of cumulative use versus never use, OR= 3.75; 95% CI 1.52 – 9.22; P for trend= 0.04). This association persisted when using different cutoff points, when restricting HD to those taking nitrate compound medications, and among never cigarette smokers. There was no significant association between nass use and HD prevalence (highest category of use versus never use, OR= 0.91; 95% CI 0.69 – 1.20). Conclusions Our study suggests a significant association between HD and heavy water-pipe smoking. Although the existing evidence suggesting similar biological consequences of water-pipe and cigarette smoking make this association plausible, results of our study were based on a modest number of water-pipe users and need to be replicated in further studies. PMID:23257174

  20. Comparisons of Objective Sleep Quality Between Elderly Individuals With and Without Cataract Surgery: A Cross-Sectional Study of the HEIJO-KYO Cohort

    Kenji Obayashi

    2015-08-01

    Full Text Available Background: Cataract surgery (CS drastically increases the capacity for light reception to the retina. Several previous studies have suggested the beneficial effect of CS on subjectively measured sleep quality; however, the association between CS and objectively measured sleep quality remains uncertain. Methods: To evaluate the association between CS and objectively measured sleep quality in home settings, we conducted a cross-sectional study in 1037 elderly individuals (mean age, 71.9 years. We evaluated actigraphically measured sleep quality, urinary 6-sulfatoxymelatonin excretion, and ambulatory light levels, in addition to CS status. Results: The CS group (n = 174 showed significantly higher sleep efficiency and shorter wake after sleep onset than the no CS group (n = 863, even after adjustment for age, gender, body mass index, current smoking status, alcohol consumption, hypertension, diabetes, sleep medication, bedtime, rising time, daytime physical activity, daytime and nighttime light exposure, and urinary 6-sulfatoxymelatonin excretion (sleep efficiency: 85.8% in the CS group vs 84.4% in the no CS group, P = 0.042; wake after sleep onset: 45.7 min vs 50.6 min, respectively, P = 0.033. In contrast, urinary 6-sulfatoxymelatonin excretion, sleep onset latency, total sleep time, and sleep-mid time did not differ significantly between the CS and no CS groups. Conclusions: Among a community-dwelling elderly population, CS is significantly associated with objectively measured sleep quality, but urinary levels of melatonin metabolite do not differ between individuals with and without CS. These associations are independent of daily light exposure profiles.

  1. Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy: A Cross-Sectional Study from the St. Jude Lifetime Cohort

    Mulrooney, Daniel A.; Armstrong, Gregory T.; Huang, Sujuan; Ness, Kirsten K.; Ehrhardt, Matthew J.; Joshi, Vijaya M.; Plana, Juan Carlos; Soliman, Elsayed Z.; Green, Daniel M.; Srivastava, Deokumar; Santucci, Aimee; Krasin, Matthew J.; Robison, Leslie L.; Hudson, Melissa M.

    2016-01-01

    Background Studies of cardiac disease among adult survivors of childhood cancer have generally relied upon self-reported or registry-based data. Objective Systematically assess cardiac outcomes among childhood cancer survivors Design Cross-sectional Setting St. Jude Children's Research Hospital Patients 1,853 adult survivors of childhood cancer, ≥18 years old, and ≥10 years from treatment with cardiotoxic therapy for childhood cancer. Measurements History/physical examination, fasting metabolic and lipid panels, echocardiogram, electrocardiogram (ECG), 6-minute walk test (6MWT) all collected at baseline evaluation. Results Half (52.3%) of the survivors were male, median age 8.0 years (range: 0-24) at cancer diagnosis, 31.0 years (18-60) at evaluation. Cardiomyopathy was present in 7.4% (newly identified at the time of evaluation in 4.7%), coronary artery disease (CAD) in 3.8% (newly identified in 2.2%), valvular regurgitation/stenosis in 28.0% (newly identified in 24.8%), and conduction/rhythm abnormalities in 4.6% (newly identified in 1.4%). Nearly all (99.7%) were asymptomatic. The prevalences of cardiac conditions increased with age at evaluation, ranging from 3-24% among those 30-39 years to 10-37% among those ≥40 years. On multivariable analysis, anthracycline exposure ≥250 mg/m2 increased the odds of cardiomyopathy (odds ratio [OR] 2.7, 95% CI 1.1-6.9) compared to anthracycline unexposed survivors. Radiation to the heart increased the odds of cardiomyopathy (OR 1.9 95% CI 1.1-3.7) compared to radiation unexposed survivors. Radiation >1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings. Limitations 61% participation rate of survivors exposed to cardiotoxic therapies, which were limited to anthracyclines and cardiac-directed radiation. A comparison group and longitudinal assessments are not available. Conclusions Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood

  2. [Non elective cesarean section: use of a color code to optimize management of obstetric emergencies].

    Rudigoz, René-Charles; Huissoud, Cyril; Delecour, Lisa; Thevenet, Simone; Dupont, Corinne

    2014-06-01

    The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour. PMID:26983190

  3. Type D personality is a risk factor for psychosomatic symptoms and musculoskeletal pain among adolescents: a cross-sectional study of a large population-based cohort of Swedish adolescents

    Condén Emelie

    2013-01-01

    Full Text Available Abstract Background Type D personality, or the “distressed personality”, is a psychosocial factor associated with negative health outcomes, although its impact in younger populations is unclear. The purpose of this study was to investigate the prevalence of Type D personality and the associations between Type D personality and psychosomatic symptoms and musculoskeletal pain among adolescences. Methods A population-based, self-reported cross-sectional study conducted in Västmanland, Sweden with a cohort of 5012 students in the age between 15–18 years old. The participants completed the anonymous questionnaire Survey of Adolescent Life in Västmanland 2008 during class hour. Psychosomatic symptoms and musculoskeletal pain were measured through index measuring the presence of symptoms and how common they were. DS14 and its two component subscales of negative affectivity (NA and social inhibition (SI were measured as well. Results There was a difference depending on sex, where 10.4% among boys and 14.6% among girls (p =  Conclusions There was a strong association between Type D personality and both psychosomatic symptoms and musculoskeletal pain where adolescent with a type D personality reported more symptoms. The present study contributes to the mapping of the influence of Type D on psychosomatic symptoms and musculoskeletal pain among adolescents.

  4. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off Padrones de partos en una cohorte de nacimientos: cesáreas casi universales para los riesgos Padrões dos partos em uma coorte de nascimentos: cesarianas quase universais para os ricos

    Aluísio J D Barros

    2011-08-01

    Full Text Available OBJECTIVE: To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS: All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS: The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS: C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.OBJETIVO: Describir el padrón de los partos en una cohorte de nacimientos, comparando partos normales y cesáreos. MÉTODOS: Todos los recién nacidos de moradoras de área urbana de Pelotas (Sur de Brasil en 2004 fueron reclutados para una cohorte de nacimientos. Las madres

  5. Post operatory analgesia in caesarean surgery. Analgesia posoperatoria en la operación cesárea.

    María Antonia Cabezas Poblet

    2003-12-01

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  6. Rising frequency of placenta previa and associated morbidity in women with previous casearean section

    To determine rising frequency of placenta previa and its associated morbidity in women with previous caesarean section. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted in the Department of Obstetrics and Gynecology at CMH Kohat from Jul 2010 to Jun 2011. Patients and Methods: This study included all pregnant women undergoing repeat caesarean sections. Of these, total 74 patients were admitted with placenta previa. The frequency and associated morbidity were determined. Results: In our study 74 patients with placenta previa were included. 71.62% were less than 35 yrs of age, while 28.38% were equal to or more than 35 years. The gestational age at presentation was 24-36 weeks in 74.3% and 37 + weeks in 5.7% at presentation, 89% patients were symptomatic and 11% were asympyomatic. The morbidities observed were placenta accrete 47%, urinary tract trauma in 63.51%, caesarean hysterectomy in 62.16%, post operative febrile morbidity in 77.03%, maternal mortality was nil, paralytic ileus in 28.38%, PPH in 82.43%, surgical site infection in 16.21%. Conclusion: Frequency of placenta previa and its associated morbidity was raised due to repeated caesarean section rate which must be reduced to decrease maternal morbidity and mortality. (author)

  7. The effect of the use of a new type of partogram on the cesarean section rates

    Vlachos, Georgios; Tsikouras, Panagiotis; Manav, Bachar; Trypsianis, Grigorios; Liberis, Vasileios; Karpathios, Sakellarios; Galazios, Georgios

    2015-01-01

    Objective To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. Material and Methods The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. Results A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p<0.001, A: median: 318.4±10.4 min, B: 246.56±8.28 min) and in caesarean section rates was noted (p<0.001, A: 89 vs B: 49). Conclusion The new type of partogram seems to have potential benefits such as reducing the incidence of prolonged labor and decreasing the caesarean section rates. PMID:26401106

  8. A Synthetic Cohort Analysis of Canadian Housing Careers

    Thomas F. Crossley; Yuri Ostrovsky

    2003-01-01

    This paper uses a time-series of cross-sections drawn from three different surveys to explore life-cycle profiles of housing arrangements in Canada. Synthetic cohort (quasi-panel) methods are employed to disentangle age profiles from cohort effects. The results suggest limited "downsizing" in later life. Potential biases arising from changes in cohort composition are also explored.

  9. [Acute pancreas necrosis with biliary peritonitis in cesarean section].

    Zoldos, L; Hincová, M

    1986-01-01

    The authors describe the case of a hemorrhagic pancreatitis with non-perforating biliary peritonitis. The abdomen symptomatology was hidden by the beginning contractions and due to the dystocia the delivery was finished by caesarean section. The presence of choleperitoneum required a surgical revision of the abdominal cavity which enabled to make the right diagnosis. This thesis deals with aetiology and mechanism of choleperitoneum inception during hemorrhagic pancreatitis. PMID:3788337

  10. Intracranial haemorrhage: an incidental finding at magnetic resonance imaging in a cohort of late preterm and term infants

    Sirgiovanni, Ida; Groppo, Michela; Bassi, Laura; Passera, Sofia; Schiavolin, Paola; Fumagalli, Monica; Mosca, Fabio [Universita degli Studi di Milano, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy); Avignone, Sabrina; Cinnante, Claudia; Triulzi, Fabio [Universita degli Studi di Milano, Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy); Lista, Gianluca [V. Buzzi Children' s Hospital, ICP, Neonatal Intensive Care Unit, Milan (Italy)

    2014-03-15

    Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear. To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks' gestation or more and to correlate MRI findings with neonatal symptoms. We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks' gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement. Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38 ± 2 weeks vs. 37 ± 2 weeks) and birth weight (3,097 ± 485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section. Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement. (orig.)

  11. NCI Cohort Consortium Membership

    The NCI Cohort Consortium membership is international and includes investigators responsible for more than 40 high-quality cohorts who are studying large and diverse populations in more than 15 different countries.

  12. Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section.

    2005-09-01

    Full Text Available BACKGROUND: There is currently no validated method for antepartum prediction of the risk of failed vaginal birth after cesarean section and no information on the relationship between the risk of emergency cesarean delivery and the risk of uterine rupture. METHODS AND FINDINGS: We linked a national maternity hospital discharge database and a national registry of perinatal deaths. We studied 23,286 women with one prior cesarean delivery who attempted vaginal birth at or after 40-wk gestation. The population was randomly split into model development and validation groups. The factors associated with emergency cesarean section were maternal age (adjusted odds ratio [OR] = 1.22 per 5-y increase, 95% confidence interval [CI]: 1.16 to 1.28, maternal height (adjusted OR = 0.75 per 5-cm increase, 95% CI: 0.73 to 0.78, male fetus (adjusted OR = 1.18, 95% CI: 1.08 to 1.29, no previous vaginal birth (adjusted OR = 5.08, 95% CI: 4.52 to 5.72, prostaglandin induction of labor (adjusted OR = 1.42, 95% CI: 1.26 to 1.60, and birth at 41-wk (adjusted OR = 1.30, 95% CI: 1.18 to 1.42 or 42-wk (adjusted OR = 1.38, 95% CI: 1.17 to 1.62 gestation compared with 40-wk. In the validation group, 36% of the women had a low predicted risk of caesarean section (< 20% and 16.5% of women had a high predicted risk (> 40%; 10.9% and 47.7% of these women, respectively, actually had deliveries by caesarean section. The predicted risk of caesarean section was also associated with the risk of all uterine rupture (OR for a 5% increase in predicted risk = 1.22, 95% CI: 1.14 to 1.31 and uterine rupture associated with perinatal death (OR for a 5% increase in predicted risk = 1.32, 95% CI: 1.02 to 1.73. The observed incidence of uterine rupture was 2.0 per 1,000 among women at low risk of cesarean section and 9.1 per 1,000 among those at high risk (relative risk = 4.5, 95% CI: 2.6 to 8.1. We present the model in a simple-to-use format. CONCLUSIONS: We present, to our knowledge, the

  13. Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section.

    Gordon C S Smith

    2005-09-01

    Full Text Available BACKGROUND: There is currently no validated method for antepartum prediction of the risk of failed vaginal birth after cesarean section and no information on the relationship between the risk of emergency cesarean delivery and the risk of uterine rupture. METHODS AND FINDINGS: We linked a national maternity hospital discharge database and a national registry of perinatal deaths. We studied 23,286 women with one prior cesarean delivery who attempted vaginal birth at or after 40-wk gestation. The population was randomly split into model development and validation groups. The factors associated with emergency cesarean section were maternal age (adjusted odds ratio [OR] = 1.22 per 5-y increase, 95% confidence interval [CI]: 1.16 to 1.28, maternal height (adjusted OR = 0.75 per 5-cm increase, 95% CI: 0.73 to 0.78, male fetus (adjusted OR = 1.18, 95% CI: 1.08 to 1.29, no previous vaginal birth (adjusted OR = 5.08, 95% CI: 4.52 to 5.72, prostaglandin induction of labor (adjusted OR = 1.42, 95% CI: 1.26 to 1.60, and birth at 41-wk (adjusted OR = 1.30, 95% CI: 1.18 to 1.42 or 42-wk (adjusted OR = 1.38, 95% CI: 1.17 to 1.62 gestation compared with 40-wk. In the validation group, 36% of the women had a low predicted risk of caesarean section ( 40%; 10.9% and 47.7% of these women, respectively, actually had deliveries by caesarean section. The predicted risk of caesarean section was also associated with the risk of all uterine rupture (OR for a 5% increase in predicted risk = 1.22, 95% CI: 1.14 to 1.31 and uterine rupture associated with perinatal death (OR for a 5% increase in predicted risk = 1.32, 95% CI: 1.02 to 1.73. The observed incidence of uterine rupture was 2.0 per 1,000 among women at low risk of cesarean section and 9.1 per 1,000 among those at high risk (relative risk = 4.5, 95% CI: 2.6 to 8.1. We present the model in a simple-to-use format. CONCLUSIONS: We present, to our knowledge, the first validated model for antepartum prediction of the

  14. ECSSIT - Elective caesarean section Syntocinon infusion trial a multi-centre randomized controlled trial oxytocin Syntocinon % iu bolus and placebo infusion versus oxtocin 5 iu bolus and 40 iu infusion for the control of blood loss at elective caesarean section

    Sheehan, S

    2011-02-01

    Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2010

  15. 34 CFR 694.3 - What are the requirements for a cohort?

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false What are the requirements for a cohort? 694.3 Section... PROGRAMS (GEAR UP) § 694.3 What are the requirements for a cohort? (a) In general. Each cohort to be served... promote program effectiveness, a cohort may consist of all of the students in a particular grade level...

  16. An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth

    Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

    2011-01-01

    We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and...

  17. Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: a chart review

    Kim Young-Mi

    2012-03-01

    Full Text Available Abstract Background Increasing appropriate use and documentation of caesarean section (CS has the potential to decrease maternal and perinatal mortality in settings with low CS rates. We analyzed data collected as part of a comprehensive needs assessment of emergency obstetric and newborn care (EmONC facilities in Afghanistan to gain a greater understanding of the clinical indications, timeliness, and outcomes of CS deliveries. Methods Records were reviewed at 78 government health facilities expected to function as EmONC providers that were located in secure areas of the country. Information was collected on the three most recent CS deliveries in the preceding 12 months at facilities with at least one CS delivery in the preceding three months. After excluding 16 facilities with no recent CS deliveries, the sample includes 173 CS deliveries at 62 facilities. Results No CS deliveries were performed in the previous three months at 21% of facilities surveyed; all of these were lower-level facilities. Most CS deliveries (88% were classified as emergencies, and only 12% were referrals from another facility. General anesthesia was used in 62% of cases, and spinal or epidural anesthesia in 34%. Only 28% of cases were managed with a partograph. Surgery began less than one hour after the decision for a CS delivery in just 30% of emergency cases. Among the 173 cases, 27 maternal deaths, 28 stillbirths, and 3 early neonatal deaths were documented. In cases of maternal and fetal death, the most common indications for CS delivery were placenta praevia or abruption and malpresentation. In 62% of maternal deaths, the fetus was stillborn or died shortly after birth. In 48% of stillbirths, the fetus had a normal heart rate at the last check. Information on partograph use was missing in 38% of cases, information on parity missing in 23% of cases and indications for cesareans missing in 9%. Conclusions Timely referral within and to EmONC facilities would decrease

  18. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial

    Mitra Jabalameli

    2012-01-01

    Conclusions: In patients undergoing the caesarean section under hyperbaric bupivacaine spinal anesthesia, the addition of 50, 75, or 100 mg magnesium sulfate provides safe and effective anesthesia, but 75 mg of this drug was enough to lead a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade, without increasing major side effects.

  19. The stress, coping and parenting experiences of mothers who gave birth by unplanned Caesarean section / Samantha Lynne van Reenen

    Van Reenen, Samantha Lynne

    2012-01-01

    Pregnancy and childbirth are important life experiences in a woman’s psychosocial and psychological development. For many women, vaginal birth is still considered an integral part of being a woman and becoming a mother. Furthermore, it is thought to promote maternal well-being through helping women to match their expectations to experiences. For these women, a failed natural birth can be a psychological, psychosocial, and existential challenge that can result in significant ...

  20. A quality improvement tool - driver diagram: a model of driver diagram to reduce primary caesarean section rates

    Naima Fathima

    2016-01-01

    Background: Quality improvement in health care is emerging as a science with proven, effective tools and methodologies. This article aims at presenting the importance of adopting one of the effective and simple methodologies and gives an example of a Driver Diagram in obstetrics. Methods: Usefulness of driver diagram in understanding the aim and the interventions or changes. Results: Various quality improvement tools can be used in the clinical context. Among them, driver diagram is mo...

  1. Surveillance of hospital-acquired infections in women having undergone caesarean section in the County of Aarhus

    Leth, Rita Andersen

      Cirka 10% af indlagte patienter på danske sygehuse får en infektion i forbindelse med indlæggelsen. Overvågning af disse hospitalserhvervede infektioner (HAI) efterfulgt af feedback til klinikere har tidligere vist at kunne reducere prævalensen af HAI med en tredjedel. En af forudsætningerne fo...

  2. A history of abuse and operative delivery--results from a European multi-country cohort study.

    Berit Schei

    Full Text Available OBJECTIVE: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. DESIGN: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS, or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. RESULTS: Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49, and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24. Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3. Neither physical abuse (in adulthood or childhood <18 years, nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19. CONCLUSION: Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.

  3. Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Healthy Ageing (MELSHA): cross-sectional analysis of prevalence and risk factors

    Browning Colette; Wang Wei C; Thomson Jennifer A; Kendig Hal L

    2010-01-01

    Abstract Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community. Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects...

  4. Cohort Profile Update

    Omland, Lars Haukali; Ahlström, Magnus Glindvad; Obel, Niels

    2014-01-01

    of Causes of Death, the Danish National Prescription Registry, the Attainment Register and the Integrated Database for Labour Market Research to get information on vital status, migration, cancer, hospital contacts, causes of death, dispensed prescriptions, education and employment. Using this design, rates...... to extract an age- and sex-matched comparison cohort from the general population, as well as cohorts of family members of the HIV-infected patients and of the comparison cohort. The combined cohort is linked with CRS, the Danish Cancer Registry, the Danish National Hospital Registry, the Danish Registry...

  5. ANAESTHESIA MANAGEMENT OF A TERM PREGNANT PATIENT W ITH GULLAIN BARRE SYNDROME POSTED FOR ELECTIVE CAESAREA N SECTION – A CASE REPORT

    Poornima

    2013-05-01

    Full Text Available ABSTRACT: Guillain Barre Syndrome (GBS is an acute, inflamm atory, demyelinating polyneuropathy that present with ascending, symmetr ical flaccid paralysis accompanied by sensory and autonomic involvement. GBS complicating pregnan cy is a rare event and the anaesthesia management of a parturient with GBS is not well def ined. We report anaesthesia management and its anaesthetic implications in term pregnant patie nt with GBS who was posted for elective caesarean section. In this case the caesarean secti on was successfully carried out under general anaesthesia.

  6. On the correspondence between CAL and lagged cohort life expectancy

    Michel Guillot; Hyun Sik Kim

    2011-01-01

    It has been established that under certain mortality assumptions, the current value of the Cross-sectional Average length of Life (CAL) is equal to the life expectancy for the cohort currently reaching its life expectancy. This correspondence is important, because the life expectancy for the cohort currently reaching its life expectancy, or lagged cohort life expectancy (LCLE), has been discussed in the tempo literature as a summary mortality measure of substantive interest. In this paper, we...

  7. Cohort Profile: Mysore Parthenon Birth Cohort

    Krishnaveni, Ghattu V.; Veena, Sargoor R; Hill, Jacqueline C.; Karat, Samuel C.; Fall, Caroline HD

    2014-01-01

    The Mysore Parthenon Birth Cohort was established to examine the long-term effects of maternal glucose tolerance and nutritional status on cardiovascular disease risk factors in the offspring. During 1997-1998, 830 of 1233 women recruited from the antenatal clinics of the Holdsworth Memorial Hospital (HMH), Mysore, India underwent an oral glucose tolerance test. Of these, 667 women delivered live babies at HMH. Four babies with major congenital anomalies were excluded, and the remaining 663 w...

  8. Cancer Epidemiology Cohorts

    Cohort studies are fundamental for epidemiological research by helping researchers better understand the etiology of cancer and provide insights into the key determinants of this disease and its outcomes.

  9. Occupational Cohort Time Scales

    Deubner, David C.; Roth, H. Daniel

    2015-01-01

    Purpose: This study explores how highly correlated time variables (occupational cohort time scales) contribute to confounding and ambiguity of interpretation. Methods: Occupational cohort time scales were identified and organized through simple equations of three time scales (relational triads) and the connections between these triads (time scale web). The behavior of the time scales was examined when constraints were imposed on variable ranges and interrelationships. Results: Constraints on ...

  10. 34 CFR 694.4 - Which students must a State or Partnership serve when there are changes in the cohort?

    2010-07-01

    ... there are changes in the cohort? 694.4 Section 694.4 Education Regulations of the Offices of the... Partnership serve when there are changes in the cohort? (a) At the school where the cohort began. A Partnership or State must serve, as part of the cohort, any additional students who— (1) Are at the...

  11. 1970 British Cohort Study

    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London. BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of can be accessed by bona fide researchers through the a href="http://discover.ukdataservice.ac.uk/series/?sn=200001" UK Data Service at the University of Essex.

  12. 1970 British Cohort Study

    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London.  BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of BCS70 survey data can be accessed by bona fide researchers through the UK Data Service at the University of Essex.

  13. Maternal and fetal arterial blood gas data during general anaesthesia for caesarean delivery of preterm twin lambs.

    Musk, G C; Kemp, M W

    2016-06-01

    Much remains to be understood with regards the effects of prolonged anaesthesia on maternal and fetal haemodynamics and oxygenation. With the aim of improving anaesthetic management of pregnant sheep undergoing recovery surgery under anaesthesia, paired maternal and fetal arterial blood samples were collected during caesarean delivery of twin preterm lambs to document the blood gas status of the ewe and fetus. Twenty-one Merino twin pregnant ewes at 126 (±1) days of gestation were anaesthetized for caesarean delivery of their fetuses. Arterial blood samples were collected from the radial artery of the ewe and umbilical artery of the fetus at the point of delivery. There was a significant difference between maternal PaCO2 and end-tidal CO2 and alveolar and arterial PaO2, indicating ventilation perfusion mismatch. Interestingly, the ewes were anaemic but the fetuses were not. These data underscore the need to undertake further work to determine the optimal anaesthetic regimen for twin pregnant ewes at different gestational ages in a biomedical research setting. PMID:26219550

  14. Femoral morphology and epiphyseal growth plate changes of the hip during maturation: MR assessments in a 1-year follow-up on a cross-sectional asymptomatic cohort in the age range of 9-17 years

    The goal of this prospective study was to characterize the morphology and physeal changes of the femoral head during maturation using MRI in a population-based group of asymptomatic volunteers. Sixty-four pupils (127 hips) of 331 pupils from a primary and high school were asked to take part in this study and were willing to participate. 3T MRI of the hip was obtained at baseline and 1-year follow-up. With these images, we analyzed the femoral morphology and epiphyseal changes related to age, status of the physis, and location on the femur. The radius of the femoral head and neck increased with age, as expected, (p 0.05). Building groups by using the epiphyseal status, we found that the epiphyseal extension had the highest changes in the ''open'' group and almost stopped in the ''closed'' group. The tilt angle did not change significantly (p > 0.05). Significant smaller alpha-angles were found in the ''closed'' group, however, these were in a normal range in all of them. Correlated to the position, the highest alpha-angle values were located in anterior-superior and superior-anterior position. Our data can be used as normative values, which can be compared to patients or cohorts with certain risk factors (e.g., professional athletes), this will offer the chance to detect and understand pathological changes. (orig.)

  15. Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study.

    Ank de Jonge

    Full Text Available To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care.We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study, 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events. Secondary outcomes were postpartum haemorrhage and manual removal of placenta.Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71 and for parous women 0.47 (0.36 to 0.62.Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

  16. COMPARISON OF SINGLE DOSE PROPHYLACTIC ANTIBIOTICS VERSUS FIVE DAYS ANTIBIOTIC IN CESAREAN SECTION

    Zeel

    2014-03-01

    Full Text Available AIMS AND OBJECTIVES: To compare if single dose antibiotic is as effective as multiple doses in prevention of post-operative infection in caesarean section. To compare the cost effectiveness of drugs in both the groups. MATERIAL AND METHOD: This prospective randomized controlled study was carried out to evaluate the effectiveness of single dose antibiotic versus multiple doses in caesarean section. The study population consisted of 600 patients that were randomly allocated to single or multiple dose groups. All potentially infected cases were excluded from this study. All patients received inj Cefotaxime IV half hour before surgery. In addition the multiple dose group received antibiotics for five days post-operatively. Each patient in the study was observed till discharge for presence of any morbidity like endometritis, urinary tract infections, and wound infections. STATISTICAL ANALYSISIS: Fischer exact test, unpaired t test used for analysis. RESULTS: There was no statistically significance in the rate of infections in both the groups. The rate of febrile morbidity, endometritis, urinary tract infection and wound infections were statistically not significant. However the difference in cost of antibiotic in both the groups was significant. CONCLUSIONS: Single dose antibiotics are effective as multiple doses in prevention of post-operative infections in caesarean sections Careful periodic surveillance of antibiotic prophylaxis is necessary to detect the emergence of drug resistant strains of bacteria in our institution because it caters to the needs of local population.

  17. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile

    Esmaeil, Samia; Alzeidan, Rasmieh; Elawad, Mamoun; Tabassum, Rabeena; Hansoti, Shehnaz; Magzoup, Mohie Edein; Al-Kadri, Hanan; Elsherif, Elham; Al-Mandil, Hazim; Al-Shaikh, Ghadeer; Zakaria, Nasria

    2016-01-01

    Objectives To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant. Methods A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated. Findings The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%. Conclusion Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world. PMID:26937965

  18. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile.

    Hayfaa Wahabi

    Full Text Available To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant.A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated.The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%.Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

  19. Femoral morphology and epiphyseal growth plate changes of the hip during maturation: MR assessments in a 1-year follow-up on a cross-sectional asymptomatic cohort in the age range of 9-17 years

    Kienle, Karl-Philipp [University of Bern, Department of Orthopedic Surgery, Bern (Switzerland); University of Bern, Inselspital, Bern, Department of Orthopaedic Surgery, Erlangen (Germany); Keck, Johannes; Siebenrock, Klaus-Arno; Mamisch, Tallal Charles [University of Bern, Department of Orthopedic Surgery, Bern (Switzerland); Werlen, Stefan [Department of Radiology, Sonnenhof Clinic, Bern (Switzerland); Kim, Young-Jo [Harvard Medical School, Department of Orthopaedic Surgery, Children' s Hospital, Boston, MA (United States)

    2012-11-15

    The goal of this prospective study was to characterize the morphology and physeal changes of the femoral head during maturation using MRI in a population-based group of asymptomatic volunteers. Sixty-four pupils (127 hips) of 331 pupils from a primary and high school were asked to take part in this study and were willing to participate. 3T MRI of the hip was obtained at baseline and 1-year follow-up. With these images, we analyzed the femoral morphology and epiphyseal changes related to age, status of the physis, and location on the femur. The radius of the femoral head and neck increased with age, as expected, (p < 0.001). The epiphyseal extension increased significantly with age (p < 0.05), but epiphyseal tilt and alpha angle showed no differences (p > 0.05). Building groups by using the epiphyseal status, we found that the epiphyseal extension had the highest changes in the ''open'' group and almost stopped in the ''closed'' group. The tilt angle did not change significantly (p > 0.05). Significant smaller alpha-angles were found in the ''closed'' group, however, these were in a normal range in all of them. Correlated to the position, the highest alpha-angle values were located in anterior-superior and superior-anterior position. Our data can be used as normative values, which can be compared to patients or cohorts with certain risk factors (e.g., professional athletes), this will offer the chance to detect and understand pathological changes. (orig.)

  20. The Danish Youth Cohort

    Vinther-Larsen, Mathilde; Riegels, Mette; Rod, Morten Hulvej;

    2010-01-01

    income. Loss to follow-up was only associated with adolescents' higher probability of drinking and use of tobacco, and none of the other factors were associated with attrition. CONCLUSIONS: The participants in the Danish Youth Cohort represent a great variety of different groups of socio......AIMS: The aim of this paper is to describe the design and methods used in the Danish Youth Cohort and to give a description of the study participants with special attention to a comparison between participants and non-participants regarding sociodemographic characteristics. METHODS: A total of 1......,945 schools were invited, out of which 506 participated. The participating 7th grades comprised a total of 12,498 responding adolescents. The response rate for the Danish Youth Cohort established in 2005 was 63%. The sample of 12,498 adolescents represents 18.2% of all pupils (n = 68,764) in the 7th grade...

  1. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    DeMuro, Jp; Hanna, Af; Chalas, E; Cunha, Ba

    2012-01-01

    We report a case of a previously healthy woman after an uneventful caesarean section who developed polymicrobial necrotizing fasciitis. She was given a non-steroidal anti-inflamatory drug (NSAID) after her delivery. Her post-delivery course was complicated by septic shock, and required multiple debridements before abdominal reconstruction. This case describes the increased risk of necrotizing fasciitis with NSAID use. Unusual were the organisms causing the polymicrobial necrotizing fasciitis: Staphylococcus aureus, Enterobacter agglomerans, Acinetobacter baumannii, and two strains of Enterobacter cloacae. PMID:24960796

  2. IL28B, HLA-C, and KIR variants additively predict response to therapy in chronic hepatitis C virus infection in a European Cohort: a cross-sectional study.

    Vijayaprakash Suppiah

    2011-09-01

    Full Text Available BACKGROUND: To date, drug response genes have not proved as useful in clinical practice as was anticipated at the start of the genomic era. An exception is in the treatment of chronic hepatitis C virus (HCV genotype 1 infection with pegylated interferon-alpha and ribavirin (PegIFN/R. Viral clearance is achieved in 40%-50% of patients. Interleukin 28B (IL28B genotype predicts treatment-induced and spontaneous clearance. To improve the predictive value of this genotype, we studied the combined effect of variants of IL28B with human leukocyte antigen C (HLA-C, and its ligands the killer immunoglobulin-like receptors (KIR, which have previously been implicated in HCV viral control. METHODS AND FINDINGS: We genotyped chronic hepatitis C (CHC genotype 1 patients with PegIFN/R treatment-induced clearance (n = 417 and treatment failure (n = 493, and 234 individuals with spontaneous clearance, for HLA-C C1 versus C2, presence of inhibitory and activating KIR genes, and two IL28B SNPs, rs8099917 and rs12979860. All individuals were Europeans or of European descent. IL28B SNP rs8099917 "G" was associated with absence of treatment-induced clearance (odds ratio [OR] 2.19, p = 1.27×10(-8, 1.67-2.88 and absence of spontaneous clearance (OR 3.83, p = 1.71×10(-14, 2.67-5.48 of HCV, as was rs12979860, with slightly lower ORs. The HLA-C C2C2 genotype was also over-represented in patients who failed treatment (OR 1.52, p = 0.024, 1.05-2.20, but was not associated with spontaneous clearance. Prediction of treatment failure improved from 66% with IL28B to 80% using both genes in this cohort (OR 3.78, p = 8.83×10(-6, 2.03-7.04. There was evidence that KIR2DL3 and KIR2DS2 carriage also altered HCV treatment response in combination with HLA-C and IL28B. CONCLUSIONS: Genotyping for IL28B, HLA-C, and KIR genes improves prediction of HCV treatment response. These findings support a role for natural killer (NK cell activation in PegIFN/R treatment

  3. NCI Cohort Consortium

    The NCI Cohort Consortium is an extramural-intramural partnership formed by the National Cancer Institute to address the need for large-scale collaborations to pool the large quantity of data and biospecimens necessary to conduct a wide range of cancer studies.

  4. Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.

    Malene M Andersen

    Full Text Available To compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD and complete uterine rupture with those recorded in controls with prior CD without uterine rupture.Women with complete uterine rupture during labour between 1997 and 2008 were identified in the Danish Medical Birth Registry (n = 181. Cases were validated by review of medical records and 53 cases with prior CD, trial of labour, available cardiotocogram (CTG and complete uterine rupture were included and compared with 43 controls with prior CD, trial of labour and available CTG. The CTG tracings were assessed by 19 independent experts divided into groups of three different experts for each tracing. The assessors were blinded to group, outcome and clinical data. They analyzed occurrence of defined abnormalities and classified the traces as normal, suspicious, pathological or pre-terminal according to international guidelines (FIGO.A pathological CTG during the first stage of labour was present in 77% of cases and in 53% of the controls (OR 2.58 [CI: 0.96-6.94] P = 0.066. Fetal tachycardia was more frequent in cases with uterine rupture (OR 2.50 [CI: 1.0-6.26] P = 0.053. Significantly more cases showed more than 10 severe variable decelerations compared with controls (OR 22 [CI: 1.54-314.2] P = 0.022. Uterine tachysystole was not correlated with the presence of uterine rupture.A pathological cardiotocogram should lead to particular attention on threatening uterine rupture but cannot be considered a strong predictor as it is common in all women with trial of labour after caesarean delivery.

  5. International Childhood Cancer Cohort Consortium

    An alliance of several large-scale prospective cohort studies of children to pool data and biospecimens from individual cohorts to study various modifiable and genetic factors in relation to cancer risk

  6. Cohort postponement and period measures

    Joshua R. Goldstein; Thomas Cassidy

    2010-01-01

    We introduce a new class of models in which demographic behavior such as fertility is postponed by differing amounts depending only on cohort membership. We show how this model fits into a general framework of period and cohort postponement that includes the existing models in the literature, notably those of Bongaarts and Feeney and Kohler and Philipov. The cohort-based model shows the effects of cohort shifts on period fertility measures and provides an accompanying tempo-adjusted measure o...

  7. Cross-Sectional and Longitudinal Associations between Egg Consumption and Metabolic Syndrome in Adults ≥ 40 Years Old: The Yangpyeong Cohort of the Korean Genome and Epidemiology Study (KoGES_Yangpyeong).

    Woo, Hye Won; Choi, Bo Youl; Kim, Mi Kyung

    2016-01-01

    Since the 1970s, the public has been advised to limit egg consumption even though there is little evidence of any harmful effect of eggs on blood cholesterol. The purpose of this cross-sectional and prospective study was to evaluate the potential association between egg consumption and metabolic syndrome (MetS) and MetS components in adults ≥ 40 years in KoGES_Yangpyeong. Yangpyeong is a rural area in South Korea. A total of 2,887 subjects (men 1,115, women 1,772) were recruited from 2005 to 2009, based on a physical examination and questionnaires administered using standardized protocol. After excluding subjects who had MetS at baseline, 1,663 subjects (675 men, 958 women) were followed for 3.20 years (range: 0.34-8.70). During the follow-up period, MetS occurred in 289 subjects. More than 3 eggs per week was significantly associated with decreased risk of MetS in both men (RR = 0.46, 95% CI, 0.26-0.82, P for trend = 0.1093) and women (RR = 0.54, 95% CI, 0.31-0.93, P for trend 0.0325) compared to non-users. There was a cross-sectional inverse relationship between egg consumption and abdominal obesity in men and women. Also, prospectively, higher egg consumption in men was associated with a decreased risk of high fasting blood glucose (RR = 0.39, 95% CI, 0.22-0.67, P for trend = 0.0042) and high triglycerides (RR = 0.42, 95% CI, 0.22-0.80, P for trend = 0.1080). In conclusion, our findings suggest that higher egg consumption may reduce the risk of MetS both in men and women, and the risk of high fasting blood glucose and high triglycerides in men. Current guidelines regarding egg consumption may need to be re-visited for healthy middle-aged and elderly people. PMID:26808174

  8. Cohort profile: Mysore parthenon birth cohort.

    Krishnaveni, Ghattu V; Veena, Sargoor R; Hill, Jacqueline C; Karat, Samuel C; Fall, Caroline H D

    2015-02-01

    The Mysore Parthenon Birth Cohort was established to examine the long-term effects of maternal glucose tolerance and nutritional status on cardiovascular disease risk factors in the offspring. During 1997-98, 830 of 1233 women recruited from the antenatal clinics of the Holdsworth Memorial Hospital (HMH), Mysore, India, underwent an oral glucose tolerance test. Of these, 667 women delivered live babies at HMH. Four babies with major congenital anomalies were excluded, and the remaining 663 were included for further follow-up. The babies had detailed anthropometry at birth and at 6-12-monthly intervals subsequently. Detailed cardiovascular investigations were done at ages 5, 9.5 and 13.5 years in the children, and in the parents at the 5-year and 9.5-year follow-ups. This ongoing study provides extensive data on serial anthropometry and body composition, physiological and biochemical measures, dietary intake, nutritional status, physical activity measures, stress reactivity measures and cognitive function, and socio-demographic parameters for the offspring. Data on anthropometry, cardiovascular risk factors and nutritional status are available for mothers during pregnancy. Anthropometry and risk factor measures are available for both parents at follow-up. PMID:24609067

  9. Clinical Study of Transverse Incision Outside the Peritoneum Caesarean Technique%横切口腹膜外剖宫产的临床研究

    蔡宇

    2009-01-01

    目的 探讨横切口腹膜外剖宫产术的临床价值.方法 对55例因孕足月行剖宫产术的患者随机分成两组,研究者35例采用腹部横切口腹膜外子宫下段剖宫产术,对照组20例采用传统经腹子宫下段剖宫产术.结果 横切口腹膜外剖宫产术操作简单,组织损伤小,手术时间短,出血量少,术后疼痛轻,恢复快,住院时间短,皮肤外表美观等优点.结论 横切口腹膜外剖宫产术优于传统的经腹子宫下段剖宫产术.%Objective:Explore the clinical value of the transverse cutting outside the peritoneum caesarean technique.Method: The 55 examples of the full-term pregnant women are randomly divided into two groups. The research group of 35 uses the abdomen transverse cutting on the lower womb outside the peritoneum while the comparison group of 20 uses the traditional cesarean technique.Results: The advantages of transverse cutting outside the peritoneum caesarean technique are many: it is a simple procedure that causes slight tissue damage and requires less operation time. Patients undergo less pain, less hemorrhage, speedier recovery, shorter hospitalization, and the scar has a more aesthetical appearance.Conclusion: The transverse cutting outside the peritoneum caesarean technique is superior to the traditional caesarean technique.

  10. Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour

    Hyejin Jeong; Seongheon Lee; Cheolwon Jeong; Jongun Lee; Seongtae Jeong; Sungsu Chung; Kyungyeon Yoo

    2011-01-01

    Inverted takotsubo cardiomyopathy (TTC), a variant of stress-induced cardiomyopathy, features transient myocardial dysfunction characterized by a hyperdynamic left ventricular apex and akinesia of the base. Herein, we describe a 38-year-old primigravida with severe preeclampsia who had active labour for 4 h followed by an emergency caesarean delivery. She developed postpartum haemorrhage due to uterine atony complicated by pulmonary oedema, which was managed with large-volume infusion and hys...

  11. Impact of alternative reimbursement strategies in the new cooperative medical scheme on caesarean delivery rates: a mixed-method study in rural China

    Huang Kun

    2012-07-01

    Full Text Available Abstract Background The rate of caesarean delivery (CD in rural China has been rapidly increasing in recent decades. Due to the exorbitant costs associated with CD, paying for this expensive procedure is often a great challenge for the majority of rural families. Since 2003, the Chinese government has re-established the New Cooperative Medical Scheme (NCMS, aimed to improve the access of essential healthcare to rural residents and reduce financial burden owing to high out of pocket payments. This paper seeks to test the hypothesis that NCMS may provide service users and providers with financial incentives to select CD. It also assesses the effect of different health insurance reimbursement strategies of NCMS on CD rates in rural China. Methods Mixed quantitative and qualitative methods were adopted for data collection. Two cross-sectional household surveys were conducted with women having babies delivered in 2006 and 2009; 2326 and 1515 women, respectively, from the study sites were interviewed using structured questionnaires, to collect demographic and socio-economic data, maternal and child care characteristics and health-related expenditures. Focus group discussions (FGDs and in-depth key informant interviews (KIIs were undertaken with policy makers, health managers, providers and mothers to understand their perceptions of the influence of NCMS on the choices of delivery mode. Results The CD rates in the two study counties were 46.0 percent and 64.7 percent in 2006, increasing to 63.6 percent and 82.1 percent, respectively, in 2009. The study found that decisions on the selection of CD largely came from the pregnant women. Logistic regression analysis, after adjusting for socio-economic, maternal and fetal characteristics, did not indicate a significant effect of either proportional reimbursement or fixed amount reimbursement on the choice of CD for both study years. Interviews with stakeholders reflected that different reimbursable rates for

  12. Stratified case-cohort analysis of general cohort sampling designs

    2006-01-01

    We first point out that variance estimates for regression coefficients in exposure stratified case-cohort studies (Borgan et al., 2000) can easily be obtained from influence terms routinely calculated in standard software for Cox regression. We also place the estimators proposed by Chen (2001) for a general class of cohort sampling designs within the Borgan et al. framework by allowing for post-stratification on outcome. This facilitates simple variance estimation for this class of cohort sam...

  13. Effects of a simple or a complex starter microbiota on intestinal microbiota composition in caesarean derived piglets.

    Jansman, A J M; Zhang, J; Koopmans, S J; Dekker, R A; Smidt, H

    2012-12-01

    The present study was designed to develop a model in piglets that allows the investigation of the effects of postnatal association with a simple or a complex microbiota on gut health and development. Thirty piglets from 2 sows were obtained by caesarean delivery (day 0) and were equally divided over 2 treatment groups housed in separate clean, nonsterile rooms. All piglets received orally a simple microbiota consisting of Lactobacillus amylovorus, Clostridium glycolicum, and Parabacteroides spp. on days 1, 2, and 3 after birth. On day 3 and 4 the piglets received either a complex microbiota by providing them with a fecal inoculant of an adult sow [complex association (CA)] or a placebo inoculant [simple association (SA)]. Fecal microbiota composition, as determined by denaturing gradient gel electrophoresis and by pig intestinal tract chip (PITChip) analysis of 16S rRNA genes (days 3, 5, 7, 14, and 28), was less diverse in the SA group compared to the CA group. A difference in fecal microbiota composition between treatments persisted until the end of the study. It was concluded that the composition of microbiota in feces of cesarean delivery-derived piglets is influenced by bacterial association in the first days after birth. Differences in fecal microbiota composition between piglets exposed to a simple or complex inoculum at early age persisted for at least 3 wk. PMID:23365401

  14. The IDEFICS Cohort

    Ahrens, Wolfgang; Bammann, Karin; Siani, Alfonso;

    2011-01-01

    tests. The proportion of children donating venous blood, urine and saliva was 57, 86 and 88%, respectively. Conclusion: The IDEFICS cohort provides valuable data to investigate the interplay of social, environmental, genetic, physiological and behavioural factors in the development of major diet- and...... children included anthropometry, blood pressure, fitness, accelerometry, DNA from saliva and physiological markers in blood and urine. The built environment, sensory taste perception and other mechanisms of children's food choices and consumer behaviour were studied in subgroups. Results: Between 1507 and....... At least one 24-h dietary recall was obtained for two-thirds of the children. Blood pressure and anthropometry were assessed in more than 90%. A 3-day accelerometry was performed in 46%, motor fitness was assessed in 41%, cardiorespiratory fitness in 35% and ~11% participated in taste perception...

  15. Strategy for diagnosis and correction of vaginal dysbiosis in terms of preparation of pregnant for planned cesarean section and prevention of postpartum endometritis.

    Voronin K.V.; Alale A.M.; Alale I.I.; Dzyba Y.N.

    2013-01-01

    Clinical features of vaginal dysbiosis as a factor in the high risk of septic complications, especially in pregnant women diagnosed with anaerobic vaginal dysbiosis were examined. Low efficiency of the traditional methods of treating bacterial dysbiosis, a high rate of recurrences and the risk of preterm delivery dictate the need to find alternative methods of treatment and prevention of antenatal and post-natal complications. The widespread introduction of caesarean section into obstetric pr...

  16. Exposure to traffic and lung function in adults: a general population cohort study

    Carlsen, Hanne Krage; Modig, Lars; Levinsson, Anna; Kim, Jeong-Lim; Toren, Kjell; Nyberg, Fredrik; Olin, Anna-Carin

    2015-01-01

    Objectives: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design: Cross-sectional results from a cohort study. Setting: The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 ...

  17. Cohort Profile Update: The China Jintan Child Cohort Study.

    Liu, Jianghong; Cao, Siyuan; Chen, Zehang; Raine, Adrian; Hanlon, Alexandra; Ai, Yuexian; Zhou, Guoping; Yan, Chonghuai; Leung, Patrick W; McCauley, Linda; Pinto-Martin, Jennifer

    2015-10-01

    The China Jintan Child Cohort study began in 2004 with 1656 pre-school participants and a research focus on studying the impact of environmental exposures, such as lead, on children's neurobehavioural outcomes. This population cohort now includes around 1000 of the original participants, who have been assessed three times over a period of 10 years. Since the original IJE cohort profile publication in 2010, participants have experienced a critical developmental transition from pre-school to school age and then adolescence. The study has also witnessed an increase in breadth and depth of data collection from the original aim of risk assessment. This cohort has added new directions to investigate the mechanisms and protective factors for the relationship between early health factors and child physical and mental health outcomes, with an emphasis on neurobehavioural consequences. The study now encompasses 11 domains, composed of repeated measures of the original variables and new domains of biomarkers, sleep, psychophysiology, neurocognition, personality, peer relationship, mindfulness and family dynamics. Depth of evaluation has increased from parent/teacher report to self/peer report and intergenerational family report. Consequently, the cohort has additional directions to include: (i) classmates of the original cohort participants for peer relationship assessment; and (ii) parental and grandparental measures to assess personality and dynamics within families. We welcome interest in our study and ask investigators to contact the corresponding author for additional information on data acquisition. PMID:26323725

  18. Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

    Esteves-Pereira, Ana Paula; Deneux-Tharaux, Catherine; Nakamura-Pereira, Marcos; Saucedo, Monica; Bouvier-Colle, Marie-Hélène; Leal, Maria do Carmo

    2016-01-01

    Background Cesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women’s health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil. Methods This was a population-based case—control study performed in eight Brazilian states. To control for indication bias, deaths due to antenatal morbidity were excluded. We included 73 cases of postpartum maternal deaths from 2009–2012. Controls were selected from the Birth in Brazil Study, a 2011 nationwide survey including 9,221 postpartum women. We examined the association of cesarean section and postpartum maternal death by multivariate logistic regression, adjusting for confounders. Results After controlling for indication bias and confounders, the risk of postpartum maternal death was almost three-fold higher with cesarean than vaginal delivery (OR 2.87, 95% CI 1.63–5.06), mainly due to deaths from postpartum hemorrhage and complications of anesthesia. Conclusion Cesarean delivery is an independent risk factor of postpartum maternal death. Clinicians and patients should consider this fact in balancing the benefits and risks of the procedure. PMID:27073870

  19. 昂丹司琼在剖宫产术后镇痛中的应用%Ondansetron for Patient Controlled Intravenous Analgesia after Caesarean Section

    倪正强

    2008-01-01

    目的:观察中枢性镇吐药昂丹司琼在剖宫产术后镇痛中预防恶心、呕吐的效果.方法:选择行剖宫产术者120例,术后使用自控静脉镇痛,并随机分为3组,每组40例.A组镇痛泵中加入昂丹司琼8 mg.手术结束前静脉注射昂丹司琼4 mg;B组镇痛泵中加入昂丹司琼8 mg;C组镇痛泵中加入氟哌利多5 mg.记录各组术后恶心、呕吐发生例数以及应用止吐药的例数.结果:A组恶心2例,呕吐1例;B组恶心4例,呕吐2例;C组恶心8例,呕吐4例,3组间恶心、呕吐发生率比较差异均有统计学意义(P<0.05).结论:应用昂丹司琼能减少术后镇痛所致恶心、呕吐的发生率,且手术结束前静脉注射昂丹司琼对降低恶心、呕吐的发生效果更加明显,值得临床推广.

  20. Metabolic syndrome and dementia risk in a multiethnic elderly cohort

    Muller, Majon; Tang, Ming-Xin; Schupf, Nicole; Manly, Jennifer J.; Mayeux, Richard; Luchsinger, Jose A.

    2007-01-01

    Background/ Aims: The metabolic syndrome (MeSy) may be related to Alzheimer's disease ( AD). Our aims were to investigate the association of the MeSy with incident dementia in a multiethnic elderly cohort in the United States. Methods: We conducted cross-sectional and prospective analyses in 2,476 m

  1. INFLUENCE OF PROLONGED SITTING POSITION ON EFFECTS OF SPINAL ANAESTHESIA ON CAESAREAN DELIVERY: A RANDOMIZED CONTROLLED TRIAL

    Priti

    2014-08-01

    postoperative analgesia was prolonged in both the fentanyl Groups. CONCLUSION: prolonged sitting position after spinal anesthesia not only limit the spread of LA, producing lower sensory block height but also reduces the incidence of hypotension and Intraoperative ephedrine requirement in caesarean delivery.

  2. Cesarean Sections

    ... arise with the mother and/or baby during pregnancy or labor. An emergency C-section might be required if: labor stops ... of possible problems with the placenta during future pregnancies. In the case of emergency C-sections, the benefits usually far outweigh the ...

  3. 20 CFR 30.214 - How does a claimant establish that the employee is a member of the Special Exposure Cohort?

    2010-04-01

    ... employee is a member of the Special Exposure Cohort? 30.214 Section 30.214 Employees' Benefits OFFICE OF... a member of the Special Exposure Cohort? (a) For purposes of establishing eligibility as a member of the Special Exposure Cohort (SEC) under § 30.210(a)(1), the employee must have been a DOE employee,...

  4. Age, period, and cohort analysis of regular dental care behavior and edentulism: A marginal approach

    Lam Kwok-Fai; Wong May; Li Kar-Yan; Schwarz Eli

    2011-01-01

    Abstract Background To analyze the regular dental care behavior and prevalence of edentulism in adult Danes, reported in sequential cross-sectional oral health surveys by the application of a marginal approach to consider the possible clustering effect of birth cohorts. Methods Data from four sequential cross-sectional surveys of non-institutionalized Danes conducted from 1975-2005 comprising 4330 respondents aged 15+ years in 9 birth cohorts were analyzed. The key study variables were seekin...

  5. OUTCOME OF CHILDREN AT 1-2 YEARS AND MATERNAL MORB IDITY AFTER CESAREAN SECTION VS VAGINAL BIRTH FOR BREECH PRESENTATION AT OR NEAR TERM

    Jyoti Ramesh

    2013-02-01

    Full Text Available ABSTRACT: Back ground: In 2000 an international multicentric randomized co ntrol trial of planned vaginal delivery vs planned elective caesarea n section for uncomplicated term breech presentation confirmed that perinatal mortality and s erious neonatal morbidity were significantly lower in planned caesarean group. Seco ndary analysis of Term Breech Trial showed that prelabour caesarean and caesarean during early labour were associated with lowest adverse perinatal outcome due to labour or de livery and that vaginal delivery had the highest risk of adverse outcome AIMS: The purpose of this study is to determine the outco me of children at 1-2 years and maternal morbidity after caesarean section vs. vaginal birth for breech presentation at or near term. SETTINGS AND DESIGN: Prospective observational study from 1 st January 2008-30 th June 2009( 18 months at Institute of Maternal & Child Health , Govt. Medical College Kozhikode. METHODS AND MATERIAL: Outcome of 45 assisted breech deliveries during this period analyzed from case rec ords. 90 Cesarean deliveries during the same period randomly selected as control. STATISTICAL ANALYSIS USED: Data analyzed using SPSS version 16.0.Chi square test was used to compare the outcome. A p value <0.05 was considered to indicate statistical significance. RESULTS : Vaginal delivery group- Five minute Apgar <7 (p=0.019, NICU admission (p=0.00001(RR 4.71 , 95% CI 2.33 to 9.91,Neonatal morbidity (p=0.012RR 2.627,95% CI 1.216 to 5.678 , Prolonged hospitalisation (p=0.005 RR = 2.962 ,95% CI 1.354 to 6.478 statistically signific ant in vaginal delivery group .Caesarean Section group-Elective 30(33.3% Emergency 60(66.6% Neonatal complication( p=0.03 RR=2.57 ,95% CI 1.06 to 6.2, NICU admission ( p=0.01 3 RR=2.86 ,95% CI 1.21 to 6.76. were statistically significant in elective section grou p Maternal morbidity was not associated with type of CS p=0.2 RR = 1.39 ,95% CI 0.447 to 4.307. However the perinatal mortality was

  6. Methodology Series Module 1: Cohort Studies

    Maninder Singh Setia

    2016-01-01

    Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be pro...

  7. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort.

    Louise C Kenny

    Full Text Available BACKGROUND: Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited. METHODS: We performed a population-based cohort study using data on all singleton births in 2004-2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30-34, 35-39 and ≥40 years with women aged 20-29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index. RESULTS: The final study cohort consisted of 215,344 births; 122,307 mothers (54.19% were aged 20-29 years, 62,371(27.63% were aged 30-34 years, 33,966(15.05% were aged 35-39 years and 7,066(3.13% were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37-2.43], pre-term (RR = 1.25, [95% CI: 1.14-1.36] and very pre-term birth (RR = 1.29, [95% CI:1.08-1.55], Macrosomia (RR = 1.31, [95% CI: 1.12-1.54], extremely large for gestational age (RR = 1.40, [95% CI: 1.25-1.58] and Caesarean delivery (RR = 1.83, [95% CI: 1.77-1.90]. CONCLUSIONS: Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers.

  8. Métodos para estimar razão de prevalência em estudos de corte transversal Métodos para estimar razón de prevalencia en estudios de cohorte transversal Methods for estimating prevalence ratios in cross-sectional studies

    Leticia M S Coutinho

    2008-12-01

    y alta en 13%, casi 100% y cuatro veces mas, respectivamente. CONCLUSIONES: En análisis de datos de estudios de cohorte transversal, los modelos Cox y Poisson con varianza robusta son mejores alternativas que la regresión logística. El modelo de regresión log-binomial produjo estimaciones sin sesgo de la RP, pero puede presentar dificultad de convergencia cuando el resultado es muy frecuente y la variable de confusión es continua.OBJECTIVE: To empirically compare the Cox, log-binomial, Poisson and logistic regressions to obtain estimates of prevalence ratios (PR in cross-sectional studies. METHODS: Data from a population-based cross-sectional epidemiological study (n = 2072 on elderly people in Sao Paulo (Southeastern Brazil, conducted between May 2003 and April 2005, were used. Diagnoses of dementia, possible cases of common mental disorders and self-rated poor health were chosen as outcomes with low, intermediate and high prevalence, respectively. Confounding variables with two or more categories or continuous values were used. Reference values for point and interval estimates of prevalence ratio (PR were obtained by means of the Mantel-Haenszel stratification method. Adjusted PR estimates were calculated using Cox and Poisson regressions with robust variance, and using log-binomial regression. Crude and adjusted odds ratios (ORs were obtained using logistic regression. RESULTS: The point and interval estimates obtained using Cox and Poisson regressions were very similar to those obtained using Mantel-Haenszel stratification, independent of the outcome prevalence and the covariates in the model. The log-binomial model presented convergence difficulties when the outcome had high prevalence and there was a continuous covariate in the model. Logistic regression produced point and interval estimates that were higher than those obtained using the other methods, particularly when for outcomes with high initial prevalence. If interpreted as PR estimates, the ORs

  9. Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour

    Hyejin Jeong

    2011-01-01

    Full Text Available Inverted takotsubo cardiomyopathy (TTC, a variant of stress-induced cardiomyopathy, features transient myocardial dysfunction characterized by a hyperdynamic left ventricular apex and akinesia of the base. Herein, we describe a 38-year-old primigravida with severe preeclampsia who had active labour for 4 h followed by an emergency caesarean delivery. She developed postpartum haemorrhage due to uterine atony complicated by pulmonary oedema, which was managed with large-volume infusion and hysterectomy. Her haemodynamic instability was associated with cardiac biomarkers indicative of diffuse myocardial injury and echocardiographic findings of an “inverted” TTC. The patient was almost fully recovered one month later. Our case shows that a reversible inverted TTC may result from a prolonged painful labour. TTC should be listed in the differential diagnosis of the patient presenting with pulmonary oedema of unknown origin, especially in patients with severe preeclampsia.

  10. Generational cohorts and their attitudes toward advertising

    Ernest Cyril De Run; Hiram Ting

    2013-01-01

    This research is aimed at determining the attitudes with regard to advertising from the perspective of generational cohorts in Sarawak. A two-phase of study was conducted to firstly identify generational cohorts in the state and, secondly, to investigate the attitude of each cohort to advertising. Utilizing theories of generations, a qualitative approach by means of personal interviews was used at the outset to identify external events which bring about the formation of cohorts. Accordingly, ...

  11. A Cohort Model of Fertility Postponement

    Joshua R. Goldstein; Cassidy, Thomas

    2014-01-01

    We introduce a new formal model in which demographic behavior such as fertility is postponed by differing amounts depending only on cohort membership. The cohort-based model shows the effects of cohort shifts on period fertility measures and provides an accompanying tempo adjustment to determine the period fertility that would have occurred without postponement. Cohort-based postponement spans multiple periods and produces “fertility momentum,” with implications for future fertility rates. We...

  12. A Study of Group Dynamics in Educational Leadership Cohort and Non-Cohort Groups

    Greenlee, Bobbie J.; Karanxha, Zorka

    2010-01-01

    The purpose of this study was to examine group dynamics of educational leadership students in cohorts and make comparisons with the group dynamics characteristics of non-cohort students. Cohorts have emerged as dynamic and adaptive entities with attendant group dynamic processes that shape collective learning and action. Cohort (n=42) and…

  13. Pregnancy and birth cohort resources in europe

    Larsen, Pernille Stemann; Kamper-Jørgensen, Mads; Adamson, Ashley;

    2013-01-01

    During the past 25 years, many pregnancy and birth cohorts have been established. Each cohort provides unique opportunities for examining associations of early-life exposures with child development and health. However, to fully exploit the large amount of available resources and to facilitate cross-cohort...... collaboration, it is necessary to have accessible information on each cohort and its individual characteristics. The aim of this work was to provide an overview of European pregnancy and birth cohorts registered in a freely accessible database located at http://www.birthcohorts.net....

  14. Consumer Cohorts and Milk Purchases

    Gustavsen, Geir Waehler; Rickertsen, Kyrre

    2008-01-01

    Fluid milk is the most important product of Norwegian agriculture, and the decline in milk purchase has impact in many rural communities. By decomposing the milk purchase into cohort effects, age effects and year effects we show that the reason for the decline is that older generations purchase more milk than younger generations, and during lifetime consumption decline with age. Consequently, as younger generations replace older generations milk purchase decline. We show that towards 2021 the...

  15. GENERALIZED PERITONITIS WITH UTERINE INCISION NECROSIS WITH DEHISCENCE FOLLOWING CESAREAN SECTION PRESE N TING AS GENITOURINARY FISTULA: A UNIQUE COMPLICATION

    Madhuri

    2014-01-01

    Full Text Available Generalized peritonitis following lower segment caesarean section with uterine incision necrosis and dehiscence presenting as genitourinary fistula is very unusual. Herein we report a case of 28 years old woman who was received in emergency hours as a referred case from a private nursing home with history of caesarean section done 11 days back for premature rupture of membranes and pregnancy induced hypertension. She came w ith complaints of continuous watery discharge per vaginum , high grade fever with chills and rigor , nausea , vomiting , breathlessness , severe diffuse abdominal pain and distension of abdomen since last 4 - 5 days. Here acute abdomen series was done. The urologist ruled out genitourinary fistula. CECT of abdomen was done. She was diagnosed to be a case of generalized peritonitis following ca esarean section with necrosis and dehiscence of suture line of uterus through which ascitic fluid was being drained into vagina. Consequently , patient underwent laparotomy. Gentle adhesiolysis with supra cervical hysterectomy was done. Thorough drainage an d irrigation of pelvi - abdominal cavity was done. Post - operative period was uneventful

  16. Dyslipidemia in a Cohort of HIV-infected Latin American Children Receiving Highly Active Antiretroviral Therapy*

    Brewinski, Margaret; Megazzini, Karen; Freimanis Hance, Laura; Cruz, Miguel Cashat; Pavia-Ruz, Noris; Della Negra, Marinella; Ferreira, Flavia Gomes Faleiro; Marques, Heloisa; Hazra, Rohan

    2010-01-01

    In order to describe the prevalence of hypercholesterolemia and hypertriglyceridemia in a cohort of HIV-infected children and adolescents in Latin America and to determine associations with highly active antiretroviral therapy (HAART), we performed this cross-sectional analysis within the NICHD International Site Development Initiative pediatric cohort study. Eligible children had to be at least 2 years of age and be on HAART. Among the 477 eligible HIV-infected youth, 98 (20.5%) had hypercho...

  17. The Assets and Liabilities of Cohorts: The Antecedents of Retirement Security

    J. Michael Collins; John Karl Scholz; Ananth Seshadri

    2013-01-01

    This paper uses repeated cross-sectional data from the Surveys of Consumer Finances (SCF) to characterize cohort patterns of net worth and debt of American households. Cohort patterns provide a useful benchmark for identifying potentially vulnerable households based on relative financial positions over time at similar ages. We also summarize attitudinal measures thought to be related financial capability. Both sets of descriptive data are useful in assessing the well-being of households over ...

  18. Cohort

    Eben, Kryštof; Malý, Marek

    Chichester : John Wiley & Sons, 2004 - (Teugels, J.; Sundt, B.), s. 283-286 ISBN 0-470-84676-3 Institutional research plan: CEZ:AV0Z1030915 Keywords : bayesian statistics * censoring * competing risks * occurence/exposure rate * Wilkie investment model Subject RIV: AO - Sociology, Demography

  19. Depression with postpartum onset: a prospective cohort study in women undergoing elective cesarean section in Brasilia, Brazil Depressão com início após o parto: estudo de corte prospectivo em mulheres submetidas à cesárea eletiva em Brasília, Brasil

    Alberto Moreno Zaconeta

    2013-03-01

    Full Text Available PURPOSE: It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS: A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS: Among the 107 women who completed the study, 11 (10.3% had significant depressive symptoms during pregnancy and 12 (11.2% during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04, a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002. The risk of depression was not influenced by age, parity or educational level. CONCLUSION: Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.OBJETIVO: Foi determinar a prevalência de sintomas depressivos em uma amostra de puérperas da cidade de Brasília, Brasil, discriminando os casos com surgimento após o parto daqueles já presentes durante a gestação. MÉTODOS: Estudo de corte prospectivo. Amostragem por conveni

  20. The Danish National Birth Cohort

    Olsen, J; Melbye, M; Olsen, S F;

    2001-01-01

    component causes that act early in life. Exposures in this period, which influence fetal growth, cell divisions, and organ functioning, may have long-lasting impact on health and disease susceptibility. METHODS: To investigate these issues the Danish National Birth Cohort (Better health for mother and child......-pregnancy. Furthermore, a biological bank has been set up with blood taken from the mother twice during pregnancy and blood from the umbilical cord taken shortly after birth. Data collection started in 1996 and the project covered all regions in Denmark in 1999. By August 2000. a total of 60,000 pregnant women had been...

  1. A cohort model of fertility postponement.

    Goldstein, Joshua R; Cassidy, Thomas

    2014-10-01

    We introduce a new formal model in which demographic behavior such as fertility is postponed by differing amounts depending only on cohort membership. The cohort-based model shows the effects of cohort shifts on period fertility measures and provides an accompanying tempo adjustment to determine the period fertility that would have occurred without postponement. Cohort-based postponement spans multiple periods and produces "fertility momentum," with implications for future fertility rates. We illustrate several methods for model estimation and apply the model to fertility in several countries. We also compare the fit of period-based and cohort-based shift models to the recent Dutch fertility surface, showing how cohort- and period-based postponement can occur simultaneously. PMID:25233957

  2. Cohort Fertility Patterns in the Nordic Countries

    Andersson, Gunnar; Rønsen, Marit; Knudsen, Lisbeth B.;

    2009-01-01

    Previous analyses of period fertility suggest that the trends of the Nordic countries are sufficiently similar to speak of a common "Nordic fertility regime". We investigate whether this assumption can be corroborated by comparing cohort fertility patterns in the Nordic countries. We study...... cumulated and completed fertility of Nordic birth cohorts based on the childbearing histories of women born in 1935 and later derived from the population registers of Denmark, Finland, Norway, and Sweden. We further explore childbearing behaviour by women's educational attainment. The results show...... remarkable similarities in postponement and recuperation between the countries. Median childbearing age is about 2-3 years higher in the 1960-64 cohort than in the 1950-54 cohort, but the younger cohort recuperates the fertility level of the older cohort at ages 30 and above. A similar pattern of...

  3. Profile of vitamin D in a cohort of physicians and diabetologists in Kolkata

    Arjun Baidya

    2012-01-01

    Full Text Available Introduction: Vitamin D deficiency has been documented across all age groups and both sexes from India. However, there is paucity of data on vitamin D deficiency in a particular cohort of population. Objectives: To assess the vitamin D status in a cohort of physicians and diabetologists in Kolkata. Material and Methods: An observational cross sectional study carried out in the month of December 2011 in a cohort of 40 physicians and diabetologists in Kolkata. Results: A total of 40 subjects were studied. Mean age of the cohort was 52.22 ± 10.91.Mean serum vitamin D level was 13.02 ± 4.77 ng/ml. Nearly 92.5% and 5.0% of subjects had vitamin D deficiency and insufficiency, respectively. Conclusions : Vitamin D deficiency is highly prevalent in physicians and diabetologists in Kolkata.

  4. Graduate Cohort Approach in Teacher Education

    Mattson-Gearhart, Jeanine

    2012-01-01

    The use of the cohorts in teacher education has steadily increased over the last decade. Research indicates both beneficial and negative aspects to this approach, with the field undecided. This study focuses on a Midwestern university's accelerated graduate program for special educators. The program uses a mixed cohort approach to model…

  5. Cohort Crowding and Nonresident College Enrollment

    Winters, John V.

    2012-01-01

    This study uses a fixed effects panel data framework to examine the effects of cohort crowding and other variables on nonresident enrollment at four-year public colleges and universities. The results suggest that larger cohorts of resident students crowd out nonresident students at flagship universities, but there is inconsistent evidence of crowd…

  6. 2011 Cohort Graduation and Dropout Rate Report

    Utah State Office of Education, 2011

    2011-01-01

    To align with new federal No Child Left Behind (NCLB) regulations for graduation rate calculations, the Utah State Office of Education (USOE) is reporting a new graduation rate beginning with the 2011 graduating class (also known as the 2011 cohort). The four-year cohort rate (includes all students who started 9th grade in 2007-2008 plus…

  7. Cohort profile: the Young Lives study.

    Barnett, Inka; Ariana, Proochista; Petrou, Stavros; Penny, Mary E; Duc, Le Thuc; Galab, S; Woldehanna, Tassew; Escobal, Javier A; Plugge, Emma; Boyden, Jo

    2013-06-01

    Young Lives is an international longitudinal study investigating the changing nature of childhood poverty in four low-income countries [Ethiopia, India (Andhra Pradesh), Peru and Vietnam] over a 15-year period. In each country, the cohort is comprised of ≈ 2000 children aged between 6 and 18 months and up to 1000 children aged between 7 and 8 years, recruited in 2002 and sampled from 20 sentinel sites. The first survey data collection from primary caregivers and older children took place in 2002, the second in 2006-07 and the third in 2009-10. Data on the community contexts were collected to complement the household surveys. To elaborate and extend the quantitative data, longitudinal qualitative research with a subgroup of the children was carried out in 2007, 2008 and 2010-11. Topic areas covered included nutrition, health and well-being, cognitive and physical development, health behaviours and education, as well as the social, demographic and economic status of the household. Survey data from the study are archived in the International Section of the UK Public Data Archive. PMID:22617687

  8. Cohort Fertility Patterns in the Nordic Countries

    Andersson, Gunnar; Rønsen, Marit; Knudsen, Lisbeth B.;

    Previous analyses of period fertility suggest that the trends of the Nordic countries are sufficiently similar to speak of a common "Nordic fertility regime". We investigate whether this assumption can be corroborated by comparing cohort fertility patterns in the Nordic countries. We study...... cumulated and completed fertility of Nordic birth cohorts based on the childbearing histories of women born in 1935 and later derived from the population registers of Denmark, Finland, Norway and Sweden. We further explore childbearing behaviour by women’s educational attainment. The results show remarkable...... similarities in postponement and recuperation between the countries and very small differences in completed fertility across educational groups. Median childbearing age is about 2-3 years higher in the 1960-64-cohort than in the 1950-54-cohort, but the younger cohort recuperates the fertility level of the...

  9. Pooling birth cohorts in allergy and asthma

    Bousquet, Jean; Anto, Josep; Sunyer, Jordi;

    2013-01-01

    Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in...... the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European...... Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim...

  10. Work engagement and meaningful work across generational cohorts

    Crystal Hoole

    2015-03-01

    Full Text Available Orientation: Engaging employees and providing employees with a sense of meaning at work is not a one-size-fits-all approach. Although research has shown that differences between work engagement and meaningful work amongst generational cohorts exist, results are still inconclusive. With age becoming increasingly more important as a diversity factor, a better understanding of the dynamics between work engagement and meaningful work across different generational cohorts is necessary to design the right strategy for each organisation’s unique parameters.Research purpose: The aim of this study was to determine whether there is a relationship between work engagement and meaningful work and whether there are significant variances between the levels of work engagement and meaningful work between different generational cohorts.Motivation for study: Work engagement has consistently been highlighted by researchers and human resources experts as a recommended solution to provide companies with the upper hand when it comes to creating a competitive edge. Yet, levels of work engagement are far from ideal, requiring intensified efforts to identify solutions towards raising overall engagement levels. In recent years, much of the focus in terms of generating engagement has been aimed in the direction of financial rewards and other benefits; some organisational experts are of the opinion that a shift is occurring towards meaningful work instead of monetary rewards as the driver of engagement. The changing nature of the work landscape also suggests that generational cohorts experience work engagement and meaningful work differently. Understanding these complexities is mandatory in creating solutions towards improving levels of engagement and meaningful work.Research approach, design and method: A cross-sectional quantitative research approach has been followed. The Utrecht Work Engagement Scale (UWES and Psychological Meaningful Scale (PMS were administered to

  11. Cohort Learning for Graduate Students at the Dissertation Stage

    Holmes, Barbara D.; Birds, Kimberly; Seay, Angela D.; Smith, Debra B.; Wilson, Kimberly N.

    2010-01-01

    Doctoral students discuss the power of collaborative cohort learning in transforming the dissertation phase of doctoral study. Innovative components of doctoral cohort learning and dissertation preparation are detailed.

  12. Vaginal birth after cesarean section (VBAC versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

    B. S. Dhillon

    2014-06-01

    Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824 cesarean section and (10.1% (n=15664 were the number of previous cesarean section. In 84% (n=13151 had repeat cesarean delivery and 2513 (16% delivered vaginally. A trial of labor was planned in 4035 (25.8% women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7% delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%, foetal distress (25.8%, severe PIH/eclampsia (5.0%, previous 2 CS (0.7%, APH (1.4% and others (2.7%. In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 592-597

  13. Generational cohorts and their attitudes toward advertising

    Ernest Cyril de Run

    2013-12-01

    Full Text Available This research is aimed at determining the attitudes with regard to advertising from the perspective of generational cohorts in Sarawak. A two-phase of study was conducted to firstly identify generational cohorts in the state and, secondly, to investigate the attitude of each cohort to advertising. Utilizing theories of generations, a qualitative approach by means of personal interviews was used at the outset to identify external events which bring about the formation of cohorts. Accordingly, 48 interviews were conducted and data were content-analyzed. The findings were then incorporated into the second phase of study to investigate cohorts’ views about advertising, using theory of reasoned action. A quantitative approach via questionnaire-based survey was administered, and 1,410 copies were collected for analysis. Five distinct cohorts are proposed in the initial findings. They are labeled as Neoteric Inheritors, Prospective Pursuers, Social Strivers, Idealistic Strugglers and Battling Lifers on the basis of their respective engagement with events during the coming-of-age years. The subsequent findings show that beliefs about advertising are significant predictors of the attitudes to advertising, and so are the attitudes with regard to the intention of every cohort. However, their beliefs and attitudes to advertising are found to differ significantly, especially in the older cohort. The study thus highlights the implication of generational differences on the attitudes to advertising.

  14. Cohort Fertility Patterns in the Nordic Countries

    Gunnar Andersson

    2009-04-01

    Full Text Available Previous analyses of period fertility suggest that the trends of the Nordic countries are sufficiently similar to speak of a common "Nordic fertility regime". We investigate whether this assumption can be corroborated by comparing cohort fertility patterns in the Nordic countries. We study cumulated and completed fertility of Nordic birth cohorts based on the childbearing histories of women born in 1935 and later derived from the population registers of Denmark, Finland, Norway, and Sweden. We further explore childbearing behaviour by women's educational attainment. The results show remarkable similarities in postponement and recuperation between the countries and very small differences in completed fertility across educational groups. Median childbearing age is about 2-3 years higher in the 1960-64 cohort than in the 1950-54 cohort, but the younger cohort recuperates the fertility level of the older cohort at ages 30 and above. A similar pattern of recuperation can be observed for highly educated women as compared to women with less education. An interesting finding is that of a positive relationship between educational level and the final number of children when women who become mothers at similar ages are compared. Country differences in fertility outcome are generally rather low. Childlessness is highest in Finland and lowest in Norway, and the educational differentials are largest in Norway. Despite such differences, the cohort analyses in many ways support the notion of a common Nordic fertility regime.

  15. Household Saving Behaviour in New Zealand: A Cohort Analysis

    Gibson, John K.; Grant M. Scobie

    2001-01-01

    This paper seeks to improve our understanding of household saving behaviour. It is based on an analysis of unit record data from March years 1984 to 1998 taken from the Household Economic Survey (HES). There are limitations of the data set but it provides the only available estimates of income and expenditure, from which saving is estimated as a residual. The HES is a series of cross-sectional surveys rather than a true panel, so we construct synthetic cohorts rather than tracking individual ...

  16. Changing mortality and average cohort life expectancy

    Schoen, Robert; Canudas-Romo, Vladimir

    2005-01-01

    Period life expectancy varies with changes in mortality, and should not be confused with the life expectancy of those alive during that period. Given past and likely future mortality changes, a recent debate has arisen on the usefulness of the period life expectancy as the leading measure of......, the average cohort life expectancy (ACLE), to provide a precise measure of the average length of life of cohorts alive at a given time. To compare the performance of ACLE with CAL and with period and cohort life expectancy, we first use population models with changing mortality. Then the four...

  17. Determinantes sociais e biológicos da cárie dentária em crianças de 6 anos de idade: um estudo transversal aninhado numa coorte de nascidos vivos no Sul do Brasil Effects of Social and biological factors on dental caries in 6-year-old children: a cross sectional study nested in a birth cohort in Southern Brazil

    Marco Aurélio Peres

    2003-12-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi investigar os determinantes sociais e biológicos, medidos no período perinatal e na infância, sobre a ocorrência de cárie dentária em crianças de 6 anos de idade. MÉTODOS: Foi realizado um estudo transversal de cárie dentária em 1999, em uma subamostra de 400 crianças pertencentes a uma coorte de nascidos vivos iniciada em 1993, em Pelotas, RS. Os índices e critérios de diagnóstico adotados foram os preconizados pela Organização Mundial da Saúde (1997. Os resultados do estudo de cárie foram inseridos no banco de dados da coorte, que continha informações sobre as condições sociais e de saúde coletadas ao nascimento, no primeiro, terceiro, sexto e décimo segundo meses e no sexto ano de vida da criança. O índice de cárie (ceo-d = 0 ou > 1 foi a variável dependente. Foram realizadas análises univariada e de regressão logística múltipla não condicional, tendo como base um modelo teórico hierárquico de determinação. RESULTADOS: Escolaridade materna abaixo ou igual a 8 anos, renda familiar menor que 6 salários mínimos, não freqüentar pré-escola e consumo de doces pelo menos uma vez ao dia aos 6 anos de idade foram fatores de risco à cárie. CONCLUSÕES: Os fatores de risco sociais, como baixa escolaridade materna e baixa renda familiar, não freqüentar a pré-escola e dieta inadequada são comuns à cárie dentária e outras doenças e agravos infantis, sugerindo que medidas de intervenção dirigidas a estes fatores seriam mais adequadas à prevenção da cárie do que medidas específicas.OBJECTIVE: The aim of this study was to investigate the relationship between the social and biological conditions experienced in early life and dental caries in 6-year-old children, using a life course approach. METHODS: An oral health cross-sectional study was nested in a birth cohort study initiated in Pelotas, Brazil in 1993. In 1999, a sample of 400 6-year-old children was selected

  18. Multistate cohort models with proportional transfer rates

    Schoen, Robert; Canudas-Romo, Vladimir

    2006-01-01

    We present a new, broadly applicable approach to summarizing the behavior of a cohort as it moves through a variety of statuses (or states). The approach is based on the assumption that all rates of transfer maintain a constant ratio to one another over age. We present closed-form expressions for...... the size and state composition of the cohort at every age and provide expressions for other useful summary measures. The state trajectories, or life course schematics, depict all the possible size and state configurations that the cohort can exhibit over its life course under the specified pattern of.......61. Increases in parity progression rates to parities 4 and above have little effect on a cohort's TFR, while changes in childlessness have a substantial impact....

  19. Validation of the pooled cohort risk score in an Asian population – a retrospective cohort study

    Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

    2014-01-01

    Background The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort ...

  20. European birth cohorts for environmental health research

    Vrijheid, Martine; Casas, Maribel; Bergström, Anna;

    2012-01-01

    Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning.......Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning....

  1. High mortality in the Thule cohort

    Juel, K

    1994-01-01

    The objective was to study mortality in the Thule cohort in order to clarify whether it is a selected population and to ascertain the possibility of misinterpretation when national mortality rates are used as reference in the analysis of occupational mortality.......The objective was to study mortality in the Thule cohort in order to clarify whether it is a selected population and to ascertain the possibility of misinterpretation when national mortality rates are used as reference in the analysis of occupational mortality....

  2. Oral health changes in an adult Norwegian population : a cohort analytical approach

    Holst, D; Schuller, A A

    2000-01-01

    OBJECTIVES: The purpose of this analysis was to study temporal variation in oral health in an adult population. The cohort analysis comprised 1) estimation of longitudinal, cross-sectional, and time-lag differences in caries and treatment experience of the adult population in Trøndelag from 1973 to

  3. Decreasing Sports Activity with Increasing Age? Findings from a 20-Year Longitudinal and Cohort Sequence Analysis

    Breuer, Christoph; Wicker, Pamela

    2009-01-01

    According to cross-sectional studies in sport science literature, decreasing sports activity with increasing age is generally assumed. In this paper, the validity of this assumption is checked by applying more effective methods of analysis, such as longitudinal and cohort sequence analyses. With the help of 20 years' worth of data records from the…

  4. Asthma and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Prospective Cohort Study

    Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

    2013-01-01

    Background: Previous cross-sectional studies have suggested an association between asthma and attention-deficit/hyperactivity disorder (ADHD), but the temporal relationship was not determined. Using a nationwide population-based prospective case-control cohort study (1:4, age-/gender-matched), we hypothesized that asthma in infanthood or early…

  5. Obstetrical Mode of Delivery and Childhood Behavior and Psychological Development in a British Cohort

    Curran, Eileen A.; Cryan, John F.; Kenny, Louise C.; Dinan, Timothy G.; Kearney, Patricia M.; Khashan, Ali S.

    2016-01-01

    The association between mode of delivery [specifically birth by Cesarean section (CS)] and induction of labor (IOL) psychological development at age 7 was assessed [including autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) and behavioral difficulties]. The Millennium cohort study, a nationally representative UK…

  6. Self-reported oral health and associated factors in the North Finland 1966 birth cohort at the age of 31

    Lintula, Terho; Laitala, Ville; Pesonen, Paula; Sipilä, Kirsi; Laitala, Marja-Liisa; Taanila, Anja; Anttonen, Vuokko

    2014-01-01

    Background The Northern Finland 1966 birth cohort (NFBC 1966) is an epidemiological study where the participants have been controlled since pregnancy both in field tests and using questionnaires. This study aimed to evaluate cross-sectionally the association of self-reported oral symptoms (dental caries and bleeding of gums) with sociodemographic and health behavior factors among the subjects. Methods Of the 11,541 original members of the cohort, 8,690 (75%) responded to the questionnaire on ...

  7. COMPARATIVE STUDY OF HYPERBARIC BUPIVACAINE AND PLAIN ROPIVACAINE WITH FENTANYL AS AN ADJUVANT FOR SPINAL ANAESTHESIA IN CEASAREAN SECTION

    Vindhya

    2014-07-01

    Full Text Available : Spinal anaesthesia is very popular for cesarean section and currently both hyperbaric and plain solutions of local anaesthesia along with opioids are used. Difference in the baricity can affect the intrathecal distribution of local anaesthetics. AIM: We compared the effects of intrathecal hyperbaric (heavy 0.5% bupivacaine and isobaric (plain 0.75%ropivacaine combined with 25micro grams fentanyl regarding the degree of sensory and motor block, quality of intraoperative anaesthesia, side effects and post-operative analgesia in patients undergoing cesarean section by doing a randomized controlled study. MATERIALS AND METHODS: Sixty women undergoing caesarean section were randomized into two groups, Group BF (n=30, group RF (n= 30. Group BF received 10 mg (2 ml of 0.5% hyperbaric bupivacaine with 25µgs of preservative free fentanyl and Group RF received 15mgs (2ml 0.75% plain Ropivacaine (isobaric with 25µgs of fentanyl for spinal anaesthesia. In case of insufficient blocks both the groups were supplemented with analgesic dose of ketamine. RESULTS: No difference was observed in onset time, highest level and recovery of sensory block. Recovery of motor block was slightly prolonged in RF group. The incidence of insufficient block requiring ketamine supplementation and duration of postoperative analgesia was same in both groups. The side effects were also similar in both the groups except for hypotension lower systolic pressure in BF group. The neonatal outcome was unaffected. CONCLUSION: In this study we did not find any difference in the two groups despite difference in density suggesting that the spread of spinal solution is not dependent on density in patients undergoing caesarean section.

  8. Personality and Smoking: Individual-Participant Meta-Analysis of 9 Cohort Studies

    Christian Hakulinen; Mirka Hintsanen; Munafò, Marcus R.; Marianna Virtanen; Mika Kivimäki; David Batty, G.; Markus Jokela

    2015-01-01

    Aims: To investigate cross-sectional and longitudinal associations between personality and smoking, and test whether sociodemographic factors modify these associations.Design: Cross-sectional and longitudinal individual-participant meta-analysis. Setting: Nine cohort studies from Australia, Germany, UK and US. Participants: A total of 79,757 men and women (mean age = 51 years). Measurements: Personality traits of the Five-Factor Model (extraversion, neuroticism, agreeableness, conscientiousne...

  9. Personality and smoking: Individual-participant meta-analysis of 9 cohort studies

    Hakulinen, Christian; Hintsanen, Mirka; Munafò, Marcus R.; Virtanen, Marianna; Kivimäki, Mika; Batty, G David; Jokela, Markus

    2015-01-01

    Aims: To investigate cross-sectional and longitudinal associations between personality and smoking, and test whether sociodemographic factors modify these associations.Design: Cross-sectional and longitudinal individual-participant meta-analysis. Setting: Nine cohort studies from Australia, Germany, UK and US. Participants: A total of 79,757 men and women (mean age = 51 years). Measurements: Personality traits of the Five-Factor Model (extraversion, neuroticism, agreeableness, conscientiousne...

  10. Cohort Profile : LifeLines, a three-generation cohort study and biobank

    Scholtens, Salome; Smidt, Nynke; Swertz, Morris A.; Bakker, Stephan J. L.; Dotinga, Aafje; Vonk, Judith M.; van Dijk, Freerk; van Zon, Sander K. R.; Wijmenga, Cisca; Wolffenbuttel, Bruce H. R.; Stolk, Ronald P.

    2015-01-01

    The LifeLines Cohort Study is a large population-based cohort study and biobank that was established as a resource for research on complex interactions between environmental, phenotypic and genomic factors in the development of chronic diseases and healthy ageing. Between 2006 and 2013, inhabitants

  11. Cohort versus Non-Cohort High School Students' Math Performance: Achievement Test Scores and Coursework

    Parke, Carol S.; Keener, Dana

    2011-01-01

    The purpose of this study is to compare multiple measures of mathematics achievement for 1,378 cohort students who attended the same high school in a district from 9th to 12th grade with non-cohort students in each grade level. Results show that mobility had an impact on math achievement. After accounting for gender, ethnicity, and SES, adjusted…

  12. Regulation of Viable and Optimal Cohorts

    Aubin, Jean-Pierre, E-mail: aubin.jp@gmail.com [VIMADES (Viabilité, Marchés, Automatique, Décisions) (France)

    2015-10-15

    This study deals with the evolution of (scalar) attributes (resources or income in evolutionary demography or economics, position in traffic management, etc.) of a population of “mobiles” (economic agents, vehicles, etc.). The set of mobiles sharing the same attributes is regarded as an instantaneous cohort described by the number of its elements. The union of instantaneous cohorts during a mobile window between two attributes is a cohort. Given a measure defining the number of instantaneous cohorts, the accumulation of the mobile attributes on a evolving mobile window is the measure of the cohort on this temporal mobile window. Imposing accumulation constraints and departure conditions, this study is devoted to the regulation of the evolutions of the attributes which are1.viable in the sense that the accumulations constraints are satisfied at each instant;2.and, among them, optimal, in the sense that both the duration of the temporal mobile window is maximum and that the accumulation on this temporal mobile window is the largest viable one. This value is the “accumulation valuation” function. Viable and optimal evolutions under accumulation constraints are regulated by an “implicit Volterra integro-differential inclusion” built from the accumulation valuation function, solution to an Hamilton–Jacobi–Bellman partial differential equation under constraints which is constructed for this purpose.

  13. Regulation of Viable and Optimal Cohorts

    This study deals with the evolution of (scalar) attributes (resources or income in evolutionary demography or economics, position in traffic management, etc.) of a population of “mobiles” (economic agents, vehicles, etc.). The set of mobiles sharing the same attributes is regarded as an instantaneous cohort described by the number of its elements. The union of instantaneous cohorts during a mobile window between two attributes is a cohort. Given a measure defining the number of instantaneous cohorts, the accumulation of the mobile attributes on a evolving mobile window is the measure of the cohort on this temporal mobile window. Imposing accumulation constraints and departure conditions, this study is devoted to the regulation of the evolutions of the attributes which are1.viable in the sense that the accumulations constraints are satisfied at each instant;2.and, among them, optimal, in the sense that both the duration of the temporal mobile window is maximum and that the accumulation on this temporal mobile window is the largest viable one. This value is the “accumulation valuation” function. Viable and optimal evolutions under accumulation constraints are regulated by an “implicit Volterra integro-differential inclusion” built from the accumulation valuation function, solution to an Hamilton–Jacobi–Bellman partial differential equation under constraints which is constructed for this purpose

  14. Review of Cohort Studies for Mood Disorders.

    Jeon, Hong Jin; Baek, Ji Hyun; Ahn, Yong-Min; Kim, Se Joo; Ha, Tae Hyun; Cha, Boseok; Moon, Eunsoo; Kang, Hee-Ju; Ryu, Vin; Cho, Chul-Hyun; Heo, Jung-Yoon; Kim, Kiwon; Lee, Heon-Jeong

    2016-05-01

    This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients. PMID:27247592

  15. Environmental exposure assessment in European birth cohorts

    Gehring, Ulrike; Casas, Maribel; Brunekreef, Bert;

    2013-01-01

    hand tobacco smoke (SHS), persistent organic pollutants (POPs), noise, radiation, and occupational exposures. The review lists methods and data on environmental exposures in 37 European birth cohort studies. Most data is currently available for smoking and SHS (N=37 cohorts), occupational exposures (N...... of the environmental exposure and health data in these studies was made as part of the ENRIECO (Environmental Health Risks in European Birth Cohorts) project. The focus with regard to exposure was on outdoor air pollution, water contamination, allergens and biological organisms, metals, pesticides, smoking and second......=33), outdoor air pollution, and allergens and microbial agents (N=27). Exposure modeling is increasingly used for long-term air pollution exposure assessment; biomonitoring is used for assessment of exposure to metals, POPs and other chemicals; and environmental monitoring for house dust mite...

  16. The new pooled cohort equations risk calculator

    Preiss, David; Kristensen, Søren L

    2015-01-01

    total cardiovascular risk score. During development of joint guidelines released in 2013 by the American College of Cardiology (ACC) and American Heart Association (AHA), the decision was taken to develop a new risk score. This resulted in the ACC/AHA Pooled Cohort Equations Risk Calculator. This risk...... calculator, based on major National Heart, Lung, and Blood Institute-funded cohort studies, is designed to predict 10-year risk of 'hard' atherosclerotic cardiovascular disease (ASCVD) events, namely, nonfatal myocardial infarction, fatal coronary heart disease, nonfatal, or fatal stroke. Considerable...... disease and any measure of social deprivation. An early criticism of the Pooled Cohort Equations Risk Calculator has been its alleged overestimation of ASCVD risk which, if confirmed in the general population, is likely to result in statin therapy being prescribed to many individuals at lower risk than...

  17. The Danish National Cohort Study (DANCOS)

    Davidsen, Michael; Kjøller, Mette; Helweg-Larsen, Karin

    2011-01-01

    INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self-reported h......INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self...

  18. A cohort of novice Danish science teachers

    Nielsen, Birgitte Lund

    2011-01-01

    A survey on science background and argumentation about science teaching was conducted on a local cohort of newly qualified Danish science teachers. The survey was administered before the novice teachers began their first jobs in primary and lower secondary schools and focused on their reflections...... on students' activities as a goal in themselves, few considered what the students learned through the activities. Results furthermore suggest that the teachers' own assessment of their subject matter knowledge in the physics field may, for a large subgroup in the cohort, affect their approach to...

  19. Cohort profile: the Spanish WORKing life Social Security (WORKss) cohort study

    López Gómez, María Andrée; Durán, Xavier; Zaballa, Elena; Sanchez-Niubo, Albert; Delclos, George L; Benavides, Fernando G

    2016-01-01

    Purpose The global economy is changing the labour market and social protection systems in Europe. The effect of both changes on health needs to be monitored in view of an ageing population and the resulting increase in prevalence of chronic health conditions. The Spanish WORKing life Social Security (WORKss) cohort study provides unique longitudinal data to study the impact of labour trajectories and employment conditions on health, in terms of sickness absence, permanent disability and death. Participants The WORKss cohort originated from the Continuous Working Life Sample (CWLS) generated by the General Directorate for the Organization of the Social Security in Spain. The CWLS contains a 4% representative sample of all individuals in contact with the Social Security system. The WORKss cohort exclusively includes individuals with a labour trajectory from 1981 or later. In 2004, the cohort was initiated with 1 022 779 Social Security members: 840 770 (82.2%) contributors and 182 009 (17.8%) beneficiaries aged 16 and older. Findings to date The WORKss cohort includes demographic characteristics, chronological data about employment history, retirement, permanent disability and death. These data make possible the measurement of incidence of permanent disability, the number of potential years of working life lost, and the number of contracts and inactive periods with the Social Security system. The WORKss cohort was linked to temporary sickness absence registries to study medical diagnoses that lead to permanent disability and consequently to an earlier exit from the labour market in unhealthy conditions. Future plans Thanks to its administrative source, the WORKss cohort study will continue follow-up in the coming years, keeping the representativeness of the Spanish population affiliated to the Social Security system. The linkage between the WORKss cohort and temporary sickness absence registries is envisioned to continue. Future plans include the linkage of

  20. Brain-Science Based Cohort Studies

    Koizumi, Hideaki

    2011-01-01

    This article describes a number of human cohort studies based on the concept of brain-science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media,…

  1. Cohort Size and the Academic Labor Market.

    Stapleton, David C.

    1989-01-01

    Argues that policymakers should be skeptical of forecasts that predict faculty shortages and surpluses according to population trends and analyzes an economic model of the academic labor market. Concludes that forecasts from such models do not support policies designed to offset the impact of cohort size on the academic labor market. (Author/CH)

  2. European Birth Cohorts for Environmental Health Research

    Vrijheid, M.; Casas, M.; Bergström, A.; Carmichael, A.; Cordier, S.; Eggesbø, M.; Eller, E.; Fantini, M. P.; Fernández, M. F.; Fernández-Somoano, A.; Gehring, U.; Grazuleviciene, R.; Hohmann, C.; Karvonen, A. M.; Keil, T.; Kogevinas, M.; Koppen, G.; Krämer, U.; Kuehni, C. E.; Magnus, P.; Majewska, R.; Andersen, A. M. N.; Patelarou, E.; Petersen, M. S.; Pierik, F. H.; Polanska, K.; Porta, D.; Richiardi, L.; Santos, A. C.; Slama, R.; Šrám, Radim; Thijs, C.; Tischer, C.; Toft, G.; Trnovec, T.; Vandentorren, S.; Vrijkotte, T. G. M.; Wilhelm, M.; Wright, J.; Nieuwenhuijsen, M.

    2012-01-01

    Roč. 120, č. 1 (2012), s. 29-37. ISSN 0091-6765 Institutional research plan: CEZ:AV0Z50390703 Keywords : environment pollution * child health * European birth cohorts Subject RIV: DN - Health Impact of the Environment Quality Impact factor: 7.260, year: 2012

  3. Familial aggregation of hypospadias: a cohort study

    Schnack, Tine H; Zdravkovic, Slobodan; Myrup, Charlotte;

    2008-01-01

    hypospadias in a cohort of 1,201,790 boys born in 1973-2005. Using binomial log-linear regression, they estimated recurrence risk ratios of hypospadias for male twin pairs and first-, second-, and third-degree relatives of a hypospadias case, which were 50.8 (95% confidence interval [CI]: 34.2, 75.5), 11...

  4. Constrictive pericarditis in a contemporary Danish cohort

    Landex, Nadia Lander; Ihlemann, Nikolaj; Olsen, Peter Skov;

    2015-01-01

    OBJECTIVES: The aetiology and outcome of constrictive pericarditis vary between geographic regions and has changed over time. We describe the diagnostic work-up and outcome in a contemporary cohort of Danish patients with constrictive pericarditis. DESIGN: Hospital databases were searched for...

  5. Knee Arthroscopy Cohort Southern Denmark (KACS)

    Thorlund, Jonas Bloch; Christensen, Robin; Nissen, Nis;

    2013-01-01

    pain, function and quality of life after meniscus surgery and factors affecting these outcomes. The aim of this prospective cohort study is to investigate the natural time course of patient-reported outcomes in patients undergoing meniscus surgery, with particular emphasis on the role of type of...

  6. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  7. Cohort profile: systemic lupus erythematosus in Sweden: the Swedish Lupus Linkage (SLINK) cohort

    Arkema, Elizabeth V; Simard, Julia F

    2015-01-01

    Purpose A cohort of individuals with systemic lupus erythematosus (SLE) was identified through linkage of several national registers to investigate important epidemiological questions using not only population-based data to minimise selection bias, but also to identify matched comparators from the general population to serve as controls. This cohort was established to overcome the general dearth of data in SLE epidemiology. Participants All individuals registered in Sweden with a personal ide...

  8. Do eating habits differ according to alcohol consumption? Results of a study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC).

    Kesse, Emmanuelle; Clavel-Chapelon, Françoise; Slimani, Nadia; Van Liere, Marti,

    2001-01-01

    BACKGROUND: The potential of dietary habits to confound the association between alcohol consumption and health needs further study. OBJECTIVE: We examined whether eating habits differed according to alcohol consumption in a large cohort of French women. DESIGN: This was a cross-sectional study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC). The cohort was established in 1990 and includes 100000 women born between 1925 and 1950. Dietary data...

  9. A diminishing population whose every cohort more than replaces itself

    Robert Schoen; JONSSON, STEFAN H.

    2003-01-01

    We observe that a dynamic population model can have period fertility that is always below replacement and cohort fertility that is always above replacement. We ask whether such a paradoxical population will get larger or smaller, and show that it must become smaller. Cohort replacement does not imply population replacement, and emphasizing fertility timing and cohort fertility ignores the issue of relative cohort size. The resolution of this apparent paradox reinforces the importance of the l...

  10. Within-Cohort Age-Related Differences in Cognitive Functioning

    Salthouse, Timothy A.

    2013-01-01

    It is widely accepted that the level of cognitive functioning can be influenced by characteristics of the environment that change over time. Many developmental researchers have referred to these influences as cohort effects, and have used year of birth as the basis for determining cohort membership. Furthermore, age-related differences in cognitive functioning are sometimes assumed to be primarily attributable to cohort differences, which implies that differences between birth cohorts should ...

  11. Case–Cohort Analysis with Accelerated Failure Time Model

    Kong, Lan; Cai, Jianwen

    2008-01-01

    In a case–cohort design, covariates are assembled only for a subcohort that is randomly selected from the entire cohort and any additional cases outside the subcohort. This design is appealing for large cohort studies of rare disease, especially when the exposures of interest are expensive to ascertain for all the subjects. We propose statistical methods for analyzing the case–cohort data with a semiparametric accelerated failure time model that interprets the covariates effects as to acceler...

  12. The CONSTANCES cohort: an open epidemiological laboratory

    Zins Marie

    2010-08-01

    Full Text Available Abstract Background Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging. Methods/Design The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death. To take into account non-participation at inclusion and attrition throughout the

  13. Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts

    Mediouni, Z; Bodin, J; Dale, A M; Herquelot, E; Carton, M; Leclerc, A; Fouquet, N; Dumontier, C; Roquelaure, Y; Evanoff, B A; Descatha, A

    2015-01-01

    Objectives The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. Settings and participants The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. Primary and secondary outcome measures During a follow-up of 3–5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. Results In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. Conclusions Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion. PMID:26353869

  14. Evaluation of different hemostatic methods during caesarean section with pernicious placenta previa ;and placenta accreta%凶险型前置胎盘伴胎盘植入剖宫产术中止血方式评价

    金日男; 钟永红

    2014-01-01

    目的:探讨以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法在凶险型前置胎盘伴胎盘植入剖宫产术中的止血效果及临床应用价值。方法收集广东省韶关市粤北人民医院自2012年1月至2014年6月收治的46例凶险型前置胎盘患者的临床资料,对胎盘植入发生率、诊断、处理方法及随诊情况进行回顾性分析。结果(1)46例凶险型前置胎盘中并发胎盘植入17例,发生率36.96%;穿透性胎盘植入9例,发生率19.57%。(2)术前彩色多普勒超声诊断胎盘植入7例,诊断率70.00%(7/10);术前行MR检查诊断胎盘植入8例,诊断率为88.89%。(3)保留子宫38例(82.61%),切除子宫8例,子宫切除率17.39%。(4)术后42~61 d随访8例胎盘植入保留子宫患者,均恶露干净、子宫复旧良好。结论彩色多普勒检查和盆腔MR 检查可提高凶险型前置胎盘伴胎盘植入的诊断率;剖宫产术中采用以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法,可迅速有效地减少剖宫产术中出血量,缩短手术时间,降低子宫切除率。%Objective To evaluate the hemostatic effect of transverse annular compression sutures combined surgical repair in the lower uterine segment and its value on clinical application to control postpartum Hemorrhage at cesarean delivery for pernicious placenta previa with placenta accreta. Methods We conducted a retrospective study at 46 pregnant women with pernicious placenta previa, who were treated at the Affiliated Yuebei People's Hospital of Shantou University Medical College from January 2008 to June 2012. This study reviewed the incidence rates, diagnosis and treatment. Results Among the 46 patients, 17 were diagnosed pernicious placenta praevia with placenta accreta; the incidence rate was 36.5%;while 9 patients were pernicious placenta praevia with placenta percreta, which incidence rate was 19.57%. Ten patients were diagnosed by color Doppler ultrasound before operation;the diagnosis rate was 70.00%(7/10);Eight patients were diagnosed by magnetic-resonance before operation;the diagnosis rate was 88.89%(8/9). Hysterectomy was used in 8 cases (17.39%), and 38 cases (82.61%) were preserve utero. Eight postoperative patients of pernicious placenta praevia with placenta accreta were followed up to 42-61 days, not only their lochia all disappeared, but uterine instauration was good. Conclusion Color Doppler ultrasonography and magnetic-resonance can improve the diagnosis rate of pernicious placenta previa with placenta accreta. It is the effective way to reduce bleeding,operating time and hysterectomy rate of pernicious placenta previa with placenta accreta cases applying transverse annular compression sutures combined surgical repair in the lower uterine segment.

  15. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

    Mridul M Panditrao

    2010-01-01

    Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  16. 昂丹司琼预防剖宫产产妇寒战的临床观察%Preventive Effect of Ondansetron on Shivering in Caesarean Section Patients

    曾振平

    2007-01-01

    目的:研究昂丹司琼对剖宫产产妇寒战的预防作用.方法:选择在腰硬联合麻醉下行剖宫产的产妇80例, ASAⅠ~Ⅱ级,随机分成2组:昂丹司琼组(Ⅰ组),对照组(Ⅱ组)每组40例.麻醉前开放静脉通路,Ⅰ组即给予昂丹司琼8 mg静脉注射,Ⅱ组即给予注射用水4 mL静脉注射.观察记录产妇术中寒战发生的情况,并持续监测围术期呼吸循环的变化,测定麻醉阻滞平面,记录胎儿出生后的Apgar评分. 结果:寒战发生率Ⅰ组为27、5%,Ⅱ组为60.0%;Ⅰ组与Ⅱ组比较差异均有显著性(P<0.05);2组比较围术期呼吸循环变化差异无显著性(P>0.05);2组胎儿出生后Apgar评分差异亦无显著性(P>0.05);术中恶心、呕吐发生率Ⅰ组(5.0%)比Ⅱ组(20%)显著降低(P<0.05).结论:麻醉前预先静脉注射昂丹司琼8 mg,有助于预防剖宫产产妇寒战,昂丹司琼还可明显降低术中恶心、呕吐的发生率.

  17. 恩丹西酮预防剖宫产产妇寒战的临床观察%The clinic study of ondansetron for prevention of shivering in caesarean section

    刘德昭; 黄品婕; 陈信芝; 周少丽; 黑子清; 马武华

    2004-01-01

    目的研究恩丹西酮对剖宫产产妇寒战的预防作用,并与曲马多进行比较.方法选择在腰硬联合麻醉下行剖宫产产妇90例,ASA Ⅰ~Ⅱ级,随机分成3组:恩丹西酮组(E组),曲马多组(T组),对照组(C组),每组30例.麻醉前开放静脉通路,E组即给予恩丹西酮8mg静脉注射(用生理盐水稀释到10ml),T组即给予曲马多50mg静脉注射(用生理盐水稀释到10 ml),C组即给予生理盐水10 ml静脉注射.观察记录产妇术中寒战发生的情况,并持续监测围术期呼吸、循环的变化,测定麻醉阻滞平面,记录胎儿出生后的Apgar评分.结果寒战发生率E组为10%,T组为6.7%,C组为33.3%;E,T组与C组比较差异均有显著性(P<0.05).3组比较围术期呼吸循环变化差异无显著性(P>0.05);3组胎儿出生后Apgar评分差异亦无显著性(P>0.05).术中恶心、呕吐发生率E组(3.3%)比C组(20%)和T组(26.7%)显著降低(P<0.05),而T组和C组比较差异无显著性(P>0.05).结论麻醉前预先静脉注射恩丹西酮8 mg与曲马多50 mg均有助于预防剖宫产产妇寒战,恩丹西酮还可明显降低术中恶心、呕吐发生率.

  18. The preemptive analgesia of propacetamol hydrochloride on contractions pain after caesarean section%超前应用盐酸丙帕他莫预防剖宫产术后宫缩痛的临床研究

    韩玉龙; 王欣欣; 李彦平

    2013-01-01

    目的 观察在剖宫产手术中超前应用盐酸丙帕他莫预防术后宫缩痛的临床疗效.方法 选择剖宫产手术术后行硬膜外自控镇痛(PCEA)患者60例,随机分为两组:丙帕他莫+PCEA组(P-E组,n=30)和单纯PCEA组(E组,n=30).全部病例均在硬膜外麻醉下手术,术毕均于硬膜外腔留置导管内注入镇痛药物(0.125%甲磺酸罗哌卡因+舒芬太尼1 μg)5 ml后接镇痛泵.术后镇痛泵药物配方:舒芬太尼40 μg+0.12%甲磺酸罗哌卡因+生理盐水共100 ml;镇痛泵给药模式:维持量为2 ml/h,单次负荷剂量为0.5 ml,锁定时间为15 min.E-P组剖宫产手术在婴儿取出后,丙帕他莫2 g溶于100 ml盐水中15 min内静脉输入;E组剖宫产手术在婴儿取出后,应用100 ml盐水15 min内静脉输入.观察指标:①应用VAS疼痛评分法观察两组术后30 min、2 h、6 h、12 h的手术伤口疼痛强度;②应用VAS疼痛评分法观察两组术后30 min、2 h、6 h、12 h的宫缩痛疼痛强度;③术后宫缩痛评定标准对比观察;④观察两组术后2 h内恶心、呕吐、瘙痒、发热、呼吸抑制等并发症的发生率.结果 E-P组与P组的伤口镇痛效果无显著性差异(P>0.05),而E-P组的宫缩痛的发生率和疼痛强度明显低于P组(P<0.05),且恶心、呕吐、发热等发生率低于P组,差异有显著性(P<0.05).结论 超前应用丙帕他莫对剖宫产术后宫缩痛的发生具有预防作用,可有效控制宫缩痛的疼痛程度,同时减少副作用发生率.

  19. Case -cohort design in practice - experiences from the MORGAM Project

    Kulathinal, S.; Karvanen, J.; Saareka, O.; K. Kuulasmaa; Evans, Alun; Yarnell, John

    2007-01-01

    When carefully planned and analysed, the case-cohort design is a powerful choice for follow-up studies with multiple event types of interest. While the literature is rich with analysis methods for case-cohort data, little is written about the designing of a case-cohort study. Our experiences in designing, coordinating and analysing the MORGAM case-cohort study are potentially useful for other studies with similar characteristics. The motivation for using the case-cohort design in the MORGAM g...

  20. The Danish National Cohort Study (DANCOS)

    Helweg-Larsen, Karin; Kjøller, Mette; Davidsen, Michael;

    2003-01-01

    -interview survey. As part of the national health interview survey programme, three nation-wide surveys were conducted in 1986/1987, 1991 and 1994. The samples in the three cohorts consisted of 23,096 adult Danes ages 16 years and older, and 18,296 (79.2%) were personally interviewed on socio-economic status...... Service Register recorded 980,043 contacts with general practitioners and specialist physicians. For 1943-1996, the Danish cancer Registry contained information about one or more cancer diseases among 1,432 people. A total of 4,334 people in the 1994 cohort were re-interview in 2000. DANCOS allows...... for a wide range of analysis in a historical prospective design of determinants of morbidity and mortality, of health care utilization and of the social effects of ill health. DANCOS also allows studies of methodological issues, including analyzing the characteristics of non-respondents. Udgivelsesdato: 2003...

  1. Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts Saúde materno-infantil em Pelotas, Rio Grande do Sul, Brasil: principais conclusões das comparações de coortes de nascimento de 1982, 1993 e 2004

    Fernando C. Barros

    2008-01-01

    Full Text Available Important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of Pelotas, Southern Brazil. Maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. Also, there were more single mothers, and maternal obesity increased. Coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45% of deliveries in 2004. With regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births - 14.7% of all births in 2004 - appears to have colluded with this stagnation. Other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. Regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. The existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.Foram observadas mudanças importantes nas características maternas, de assistência à saúde e de saúde infantil ao longo dos 22 anos cobertos pelas três coortes de base populacional na cidade de Pelotas, Rio Grande do Sul. Melhorou o nível de escolaridade materna, houve uma redução no tabagismo durante a gravidez e aumentou o espaçamento entre filhos. Além disso, havia mais mães solteiras e aumentou a obesidade materna. Melhoraram a cobertura pré-natal e assistência ao parto por profissionais, mas houve um aumento marcante nos partos induzidos e nas cesarianas, que representaram 45% do total de partos em 2004. Com relação à saúde infantil, houve uma redução apenas modesta nas taxas de mortalidade neonatal e infantil

  2. Risk set sampling in epidemiologic cohort studies

    Langholz, Bryan; Goldstein, Larry

    1996-01-01

    Recent work has extended the methods for the analysis of nested case-control studies to accomodate a broad variety of risk set sampling designs. These results have implications for the design of sampled epidemiologic cohort studies. We describe a model which is a natural extension of the Cox proportional hazards model and may be used to estimate parameters from sampled risk set data. We illustrate how these techniques may be used to solve three diverse design and analysis problems from epidem...

  3. Existing data sources for clinical epidemiology: Danish Cancer in Primary Care cohort

    Jensen H.; Tørring ML; Larsen MB; Vedsted P

    2014-01-01

    Henry Jensen,1,2 Marie Louise Tørring,1 Mette Bach Larsen,3 Peter Vedsted11Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, 2Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, 3Department of Public Health Programs, Randers Regional Hospital, Randers NOE, Denmark Background: In this paper, we describe the settings, content, and possibilities of the Danish Cancer in Primary Care (CaP) cohort as wel...

  4. Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study

    Griffiths, Lucy J; Dezateux, Carol; Hill, Andrew

    2011-01-01

    Objectives. We examined cross-sectional and longitudinal associations between obesity and emotional and behavioural problems in a nationally representative sample of young children. Methods. Data were available from 11 202 children (50% boys) participating in the UK's Millennium Cohort Study. Height and weight were measured at 3 and 5 years and children defined as obese using IOTF cut-offs for body mass index (BMI). Emotional and behavioural problems were parentally assessed using the Strengt...

  5. Widow Inheritance and HIV Prevalence in Bondo District, Kenya: Baseline Results from a Prospective Cohort Study

    Agot, Kawango E; Vander Stoep, Ann; Tracy, Melissa; Obare, Billy A.; Bukusi, Elizabeth A.; Ndinya-Achola, Jeckoniah O; Moses, Stephen; Weiss, Noel S.

    2010-01-01

    Background Widow Inheritance is a widespread cultural practice in sub-Saharan Africa that has been postulated as contributing to risk of HIV transmission. We present baseline results from a study designed to investigate the association between widow inheritance and HIV acquisition. Methods and Findings We performed a cross-sectional analysis of baseline data from a prospective cohort study to investigate if widow inheritance is a risk practice for HIV infection. Study participants were 1,987 ...

  6. Geography of Diet in the UK Women’s Cohort Study: A Cross-Sectional Analysis

    Morris, MA; Clarke, GP; Edwards, KL; Hulme, C.; Cade, JE

    2016-01-01

    Diet can influence health outcomes and chronic disease risk, therefore a better understanding of factors influencing diet is important in promotion of healthier dietary choices. Many factors influence food choice, including the environment in which we live. This study aims to explore differences in dietary pattern consumption by two spatial measures: Government Office Region (a large regional unit of geography) and Output Area Classification (a small area geography combined with demographic c...

  7. FEMA DFIRM Cross Sections

    Minnesota Department of Natural Resources — FEMA Cross Sections are required for any Digital Flood Insurance Rate Map database where cross sections are shown on the Flood Insurance Rate Map (FIRM). Normally...

  8. Cesarean Section Birth

    Full Text Available ... c-section delivery without labor, there's an increased risk for the baby to need some extra help. ... with each successive c-section, there's an increased risk of there being scar tissue, which may increase ...

  9. Cesarean Section Birth

    Full Text Available ... classical cesarean sections, because the risk of uterine rupture with subsequent labor is greater, we generally don' ... With a BVAC, there's a risk of uterine rupture. With multiple cesarean sections, there's a risk of ...

  10. Cesarean Section Birth

    Full Text Available ... JODI JACKSON, MD: Anytime that you have a c-section delivery without labor, there's an increased risk ... important to think about the reasons why a c-section is indicated. The literature suggests that once ...

  11. Maternal Risk Exposure and Adult Daughters' Health, Schooling, and Employment: A Constructed Cohort Analysis of 50 Developing Countries.

    Li, Qingfeng; Tsui, Amy O

    2016-06-01

    This study analyzes the relationships between maternal risk factors present at the time of daughters' births-namely, young mother, high parity, and short preceding birth interval-and their subsequent adult developmental, reproductive, and socioeconomic outcomes. Pseudo-cohorts are constructed using female respondent data from 189 cross-sectional rounds of Demographic and Health Surveys conducted in 50 developing countries between 1986 and 2013. Generalized linear models are estimated to test the relationships and calculate cohort-level outcome proportions with the systematic elimination of the three maternal risk factors. The simulation exercise for the full sample of 2,546 pseudo-cohorts shows that the combined elimination of risk exposures is associated with lower mean proportions of adult daughters experiencing child mortality, having a small infant at birth, and having a low body mass index. Among sub-Saharan African cohorts, the estimated changes are larger, particularly for years of schooling. The pseudo-cohort approach can enable longitudinal testing of life course hypotheses using large-scale, standardized, repeated cross-sectional data and with considerable resource efficiency. PMID:27154342

  12. The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year

    Schorr, S. G.; Slooff, C. J.; Bruggeman, R.; Taxis, K.

    2009-01-01

    Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia. This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find var

  13. Associations with Intraocular Pressure in a Large Cohort

    Chan, Michelle P.Y.; Grossi, Carlota M.; Khawaja, Anthony P.; Yip, Jennifer L.Y.; Khaw, Kay-Tee; Patel, Praveen J.; Khaw, Peng T.; Morgan, James E.; Vernon, Stephen A.; Foster, Paul J.

    2016-01-01

    Purpose To describe the associations of physical and demographic factors with Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) in a British cohort. Design Cross-sectional study within the UK Biobank, a large-scale multisite cohort study in the United Kingdom. Participants We included 110 573 participants from the UK Biobank with intraocular pressure (IOP) measurements available. Their mean age was 57 years (range, 40–69 years); 54% were women, and 90% were white. Methods Participants had 1 IOP measurement made on each eye using the Ocular Response Analyzer noncontact tonometer. Linear regression models were used to assess the associations of IOP with physical and demographic factors. Main Outcome Measures The IOPg and IOPcc. Results The mean IOPg was 15.72 mmHg (95% confidence interval [CI], 15.70–15.74 mmHg), and the mean IOPcc was 15.95 mmHg (15.92–15.97 mmHg). After adjusting for covariates, IOPg and IOPcc were both significantly associated with older age, male sex, higher systolic blood pressure (SBP), faster heart rate, greater myopia, self-reported glaucoma, and colder season (all P < 0.001). The strongest determinants of both IOPg and IOPcc were SBP (partial R2: IOPg 2.30%, IOPcc 2.26%), followed by refractive error (IOPg 0.60%, IOPcc 1.04%). The following variables had different directions of association with IOPg and IOPcc: height (−0.77 mmHg/m IOPg; 1.03 mmHg/m IOPcc), smoking (0.19 mmHg IOPg, −0.35 mmHg IOPcc), self-reported diabetes (0.41 mmHg IOPg, −0.05 mmHg IOPcc), and black ethnicity (−0.80 mmHg IOPg, 0.77 mmHg IOPcc). This suggests that height, smoking, diabetes, and ethnicity are related to corneal biomechanical properties. The increase in both IOPg and IOPcc with age was greatest among those of mixed ethnicities, followed by blacks and whites. The same set of covariates explained 7.4% of the variability of IOPcc but only 5.3% of the variability of IOPg. Conclusions This analysis

  14. Age, period, and cohort analysis of regular dental care behavior and edentulism: A marginal approach

    Lam Kwok-Fai

    2011-03-01

    Full Text Available Abstract Background To analyze the regular dental care behavior and prevalence of edentulism in adult Danes, reported in sequential cross-sectional oral health surveys by the application of a marginal approach to consider the possible clustering effect of birth cohorts. Methods Data from four sequential cross-sectional surveys of non-institutionalized Danes conducted from 1975-2005 comprising 4330 respondents aged 15+ years in 9 birth cohorts were analyzed. The key study variables were seeking dental care on an annual basis (ADC and edentulism. For the analysis of ADC, survey year, age, gender, socio-economic status (SES group, denture-wearing, and school dental care (SDC during childhood were considered. For the analysis of edentulism, only respondents aged 35+ years were included. Survey year, age, gender, SES group, ADC, and SDC during childhood were considered as the independent factors. To take into account the clustering effect of birth cohorts, marginal logistic regressions with an independent correlation structure in generalized estimating equations (GEE were carried out, with PROC GENMOD in SAS software. Results The overall proportion of people seeking ADC increased from 58.8% in 1975 to 86.7% in 2005, while for respondents aged 35 years or older, the overall prevalence of edentulism (35+ years decreased from 36.4% in 1975 to 5.0% in 2005. Females, respondents in the higher SES group, in more recent survey years, with no denture, and receiving SDC in all grades during childhood were associated with higher probability of seeking ADC regularly (P P P Conclusions With the use of GEE, the potential clustering effect of birth cohorts in sequential cross-sectional oral health survey data could be appropriately considered. The success of Danish dental health policy was demonstrated by a continued increase of regular dental visiting habits and tooth retention in adults because school dental care was provided to Danes in their childhood.

  15. Evaluating HIV prevention efforts using semiparametric regression models: results from a large cohort of women participating in an HIV prevention trial from KwaZulu-Natal, South Africa

    Gita Ramjee

    2013-11-01

    Full Text Available Objective: To describe and quantify the differences in risk behaviours, HIV prevalence and incidence rates by birth cohorts among a group of women in Durban, South Africa. Methods: Cross-sectional and prospective cohort analyses were conducted for women who consented to be screened and enrolled in an HIV prevention trial. Demographic and sexual behaviours were described by five-year birth cohorts. Semiparametric regression models were used to investigate the bivariate associations between these factors and the birth cohorts. HIV seroconversion rates were also estimated by birth cohorts. Results: The prevalence of HIV-1 infection at the screening visit was lowest (20.0% among the oldest (born before 1960 cohorts, while the highest prevalence was observed among those born between 1975 and 79. Level of education increased across the birth cohorts while the median age at first sexual experience declined among those born after 1975 compared to those born before 1975. Only 33.03% of the oldest group reported ever using a condom while engaging in vaginal sex compared to 73.68% in the youngest group; however, HIV and other sexually transmitted infection (STI incidence rates were significantly higher among younger women compared to older women. Conclusions: These findings clearly suggest that demographic and sexual risk behaviours are differentially related to the birth cohorts. Significantly high HIV and STI incidence rates were observed among the younger group. Although the level of education increased, early age at sexual debut was more common among the younger group. The continuing increase in HIV and STI incidence rates among the later cohorts suggests that the future trajectory of the epidemic will be dependent on the infection patterns in younger birth cohorts.

  16. Period effects, cohort effects, and the narrowing gender wage gap.

    Campbell, Colin; Pearlman, Jessica

    2013-11-01

    Despite the abundance of sociological research on the gender wage gap, questions remain. In particular, the role of cohorts is under investigated. Using data from the Current Population Survey, we use age-period-cohort analysis to uniquely estimate age, period, and cohort effects on the gender wage gap. The narrowing of the gender wage gap that occurred between 1975 and 2009 is largely due to cohort effects. Since the mid-1990s, the gender wage gap has continued to close absent of period effects. While gains in female wages contributed to declines in the gender wage gap for cohorts born before 1950, for later cohorts the narrowing of the gender wage gap is primarily a result of declines in male wages. PMID:24090861

  17. GESTATIONAL OBESITY AS A DETERMINANT OF GENERAL ANESTHESIA TECHNIQUE FOR CAESAREAN DELIVERY: A CASE REPORT Obesidad en la gestación como determinante de técnica anestésica general para cesárea: reporte de caso

    José Ricardo Navarro-Vargas; José Luis Aldana-Díaz; Javier H. Eslava-Schamalbach

    2009-01-01

    Background. The incidence of obesity has undergone a dramatic increase around the world during the last few years. Such epidemic behavior has been associated with obstetric patient’s frequent presentation of different stages of obesity when undergoing anesthetic procedure. Obesity in pregnant women involves the risk of adverse maternal and fetal outcomes. Hypertension and preeclampsia, diabetes, fetal macrosomia, caesarean delivery, difficult airway management and neuroaxial techniques are mo...

  18. Canadian family physicians' decision to collaborate: age, period and cohort effects.

    Sarma, Sisira; Devlin, Rose Anne; Thind, Amardeep; Chu, Man-Kee

    2012-11-01

    One of the core primary care reform initiatives seen across provinces in Canada is the introduction of inter-professional primary healthcare teams in which family physicians are encouraged to collaborate with other health professionals. Although a higher proportion of physicians are collaborating with various health professionals now compared to the previous decade, a substantial number of physicians still do not work in a collaborative setting. The objective of this paper is to examine the age, period and cohort effects of Canadian family physicians' decisions to collaborate with seven types of health professionals: specialists, nurse practitioners, nurses, dieticians, physiotherapists, psychologists and occupational therapists. To this end, this paper employs a multivariate probit model consisting of seven equations and a cross-classified fixed-effects strategy to explain the collaborative decisions of family physicians. Utilizing three cross-sectional physician surveys from Canada over the 2001-2007 period, cohorts are defined over five-year intervals according to their year of graduation from medical school. We find that newer cohorts of physicians are more likely to collaborate with dieticians, physiotherapists, psychologists and occupational therapists; newer female cohorts are more likely to collaborate with nurses while newer male cohorts are less likely to collaborate with nurses but more likely to collaborate with specialists. Older physicians are more likely to collaborate with specialists, physiotherapists, psychologists, and occupational therapists; the age effect for nurses is U-shaped for male physicians while it is inverse U-shaped for females. Family physicians are collaborating more with all seven health professionals in 2004 and 2007 compared to 2001. Belonging to a group practice has a largely positive influence on collaborations; and being paid by a fee-for-service remuneration scheme exerts a negative influence on collaboration, ceteris

  19. The New Zealand Asthma and Allergy Cohort Study (NZA2CS: Assembly, Demographics and Investigations

    Epton Michael J

    2007-02-01

    Full Text Available Abstract Background Asthma and allergy are highly prevalent in industrialised countries. Longitudinal and cross-sectional studies have identified a number of potential risk factors for these conditions, including genetic and environmental factors, with significant gene-environment relationships. Birth cohort studies have been proposed as an important tool to explore these risk factors, particularly exposures in early life that are associated with later disease or protection from disease. This paper describes the establishment of a birth cohort in New Zealand. Methods A birth cohort was established in 1996 in Christchurch and Wellington and infants recruited between 1997–2001. Expectant mothers were recruited by midwives. Children and mothers have undergone assessment by serial questionnaires, environmental assessment including mould and allergen exposure, skin-prick testing, and at age six years are undergoing full assessment for the presence of asthma, atopy and allergic disease, including genetic assessment. Results A total of 1105 children have been recruited, and the retention rate at fifteen months was 91.4%. 15.2% of the children at recruitment have been identified as Maori. A positive family history of asthma, eczema or hay fever has been reported in 84% of children. All children have now been assessed at fifteen months and 685 children from the cohort have reached age six years and have completed the six year assessment. Conclusion The cohort is fully assembled, and assessment of children is well advanced, with good retention rates. The study is well placed to address many current hypotheses about the risk factors for allergic disease and asthma.

  20. Tinned Fruit Consumption and Mortality in Three Prospective Cohorts

    Aasheim, Erlend T.; Sharp, Stephen J.; Appleby, Paul N.; Shipley, Martin J.; Lentjes, Marleen A.H.; Kay-Tee Khaw; Eric Brunner; Key, Tim J.; Wareham, Nicholas J

    2015-01-01

    Dietary recommendations to promote health include fresh, frozen and tinned fruit, but few studies have examined the health benefits of tinned fruit. We therefore studied the association between tinned fruit consumption and mortality. We followed up participants from three prospective cohorts in the United Kingdom: 22,421 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort (1993-2012), 52,625 participants from the EPIC-Oxford cohort (1993-20...

  1. Cohort Effects and Returns to Seniority in France

    Margolis, David N.

    1995-01-01

    We examine empirically returns to seniority in France and estimate cohort effects in both firm specific compensation policies and returns to job seniority. We demonstrate the biases in several estimators of returns to seniority and show that allowing firm specific compensation policies and returns to seniority to vary by entry cohort uncovers patterns of variance within firm and within cohort in estimated intercepts and slopes that can be explained by no single theory.

  2. AGRICOH: A Consortium of Agricultural Cohorts

    Shelia H. Zahm

    2011-04-01

    Full Text Available AGRICOH is a recently formed consortium of agricultural cohort studies involving 22 cohorts from nine countries in five continents: South Africa (1, Canada (3, Costa Rica (2, USA (6, Republic of Korea (1, New Zealand (2, Denmark (1, France (3 and Norway (3. The aim of AGRICOH, initiated by the US National Cancer Institute (NCI and coordinated by the International Agency for Research on Cancer (IARC, is to promote and sustain collaboration and pooling of data to investigate the association between a wide range of agricultural exposures and a wide range of health outcomes, with a particular focus on associations that cannot easily be addressed in individual studies because of rare exposures (e.g., use of infrequently applied chemicals or relatively rare outcomes (e.g., certain types of cancer, neurologic and auto-immune diseases. To facilitate future projects the need for data harmonization of selected variables is required and is underway. Altogether, AGRICOH provides excellent opportunities for studying cancer, respiratory, neurologic, and auto-immune diseases as well as reproductive and allergic disorders, injuries and overall mortality in association with a wide array of exposures, prominent among these the application of pesticides.

  3. Cohort study of atypical pressure ulcers development.

    Jaul, Efraim

    2014-12-01

    Atypical pressure ulcers (APU) are distinguished from common pressure ulcers (PU) with both unusual location and different aetiology. The occurrence and attempts to characterise APU remain unrecognised. The purpose of this cohort study was to analyse the occurrence of atypical location and the circumstances of the causation, and draw attention to the prevention and treatment by a multidisciplinary team. The cohort study spanned three and a half years totalling 174 patients. The unit incorporates two weekly combined staff meetings. One concentrates on wound assessment with treatment decisions made by the physician and nurse, and the other, a multidisciplinary team reviewing all patients and coordinating treatment. The main finding of this study identified APU occurrence rate of 21% within acquired PU over a three and a half year period. Severe spasticity constituted the largest group in this study and the most difficult to cure wounds, located in medial aspects of knees, elbows and palms. Medical devices caused the second largest occurrence of atypical wounds, located in the nape of the neck, penis and nostrils. Bony deformities were the third recognisable atypical wound group located in shoulder blades and upper spine. These three categories are definable and time observable. APU are important to be recognisable, and can be healed as well as being prevented. The prominent role of the multidisciplinary team is primary in identification, prevention and treatment. PMID:23374746

  4. Adult outcomes of teen mothers across birth cohorts

    Anne Driscoll

    2014-04-01

    Full Text Available Background: Teen and young adult mothers have lower socioeconomic status than older mothers. Objective: This study analyzes the socioeconomic status (SES of teen, young adult, and older adult mothers across four five-year birth cohorts from 1956 to 1975 who were teens from 1971 to 1994. Methods: Data were pooled from the 1995, 2002, and 2006-2010 National Survey of Family Growth (NSFG. Mothers were categorized by age at first birth and by their birth cohorts. The SES (education, single motherhood, poverty, employment of teen, young adult, and older mothers was compared across cohorts and within cohorts. Results: Among teen mothers, the odds of fulltime employment improved across birth cohorts and the odds of educational attainment beyond high school did not vary. Their odds of single motherhood and living in poverty increased across cohorts. The odds of higher education and single motherhood increased across birth cohorts for young adult mothers as did the odds of living in poverty, even if working fulltime. Among older adult mothers, educational attainment and the odds of single motherhood rose for recent cohorts. Conclusions: Comparisons between teen mothers and both young adult and all adult mothers within cohorts suggest that gaps in single motherhood and poverty between teen and adult mothers have widened over time, to the detriment of teen mothers. Teen mothers have become more likely to be single and poor than in the past and compared to older mothers.

  5. Period Effects, Cohort Effects, and the Narrowing Gender Wage Gap

    Campbell, Colin; Pearlman, Jessica

    2013-01-01

    Despite the abundance of sociological research on the gender wage gap, questions remain. In particular, the role of cohorts is under investigated. Using data from the Current Population Survey, we use Age-Period-Cohort analysis to uniquely estimate age, period, and cohort effects on the gender wage gap. The narrowing of the gender wage gap that occurred between 1975 and 2009 is largely due to cohort effects. Since the mid-1990s, the gender wage gap has continued to close absent of period effe...

  6. A Comparison of Urinary Catheter Intubation Before and After Anaesthesia in Selective Caesarean Delivery%择期剖宫产麻醉前后留置尿管的比较观察

    林丽萍

    2014-01-01

    目的:观察择期剖宫产手术孕妇在麻醉前后留置尿管的不适程度及尿路感染情况的比较。方法选择自愿择期剖宫产的孕妇120例,将其随机分为两组。其中Ⅰ组为腰硬联合麻醉后留置尿管,Ⅱ组为在病房进行术前准备时留置尿管,对孕妇插管时舒适度,疼痛程度及术后3d内发出尿路感染的比较。结果Ⅰ组孕妇在留置尿管时比Ⅱ组孕妇舒适度高,疼痛感不明显,插管成功率高,术后3d内尿路感染发生率低。结论麻醉后留置尿管可减轻患者疼痛、不适,提高一次性插管的成功率,减少尿路感染发生率。%Objective To observe the discomfort level and urinary infection of indwel ing urinary catheter in selective caesarean delivery. Methods 120 cases of selective caesarean delivery was divided randomly into two groups, intubation of urinary catheter was carried out after combined subarachnoid epidural analgesia in group one, while it was done during preoperative preparation in the ward in group two. The discomfort in intubation, pain and urinary infection 3 days after operation were compared. Results: Patients in Group one had less pain and higher success in intubation, the pain and urinary infection were significantly less compared with Group two patients. Conclusion Intubation of urinary catheter after combined subarachnoid epidural analgesia can lessen the pain and discomfort , improve the success of intubation and decrease the incidence of urinary infection.

  7. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease

    Riis, L; Vind, Ida; Politi, P; Wolters, F; Vermeire, S; Tsianos, E; Freitas, J; Mouzas, I; Ruiz Ochoa, V; O'Morain, C; Odes, S; Binder, V; Moum, B; Stockbrugger, R; Langholz, E; Munkholm, P; European Collaborative study group on Inflammatory Bowel disease, NN

    2006-01-01

    %, p = 0.005), whereas elective abortion was not significantly different. 48.6% of the patients took medication at the time of conception and 46.9% during pregnancy. The use of cesarean section increased after IBD diagnosis (8.1% vs 28.7% of pregnancies). CD patients pregnant during the disease course......BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) often affects patients in their fertile age. The aim of this study was to describe pregnancy outcome in a European cohort of IBD patients. As data are limited regarding the effect of pregnancy on disease course, our second objective was to...... investigate whether pregnancy influences disease course and phenotype in IBD patients. METHODS: In a European cohort of IBD patients, a 10-yr follow-up was performed by scrutinizing patient files and approaching the patients with a questionnaire. The cohort comprised 1,125 patients, of whom 543 were women...

  8. Cesarean Section Birth

    Full Text Available ... opinion on this seemingly growing trend to undergo electric cesarean section instead of traditional vaginal delivery, especially ... that we've got a completely dry operative field. And it looks really great. So we sort ...

  9. Flow Cytometry Section

    Federal Laboratory Consortium — The primary goal of the Flow Cytometry Section is to provide the services of state-of-the-art multi-parameter cellular analysis and cell sorting for researchers and...

  10. Light Imaging Section

    Federal Laboratory Consortium — The mission of the Light Imaging Section is to give NIAMS scientists access to state-of-the-art light imaging equipment and to offer training and assistance at all...

  11. Cesarean Section Birth

    Full Text Available ... for granted and feel that this is not something that's potentially dangerous, and therefore, maybe we might ... be with the family as much, so it's something to consider always when performing a c-section ...

  12. Cesarean Section Birth

    Full Text Available ... sections sometimes have a good bit of scar tissue. Sometimes there's really not a whole lot there. ... there's an increased risk of there being scar tissue, which may increase the patient's risk for complications ...

  13. Cesarean Section: The Operation

    Full Text Available ... Just a moment, please. You've saved this page It's been added to your dashboard . Cesarean section: ... Map Premature birth report card Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness ...

  14. Cesarean Section: The Operation

    Full Text Available ... Your e-mail was sent. Save to my dashboard Sign in or Sign up to save this ... saved this page It's been added to your dashboard . Cesarean section: The operation 3:12 Dr. Siobhan ...

  15. Cesarean Section Birth

    Full Text Available ... may increase the patient's risk for complications or injury to surrounding organs such as bowel or bladder. ... sections, there's a risk of scar tissue and injury to surrounding organs. So I think it's oftentimes ...

  16. Cesarean Section Birth

    Full Text Available ... hear the baby and the baby will be right here with her immediately after delivery. So we' ... a repeat cesarean section, we make the incision right through the patient's previous incision. This is called ...

  17. Cesarean Section Birth

    Full Text Available ... We've already started, so things are going well. 00:05:37 FEMALE VOICE: [Unintelligible.] 00:05: ... D. RIDGWAY, MD: Sure. The repeat cesarean section. Well, typically we try not to do elective deliveries ...

  18. Cesarean Section Birth

    Full Text Available ... need a lot of special help. So it's real important when c-sections are performed that we ... patients, the particular risks of both, and both options need to be discussed. And then the patient ...

  19. Utility straight sections

    Leemann, B.; Peggs, S.; Peterson, J.

    1985-10-01

    Utility straight sections are insertions in the SSC lattice to provide relatively free space to facilitate various beam manipulations. These uses include beam-abort, injection (and conceivably ejection), space for the rf system, and collimation. A typical utility straight section is 1500 meters in overall length (ranging from 500 to 1200 meters). It has zero dispersion and high values of the beta functions. The betatron phase shift across the insertion is about 90{degrees} in each plane.

  20. On Aggregating Human Capital Across Heterogeneous Cohorts

    Growiec, Jakub; Groth, Christian

    Based on a general framework for computing the aggregate human capital stock under heterogeneity across population cohorts, the paper derives aggregate human capital stocks in the whole population and in the labor force, and relates these variables to average years of schooling and average work...... experience. Under the scenarios considered here, the "macro-Mincer" (log-linear) relationship between aggregate human capital and average years of schooling is obtained only in cases which are inconsistent with heterogeneity in years of schooling and based on empirically implausible demographic survival laws....... Our numerical results indicate that the macro-Mincer equation can be a reasonable approximation of the true relationship only if returns to schooling and work experience are roughly constant across countries...