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Sample records for america classifying caesarean

  1. WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

    Directory of Open Access Journals (Sweden)

    Faúndes Anibal

    2009-10-01

    Full Text Available Abstract Background Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3 represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5 represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections. The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1 or induced or delivered by caesarean section before labour (group 2, which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care

  2. Rates and implications of caesarean sections in Latin America: ecological study

    Science.gov (United States)

    Belizán, José M; Althabe, Fernando; Barros, Fernando C; Alexander, Sophie

    1999-01-01

    Objectives To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables. Design Descriptive and ecological study. Setting 19 Latin American countries. Main outcome measures National estimates of caesarean section rates in each country. Results Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (rs=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region. Conclusions The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets. Key messages12 of the 19 Latin American countries studied had caesarean section rates above 15%, ranging from 16.8% to 40%These12 countries account for 81% of the deliveries in the regionBetter socioeconomic conditions were associated with higher caesarean section ratesOver 850 000 unnecessary caesarean sections are performed each year in Latin AmericaReduction of caesarean section rates will need concerted action from public health authorities, medical associations, medical schools, health professionals, the general population, and the media PMID:10574855

  3. Caesarean delivery: conflicting interests.

    Science.gov (United States)

    Osuna, Eduardo; Pérez Cárceles, Maria Dolores; Sánchez Ferrer, Maria Luisa; Machado, Francisco

    2015-12-01

    Within the maternal-fetal relationship, interests may sometimes diverge. In this paper, a pregnant woman's refusal to undergo a caesarean delivery, which was recommended both to save the life of the fetus and to minimize risks to her, is described. The legal aspects involved in the conflict between maternal autonomy and fetal well-being are analysed. The patient requested an abortion because of the poor condition of the fetus; however, according to Spanish legislation, the possibility of abortion was rejected as the pregnancy was in its 27th week. The woman still persisted in her refusal to accept a caesarian delivery. After the medical team sought guidance on the course to follow, the Duty Court authorized a caesarean delivery against the wishes of the patient. From a legal point of view, at stake were the freedom of the woman - expressed by the decision to reject a caesarean delivery - and the life of the unborn child. In clinical treatment, the interests of the fetus are generally aligned with those of the pregnant woman. When they are not, it is the pregnant woman's autonomy that should be respected, and coercion should form no part of treatment, contrary to the decision of this court. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Rising rates of Caesarean sections: an audit of Caesarean sections ...

    African Journals Online (AJOL)

    Most of the caesarean sections were carried out because of a previous CS; maternal request and HIV status also contributed to the high rate. Conclusion: The high CS rate in private practice is probably a window to the increased rates of Caesarean section being performed worldwide. This high rate is in keeping with trends ...

  5. Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis.

    Science.gov (United States)

    Ronsmans, Carine; Holtz, Sara; Stanton, Cynthia

    2006-10-28

    Little is known about socioeconomic differences in access to life-saving obstetric surgery, yet access to a caesarean for women is essential to achieve low levels of maternal mortality. We examined population-based caesarean rates by socioeconomic groups in various developing countries. We used data from 42 Demographic and Health Surveys in sub-Saharan Africa, south and southeast Asia, and Latin America and the Caribbean. We report caesarean rates by wealth quintile and the absolute and relative difference between the richest and poorest quintiles. We also categorise the sample into richer and poorer halves and examine caesarean rates within rural areas. Caesarean rates were extremely low among the very poor: they were below 1% for the poorest 20% of the population in 20 countries and were below 1% for 80% of the population in six countries. Only in five countries did the very poor have caesarean rates exceeding 5%. At the other extreme are seven countries, mostly in Latin America, where caesareans are far in excess of the suggested maximum threshold of 15% for at least 40% of the population. In the poorest countries-mostly in sub-Saharan Africa-large segments of the population have almost no access to potentially life-saving caesareans, whereas in some mid-income countries more than half the population has rates in excess of medical need. These data deserve the immediate attention of policymakers at national and international levels.

  6. Surveillance of selected post-caesarean infections based on electronic registries: validation study including post-discharge infections

    DEFF Research Database (Denmark)

    Leth, R A; Nørgaard, M; Uldbjerg, N

    2010-01-01

    ) within 30 days after caesarean section. We assessed the use of data from various electronic registries to identify patients with post-caesarean UTI and PWI classified according to a reference standard. The standard was based on information from medical records and self-reported data (questionnaire) using...

  7. Hematometra following caesarean section for placenta previa ...

    African Journals Online (AJOL)

    year-old woman who had undergone caesarean section for placenta previa. She presented with cryptomenorrhoea and hematometra after 5 months of caesarean delivery owing to adhesions in the vagina. The hematometra was drained ...

  8. Postoperative pain management following caesarean section in ...

    African Journals Online (AJOL)

    Postoperative pain management following caesarean section in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. ... Conclusion: Pain remains a significant problem following surgical operations in our environment. Keywords: Postoperative, Analgesia, Caesarean section, Effectiveness, Patient satisfaction.

  9. Antimicrobial prophylaxis in caesarean section delivery

    OpenAIRE

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-01-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A pros...

  10. Caesarean section at Usmanu Danfodiyo University Teaching ...

    African Journals Online (AJOL)

    Results: A total of 4,115 deliveries were recorded during the study period and 435 of them (10.6%) were through caesarean section (CS). Emergency CS accounted for 65.1% of caesarean deliveries.The mean age was 28±6 years. Previous CS was the commonest indication for caesarean section (25.7%). Elective CS had ...

  11. Caesarean section and anaesthetic mortality

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group. LETTER TO THE EDITOR. Caesarean section and ... births there are 3.1 maternal deaths,2 13 neonatal deaths, 28 infantile deaths and 40 deaths under the age of 5 ...

  12. Classifying spaces and classifying topoi

    CERN Document Server

    Moerdijk, Izak

    1995-01-01

    This monograph presents a new, systematic treatment of the relation between classifying topoi and classifying spaces of topological categories. Using a new generalized geometric realization which applies to topoi, a weak homotopy equival- ence is constructed between the classifying space and the classifying topos of any small (topological) category. Topos theory is then applied to give an answer to the question of what structures are classified by "classifying" spaces. The monograph should be accessible to anyone with basic knowledge of algebraic topology, sheaf theory, and a little topos theory.

  13. Elective caesarean sections at the Jos University Teaching Hospital ...

    African Journals Online (AJOL)

    Context: Elective caesarean sections have been pronounced safer for both mother and fetus compared with emergency caesarean sections. Emergency caesarean sections however have continued to constitute the lion share of caesarean sections in our facility. Objective: To determine the caesarean section rate, examine ...

  14. Caesarean Delivery: Why The Aversion? | Ezechi | Tropical Journal ...

    African Journals Online (AJOL)

    While only 28.9% will accept caesarean section on doctor\\'s advice, 71.1% will not accept caesarean delivery for any reason. 26.8% of the patients that have had previous caesarean section prefer to die while attempting vaginal delivery than to have a repeat caesarean section. Reasons for refusing caesarean section were ...

  15. Effective education to decrease elective caesarean section

    International Nuclear Information System (INIS)

    Sanavi, F. S.; Rakhshani, F.

    2014-01-01

    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)

  16. Classifying Microorganisms

    DEFF Research Database (Denmark)

    Sommerlund, Julie

    2006-01-01

    This paper describes the coexistence of two systems for classifying organisms and species: a dominant genetic system and an older naturalist system. The former classifies species and traces their evolution on the basis of genetic characteristics, while the latter employs physiological characteris......This paper describes the coexistence of two systems for classifying organisms and species: a dominant genetic system and an older naturalist system. The former classifies species and traces their evolution on the basis of genetic characteristics, while the latter employs physiological...... of Denmark. It is thus a 'real time' and material study of scientific paradigms and discourses....

  17. Classifiers and Plurality: evidence from a deictic classifier language

    Directory of Open Access Journals (Sweden)

    Filomena Sandalo

    2016-12-01

    Full Text Available This paper investigates the semantic contribution of plural morphology and its interaction with classifiers in Kadiwéu. We show that Kadiwéu, a Waikurúan language spoken in South America, is a classifier language similar to Chinese but classifiers are an obligatory ingredient of all determiner-like elements, such as quantifiers, numerals, and wh-words for arguments. What all elements with classifiers have in common is that they contribute an atomized/individualized interpretation of the NP. Furthermore, this paper revisits the relationship between classifiers and number marking and challenges the common assumption that classifiers and plurals are mutually exclusive.

  18. Predictors of Severe Neonatal Compromise Following Caesarean ...

    African Journals Online (AJOL)

    BACKGROUND: The potential harm to a mother and baby from caesarean delivery for clinically diagnosed foetal distress may not always be justified by the degree of neonatal depression at birth. OBJECTIVE: To assess the accuracy of clinical diagnosis of foetal distress indicating caesarean section and identify antepartum ...

  19. Preoperative predictors of thrombocytopenia in Caesarean delivery ...

    African Journals Online (AJOL)

    Preoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary? ... moderate thrombocytopenia. All asymptomatic patients, including those who were HIV positive, had platelet counts > 70 000/μl. Keywords: Caesarean delivery, HIV, obstetrics, pregnancy, thrombocytopenia ...

  20. General Anaesthesia for Caesarean Section | Downing | South ...

    African Journals Online (AJOL)

    General Anaesthesia for Caesarean Section. ... Fifty mothers presenting for elective Caesarean section were anaesthetised using a technique previously recommended for obstetric anaesthesia. Clinically, most infants were in good ... Evidence of postoperative chest infection was found in 5 mothers (10%). Thus, the ...

  1. Caesarean section on maternal request in north-eastern Nigeria ...

    African Journals Online (AJOL)

    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 ...

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

    LENUS (Irish Health Repository)

    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.

  3. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries.

    Science.gov (United States)

    Boatin, Adeline Adwoa; Schlotheuber, Anne; Betran, Ana Pilar; Moller, Ann-Beth; Barros, Aluisio J D; Boerma, Ties; Torloni, Maria Regina; Victora, Cesar G; Hosseinpoor, Ahmad Reza

    2018-01-24

    To provide an update on economic related inequalities in caesarean section rates within countries. Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Women aged 15-49 years with a live birth during the two or three years preceding the survey. Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Substantial within country economic inequalities in caesarean deliveries remain

  4. Tree species composition in areas of Atlantic Forest in southeastern Brazil is consistent with a new system for classifying the vegetation of South America

    Directory of Open Access Journals (Sweden)

    Pedro Vasconcellos Eisenlohr

    2014-06-01

    Full Text Available Rigorous and well-defined criteria for the classification of vegetation constitute a prerequisite for effective biodiversity conservation strategies. In 2009, a new classification system was proposed for vegetation types in extra-Andean tropical and subtropical South America. The new system expanded upon the criteria established in the existing Brazilian Institute of Geography and Statistics classification system. Here, we attempted to determine whether the tree species composition of the formations within the Atlantic Forest Biome of Brazil is consistent with this new classification system. We compiled floristic surveys of 394 sites in southeastern Brazil (between 15º and 25ºS; and between the Atlantic coast and 55ºW. To assess the floristic consistency of the vegetation types, we performed non-metric multidimensional scaling (NMDS ordination analysis, followed by multifactorial ANOVA. The vegetation types, especially in terms of their thermal regimes, elevational belts and top-tier vegetation categories, were consistently discriminated in the first NMDS axis, and all assessed attributes showed at least one significant difference in the second axis. As was expected on the basis of the theoretical background, we found that tree species composition, in the areas of Atlantic Forest studied, was highly consistent with the new system of classification. Our findings not only help solidify the position of this new classification system but also contribute to expanding the knowledge of the patterns and underlying driving forces of the distribution of vegetation in the region.

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

    NARCIS (Netherlands)

    S. van der Vaart (Sondra); H. Berger (Howard); C. Tam (Carolyn); Y.I. Goh (Ingrid); V.M.G.J. Gijsen (Violette); S.N. de Wildt (Saskia); A. Taddio (Anna); G. Koren (Gideon)

    2011-01-01

    textabstractIntroduction: 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,

  6. Prolonged labour as indication for emergency caesarean section

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Sorensen, B L; Onesmo, R

    2012-01-01

    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.......To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour....

  7. Caesarean Section Rates in South Africa: evidence of bias among different ‘population groups’

    Science.gov (United States)

    MATSHIDZE, K. PATRICK; RICHTER, LINDA M.; ELLISON, GEORGE T. H.; LEVIN, JONATHAN B.; McINTYRE, JAMES A.

    2007-01-01

    Objective The aim of this study was to assess the effect of ‘population group’ classification, as a specific instance of ‘racial’ categorization, on caesarean section rates in South Africa. Design Information on ‘population group’ classification (‘Black’, ‘Coloured’, ‘Indian’ or ‘White’, as defined under apartheid legislation) and place of delivery, together with basic obstetric, sociodemographic and perinatal data, were extracted from the birth notification forms of 5456 children who made up the birth cohort of the Birth to Ten longitudinal study. This cohort included all births that occurred to mothers resident in Soweto-Johannesburg during a 7-week period in 1990. Results After accounting for differences in maternal age, gravidity, birth weight and gestational age at delivery, the rate of caesarean sections at private facilities was more than twice that at public facilities. Although there were significant differences in the utilisation of private facilities by women from different ‘population groups’, there was an independent effect of ‘population group’ classification on caesarean section rates: caesarean section rates among women classified as ‘White’ and ‘Coloured’ were significantly higher (95% confidence intervals for odds ratios: 1.40-2.42 and 1.05-1.81, respectively) than among women classified as ‘Black’. Conclusion ‘Population group’ differences in caesarean section rates among South African women are not explained by differences in demographic risk factors for assisted delivery, nor by differences in access to private health care. Instead, the differences in section rates may reflect the effect of bias in clinical decision-making, and/or differences among women from different ‘population groups’ in their attitude towards assisted delivery, and their capacity to negotiate with clinicians. PMID:9673465

  8. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    OBJECTIVE: To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN: Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned...... vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine...... rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS: We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3...

  9. Wound Infection following Caesarean Section in a University ...

    African Journals Online (AJOL)

    Background: Caesarean section is a common operation in obstetric practice, but there is a general aversion to caesarean section amongst Nigerian women due to a myriad of reasons amongst which are its associated morbidity and mortality. Surgical site infection following caesarean section is both a major cause of ...

  10. Social predictors of caesarean section births in Italy | Kambale ...

    African Journals Online (AJOL)

    Background: Caesarean section birth is a frequent mode of delivery worldwide. Several social factors have been demonstrated to be strong predictors of caesarean births. Objectives: To identify possible social predictors of caesarean section births in Italy. Methods: Data for this study were drawn from the Italian Institute of ...

  11. Ogilvie’s syndrome following caesarean section

    Science.gov (United States)

    Latunde-Dada, Adeyinka Oluseun; Alleemudder, Djavid I; Webster, Daniel P

    2013-01-01

    Acute colonic pseudo-obstruction syndrome, also known as Ogilvie’s syndrome, is a rare condition associated with significant morbidity and mortality. We report a case that developed very rapidly after emergency caesarean section. A 20-year-old woman underwent an emergency caesarean section for failure to progress in the first stage of labour and a healthy male infant was delivered without incident. However, soon afterwards the patient developed significant abdominal distension and pain. Ogilvie's syndrome was diagnosed following an abdominal x-ray  which revealed a gross large bowel obstruction without mechanical cause. To prevent caecal rupture, the patient underwent successful emergency colonic decompression. PMID:23784768

  12. Epidemiological Characteristics and Trends of Caesarean Delivery ...

    African Journals Online (AJOL)

    Background: Current obstetric practice is characterised by a continuous increase in caesarean section (CS) delivery rates. Objective: Main purpose of our study was to estimate the overall and annual rates of CS in a University Hospital in Greece. Methods: This was a retrospective chart review of all singleton pregnancies ...

  13. blood transfusion requirement during caesarean delivery

    African Journals Online (AJOL)

    blood loss during Caesarean section (CS) such as the level of expertise of the surgeon and the presence of co-morbidities which predispose to anaemia in pregnancy4 (such as Human Immunodeficiency Virus. (HIV) infection) have not been previously studied in our institution. Anaemia in pregnancy is not uncommon.

  14. Anterior abdominal wall endometriosis following Caesarean Section ...

    African Journals Online (AJOL)

    ... her monthly menstruation, in whom abdominal examination revealed a midline subumbilical scar with a sinus surrounded by area of induration discharging menstrum. A wide excision of the lesion was performed and history confirmed endometriosis. Keywords: Caesarean section, scar endometriosis, polypropylene mesh ...

  15. Post caesarean section anterior abdominal wall endometriosis ...

    African Journals Online (AJOL)

    Abdominal wall endometriosis is a likely sequelae of caesarean section as viable endometrial tissue are deposited in the peritoneal cavity or anterior abdominal wall. One such case to sensitize clinicians of this rare presentation of the disease is presented. The patient was a 48 year old woman who presented with a lesion ...

  16. BLOOD LOSS DURING CAESAREAN MYOMECTOMY: A ...

    African Journals Online (AJOL)

    Administrator

    Classical Caesarean operations and bilateral tuballigation for myomas. Estimated blood loss. Number of patients. Percentage of patients. Units of blood transfused. Less than 500ml. 6. 16.66. -. 500 – less than. 1000ml. 25. 69.44. 1. 1000ml and above. 5. 13.88. 10. Total. 36. 100. 11. Location of fibroid. Number of fibroids.

  17. blood transfusion requirement during caesarean delivery

    African Journals Online (AJOL)

    pregnant patient. Factors predisposing to increased risk for blood transfusion identified from previous studies include preoperative anaemia, previous Caesarean ... abnormalities such as bone marrow depression, anaemia9 and ... study which could fall into either of the following conditions: satisfactory post- operative ...

  18. Inevitable caesarean myomectomy; a case report | Igwegbe ...

    African Journals Online (AJOL)

    Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal ...

  19. Intervention for Postpartum Infections following Caesarean Section

    DEFF Research Database (Denmark)

    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...

  20. Predicting spinal hypotension during Caesarean section | Bishop ...

    African Journals Online (AJOL)

    Hypotension under spinal anaesthesia for Caesarean section remains a common problem with attendant maternal and foetal morbidity attached to it. This review examines some of the issues surrounding the prediction of spinal hypotension, including concerns with current evidence, debate regarding the mechanism of ...

  1. Prevention of Spinal Hypotension During Caesarean Section ...

    African Journals Online (AJOL)

    Background: Volume preload with intravenous fluid is a method used in preventing spinal anaesthesia induced hypotension during caesarean section. We compared the efficacy of preloading with 1000ml Ringer's Lactate (RL) solution versus 500ml 6% Hydroxyethyl starch (HES) in preventing hypotension in two groups of ...

  2. Perimortem caesarean section; successful neonatal outcome after ...

    African Journals Online (AJOL)

    Perimortem caesarean section presents a unique opportunity to successfully resuscitate a pregnant woman who has suffered cardio-vascular collapse, and potentially save the fetus as well. Outcomes for cardio-pulmonary resuscitation have been reported to improve with 'emptying of the uterus', by increasing the maternal ...

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

    LENUS (Irish Health Repository)

    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.

  4. Antimicrobial prophylaxis in caesarean section delivery.

    Science.gov (United States)

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-08-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics. Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients. The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years. The highest proportion of patients were primigravida 72%. Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days. In total, 27% of patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes. Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes. Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

  5. The professional responsibility model of obstetric ethics and caesarean delivery.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2013-04-01

    In this chapter, we provide an account of the professional responsibility model of obstetric ethics, and identify its implications for two major topics: patient-choice caesarean delivery and trial of labour after caesarean delivery. The professional responsibility model of obstetric ethics is based on the ethical concept of medicine as a profession and the ethical principles of beneficence and respect for autonomy. The obstetrician has beneficence-based and autonomy-based obligations to the pregnant woman and beneficence-based obligations to the fetus when it is a patient. Because the viable fetus is a patient, the ethics of caesarean delivery requires balancing of obligations to the pregnant and fetal patient. The implication of the professional responsibility model for patient-choice caesarean delivery is that the obstetrician should respond to such requests with a recommendation against non-indicated caesarean delivery and for vaginal delivery. These recommendations should be explained and discussed in the informed consent process. It is ethically permissible to implement an informed, reflective decision for non-indicated caesarean delivery. The implication for trial of labour after caesarean delivery is that, in settings properly equipped and staffed, the obstetrician should offer both trial of labour after caesarean delivery and planned caesarean delivery to women who have had one previous low transverse incision. The obstetrician should recommend against trial of labour after caesarean delivery for women with a previous classical incision. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Achondroplasia: anaesthetic challenges for caesarean section.

    Science.gov (United States)

    Dubiel, L; Scott, G A; Agaram, R; McGrady, E; Duncan, A; Litchfield, K N

    2014-08-01

    Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. [Elective caesarean: impact of evolution neonatal respiration].

    Science.gov (United States)

    Jonguitud Aguilar, Adriana

    2011-04-01

    The number of Caesarean births has increased worldwide. Respiratory distress syndrome is associated with caesarean delivery, especially in the absence of labor. During the latter stages of pregnancy physiologic changes occur that are accelerated with the onset of labor, which is accompanied by changes in hormones and mediators in the mother and fetus. An acceleration in the evacuation of lung liquid is held in this period, largely dependent sodium channels sensitive to amiloride than are found in the alveolar epithelium. The failure of these mechanisms can lead to newborn severe respiratory difficulty and require intensive care, mechanical ventilation and surfactant. We need to develop preventive and therapeutic strategies to improve outcomes in this vulnerable population.

  8. Caesarean section in Ancient Greek mythology.

    Science.gov (United States)

    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.

  9. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  10. Epidemio-Clinical Factors Associated with Caesarean Section in ...

    African Journals Online (AJOL)

    Abstract Caesarean section incurs significant cost and poses a hindrance to healthcare. The aim of the study was to determine maternal, foetal outcomes and cost. This was a cross sectional study conducted at the two health facilities. The study covered an eight month period. The rate of caesarean section was 5.69% and ...

  11. Outcomes in women attempting vaginal birth after caesarean section ...

    African Journals Online (AJOL)

    A successful vaginal delivery was associated with lower NICU admissions and higher APGAR scores in the neonate than those delivered by caesarean section but there was no statistically significant difference between the groups for APGAR scores <7. There were 3 cases of uterine rupture discovered at caesarean section ...

  12. Indications and Trends of Caesarean Section at ATertiary Hospital in ...

    African Journals Online (AJOL)

    There is need to introduce electronic monitoring of the fetal heart rate and equipments for fetal blood sampling in labour in all our tertiary health facilities. Multi-centered trials evaluating the success of vaginal birth after two previous Caesarean deliveries in our country and regular audits of Caesarean sections in our health ...

  13. Caesarean delivery: An experience from a tertiary institution in North ...

    African Journals Online (AJOL)

    Objective: To assess the overall caesarean section (CS) rate, indications and outcomes in a tertiary hospital in Northwestern Nigeria. Materials and Methods: A cross-sectional study carried out over a period of two years. All patients who had caesarean section at any time within the day were noted and followed up till ...

  14. Blood transfusion requirement during caesarean delivery: Risk factors

    African Journals Online (AJOL)

    Background: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. Methods: This was a prospective ...

  15. Caesarean delivery: An experience from a tertiary institution in North ...

    African Journals Online (AJOL)

    increasing use of CS as a mode of delivery in Europe and the. USA is because of fear of malpractice litigation, increased ... Daniel and Singh: Caesarean delivery, Nigeria. 19. Nigerian Journal of Clinical Practice • Jan-Feb ..... Efetie RE, Umezulike AC, Agboghoroma CO. Caesarean section at the. National Hospital, Abuja ...

  16. Caesarean delivery in urban second tier missionary hospital in Nigeria

    African Journals Online (AJOL)

    Objective: To determine the current trend of Caesarean and highlight the role of a major operative obstetric practice in materno-foetal medicine. Design: Descriptive case study. Setting: St Philomena Catholic Hospital (SPCH), an urban second tier missionary hospital. Subjects: One thousand and fourteen (1014) Caesarean ...

  17. Supplemental oxygen for Caesarean section under spinal anaesthesia

    African Journals Online (AJOL)

    Background: Routine administration of supplemental oxygen to parturients undergoing Caesarean section under spinal anaesthesia has been criticised in recent times. Objectives: To assess the need for routine supplementary oxygen in healthy women undergoing Caesarean section under spinal anaesthesia in resource ...

  18. In vitro myometrial contractility reflects indication for caesarean section.

    Science.gov (United States)

    Quenby, S; Matthew, A; Zhang, J; Dawood, F; Wray, S

    2011-11-01

    To assess the extent to which in vitro measurements of myometrial contractility reflect the clinical indication for caesarean section. A prospective, observational hypothesis-generating study. Women were recruited from Liverpool Women's NHS Foundation Trust and experiments were performed in the Physiology Department at the University of Liverpool. Myometrial samples were taken from women undergoing a caesarean section during labour (n = 50) or from women having a repeat nonlabouring caesarean section (n = 70). The demographic characteristics of the women and indications for current and previous caesarean sections were recorded. The force, frequency and duration of spontaneous contractions of myometrial strips, and changes in the intracellular calcium concentration of the strips, were measured. Kruskall-Wallis and post hoc tests were used to assess the significance of differences between groups. Samples from women whose caesarean section was for fetal distress/acidosis (scalp pH force than those from women whose caesarean section was for delay in the first stage of labour (P force than did samples from women whose first caesarean section was for delay in the first stage of labour (P = 0.03). These findings suggest that the myometrium contracts with greater force in women who have a caesarean section for fetal distress. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  19. Caesarean section on maternal request in north-eastern Nigeria ...

    African Journals Online (AJOL)

    McRoy

    2014-03-30

    Mar 30, 2014 ... views of pregnant women in two tertiary institutions in Nigeria towards caesarean delivery on maternal request. ... perception and attitude toward caesarean delivery are encouraging. The low number of maternal request ..... and Health Survey 2008. Abuja,. Nigeria: National Population Commission and ICF.

  20. Elective caesarean section at 38 weeks versus 39 weeks

    DEFF Research Database (Denmark)

    Glavind, Julie; Kindberg, S F; Uldbjerg, N

    2013-01-01

    To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.......To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes....

  1. How Unsafe is Myomectomy at Caesarean Section? | Ehigiegba ...

    African Journals Online (AJOL)

    Objective: To provide evidence on the safety or otherwise of the practice of myomectomy during Caesarean section. Methods: This was a prospective, randomized, case controlled study conducted at the Obio Cottage Hospital, Port Harcourt, Nigeria, between November 2011 and October 2012. 42 Caesarean section ...

  2. Feasibility of Reducing the Caesarean Section Rate at the University ...

    African Journals Online (AJOL)

    Context: Caesarean section carries a significantly higher mortality and morbidity than vaginal delivery. There has been a growing concern over the increasing rate of caesarean operations worldwide and the need to reduce this. This is particularly important in Nigeria where women dislike the operation and the risks are ...

  3. Caesarean Risk Factors in Northern Region of Bangladesh: A ...

    African Journals Online (AJOL)

    Purpose: To explore the measurement of a scale of caesarean (C-section) risk factors and degree of risk contribution in different health facilities and to determine a suitable graphical representation (image) of caesarean cases. Methods: Based on seventeen indicators, a composite index was computed for each respondent ...

  4. A Six Year Review of Caesarean Sections at Olabisi Onabanjo ...

    African Journals Online (AJOL)

    The commonest indication was previous caesarean section (25.2%), followed by obstructed labour (17.0%). Maternal complications occurred in 23.1% of the subjects with wound infection being the commonest. Birth asphyxia was the commonest foetal complication. This study demonstrates a high caesarean section rate in ...

  5. Epidemio-Clinical Factors Associated with Caesarean Section in ...

    African Journals Online (AJOL)

    Epidemio-Clinical Factors Associated with Caesarean Section in Two Referral Hospitals (Public/Faith-Based), Far-North Region, Cameroon. ... The rate of caesarean section was 5.69% and 6.22% at the semi-urban and rural hospital. ... Post-operative complications were dominated by haemorrhage and infection. The mean ...

  6. Attitude To Caesarean Section Amongst Antenatal Clients In Ibadan ...

    African Journals Online (AJOL)

    This was a cross-sectional study carried out on 372 clients receiving antenatal care at a rural, suburban and urban centres, in order to assess the acceptance of caesarean delivery amongst them and the factors influencing their attitude. Caesarean section was acceptable to 65.7%. Many respondents will refuse the surgery, ...

  7. Thromboprophylaxis for women undergoing caesarean section.

    LENUS (Irish Health Repository)

    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.

  8. Caesarean sections in Mexico: are there too many?

    Science.gov (United States)

    Gonzalez-Perez, G J; Vega-Lopez, M G; Cabrera-Pivaral, C; Muñoz, A; Valle, A

    2001-03-01

    This paper seeks to quantify the magnitude of caesarean sections in Mexican public health-care institutions in recent years, to characterize the evolution of caesarean section rates (CSR) during the last decade, and to estimate the possible economic cost caused by the excess of caesareans performed in these institutions. The study is based on data obtained from the health sector, both for Mexico in the 5-year period 1993-97 and for the Mexican State of Jalisco between 1983 and 1998. Linear regression analysis was used to evaluate time series, and "excess of caesareans" was considered the number of caesarean deliveries performed above the admissible 15% CSR. The results reflect that on the national level, more than one-quarter of the deliveries handled by public institutions ended in caesarean section for each analyzed year, and if the deliveries performed in private institutions are included, the national rate is around 30%. A marked increase in CSR can be observed in Jalisco between 1983 and 1998 (almost 50%); and the cost for the nation of this CSR excess in financial terms is highly significant: several millions of dollars--obtained from public funds--are spent annually and unnecessarily by health services. The findings suggest that the increase in CSR is a public health problem that has not been satisfactorily faced by the health sector authorities. Many unnecessary caesareans would undoubtedly be avoided if the policies of these public health-care institutions were to consider, as a priority, both the known higher risk implicit in a caesarean for the health of the mother and child, and the economic impact on the country and its health institutions of the excessive number of caesareans performed yearly.

  9. Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound

    OpenAIRE

    Radhika, A.G.; Singal, Archana; Radhakrishnan, Gita; Singh, Smita

    2015-01-01

    A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangreno...

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

    DEFF Research Database (Denmark)

    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 increased risk...... of asthma....

  11. [Abdominal necrotizing fasciitis after caesarean delivery].

    Science.gov (United States)

    Barant, S; Radbata, D; Oberweis, D; Jacobs, D; Marecaux, G; Zielonka, E; Maréchal, M

    2016-01-01

    Necrotizing fasciitis (NF) is a rare infection (0,2 to 0,4/100,000 adults) of the dermis and hypodermis extending along muscular fascia1. The absence of pathognomonic symptoms makes its diagnosis difficult. Rapidly progressive, it is a life-threatening emergency whose prognosis is letal in 30 % of cases. Treatment of necrotizing fasciitis is mixed and involves aggressive surgical debridement and medical treatment with antibiotics and supportive agents. This article is presenting the case of a young woman who developed abdominal necrotizing fasciitis following a caesarean section. In forty-eight hours, the patient developed septic shock with an extensive and rapid destruction of her abdominal wall. After hysterectomy and multiple surgical debridements, evolution was favorable. After one month, a reconstruction of the abdominal wall could be performed.

  12. Caesarean section and risk of autism across gestational age

    DEFF Research Database (Denmark)

    Yip, Benjamin Hon Kei; Leonard, Helen; Stock, Sarah

    2017-01-01

    BACKGROUND: The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did...

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

    DEFF Research Database (Denmark)

    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...

  14. No. 155-Guidelines for Vaginal Birth After Previous Caesarean Birth.

    Science.gov (United States)

    Martel, Marie-Jocelyne; MacKinnon, Catherine Jane

    2018-03-01

    To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

  15. Non-clinical interventions for reducing unnecessary caesarean section.

    Science.gov (United States)

    Khunpradit, Suthit; Tavender, Emma; Lumbiganon, Pisake; Laopaiboon, Malinee; Wasiak, Jason; Gruen, Russell L

    2011-06-15

    Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. To evaluate the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections. We searched the following electronic databases: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (29 March 2010), the Cochrane Pregnancy and Childbirth Group Specialised Register (29 March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2); MEDLINE (1950 to March 2010); EMBASE (1947 to March 2010) and CINAHL (1982 to March 2010). We included randomised controlled trials (RCTs), quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) with at least two intervention and control sites, and interrupted time series analyses (ITS) where the intervention time was clearly defined and there were at least three data points before and three after the intervention. Studies evaluated non-clinical interventions to reduce unnecessary caesarean section rates. Participants included pregnant women and their families, healthcare providers who work with expectant mothers, communities and advocacy groups. Three review authors independently assessed the quality and abstracted data of all eligible studies using a standardised data extraction form, modified from the Cochrane EPOC checklists. We contacted study authors for additional information. We included 16 studies in this review.Six studies specifically targeted pregnant women. Two RCTs were shown to be effective in reducing caesarean section rates: a nurse-led relaxation training programme for women with a fear or anxiety of childbirth and birth preparation sessions. However, both RCTs were small in size and

  16. Delivery settings and caesarean section rates in China.

    Science.gov (United States)

    Sufang, Guo; Padmadas, Sabu S; Fengmin, Zhao; Brown, James J; Stones, R William

    2007-10-01

    To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China. We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China. The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002. Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables. Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively. Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions. The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births. The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test. Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure.

  17. Back to "once a caesarean: always a caesarean"? A trend analysis in Switzerland.

    Science.gov (United States)

    Christmann-Schmid, Corina; Raio, Luigi; Scheibner, Katrin; Müller, Martin; Surbek, Daniel

    2016-11-01

    Caesarean sections (CS) have significantly increased worldwide and a previous CS is nowadays an important and increasingly reported indication to perform a repeat CS. There is a paucity of information in Switzerland on the incidence of repeat CS after previous CS and relationship between the rates of vaginal birth after CS (VBAC). The aim of this study was to analyse the actual trend in VBAC in Switzerland. We performed a retrospective cohort study to analyse the proportion of VBAC among all pregnant women with previous sections which give birth during two time periods (group 1:1998/1999 vs. group 2:2004/2005) in our tertiary care referral hospital and in the annual statistics of Swiss Women's Hospitals (ASF-Statistics). In addition, the proportion of induction of labour after a previous caesarean and its success was analysed. In both cohorts studied, we found a significant decrease of vaginal births (p Switzerland. There was no significant change in labour induction during the study period. While this trend might reflect an increasing demand for safety in pregnancy and childbirth, it concomitantly increases maternal risks of further pregnancies, and women need to be appropriately informed about long-term risks.

  18. Preoperative sleep quality predicts postoperative pain after planned caesarean delivery.

    Science.gov (United States)

    Orbach-Zinger, S; Fireman, S; Ben-Haroush, A; Karoush, T; Klein, Z; Mazarib, N; Artyukh, A; Chen, R; Ioscovich, A; Eidelman, L A; Landau, R

    2017-05-01

    Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet. Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 μg, morphine 100 μg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0-5 indicating good sleep quality, PSQI 6-21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h. Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p sleep quality had significantly higher peak pain scores upon movement (46.7 ± 28.8 vs. 36.2 ± 25.6, respectively; p = 0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (VNPS ≥70; OR 2.64; 95% CI 1.2-6.0; p = 0.02). A significant proportion of women scheduled for caesarean delivery were identified preoperatively as having poor sleep quality, which was associated with more severe pain and increased analgesic intake after delivery. The PSQI score may therefore be a useful tool to predict increased risk for acute post-caesarean pain and higher analgesic requirements, and help tailor anaesthetic management. Multiple studies have evaluated predictors for severe acute pain after caesarean delivery that may be performed in a clinical setting, however, sleep quality prior to delivery has not been included in predictive models for post-caesarean pain. The PSQI

  19. [Less neonatal morbidity with elective caesarean sections at term: local guideline for elective caesarean section is effective].

    Science.gov (United States)

    Tanger, Helen L; van den Berg, Anemone; Bolte, Antoinette C; van Elburg, Ruurd M

    2010-01-01

    To assess the effect of a local guideline advising elective caesarean section without maternal comorbidity at a gestational age of >or= 39+0 weeks. Retrospective cohort study. Children born by elective caesarean section in the period 2003-2007 at the VUmc with a gestational age >or= 37+0 weeks and without maternal comorbidity were included. Respiratory complications, length of hospital stay, admission to the neonatal intensive care unit (NICU), respiratory support and medication were recorded from charts of admitted children. These data were compared with data collected in 1994-1998 before implementation of the local guideline. In 2003-2007, 501 children were born from 486 elective caesarean sections. In 1994-1998, 333 children were born from 324 elective caesarean sections. In 2003-2007, mean maternal age was younger, local anaesthesia more frequent, elective caesarean section was more often performed at >or= 39+0 weeks (p < 0.001) and the birth weight was higher. In 2003-2007, fewer infants were admitted to an NICU than in 1994-1998 (6/501 versus 17/333, p < 0.001), of whom fewer infants were born with gestational age caesarean sections performed at gestational age of 38+4/7-38+6 weeks in 2003-2007 (63%) compared with 1994-1998 (28%; p < 0.001). After correction for confounders, the odds ratio for developing respiratory morbidity in 2003-2007 was 0.27 compared with 1994-1998 (95% CI: 0.10-0.70). Implementation of the guideline reduced elective caesarean sections before a gestational age of 39+0 weeks and consequently reduced neonatal respiratory morbidity.

  20. Refusal of emergency caesarean section in Ireland: a relational approach.

    Science.gov (United States)

    Wade, Katherine

    2014-01-01

    This article examines the issue of emergency caesarean section refusal. This raises complex legal and ethical issues surrounding autonomy, capacity, and the right to refuse treatment. In Ireland, the situation is complicated further by the constitutional right to life of the unborn. While cases involving caesarean section refusal have occurred in other jurisdictions, a case of this nature has yet to be reported in Ireland. This article examines possible ways in which the interaction of a woman's right to refuse treatment and the right to life of the unborn could be approached in Ireland in the context of caesarean section refusal. The central argument of the article is that the liberal individualistic approach to autonomy evident in the caesarean section cases in England and Wales is difficult to apply in the Irish context, due to the conflicting constitutional rights of the woman and foetus. Thus, alternative visions of autonomy which take the interests and rights of others into account in medical decision-making are examined. In particular, this article focuses on the concept of relational consent, as developed by Alasdair Maclean and examines how such an approach could be applied in the context of caesarean section refusal in Ireland. The article explains why this approach is particularly appropriate and identifies mechanisms through which such a theory of consent could be applied. It is argued that this approach enhances a woman's right to autonomy, while at the same time allows the right to life of the unborn to be defended.

  1. Risk of a venous thromboembolic episode due to caesarean section and BMI

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Ladelund, S; Rasmussen, S

    2014-01-01

    BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery.......BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery....

  2. Classifying Returns as Extreme

    DEFF Research Database (Denmark)

    Christiansen, Charlotte

    2014-01-01

    I consider extreme returns for the stock and bond markets of 14 EU countries using two classification schemes: One, the univariate classification scheme from the previous literature that classifies extreme returns for each market separately, and two, a novel multivariate classification scheme...... that classifies extreme returns for several markets jointly. The new classification scheme holds about the same information as the old one, while demanding a shorter sample period. The new classification scheme is useful....

  3. COMPARATIVE STUDY OF MATERNAL OUTCOME IN EMERGENCY VERSUS ELECTIVE CAESAREAN SECTION

    OpenAIRE

    Indira Priyadarshini; Saraswathi; Ratna Kumari

    2015-01-01

    : OBJECTIVE: The aim of this study was to find out the maternal outcome in emergency and elective caesarean sections and to compare the intraoperative and postoperative maternal complications in emergency and elective caesarean sections. METHOD: In this hospital based descriptive study 100 cases of emergency caesarean section (EMCS) were compared with 100 cases of elective caesarean section (ELCS) over a period of 2 years in the department of obstetrics and gynaecology in Niloufer...

  4. Caesarean Delivery: The Trend Over a Ten-Year Period at Ilorin ...

    African Journals Online (AJOL)

    Background: There has been tremendous increase in caesarean deliveries in modern obstetric practise as a result of extension of the indications for caesarean section, which is now an international public health issue. Method: Records of all caesarean deliveries that occurred at University of Ilorin Teaching Hospital ...

  5. National Rates of Uterine Rupture are not Associated with Rates of Previous Caesarean Delivery

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Langhoff-Roos, Jens; Jakobsson, Maija

    2017-01-01

    BACKGROUND: Previous caesarean delivery and intended mode of delivery after caesarean are well-known individual risk factors for uterine rupture. We examined if different national rates of uterine rupture are associated with differences in national rates of previous caesarean delivery and intende...

  6. Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound.

    Science.gov (United States)

    Radhika, A G; Singal, Archana; Radhakrishnan, Gita; Singh, Smita

    2015-01-01

    A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangrenosum. The patient's management included oral medication with prednisolone, cyclosporin and dapsone and wound care. There was a dramatic response to this treatment. The wound completely healed by the eighth postoperative month. The oral medications were tapered off slowly and stopped by that time.

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

    LENUS (Irish Health Repository)

    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.

  8. Caesarean section may have long-term consequences for both mother and child

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Krebs, Lone; Lykke, Jacob A

    2014-01-01

    The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery it is enc......The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery...... it is encouraged that all these issues are taken into account and balanced to the benefits of having a caesarean section....

  9. Classifying Cereal Data

    Science.gov (United States)

    The DSQ includes questions about cereal intake and allows respondents up to two responses on which cereals they consume. We classified each cereal reported first by hot or cold, and then along four dimensions: density of added sugars, whole grains, fiber, and calcium.

  10. LCC: Light Curves Classifier

    Science.gov (United States)

    Vo, Martin

    2017-08-01

    Light Curves Classifier uses data mining and machine learning to obtain and classify desired objects. This task can be accomplished by attributes of light curves or any time series, including shapes, histograms, or variograms, or by other available information about the inspected objects, such as color indices, temperatures, and abundances. After specifying features which describe the objects to be searched, the software trains on a given training sample, and can then be used for unsupervised clustering for visualizing the natural separation of the sample. The package can be also used for automatic tuning parameters of used methods (for example, number of hidden neurons or binning ratio). Trained classifiers can be used for filtering outputs from astronomical databases or data stored locally. The Light Curve Classifier can also be used for simple downloading of light curves and all available information of queried stars. It natively can connect to OgleII, OgleIII, ASAS, CoRoT, Kepler, Catalina and MACHO, and new connectors or descriptors can be implemented. In addition to direct usage of the package and command line UI, the program can be used through a web interface. Users can create jobs for ”training” methods on given objects, querying databases and filtering outputs by trained filters. Preimplemented descriptors, classifier and connectors can be picked by simple clicks and their parameters can be tuned by giving ranges of these values. All combinations are then calculated and the best one is used for creating the filter. Natural separation of the data can be visualized by unsupervised clustering.

  11. Caesarean section delivery and breastfeeding initiation at the ...

    African Journals Online (AJOL)

    Background: Caesarean section (CS) presents a challenge for early breastfeeding of the newborn infant. It is expected that with the Baby Friendly Hospital Initiative (BFHI), mothers who deliver by CS can be helped to initiate breastfeeding early. Objectives: This study aims to determine the time of initiation of breastfeeding in ...

  12. Is the attendance of paediatricians at all elective caesarean sections ...

    African Journals Online (AJOL)

    Objectives. To determine the need for resuscitation at the birth of babies delivered by elective caesarean section (CS) and to record the time spent by doctors attending such deliveries. Methods. Data were collected prospectively on all elective CSs performed at Groote Schuur Hospital over a 3-month period. Data collected ...

  13. Is routine caesarean section necessary for breech-breech and ...

    African Journals Online (AJOL)

    Subjects: Twin gestations with breech-breech and breech-transverse presentations. Main outcome measures: Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections.

  14. Ectopic pregnancy through a caesarean scar in a ewe.

    Science.gov (United States)

    Brozos, C; Karagiannis, I; Kiossis, E; Giadinis, N D; Boscos, C

    2013-11-01

    A routine ultrasonographic examination for pregnancy diagnosis in a 3-year-old ewe revealed a normal embryo located in the uterine cavity and an abnormal mass located in the abdomen. At the time of examination, the ewe was 4.5 months pregnant, but 10 months previously she had undergone a caesarean section due to dystocia. The abnormal mass (12 cm × 8 cm) was located outside the uterine cavity; it was anechoic at the periphery, and in the centre there was an echogenic embryo-like structure. Exploratory laparotomy was performed, which revealed an ectopic pregnancy through the caesarean scar. The ectopic foetus was excised and the caesarean scar was repaired. The ewe made a complete recovery and the intrauterine pregnancy was completed to full-term, resulting in the birth of a healthy female lamb 35 days after the removal of the ectopic foetus. Ectopic pregnancies have previously been described in ewes. As far as the authors are aware, this is the first report of an ectopic pregnancy through a caesarean scar in sheep or any other farm animal species.

  15. Indications for Caesarean Section at a Nigerian District Hospital

    African Journals Online (AJOL)

    Alasia Datonye

    General Hospital Aliero, Kebbi State Nigeria. ABSTRACT. Background: Caesarean section (CS) is a common surgical procedure performed in women of reproductive age. The numerous indications for a CS may be due to foetal or maternal problems. Though it is a life saving procedure, it also carries a higher morbidity and ...

  16. The effect of restructuring of health care services on caesarean ...

    African Journals Online (AJOL)

    Objective. To review the anticipated changes in caesarean section (CS) rates following the restructuring of maternity health care services from regional to district level. Hypothesis. A change in provision of maternity services from regional to district level results in a decline in the CS rates. Method. A retrospective audit was ...

  17. Caesarean Sections at Juba Teaching Hospital 2008 - 2009

    African Journals Online (AJOL)

    Ann Burgess

    Summary. A summary and analysis of all recorded emergency and elective caesarean sections (CS) performed at Juba. Teaching Hospital (JTH), Juba, Southern Sudan from October 2008 to September 2009 was made. During this period 430 CS were performed giving a mean of 1.2 each day, the main reason being cited ...

  18. blood transfusion requirement during caesarean delivery: risk factors

    African Journals Online (AJOL)

    Operative delivery poses the risk of excessive blood loss and possible need for blood transfusion in the pregnant patient. Factors predisposing to increased risk for blood transfusion identified from previous studies include preoperative anaemia, previous Caesarean section and antepartum haemorrhage among others.1-.

  19. Graded epidural anaesthesia for Caesarean section in a parturient ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the. Creative Commons License ... CASE REPORT. Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study. Anjum Naza*, Sugata Dasguptab, Bijoy Kumar Bandyopadhyayb and Hasibul Hasan Shirazeec. aDepartment of ...

  20. Transversus abdominis plane block after Caesarean section in an ...

    African Journals Online (AJOL)

    part of multimodal pain management following Caesarean section in an area with limited resources. The study also looked at the advantage of this block in reducing the consumption of morphine and diclofenac postoperatively. Methods: After approval by the institutional ethics committee and informed consent of participants ...

  1. The effect of restructuring of health care services on caesarean ...

    African Journals Online (AJOL)

    Nicky

    2005-06-24

    Jun 24, 2005 ... The effect of restructuring of health care services on caesarean section rates. ARTICLE. Medical Research Council/ University of KwaZulu-Natal, Pregnancy Hypertension Research. Unit and Department of Obstetrics and Gynaecology, Nelson R Mandela School of Health. Sciences, University of ...

  2. Factors associated with failed spinal anaesthesia for Caesarean ...

    African Journals Online (AJOL)

    Background: The use of spinal anaesthesia has increased in the last three decades, given that it is the recommended anaesthetic of choice for better foetal and maternal outcomes in Caesarean section. Failed spinal anaesthesia (FSA) exposes patients to unfavourable experience of pain and the potential complications of ...

  3. Caesarean of Lion ( Panthera leo ) at Dulahajra Safari Park ...

    African Journals Online (AJOL)

    A six years eight months pregnant lioness at the Dulahajara Safari Park, Chakoria, Cox's Bazar, Bangladesh, was presented with dystocia. This paper described the pre-, intra- and postoperative procedures including anesthetic protocol carried out and performing a caesarean section to remove dead fetuses and the ...

  4. Should women be able to choose caesarean section?

    African Journals Online (AJOL)

    2006-04-26

    Apr 26, 2006 ... or even to maintain their vaginal tone. More serious motives behind wanting a section are tokophobia (a fear of childbirth)2 or the opportunity for sterilisation.7 Some women have a genuine phobia relating to childbirth, and one way to avoid the need for vaginal examination in labour is to request caesarean ...

  5. Second-stage primary Caesarean deliveries: Are maternal ...

    African Journals Online (AJOL)

    For the purpose of this study, the second stage of labour was defined as the full dilation of the cervix between ... For the purposes of comparison, 53 first-stage emergency CSs were obtained from the 120 first-stage CSs by ..... RCOG Clinical Effectiveness Support Unit. The. National Sentinel Caesarean Section Audit Report.

  6. Techniques for caesarean section – a re-appraisal | Kennedy ...

    African Journals Online (AJOL)

    Techniques for caesarean section – a re-appraisal. Deon Kennedy. Abstract. Obstetrics & Gynaecology Forum • October 2013. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for ...

  7. Factors associated with failed spinal anaesthesia for Caesarean ...

    African Journals Online (AJOL)

    Adeyinka Abiodun Alabi

    Results: The incidence of failed spinal anaesthesia was 11.7%, which was slightly higher in emergency Caesarean sections. In univariate analysis, previous anaesthesia, obesity, dry tap of cerebrospinal fluid (CSF), bloody CSF and duration of work experience less than one year were significantly associated with FSA in the ...

  8. Bacteriology of Post Caesarean Wound Infection in a Specialist ...

    African Journals Online (AJOL)

    The aim of the present study is to establish the spectrum of microbes causing post caesarean wound infection and antibiotic sensitivity pattern in our locality. ... used antibiotics such as cotrimoxazole, tetracycline, cefuroxime and cloxacillin, while cephalosporin and fluoroquinolones were highly effective against the isolates.

  9. Impetigo herpetiformis and pregnancy: Anesthetic management for caesarean delivery

    Directory of Open Access Journals (Sweden)

    Susmita Bhattacharyya

    2017-01-01

    Full Text Available The case report presented here is of a primigravida who was admitted with impetigo herpetiformis and was planned for an emergency caesarean section due to fetal distress. General anesthesia was administered. Immediately after extubation, she developed severe laryngospasm, which was relieved by administration of intravenous calcium gluconate. Rest of the postoperative period was uneventful.

  10. Risks associated with subsequent pregnancy after one caesarean ...

    African Journals Online (AJOL)

    Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population. ... Statistical Analysis Used: Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential ...

  11. Caesarean Risk Factors in Northern Region of Bangladesh: A ...

    African Journals Online (AJOL)

    http://dx.doi.org/10.4314/tjpr.v11i5.17. Research Article. Caesarean Risk Factors in Northern Region of. Bangladesh: A Statistical Analysis. Mostafizur Rahman1, Asma Ahmad Shariff1* and Aziz Shafie2. 1Centre for Foundation Studies in Science, 2Department of Geography, University of Malaya, Kuala Lumpur, Malaysia.

  12. Incidence of obesity in parturients scheduled for caesarean section ...

    African Journals Online (AJOL)

    Objectives: To determine the incidence of obesity in parturients scheduled for Caesarean section, identify intra-operative complications, management and outcome. Design: A prospective observational study. Setting: University of Benin Teaching Hospital, a university-affiliated tertiary centre. Subjects: Parturients scheduled ...

  13. Maternal views and experiences regarding repeat Caesarean section

    African Journals Online (AJOL)

    Objective: The aim was to determine maternal views and experiences regarding repeat caesarean section. Methods: A pretested and validated semi‑structured questionnaire was administered to women with prior cesarean section by trained research assistants and resident doctors; anonymity and confidentiality were ...

  14. Maternal deaths from bleeding associated with caesarean delivery ...

    African Journals Online (AJOL)

    subcategory of haemorrhage-related maternal death, unlike the pattern in other countries. ... Maternal deaths associated with caesarean deliveries (CDs) have been increasing in South Africa over the past decade. The objective of this ..... haemorrhage, or delayed action in response to deteriorating vital signs. • There was ...

  15. Should women be able to choose caesarean section? | Ching ...

    African Journals Online (AJOL)

    ... and the conclusion is that caesarean section should be performed only when medically indicated. The majority of young doctors now entering obstetrics in the UK are female, but this does not necessarily mean that there will be a shift in favour of women's rights. South African Journal of Obstetrics and Gynaecology Vol.

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

    DEFF Research Database (Denmark)

    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...

  17. Managing Caesarean Scar Pregnancy in low Resource Settings: 2 ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    sac diameter (MSD) 25.5 mm (See figure 1). The. GS was implanted in the lower anterior myometrium at the level of the caesarean scar. The uterine cavity and the cervical canal were assessed as empty. There were no adnexal masses and the. Pouch of Douglas (POD) was free of fluid. Based on the CRL, the pregnancy ...

  18. Records of caesarean sections in bitches presented to the veterinary ...

    African Journals Online (AJOL)

    Case records at the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta were reviewed between January, 2012 and December, 2014 to determine the frequency of caesarean sections (CS) performed in dogs. Data recorded include breed and age of dogs, indication for CS and method of anaesthesia ...

  19. The Impact of Turmeric Cream on Healing of Caesarean Scar

    Science.gov (United States)

    Mahmudi, G; Nikpour, M; Azadbackt, M; Zanjani, R; Jahani, MA; Aghamohammadi, A; Jannati, Y

    2015-01-01

    ABSTRACT Objective: The aim of this study was to assess the impact of turmeric cream on the healing of Caesarean wound. Methods: This study was done as a randomized double blind trial in three groups of women who had a Caesarean operation. The redness, oedema, ecchymosis, drainage, approximation (REEDA) scale was used to evaluate the wound healing process. The χ2, analysis of variance (ANOVA) and Tukey tests were used for statistical analysis. Results: Seven days after the surgery, the averages of REEDA score in the intervention, placebo and control groups were respectively, 0.46, 0.88 and 1.17 (p < 0.001), while on day 14, it was 0.03, 0.22 and 0.36 (p < 0.001), showing a significant statistical difference. Similarly, there was a difference between the intervention and placebo groups in the amount of oedema on the 7th and 14th days after the surgery (respectively, p = 0.066 and p < 0.001). The observed difference between the intervention and control groups in the amount of oedema was statistically significant on the 7 th and 14 th days after the surgery (p < 0.001). Conclusion: Turmeric was effective in faster healing of wounds of Caesarean operation. The use of turmeric is suggested to reduce the complications of the wounds from Caesarean section. PMID:26624595

  20. Caesarean section – desired rate versus actual need

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    2016-03-11

    Mar 11, 2016 ... neonatal mortality.5 However, increasing the rate above this value has little effect ... neonate. The data suggest the association between caesarean section and increased neonatal respiratory morbidity and lacerations, possibly decreased central and peripheral ... of hemorrhage requiring blood transfusion.

  1. combined with caesarean sectIon Low spinal anaesthesia local ...

    African Journals Online (AJOL)

    1983-01-01

    Jan 1, 1983 ... postgraduate training in anaesthetics are frequently faced with the problem of anaesthetizing women ... with resuscitation.2 A very safe but effective technique of anaes- thesia for routine caesarean section is ... Division ofCommunity Obstetrics, King Edward VIll Hospi- tal, Durban. J. V. LARSEN, M.B. CH.

  2. Maternal views and experiences regarding repeat Caesarean section

    African Journals Online (AJOL)

    2014-11-28

    Nov 28, 2014 ... A woman's refusal of cesarean section can create a challenging situation for obstetric care providers.[6] In addition, refusal of cesarean delivery, especially when medically indicated, can be a problem for the woman herself. A study from Nigeria reported a caesarean section refusal rate of 11.6% among all ...

  3. Maternal obesity and Caesarean delivery in sub-Saharan Africa.

    Science.gov (United States)

    Cresswell, Jenny A; Campbell, Oona M R; De Silva, Mary J; Slaymaker, Emma; Filippi, Veronique

    2016-07-01

    To quantify maternal obesity as a risk factor for Caesarean delivery in sub-Saharan Africa. Multivariable logistic regression analysis using 31 nationally representative cross-sectional data sets from the Demographic and Health Surveys (DHS). Maternal obesity was a risk factor for Caesarean delivery in sub-Saharan Africa; a clear dose-response relationship (where the magnitude of the association increased with increasing BMI) was observable. Compared to women of optimal weight, overweight women (BMI 25-29 kg/m(2) ) were significantly more likely to deliver by Caesarean (OR: 1.54; 95% CI: 1.33, 1.78), as were obese women (30-34.9 kg/m(2) (OR: 2.39; 95%CI: 1.96-2.90); 35-39.9 kg/m(2) (OR: 2.47 95%CI: 1.78-3.43)) and morbidly obese women (BMI ≥40 kg/m(2) OR: 3.85; 95% CI: 2.46-6.00). BMI is projected to rise substantially in sub-Saharan Africa over the next few decades and demand for Caesarean sections already exceeds available capacity. Overweight women should be advised to lose weight prior to pregnancy. Furthermore, culturally appropriate prevention strategies to discourage further population-level rises in BMI need to be designed and implemented. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  4. Puerperal infection after caesarean section at Chris Hani ...

    African Journals Online (AJOL)

    Objectives. To determine the incidence of puerperal sepsis after caesarean section (CS) at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods. A longitudinal descriptive study was done on women undergoing CS, with follow-up for readmission or development of sepsis, including telephone ...

  5. Indwelling Catheterization in Caesarean Section: Time To Retire It!

    Science.gov (United States)

    Pandey, Divya; Mehta, Sumita; Grover, Anshul; Goel, Neerja

    2015-09-01

    Routine placement of indwelling catheter preoperatively in Caesarean Section is being practiced without justified scientific evidence. To evaluate the effect of routine indwelling catheterization on the postoperative ambulation, morbidity and hospital stay in women undergoing Caesarean section. Case-Control study carried in a tertiary teaching hospital. This study was carried over 150 women undergoing primary Caesarean section without any medical complication or pre-existing Urinary Tract Infections (UTI). The subjects were randomly allocated to 2 groups i.e. Group 1(Non-Catheterized; NC) and Group 2 (Catheterized for 24 hours postoperatively; C). Parameters noted were; duration of surgery, time of ambulation, postoperative voiding discomfort {graded as - no, mild, moderate-severe, by Visual Analog Scoring (VAS)}, incidence of UTI, postoperative urinary retention, need of postoperative antibiotics and duration of hospital stay. Results were analysed using unpaired t-test. There was no significant difference in duration of surgery and postoperative urinary retention in both groups. However, it was seen that non-catheterized patients had significantly earlier ambulation, shorter hospital stay, took less time for first voiding, lesser voiding discomfort, less incidence of UTI and lesser use of postoperative antibiotics. The routine use of indwelling catheter in Caesarean section is unscientific and unnecessary. There should be selective rather than routine catheterization.

  6. Post-operative morbidity in elective versus emergency caesarean ...

    African Journals Online (AJOL)

    Design: Prospective cohort study. Setting: Department of Obstetrics and Gynaecology University of Abuja Teaching Hospital, Abuja in Nigeria Population : Women who underwent either elective or emergency caesarean sections at the hospital during the designated study period. Main Outcome measures: Wound infection.

  7. Techniques and materials for skin closure in caesarean section

    DEFF Research Database (Denmark)

    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...

  8. Maternal and perinatal morbidity and mortality of Caesarean ...

    African Journals Online (AJOL)

    Maternal and perinatal morbidity and mortality of Caesarean delivery in the late first stage and second stage of labour. ... Results: There was no difference between cases and controls for the following variables: age, gravidity, parity, past obstetric history, gestational age, HIV status, cardiotocography (CTG) tracing, labour ...

  9. Caesarean section – etymology and early history | van Dongen ...

    African Journals Online (AJOL)

    The expression caesarean section (CS) is most probably creative etymology and not derived from the CS allegedly performed on the mother of Julius Caesar. Mythology and legends emphasise the importance of being 'superhuman' if delivered by CS, and therefore avoid mentioning normal vaginal delivery. Many religions ...

  10. Management of failed spinal anaesthesia for caesarean section

    African Journals Online (AJOL)

    July 2017, Vol. 107, No. 7. RESEARCH. Spinal anaesthesia has become the preferred choice of anaesthetic for caesarean section (CS) owing to rapid onset, predictable and reliable block and excellent postoperative .... Of those who used: (i) light touch, 55% accepted a block level of. T6 - 8; (ii) temperature, 41.7% ...

  11. Intelligent Garbage Classifier

    Directory of Open Access Journals (Sweden)

    Ignacio Rodríguez Novelle

    2008-12-01

    Full Text Available IGC (Intelligent Garbage Classifier is a system for visual classification and separation of solid waste products. Currently, an important part of the separation effort is based on manual work, from household separation to industrial waste management. Taking advantage of the technologies currently available, a system has been built that can analyze images from a camera and control a robot arm and conveyor belt to automatically separate different kinds of waste.

  12. Classifying Linear Canonical Relations

    OpenAIRE

    Lorand, Jonathan

    2015-01-01

    In this Master's thesis, we consider the problem of classifying, up to conjugation by linear symplectomorphisms, linear canonical relations (lagrangian correspondences) from a finite-dimensional symplectic vector space to itself. We give an elementary introduction to the theory of linear canonical relations and present partial results toward the classification problem. This exposition should be accessible to undergraduate students with a basic familiarity with linear algebra.

  13. Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study

    NARCIS (Netherlands)

    Kok, N.; Ruiter, L.; Hof, M.; Ravelli, A.; Mol, B. W.; Pajkrt, E.; Kazemier, B.

    2014-01-01

    To compare the difference in risks of neonatal and maternal complications, including uterine rupture, in a second birth following a planned caesarean section versus emergency caesarean section in the first birth. Prospective cohort study. Population-based cohort in the Netherlands. Linked data set

  14. External cephalic version before elective caesarean section for breech presentation

    International Nuclear Information System (INIS)

    Zafar, F.; Sanusi, A.

    2008-01-01

    The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech Presentation should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. To ascertain the acceptability of external cephalic version before elective caesarean section for breech Presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. The clinical audit was registered with the audit department at Watford general hospital and written Consent for the access of medical records was obtained. A retrospective view of 86 accessible medical records out of Total 110 elective breech caesarean sections was done over a period of one year. This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who under went elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient's profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version. Among 37 patients who were offered external cephalic version only 15 patients accepted (22 declined) the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. External cephalic version was not successful in any of the patient. Causes for

  15. Classifying TDSS Stellar Variables

    Science.gov (United States)

    Amaro, Rachael Christina; Green, Paul J.; TDSS Collaboration

    2017-01-01

    The Time Domain Spectroscopic Survey (TDSS), a subprogram of SDSS-IV eBOSS, obtains classification/discovery spectra of point-source photometric variables selected from PanSTARRS and SDSS multi-color light curves regardless of object color or lightcurve shape. Tens of thousands of TDSS spectra are already available and have been spectroscopically classified both via pipeline and by visual inspection. About half of these spectra are quasars, half are stars. Our goal is to classify the stars with their correct variability types. We do this by acquiring public multi-epoch light curves for brighter stars (rpulsating white dwarfs, and other exotic systems. The key difference between our catalog and others is that along with the light curves, we will be using TDSS spectra to help in the classification of variable type, as spectra are rich with information allowing estimation of physical parameters like temperature, metallicity, gravity, etc. This work was supported by the SDSS Research Experience for Undergraduates program, which is funded by a grant from Sloan Foundation to the Astrophysical Research Consortium.

  16. Classifying basic research designs.

    Science.gov (United States)

    Burkett, G L

    1990-01-01

    Considerable confusion over terminology for classifying basic types of research design in family medicine stems from the rich variety of substantive topics studied by family medicine researchers, differences in research terminology among the disciplines that family medicine research draws from, and lack of uniform research design terminology within these disciplines themselves. Many research design textbooks themselves fail to specify the dimensions on which research designs are classified or the logic underlying the classification systems proposed. This paper describes a typology based on three dimensions that may be used to characterize the basic design qualities of any study. These dimensions are: 1) the nature of the research objective (exploratory, descriptive, or analytic); 2) the time frame under investigation (retrospective, cross-sectional, or prospective); and 3) whether the investigator intervenes in the events under study (observational or interventional). This three-dimensional typology may be helpful for teaching basic research design concepts, for contemplating research design decisions in planning a study, and as a basis for further consideration of a more detailed, uniform research design classification system.

  17. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    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.

  18. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Stack filter classifiers

    Energy Technology Data Exchange (ETDEWEB)

    Porter, Reid B [Los Alamos National Laboratory; Hush, Don [Los Alamos National Laboratory

    2009-01-01

    Just as linear models generalize the sample mean and weighted average, weighted order statistic models generalize the sample median and weighted median. This analogy can be continued informally to generalized additive modeels in the case of the mean, and Stack Filters in the case of the median. Both of these model classes have been extensively studied for signal and image processing but it is surprising to find that for pattern classification, their treatment has been significantly one sided. Generalized additive models are now a major tool in pattern classification and many different learning algorithms have been developed to fit model parameters to finite data. However Stack Filters remain largely confined to signal and image processing and learning algorithms for classification are yet to be seen. This paper is a step towards Stack Filter Classifiers and it shows that the approach is interesting from both a theoretical and a practical perspective.

  1. 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.

    LENUS (Irish Health Repository)

    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

  2. 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.

    LENUS (Irish Health Repository)

    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

  3. 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

    Directory of Open Access Journals (Sweden)

    Montgomery Alan A

    2009-08-01

    Full Text Available Abstract 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

  4. 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

    Science.gov (United States)

    Murphy, Deirdre J; Carey, Michael; Montgomery, Alan A; Sheehan, Sharon R

    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

  5. Owning the birth experience: what factors influence women's vaginal birth after caesarean decision?

    Science.gov (United States)

    Konheim-Kalkstein, Yasmine L; Kirk, Colleen P; Berish, Kristen; Galotti, Kathleen M

    2017-09-01

    Our quantitative analysis examined what factors influence pregnant women to choose a vaginal birth after a caesarean (VBAC). There is growing concern over the high rates of caesarean section; much of the high rate is driven by repeat caesareans. A trial of labour after a previous caesarean is an option for many women increasingly supported by medical literature. Survey data from 173 pregnant women who had had only one birth by caesarean were analysed using a hierarchical binary logistic regression model. Desire for the experience of a vaginal birth strongly predicted choice of VBAC; however, this relationship was dampened among women with a high (versus low) powerful others (e.g. doctors and nurses) locus of control. Prior reason for a caesarean section and practical factors also play a role. Women may be more likely to choose VBAC if they are encouraged to believe that they can help control the outcome, especially if their desire for a vaginal birth experience is high.

  6. Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea.

    Science.gov (United States)

    Mark, Terence B; Radcliffe, Jim; Laman, Moses

    2014-07-01

    We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. Failure to predict difficult tracheal intubation for emergency caesarean section.

    Science.gov (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon

    2010-11-01

    Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Our aim was to evaluate five bedside predictors that might identify women with potential intubation difficulty immediately prior to emergency caesarean section. Women requiring emergency caesarean section with general anaesthesia and tracheal intubation who had been assessed by the same experienced anaesthesiologist preoperatively were included in this study. Mallampati score, sternomental distance, thyromental distance, interincisor gap and atlantooccipital extension were all measured. The same anaesthesiologist performed laryngoscopy and graded the laryngeal view according to Cormack and Lehane. Exact logistic regression was used to identify significant independent predictors for difficult intubation (Cormack and Lehane grades ≥ 3) with two-sided P value less than 0.05 considered as significant. In 3 years, 239 women were recruited. Cormack and Lehane grades of 2 or less (easy) were found in 225 and grade of at least 3 (difficult) in 14 women. Patients' characteristics (age, height, weight, BMI or weight gain) were not significantly associated with difficulty of intubation. The incidence of difficult intubation was 1/17 women [95% confidence interval (CI) from 1/31 to 1/10]. A positive result from any of the five predictors combined had a sensitivity of 0.21 (95%CI 0.05-0.51), a specificity of 0.92 (95%CI 0.88-0.96), a positive predictive value of 0.15 (95%CI 0.032-0.38) and a negative predictive value of 0.95 (95%CI 0.91-0.97) for a Cormack and Lehane grade of at least 3 at laryngoscopy. Airway assessment using these tests cannot be relied upon to predict a difficult intubation at emergency caesarean section as the low sensitivity means that 79% (95%CI 49-95) of difficult intubations will be missed.

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

    LENUS (Irish Health Repository)

    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.

  9. Role of single dose prophylactic antibiotic in elective caesarean section

    Directory of Open Access Journals (Sweden)

    Hasna Hena Pervin

    2016-08-01

    Full Text Available Background: Maternal morbidity related to infection after caesarean section has been reported to be higher than that of vaginal delivery. The prevention of infection in patients undergoing caesarean section is a major challenge, particularly in hospitals, where there is frequent chance of cross infection due to overcrowding. Objective: The present study was undertaken to see the efficacy of single dose cetriaxone as a prophylaxis in elective caesarean section to prevent postop­erative infection. Methods: This cross sectional study was conducted on 100 patients who underwent elective caesarean section where single dose of Ceftriaxone was used as prophylaxis in the Department of Obstetrics & Gynaecology, Bang­abandhu Sheikh Mujib Medical University Hospital, between January to June 2010. The outcomes measures were post­operative febrile morbidity, wound infe-ction and other infections (urinary tract infection, chest infection. Data were analysed using statistical package for social sciences (SPSS version 11.5.Results: Over one-third (38% patients age group was between 18 -25 years, 56% in between 25 -35 years and 6% were over 35 years old. Nearly half(46% was anemic (haemoglobin< 11 g/dl and 16% was obese (BMI≥28 kg/m2. All the patients were operated by obstetricians of same level. Three per cent patients developed wound infection, 5% developed other infections like UTI and chest infection and 7% had febrile illness. Among the several factors suspected to be associated with post operative complications, preoperative anaemia, long duration of operation (>60 minutes and prolonged hospital stay (>1 week were found to be significantly assocated with postoperative complications.Conclusion: The present study suggests that single dose prophylactic antibiotic ceftriaxone given 1 hour before operation in patients with cesarean section deliveries reduces the chance of postoperative infection to a bare minimum.

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

    International Nuclear Information System (INIS)

    Qureshi, R.N.; Ali, S.K.

    2013-01-01

    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)

  11. Portrayal of caesarean section in Brazilian women’s magazines: 20 year review

    Science.gov (United States)

    Daher, Silvia; Betrán, Ana Pilar; Widmer, Mariana; Montilla, Pilar; Souza, Joao Paulo; Merialdi, Mario

    2011-01-01

    Objective To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women’s magazines. Design Review of articles published during 1988-2008 in top selling women’s magazines. Setting Brazil, one of the countries with the highest caesarean section rates in the world. Data sources Women’s magazines with the largest distribution during the study period, identified through the official national media indexing organisations. Selection criteria Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section. Main outcome measures Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section. Results 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section. Conclusions Most of the articles published in Brazilian women’s magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to

  12. Portrayal of caesarean section in Brazilian women's magazines: 20 year review.

    Science.gov (United States)

    Torloni, Maria Regina; Daher, Silvia; Betrán, Ana Pilar; Widmer, Mariana; Montilla, Pilar; Souza, Joao Paulo; Merialdi, Mario

    2011-01-25

    To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women's magazines. Review of articles published during 1988-2008 in top selling women's magazines. Brazil, one of the countries with the highest caesarean section rates in the world. Women's magazines with the largest distribution during the study period, identified through the official national media indexing organisations. Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section. Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section. 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section. Most of the articles published in Brazilian women's magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to underestimate the maternal/perinatal risks associated with this route of delivery.

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

    International Nuclear Information System (INIS)

    Raja, J.F.; Bangash, K.T.; Mahmud, G.

    2013-01-01

    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)

  14. Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms.

    Science.gov (United States)

    Fergus, Paul; Hussain, Abir; Al-Jumeily, Dhiya; Huang, De-Shuang; Bouguila, Nizar

    2017-07-06

    Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤ 7.20-acidosis, n = 18; pH > 7.20 and pH machine-learning algorithms are trained, and validated, using binary classifier performance measures. The findings show that deep learning classification achieves sensitivity = 94%, specificity = 91%, Area under the curve = 99%, F-score = 100%, and mean square error = 1%. The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies.

  15. Recovery after caesarean birth: a qualitative study of women's accounts in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Kealy Michelle A

    2010-08-01

    Full Text Available Abstract Background The caesarean section rate is increasing globally, especially in high income countries. The reasons for this continue to create wide debate. There is good epidemiological evidence on the maternal morbidity associated with caesarean section. Few studies have used women's personal accounts of their experiences of recovery after caesarean. The aim of this paper is to describe women's accounts of recovery after caesarean birth, from shortly after hospital discharge to between five months and seven years after surgery. Method Women who had at least one caesarean birth in a tertiary hospital in Victoria, Australia, participated in an interview study. Women were selected to ensure diversity in experiences (type of caesarean, recency, caesarean and vaginal birth, and maternal request caesarean section. Interviews were audiotaped and transcribed verbatim. A theoretical framework was developed (three Zones of clinical practice and thematic analysis informed the findings. Results Thirty-two women were interviewed who between them had 68 births; seven women had experienced both caesarean and vaginal births. Three zones of clinical practice were identified in women's descriptions of the reasons for their first caesareans. Twelve women described how, at the time of their first caesarean section, the operation was performed for potentially life-saving reasons (Central Zone, 11 described situations of clinical uncertainty (Grey Zone, and nine stated they actively sought surgical intervention (Peripheral Zone. Thirty of the 32 women described difficulties following the postoperative advice they received prior to hospital discharge and their physical recovery after caesarean was hindered by a range of health issues, including pain and reduced mobility, abdominal wound problems, infection, vaginal bleeding and urinary incontinence. These problems were experienced across the three zones of clinical practice, regardless of the reasons women gave

  16. Outcome of trial of scar in patients with previous caesarean section

    International Nuclear Information System (INIS)

    Khan, B.; Bashir, R.; Khan, W.

    2016-01-01

    Medical evidence indicates that 60-80% of women can achieve vaginal delivery after a previous lower segment caesarean section. Proper selection of patients for trial of scar and vigilant monitoring during labour will achieve successful maternal and perinatal outcome. The objective of our study is to establish the fact that vaginal delivery after one caesarean section has a high success rate in patients with previous one caesarean section for non-recurrent cause. Methods: The study was conducted in Ayub Teaching Abbottabad, Gynae-B Unit. All labouring patients, during the study period of five years, with previous one caesarean section and between 37 weeks to 41 weeks of gestation for a non-recurrent cause were included in the study. Data was recorded on special proforma designed for the purpose. Patients who had previous classical caesarean section, more than one caesarean section, and previous caesarean section with severe wound infection, transverse lie and placenta previa in present pregnancy were excluded. Foetal macrosomia (wt>4 kg) and severe IUGR with compromised blood flow on Doppler in present pregnancy were also not considered suitable for the study. Patients who had any absolute contraindication for vaginal delivery were also excluded. Results: There were 12505 deliveries during the study period. Total vaginal deliveries were 8790 and total caesarean sections were 3715. Caesarean section rate was 29.7%. Out of these 8790 patients, 764 patients were given a trial of scar and 535 patients delivered successfully vaginally (70%). Women who presented with spontaneous onset of labour were more likely to deliver vaginally (74.8%) as compared to induction group (27.1%). Conclusion: Trial of vaginal birth after caesarean (VBAC) in selected cases has great importance in the present era of the rising rate of primary caesarean section. (author)

  17. Techniques for assisting difficult delivery at caesarean section.

    Science.gov (United States)

    Waterfall, Heather; Grivell, Rosalie M; Dodd, Jodie M

    2016-01-31

    Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Methods to assist with delivery include vacuum or forceps extraction or manual delivery utilising fundal pressure. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section. Delivery of the impacted head after prolonged obstructed labour can be associated with significant maternal and neonatal complication; to facilitate delivery of the head the surgeon may utilise either reverse breech extraction or head pushing. To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo and to compare different extraction methods at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies. All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby. Use of instrument versus manual delivery to facilitate birth of the baby. Reverse breech extraction versus head pushing to facilitate delivery of the deeply impacted fetal head. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Seven randomised controlled trials, involving 582 women undergoing caesarean section were included in this review. The risk of bias of included trials was variable, with some trials not adequately describing allocation or

  18. Multi Variate Analysis Of Risk Factors For Caesarean Section In The ...

    African Journals Online (AJOL)

    Method: Retrospective analysis of the mode of delivery within a 5 year period as contained in patients' medical records using frequency distribution and cross tabulations of risk factors. Logistic regression analysis was used to determine the predictors of Caesarean section. Result: Caesarean section rate was 22%.

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

    LENUS (Irish Health Repository)

    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.

  20. An audit of caesarean section in a tertiary hospital northwest Nigeria ...

    African Journals Online (AJOL)

    Despite the increasing safety of anesthesia and surgical technique, caesarean delivery accounts for more maternal morbidity and mortality compared to a normal ... Records of patients who had caesarean section (CIS) were retrieved from the operation record book in the theatre and the labour ward delivery record book.

  1. CAESAREAN BIRTH RATES IN PRIMIGRAVIDA: A QUEST FOR DETERMINANTS, A HOSPITAL BASED RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Sai Priyanka Balabhadra

    2016-07-01

    Full Text Available BACKGROUND Rates of caesarean section have risen around the world in recent years, accordingly much effort is being made worldwide to understand this trend and counteract effectively. This increasing trend seems to be due to previous caesarean deliveries which in hindsight partly points towards an increased caesarean rate amongst the primigravida. AIMS AND OBJECTIVES The main aim of this study is to highlight the indications of caesarean section in primigravida and to emphasise on the need to control it. METHODS A clinical records review was conducted from 1 st of September 2013 to 31 st of August 2015. During this period, records of all primigravida who underwent vaginal or caesarean delivery were reviewed. Simple descriptive statistical methods were used to describe the study variables. RESULTS Out of 382 primi deliveries during the study period, 154 caesarean sections were performed with a frequency of 40.3%. The most common indications were foetal distress (48.03%, Cephalopelvic disproportion (16.23%, and Non-progression of labour (13.63. INTERPRETATION Preventive efforts should be directed towards decreasing the frequency of caesarean section in primigravida by appropriate management of labour. Efforts to lower caesarean section rate should focus on areas of Foetal distress, failure to progress in labour, failed induction and strict guidelines are to be formulated to define the same.

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

    LENUS (Irish Health Repository)

    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.

  3. A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary ...

    African Journals Online (AJOL)

    Background: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques, caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus, the current ...

  4. Superficial fascial system repair: an abdominoplasty technique to reduce local complications after caesarean delivery.

    Science.gov (United States)

    Al-Benna, Sammy; Al-Ajam, Yazan; Tzakas, Elias

    2009-05-01

    Abdominal incision complications are a major source of morbidity after caesarean delivery. Repair of the superficial fascial system may avert local complications after caesarean delivery by minimising tension to the skin and increasing the initial biomechanical strength of wound which has the potential to decrease early wound dehiscence and as a by-product correct suprapubic bulging.

  5. Non-closure of peritoneal surfaces at caesarean section — a ...

    African Journals Online (AJOL)

    Non-closure of peritoneal surfaces at caesarean section — a systematic review. ... Caesarean section (CS) is a very common surgical procedure worldwide. Suturing the peritoneal ... The trend for analgesia requirement and wound infection tended to favour non-closure, while endometritis results were variable. Long-term ...

  6. The Rate of Caesarean Section in Nnewi, Nigeria: A 10-year Review ...

    African Journals Online (AJOL)

    Background: There is widespread public and professional concern about the increasing proportion of births by caesarean section (c/s). Objectives: This study is to determine the c/s rate, the indications and the reasons for the high rate. Methods: The obstetric records of all caesarean deliveries that occurred at Nnamdi ...

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

    NARCIS (Netherlands)

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

    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

  8. Acute airway obstruction during spinal anaesthesia for caesarean section.

    Science.gov (United States)

    Buggy, D J; Hughes, N

    1998-10-01

    A 30-year-old primiparous Caucasian woman with known placenta praevia required an emergency caesarean section for a mild antepartum haemorrhage at the onset of spontaneous term labour. Following intravenous prehydration with 500 ml gelatin colloid (Haemaccel trade mark ), spinal anaesthesia was induced in the sitting position with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg). The patient was then placed in the recumbent position with left lateral tilt, whereupon she suddenly became dyspnoeic. A generalized erythematous urticarial rash with associated facial, periorbital, glossal and perioral oedema became evident. Although maternal blood pressure remained within normal limits, emergency conversion to general anaesthesia with tracheal intubation was necessary to secure the airway. Laryngoscopy revealed gross submucosal, epiglottic and pharyngeal oedema, characteristics of the syndrome of angioneurotic oedema, which may complicate an anaphylactoid reaction. After the airway was secured with a cuffed endotracheal tube, caesarean section proceeded uneventfully and a healthy male infant was delivered. Maternal facial and airway oedema subsided and extubation was performed in intensive care 2 h later. Life-threatening airway obstruction often accompanies angioneurotic oedema. Since parturients have a higher incidence of difficult airway management than the general population, anaphylactoid reactions presenting as angioneurotic oedema pose a particular challenge for the anaesthetist. The lower incidence of allergy associated with hydroxyethyl starch (Hetastarch) may make it a more appropriate choice of colloid in this setting. However, the balance of evidence now suggests that vasopressors, particularly ephedrine, are superior to fluids for maintenance of blood pressure during regional anaesthesia for caesarean section.

  9. Birth after caesarean study – planned vaginal birth or planned elective repeat caesarean for women at term with a single previous caesarean birth: protocol for a patient preference study and randomised trial

    Directory of Open Access Journals (Sweden)

    Haslam Ross R

    2007-08-01

    Full Text Available Abstract Background For women who have a caesarean section in their preceding pregnancy, two care policies for birth are considered standard: planned vaginal birth and planned elective repeat caesarean. Currently available information about the benefits and harms of both forms of care are derived from retrospective and prospective cohort studies. There have been no randomised trials, and recognising the deficiencies in the literature, there have been calls for methodologically rigorous studies to assess maternal and infant health outcomes associated with both care policies. The aims of our study are to assess in women with a previous caesarean birth, who are eligible in the subsequent pregnancy for a vaginal birth, whether a policy of planned vaginal birth after caesarean compared with a policy of planned repeat caesarean affects the risk of serious complications for the woman and her infant. Methods/Design Design: Multicentred patient preference study and a randomised clinical trial. Inclusion Criteria: Women with a single prior caesarean presenting in their next pregnancy with a single, live fetus in cephalic presentation, who have reached 37 weeks gestation, and who do not have a contraindication to a planned VBAC. Trial Entry & Randomisation: Eligible women will be given an information sheet during pregnancy, and will be recruited to the study from 37 weeks gestation after an obstetrician has confirmed eligibility for a planned vaginal birth. Written informed consent will be obtained. Women who consent to the patient preference study will be allocated their preference for either planned VBAC or planned, elective repeat caesarean. Women who consent to the randomised trial will be randomly allocated to either the planned vaginal birth after caesarean or planned elective repeat caesarean group. Treatment Groups: Women in the planned vaginal birth group will await spontaneous onset of labour whilst appropriate. Women in the elective repeat

  10. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola

    2017-01-01

    INTRODUCTION: Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. METHODS......: The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. RESULTS......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

  11. Morbidity and mortality following high order caesarean section in a developing country.

    Science.gov (United States)

    Hyginus, Ezegwui; Eric, Nwogu-Ikojo; Lawrence, Ikeako; Sylvester, Nweze

    2012-10-01

    To determine the morbidity and mortality associated with multiple (four and higher order) caesarean section. A group of 92 women who had undergone four or more caesarean sections was compared with another group of 184 women who had three or less such procedures at the obstetric unit of the University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1, 1999 and December 31, 2007. The record were retrieved by trained staff and data was extracted using pre-tested forms. SPSS 15 and Z test were used for statistical analysis. There were a total of 1,755 caesarean sections out of which 92 (5.24%) were higher order repeat caesarean. Three women had the 6th caesarean section, while one had her seventh. Women in the study group were three times more likely to have primary postpartum haemorrhage (p = 0.001); to spend more time on the operation table; and to receive blood transfusion (p = 0.001) compared to the control group. More neonatal morbidities were observed among the controls. Hypertensive disorder was the second most common indication for caesarean section in the control group. There was no clear difference in terms of hospital stay, pre-operative haemoglobin concentration, and caesarean hysterectomy in the two groups. No death was observed during the period. Higher order caesarean section was associated with increased maternal morbidity but there was no mortality. Every effort to reduce primary and repeat caesarean sections should be encouraged, as this will reduce the higher order caesarean section rate, especially in the developing world which places high premium on child-bearing and large family size. Counselling on different methods of contraception during visits to antenatal clinics must be done to limit family size.

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

    Directory of Open Access Journals (Sweden)

    Christopher G Fawsitt

    Full Text Available BACKGROUND: 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. METHODS: Using a decision analytic model, a cost-effectiveness analysis (CEA was performed where the measure of health gain was quality-adjusted life years (QALYs over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations. RESULTS: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€ 1,835.06 versus € 4,039.87 per women, respectively, and QALYs were modestly higher (0.84 versus 0.70. Our findings were supported by probabilistic sensitivity analysis. CONCLUSIONS: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single

  13. Classifier Selection with Permutation Tests

    OpenAIRE

    Arias, Marta; Arratia, Argimiro; Duarte-Lopez, Ariel

    2017-01-01

    This work presents a content-based recommender system for machine learning classifier algorithms. Given a new data set, a recommendation of what classifier is likely to perform best is made based on classifier performance over similar known data sets. This similarity is measured according to a data set characterization that includes several state-of-the-art metrics taking into account physical structure, statis- tics, and information theory. A novelty with respect to prior work is the use of ...

  14. Emergency caesarean section in a patient with intracerebral tuberculoma

    Directory of Open Access Journals (Sweden)

    Ranju Gandhi

    2007-01-01

    Full Text Available The incidence of tuberculosis in pregnancy ranges between 1-2% amongst hospital deliveries in the trop-ics. Tuberculosis of central nervous system accounts for about 5% of extra pulmonary cases and manifests as meningitis or uncommonly as tuberculoma. The management of intracerebral tuberculoma diagnosed during pregnancy should be same as that in non-pregnant subjects with antituberculous treatment. Emergency caesar-ean section in a patient with intracerebral tuberculoma poses unique challenges to the anaesthesiologist. There are no published reports on anaesthetic management of pregnancy with tuberculoma. We report the case of a woman with intracerebral tuberculoma presenting for emergency caesarean section. The anaesthetic goals in this patient were combined to that of principles of obstetrical anaesthesia to ensure a favourable maternal and fetal outcome. The anaesthetic technique chosen should prevent aspiration, avoid fluctuations in intracranial pressure, maintain stable haemodynamics, provide a sufficient depth of anaesthesia and good postoperative analgesia. We believe that general anaesthesia is the safest approach in such patients. We suggest general anaesthesia to be preferred over regional anaesthesia technique.

  15. First trimester caesarean scar ectopic pregnancy evaluation using MRI

    International Nuclear Information System (INIS)

    Peng, K.-W.; Lei, Z.; Xiao, T.-H.; Jia, F.-G.; Zhong, W.-X.; Gao, Y.; Shen, B.-X.; Xie, J.-W.

    2014-01-01

    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

  16. Pulmonary thromboembolism after caesarean section: A case report

    Directory of Open Access Journals (Sweden)

    Uğur Çom

    2014-12-01

    Full Text Available The death of a female during pregnancy period, independent from the gestational age and localization or in a 42 day period after the end of pregnancy due to pregnancy related reasons or reasons aggravated by the pregnancy, but containing no relation with accidental or forced incidents, is defined as maternal death by the World Health Organization. Discussion of the requirements for an emboli diagnosis in an autopsy practice through literature data is aimed in our study. It has been reported that the case was 38 years old, G5 P4 and died with a respiratory distress occurred during the follow ups in 24 hours after the caesarean section. In autopsy, the body mass index was calculated as 32.8 kg/m2 (obese and thrombus was detected in pulmonary arteries of both lungs. Thrombus was confirmed also through histopathological analysis. Evaluation of the medical history and data obtained from a detailed autopsy are of great importance for maternal deathswhich may occur after a caesarean section and involve a pulmonary thromboembolism diagnosis in order to determine the cause of death and prevent a loss of right in medical malpractice claims.

  17. Staphylococcus lugdunensis cultured from the amniotic fluid at Caesarean Section.

    Directory of Open Access Journals (Sweden)

    Zbigniew Marchocki

    Full Text Available Staphylococcus lugdunensis is a virulent coagulase-negative staphylococcus. It behaves like and can be mistaken in culture for Staphylococcus aureus. While originally thought to be a skin commensal rarely responsible for opportunistic infection, it was rapidly established as a significant human pathogen. It has been mainly associated with native and prosthetic valve endocarditis, osteomyelitis, and skin and soft tissue cellulitis, but has also been reported as a cause of fasciitis as well as peritonitis. Staphylococcus lugdunensis has been reported as a cause of endometritis but has not been previously isolated from amniotic fluid. Here, amniotic fluid samples were collected in the course of a larger study on amniotic fluid bacteriology, with prior ethical approval and informed patient consent. Amniotic fluid was obtained at Caesarean Section by direct needle aspiration from the intact amnion. Analysis with Staphylococcal API test kits led to identification of Staphylococcus lugdunensis in two cases. The clinical significance of the finding in these reported cases is undetermined. Staphylococcus lugdunensis has been shown to be a cause of serious and potentially fatal morbidities, but this is the first report of its culture from amniotic fluid. As caesarean delivery is accepted as the single most important factor associated with post-partum infectious complications in both mother and neonate, the identification of this pathogen is a new concern.

  18. RETROSPECTIVE STUDY OF PRIMARY CAESAREAN SECTION AT A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    S. Prasanna Lakshmi

    2016-12-01

    Full Text Available BACKGROUND The caesarean section epidemic is a reason for immediate concern and deserves serious National and International attention. Rates of caesarean section are of concern to both developed and developing countries. The indications for caesarean section have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economical and medicolegal factors play a role in the rising trend of caesarean section. The aim of the study was undertaken to determine the rate, indications, intraoperative and postoperative complications of primary caesarean section in primi and multipara and maternal and foetal morbidities in these patients. MATERIALS AND METHODS This is a retrospective study carried out on primary caesarean section in the Department of O and G at Mahatma Gandhi Memorial Government Hospital attached to K.A.P.Viswanatham Government Medical College, Trichy, during 1 year period from January 2015-December 2015. Inclusion Criteria- Patients (booked/unbooked attending the labour room undergoing primary caesarean section in the department. Their intraoperative and postoperative complications were noted and also maternal and foetal morbidities and complications. Exclusion Criteria- Gestational age <28 wks., previous LSCS, previous uterine surgery or hysterotomy, multiple gestation. RESULTS There has been a steady increase in total deliveries (increase by 5.2% in the last 2 yrs. at Mahathma Gandhi Memorial Government Hospital attached to K.A.P. Viswanatham Government Medical College, Trichy, and total caesarean section rate (increased by 19.3% and primary caesarean section rate (increased by 12.3% in the past 2 years with concomitant reduction in neonatal mortality rate by 28%. However, this doesn’t justify the increase in primary caesarean section rate. CONCLUSION Potentially modifiable factors such as patient preferences, practice variations among hospitals, systems and

  19. Out Come Of Trial Of Scar In Patients With Previous Caesarean Section.

    Science.gov (United States)

    Khan, Bushra; Deeba, Farhat; Bashir, Rubina; Khan, Wajiha

    2016-01-01

    Patients who had one caesarean section were previously not given a trial of scar due to fear of increased morbidity. However, recently there has been a trend to give a trial of labour to patients with a previous caesarean section for a non-recurrent cause. Medical evidence indicates that 60-80% of women can achieve vaginal delivery after a previous lower segment caesarean section. Proper selection of patients for trial of scar and vigilant monitoring during labour will achieve successful maternal and perinatal outcome. The objective of our study is to establish the fact that vaginal delivery after one caesarean section has a high success rate in patients with previous one caesarean section for non-recurrent cause. The study was conducted in Ayub Teaching Abbottabad, Gynae-B Unit. All labouring patients, during the study period of five years, with previous one caesarean section and between 37 weeks to 41 weeks of gestation for a non-recurrent cause were included in the study. Data was recorded on special pro forma designed for the purpose. Patients who had previous classical caesarean section, more than one caesarean section, and previous caesarean section with severe wound infection, transverse lie and placenta previa in present pregnancy were excluded. Foetal macrosomia (wt>4 kg) and severe IUGR with compromised blood flow on Doppler in present pregnancy were also not considered suitable for the study. Patients who had any absolute contraindication for vaginal delivery were also excluded. There were 12505 deliveries during the study period. Total vaginal deliveries were 8790 and total caesarean sections were 3715. Caesarean section rate was 29.7%. Out of these 8790 patients, 764 patients were given a trial of scar and 535 patients delivered successfully vaginally (70%). Women who presented with spontaneous onset of labour were more likely to deliver vaginally (74.8%) as compared to induction group (27.1%). Trial of vaginal birth after caesarean (VBAC) in selected

  20. Plurality in a Classifier Language.

    Science.gov (United States)

    Li, Yen-Hui Audrey

    1999-01-01

    Argues that a classifier language can have a plural morpheme within a nominal expression, suggesting that -men in Mandarin Chinese is best analyzed as a plural morpheme, in contrast to a regular plural on an element in N, such as the English -s. The paper makes a prediction about the structures of nominal expressions in classifier and…

  1. [Caesarean section at full dilatation: What are the risks to fear for the mother and child?

    Science.gov (United States)

    Bruey, N; Beucher, G; Pestour, D; Creveuil, C; Dreyfus, M

    2017-03-01

    Caesarean section is associated with increased maternal morbidity compared to a vaginal delivery, especially if it occurs during labour. Little data on caesarean section performed at full dilatation is available. This was a retrospective study done in University Hospital of type 3 over a period of ten years, including future primiparous patients who had a caesarean section performed at full dilatation, compared to a control group of patients whose caesarean section was conducted in first part of the labour. We collected different maternal data per- and postoperative and neonatal. In total, 824 patients were enrolled including 412 in each group. For caesarean section at full dilatation, foetal extraction required more manoeuvres (RR=3.05; 95% CI: 2.1; 4.39; P<0.001); we noted more extension of hysterotomy (RR=1.79; 95% CI: 1.30; 2.46; P<0.001). Postoperative and neonatal maternal morbidity was not different, except more frequent neonatal trauma for caesarean section at full dilatation. A caesarean section at full dilatation has an excess intraoperative risk and requires great caution. Nevertheless, no significant increase of postoperative and neonatal complications can be proved. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Classified

    CERN Multimedia

    Computer Security Team

    2011-01-01

    In the last issue of the Bulletin, we have discussed recent implications for privacy on the Internet. But privacy of personal data is just one facet of data protection. Confidentiality is another one. However, confidentiality and data protection are often perceived as not relevant in the academic environment of CERN.   But think twice! At CERN, your personal data, e-mails, medical records, financial and contractual documents, MARS forms, group meeting minutes (and of course your password!) are all considered to be sensitive, restricted or even confidential. And this is not all. Physics results, in particular when being preliminary and pending scrutiny, are sensitive, too. Just recently, an ATLAS collaborator copy/pasted the abstract of an ATLAS note onto an external public blog, despite the fact that this document was clearly marked as an "Internal Note". Such an act was not only embarrassing to the ATLAS collaboration, and had negative impact on CERN’s reputation --- i...

  3. Building America

    Energy Technology Data Exchange (ETDEWEB)

    Brad Oberg

    2010-12-31

    IBACOS researched the constructability and viability issues of using high performance windows as one component of a larger approach to building houses that achieve the Building America 70% energy savings target.

  4. Presentation of undiagnosed mixed mitral valve disease during caesarean section

    Directory of Open Access Journals (Sweden)

    Michelle R. Cole

    2014-01-01

    Full Text Available This report describes a woman presenting for an elective caesarean section, with undiagnosed valvular heart disease. She had recent hospital admissions for respiratory dysfunction. Soon after the initial surgical incision, she became asystolic for 20-30 s with an un-recordable blood pressure. She was treated with anticholinergics and became cardiovascularly stable enough for the procedure to continue. However, she had deteriorating respiratory function. A transthoracic echocardiogram in recovery demonstrated mixed mitral valve (MV disease, moderate mitral stenosis, and severe mitral regurgitation with evidence of severe pulmonary hypertension. She had a dilated left atrium, dilated right ventricle with pulmonary artery systolic pressures of 100 mmHg. She underwent a period of medical optimization followed by a mechanical MV replacement 6 weeks postdelivery. This case attempts to highlight the diagnostic dilemma of unknown maternal cardiac disease. The growing popularity of echocardiography as a diagnostic tool among anaesthetists and critical care physicians proved pivotal in this case.

  5. [Anesthetic management for caesarean delivery in a parturient with achondroplasia].

    Science.gov (United States)

    Ando, Akira; Hishinuma, Norimasa; Shirotori, Toru; Sasao, Junichi; Tanaka, Satoshi; Kawamata, Mikito

    2014-06-01

    A 27-year-old parturient (height, 130 cm; weight, 43 kg) with achondroplasia, which is characterized by rhizomeric short stature, large head and frontal bossing, was scheduled for elective caesarean section (C/S) because of her contracted pelvis. Her first delivery had been performed by C/S under general anesthesia at a regional hospital 6 years before. Preoperative airway assessment showed normal mouth opening and mobile cervical spine. Since she had anxiety about needle puncture and refused neuraxial blockade and since we considered the trachea could be intubated, we decided to perform C/S under general anesthesia at 37 weeks of gestation. The patient and baby had an uneventful perioperative course. Underdevelopment of bone formation results in characteristic craniofacial and vertebral abnormalities in patients with achondroplasia. Anesthetic management of achondroplastic parturients should be specified to individual basis based on careful preoperative assessment of craniofacial and vertebral deformities.

  6. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    DEFF Research Database (Denmark)

    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...... regression with adjustment for prematurity, asphyxia, birth weight, multiple births, single parenthood, maternal smoking during pregnancy, older siblings, and asthma diagnoses up to 2 weeks before hospitalization for RSV infection, to compare the effects of acute or elective CS versus vaginal delivery...... infection in children born by acute CS and by elective CS were 1.09 (1.01 - 1.17) and 1.27 (1.19 - 1.36), respectively. The effect of elective CS remained unchanged throughout the first two years of life (p = 0.53), whereas the effect of acute CS was only present in the second year of life (p = 0...

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

    Directory of Open Access Journals (Sweden)

    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

  8. Skin preparation for preventing infection following caesarean section.

    Science.gov (United States)

    Hadiati, Diah R; Hakimi, Mohammad; Nurdiati, Detty S; Ota, Erika

    2014-09-17

    The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increasing rate of caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and methods for preoperative skin preparation to prevent infection. To compare the effects of different agent forms and methods of preoperative skin preparation for preventing postcaesarean infection. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 June 2014) and the reference lists of all included studies and review articles. Randomised and quasi-randomised trials, including cluster-randomised trials, evaluating any type of preoperative skin preparation agents, forms and methods of application for caesarean section. Three review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy. We included six trials with a total of 1522 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infection in either group. One trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in wound infection (RR 0.33; 95% CI 0.04 to 2.99).Two trials reported endometritis, one trial comparing alcohol scrub and iodophor drape with iodophor scrub only found no significant difference (RR 1.62; 95% CI 0.29 to 9.16). The other trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone

  9. Quantum ensembles of quantum classifiers.

    Science.gov (United States)

    Schuld, Maria; Petruccione, Francesco

    2018-02-09

    Quantum machine learning witnesses an increasing amount of quantum algorithms for data-driven decision making, a problem with potential applications ranging from automated image recognition to medical diagnosis. Many of those algorithms are implementations of quantum classifiers, or models for the classification of data inputs with a quantum computer. Following the success of collective decision making with ensembles in classical machine learning, this paper introduces the concept of quantum ensembles of quantum classifiers. Creating the ensemble corresponds to a state preparation routine, after which the quantum classifiers are evaluated in parallel and their combined decision is accessed by a single-qubit measurement. This framework naturally allows for exponentially large ensembles in which - similar to Bayesian learning - the individual classifiers do not have to be trained. As an example, we analyse an exponentially large quantum ensemble in which each classifier is weighed according to its performance in classifying the training data, leading to new results for quantum as well as classical machine learning.

  10. IAEA safeguards and classified materials

    International Nuclear Information System (INIS)

    Pilat, J.F.; Eccleston, G.W.; Fearey, B.L.; Nicholas, N.J.; Tape, J.W.; Kratzer, M.

    1997-01-01

    The international community in the post-Cold War period has suggested that the International Atomic Energy Agency (IAEA) utilize its expertise in support of the arms control and disarmament process in unprecedented ways. The pledges of the US and Russian presidents to place excess defense materials, some of which are classified, under some type of international inspections raises the prospect of using IAEA safeguards approaches for monitoring classified materials. A traditional safeguards approach, based on nuclear material accountancy, would seem unavoidably to reveal classified information. However, further analysis of the IAEA's safeguards approaches is warranted in order to understand fully the scope and nature of any problems. The issues are complex and difficult, and it is expected that common technical understandings will be essential for their resolution. Accordingly, this paper examines and compares traditional safeguards item accounting of fuel at a nuclear power station (especially spent fuel) with the challenges presented by inspections of classified materials. This analysis is intended to delineate more clearly the problems as well as reveal possible approaches, techniques, and technologies that could allow the adaptation of safeguards to the unprecedented task of inspecting classified materials. It is also hoped that a discussion of these issues can advance ongoing political-technical debates on international inspections of excess classified materials

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

    LENUS (Irish Health Repository)

    Sinnott, Sarah-Jo

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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 studies...... in English on elective caesarean section and respiratory morbidity in the newborn. We included studies that compared elective caesarean section to vaginal or intended vaginal delivery, with clear definition of outcome measures and information about gestational age. RESULTS: Nine eligible studies were...... identified. All studies found that delivery by elective caesarean section increased the risk of various respiratory morbidities in the newborn near term compared with vaginal delivery, although the findings were not statistically significant in all studies. It was inappropriate to carry out a meta...

  14. Circulatory collapse following epidural bolus for Caesarean section a profound vasovagal reaction? A case report

    Directory of Open Access Journals (Sweden)

    Eva Oddby

    2016-01-01

    Concluiosn: A structured plan for the handling of cardiovascular crisis must be available wherever Caesarean section are performed. Adequate volume loading, left tilt and vigilant control of circulation following regional block performance is of outmost importance.

  15. Hybrid classifiers methods of data, knowledge, and classifier combination

    CERN Document Server

    Wozniak, Michal

    2014-01-01

    This book delivers a definite and compact knowledge on how hybridization can help improving the quality of computer classification systems. In order to make readers clearly realize the knowledge of hybridization, this book primarily focuses on introducing the different levels of hybridization and illuminating what problems we will face with as dealing with such projects. In the first instance the data and knowledge incorporated in hybridization were the action points, and then a still growing up area of classifier systems known as combined classifiers was considered. This book comprises the aforementioned state-of-the-art topics and the latest research results of the author and his team from Department of Systems and Computer Networks, Wroclaw University of Technology, including as classifier based on feature space splitting, one-class classification, imbalance data, and data stream classification.

  16. The use of snake venom derived fibrin glue in hysterorrhaphy of ovine caesarean surgery

    OpenAIRE

    CHALHOUB, M.; PRESTES, N. C.; LOPES, M. D.; ROCHA, N. S.; THOMAZINI-SANTOS, I. A.; MENDES-GIANNINI, M.J.

    2000-01-01

    Fibrin glue has been used on its own or in conjunction with suturing materials to promote hemostasis, reduce adherence, strengthen the wound site, and improve healing. Snake venom derived fibrin glue was evaluated as an alternative to conventional uterine suturing after ovine caesarean surgery. Twenty-eight pregnant ewes of known mating date were used. The animals submitted to conventional caesarean sections showed a better wound healing process. As expected, all the operated animals had reta...

  17. Successful Pregnancy Following Repair of Vesicouterine Fistula Following Repeat Caesarean Section: A Case Report

    OpenAIRE

    Dilruba Akter; Salahuddin Shah; Ferdousi Islam; Saria Tasnim

    2012-01-01

    A lady, para 2, both delivered by caesarean section for prolonged labour, presented with the complaints of menouria and infertility for 3 years following her last caesarean section. She had history of haematuria during menstruation and her menstrual flow is scanty. Her first baby was female and alive, but her second baby was stillborn following prolonged and obstructed labour. This has been continuously blamed by family and others for happening that events. Her fistula was confirmed by ultras...

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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. Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.

    Directory of Open Access Journals (Sweden)

    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.

  1. Cliff-edge model predicts intergenerational predisposition to dystocia and Caesarean delivery.

    Science.gov (United States)

    Mitteroecker, Philipp; Windhager, Sonja; Pavlicev, Mihaela

    2017-10-31

    Recently, we presented the cliff-edge model to explain the evolutionary persistence of relatively high incidences of fetopelvic disproportion (FPD) in human childbirth. According to this model, the regular application of Caesarean sections since the mid-20th century has triggered an evolutionary increase of fetal size relative to the dimensions of the maternal birth canal, which, in turn, has inflated incidences of FPD. While this prediction is difficult to test in epidemiological data on Caesarean sections, the model also implies that women born by Caesarean because of FPD are more likely to develop FPD in their own childbirth compared with women born vaginally. Multigenerational epidemiological studies indeed evidence such an intergenerational predisposition to surgical delivery. When confined to anatomical indications, these studies report risks for Caesarean up to twice as high for women born by Caesarean compared with women born vaginally. These findings provide independent support for our model, which we show here predicts that the risk of FPD for mothers born by Caesarean because of FPD is 2.8 times the risk for mothers born vaginally. The congruence between these data and our prediction lends support to the cliff-edge model of obstetric selection and its underlying assumptions, despite the genetic and anatomical idealizations involved. Copyright © 2017 the Author(s). Published by PNAS.

  2. 3D Bayesian contextual classifiers

    DEFF Research Database (Denmark)

    Larsen, Rasmus

    2000-01-01

    We extend a series of multivariate Bayesian 2-D contextual classifiers to 3-D by specifying a simultaneous Gaussian distribution for the feature vectors as well as a prior distribution of the class variables of a pixel and its 6 nearest 3-D neighbours.......We extend a series of multivariate Bayesian 2-D contextual classifiers to 3-D by specifying a simultaneous Gaussian distribution for the feature vectors as well as a prior distribution of the class variables of a pixel and its 6 nearest 3-D neighbours....

  3. An audit and trial aiming to reduce the rate of surgical site infections for women having a caesarean section

    OpenAIRE

    Ridley, Neesha

    2016-01-01

    Surgical site infection (SSI) following caesarean is a common cause of morbidity. To ensure best practice, Lancashire Teaching Hospitals NHS Foundation Trust decided to audit the rate of SSI following caesarean section. The results revealed that women who had the wound covered for a longer time were less likely to develop a wound infection. A trial was undertaken using two different wound dressings. Following the trial, new wound dressings were introduced for all women having a caesarean sect...

  4. Qualitative website analysis of information on birth after caesarean section.

    Science.gov (United States)

    Peddie, Valerie L; Whitelaw, Natalie; Cumming, Grant P; Bhattacharya, Siladitya; Black, Mairead

    2015-08-19

    The United Kingdom (UK) caesarean section (CS) rate is largely determined by reluctance to augment trial of labour and vaginal birth. Choice between repeat CS and attempting vaginal birth after CS (VBAC) in the next pregnancy is challenging, with neither offering clear safety advantages. Women may access online information during the decision-making process. Such information is known to vary in its support for either mode of birth when assessed quantitatively. Therefore, we sought to explore qualitatively, the content and presentation of web-based health care information on birth after caesarean section (CS) in order to identify the dominant messages being conveyed. The search engine Google™ was used to conduct an internet search using terms relating to birth after CS. The ten most frequently returned websites meeting relevant purposive sampling criteria were analysed. Sampling criteria were based upon funding source, authorship and intended audience. Images and written textual content together with presence of links to additional media or external web content were analysed using descriptive and thematic analyses respectively. Ten websites were analysed: five funded by Government bodies or professional membership; one via charitable donations, and four funded commercially. All sites compared the advantages and disadvantages of both repeat CS and VBAC. Commercially funded websites favoured a question and answer format alongside images, 'pop-ups', social media forum links and hyperlinks to third-party sites. The relationship between the parent sites and those being linked to may not be readily apparent to users, risking perception of endorsement of either VBAC or repeat CS whether intended or otherwise. Websites affiliated with Government or health services presented referenced clinical information in a factual manner with podcasts of real life experiences. Many imply greater support for VBAC than repeat CS although this was predominantly conveyed through subtle

  5. Latin America.

    Science.gov (United States)

    Soni, P. Sarita, Ed.

    1993-01-01

    This serial issue features 6 members of the Indiana University System faculty who have focused their research on Latin America, past and present. The first article, "A Literature of Their Own," highlights Darlene Sadlier's research on Brazilian women's fiction and poetry that has led to an interest in the interplay of Brazilian and…

  6. Latin America.

    Science.gov (United States)

    Greenfield, Gerald Michael

    1986-01-01

    Notes the problematical elements of diversity within Latin America, establishes priorities for the social studies curriculum, and reviews what should be taught about its geography, resources, people, religion, customs, economics, politics, history, and international relationships. Lists Latin American Studies programs and published instructional…

  7. Illiterate America.

    Science.gov (United States)

    Kozol, Jonathan

    Intended for those involved in American social service and educational communities, this book addresses the widespread problem of illiteracy in the United States and the social consequences of this problem. Following an introduction, the chapters in the first section of the book discuss the growing crisis of illiterate America, specifically, the…

  8. Textbook America.

    Science.gov (United States)

    Karp, Walter

    1980-01-01

    Focuses on how political attitudes have been influenced by American history textbooks at various times throughout history. Excerpts from traditional and revisionist textbooks are presented, with emphasis on "America Revised" by Frances FitzGerald. Journal available from Harper's Magazine Co., 2 Park Ave., New York, NY 10016. (DB)

  9. Classifying Cereal Data (Earlier Methods)

    Science.gov (United States)

    The DSQ includes questions about cereal intake and allows respondents up to two responses on which cereals they consume. We classified each cereal reported first by hot or cold, and then along four dimensions: density of added sugars, whole grains, fiber, and calcium.

  10. Knowledge Uncertainty and Composed Classifier

    Czech Academy of Sciences Publication Activity Database

    Klimešová, Dana; Ocelíková, E.

    2007-01-01

    Roč. 1, č. 2 (2007), s. 101-105 ISSN 1998-0140 Institutional research plan: CEZ:AV0Z10750506 Keywords : Boosting architecture * contextual modelling * composed classifier * knowledge management , * knowledge * uncertainty Subject RIV: IN - Informatics, Computer Science

  11. Classifying polynomials and identity testing

    Indian Academy of Sciences (India)

    hard to compute [3,4]! Therefore, the solution to. PIT problem has a key role in our attempt to com- putationally classify polynomials. In this article, we will focus on this connection between PIT and polynomial classification. We now formally define arithmetic circuits and the identity testing problem. 1.1 Problem definition.

  12. Correlation Dimension-Based Classifier

    Czech Academy of Sciences Publication Activity Database

    Jiřina, Marcel; Jiřina jr., M.

    2014-01-01

    Roč. 44, č. 12 (2014), s. 2253-2263 ISSN 2168-2267 R&D Projects: GA MŠk(CZ) LG12020 Institutional support: RVO:67985807 Keywords : classifier * multidimensional data * correlation dimension * scaling exponent * polynomial expansion Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 3.469, year: 2014

  13. A population-based cohort study of the effect of Caesarean section on subsequent fertility.

    Science.gov (United States)

    Gurol-Urganci, I; Cromwell, D A; Mahmood, T A; van der Meulen, J H; Templeton, A

    2014-06-01

    Is there an association between Caesarean section and subsequent fertility? There is no or only a slight effect of Caesarean section on future fertility. Previous studies have reported that delivery by a Caesarean section is associated with fewer subsequent pregnancies and longer inter-pregnancy intervals. The interpretation of these findings is difficult because of significant weaknesses in study designs and analytical methods, notably the potential effect of the indication for Caesarean section on subsequent delivery. Retrospective cohort study of 1 047 644 first births to low-risk women using routinely collected, national administrative data of deliveries in English maternity units between 1 April 2000 and 31 March 2012. Primiparous women aged 15-40 years who had a singleton, term, live birth in the English National Health Service were included. Women with high-risk pregnancies involving placenta praevia, pre-eclampsia, eclampsia (gestational or pre-existing), hypertension or diabetes were excluded from the main analysis. Kaplan-Meier analyses and Cox proportional hazard models were used to assess the effect of mode of delivery on time to subsequent birth, adjusted for age, ethnicity, socio-economic deprivation and year of index delivery. Among low-risk primiparous women, 224 024 (21.4%) were delivered by Caesarean section. The Kaplan-Meier estimate of the subsequent birth rate at 10 years for the cohort was 74.7%. Compared with vaginal delivery, subsequent birth rates were marginally lower after elective Caesarean for breech (adjusted hazard ratio, HR 0.96, 95% CI 0.94-0.98). Larger effects were observed after elective Caesarean for other indications (adjusted HR 0.81, 95% CI 0.78-0.83), and emergency Caesarean (adjusted HR 0.91, 95% CI 0.90-0.93). The effect was smallest for elective Caesarean for breech, and this was not statistically significant in women younger than 30 years of age (adjusted HR 0.98, 95% CI 0.96-1.01). We used birth cohorts from maternity

  14. Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention.

    Directory of Open Access Journals (Sweden)

    Blake C Alkire

    Full Text Available BACKGROUND: Although advances in the reduction of maternal mortality have been made, up to 273,000 women will die this year from obstetric etiologies. Obstructed labor (OL, most commonly treated with Caesarean delivery, has been identified as a major contributor to global maternal morbidity and mortality. We used economic and epidemiological modeling to estimate the cost per disability-adjusted life-year (DALY averted and benefit-cost ratio of treating OL with Caesarean delivery for 49 countries identified as providing an insufficient number of Caesarean deliveries to meet demand. METHODS AND FINDINGS: Using publicly available data and explicit economic assumptions, we estimated that the cost per DALY (3,0,0 averted for providing Caesarean delivery for OL ranged widely, from $251 per DALY averted in Madagascar to $3,462 in Oman. The median cost per DALY averted was $304. Benefit-cost ratios also varied, from 0.6 in Zimbabwe to 69.9 in Gabon. The median benefit-cost ratio calculated was 6.0. The main limitation of this study is an assumption that lack of surgical capacity is the main factor responsible for DALYs from OL. CONCLUSIONS: Using the World Health Organization's cost-effectiveness standards, investing in Caesarean delivery can be considered "highly cost-effective" for 48 of the 49 countries included in this study. Furthermore, in 46 of the 49 included countries, the benefit-cost ratio was greater than 1.0, implying that investment in Caesarean delivery is a viable economic proposition. While Caesarean delivery alone is not sufficient for combating OL, it is necessary, cost-effective by WHO standards, and ultimately economically favorable in the vast majority of countries included in this study.

  15. Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention.

    Science.gov (United States)

    Alkire, Blake C; Vincent, Jeffrey R; Burns, Christy Turlington; Metzler, Ian S; Farmer, Paul E; Meara, John G

    2012-01-01

    Although advances in the reduction of maternal mortality have been made, up to 273,000 women will die this year from obstetric etiologies. Obstructed labor (OL), most commonly treated with Caesarean delivery, has been identified as a major contributor to global maternal morbidity and mortality. We used economic and epidemiological modeling to estimate the cost per disability-adjusted life-year (DALY) averted and benefit-cost ratio of treating OL with Caesarean delivery for 49 countries identified as providing an insufficient number of Caesarean deliveries to meet demand. Using publicly available data and explicit economic assumptions, we estimated that the cost per DALY (3,0,0) averted for providing Caesarean delivery for OL ranged widely, from $251 per DALY averted in Madagascar to $3,462 in Oman. The median cost per DALY averted was $304. Benefit-cost ratios also varied, from 0.6 in Zimbabwe to 69.9 in Gabon. The median benefit-cost ratio calculated was 6.0. The main limitation of this study is an assumption that lack of surgical capacity is the main factor responsible for DALYs from OL. Using the World Health Organization's cost-effectiveness standards, investing in Caesarean delivery can be considered "highly cost-effective" for 48 of the 49 countries included in this study. Furthermore, in 46 of the 49 included countries, the benefit-cost ratio was greater than 1.0, implying that investment in Caesarean delivery is a viable economic proposition. While Caesarean delivery alone is not sufficient for combating OL, it is necessary, cost-effective by WHO standards, and ultimately economically favorable in the vast majority of countries included in this study.

  16. Seeking control in the midst of uncertainty: Women's experiences of choosing mode of birth after caesarean.

    Science.gov (United States)

    Munro, Sarah; Janssen, Patricia; Corbett, Kitty; Wilcox, Elizabeth; Bansback, Nick; Kornelsen, Jude

    2017-04-01

    Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women's decision-making. The goal of this study was to explore attitudes towards and experiences with decision-making for mode of delivery after caesarean from the perspectives of Canadian women. In-depth, semi-structured interviews were conducted with 23 women eligible for VBAC in three rural and two urban communities in British Columbia, Canada, during summer 2015. Constructivist grounded theory informed iterative data collection and analysis. Women's decision-making experiences were a process of "seeking control in the midst of uncertainty." Women formed early preferences for mode of delivery after their primary caesareans and engaged in careful deliberation during their inter-pregnancy interval, consisting of: reflecting on their birth, clarifying their values, becoming informed, considering the feasibility of options, deliberating with the care team, and making an actual choice. Women struggled to make trade-offs between having a healthy baby and social attributes of delivery, such as uninterrupted bonding with their newborn. Women begin decision-making for birth after caesarean earlier than previously reported and their choices are influenced by personal experience and psychosocial concerns. Future interventions to support choice of mode of delivery should begin early after the primary caesarean, to reflect when women begin to form preferences. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  17. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study.

    Science.gov (United States)

    MacArthur, C; Glazener, C; Lancashire, R; Herbison, P; Wilson, D

    2011-07-01

    To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries. Twelve-year longitudinal study. Maternity units in Aberdeen, Birmingham and Dunedin. Women who returned postal questionnaires 3 months and 12 years after index birth. Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth. Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth. Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37-0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89-1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66-1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73-1.54). Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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

    Directory of Open Access Journals (Sweden)

    Yibeltal T. Bayou

    2016-07-01

    Full Text Available 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 socioeconomic 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. [Carbetocin versus Oxytocin during caesarean section for preventing postpartum haemorrhage].

    Science.gov (United States)

    Pizzagalli, F; Agasse, J; Marpeau, L

    2015-05-01

    The aim of the study was to compare the effectiveness of Carbetocin versus Oxyotcin during caesarean section for preventing postpartum haemorrhage. Prospective observational study (before/after design). Five hundred and forty patients who received an injection of Oxytocin were compared to 262 patients with single injection of 100 micrograms of Carbetocin. The primary outcome was to compare the differential hematocrit level between pre- and postoperative blood samples. The secondary outcome was to compare differential hemoglobin level and the use of complementary therapies for postpartum haemorrhage. We did not find any difference between the Oxytocin and Carbetocin groups on differential hematocrit level. There was no difference between the groups regarding the use of additionnal therapies (Sulproston injections, blood transfusions and surgery methods). The rate of postpartum haemorrhage was similar in the two groups (18.7% vs 21.6%; P=0.33). We found a lower percentage of patients with differential of hemoglobin level between 2 g/dL and 4 g/dL in the Carbetocin group (6.5% vs 15.6%, Poxytocin. Carbetocin seems to reduce the need for postoperative intravenous iron injection. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Maternity in adolescents and its association with caesarean labor

    Directory of Open Access Journals (Sweden)

    Henry Rodrigo Gallardo-Lizarazo

    2015-12-01

    Full Text Available Objective: to evaluate the association between adolescence and cesarean section in women aged 10-19 years compared with those found in ages between 19 and 25 years, patients in a hospital, and determine its association with sociodemographic variables and neonatal in terms of prematurity, and Apgar low birth weight. Materials and Methods: a case-control study was performed using a simple random sampling, considering the calculation of a statistical sample. a total of 1,304 cases and 2,608 controls were included. First time mom patients treated at an institution x over a period of three years, to determine associations of risk through analysis of hypothesis testing is included. Results: the risk of caesarean section in teenagers is (OR 1.13, 95% CI 1.10 to 1.51. In addition, it was determined that there is an increased risk of low birth weight (OR 9.4, 95% CI 7.59 to 11.76, with no difference in adolescents in the risk of Apgar down score at minute and 5 minutes later. Conclusion: there is an increased risk of low birth weight and require termination of pregnancy via cesarean in adolescents compared to young adults, especially if they are under 14. It is necessary to promote campaigns to prevent teenage pregnancy, as the main measure of control over these population.

  1. The role of caesarean section in modern Obstetrics

    Directory of Open Access Journals (Sweden)

    Alessandra Meloni

    2012-10-01

    Full Text Available Caesarean section (CS is a safe obstetric surgical procedure that contributes to reducing maternal and perinatal mortality and morbidity. Nevertheless, its advantages do not justify its continuous increase. During the last few years an average of 35% of deliveries have occurred by CS in Italy whereas an average of 20-25% is very common in other western countries. Although these percentages are very different, an important issue of modern obstetric Medicine is to ascertain whether the threshold of 15% proposed by the WHO in 1985 is actually adequate. Different medical, cultural, social, economic and medico-legal issues are of concern in the different countries and in contemporary society compared with the past. If we wish to discuss whether a new threshold should be proposed to reach the best balance between risks and benefits of CS in modern Obstetrics, it is mandatory to evaluate the reasons why these high percentages of CS occur in western countries and, in particular, in Italy. To reach this goal an optimal management of the delivery room should be pursued by implementing an organizational program, considering the objective delivery trend (Robson’s ten group classification and organizing continuous audit processes. The potential concern for the medico-legal issue, women’s choice and the use of analgesia in childbirth must be taken into account.

  2. Pelvic abscess due to Mycoplasma hominis following caesarean section.

    Science.gov (United States)

    Mori, Nobuaki; Takigawa, Aya; Kagawa, Narito; Kenri, Tsuyoshi; Yoshida, Shinji; Shibayama, Keigo; Aoki, Yasuko

    2016-08-01

    Mycoplasma hominis is associated with genito-urinary tract infection and adverse pregnancy outcomes. However, whether the species is a true pathogen or part of the genito-urinary tracts natural flora remains unclear. A 41-year-old pregnant woman was admitted to our hospital at 38 weeks and 5 days of gestation owing to premature rupture of the membranes. The patient delivered by caesarean section. Subsequently, the patient complained of lower abdominal pain and had persistent fever. Enhanced computed tomography revealed pelvic abscesses. Gram staining of pus from the abscess and vaginal secretions indicated presence of polymorphonuclear leucocytes but no pathogens. Cultures on blood agar showed growth of pinpoint-sized colonies in an anaerobic environment within 48 h. Although administration of carbapenem and metronidazole was ineffective and we could not fully drain the abscess, administration of clindamycin led to clinical improvement. The isolates 16S rRNA gene and yidC gene sequences exhibited identity with those of M. hominis. Physicians should consider M. hominis in cases of pelvic abscesses where Gram staining yields negative results, small colonies are isolated from the abscess and treatment with β-lactam antibiotics is ineffective.

  3. Caesarean delivery complicated by unintentional subdural block and conversion disorder.

    Science.gov (United States)

    Elsharkawy, Hesham; Khanna, Ashish K; Barsoum, Sabri

    2013-01-01

    Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far.

  4. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.

    Science.gov (United States)

    Akinlusi, Fatimat M; Rabiu, Kabiru A; Durojaiye, Idayat A; Adewunmi, Adeniyi A; Ottun, Tawaqualit A; Oshodi, Yusuf A

    2018-01-10

    Caesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization. A prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion. Of the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25-4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22-476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06-211.02, p blood transfusion (aOR = 0.24, 95% CI = 0.09-0.61, p = 0.0024). The overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and

  5. Rates and Predictors of Caesarean Section for First and Second Births: A Prospective Cohort of Australian Women.

    Science.gov (United States)

    Hure, Alexis; Powers, Jennifer; Chojenta, Catherine; Loxton, Deborah

    2017-05-01

    Objective To determine rates of vaginal delivery, emergency caesarean section, and elective caesarean section for first and second births in Australia, and to identify maternal predictors of caesarean section. Methods Data were from the Australian Longitudinal Study on Women's Health. A total of 5275 women aged 18-38 years, who had given birth to their first child between 1996 and 2012 were included; 75.0% (n = 3956) had delivered a second child. Mode of delivery for first and second singleton birth(s) was obtained from longitudinal survey data. Socio-demographic, lifestyle, anthropometric and medical history variables were tested as predictors of mode of delivery for first and second births using multinomial logistic regression. Results Caesarean sections accounted for 29.1% (n = 1535) of first births, consisting of 18.2% emergency and 10.9% elective caesareans. Mode of delivery for first and second births was consistent for 85.5% of women (n = 3383) who delivered both children either vaginally or via caesarean section. Higher maternal age and body mass index, short-stature, anxiety and having private health insurance were predictive of caesarean section for first births. Vaginal birth after caesarean section was more common in women who were older, short-statured, or had been overweight or obese for both children, compared to women who had two vaginal deliveries. Conclusions for Practice Rates of caesarean section in Australia are high. Renewed efforts are needed to reduce the number of unnecessary caesarean births, with particular caution applied to first births. Interventions could focus on elective caesareans for women with private health insurance or a history of anxiety.

  6. 76 FR 34761 - Classified National Security Information

    Science.gov (United States)

    2011-06-14

    ... MARINE MAMMAL COMMISSION Classified National Security Information [Directive 11-01] AGENCY: Marine... Commission's (MMC) policy on classified information, as directed by Information Security Oversight Office... of Executive Order 13526, ``Classified National Security Information,'' and 32 CFR part 2001...

  7. Life saving or money wasting? Perceptions of caesarean sections among users of services in rural Bangladesh.

    Science.gov (United States)

    Parkhurst, Justin Oliver; Rahman, Syed Azizur

    2007-03-01

    Bangladesh has a high level of maternal mortality, corresponding to one of the world's lowest rates of use of skilled birth attendance (12.1%), and a similarly low rate of caesarean births (2.4%). While increasing the proportion of women who deliver with professional medical care is essential to prevent maternal deaths, past work has identified distrust of caesarean procedures in Bangladesh. The reasons behind this distrust can manifest itself in health seeking behaviour around maternal care. This paper presents findings from a qualitative study of 30 women in a rural district of Bangladesh who recently delivered in a health facility. It finds that the distrust in doctor's recommendations for surgery stemmed from high costs incurred and a belief that it was used when not medically justified. This could lead to women avoiding or leaving medical facilities in extreme cases. Some women's experiences further illustrated disagreement among medical staff as to whether or not a caesarean procedure should be done, with conflicting financial incentives for doctors to perform caesarean deliveries, and for nurses and midwives to conduct normal deliveries. Policy makers must recognise that the fears women hold of caesarean deliveries may not simply be rooted in ignorance and may, in fact, reflect legitimate concerns with medical practice. Ultimately, it will be essential to address problems in the health systems environment, which may promote improper service provision.

  8. Factors associated with caesarean section among primiparous adolescents in Brazil, 2011-2012.

    Science.gov (United States)

    Gama, Silvana Granado Nogueira da; Viellas, Elaine Fernandes; Schilithz, Arthur Orlando Corrêa; Theme Filha, Mariza Miranda; Carvalho, Márcia Lazaro de; Gomes, Keila Rejane Oliveira; Costa, Maria Conceição Oliveira; Carmo Leal, Maria do

    2014-08-01

    This paper presents the factors associated with caesarean section in primiparous adolescents in Brazil using data from a national hospital-based survey conducted between 2011 and 2012. Information was obtained from postpartum women through face-to-face and telephone interviews and a theoretical model with three levels of hierarchy was used to analyze associations with the dependent variable mode of delivery (caesarean or vaginal). The results show that the caesarean section rate among primiparous teenagers is high (40%). The most significant contributing factors for caesarean section were: considering this mode of delivery safer (OR=7.0; 95%CI: 4.3-11.4); giving birth under the private health system (OR=4.3; 95%CI: 2.3-9.0); being attended by the same health care professional throughout prenatal care and delivery (OR=5.7; 95%CI: 3.3-9.0) and clinical history of risk and complications during pregnancy (OR=10.8; 95%CI: 8.5-13.7). Adolescent pregnancy continues to be an important concern on the reproductive health agenda and the rates observed by this study are worrying given the effects of early exposure to caesarean section.

  9. The Overview of Surgical Site Infection of Pasca Caesarean Section at Arifin Achmad General Hospital of Riau Province 1 January – 31 December 2014 Period

    OpenAIRE

    Muttaqien, M. Imam; Hamidy, Muhammad Yulis; Rustam, Ruza Prima

    2016-01-01

    Caesarean section has high risk of surgical site infection (SSI). This research explain about surgical site infection after caesarean section in RSUD Arifin Achmad Province of Riau 1 January – 31 December period. The method of this research is retrospective descriptive. The source of data were taken from medical record of patient that underwent caesarean section in RSUD Arifin Achmad Province of Riau. This research found 573 patients that underwent caesarean section in 2014. The number of SSI...

  10. Preoperative administration of cephalosporins for elective caesarean delivery

    Directory of Open Access Journals (Sweden)

    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.

  11. Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review.

    Science.gov (United States)

    Beake, Sarah; Bick, Debra; Narracott, Cath; Chang, Yan-Shing

    2017-10-01

    Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented. © 2016 John Wiley & Sons Ltd.

  12. Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

    Directory of Open Access Journals (Sweden)

    Thobeka P. Jikijela

    2018-01-01

    Conclusion: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

  13. Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

    Science.gov (United States)

    Wanyonyi, Sikolia; Muriithi, Francis G

    2015-10-01

    Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

  14. Obesity and the challenges of caesarean delivery: prevention and management of wound complications.

    Science.gov (United States)

    Ayres-de-Campos, Diogo

    2015-04-01

    Caesarean section in obese patients is associated with an increased risk of surgical wound complications, including haematoma, seroma, abscess and dehiscence. This review focusses on the available strategies to decrease wound complications in this population, and on the clinical management of these situations. Appropriate dose of prophylactic antibiotics, closure of the subcutaneous tissue, and avoidance of subcutaneous drains reduce the incidence of wound complications associated with caesarean section in obese patients. For treatment of superficial wound infection associated with dehiscence, there are data from general surgery patients to suggest that the use of vacuum-assisted devices leads to faster healing and that surgical reclosure is preferable to healing by secondary intention, when there are no signs of ongoing infection. There is a need for stronger evidence regarding the prevention and management of wound complications for caesarean section in obese women. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India.

    Directory of Open Access Journals (Sweden)

    Gayatri Desai

    Full Text Available Even though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India.The aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India.Prospectively collected data of deliveries (N = 19923 from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women.The caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01 respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01 of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%, previous caesarean section (23.9%, breech (16% and prolonged labour (11.2%. There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90 and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26 comparing the tribal and non-tribal women.Similar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries.

  16. Dimensionality Reduction Through Classifier Ensembles

    Science.gov (United States)

    Oza, Nikunj C.; Tumer, Kagan; Norwig, Peter (Technical Monitor)

    1999-01-01

    In data mining, one often needs to analyze datasets with a very large number of attributes. Performing machine learning directly on such data sets is often impractical because of extensive run times, excessive complexity of the fitted model (often leading to overfitting), and the well-known "curse of dimensionality." In practice, to avoid such problems, feature selection and/or extraction are often used to reduce data dimensionality prior to the learning step. However, existing feature selection/extraction algorithms either evaluate features by their effectiveness across the entire data set or simply disregard class information altogether (e.g., principal component analysis). Furthermore, feature extraction algorithms such as principal components analysis create new features that are often meaningless to human users. In this article, we present input decimation, a method that provides "feature subsets" that are selected for their ability to discriminate among the classes. These features are subsequently used in ensembles of classifiers, yielding results superior to single classifiers, ensembles that use the full set of features, and ensembles based on principal component analysis on both real and synthetic datasets.

  17. Maternal CD4+ microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section.

    Science.gov (United States)

    Buxmann, H; Reitter, A; Bapistella, S; Stürmer, M; Königs, C; Ackermann, H; Louwen, F; Bader, P; Schlößer, R L; Willasch, A M

    2016-07-01

    Maternal CD4+ cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. To evaluate maternal CD4+ cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4+ cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4+ cells (95% confidence interval (CI): 0.00-0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01-0.66% maternal cells (95% CI: -0.06-0.16; P=0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4+ cells in one (0.05%; 95% CI: -0.02-0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: -0.06-0.16; P=0.04). There was no MTCT in any of the newborns. In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4+ cell transfer to newborns compared to planned caesarean section. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    LENUS (Irish Health Repository)

    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.

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

    LENUS (Irish Health Repository)

    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.

  20. Acute colonic pseudo-obstruction (Ogilvie's syndrome) with caecal perforation after caesarean section.

    Science.gov (United States)

    Khajehnoori, Masoomeh; Nagra, Sonal

    2016-08-23

    Ogilvie syndrome or acute colonic pseudo-obstruction is characterized by acute dilatation of the colon usually involving caecum and right hemi-colon in the absence of any mechanical obstruction. It is usually associated with an underlying severe illness/infection or surgery, mostly caesarean section and rarely occurs spontaneously. Identification of this condition is important due to the increased risk of bowel ischaemia and perforation particularly with caecal diameter >9 cm. This is a case report of bowel perforation following caesarean section leading to urgent laparotomy. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  1. Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria.

    Science.gov (United States)

    Ugwa, Emmanuel; Ashimi, Adewale; Abubakar, Mohammed Yusuf

    2015-01-01

    This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1(st) January 2010 to 31st December, 2012. This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1(st) January 2010 to 31(st) December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson's Coefficient of correlation and student t- test. P - value accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1%) and bad obstetrics history the least indication (1.4%). There is a weak positive correlation (r = 0.35) between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12). Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is not likely to improve perinatal outcomes in babies of normal weight; therefore the caesarean section rate in this centre should be reduced. Measures to reduce perinatal mortality such as skilled attendant in labour and training of medical staff in neonatal resuscitation should be adopted.

  2. The impact of a novel transendometrial approach for caesarean myomectomy on obstetric outcomes of subsequent pregnancy: a longitudinal panel study.

    Science.gov (United States)

    Huang, S Y; Shaw, S W; Su, S Y; Li, W F; Peng, H H; Cheng, P J

    2018-03-01

    To evaluate the obstetric and surgical outcomes of a novel transendometrial approach for myomectomy during caesarean section in subsequent pregnancies. Longitudinal panel study. Chang Gung Memorial Hospital, Taiwan, with approximately 5000 births per annum. Pregnant women complicated with uterine myoma. Sixty-three pregnant women who received transendometrial myomectomy during the first caesarean delivery reported a subsequent live pregnancy and planned an elective repeat caesarean delivery. Obstetric outcomes consisted of gestational age at birth, newborn weight, Apgar score, birthweight adequacy, uterine rupture, placental abruption, placenta praevia, placenta accreta, spontaneous preterm birth and preterm premature rupture of membranes. Surgical outcomes consisted of surgical time, blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score. The mean gestational age at birth and newborn weight at the subsequent caesarean section were superior to those at the first caesarean delivery. Spontaneous preterm birth, small-for-gestational-age infants and preterm premature rupture of membranes occurred more often in the first pregnancy than in the subsequent pregnancy. The mean surgical time was shorter for the subsequent caesarean delivery than for the first caesarean delivery combined with myomectomy. The other surgical composite outcomes of blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score were similar across the two stages of caesarean deliveries. The novel transendometrial approach for caesarean myomectomy may improve the obstetric outcomes of subsequent pregnancy without causing any additional immediate and long-term adverse surgical outcomes. Transendometrial caesarean myomectomy may improve future obstetric outcomes. © 2017 Royal College of Obstetricians and Gynaecologists.

  3. Suspected total spinal in patient having emergent Caesarean section, a case report and literature review

    Directory of Open Access Journals (Sweden)

    H. Virgin, MD

    2016-01-01

    Concluiosn: To perform spinal anaesthesia for emergent Caesarean in patients having an epidural for labour pain is a feasible option and should be considered in category 2–3 section. The dose for a convert spinal block should be assessed on an individual basis and reasonably reduced.

  4. Differences in nulliparous caesarean section rates across models of care: a decomposition analysis.

    LENUS (Irish Health Repository)

    Brick, Aoife

    2016-01-01

    To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates.

  5. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis

    Directory of Open Access Journals (Sweden)

    Kaundinya Kiran Bharatam

    2015-01-01

    Conclusion: Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy.

  6. Comparison of intrathecal plain articaine and levobupivacaine with fentanyl for Caesarean section.

    Science.gov (United States)

    Demircioglu, Rüveyda I; Gozdemir, Muhammet; Usta, Burhanettin; Sert, Hüseyin; Karabayirli, Safinaz; Muslu, Bünyamin; Keskin, Esra A

    2016-12-01

    Articaine is used as a local anesthetic for outpatient surgery because it offers rapid onset of anesthesia and short duration motor block. Levobupivacaine is often preferred for Caesarean section. We evaluated the anesthetic characteristics of fentanyl-supplemented plain articaine and levobupivacaine for Caesarean section under combine spinal epidural anesthesia. Patients undergoing Caesarean section received in random order plain articaine 40 mg (Group A, n=50) or plain levobupivacaine 10 mg (Group L, n=50) mixed with fentanyl 20 µg intrathecally. The onset and duration of sensory and motor block, first analgesic request, and hemodynamic parameters were recorded. Onset times of maximum motor block were longer in Group L than Group A (P=0,001). Time to two-segment regression of sensory block were 70 min for Group A and 90 min group L (P=0.001). Times to complete regression of motor blockade were significantly longer in group L than group A (P =0,001). To have a faster onset and shorter duration of spinal anesthesia, we recommend the use of plain articaine for Caesarean section.

  7. Key Informant Views of a Free Delivery and Caesarean Policy in ...

    African Journals Online (AJOL)

    This article presents the findings of one component of an evaluation of the national policy for free deliveries and caesareans in Senegal. The policy was introduced in 2005 in five more deprived regions of the country. It aimed to reduce the financial barriers to using maternity services and to increase the number of ...

  8. Techniques for wound closure at caesarean section: a randomized clinical trial

    NARCIS (Netherlands)

    de Graaf, I. M.; Oude Rengerink, K.; Wiersma, I. C.; Donker, M. E.; Mol, B. W.; Pajkrt, E.

    2012-01-01

    Objective: It is unclear which technique for skin closure should be used at caesarean section (CS) in order to get the best cosmetic result. Study design: We conducted a randomized controlled trial to assess the cosmetic result of different techniques for skin closure after CS. A two-center

  9. Spinal anaesthesia for Caesarean section: How can we make it safer?

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... Jenkins JG, Khan MM: Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003; 58: 1114-8. 2. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP: Anaesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997; 86: 277-284.

  10. Vaginal birth after caesarean section is not a safe option in low ...

    African Journals Online (AJOL)

    Vaginal Birth After Caesarean Section (VBAC), has for a long time been practised in low resource settings using nonconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice had been informed by observational ...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    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 elective caesarean...

  12. Learning Curve Characteristics for Caesarean Section Among Associate Clinicians : A Prospective Study from Sierra Leone

    NARCIS (Netherlands)

    Waalewijn, B.P.; van Duinen, A.; Koroma, A. P.; Rijken, M. J.; Elhassein, M.; Bolkan, H. A.

    2017-01-01

    Background: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to

  13. A Parturient with Chronic Immune Thrombocytopenic Purpura: Anaesthetic Management for Caesarean Section

    Directory of Open Access Journals (Sweden)

    Sushma KS

    2015-08-01

    Full Text Available Immune Thrombocytopenic Purpura (ITP accounts for 4-5% of cases of pregnancy with thrombocytopenia. Their clinical condition may deteriorate during pregnancy subjecting these patients at high risk of bleeding. We report anaesthetic management of a parturient with chronic ITP for caesarean section.

  14. Rising trend and indications of caesarean section at the university of ...

    African Journals Online (AJOL)

    Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, ...

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

    NARCIS (Netherlands)

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

    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

  16. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania

    NARCIS (Netherlands)

    Heemelaar, S; Nelissen, E; Mdoe, P; Kidanto, H; van Roosmalen, J; Stekelenburg, J

    OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity

  17. A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary ...

    African Journals Online (AJOL)

    Uche

    complication, occurring in 319 (32.5%) women, followed by pyrexia 236 (24%) and wound infection 88 (9%). There were 7 cases of maternal deaths recorded in the study period giving a case fatality rate of 0.7%. These are shown in table 5. Six of these seven maternal deaths (85.7%) followed emergency caesarean section ...

  18. Parental height differences predict the need for an emergency Caesarean section

    NARCIS (Netherlands)

    Stulp, Gert; Verhulst, Simon; Pollet, Thomas V.; Nettle, Daniel; Buunk, Abraham P.

    2011-01-01

    More than 30% of all pregnancies in the UK require some form of assistance at delivery, with one of the more severe forms of assistance being an emergency Caesarean section (ECS). Previously it has been shown that the likelihood of a delivery via ECS is positively associated with the birth weight

  19. Association between placental abruption and caesarean section among patients at Khyber teaching hospital Peshawar

    International Nuclear Information System (INIS)

    Gul, S.; Jamal, T.; Rana, G.E.; Majid, A.; Iqbal, M.; Abrar, S.

    2016-01-01

    Background: Ante partum haemorrhage remains to be a major cause of morbidity and mortality. 30 percentage of this haemorrhage is attributed to placental abruption. Along with other adverse maternal outcomes, it increases the risk of Caesarean sections in patients, which is a public health concern. This study was conducted to find out whether any significant association exists between placental abruption and C-section in our set up. Methods: A cross-sectional study was conducted from July 26th, 2011 to May 1st, 2013 (i.e., 21 months) in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital Peshawar on a sample of 334 patients who presented with antepartum haemorrhage after 28 weeks of gestation. All those patients with and without placental abruption were followed throughout pregnancy and labour to detect the risk of caesarean section. Results: Among study participants, parity had the highest dispersion while gestational age had the lowest. Caesarean section was performed on 26.3 percentage (95 percentage CI) of the study participants. Proportion of placental abruption among patients presenting with ante partum haemorrhage was 20.6 percentage, (95 percentage CI) out of which 7.5 percentage underwent C-section. Association between placental abruption and C-section was found significant at a=0.05 (ρ=0.03). Conclusion: Risk of caesarean section is increased in pregnancies complicated by placental abruption as compared to pregnancies complicated by other causes of ante partum haemorrhage. (author)

  20. Caesarean Section--A Density-Equalizing Mapping Study to Depict Its Global Research Architecture.

    Science.gov (United States)

    Brüggmann, Dörthe; Löhlein, Lena-Katharina; Louwen, Frank; Quarcoo, David; Jaque, Jenny; Klingelhöfer, Doris; Groneberg, David A

    2015-11-17

    Caesarean section (CS) is a common surgical procedure. Although it has been performed in a modern context for about 100 years, there is no concise analysis of the international architecture of caesarean section research output available so far. Therefore, the present study characterizes the global pattern of the related publications by using the NewQIS (New Quality and Quantity Indices in Science) platform, which combines scientometric methods with density equalizing mapping algorithms. The Web of Science was used as a database. 12,608 publications were identified that originated from 131 countries. The leading nations concerning research activity, overall citations and country-specific h-Index were the USA and the United Kingdom. Relation of the research activity to epidemiologic data indicated that Scandinavian countries including Sweden and Finland were leading the field, whereas, in relation to economic data, countries such as Israel and Ireland led. Semi-qualitative indices such as country-specific citation rates ranked Sweden, Norway and Finland in the top positions. International caesarean section research output continues to grow annually in an era where caesarean section rates increased dramatically over the past decades. With regard to increasing employment of scientometric indicators in performance assessment, these findings should provide useful information for those tasked with the improvement of scientific achievements.

  1. Is there a safe limit of delay for emergency caesarean section in ...

    African Journals Online (AJOL)

    Abstract. Objective: To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival. Methods: Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal ...

  2. Beyond the short term effects of caesarean delivery and gynaecological surgery

    NARCIS (Netherlands)

    Kok, N.

    2015-01-01

    The work presented in this thesis focuses on the risk of maternal and neonatal complications in pregnancies after previous caesarean section and strategies for the prevention of post-surgical adhesion formation after abdominal and gynaecological surgery. In Part One: "Pregnancy and delivery after

  3. Incidence and risk factors for caesarean wound infection in Lagos Nigeria

    Directory of Open Access Journals (Sweden)

    Gab-Okafor Chidinma V

    2009-09-01

    Full Text Available Abstract Background Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors. Findings Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0. Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3% of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3% than in the subjects without wound infection (33.9% p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02, prolonged operation time (p = 0.001, anaemia (p = 0.031 and multiple vaginal examinations during labour (0.021 among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45, prolonged operation time (OR = 2.87 and body max index > 25 (2.34 retained their association with post caesarean wound infection. Conclusion Effort should be geared towards the prevention of prolonged

  4. Factors associated to Caesarean delivery in public and private health care systems.

    Science.gov (United States)

    Oliveira, Rosana Rosseto de; Melo, Emiliana Cristina; Novaes, Elisiane Soares; Ferracioli, Patrícia Louise Rodrigues Varela; Mathias, Thais Aidar de Freitas

    2016-01-01

    Identifying factors associated to Caesarean sections among the residents of Maringá-PR, according to the financing source for delivery. A cross-sectional study with data from 920 postpartum women interviewed between October 2013 and February 2014. Association analysis was performed by logistic regression. Caesarean section rates were 55.5% in the Unified Healthcare System (SUS) and 93.8% in the private system. Factors associated with Caesarean section in the SUS were: previous Caesarean section (OR=8.9; CI=4.6-16.9), desire for Caesarean section early in pregnancy (OR=2.0; CI=1.1-3.6), pregestational overweight/obesity (OR=1.8; CI=1.1-2.8), and per capita family income higher than one minimum wage (OR=2.1; CI=1.3-3.4). In the private system, desire for Caesarean section early in pregnancy (OR=25.3) and a previous Caesarean section (OR=11.3) were strongly associated to its performance. It is necessary to properly orientate all pregnant women who desire a Caesarean delivery, from both the SUS and the private system, about the inherent risks of the surgical procedure without indication. In the public health sector, guidelines should be focused on pregnant women with previous Caesarean delivery, with a per capita income higher than one minimum wage and those who are overweight or obese, as these women are more likely to have a Caesarean section. Identificar fatores associados à cesárea entre residentes de Maringá-PR, segundo a fonte de financiamento do parto. Estudo transversal com dados de 920 puérperas entrevistadas entre outubro de 2013 e fevereiro de 2014. A análise de associação foi feita por regressão logística. A taxa de cesariana foi de 55,5% e 93,8% no Sistema Único de Saúde (SUS) e no sistema privado, respectivamente. Associou-se à cesárea no SUS: realização de cesárea anterior (OR=8,9; IC=4,6-16,9), desejo pela cesárea no início da gestação (OR=2,0; IC=1,1-3,6), sobrepeso/obesidade pré-gestacional (OR=1,8; IC=1,1-2,8), e renda familiar

  5. Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section

    Science.gov (United States)

    Gonsalves, Hazel; Al-Riyami, Nihal; Al-Dughaishi, Tamima; Gowri, Vaidayanathan; Al-Azri, Mohammed; Salahuddin, Ayesha

    2016-01-01

    Objectives This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results Most women were 25–35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). Conclusion The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications. PMID:28003890

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

    Science.gov (United States)

    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.

  7. Combining multiple classifiers for age classification

    CSIR Research Space (South Africa)

    Van Heerden, C

    2009-11-01

    Full Text Available classifier is also developed by using an SVM to predict posterior class probabilities using two different types of classifier outputs; gender classification results and regression age estimates. The authors show that for combining posterior probabilities...

  8. Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database.

    Directory of Open Access Journals (Sweden)

    Sarah J Stock

    Full Text Available There is evidence that induction of labour (IOL around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery. However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management.We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176. Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401 of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]. There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]. In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75] and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00].A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.

  9. Aggregation Operator Based Fuzzy Pattern Classifier Design

    DEFF Research Database (Denmark)

    Mönks, Uwe; Larsen, Henrik Legind; Lohweg, Volker

    2009-01-01

    This paper presents a novel modular fuzzy pattern classifier design framework for intelligent automation systems, developed on the base of the established Modified Fuzzy Pattern Classifier (MFPC) and allows designing novel classifier models which are hardware-efficiently implementable. The perfor...

  10. Feature selection based classifier combination approach for ...

    Indian Academy of Sciences (India)

    based classifier combination is the simplest method in which final decision is that class for which maximum (greater than N/2) participating classifier vote, where N is the number of classifiers. 3.2b Decision templates: The method based on decision template, (Kuncheva et al 2001) firstly creates DT for each class using ...

  11. 15 CFR 4.8 - Classified Information.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Classified Information. 4.8 Section 4... INFORMATION Freedom of Information Act § 4.8 Classified Information. In processing a request for information..., the information shall be reviewed to determine whether it should remain classified. Ordinarily the...

  12. Pulmonary effects of bupivacaine, ropivacaine, and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery: a randomised controlled study

    NARCIS (Netherlands)

    Lirk, P.; Kleber, N.; Mitterschiffthaler, G.; Keller, C.; Benzer, A.; Putz, G.

    2010-01-01

    BACKGROUND: Spinal anaesthesia is the method of choice for elective caesarean delivery, but has been reported to worsen dynamic pulmonary function when using bupivacaine. Similar investigations are lacking for ropivacaine and levobupivacaine. We have therefore compared the pulmonary effects of

  13. Management of a Viable Ectopic Pregnancy on Caesarean Scar After IVF-ET Procedure: A Case Presentation

    Directory of Open Access Journals (Sweden)

    Kazım Gezginç

    2012-04-01

    bleeding focus could be detected but bilateral uterine arteries were ligated. As a result, caesarean scar pregnancy is a highly complicated type of ectopic pregnancy and should be kept in mind during routine obstetric practice.

  14. America's challenge.

    Science.gov (United States)

    Lindsay, G N

    1968-01-01

    As government increasingly recognizes its own obligations to support and provide family planning as a health and social measure, serious questions are raised as to the proper role for Planned Parenthood World Federation as a private organization. Federal programs both at home and abroad tend to make private fundraising more difficult, whatever the role of this organization may be. Contrary to common impression, experience thus far indicates that the existence of governmental programs does not decrease demands on Planned Parenthood as a private agency. A wide gap also exists between public acceptance, which has been realized, and public conviction, which still has not been accepted. Only those who feel distress at the vision of an all-encompassing megalopolis, only those with concern for the qualify of life in the crowd, and only those who see finite limits of resources recognize that the US must someday plan a halt to population growth. As the gap between the developed and the underdeveloped world widens, economists point out that the US, with less than 6% of the world's population, already consumes some 50% of the world's available raw materials. Business and government leaders are beginning to understand the rate at which an industrial and affluent society consumes the world's substance and threatens the environment. If the assumption is correct that the population explosion constitutes a major threat to life on earth, then America's own attitudes and actions at home, as well as abroad and in the developing countries, are vital. In the next few years Planned Parenthood faces the task of converting the tide of public acceptance into one of conviction and effective action on a giant scale both at home and abroad. In its effort, Planned Parenthood has continued to expand its own service functions. It now has 157 local affiliates with an additional 30 in the organizational stage. In 1967 Planned Parenthood affiliates operated 470 family planning centers, 71 more than

  15. Trial of labour after caesarean section: Two-year analysis at a Portuguese centre.

    Science.gov (United States)

    Abreu-Silva, Joao; Castro, Jorge; Maia, Catarina; Pinho, Manuela; Carvalho, Claudina

    2017-08-01

    We conducted a retrospective study aimed at determining variables associated with a higher success rate for vaginal delivery after caesarean section, and assessing the impact of induction of labour. Secondarily, we aimed to describe our vaginal delivery and uterine rupture rates with the use of a controlled-release dinoprostone vaginal insert for cervical ripening. Of 292 women who met the inclusion criteria, induction of labour occurred in 48% (94% with dinoprostone). There was a non-significant difference between the vaginal delivery rate of spontaneous labour (57%) and induction of labour (33%), after adjusting for confounding variables. The success rate was influenced by a Bishop score ≥6, previous vaginal delivery and previous caesarean for dystocia or failed induction. There was only one case of uterine rupture, which was associated with dinoprostone use (overall rate 0.34%, 0.77% for dinoprostone). Impact statement Trial of labour after caesarean section is considered an alternative to elective repeat caesarean. Both present associated benefits and risks, the most fearsome of which is uterine rupture during labour (0.78% in term pregnancies). Induction is also possible but carries a higher risk of uterine rupture and lower success rate for vaginal birth. Prostaglandins have been of particular concern due to a higher risk of uterine scar rupture, estimated at 2% for dinoprostone; however, its use as a controlled-release vaginal insert has been under-reported. Our study confirms the reported impact of previous vaginal delivery, previous caesarean indication and Bishop score at admission on success rate for vaginal birth after caesarean. We were unable to prove a lower success rate for induction of labour after adjusting for other variables. Despite our study limitations, we report on the use of a controlled-release vaginal insert with 10mg of dinoprostone in 130 women with a uterine rupture rate of 0.77%, lower than previously reported and similar to the

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

    Directory of Open Access Journals (Sweden)

    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

  17. Joint effect of education and age at childbirth on the risk of caesarean delivery: findings from Germany 2008-2015.

    Science.gov (United States)

    Castiglioni, L; Schmiedeberg, C

    2018-02-01

    This article aims at assessing the joint effect of maternal age and education on the risk of having a caesarean delivery. As high maternal education is often associated with lower caesarean-birth rates, but high-educated women tend to postpone motherhood, these effects may offset each other in traditional analyses. Secondary analysis of the data from the German Family Panel pairfam. The interview-based data refer to 1020 births between 2008 and 2015. We analyse only reports from mothers and calculate logistic regression models. The caesarean delivery rate differs strongly between education levels, and low-educated women are at higher risk of having a caesarean delivery when controlling for parity and age. A positive age gradient is found, indicating a higher risk of caesarean section for older mothers. Without controlling for age, the association of education and caesarean section risk is weaker, i.e., effects of age and education partially level each other out. A model including an interaction term between age and education confirms this result. The risk of having a caesarean delivery does not differ between levels of education when maternal age is not taken into account. Lower maternal education and higher age are both positively associated with the risk of experiencing a caesarean section in Germany. However, as higher educated women tend to have their children later, effects of education and age weigh each other out. Preventive campaigns should target women with lower education and raise women's awareness on the risks associated with late motherhood. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  18. Trial of labour after caesarean section and the risk of neonatal and infant death: a nationwide cohort study.

    LENUS (Irish Health Repository)

    O'Neill, Sinéad M

    2017-02-27

    Caesarean section (CS) rates are increasing worldwide and as a result repeat CS is common. The optimal mode of delivery in women with one previous CS is widely debated and the risks to the infant are understudied. The aim of the current study was to evaluate if women with a trial of labour after caesarean (TOLAC) had an increased odds of neonatal and infant death compared to women with an elective repeat CS (ERCS).

  19. Error minimizing algorithms for nearest eighbor classifiers

    Energy Technology Data Exchange (ETDEWEB)

    Porter, Reid B [Los Alamos National Laboratory; Hush, Don [Los Alamos National Laboratory; Zimmer, G. Beate [TEXAS A& M

    2011-01-03

    Stack Filters define a large class of discrete nonlinear filter first introd uced in image and signal processing for noise removal. In recent years we have suggested their application to classification problems, and investigated their relationship to other types of discrete classifiers such as Decision Trees. In this paper we focus on a continuous domain version of Stack Filter Classifiers which we call Ordered Hypothesis Machines (OHM), and investigate their relationship to Nearest Neighbor classifiers. We show that OHM classifiers provide a novel framework in which to train Nearest Neighbor type classifiers by minimizing empirical error based loss functions. We use the framework to investigate a new cost sensitive loss function that allows us to train a Nearest Neighbor type classifier for low false alarm rate applications. We report results on both synthetic data and real-world image data.

  20. Suction Evacuation with Methotrexate as a Successful Treatment Modality for Caesarean Scar Pregnancies; Case series

    Directory of Open Access Journals (Sweden)

    Sumita Datta

    2015-11-01

    Full Text Available Pregnancy resulting from the implantation of an embryo within a scar of a previous Caesarean section is extremely rare. The diagnosis and treatment of Caesarean scar pregnancies (CSPs are challenging and the optimal course of treatment is still to be determined. We report a case series of six patients with CSPs who presented to the Royal Hospital in Muscat, Oman, between October 2012 and April 2014. All of the patients were successfully treated with systemic methotrexate and five patients underwent suction evacuation either before or after the methotrexate administration. The patients were followed up for a period of 6–9 weeks after treatment and recovered completely without any significant complications. Suction evacuation with methotrexate can therefore be considered an effective treatment option with good maternal outcomes.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    Kashif, S.; Saleem, J.

    2015-01-01

    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. (author)

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

    DEFF Research Database (Denmark)

    Larsen, Klaus Richter; Kristensen, B B; Rasmussen, M A

    2015-01-01

    BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined. METHODS: Ninety patients scheduled for elective Caesarean...... section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary...... 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...

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

    LENUS (Irish Health Repository)

    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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... that is the case for patients exposed to spinal anesthesia is not known. OBJECTIVES: To evaluate the impact of phenylephrine vs. ephedrine on ScO2during caesarean section with spinal anesthesia in a single center, open-label parallel-group study with balanced randomization of 24 women (1:1). Secondary aims were...

  6. Changes of RAAS in maternal and placental blood during caesarean operation

    International Nuclear Information System (INIS)

    Huang Daihua; Cui Bangping; Hu Wei; Zhou Wei

    2006-01-01

    To study changes of renin-angiotensin-aldosterone system (RAAS) and influence of anesthetic effect on it during caesarean operation, PRA, AT II and ALD in maternal and placental blood were determined by RIA for 30 healthy women scheduled for caesarean operation. Blood was taken before anesthesia(T 0 group) and just at the end of surgery (T 1 group) for comparison. Results showed that there were significant differences in PRA(P 0 and T 1 group, but there were no significant differences in ALD, PRA and AT II between placental blood, umbilical arteria and vein blood. The data suggest that there was obvious relationship between anesthetic effect and the secretion of RAAS. The levels of AT II, ALD and PRA in patients of partial block anesthesia were significantly than those in patients of complete block anesthesia. (authors)

  7. Successful Pregnancy Following Repair of Vesicouterine Fistula Following Repeat Caesarean Section: A Case Report

    Directory of Open Access Journals (Sweden)

    Dilruba Akter

    2012-06-01

    Full Text Available A lady, para 2, both delivered by caesarean section for prolonged labour, presented with the complaints of menouria and infertility for 3 years following her last caesarean section. She had history of haematuria during menstruation and her menstrual flow is scanty. Her first baby was female and alive, but her second baby was stillborn following prolonged and obstructed labour. This has been continuously blamed by family and others for happening that events. Her fistula was confirmed by ultrasound scan, histerography and cystoscopy. The vesicouterine fistula was treated by local repair with omental patch through transperitoneal approach. Pregnancy following one year of successful repair has turned her from miserable to happiness in life.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11030 BSMMU J 2012; 5(1:76-78 

  8. [Caesarean section in conflict with the patient's right to self-determination?].

    Science.gov (United States)

    Blondeau, Marie-José C E; Koorengevel, Kathelijne M; Schneider, A J Tom; van der Knijff-van Dortmont, A L M J Anouk; Dondorp, Wybo J

    2015-01-01

    Competent patients have the right to refuse treatment and healthcare workers should acknowledge their wishes. In the Netherlands there are conflicting (constitutional) rights of the foetus and of mentally ill patients. This paper describes the legal and ethical problems in the case of a mentally ill patient at 37 weeks of pregnancy who refused an obstetric examination. The patient refused to cooperate and have her physical condition and mental status examined. Her refusal endangered the life of the foetus. The obstetrician decided to perform a caesarean section, even if this would be in conflict with the patient's right to self-determination. In these cases no legal framework exists for providing the best medical care. New legislation should be drawn up to prevent similar cases occurring in the future. If a caesarean section is in conflict with a patient's right to self-determination, it should always be performed as a last resort.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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 spontaneous labor with a single fetus in cephalic presentation at term. METHODS: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery...... was 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...

  11. The free delivery and caesarean policy in Morocco: how much do households still pay?

    Science.gov (United States)

    Boukhalfa, C; Abouchadi, S; Cunden, N; Witter, S

    2016-02-01

    The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes. © 2015 John Wiley & Sons Ltd.

  12. Pregnancy Located below the Internal Os − Cervical and Caesarean Scar Ectopics

    Directory of Open Access Journals (Sweden)

    Sumia Bari

    2015-05-01

    Full Text Available Cervical pregnancy is an extremely rare condition with potential grave consequences if not diagnosed early and treated properly. Here we report two cases of early cervical ectopic pregnancy with a history of previous one caesarean section. One case severely bled during evacuation and curettage and was successfully treated by hysterotomy followed by digital separation of product of conception. Another case was managed conservatively by medical method with injectable methotrexate.

  13. [The Decision-Making Processes in Taiwanese Women With Repeat Caesarean Deliveries].

    Science.gov (United States)

    Chen, Shu-Wen

    2016-10-01

    Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy. To explore the decision-making processes regarding RCD in Taiwanese women. A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis. A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women's decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician's recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians' professional judgment, and a lack of progress during the course of labour. The well-being of mother and fetus is the major concern affecting mothers' decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth

  14. Role of tranexamic acid in reducing blood loss during and after caesarean section

    Directory of Open Access Journals (Sweden)

    Simran Kaur Bhatia

    2015-01-01

    Full Text Available Introduction: Association between caesarean section and intra operative and post operative bleeding is known. Post-partum hemorrhage is still a leading cause for maternal morbidity and mortality. This study will evaluate the efficacy and safety of tranexamic acid in reducing the blood loss after placental delivery following lower segment caesarean section (LSCS and note any adverse effects. Materials and Methods: A total of 100 women, who underwent elective or emergency primary caesarean section at term between 37 and 41 weeks have been studied prospectively. They were divided into two groups. In the study group of 50, tranexamic acid 1 gm IV was given 20 minutes before making incision for caesarean section and the control group of 50 did not receive tranexamic acid. Statistical Analysis: For quantitative outcomes, the t-test was used to test for difference in the two groups. For categorical outcomes, chi square and odds ratio with 95% confidence interval were used as applicable. Results: The patient characteristics, namely age, height, weight, gestational age and gravidity in two groups were similar which was statistically insignificant. Hemoglobin decreased slightly after birth in both groups but no statistical difference between two groups was noticed. There was no episode of thrombosis in the study. Tranexamic acid significantly reduced the quantity of the blood loss from time of placental delivery to 2 hours postpartum (P < 0.001 and from end of LSCS to 2 hours postpartum (P < 0.001. However, there was no statistical difference in quantity of blood loss from time of placental delivery to end of LSCS in both groups (P < 0.001. Conclusion: A safe dose of tranexamic acid has an effective role in reducing blood loss during LSCS without causing adverse reaction. Thus, drug can be used effectively in reducing maternal morbidity and mortality during LSCS.

  15. Risk adjustment for inter-hospital comparisons of caesarean section rates in Taipei municipal hospitals.

    Science.gov (United States)

    Hsu, Chun-Chyang; Shieh, Guahn-Ren; Wu, Chuan-Song; Shen, Hsi-Che; Tang, Chao-Hsiun

    2006-08-01

    This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR=1.08, CI=1.01-1.15) and C (RR=1.01, CI=1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR=1.09, CI=1.05-1.14) and D (RR=1.02, CI=0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR=0.92, CI=0.88-0.96) and F (RR=0.80, CI=0.77-0.84) were the same as the observed rates. Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.

  16. Perioperative Anaesthetic Management of Caesarean Delivery in a Parturient with Portal Gastropathy

    Directory of Open Access Journals (Sweden)

    Ashwini H Ramaswamy

    2014-12-01

    Full Text Available Portal hypertensive gastropathy occurs both in cirrhotic and non cirrhotic patients leading to haemetemesis secondary to oesophageal varices. The hyper dynamic circulatory state of pregnancy in these patients poses special problems necessitating specialized care preferably in a tertiary care centre. We report the perioperative anaesthetic management for elective caesarean section in a 32-year-old pregnant lady at 39 weeks gestation with portal gastropathy secondary to periportal fibrosis of the liver.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Thermal territories of the abdomen after Caesarean Section birth : infrared thermography and analysis

    OpenAIRE

    Childs, Charmaine; Siraj, Mahbubur Rob; Fair, Frankie; Selvan, Arul; Soltani, Hora; Wilmott, Jon; Farrell, Rom

    2016-01-01

    Objective: To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening.\\ud Method: Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the...

  19. Acute colonic pseudo-obstruction (Ogilvie's syndrome) with caecal perforation after caesarean section

    OpenAIRE

    Khajehnoori, Masoomeh; Nagra, Sonal

    2016-01-01

    Ogilvie syndrome or acute colonic pseudo-obstruction is characterized by acute dilatation of the colon usually involving caecum and right hemi-colon in the absence of any mechanical obstruction. It is usually associated with an underlying severe illness/infection or surgery, mostly caesarean section and rarely occurs spontaneously. Identification of this condition is important due to the increased risk of bowel ischaemia and perforation particularly with caecal diameter?>9 cm. This is a case ...

  20. Incidental Unilateral Tubal Absence Detected During Caesarean Section: Report of a Case

    Directory of Open Access Journals (Sweden)

    Selçuk Erkılınç

    2016-04-01

    Full Text Available Unilateral tubal absence is a rare clinical condition with unknown etiology and probable causes are adnexal torsion, ischemia, birth defects and infection. In the literature there is limited data and only few case reports about this disease. Therefore we aimed to evaluate the clinical characteristics of an incidental unilateral tubal atrophy case during caesarean section that can be considered for publication.

  1. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis

    OpenAIRE

    Bharatam, Kaundinya Kiran; Sivaraja, P.K.; Abineshwar, N.J.; Thiagarajan, Vasundhara; Thiagarajan, D.A.; Bodduluri, Sudeep; Sriraman, K.B.; Vasantha Ragavan, A.; Priya, Shanmuga

    2015-01-01

    Introduction: Uterine scar dehiscence can complicate caesarean section with complications like post partum hemorrhage, endomyometritis, localized/generalized peritonitis, and sepsis. Presentation of case: Our patient had abdominal wound infection after LSCS surgery and features of sepsis. The wound infection was actually the presentation of a uterine scar dehiscence and localized peritonitis. Discussion: Incidence of uterine scar dehiscence is around 0.6%. Presentation can be post partu...

  2. Incidental Unilateral Tubal Absence Detected During Caesarean Section: Report of a Case

    OpenAIRE

    Selçuk Erkılınç; Ali İrfan Güzel; Melike Doğanay; İrfan Özer; Coşkun Ümit

    2016-01-01

    Unilateral tubal absence is a rare clinical condition with unknown etiology and probable causes are adnexal torsion, ischemia, birth defects and infection. In the literature there is limited data and only few case reports about this disease. Therefore we aimed to evaluate the clinical characteristics of an incidental unilateral tubal atrophy case during caesarean section that can be considered for publication.

  3. The effect of physicians' remuneration system on the Caesarean section rate: the Uruguayan case.

    Science.gov (United States)

    Triunfo, Patricia; Rossi, Máximo

    2009-12-01

    Using data about births from the perinatal information system (PIS) registered in Montevideo (Uruguay), we estimated the probability of having a Caesarian section delivery, controlled by risk factors and the endogeneity of the choice of hospital. In public hospitals in Montevideo there is a fixed payment system, but in private hospitals this procedure has to be paid for separately. In the former, there is no effect on the doctor's income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the probability of a Caesarean section increases with the age of the woman, the presence of eclampsy, pre-eclampsy, previous hypertension, previous Caesarean sections, multiple pregnancies and fetopelvic disproportion, and decreases for multiparous women and women in a public hospital. In fact, the probability of having a Caesarean section in a private institution is almost two times higher than in a public hospital (20% as against 39%). Focusing on women without risk factors, we found that the probability a Caesarian in a public hospital was 11%, but the probability in a private hospital was 25%. We conclude that the remuneration system explains an important part of this difference.

  4. A history of caesarean section: from ancient world to the modern era.

    Science.gov (United States)

    Todman, Donald

    2007-10-01

    Caesarean section has been recorded in history since ancient times in both Western and non-Western literature. Although the first use of the term in obstetrics was from the seventeenth century, its early history is obscured by mythology. The origin of the term caesarean is believed to be from the birth of Julius Caesar; however, this is unlikely considering his mother Aurelia Cotta lived for many years afterwards. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the fetus. With few exceptions, this was the pattern until the era of anaesthesia in the nineteenth century. Developments in surgical technique from the later nineteenth century and through the twentieth century have refined the procedure, with resulting low morbidity and mortality. As a consequence, the objectives of caesarean section have evolved from rescuing the fetus or for cultural or religious reasons towards concerns for the safety of mother and child as well as considering the mother's preferences.

  5. Evolving pattern of anaesthesia for caesarean section experience at the University of Benin Teaching Hospital.

    Science.gov (United States)

    Amadasun, F E; Idehen, H O; Edomwonyi, N P

    2013-01-01

    The WHO puts caesarean section rate in Nigeria at 1.8%. This is much higher in teaching, specialist and referral hospitals. In our centre University of Benin Teaching Hospital (UBTH), the average annual rate is 33.4%. General anaesthesia is the predominant choice for caesarean section (C/S) in most centres. The trend is increasing towards regional anaesthesia. Many studies have reported the trend in several centres. This study examined the evolving pattern in our centre. To examine the evolving pattern of anaesthetic technique for caesarean section, at the University of Benin Teaching Hospital. A ten-year retrospective period (2001-2010), data were pooled from the computerized data system of the department of obstetrics and gynaecology. Also, anaesthetic chart and staff records from the department of anaesthesiology were studied. Information about C/S, anaesthetic method and anaesthetist profile were derived from these sources. The data were analysed and presented as simple frequency and nominal data. Six thousand, six hundred and eleven C/S were done over the 10-year period. Emergency C/S was 82%, while 12% were elective cases. Average annual rate of anaesthetic technique used was regional anaesthesia 76.5% and general anaesthesia 23.5%. The use of regional anaesthesia grew from 30% in 2001, to 89% in 2010. Number of anaesthetists increased from 22 in 2001 to 37 in 2010. The study shows an increasing use of regional anaesthesia for C/S, predominantly subarachnoid blockade.

  6. Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study.

    Science.gov (United States)

    El Kenany, S; El Tahan, M R

    2016-05-01

    We hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery. After Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150mg or 300mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded. Compared with placebo or pregabalin 150mg, the use of a preoperative dose of pregabalin 300mg resulted in significantly lower cumulative morphine consumption at 24h (mean dose: placebo 12.9mg [95% CI 11.6 to 14.2]; pregabalin 150mg 11.9mg; [95% CI 10.7 to 13.1]; pregabalin 300mg 6mg [95% CI 5.4 to 7.3]; Ppain scores at 4h and 6h after delivery (Pumbilical cord acid-base status. Three babies in the pregabalin 300mg group (6.7%) experienced short-term poor latching-on for breastfeeding. In our study, preoperative administration of pregabalin 300mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China

    Directory of Open Access Journals (Sweden)

    Gao Xiao-ling

    2010-12-01

    Full Text Available Abstract 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. A critical examination of this issue in relation to maternal outcomes is important. At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women. To fill the gap left by trials, this indication-matched cohort study was carried out to examine prospectively the outcomes of caesarean section on women with no absolute obstetric indication compared with similar women who had vaginal delivery. Methods An indication-matched cohort study was undertaken to compare maternal outcomes following caesarean section with those undergoing vaginal delivery, in which the two groups were matched for non-absolute indications. 301 nulliparous women with caesarean section were matched successfully with 301 women who delivered vaginally in the Maternal and Children's Hospitals (MCHs in Shanghai, China. Logistic regression model or binomial regression model was used to estimate the relative risk (RR directly. Adjusted RRs were calculated adjusting for propensity score and medical indications. Results The incidence of total complications was 2.2 times higher in the caesarean section group during hospitalization post-partum, compared with the vaginal delivery group (RR = 2.2; 95% CI: 1.1-4.4. The risk of haemorrhage from the start of labour until 2 hours post-partum was significantly higher in the caesarean group (RR = 5.6; 95% CI: 1.2-26.9. The risk of chronic abdominal pain was significantly higher for the caesarean section group (RR = 3.6; 95% CI: 1.2-10.9 than for the vaginal delivery group within 12 months post-partum. The two groups had similar incidences of anaemia and complicating infections such as wound complications

  8. Audit of Caesarean Section Births in Small Private Maternity Homes: Analysis of 15-Year Data Applying the Modified Robson Criteria, Canada.

    Science.gov (United States)

    Atnurkar, Kishore B; Mahale, Arun R

    2016-10-01

    To audit the data of caesarean sections carried out in single-handed-run small private hospitals on the basis of the modified Robson criteria (Canada), to know the changing trends of caesarean sections over a considerable duration of time (15 years) in private sector, and to focus on a particular group out of the classification of caesarean section in the efforts to reduce the caesarean section rate. It is a retrospective observational study of 7342 caesarean section cases carried out in different small private maternity hospitals over a period of 15 years. The data analysed by applying the modified Robson criteria (Canada) and the changing trends were studied in the view of reducing caesarean section rate. Statistically significant increasing trend was observed in groups of both primary and repeat caesarean section cases done before the onset of labour in the last 5 years. Auditing the data of caesarean sections on the basis of the modified Robson criteria (Canada) is a better way of classification as compared to Ten Group Classification System (TGCS). The change in trends is seen only in the last 5 years, which suggests that there is shift in attitude of the obstetricians of small private hospitals in performing caesarean sections before onset of labour than performing it after the onset of labour. Our analysis suggests the obstetricians from small private hospitals to target groups 2B, 4B and 5C.

  9. Data characteristics that determine classifier performance

    CSIR Research Space (South Africa)

    Van der Walt, Christiaan M

    2006-11-01

    Full Text Available The relationship between the distribution of data, on the one hand, and classifier performance, on the other, for non-parametric classifiers has been studied. It is shown that predictable factors such as the available amount of training data...

  10. Hierarchical mixtures of naive Bayes classifiers

    NARCIS (Netherlands)

    Wiering, M.A.

    2002-01-01

    Naive Bayes classifiers tend to perform very well on a large number of problem domains, although their representation power is quite limited compared to more sophisticated machine learning algorithms. In this pa- per we study combining multiple naive Bayes classifiers by using the hierar- chical

  11. Feature selection based classifier combination approach for ...

    Indian Academy of Sciences (India)

    2016-08-26

    Aug 26, 2016 ... Feature selection based classifier combination approach for handwritten Devanagari numeral recognition. Pratibha Singh Ajay Verma ... ensemble of classifiers. The main contribution of the proposed method is that, the method gives quite efficient results utilizing only 10% patterns of the available dataset.

  12. A fuzzy classifier system for process control

    Science.gov (United States)

    Karr, C. L.; Phillips, J. C.

    1994-01-01

    A fuzzy classifier system that discovers rules for controlling a mathematical model of a pH titration system was developed by researchers at the U.S. Bureau of Mines (USBM). Fuzzy classifier systems successfully combine the strengths of learning classifier systems and fuzzy logic controllers. Learning classifier systems resemble familiar production rule-based systems, but they represent their IF-THEN rules by strings of characters rather than in the traditional linguistic terms. Fuzzy logic is a tool that allows for the incorporation of abstract concepts into rule based-systems, thereby allowing the rules to resemble the familiar 'rules-of-thumb' commonly used by humans when solving difficult process control and reasoning problems. Like learning classifier systems, fuzzy classifier systems employ a genetic algorithm to explore and sample new rules for manipulating the problem environment. Like fuzzy logic controllers, fuzzy classifier systems encapsulate knowledge in the form of production rules. The results presented in this paper demonstrate the ability of fuzzy classifier systems to generate a fuzzy logic-based process control system.

  13. Deconvolution When Classifying Noisy Data Involving Transformations

    KAUST Repository

    Carroll, Raymond

    2012-09-01

    In the present study, we consider the problem of classifying spatial data distorted by a linear transformation or convolution and contaminated by additive random noise. In this setting, we show that classifier performance can be improved if we carefully invert the data before the classifier is applied. However, the inverse transformation is not constructed so as to recover the original signal, and in fact, we show that taking the latter approach is generally inadvisable. We introduce a fully data-driven procedure based on cross-validation, and use several classifiers to illustrate numerical properties of our approach. Theoretical arguments are given in support of our claims. Our procedure is applied to data generated by light detection and ranging (Lidar) technology, where we improve on earlier approaches to classifying aerosols. This article has supplementary materials online.

  14. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.

    Directory of Open Access Journals (Sweden)

    Caroline A Crowther

    Full Text Available BACKGROUND: Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC compared with elective repeat caesarean (ERC. We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC. METHODS AND FINDINGS: 2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323 or randomisation (n = 22 to planned VBAC (1,225 patient preference, 12 randomised or planned ERC (1,098 patient preference, ten randomised. The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100% and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200. Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion, (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80. CONCLUSIONS: Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53974531

  15. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.

    Science.gov (United States)

    Crowther, Caroline A; Dodd, Jodie M; Hiller, Janet E; Haslam, Ross R; Robinson, Jeffrey S

    2012-01-01

    Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC. 2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80). Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean. Current Controlled Trials ISRCTN53974531

  16. Association of caesarean delivery with child adiposity from age 6 weeks to 15 years.

    Science.gov (United States)

    Blustein, J; Attina, T; Liu, M; Ryan, A M; Cox, L M; Blaser, M J; Trasande, L

    2013-07-01

    o assess associations of caesarean section with body mass from birth through adolescence. ongitudinal birth cohort study, following subjects up to 15 years of age. Children born in 1991-1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=10 219). standardized measures of body mass (weight-for length z-scores at 6 weeks, 10 and 20 months; and body mass index (BMI) z-scores at 38 months, 7, 9, 11 and 15 years). Secondary outcome: categorical overweight or obese (BMI: 85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years. Of the 10 219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (-46.1 g, 95% confidence interval(CI): 14.6-77.6 g; P=0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at 6 weeks (+0.11 s.d. units, 95% CI: 0.03-0.18; P=0.005), through age 15 (BMI z-score increment+0.10 s.d. units, 95% CI: 0.001-0.198; P=0.042). By age 11 caesarean-delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24-2.70; P=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal-weight mothers was weak. Cesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

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

    Directory of Open Access Journals (Sweden)

    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

  18. Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis.

    Science.gov (United States)

    Childs, C; Siraj, M R; Fair, F J; Selvan, A N; Soltani, H; Wilmott, J; Farrell, T

    2016-09-01

    To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel

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

    Directory of Open Access Journals (Sweden)

    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

  20. VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.

    Science.gov (United States)

    Seffah, J D; Adu-Bonsaffoh, K

    2014-01-01

    The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa where there are obvious systemic and management-related challenges associated with trial of scar. However, there is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated. The primary objective of the study was to determine the current trends and performance of VBAC in Ghana after decades of practice of trial of labour after caesarean section (TOLAC) in the mist of inherent challenges in deciding the optimal mode of childbirth for women with a previous caesarean birth. The secondary objective was to relate evidence based practice of TOLAC to obstetric practice in low resource settings like Ghana and provide recommendations for improving maternal and newborn health among women with prior caesarean birth. This was a retrospective study of the records of patients who had had a prior caesarean delivery and who then proceeded to deliver the next babies at the Korle Bu Teaching Hospital (KBTH) between Jan 2010 and Dec 2014. The data on demography, antenatal care, labour and delivery and outcomes were collected from the Labour and Recovery wards and the Biostatistics unit of the Maternity unit of the Hospital. Excluded were women with a previous CS who had multiple pregnancies and those with incomplete notes as well as those whose delivery plans were not predetermined antenatally.. The data were analyzed using SPSS version 20. There were 53,581 deliveries during the study period. Vaginal delivery was obtained in 31,870 (59.5%) pregnancies and 21,711(40.5%) had CS. Also, 6261 (11.7%) had had a prior CS and 2472 (39.5%) of these were selected for TOLAC while 2119 (33.8) were scheduled for planned repeat CS. There was

  1. Togetherness in the Americas.

    Science.gov (United States)

    Black, Jan Knippers

    1984-01-01

    There is a growing unacknowledged reality to the oneness of America. Latin America is increasingly sharing not only the blessings of U.S.-style modernization, but its demons as well. Also, many problems that have long plagued Latin America, e.g., indebtedness and militarism, are becoming more apparent in the United States. (RM)

  2. High dimensional classifiers in the imbalanced case

    DEFF Research Database (Denmark)

    Bak, Britta Anker; Jensen, Jens Ledet

    We consider the binary classification problem in the imbalanced case where the number of samples from the two groups differ. The classification problem is considered in the high dimensional case where the number of variables is much larger than the number of samples, and where the imbalance leads...... to a bias in the classification. A theoretical analysis of the independence classifier reveals the origin of the bias and based on this we suggest two new classifiers that can handle any imbalance ratio. The analytical results are supplemented by a simulation study, where the suggested classifiers in some...

  3. A CLASSIFIER SYSTEM USING SMOOTH GRAPH COLORING

    Directory of Open Access Journals (Sweden)

    JORGE FLORES CRUZ

    2017-01-01

    Full Text Available Unsupervised classifiers allow clustering methods with less or no human intervention. Therefore it is desirable to group the set of items with less data processing. This paper proposes an unsupervised classifier system using the model of soft graph coloring. This method was tested with some classic instances in the literature and the results obtained were compared with classifications made with human intervention, yielding as good or better results than supervised classifiers, sometimes providing alternative classifications that considers additional information that humans did not considered.

  4. 76 FR 19707 - Classified Information: Classification/Declassification/Access; Authority To Classify Information

    Science.gov (United States)

    2011-04-08

    ... Office of the Secretary of Transportation 49 CFR Part 8 RIN 9991-AA58 Classified Information: Classification/Declassification/Access; Authority To Classify Information AGENCY: Office of the Secretary of... originally classify information as SECRET or CONFIDENTIAL to the Administrator of the Federal Aviation...

  5. Is there an increased frequency of food allergy in children delivered by caesarean section compared to those delivered vaginally?

    Science.gov (United States)

    Kvenshagen, Bente; Halvorsen, Ragnhild; Jacobsen, Morten

    2009-02-01

    Allergic diseases are increasing. At the same time an increasing number of children are delivered by caesarean section. These children do not get the same contact with their mother's gut flora as babies delivered vaginally. Theoretically, lack of exposure to maternal vaginal and perineal bacteria might change the gut flora, with secondary changes in the immune system. The aim of this study was to investigate whether children delivered by caesarean section were more prone to develop food allergy. Six hundred and nine children were included at birth. At 2-year follow-up, 512 children participated, 171 delivered by caesarean section, 341 born vaginally. The children reported to have symptoms consistent with possible food allergy, were examined at the outpatient clinic. The diagnosis was based on the history, skin prick test (SPT), specific IgE, elimination/challenge test and double blind placebo controlled challenge. Thirty-five (6.8%) children were diagnosed with adverse reactions to food, 27 with non-IgE-mediated and eight with IgE-mediated allergy. There was no over representation of children born by caesarean section. In this study there seems to be no increased risk for food allergy in the first 2 years of life in children delivered by caesarean section.

  6. Artificial neural networks for classifying olfactory signals.

    Science.gov (United States)

    Linder, R; Pöppl, S J

    2000-01-01

    For practical applications, artificial neural networks have to meet several requirements: Mainly they should learn quick, classify accurate and behave robust. Programs should be user-friendly and should not need the presence of an expert for fine tuning diverse learning parameters. The present paper demonstrates an approach using an oversized network topology, adaptive propagation (APROP), a modified error function, and averaging outputs of four networks described for the first time. As an example, signals from different semiconductor gas sensors of an electronic nose were classified. The electronic nose smelt different types of edible oil with extremely different a-priori-probabilities. The fully-specified neural network classifier fulfilled the above mentioned demands. The new approach will be helpful not only for classifying olfactory signals automatically but also in many other fields in medicine, e.g. in data mining from medical databases.

  7. Classifiers based on optimal decision rules

    KAUST Repository

    Amin, Talha

    2013-11-25

    Based on dynamic programming approach we design algorithms for sequential optimization of exact and approximate decision rules relative to the length and coverage [3, 4]. In this paper, we use optimal rules to construct classifiers, and study two questions: (i) which rules are better from the point of view of classification-exact or approximate; and (ii) which order of optimization gives better results of classifier work: length, length+coverage, coverage, or coverage+length. Experimental results show that, on average, classifiers based on exact rules are better than classifiers based on approximate rules, and sequential optimization (length+coverage or coverage+length) is better than the ordinary optimization (length or coverage).

  8. Neural Network Classifiers for Local Wind Prediction.

    Science.gov (United States)

    Kretzschmar, Ralf; Eckert, Pierre; Cattani, Daniel; Eggimann, Fritz

    2004-05-01

    This paper evaluates the quality of neural network classifiers for wind speed and wind gust prediction with prediction lead times between +1 and +24 h. The predictions were realized based on local time series and model data. The selection of appropriate input features was initiated by time series analysis and completed by empirical comparison of neural network classifiers trained on several choices of input features. The selected input features involved day time, yearday, features from a single wind observation device at the site of interest, and features derived from model data. The quality of the resulting classifiers was benchmarked against persistence for two different sites in Switzerland. The neural network classifiers exhibited superior quality when compared with persistence judged on a specific performance measure, hit and false-alarm rates.

  9. Robust C-Loss Kernel Classifiers.

    Science.gov (United States)

    Xu, Guibiao; Hu, Bao-Gang; Principe, Jose C

    2018-03-01

    The correntropy-induced loss (C-loss) function has the nice property of being robust to outliers. In this paper, we study the C-loss kernel classifier with the Tikhonov regularization term, which is used to avoid overfitting. After using the half-quadratic optimization algorithm, which converges much faster than the gradient optimization algorithm, we find out that the resulting C-loss kernel classifier is equivalent to an iterative weighted least square support vector machine (LS-SVM). This relationship helps explain the robustness of iterative weighted LS-SVM from the correntropy and density estimation perspectives. On the large-scale data sets which have low-rank Gram matrices, we suggest to use incomplete Cholesky decomposition to speed up the training process. Moreover, we use the representer theorem to improve the sparseness of the resulting C-loss kernel classifier. Experimental results confirm that our methods are more robust to outliers than the existing common classifiers.

  10. Using Discriminative Dimensionality Reduction to Visualize Classifiers

    OpenAIRE

    Schulz, Alexander; Gisbrecht, Andrej; Hammer, Barbara

    2015-01-01

    Albeit automated classifiers offer a standard tool in many application areas, there exists hardly a generic possibility to directly inspect their behavior, which goes beyond the mere classification of (sets of) data points. In this contribution, we propose a general framework how to visualize a given classifier and its behavior as concerns a given data set in two dimensions. More specifically, we use modern nonlinear dimensionality reduction (DR) techniques to project a given set of data poin...

  11. Elia Kazan's America America: A Message for America.

    Science.gov (United States)

    Molofsky, Merle

    2018-03-26

    Elia Kazan's 1963 film, America America is a tribute to the immigrant experience of his own forebears, and has relevance to the refugee crisis of today. In stark black and white cinematography, the film provides insight into the refugee-immigrant experience, personified in Stavros, a young man longing for freedom, obsessed with an idealized America. His hope and innocence cannot safeguard him. His memories of his happy childhood and loving family create idealizing transferences to a world of others who manipulate and betray him as he undertakes his quest. Eventually he too learns to manipulate and betray, unconsciously identifying with the aggressor. History will offer ethical challenges, the black and white cinematography mirroring the black and white perception of good and bad, the shades of grey evoking a maturation of understanding.

  12. Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section) : a qualitative study from countries with high VBAC rates

    NARCIS (Netherlands)

    Christina Nilsson; Evelien van Limbeek; Ingela Lundgren; Katri Vehvilainen-Julkunen

    2015-01-01

    Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the

  13. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; Mortensen, Laust H.; Hvidman, Lone

    2017-01-01

    Objective: To estimate the relation of single-layer closure at previous caesarean delivery, and other pre-labour and intra-partum risk factors for complete uterine rupture in trial of vaginal birth after a caesarean (TOLAC) at term. Study design: Population-based case-control study. We identified...

  14. Variability in caesarean section rates for very preterm births at 28-31 weeks of gestation in 10 European regions: results of the MOSAIC project

    DEFF Research Database (Denmark)

    Zeitlin, Jennifer; Di Lallo, Dominico; Blondel, Béatrice

    2010-01-01

    Given the continuing debate about the benefits of caesarean section for very preterm infants, we sought to describe caesarean section rates for infants between 28 and 31 weeks of gestation in European regions and their association with regional mortality and short-term morbidity....

  15. The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section

    Directory of Open Access Journals (Sweden)

    A Subedi

    2011-03-01

    Full Text Available Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section. Methods: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5 % according to the height and weight of patients (Group AD from Harten’s dose chart developed from the Caucasian parturients and the fi xed dose (2.2 ml was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. Results: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01. The spinal block level extended above T3 level in a signifi cantly (p < 0.05 larger number of patients 12 (24 % in Group FD than in one (2 % patient in Group AD. A signifi cantly (p < 0.05 larger number of patients, 32, (64 % in Group FD had hypotension than in 15 (30 % patients in Group AD. The lowest recorded SAP (101 ± 6 mm Hg in Group AD was higher than in Group FD (96 ± 6.7 mm Hg. Nausea and vomiting were more pronounced in Group FD patients. Conclusions: The bupivacaine dose was signifi cantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fi xed compared with the dose use. keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.

  16. Impending macrosomia: will induction of labour modify the risk of caesarean delivery?

    Science.gov (United States)

    Cheng, YW; Sparks, TN; Laros, RK; Nicholson, JM; Caughey, AB

    2012-01-01

    Objective To compare the annual incidence rates of caesarean delivery between induction of labour and expectant management in the setting of macrosomia. Design This is a retrospective cohort study. Setting Deliveries in the USA in 2003. Population Singleton births of macrosomic neonates to low-risk nulliparous women at 39 weeks of gestation and beyond. Methods Women who had induction of labour at 39 weeks of gestation with a neonatal birthweight of 4000 ± 125 g (3875–4125 g) were compared with women who delivered (either induced or spontaneous labour) at 40, 41 or 42 weeks (i.e. expectant management), assuming an intrauterine fetal weight gain of 200 g per additional week of gestation. Similar comparisons were made at 40 and 41 weeks of gestation. Chi-square test and multivariable logistic regression analysis were used for statistical comparison. Main outcome measures Method of delivery, 5-minute Apgar scores, neonatal injury. Results There were 132 112 women meeting the study criteria. In women whose labours were induced at 39 weeks and who delivered a neonate with a birthweight of 4000 ± 125 g, the frequency of caesarean was lower compared with women who delivered at a later gestational age (35.2% versus 40.9%; adjusted OR 1.25, 95% CI 1.17–1.33). This trend was maintained at both 40 weeks (36.1% versus 42.6%; adjusted OR 1.31, 95% CI 1.23–1.40) and 41 weeks (38.9% versus 41.8%; adjusted OR 1.16, 95% CI 1.06–1.28) of gestation. Conclusions In the setting of known birthweight, it appears that induction of labour may reduce the risk of caesarean delivery. Future research should concentrate on clinical and radiological methods to better estimate birthweight to facilitate improved clinical care. These findings deserve examination in a large, prospective, randomised trial. PMID:22251443

  17. ROLE OF 400 MCG INTRAOPERATIVE SUBLINGUAL MISOPROSTOL FOR REDUCTION OF CAESAREAN BLOOD LOSS

    Directory of Open Access Journals (Sweden)

    Lalmohan Nayak

    2017-02-01

    Full Text Available BACKGROUND Lower segment caesarean section is a common surgical procedure. Postpartum haemorrhage incidence after LSCS is 4%. Misoprostol is a prostaglandin E1 analogue with good uterotonic properties, easy availability, low cost, thermostability, long shelf life, easy administration and few adverse effects at therapeutic dose. It is readily absorbed by oral, sublingual, buccal, vaginal or rectal route. Sublingual route attains quickest concentration. Dose of 400 mcg was chosen in this study to minimise adverse effects with optimal therapeutic benefit. The aim of the study is to determine the efficacy of sublingual misoprostol in reducing caesarean blood loss. MATERIALS AND METHODS It is a prospective experimental study done in VSSIMSAR, Burla. Women undergoing LSCS were randomly assigned to study and control groups of equal strength of 100 each. In all cases, preoperative Hb%, haematocrit, pulse, BP was noted. Study group were given 400 mcg misoprostol at the time of cord clamping. In control group, nothing was given. In all patients, active management of third stage of labour was done by using oxytocin 10 IU (IV along with uterine massage. Blood loss soaked by tetra was calculated using formula, blood loss = wet weight-dry weight/1.05 (1.05 is constant. Amount of blood loss, postoperative Hb%, haematocrit, pulse rate, BP was noted in both groups and compared. BP and pulse were noted after 1 hour and Hb%, haematocrit were noted after 24 hours. RESULTS Study group showed significant decrease in total blood loss (around 117.9 mL as compared to control group. There was significant decrease in the postoperative fall in Hb in the study group as compared to control, the mean difference being 0.631 gm%. Study group also showed decrease in postoperative fall in haematocrit as compared to control, the mean difference being 0.055. CONCLUSION Misoprostol significantly reduced caesarean blood loss and doesn’t affect foetal outcome without significant

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Effect of flunitrazepam (Rohypnol) on awareness during anaesthesia for caesarean section.

    Science.gov (United States)

    Soyannwo, O A; Elegbe, E O; Odugbesan, C O

    1988-03-01

    The incidence of awareness was compared in three groups of patients undergoing elective or emergency Caesarean section, using pethidine alone or pethidine plus flunitrazepam (Rohypnol), as adjuvants to nitrous oxide: oxygen, muscle relaxant technique of general anaesthesia. The use of 0.03 mg/kg body weight of flunitrazepam was associated with a low incidence (4%) of awareness, cardiovascular stability, postoperative sedation and anterograde amnesia. The reduced incidence of awareness is probably due to increased depth of anaesthesia and anterograde amnesic effect produced by the drug.

  20. Spinal anaesthesia for a caesarean section in a patient with paraneoplastic cerebellar ataxia

    Directory of Open Access Journals (Sweden)

    Ayca Tas Tuna

    2017-01-01

    Full Text Available Paraneoplastic cerebellar ataxia (PCA is most frequently observed in gynaecological cancers, small cell lung cancer, breast cancer, Hodgkin's lymphoma, cancer testis or malignant thymoma. In the literature, there is no data related to the effects of PCA during pregnancy or reports on the effects of anaesthesia in patients with PCA. We present management of a pregnant woman with PCA who was suddenly unable to walk with PCA and for whom effective spinal anaesthesia was performed for an elective caesarean section with no complications.

  1. Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.

    Science.gov (United States)

    Koplin, Jennifer; Allen, Katie; Gurrin, Lyle; Osborne, Nicholas; Tang, Mimi L K; Dharmage, Shyamali

    2008-12-01

    Several studies have shown differences in the composition of the gastrointestinal flora of children who develop sensitization to food allergens compared with non-allergic children. It has been hypothesized that changes in the gut microbiota resulting from caesarean section delivery could increase a child's risk of developing food allergy; however, studies examining the relationship between mode of delivery and food allergy have produced conflicting results. The objective of this review was to determine whether there is sufficient evidence to support an association between delivery by caesarean section and the development of sensitization to food allergens and immunoglobulin E (IgE) mediated food allergy. Using predefined inclusion and exclusion criteria, MEDLINE and PubMed were searched for studies investigating the relationship between caesarean section delivery and food allergy. The information on the quality of the studies and results were extracted and analysed systematically. The search identified four relevant studies as per our protocol. Symptomatic food allergy was used as the outcome in two studies and was found to occur more frequently in children born by caesarean section in one study while the second study found no association between food allergy diagnoses and mode of delivery. The other two studies measured levels of food antigen-specific IgE, with both studies showing an increase in sensitization to food allergens among children born by caesarean section. Overall, there is evidence that the risk of developing IgE-mediated sensitization to food allergens is increased among children delivered by caesarean section, however further studies using objectively diagnosed food allergy as the outcome are needed to verify whether this equates to an increase in confirmed food allergy. Future birth cohort studies should control for the effects of mode of delivery when investigating environmental modifiers of food allergy.

  2. Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

    Science.gov (United States)

    Hsia, Renee Y; Akosa Antwi, Yaa; Weber, Ellerie

    2014-01-01

    Objective To examine the between-hospital variation of charges and discounted prices for uncomplicated vaginal and caesarean section deliveries, and to determine the institutional and market-level characteristics that influence adjusted charges. Design, setting and participants Using data from the California Office of Statewide Health Planning and Development (OSHPD), we conducted a cross-sectional study of all privately insured patients admitted to California hospitals in 2011 for uncomplicated vaginal delivery (diagnosis-related group (DRG) 775) or uncomplicated caesarean section (DRG 766). Outcome measures Hospital charges and discounted prices adjusted for each patient's clinical and demographic characteristics. Results We analysed 76 766 vaginal deliveries and 32 660 caesarean sections in California in 2011. After adjusting for patient demographic and clinical characteristics, we found that the average California woman could be charged as little as US$3296 or as much as US$37 227 for a vaginal delivery, and US$8312–US$70 908 for a caesarean section depending on which hospital she was admitted to. The discounted prices were, on an average, 37% of the charges. We found that hospitals in markets with middling competition had significantly lower adjusted charges for vaginal deliveries, while hospitals with higher wage indices and casemixes, as well as for-profit hospitals, had higher adjusted charges. Hospitals in markets with higher uninsurance rates charged significantly less for caesarean sections, while for-profit hospitals and hospitals with higher wage indices charged more. However, the institutional and market-level factors included in our models explained only 35–36% of the between-hospital variation in charges. Conclusions These results indicate that charges and discounted prices for two common, relatively homogeneous diagnosis groups—uncomplicated vaginal delivery and caesarean section—vary widely between hospitals and are not well

  3. Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study.

    Science.gov (United States)

    Juárez, Sol P; Small, Rhonda; Hjern, Anders; Schytt, Erica

    2017-11-01

    To investigate the association between maternal country of birth and father's origin and unplanned and planned caesarean birth in Sweden. Population-based register study including all singleton births in Sweden between 1999 and 2012 (n = 1 311 885). Multinomial regression was conducted to estimate odds ratios (OR) for unplanned and planned caesarean with 95% confidence intervals for migrant compared with Swedish-born women. Analyses were stratified by parity. Women from Ethiopia, India, South Korea, Chile, Thailand, Iran, and Finland had statistically significantly higher odds of experiencing unplanned (primiparous OR 1.10-2.19; multiparous OR 1.13-2.02) and planned caesarean (primiparous OR 1.18-2.25; multiparous OR 1.13-2.46). Only women from Syria, the former Yugoslavia and Germany had consistently lower risk than Swedish-born mothers (unplanned: primiparous OR 0.76-0.86; multiparous OR 0.74-0.86. Planned; primiparous OR 0.75-0.82; multiparous OR 0.60-0.94). Women from Iraq and Turkey had higher odds of an unplanned caesarean but lower odds of a planned one (among multiparous). In most cases, these results remained after adjustment for available social characteristics, maternal health factors, and pregnancy complications. Both parents being foreign-born increased the odds of unplanned and planned caesarean in primiparous and multiparous women. Unplanned and planned caesarean birth varied by women's country of birth, with both higher and lower rates compared with Swedish-born women, and the father's origin was also of importance. These variations were not explained by a wide range of social, health, or pregnancy factors. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    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 energy through light touch and positive healing intention. Although 1.2 million Americans use reiki to reduce pain or depression, there is a lack of strong evidence supporting its effectiveness. A recent systematic review showed existing studies to be of poor methodological quality, with the common limitation of lack of blinding. To overcome this issue, the authors used distant reiki to assess its effectiveness in reducing pain following an elective C-section. Methods In this randomised, double-blinded study, women who underwent an elective C-section were allocated to either usual care (control, n=40) or three distant reiki sessions in addition to usual care (n=40). Pain was assessed using a visual analogue scale (VAS). The primary endpoint was the Area Under the VAS-Time Curve (AUC) for days 1–3. Secondary measures included: the proportion of women who required opioid medications and dose consumed, rate of healing and vital signs. Results AUC for pain was not significantly different in the distant reiki and control groups (mean±SD; 212.1±104.7 vs 223.1±117.8; p=0.96). There were no significant differences in opioid consumption or rate of healing; however, the distant reiki group had a significantly lower heart rate (74.3±8.1 bpm vs 79.8±7.9 bpm, p=0.003) and blood pressure (106.4±9.7 mm Hg vs 111.9±11.0 mm Hg, p=0.02) post surgery. Conclusion Distant reiki had no significant effect on pain following an elective C-section. Clinical Trial Registration

  5. Pilot plant trial of the reflux classifier

    Energy Technology Data Exchange (ETDEWEB)

    Galvin, K.P.; Doroodchi, E.; Callen, A.M.; Lambert, N.; Pratten, S.J. [University of Newcastle, Callaghan, NSW (Australia). Dept. of Chemical Engineers

    2002-01-01

    The Ludowici LMPE Reflux Classifier is a new device designed for classifying and separating particles on the basis of size or density. This work presents a series of experimental results obtained from the first pilot scale study of the reflux classifier (RC). The main focus of the investigation was to assess the particle gravity separation and throughput performance of the device. In this study, the classifier was used to separate coal and mineral matter less than 2 mm in size. The experimental results were then compared with the performance data on a teetered bed separator (TBS). It was concluded that the classifier could offer an excellent gravity separation at a remarkably high solids throughput of 47 t/m{sup 2}h more than 3 times higher than for a TBS. The separation performance of the RC was also better, with significantly less variation in the D-50 with particle size. A simple theoretical model providing an explanation of the separation performance is also presented.

  6. Improving the care pathway for women who request Caesarean section: an experience-based co-design study.

    Science.gov (United States)

    Kenyon, Sara L; Johns, Nina; Duggal, Sandhya; Hewston, Ruth; Gale, Nicola

    2016-11-09

    Maternal request for Caesarean section is controversial and yet the NICE Caesarean section Guideline recommends that that if this is requested, following discussion of the risks and benefits, women should be supported in their choice. There was a desire to improve the pathway at Birmingham Women's NHS Foundation Trust. Experience-based co-design methodology uses service user and clinicians experiences collected using qualitative methods to jointly re-design services. Firstly semi-structured interviews were conducted to elicit the views and experiences of health care professionals and women who requested Caesarean section (with and without medical indication). Analysis identified key themes arising from the health care professionals' interviews and 'touch points' (key moments or events related to the experience of care) arising from the interviews with women.. Separate workshops were then held with each group to ensure these resonated and to identify key areas for service improvement. At the first joint workshop a pathway using 'audio clips' demonstrating women's agreed 'touch points' prompted discussion and joint working began to change the pathway. A final second workshop was held to agree changes to the pathway. Interviews were conducted with health care professionals (n = 22, 10 consultant obstetricians and 12 midwives) and women (n = 15). The women's 'touch points' included repetition of request, delay in the decision for Caesarean section to be made, feeling judged, and that information was poor with similar findings identified from the health care professionals. Joint working resulted in a revised pathway for women who request Caesarean section. Changes to the pathway for women as a result of the work include written information about 'The way your baby may be born' which is given to the woman followed by a discussion about mode of birth around the 16 week appointment. If the woman wishes to have a Caesarean section, referral is made to appropriate

  7. Ranked Multi-Label Rules Associative Classifier

    Science.gov (United States)

    Thabtah, Fadi

    Associative classification is a promising approach in data mining, which integrates association rule discovery and classification. In this paper, we present a novel associative classification technique called Ranked Multilabel Rule (RMR) that derives rules with multiple class labels. Rules derived by current associative classification algorithms overlap in their training data records, resulting in many redundant and useless rules. However, RMR removes the overlapping between rules using a pruning heuristic and ensures that rules in the final classifier do not share training records, resulting in more accurate classifiers. Experimental results obtained on twenty data sets show that the classifiers produced by RMR are highly competitive if compared with those generated by decision trees and other popular associative techniques such as CBA, with respect to prediction accuracy.

  8. Reinforcement Learning Based Artificial Immune Classifier

    Directory of Open Access Journals (Sweden)

    Mehmet Karakose

    2013-01-01

    Full Text Available One of the widely used methods for classification that is a decision-making process is artificial immune systems. Artificial immune systems based on natural immunity system can be successfully applied for classification, optimization, recognition, and learning in real-world problems. In this study, a reinforcement learning based artificial immune classifier is proposed as a new approach. This approach uses reinforcement learning to find better antibody with immune operators. The proposed new approach has many contributions according to other methods in the literature such as effectiveness, less memory cell, high accuracy, speed, and data adaptability. The performance of the proposed approach is demonstrated by simulation and experimental results using real data in Matlab and FPGA. Some benchmark data and remote image data are used for experimental results. The comparative results with supervised/unsupervised based artificial immune system, negative selection classifier, and resource limited artificial immune classifier are given to demonstrate the effectiveness of the proposed new method.

  9. Reinforcement Learning Based Artificial Immune Classifier

    Science.gov (United States)

    Karakose, Mehmet

    2013-01-01

    One of the widely used methods for classification that is a decision-making process is artificial immune systems. Artificial immune systems based on natural immunity system can be successfully applied for classification, optimization, recognition, and learning in real-world problems. In this study, a reinforcement learning based artificial immune classifier is proposed as a new approach. This approach uses reinforcement learning to find better antibody with immune operators. The proposed new approach has many contributions according to other methods in the literature such as effectiveness, less memory cell, high accuracy, speed, and data adaptability. The performance of the proposed approach is demonstrated by simulation and experimental results using real data in Matlab and FPGA. Some benchmark data and remote image data are used for experimental results. The comparative results with supervised/unsupervised based artificial immune system, negative selection classifier, and resource limited artificial immune classifier are given to demonstrate the effectiveness of the proposed new method. PMID:23935424

  10. CLASSIFIED BY SUBJECT IN SPORT SCIENCES

    Directory of Open Access Journals (Sweden)

    Petar Protić

    2007-05-01

    Full Text Available High school and academic libraries users need precise classifi cation and subject access review of printed and electronic resources. In library catalogue since, Universal Decimal Classifi cation (UDC -similar to Dewey system - ex classifi es research and scientifi c areas. in subject areas of 796 Sport and 371 Teaching. Nowadays, users need structure of subjects by disciplines in science. Full-open resources of library must be set for users in subject access catalogue, because on the example of bachelors degree thesis in Faculty of Physical Education in Novi Sad they reaches for disciplines in database with 36 indexes sort by fi rst letters in names (Athletics, Boxing, Cycling, etc. This database have single and multiplied index for each thesis. Users in 80% cases of research according to the subject access catalogue of this library.

  11. Classifying Cervical Spondylosis Based on Fuzzy Calculation

    Directory of Open Access Journals (Sweden)

    Xinghu Yu

    2014-01-01

    Full Text Available Conventional evaluation of X-ray radiographs aiming at diagnosing cervical spondylosis (CS often depends on the clinic experiences, visual reading of radiography, and analysis of certain regions of interest (ROIs about clinician himself or herself. These steps are not only time consuming and subjective, but also prone to error for inexperienced clinicians due to low resolution of X-ray. This paper proposed an approach based on fuzzy calculation to classify CS. From the X-ray of CS manifestations, we extracted 10 effective ROIs to establish X-ray symptom-disease table of CS. Fuzzy calculation model based on the table can be carried out to classify CS and improve the diagnosis accuracy. The proposed model yields approximately 80.33% accuracy in classifying CS.

  12. Classifier Fusion With Contextual Reliability Evaluation.

    Science.gov (United States)

    Liu, Zhunga; Pan, Quan; Dezert, Jean; Han, Jun-Wei; He, You

    2018-05-01

    Classifier fusion is an efficient strategy to improve the classification performance for the complex pattern recognition problem. In practice, the multiple classifiers to combine can have different reliabilities and the proper reliability evaluation plays an important role in the fusion process for getting the best classification performance. We propose a new method for classifier fusion with contextual reliability evaluation (CF-CRE) based on inner reliability and relative reliability concepts. The inner reliability, represented by a matrix, characterizes the probability of the object belonging to one class when it is classified to another class. The elements of this matrix are estimated from the -nearest neighbors of the object. A cautious discounting rule is developed under belief functions framework to revise the classification result according to the inner reliability. The relative reliability is evaluated based on a new incompatibility measure which allows to reduce the level of conflict between the classifiers by applying the classical evidence discounting rule to each classifier before their combination. The inner reliability and relative reliability capture different aspects of the classification reliability. The discounted classification results are combined with Dempster-Shafer's rule for the final class decision making support. The performance of CF-CRE have been evaluated and compared with those of main classical fusion methods using real data sets. The experimental results show that CF-CRE can produce substantially higher accuracy than other fusion methods in general. Moreover, CF-CRE is robust to the changes of the number of nearest neighbors chosen for estimating the reliability matrix, which is appealing for the applications.

  13. Design of Robust Neural Network Classifiers

    DEFF Research Database (Denmark)

    Larsen, Jan; Andersen, Lars Nonboe; Hintz-Madsen, Mads

    1998-01-01

    This paper addresses a new framework for designing robust neural network classifiers. The network is optimized using the maximum a posteriori technique, i.e., the cost function is the sum of the log-likelihood and a regularization term (prior). In order to perform robust classification, we present...... a modified likelihood function which incorporates the potential risk of outliers in the data. This leads to the introduction of a new parameter, the outlier probability. Designing the neural classifier involves optimization of network weights as well as outlier probability and regularization parameters. We...

  14. A Customizable Text Classifier for Text Mining

    Directory of Open Access Journals (Sweden)

    Yun-liang Zhang

    2007-12-01

    Full Text Available Text mining deals with complex and unstructured texts. Usually a particular collection of texts that is specified to one or more domains is necessary. We have developed a customizable text classifier for users to mine the collection automatically. It derives from the sentence category of the HNC theory and corresponding techniques. It can start with a few texts, and it can adjust automatically or be adjusted by user. The user can also control the number of domains chosen and decide the standard with which to choose the texts based on demand and abundance of materials. The performance of the classifier varies with the user's choice.

  15. A survey of decision tree classifier methodology

    Science.gov (United States)

    Safavian, S. R.; Landgrebe, David

    1991-01-01

    Decision tree classifiers (DTCs) are used successfully in many diverse areas such as radar signal classification, character recognition, remote sensing, medical diagnosis, expert systems, and speech recognition. Perhaps the most important feature of DTCs is their capability to break down a complex decision-making process into a collection of simpler decisions, thus providing a solution which is often easier to interpret. A survey of current methods is presented for DTC designs and the various existing issues. After considering potential advantages of DTCs over single-state classifiers, subjects of tree structure design, feature selection at each internal node, and decision and search strategies are discussed.

  16. The effect of caesarean section on self-esteem amongst primiparous women in South-Western Nigeria: a case-control study.

    Science.gov (United States)

    Loto, Olabisi M; Adewuya, Abiodun O; Ajenifuja, Olusegun K; Orji, Ernest O; Owolabi, Alexander T; Ogunniyi, Solomon O

    2009-09-01

    This study aims to assess the level of self-esteem of newly delivered mothers who had caesarean section (CS) and evaluate the sociodemographic and obstetrics correlates of low self-esteem in them. Newly delivered mothers who had CS (n = 109) and who had spontaneous vaginal delivery (SVD) (n = 97) completed questionnaires on sociodemographic and obstetrics variables within 1 week of delivery. They also completed the Rosenberg self-esteem scale. RESULTS. Women with CS had statistically significant lower scores on the self-esteem scale than women with SVD (p = 0.006). Thirty (27.5%) of the CS group were classified as having low self-esteem compared with 11 (11.3%) of the SVD group (p = 004). The correlates of low self-esteem in the CS group included polygamy (odd ratio (OR) 4.99, 95% confidence interval (95% CI) 1.62-15.33) and emergency CS (OR 4.66, 95% CI 1.55-16.75). CS in South-Western Nigerian women is associated with lowered self-esteem in the mothers.

  17. Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

    Directory of Open Access Journals (Sweden)

    Dewi Y Bisri

    2017-01-01

    Full Text Available Presentation of primary intracranial tumour during pregnancy is extremely rare. Symptoms of brain tumour include nausea, vomiting, headache and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. In very few cases, craniotomy tumour removal is performed earlier or even simultaneously with foetal delivery. A 40-year-old woman at 32 weeks of gestation in foetal distress presented to the emergency room with decreased level of consciousness Glasgow Coma Scale 6 (E2M2V2. Computed tomographic scan revealed a mass lesion over the left temporoparietal region with midline shift and intratumoural bleeding. In view of high risk of herniation and foetal distress, she underwent emergency caesarean section followed by craniotomy tumour removal. In parturient with brain tumour, combined surgery of tumour removal and caesarean section is decided based on clinical symptoms, type of tumour and foetal viability. Successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of mother and foetus.

  18. Service quality of delivered care from the perception of women with caesarean section and normal delivery.

    Science.gov (United States)

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

    2014-01-01

    Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. 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 perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

  19. [Repeated ectopic pregnancy in previous caesarean scar: a case report and literature review].

    Science.gov (United States)

    Morgan-Ortiz, Fred; Retes-Angulo, Benjamín; Retes-Lapizco, Benjamín; Morgan-Ruiz, Fred V

    2015-10-01

    Ectopic pregnancy in previous caesarean scar, which is detected in the first trimester, is a recognized and documented today alteration. Female of 38 years old with a history of five pregnancies (two cesarean sections and three ectopic pregnancies, two EPCSS and one tubal ectopic). In March 2013 she presented the first eight weeks EPCSS diagnosed by transvaginal ultrasound. Gestational sac at the level of the previous cesarean section (CS) over the inner hole and a living embryo were observed. The patient received medical treatment with methotrexate. In March 2014 she was diagnosed with a new tubal ectopic pregnancy which was managed with laparoscopic salpingectomy. In February 2015 (Second EPCSS) she was checked for seven weeks amenorrhea and symptoms of pregnancy. A vaginal ultrasound was performed, finding a gestational sac implanted in the lower uterine segment cesarean scar level and a living embryo. The patient undergoing laparoscopic hysterectomy. The recurrent pregnancy caesarean section scar is rare and needs to be properly diagnosed as soon as possible to avoid complications. Transvaginal ultrasound is a suitable tool for diagnosis. Management must be individualized according to patient characteristics.

  20. Patient-controlled versus nurse-controlled post-operative analgesia after caesarean section

    Directory of Open Access Journals (Sweden)

    Amin Ebneshahidi

    2012-01-01

    Full Text Available Background:The aim of this study was to compare the differences in the quality of analgesia by patient-controlled analgesia (PCA and nurse-controlled analgesia (NCA for post-caesarean section analgesia. Materials and Methods:350 women who undertake elective cesarean section were assigned to the three groups. Group I (n=200, IV-PCA morphine; group II (n=100, IV-PCA methadone; group III (n=50 NCA morphine. Data collected during the 24 h observation period included visual analog scale (VAS pain and patient satisfaction scores, the incidence of nausea and vomiting, severe sedation and pruritis. Results: VAS pain scores for each time at which it was evaluated were higher for NCA group than other groups. Also patient satisfaction was significantly increased in the IV-PCA Group as compared with group III. The prevalence of pruritis was higher for NCA group than other groups. Conclusion:In post caesarean section, PCA morphine or methadone improves 24-h VAS compared with NCA.

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

    Directory of Open Access Journals (Sweden)

    José Ricardo Navarro Vargas

    2009-07-01

    Full Text Available 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 more likely to be performed in this group of patients. Materials and methods. This is a case report of a morbid obese patient scheduled for caesarean delivery and tubal ligation. Regional, spinal and epidural techniques were attempted for surgery with unsuccessful results; this entails general anesthesia for surgery. The literature on complications due to obesity during pregnancy was reviewed, emphasising relevance for the anesthesiologist. Conclusion. Obesity, especially morbid obesity in pregnant women, represents a challenge for anesthesia management. Updated knowledge of physiology and the conditions related to obesity in pregnancy is necessary; medical services must be prepared to provide optimum and safe obstetric anesthesia, analgesia and post-operation care.

  2. Ergometrine given during caesarean section and incidence of delayed postpartum haemorrhage due to uterine atony.

    Science.gov (United States)

    Lourens, R; Paterson-Brown, S

    2007-11-01

    Delayed postpartum haemorrhage due to uterine atony after caesarean section was occurring in women in our recovery area despite many of them already having an oxytocin infusion running to prevent such a problem. We therefore decided to compare the incidence of such problems for a 2-month period before and after altering our uterotonic policy: in addition to the routine bolus dose of 5 units of oxytocin after delivery of the baby, we added 500 microg of intramuscular ergometrine during abdominal closure. We noticed a reduced number of massive postpartum haemorrhages due to an atonic uterus in the recovery room but an increased incidence of nausea and vomiting. No prophylactic anti-emetic was given during this pilot study. This small study suggests that 50 women would need to be given ergometrine at caesarean section to prevent one delayed massive haemorrhage from uterine atony and four extra women would suffer with vomiting. We feel this is reasonable and now use a prophylactic anti-emetic as well as delaying the ergometrine until closure of the rectus sheath which reduces the incidence of nausea and vomiting.

  3. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis.

    Science.gov (United States)

    Bharatam, Kaundinya Kiran; Sivaraja, P K; Abineshwar, N J; Thiagarajan, Vasundhara; Thiagarajan, D A; Bodduluri, Sudeep; Sriraman, K B; Vasantha Ragavan, A; Priya, Shanmuga

    2015-01-01

    Uterine scar dehiscence can complicate caesarean section with complications like post partum hemorrhage, endomyometritis, localized/generalized peritonitis, and sepsis. Our patient had abdominal wound infection after LSCS surgery and features of sepsis. The wound infection was actually the presentation of a uterine scar dehiscence and localized peritonitis. Incidence of uterine scar dehiscence is around 0.6%. Presentation can be post partum hemorrhage, endomyometritis, and generalized/localized peritonitis. Peritonitis caused by uterine incisional necrosis must be dealt surgically. A high index of suspicion with appropriate investigations can highlight such problems for early treatment and cure with least morbidity especially related to further pregnancies. Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Case series of multiple repeat caesarean sections: operative, maternal, and neonatal outcome.

    Science.gov (United States)

    Alnoman, Abdullah; El-Khatib, Ziad; Almrstani, Ahmad M S; Walker, Mark; El-Chaar, Darine

    2016-01-01

    The objective of this study is to review the maternal and neonatal morbidity and mortality associated with six or more caesarean section (CS). We conducted a retrospective chart review, at King Abdulaziz University Hospital (KAUH) in Jeddah, for all patients admitted between 2000 through 2010 and identified five patients having more than six CS deliveries. Deliveries occurred in the ranges of 31-38 weeks, from which four cases required emergency CS. There were two cases in the series with a placenta previa. There was a single case of uterine dehiscence. Only one case required a blood transfusion and was complicated with a placenta accreta, bladder injury, urinary tract infection, and prolonged maternal hospital stay with neonatal intensive care unit (NICU) admission. All cases had moderate to severe adhesion intra-operatively. Operative time was long in all cases with a range 55-106 min. One of the five cases had a postoperative wound infection. Finally, none of the current series showed fetal or maternal mortalities. The long-term complications associated with CS should be discussed with patients in the first and subsequent pregnancies. This case series highlighted the outcomes in these unique cases of higher order caesareans.

  5. Use of Electrocautery for Coagulation and Wound Complications in Caesarean Sections

    Directory of Open Access Journals (Sweden)

    Cristiane M. Moreira

    2014-01-01

    Full Text Available Objective. To evaluate the safety of electrocautery for coagulation during Caesarean sections. Study Design. A randomized, controlled, clinical pilot study was performed at a university maternity hospital. After admission for delivery and decision to perform a C-section, volunteers were randomized to either the intervention group (use of electrocautery for coagulation or nonintervention group. The women were examined at the time of postpartum discharge (day 3, at days 7 to 10, and again at days 30 to 40 for signs of infection, hematoma, seroma, or dehiscence. Data were analyzed using an intention-to-treat analysis, and risk ratios were calculated. Results. No significant differences were found between the two groups. Only 2.8% of patients in the intervention group developed surgical wound complications during hospitalization. However, 7 to 10 days following discharge, these rates reached 23.0% and 15.4% in the intervention and nonintervention groups, respectively (RR = 1.50, 95% CI = 0.84–2.60. Conclusion. Further studies should confirm whether the use of electrocautery for coagulation does not increase the risk of surgical wound complications in patients undergoing Caesarean sections.

  6. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section.

    Science.gov (United States)

    Nabhan, Ashraf F; Allam, Nahed E; Hamed Abdel-Aziz Salama, Mohamed

    2016-06-17

    Post-caesarean section infection is a cause of maternal morbidity and mortality. Administration of antibiotic prophylaxis is recommended for preventing infection after caesarean delivery. The route of administration of antibiotic prophylaxis should be effective, safe and convenient. Currently, there is a lack of synthesised evidence regarding the benefits and harms of different routes of antibiotic prophylaxis for preventing infection after caesarean section. The aim of this review was to assess the benefits and harms of different routes of prophylactic antibiotics given for preventing infectious morbidity in women undergoing caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 January 2016) and reference lists of retrieved studies. We included randomised controlled trials (RCTs) comparing at least two alternative routes of antibiotic prophylaxis for caesarean section (both elective and emergency). Cross-over trials and quasi-RCTs were not eligible for inclusion. Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data from the included studies. These steps were checked by a third review author. We included 10 studies (1354 women). The risk of bias was unclear or high in most of the included studies.All of the included trials involved women undergoing caesarean section whether elective or non-elective. Intravenous antibiotics versus antibiotic irrigation (nine studies, 1274 women) Nine studies (1274 women) compared the administration of intravenous antibiotics with antibiotic irrigation. There were no clear differences between groups in terms of this review's maternal primary outcomes: endometritis (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.29; eight studies (966 women) (low-quality evidence)); wound infection (RR 0.49, 95% CI 0.17 to 1.43; seven

  7. Use of electrocautery for coagulation and wound complications in Caesarean sections.

    Science.gov (United States)

    Moreira, Cristiane M; Amaral, Eliana

    2014-01-01

    To evaluate the safety of electrocautery for coagulation during Caesarean sections. A randomized, controlled, clinical pilot study was performed at a university maternity hospital. After admission for delivery and decision to perform a C-section, volunteers were randomized to either the intervention group (use of electrocautery for coagulation) or nonintervention group. The women were examined at the time of postpartum discharge (day 3), at days 7 to 10, and again at days 30 to 40 for signs of infection, hematoma, seroma, or dehiscence. Data were analyzed using an intention-to-treat analysis, and risk ratios were calculated. No significant differences were found between the two groups. Only 2.8% of patients in the intervention group developed surgical wound complications during hospitalization. However, 7 to 10 days following discharge, these rates reached 23.0% and 15.4% in the intervention and nonintervention groups, respectively (RR = 1.50, 95% CI = 0.84-2.60). Further studies should confirm whether the use of electrocautery for coagulation does not increase the risk of surgical wound complications in patients undergoing Caesarean sections.

  8. [Macrosomia, shoulder dystocia and elongation of the brachial plexus: what is the role of caesarean section?

    Science.gov (United States)

    Kehila, Mehdi; Derouich, Sadok; Touhami, Omar; Belghith, Sirine; Abouda, Hassine Saber; Cheour, Mariem; Chanoufi, Mohamed Badis

    2016-01-01

    The delivery of a macrosomic infant is associated with a higher risk for maternofoetal complications. Shoulder dystocia is the most feared fetal complication, leading sometimes to a disproportionate use of caesarean section. This study aims to evaluate the interest of preventive caesarean section. We conducted a retrospective study of 400 macrosomic births between February 2010 and December 2012. We also identified cases of infants with shoulder dystocia occurred in 2012 as well as their respective birthweight. Macrosomic infants weighed between 4000g and 4500g in 86.25% of cases and between 4500 and 5000 in 12.25% of cases. Vaginal delivery was performed in 68% of cases. Out of 400 macrosomic births, 9 cases with shoulder dystocia were recorded (2.25%). All of these cases occurred during vaginal delivery. The risk for shoulder dystocia invaginal delivery has increased significantly with the increase in birth weight (p Shoulder dystocia affectd macrosoic infants in 58% of cases. Shoulder dystocia is not a complication exclusively associated with macrosomia. Screening for risky deliveries and increasing training of obstetricians on maneuvers in shoulder dystocia seem to be the best way to avoid complications.

  9. Different classes of antibiotics given to women routinely for preventing infection at caesarean section.

    Science.gov (United States)

    Gyte, Gillian M I; Dou, Lixia; Vazquez, Juan C

    2014-11-17

    Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects. To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and reference lists of retrieved papers. We included randomised controlled trials comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane reviews. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We included 35 studies of which 31 provided data on 7697 women. For the main comparison between cephalosporins versus penicillins, there were 30 studies of which 27 provided data on 7299 women. There was a lack of good quality data and important outcomes often included only small numbers of women.For the comparison of a single cephalosporin versus a single penicillin (Comparison 1 subgroup 1), we found no significant difference between these classes of antibiotics for our chosen most important seven outcomes namely: maternal sepsis - there were no women with sepsis in the two studies involving 346 women; maternal endometritis (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.81 to 1.52, nine studies, 3130 women, random effects, moderate quality of the evidence); maternal wound infection (RR 0.83, 95% CI 0.38 to 1.81, nine studies, 1497 women, random effects, low quality of the evidence), maternal urinary tract infection (RR 1.48, 95% CI 0.89 to 2.48, seven studies, 1120

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

    Directory of Open Access Journals (Sweden)

    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

  11. Classifying bicrossed products of two Taft algebras

    OpenAIRE

    Agore, A. L.

    2016-01-01

    We classify all Hopf algebras which factorize through two Taft algebras $\\mathbb{T}_{n^{2}}(\\bar{q})$ and respectively $T_{m^{2}}(q)$. To start with, all possible matched pairs between the two Taft algebras are described: if $\\bar{q} \

  12. Multiple classifier fusion in probabilistic neural networks

    Czech Academy of Sciences Publication Activity Database

    Grim, Jiří; Kittler, J.; Pudil, Pavel; Somol, Petr

    2002-01-01

    Roč. 5, č. 7 (2002), s. 221-233 ISSN 1433-7541 R&D Projects: GA ČR GA402/01/0981 Institutional research plan: CEZ:AV0Z1075907 Keywords : EM algorithm * information preserving transform * multiple classifier fusion Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 0.667, year: 2002

  13. Neural Network Classifier Based on Growing Hyperspheres

    Czech Academy of Sciences Publication Activity Database

    Jiřina Jr., Marcel; Jiřina, Marcel

    2000-01-01

    Roč. 10, č. 3 (2000), s. 417-428 ISSN 1210-0552. [Neural Network World 2000. Prague, 09.07.2000-12.07.2000] Grant - others:MŠMT ČR(CZ) VS96047; MPO(CZ) RP-4210 Institutional research plan: AV0Z1030915 Keywords : neural network * classifier * hyperspheres * big -dimensional data Subject RIV: BA - General Mathematics

  14. Dynamic classifiers improve pulverizer performance and more

    Energy Technology Data Exchange (ETDEWEB)

    Sommerlad, R.E.; Dugdale, K.L. [Loesche Energy Systems (United States)

    2007-07-15

    Keeping coal-fired steam plants running efficiently and cleanly is a daily struggle. An article in the February 2007 issue of Power explained that one way to improve the combustion and emissions performance of a plant is to optimize the performance of its coal pulverizers. By adding a dynamic classifier to the pulverizers, you can better control coal particle sizing and fineness, and increase pulverizer capacity to boot. A dynamic classifier has an inner rotating cage and outer stationary vanes which, acting in concert, provide centrifugal or impinging classification. Replacing or upgrading a pulverizer's classifier from static to dynamic improves grinding performance reducing the level of unburned carbon in the coal in the process. The article describes the project at E.ON's Ratcliffe-on-Soar Power station in the UK to retrofit Loesche LSKS dynamic classifiers. It also mentions other successful projects at Scholven Power Station in Germany, Tilbury Power Station in the UK and J.B. Sims Power Plant in Michigan, USA. 8 figs.

  15. On the interpretation of number and classifiers

    NARCIS (Netherlands)

    Cheng, L.L.; Doetjes, J.S.; Sybesma, R.P.E.; Zamparelli, R.

    2012-01-01

    Mandarin and Cantonese, both of which are numeral classifier languages, present an interesting puzzle concerning a compositional account of number in the various forms of nominals. First, bare nouns are number neutral (or vague in number). Second, cl-noun combinations appear to have different

  16. Pragmatics of classifier use in Chinese discourse

    African Journals Online (AJOL)

    KATEVG

    The present study examines a particular syntactic phenomenon in Chinese discourse, namely complex noun phrases (CNPs), and investigates the occurrence and distribution of the various forms of such constructions. The study focuses on the presence and absence of classifier phrases that modify CNPs, and explores, ...

  17. Embedded feature ranking for ensemble MLP classifiers.

    Science.gov (United States)

    Windeatt, Terry; Duangsoithong, Rakkrit; Smith, Raymond

    2011-06-01

    A feature ranking scheme for multilayer perceptron (MLP) ensembles is proposed, along with a stopping criterion based upon the out-of-bootstrap estimate. To solve multi-class problems feature ranking is combined with modified error-correcting output coding. Experimental results on benchmark data demonstrate the versatility of the MLP base classifier in removing irrelevant features.

  18. Classifying web pages with visual features

    NARCIS (Netherlands)

    de Boer, V.; van Someren, M.; Lupascu, T.; Filipe, J.; Cordeiro, J.

    2010-01-01

    To automatically classify and process web pages, current systems use the textual content of those pages, including both the displayed content and the underlying (HTML) code. However, a very important feature of a web page is its visual appearance. In this paper, we show that using generic visual

  19. Feature selection based classifier combination approach for ...

    Indian Academy of Sciences (India)

    3.2c Dempster-Shafer rule based classifier combination: Dempster–Shafer (DS) method is based on the evidence theory, proposed by Glen Shafer as a way to represent cognitive knowledge. Here the probability is obtained using belief function instead of using the Bayesian distribution. Prob- ability values are assigned to a ...

  20. MScanner: a classifier for retrieving Medline citations.

    Science.gov (United States)

    Poulter, Graham L; Rubin, Daniel L; Altman, Russ B; Seoighe, Cathal

    2008-02-19

    Keyword searching through PubMed and other systems is the standard means of retrieving information from Medline. However, ad-hoc retrieval systems do not meet all of the needs of databases that curate information from literature, or of text miners developing a corpus on a topic that has many terms indicative of relevance. Several databases have developed supervised learning methods that operate on a filtered subset of Medline, to classify Medline records so that fewer articles have to be manually reviewed for relevance. A few studies have considered generalisation of Medline classification to operate on the entire Medline database in a non-domain-specific manner, but existing applications lack speed, available implementations, or a means to measure performance in new domains. MScanner is an implementation of a Bayesian classifier that provides a simple web interface for submitting a corpus of relevant training examples in the form of PubMed IDs and returning results ranked by decreasing probability of relevance. For maximum speed it uses the Medical Subject Headings (MeSH) and journal of publication as a concise document representation, and takes roughly 90 seconds to return results against the 16 million records in Medline. The web interface provides interactive exploration of the results, and cross validated performance evaluation on the relevant input against a random subset of Medline. We describe the classifier implementation, cross validate it on three domain-specific topics, and compare its performance to that of an expert PubMed query for a complex topic. In cross validation on the three sample topics against 100,000 random articles, the classifier achieved excellent separation of relevant and irrelevant article score distributions, ROC areas between 0.97 and 0.99, and averaged precision between 0.69 and 0.92. MScanner is an effective non-domain-specific classifier that operates on the entire Medline database, and is suited to retrieving topics for which

  1. World review: Latin America

    International Nuclear Information System (INIS)

    Anon.

    2000-01-01

    The article gives information on contracts announced (and to whom) throughout Latin America in all aspects of the petroleum, natural gas and petrochemicals industries. Countries specifically mentioned are Argentina, Brazil, Chile, Mexico, Trinidad and Venezuela. The future for the oil industry in Latin America is viewed as 'highly prospective'

  2. Classifying features in CT imagery: accuracy for some single- and multiple-species classifiers

    Science.gov (United States)

    Daniel L. Schmoldt; Jing He; A. Lynn Abbott

    1998-01-01

    Our current approach to automatically label features in CT images of hardwood logs classifies each pixel of an image individually. These feature classifiers use a back-propagation artificial neural network (ANN) and feature vectors that include a small, local neighborhood of pixels and the distance of the target pixel to the center of the log. Initially, this type of...

  3. 22 CFR 125.3 - Exports of classified technical data and classified defense articles.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Exports of classified technical data and classified defense articles. 125.3 Section 125.3 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC... in the Department of Defense National Industrial Security Program Operating Manual (unless such...

  4. Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section

    NARCIS (Netherlands)

    A. Herdan; R. Roth; D. Grass; M. Klimek (Markus); S. Will; B. Schauf; R. Rossaint; M. Heesen

    2011-01-01

    textabstractHypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of

  5. Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals.

    Science.gov (United States)

    Ismail, S; Siddiqui, S; Shafiq, F; Ishaq, M; Khan, S

    2014-08-01

    Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin. A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (Ptransfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. No direct effect of an elective caesarean section on the phenotypic and functional characteristics of maternal peripheral blood T lymphocytes

    NARCIS (Netherlands)

    van Egmond, A; van der Keur, C; van Beelen, E; Scherjon, S A; Claas, F H J

    2016-01-01

    Problem: The short term effect of the caesarean delivery on the phenotypic and functional characteristics of the peripheral blood leukocytes of the mother is unknown. Method of study: We determined the composition and activation status of the maternal peripheral blood leukocytes isolated within 4 h

  7. THE IMPACT OF LAVENDER AROMATHERAPY ON PAIN INTENSITY AND BETA-ENDORPHIN LEVELS IN POST-CAESAREAN MOTHERS

    Directory of Open Access Journals (Sweden)

    Yohana Putri Apryanti

    2017-10-01

    Full Text Available Background: Caesarean section is one of the most common interventions to overcome labor complications. However, pain cannot be avoided after the surgery. Lavender aromatherapy is considered as one of non-pharmacological therapy to reduce pain and increase beta-endorphin levels. Objective: To examine the effect of lavender aromatherapy on the intensity of pain and beta-endorphin levels in post-caesarean mothers. Methods: This was a quasy-experimental study with pretest and posttest with control group at Sembiring Delitua General Hospital on December 2016 to February 2017. There were 40 samples selected using purposive sampling, with 20 samples assigned in the experiment and control group. Numerical Rating Scale (NRS was used to measure pain and ELIZA methods to measure beta-endorphin levels. Independent t-test and paired t-test were used for data analysis Results: Results of this study showed that there was a significant difference in the mean value of pain intensity levels (p=0.000 and beta-endorphin levels (p=0.023 between experiment and control group. Conclusion: There was a significant effect of lavender aromatherapy on the decrease of pain intensity and the increase of beta-endorphin hormone in post-caesarean mothers. It is expected that lavender aromatherapy can be used as an alternative treatment to reduce pain and increase beta-endorphin levels in post-caesarean mothers.

  8. A viable caesarean scar pregnancy in a woman using a levonorgestrel-releasing intrauterine device : A case report

    NARCIS (Netherlands)

    E. Hitzerd (Emilie); H. Bogers (Hein); N.A. Kianmanesh Rad (Noush); J.J. Duvekot (Hans)

    2018-01-01

    markdownabstract__Background:__ Although the levonorgestrel-releasing intrauterine device (LNG-IUD) is one of the most reliable methods of contraception, it is associated with an increased risk of ectopic pregnancy in case of unintended pregnancy. A rare form of ectopic pregnancy is the caesarean

  9. Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Alma Soxhuku-Isufi

    2015-12-01

    CONCLUSIONS: Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension.

  10. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature.

    Science.gov (United States)

    Bodur, S; Özdamar, Ö; Kılıç, S; Gün, I

    2015-04-01

    To determine the efficacy and safety of primary medical treatment with systemic methotrexate (MTX) in caesarean scar ectopic pregnancy, we conducted a Medline/PubMed search on the relevant English literature from January 1978 to January 2012. The search yielded 27 publications of 40 cases of caesarean scar ectopic pregnancy. The literature search showed a very liberal use of systemic MTX treatment with unfavourable outcomes, although the major determinant of the clinical efficacy was found in here to be β-hCG level together with embryonic cardiac activity (ECA) status. A caesarean scar ectopic pregnancy presented with a serum β-hCG concentration of ≤ 12,000 mIU/ml (odds ratio, OR 5.68, 95% confidence interval, CI, 1.37-23.48) and absence of ECA (OR 4.80, 95% CI, 1.14-20.08) was found to be associated with higher efficacy rate of primary systemic MTX treatment. Administration of primary systemic MTX treatment was found to be ideal for a caesarean scar ectopic pregnancy presented before 8 weeks' gestation, with a β-hCG concentration of ≤ 12,000 mIU/ml together with an absent ECA (OR 14.52, 95% CI, 2.36-89.09).

  11. Effect of Ketofol on Pain and Complication after Caesarean Delivery under Spinal Anaesthesia: A Randomized Double-blind Clinical Trial.

    Science.gov (United States)

    Jaafarpour, Molouk; Vasigh, Aminolah; Khajavikhan, Javaher; Khani, Ali

    2017-03-01

    Pain is the key concern of women after caesarean delivery that may interfere with breastfeeding. The aim of this study was to assess effect of ketofol (ketamine/propofol combination) on pain and complication after caesarean delivery under spinal anaesthesia. In this randomized double-blind clinical trial, 92 parturient scheduled for elective caesarean delivery under spinal anaesthesia were included. The simple random sampling method was used to place subjects in four groups of ketamine (0.25 mg/kg), propofol (0.25 mg/kg), ketofol (25 mg ketamine plus 25 mg propofol) and placebo (saline). The drugs were administered intravenously immediately after clamping the umbilical cord. Visual Analog Scale (VAS) was used to determine the intensity of pain. Complications after surgery including shivering, nausea and vomiting as well as onset of breastfeeding were recorded. The mean score of pain, morphine consumption and time of breastfeeding in the ketofol group were significantly lower than other groups at various intervals (ppain and complication after caesarean delivery indicated that it can be considered as a safe and alternative drug in these patients.

  12. America in the Eyes of America Watchers:

    DEFF Research Database (Denmark)

    Feng, Huiyun; He, Kai

    2015-01-01

    Based on an original survey conducted in the summer of 2012 in Beijing, we examine how China's America watchers—IR scholars who work on US-China relations—have viewed China's power status in the international system, US-China relations and some specific US policies in Asia. Our survey shows that ...

  13. Using Evolving Fuzzy Classifiers to Classify Consumers with Different Model Architectures

    Science.gov (United States)

    Zhao, Rong; Chai, Chunlai; Zhou, Xiaowei

    This study introduces two alternative methods for evolving fuzzy classifiers (eClass and FLEXFIS-CLass) in order to classify consumers into different categories for directing marketing purposes. We describe in detail the learning mechanisms of these classifiers and different types of model architectures including single model architectures (SM) and multi-model architectures (MM). Note that single-model architectures have different consequents: singletons corresponding to class labels, linear consequents regressing over the features and eClass MIMO which is applicable in multi-class classification. Furthermore, we place emphasis on classification accuracy and effectiveness of these approaches and compare the proposed classifiers with well-established ones, such as CART and k-NN, and also popular SVM method. The result indicates that they compare favorably with others in term of precision. With these different model architectures, managers can use the introduced approaches to classify consumers to their categories and determine the most profitable decisions.

  14. Caesarean section rates in Southwestern Ontario: changes over time after adjusting for important medical and social characteristics.

    Science.gov (United States)

    Brown, Hilary K; Hill, Jacquelyn; Natale, Renato

    2014-07-01

    To compare Caesarean section rates in a cohort of women in Southwestern Ontario over time, overall, and in patient subgroups defined by the Robson criteria, after adjusting for important medical and social characteristics. We obtained data from a perinatal database on deliveries at ≥ 22 weeks' gestation at a level II centre and a level III centre in London, Ontario between 1999 and 2010. Caesarean section rates were examined overall and in subgroups defined by parity, presentation, plurality, gestational age, and history of previous Caesarean section. Multivariable modified Poisson regression was used to compare Caesarean section rates in 2003-2006 and 2007-2010 versus 1999-2002. In the fully adjusted models, the overall Caesarean section rate was significantly higher in 2007-2010 than in 1999-2002 for the level II centre (adjusted relative risk [aRR] 1.12; 95% CI 1.05 to 1.21). An increase was also seen in the level III centre in both 2003 to 2006 (aRR 1.19; 95% CI 1.14 to 1.24) and 2007 to 2010 (aRR 1.17; 95% CI 1.12 to 1.22). Similar increases were seen over time among patient subgroups. Notably, repeat Caesarean sections without labour increased at the level II centre (2003 to 2006 aRR 1.21; 95% CI 1.01 to 1.45, and 2007 to 2010 aRR 1.44; 95% CI 1.21 to 1.71) and the level III centre (2003 to 2006 aRR 1.72; 95% CI 1.53 to 1.94, and 2007 to 2010 aRR 1.77; 95% CI 1.57 to 2.00). There has been a significant increase over time in the Caesarean section rate overall and in important subgroups. This increase remains even after controlling for other factors which may explain the trend.

  15. Disassembly and Sanitization of Classified Matter

    International Nuclear Information System (INIS)

    Stockham, Dwight J.; Saad, Max P.

    2008-01-01

    The Disassembly Sanitization Operation (DSO) process was implemented to support weapon disassembly and disposition by using recycling and waste minimization measures. This process was initiated by treaty agreements and reconfigurations within both the DOD and DOE Complexes. The DOE is faced with disassembling and disposing of a huge inventory of retired weapons, components, training equipment, spare parts, weapon maintenance equipment, and associated material. In addition, regulations have caused a dramatic increase in the need for information required to support the handling and disposition of these parts and materials. In the past, huge inventories of classified weapon components were required to have long-term storage at Sandia and at many other locations throughout the DoE Complex. These materials are placed in onsite storage unit due to classification issues and they may also contain radiological and/or hazardous components. Since no disposal options exist for this material, the only choice was long-term storage. Long-term storage is costly and somewhat problematic, requiring a secured storage area, monitoring, auditing, and presenting the potential for loss or theft of the material. Overall recycling rates for materials sent through the DSO process have enabled 70 to 80% of these components to be recycled. These components are made of high quality materials and once this material has been sanitized, the demand for the component metals for recycling efforts is very high. The DSO process for NGPF, classified components established the credibility of this technique for addressing the long-term storage requirements of the classified weapons component inventory. The success of this application has generated interest from other Sandia organizations and other locations throughout the complex. Other organizations are requesting the help of the DSO team and the DSO is responding to these requests by expanding its scope to include Work-for- Other projects. For example

  16. America's Children and the Environment

    Science.gov (United States)

    ... Protection Agency Search Search America's Children and the Environment (ACE) Contact Us Share ACE presents key information ... of updates to ACE . America's Children and the Environment (ACE) America's Children and the Environment (ACE) is ...

  17. Using a pregnancy decision support program for women choosing birth after a previous caesarean in Japan: A mixed methods study.

    Science.gov (United States)

    Torigoe, Ikuyo; Shorten, Allison

    2018-02-01

    Opportunities for women and providers to use decision aids and share decisions about birth after caesarean in practice are currently limited in Japan. This is despite known benefits of decision aids to support value-sensitive healthcare decisions. To explore Japanese women's decision making experiences using a decision aid program for birth choices after caesarean. A mixed methods study was conducted among 33 consenting pregnant women with previous caesarean in five obstetrics institutions located in the western part of Japan. Outcome measures included change in level of decisional conflict, change in knowledge, and preference for birth method. Semi-structured interviews examined women's decision making experiences, and qualitative data were analyzed using thematic analysis. The participants in the program experienced a statistically significant improvement in knowledge and reduction in decisional conflict about birth after caesarean. Four themes were identified in the qualitative data related to decision making: change in women's knowledge about birth choices, clarifying women's birth preference, feelings about shared decision making, and contrasting feelings after receiving information. This study confirmed potential benefits of using the decision aid program. However, uncertainty about mode of birth continued for some women immediately prior to the birth. This finding emphasized the need to identify additional ways to support women emotionally throughout the process of decision making about birth after caesarean. It was feasible to adapt the decision aid for use in clinical practice. Future research is necessary to examine its effectiveness when implemented in Japanese clinical settings. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. The utility of caesarean myomectomy as a safe procedure: a retrospective analysis of 21 cases with review of literature.

    Science.gov (United States)

    Kumar R, Ramesh; Patil, Manjula; Sa, Shruthi

    2014-09-01

    Myomectomy at the time of caesarean delivery has been discouraged because of the risk of intractable haemorrhage and increased postoperative morbidity. The aim of this study is to determine the safety and feasibility of caesarean myomectomy. A retrospective case control study done between June 2012 to May 2013 in a tertiary care teaching hospital in Karnataka, India which included 21 pregnant women with uterine fibroids who underwent myomectomy during caesarean section and were compared with 42 matched controls without uterine fibroids who had caesarean section alone during the same period. Primary outcome measures studied were incidence of haemorrhage and need for blood transfusion. Secondary outcome measures were duration of operation, length of hospital stay, postpartum fever and wound infection. Statistical analysis is done using IBMSPSS 20.0 software and students t-test. For calculation of incidence of haemorrhage Fisher's exact test is used. Mean age of the 21 cases was 31.81yrs and 47.62% were primigravida. Total 37 fibroids were removed. Subserosal were 30 cases(81.08%) while 1(2.07%) was submucous. 21(56.76%)fibroids were situated in fundal region and 3(8.11%) were in lower segment. Mean change in the haemoglobin from preoperative to postoperative period in the cases was 1.3gm/dl(±1.155mg/dl) and control was 1.05% (±.854mg/dl). Two of the cases(9.52%) required blood transfusion compared to none in control. None in either group required hysterectomy. Mean duration of surgery was 68.57min (±15.012min)and 51.55min (±9.595min) for controls which is statistically significant. This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.

  19. Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012.

    Science.gov (United States)

    Cresswell, Jenny A; Assarag, Bouchra; Meski, Fatima-Zahra; Filippi, Veronique; Ronsmans, Carine

    2015-05-01

    To examine trends in the utilisation of facility-based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care. Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events. Uptake of facility-based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR: 1.09; 95% CI: 1.07-1.11) than the richest quintile (annual increase RR: 1.01; 95% CI: 1.02-1.02). A similar pattern was observed for caesareans (annual increase among poorest RR: 1.13; 95% CI: 1.07-1.19 vs. annual increase among richest RR: 1.08; 95% CI: 1.06-1.10). We found no significant acceleration in trend coinciding with any of the events investigated. Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply-side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive. © 2015 John Wiley & Sons Ltd.

  20. Neural Classifier Construction using Regularization, Pruning

    DEFF Research Database (Denmark)

    Hintz-Madsen, Mads; Hansen, Lars Kai; Larsen, Jan

    1998-01-01

    In this paper we propose a method for construction of feed-forward neural classifiers based on regularization and adaptive architectures. Using a penalized maximum likelihood scheme, we derive a modified form of the entropic error measure and an algebraic estimate of the test error. In conjunctio...... with optimal brain damage pruning, a test error estimate is used to select the network architecture. The scheme is evaluated on four classification problems.......In this paper we propose a method for construction of feed-forward neural classifiers based on regularization and adaptive architectures. Using a penalized maximum likelihood scheme, we derive a modified form of the entropic error measure and an algebraic estimate of the test error. In conjunction...

  1. Toward an efficient Photometric Supernova Classifier

    Science.gov (United States)

    McClain, Bradley

    2018-01-01

    The Sloan Digital Sky Survey Supernova Survey (SDSS) discovered more than 1,000 Type Ia Supernovae, yet less than half of these have spectroscopic measurements. As wide-field imaging telescopes such as The Dark Energy Survey (DES) and the Panoramic Survey Telescope and Rapid Response System (Pan-STARRS) discover more supernovae, the need for accurate and computationally cheap photometric classifiers increases. My goal is to use a photometric classification algorithm based on Sncosmo, a python library for supernova cosmology analysis, to reclassify previously identified Hubble SN and other non-spectroscopically confirmed surveys. My results will be compared to other photometric classifiers such as PSNID and STARDUST. In the near future, I expect to have the algorithm validated with simulated data, optimized for efficiency, and applied with high performance computing to real data.

  2. Comparing cosmic web classifiers using information theory

    International Nuclear Information System (INIS)

    Leclercq, Florent; Lavaux, Guilhem; Wandelt, Benjamin; Jasche, Jens

    2016-01-01

    We introduce a decision scheme for optimally choosing a classifier, which segments the cosmic web into different structure types (voids, sheets, filaments, and clusters). Our framework, based on information theory, accounts for the design aims of different classes of possible applications: (i) parameter inference, (ii) model selection, and (iii) prediction of new observations. As an illustration, we use cosmographic maps of web-types in the Sloan Digital Sky Survey to assess the relative performance of the classifiers T-WEB, DIVA and ORIGAMI for: (i) analyzing the morphology of the cosmic web, (ii) discriminating dark energy models, and (iii) predicting galaxy colors. Our study substantiates a data-supported connection between cosmic web analysis and information theory, and paves the path towards principled design of analysis procedures for the next generation of galaxy surveys. We have made the cosmic web maps, galaxy catalog, and analysis scripts used in this work publicly available.

  3. Classifying objects in LWIR imagery via CNNs

    Science.gov (United States)

    Rodger, Iain; Connor, Barry; Robertson, Neil M.

    2016-10-01

    The aim of the presented work is to demonstrate enhanced target recognition and improved false alarm rates for a mid to long range detection system, utilising a Long Wave Infrared (LWIR) sensor. By exploiting high quality thermal image data and recent techniques in machine learning, the system can provide automatic target recognition capabilities. A Convolutional Neural Network (CNN) is trained and the classifier achieves an overall accuracy of > 95% for 6 object classes related to land defence. While the highly accurate CNN struggles to recognise long range target classes, due to low signal quality, robust target discrimination is achieved for challenging candidates. The overall performance of the methodology presented is assessed using human ground truth information, generating classifier evaluation metrics for thermal image sequences.

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

    LENUS (Irish Health Repository)

    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.

  5. Where does ergometrine stand in prevention of postpartum haemorrhage in caesarean section

    International Nuclear Information System (INIS)

    Mahmud, G.; Javaid, K.; Tasnim, N.; Tabassum, A.; Bangash, K. T.

    2014-01-01

    Objective: To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. Method: The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intra-operatively from November 1 to December 31, 2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P <0.05 was taken as statistically significant. Results: Of the total number of 701 subjects, 378 (54%) women were given 10 units syntocinon and 323 (46%) were given 0.25 mg ergometrine in addition to 10 units syntocinon. The mean age in the syntocinon group was 28+-3.5 yrs with gestational age of 37.5+-2 weeks, while that in syntocinon-ergometrine group was 29+-3.4 years and 38+-2 weeks respectively. Postpartum haemorrhage in the syntocinon group was found in 38 (10%) women versus 05 (1.5%) women) in the other group (p<0.001). Adverse effects like nausea, vomiting and raised blood pressure were slightly more with syntocinon-ergometrine than syntocinon alone (n=56; 15.3% vs n=35; 9.2%), but it was not statistically significant. Post partum haemorrhage was responsible for 40% of maternal mortality during the study period and that was in the syntocinon group. Conclusion: Prophylactic ergometrine in addition to syntocinon is superior to syntocinon alone in decreasing frequency of postpartum haemorrhage in caesarean section and associated maternal morbidity and mortality. Regarding safety profile, the two

  6. Ensembles of Classifiers based on Dimensionality Reduction

    OpenAIRE

    Schclar, Alon; Rokach, Lior; Amit, Amir

    2013-01-01

    We present a novel approach for the construction of ensemble classifiers based on dimensionality reduction. Dimensionality reduction methods represent datasets using a small number of attributes while preserving the information conveyed by the original dataset. The ensemble members are trained based on dimension-reduced versions of the training set. These versions are obtained by applying dimensionality reduction to the original training set using different values of the input parameters. Thi...

  7. A Bayesian classifier for symbol recognition

    OpenAIRE

    Barrat , Sabine; Tabbone , Salvatore; Nourrissier , Patrick

    2007-01-01

    URL : http://www.buyans.com/POL/UploadedFile/134_9977.pdf; International audience; We present in this paper an original adaptation of Bayesian networks to symbol recognition problem. More precisely, a descriptor combination method, which enables to improve significantly the recognition rate compared to the recognition rates obtained by each descriptor, is presented. In this perspective, we use a simple Bayesian classifier, called naive Bayes. In fact, probabilistic graphical models, more spec...

  8. A STUDY TO COMPARE THE EFFICACY OF SUBCUTANEOUS SUTURE REAPPROXIMATAION VERSUS SUBCUTANEOUS DRAIN FOR THE PREVENTION OF WOUND COMPLICATION IN WOMEN UNDERGOING CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Anjali H.

    2015-10-01

    Full Text Available Obesity has been linked as a risk factor for wound complication and is becoming a more common occurrence. We reviewed the risk factors, preventive strategies and recommended management of wound complication in women undergoing caesarean section. The limited available data support the use of prophylactic antibiotic before caesarean delivery, closure of subcutaneo us space >2cm and maintaining normothermic intra - operatively to help reduce the incidence of postoperative wound complication. There is a need for randomized controlled trials which evaluate the prevention and management of wound complications in obese wom en undergoing caesarean delivery

  9. Classifying Variable Sources in SDSS Stripe 82

    Science.gov (United States)

    Willecke Lindberg, Christina

    2018-01-01

    SDSS (Sloan Digital Sky Survey) Stripe 82 is a well-documented and researched region of the sky that does not have all of its ~67,500 variable objects labeled. By collecting data and consulting different catalogs such as the Catalina Survey, we are able to slowly cross-match more objects and add classifications within the Stripe 82 catalog. Such matching is performed either by pairing SDSS identification numbers, or by converting and comparing the coordinates of every object within the Stripe 82 catalog to every object within the classified catalog, such as the Catalina Survey catalog. If matching is performed with converted coordinates, a follow-up check is performed to ascertain that the magnitudes of the paired objects are within a reasonable margin of error and that objects have not been mismatched. Once matches have been confirmed, the light curves of classified objects can then be used to determine features that most effectively separate the different types of variable objects in feature spaces. By classifying variable objects, we can construct a reference for subsequent large research surveys, such as LSST (the Large Synoptic Survey Telescope), that could utilize SDSS data as a training set for its own classifications.

  10. SVM classifier on chip for melanoma detection.

    Science.gov (United States)

    Afifi, Shereen; GholamHosseini, Hamid; Sinha, Roopak

    2017-07-01

    Support Vector Machine (SVM) is a common classifier used for efficient classification with high accuracy. SVM shows high accuracy for classifying melanoma (skin cancer) clinical images within computer-aided diagnosis systems used by skin cancer specialists to detect melanoma early and save lives. We aim to develop a medical low-cost handheld device that runs a real-time embedded SVM-based diagnosis system for use in primary care for early detection of melanoma. In this paper, an optimized SVM classifier is implemented onto a recent FPGA platform using the latest design methodology to be embedded into the proposed device for realizing online efficient melanoma detection on a single system on chip/device. The hardware implementation results demonstrate a high classification accuracy of 97.9% and a significant acceleration factor of 26 from equivalent software implementation on an embedded processor, with 34% of resources utilization and 2 watts for power consumption. Consequently, the implemented system meets crucial embedded systems constraints of high performance and low cost, resources utilization and power consumption, while achieving high classification accuracy.

  11. Optimization of short amino acid sequences classifier

    Science.gov (United States)

    Barcz, Aleksy; Szymański, Zbigniew

    This article describes processing methods used for short amino acid sequences classification. The data processed are 9-symbols string representations of amino acid sequences, divided into 49 data sets - each one containing samples labeled as reacting or not with given enzyme. The goal of the classification is to determine for a single enzyme, whether an amino acid sequence would react with it or not. Each data set is processed separately. Feature selection is performed to reduce the number of dimensions for each data set. The method used for feature selection consists of two phases. During the first phase, significant positions are selected using Classification and Regression Trees. Afterwards, symbols appearing at the selected positions are substituted with numeric values of amino acid properties taken from the AAindex database. In the second phase the new set of features is reduced using a correlation-based ranking formula and Gram-Schmidt orthogonalization. Finally, the preprocessed data is used for training LS-SVM classifiers. SPDE, an evolutionary algorithm, is used to obtain optimal hyperparameters for the LS-SVM classifier, such as error penalty parameter C and kernel-specific hyperparameters. A simple score penalty is used to adapt the SPDE algorithm to the task of selecting classifiers with best performance measures values.

  12. Evolving edited k-nearest neighbor classifiers.

    Science.gov (United States)

    Gil-Pita, Roberto; Yao, Xin

    2008-12-01

    The k-nearest neighbor method is a classifier based on the evaluation of the distances to each pattern in the training set. The edited version of this method consists of the application of this classifier with a subset of the complete training set in which some of the training patterns are excluded, in order to reduce the classification error rate. In recent works, genetic algorithms have been successfully applied to determine which patterns must be included in the edited subset. In this paper we propose a novel implementation of a genetic algorithm for designing edited k-nearest neighbor classifiers. It includes the definition of a novel mean square error based fitness function, a novel clustered crossover technique, and the proposal of a fast smart mutation scheme. In order to evaluate the performance of the proposed method, results using the breast cancer database, the diabetes database and the letter recognition database from the UCI machine learning benchmark repository have been included. Both error rate and computational cost have been considered in the analysis. Obtained results show the improvement achieved by the proposed editing method.

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

    Energy Technology Data Exchange (ETDEWEB)

    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).

  14. [Skin-to-skin caesarean section: a hype or better patient care?

    Science.gov (United States)

    Korteweg, F J; de Boer, H D; van der Ploeg, J M; Buiter, H D; van der Ham, D P

    2017-01-01

    A caesarean section (CS) is one of the most common surgical procedures performed in the world, for which there are minimal variations in the surgical approach. During the last few years the "skin-to-skin" CS, also coined "natural" or "gentle" CS, is on the rise; parental participation, slow delivery and direct skin-to-skin contact are important aspects. Most Dutch hospitals offer some form of "skin-to-skin" CS but there are local differences in availability and performance of the procedure. Since 2011, the standard procedure in the Martini Hospital in Groningen is the "skin-to-skin" CS (for both elective and emergency CS, 24/7). We describe our method and share our retrospective data, and demonstrate that this procedure does not result in more complications for mother or baby.

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

    LENUS (Irish Health Repository)

    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.

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Successful use of sugammadex for caesarean section in a patient with myasthenia gravis.

    Science.gov (United States)

    Soyoral, Lokman; Goktas, Ugur; Cegin, Muhammed Bilal; Baydi, Volkan

    Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  19. [Successful use of sugammadex for caesarean section in a patient with myasthenia gravis].

    Science.gov (United States)

    Soyoral, Lokman; Goktas, Ugur; Cegin, Muhammed Bilal; Baydi, Volkan

    Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    DEFF Research Database (Denmark)

    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...... 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 nurse anaesthetists) in handling...

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

    Science.gov (United States)

    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. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Fractional CO2 laser treatment of caesarean section scars

    DEFF Research Database (Denmark)

    Karmisholt, Katrine E; Taudorf, Elisabeth H; Wulff, Camilla B

    2017-01-01

    BACKGROUND AND OBJECTIVES: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS...... AND METHODS: A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar...... Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction. RESULTS: Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0...

  3. Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review.

    Science.gov (United States)

    Boatin, A A; Cullinane, F; Torloni, M R; Betrán, A P

    2018-01-01

    In most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates. To identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates. Medline, Embase, CINAHL and LILACS were searched from 2001 to 2016. Studies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates. Data on study design, interventions used, CS rates, and perinatal outcomes were extracted. Of 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias. We identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates. Use of the Robson classification in clinical audit cycles to reduce caesarean rates. © 2017 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  4. A COMPARATIVE STUDY OF SINGLE VERSUS DOUBLE LAYER CLOSURE ON LOWER SEGMENT CAESAREAN SCAR

    Directory of Open Access Journals (Sweden)

    Kirtirekha Mohapatra

    2016-10-01

    Full Text Available BACKGROUND There are few issues in modern obstetrics that have been as controversial as management of a woman with a prior caesarean delivery. Hence, it is required to have evidence based correct practice of this surgical procedure. Healing of the uterine incision and the strength of the scar should be the most important consideration. The aim of the study is to compare the effect of technique of uterine closure (Single Layer vs. Double Layer on subsequent pregnancies and to find out, which technique has a better maternal and neonatal outcome by strengthening the scar. MATERIALS AND METHODS 500 cases of previous caesarean section pregnancies were taken, 250 from single layer closure group and 250 from double layer closure group. The mode of delivery during present pregnancy was noted. Integrity of scar, thickness of scar, presence of adhesion were documented. The neonates were observed. Results were compared so as to draw an inference about the better method. RESULTS Mean age between the two groups were similar. Majority did not have history of premature rupture of membrane during previous pregnancy. Postoperative complications were more when double layer closure of uterine scar was done in index surgery. Interpregnancy gap of <3 years was more commonly present in double layer closure group (52.8% in double layer versus 34.8% in single layer. Single layer had more scar tenderness (21.2%, thinned out scars (34.6%, incomplete ruptures (7.1% and complete ruptures (2.8% than double layer closure group. Neonatal outcomes were not statistically different in both the groups. CONCLUSION Double layer uterine closure seems to have better impact on scar integrity as compared to single layer uterine closure.

  5. A study of post-caesarean section wound infections in a regional referral hospital, oman.

    Science.gov (United States)

    Dhar, Hansa; Al-Busaidi, Ibrahim; Rathi, Bhawna; Nimre, Eman A; Sachdeva, Vibha; Hamdi, Ilham

    2014-05-01

    The aim of this study was to determine the incidence of surgical site infections (SSI) in patients undergoing a Caesarean section (CS) and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient's quality of life by increasing morbidity and extending hospital stays. A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS) SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220) were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. The total number of PCS wound infections was 211 (2.66%). There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53%) and a three-fold higher incidence of diabetes (32, 15.16%) in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27%) and the Gram-negative Escherichia coli group (40, 18.95%). The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%), while 47 (22.27%) yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques.

  6. A Study of Post-Caesarean Section Wound Infections in a Regional Referral Hospital, Oman

    Directory of Open Access Journals (Sweden)

    Hansa Dhar

    2014-05-01

    Full Text Available Objectives: The aim of this study was to determine the incidence of surgical site infections (SSI in patients undergoing a Caesarean section (CS and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient’s quality of life by increasing morbidity and extending hospital stays. Methods: A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220 were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. Results: The total number of PCS wound infections was 211 (2.66%. There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53% and a three-fold higher incidence of diabetes (32, 15.16% in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27% and the Gram-negative Escherichia coli group (40, 18.95%. The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%, while 47 (22.27% yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Conclusion: Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques.

  7. [Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations].

    Science.gov (United States)

    Uyar Türkyilmaz, Esra; Eryilmaz, Nuray Camgöz; Güzey, Nihan Aydin; Moraloğlu, Özlem

    2016-01-01

    Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Robust Framework to Combine Diverse Classifiers Assigning Distributed Confidence to Individual Classifiers at Class Level

    Directory of Open Access Journals (Sweden)

    Shehzad Khalid

    2014-01-01

    Full Text Available We have presented a classification framework that combines multiple heterogeneous classifiers in the presence of class label noise. An extension of m-Mediods based modeling is presented that generates model of various classes whilst identifying and filtering noisy training data. This noise free data is further used to learn model for other classifiers such as GMM and SVM. A weight learning method is then introduced to learn weights on each class for different classifiers to construct an ensemble. For this purpose, we applied genetic algorithm to search for an optimal weight vector on which classifier ensemble is expected to give the best accuracy. The proposed approach is evaluated on variety of real life datasets. It is also compared with existing standard ensemble techniques such as Adaboost, Bagging, and Random Subspace Methods. Experimental results show the superiority of proposed ensemble method as compared to its competitors, especially in the presence of class label noise and imbalance classes.

  9. Paralyzed Veterans of America

    Science.gov (United States)

    ... Connected Twitter @PVA1946 Facebook @Paralyzed Veterans of America Instagram @PVA1946 National Veterans Wheelchair Games App Download Now ... 838-7782 CONNECT WITH US Facebook Twitter YouTube Instagram Flickr STAY INFORMED WITH NEWS & UPDATES Enter your ...

  10. Prevent Child Abuse America

    Science.gov (United States)

    ... call the police . Crisis and support contacts For Child Abuse Reporting Numbers in your State please visit: Child ... suspected child abuse and neglect. Parent Resources Prevent Child Abuse America (800) CHILDREN A resource for tips, referrals, ...

  11. Classifying smoking urges via machine learning.

    Science.gov (United States)

    Dumortier, Antoine; Beckjord, Ellen; Shiffman, Saul; Sejdić, Ervin

    2016-12-01

    Smoking is the largest preventable cause of death and diseases in the developed world, and advances in modern electronics and machine learning can help us deliver real-time intervention to smokers in novel ways. In this paper, we examine different machine learning approaches to use situational features associated with having or not having urges to smoke during a quit attempt in order to accurately classify high-urge states. To test our machine learning approaches, specifically, Bayes, discriminant analysis and decision tree learning methods, we used a dataset collected from over 300 participants who had initiated a quit attempt. The three classification approaches are evaluated observing sensitivity, specificity, accuracy and precision. The outcome of the analysis showed that algorithms based on feature selection make it possible to obtain high classification rates with only a few features selected from the entire dataset. The classification tree method outperformed the naive Bayes and discriminant analysis methods, with an accuracy of the classifications up to 86%. These numbers suggest that machine learning may be a suitable approach to deal with smoking cessation matters, and to predict smoking urges, outlining a potential use for mobile health applications. In conclusion, machine learning classifiers can help identify smoking situations, and the search for the best features and classifier parameters significantly improves the algorithms' performance. In addition, this study also supports the usefulness of new technologies in improving the effect of smoking cessation interventions, the management of time and patients by therapists, and thus the optimization of available health care resources. Future studies should focus on providing more adaptive and personalized support to people who really need it, in a minimum amount of time by developing novel expert systems capable of delivering real-time interventions. Copyright © 2016 Elsevier Ireland Ltd. All rights

  12. Classifying spaces of degenerating polarized Hodge structures

    CERN Document Server

    Kato, Kazuya

    2009-01-01

    In 1970, Phillip Griffiths envisioned that points at infinity could be added to the classifying space D of polarized Hodge structures. In this book, Kazuya Kato and Sampei Usui realize this dream by creating a logarithmic Hodge theory. They use the logarithmic structures begun by Fontaine-Illusie to revive nilpotent orbits as a logarithmic Hodge structure. The book focuses on two principal topics. First, Kato and Usui construct the fine moduli space of polarized logarithmic Hodge structures with additional structures. Even for a Hermitian symmetric domain D, the present theory is a refinem

  13. Cubical sets as a classifying topos

    DEFF Research Database (Denmark)

    Spitters, Bas

    Coquand’s cubical set model for homotopy type theory provides the basis for a computational interpretation of the univalence axiom and some higher inductive types, as implemented in the cubical proof assistant. We show that the underlying cube category is the opposite of the Lawvere theory of De...... Morgan algebras. The topos of cubical sets itself classifies the theory of ‘free De Morgan algebras’. This provides us with a topos with an internal ‘interval’. Using this interval we construct a model of type theory following van den Berg and Garner. We are currently investigating the precise relation...

  14. An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

    Science.gov (United States)

    Khan, Rasheda; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-01-01

    Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health

  15. An examination of women experiencing obstetric complications requiring emergency care: perceptions and sociocultural consequences of caesarean sections in Bangladesh.

    Science.gov (United States)

    Khan, Rasheda; Blum, Lauren S; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-06-01

    Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008-August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health systems

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

    LENUS (Irish Health Repository)

    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

  17. Classifying Coding DNA with Nucleotide Statistics

    Directory of Open Access Journals (Sweden)

    Nicolas Carels

    2009-10-01

    Full Text Available In this report, we compared the success rate of classification of coding sequences (CDS vs. introns by Codon Structure Factor (CSF and by a method that we called Universal Feature Method (UFM. UFM is based on the scoring of purine bias (Rrr and stop codon frequency. We show that the success rate of CDS/intron classification by UFM is higher than by CSF. UFM classifies ORFs as coding or non-coding through a score based on (i the stop codon distribution, (ii the product of purine probabilities in the three positions of nucleotide triplets, (iii the product of Cytosine (C, Guanine (G, and Adenine (A probabilities in the 1st, 2nd, and 3rd positions of triplets, respectively, (iv the probabilities of G in 1st and 2nd position of triplets and (v the distance of their GC3 vs. GC2 levels to the regression line of the universal correlation. More than 80% of CDSs (true positives of Homo sapiens (>250 bp, Drosophila melanogaster (>250 bp and Arabidopsis thaliana (>200 bp are successfully classified with a false positive rate lower or equal to 5%. The method releases coding sequences in their coding strand and coding frame, which allows their automatic translation into protein sequences with 95% confidence. The method is a natural consequence of the compositional bias of nucleotides in coding sequences.

  18. A systematic comparison of supervised classifiers.

    Directory of Open Access Journals (Sweden)

    Diego Raphael Amancio

    Full Text Available Pattern recognition has been employed in a myriad of industrial, commercial and academic applications. Many techniques have been devised to tackle such a diversity of applications. Despite the long tradition of pattern recognition research, there is no technique that yields the best classification in all scenarios. Therefore, as many techniques as possible should be considered in high accuracy applications. Typical related works either focus on the performance of a given algorithm or compare various classification methods. In many occasions, however, researchers who are not experts in the field of machine learning have to deal with practical classification tasks without an in-depth knowledge about the underlying parameters. Actually, the adequate choice of classifiers and parameters in such practical circumstances constitutes a long-standing problem and is one of the subjects of the current paper. We carried out a performance study of nine well-known classifiers implemented in the Weka framework and compared the influence of the parameter configurations on the accuracy. The default configuration of parameters in Weka was found to provide near optimal performance for most cases, not including methods such as the support vector machine (SVM. In addition, the k-nearest neighbor method frequently allowed the best accuracy. In certain conditions, it was possible to improve the quality of SVM by more than 20% with respect to their default parameter configuration.

  19. Fcoused crawler bused on Bayesian classifier

    Directory of Open Access Journals (Sweden)

    JIA Haijun

    2013-12-01

    Full Text Available With the rapid development of the network,its information resources are increasingly large and faced a huge amount of information database,search engine plays an important role.Focused crawling technique,as the main core portion of search engine,is used to calculate the relationship between search results and search topics,which is called correlation.Normally,focused crawling method is used only to calculate the correlation between web content and search related topics.In this paper,focused crawling method is used to compute the importance of links through link content and anchor text,then Bayesian classifier is used to classify the links,and finally cosine similarity function is used to calculate the relevance of web pages.If the correlation value is greater than the threshold the page is considered to be associated with the predetermined topics,otherwise not relevant.Experimental results show that a high accuracy can be obtained by using the proposed crawling approach.

  20. Freud's antipathy to America.

    Science.gov (United States)

    Warner, S L

    1991-01-01

    Freud first saw this in America's attitude toward the use of cocaine. It was freely and legally used and even promoted by American physicians as beneficial in many medical conditions. Freud was first swept along by America's prococaine enthusiasm. He narrowly missed destroying his own medical reputation by his continuing close connection and advocacy of cocaine. Freud made his only visit to America in 1909. Despite the success of his visit and the congeniality of Americans toward him, he was already programmed toward a negative response. He allowed minor everyday inconveniences and cultural differences to spoil the trip for him. The chronic intestinal distress that had bothered him previously now was labelled as his "American dyspepsia." He developed additional reasons for disliking America. They accepted his three key dissenters, Adler, Jung, and Rank. He even believed that these three men achieved greater notoriety and popularity in America than he did. In fact, the Freudian psychoanalytic movement became much larger and more powerful in America than did the followings of any or all of his defectors. Freud did not like the shortcuts and lack of mastery of the basics of psychoanalysis that he believed happened in America. Some of this was true, but it was mainly exaggerated in Freud's mind. The gold of psychoanalysis was never transformed into a practical but deficient psychoanalytic alloy as Freud feared it might. There was a genuine disagreement about whether a psychoanalyst should have to become a medical doctor or not. It was a complicated issue in America because of laws that said that doing psychoanalysis was practicing medicine. Freud viewed the American stand against recognizing lay analysts as more evidence of American's being a rebellious son. Economic factors also played a significant factor in Freud's dislike of America. Freud was initially enthusiastic about President Wilson and his plans for peace. He found after World War I that all of his savings

  1. Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany

    Science.gov (United States)

    David, Matthias; Borde, Theda; Brenne, Silke; Henrich, Wolfgang; Breckenkamp, Jürgen; Razum, Oliver

    2015-01-01

    Objective The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned) and emergency (in-labor) caesareans may also vary between immigrants (first generation), their offspring (second- and third-generation women), and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants. Methods A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant) and acculturation status were included. Data was linked with information from the expectant mothers’ antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status. Results The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants. Conclusion Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history. PMID:25985437

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany.

    Directory of Open Access Journals (Sweden)

    Matthias David

    Full Text Available The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned and emergency (in-labor caesareans may also vary between immigrants (first generation, their offspring (second- and third-generation women, and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants.A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant and acculturation status were included. Data was linked with information from the expectant mothers' antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status.The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants.Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.

  4. The differences between pregnant women who request elective caesarean and those who plan for vaginal birth based on Health Belief Model.

    Science.gov (United States)

    Darsareh, Fatemeh; Aghamolaei, Teamur; Rajaei, Minoo; Madani, Abdoulhossain; Zare, Shahram

    2016-12-01

    Although vaginal birth is the safest type of childbirth, sometimes caesarean is necessary for the safety of the mother or the infant. The problem is that low-risk, healthy women are choosing caesarean as a birth option despite the fact that it is fraught with possible complications. To determine the differences and identify the predictors for the way women plan their childbirth based on Health Belief Model. A cross-sectional study was conducted in Bandar abbas city, Iran, from May to October 2015. The study recruited eligible women who self identified themselves as requesting a caesarean or vaginal birth in their response to a questionnaire. Of 470 recruited women, 183 (38.9%) planned to have a caesarean without medical indication. Maternal characteristics (age, level of education, occupational status, involvement in a medical profession, and household income) and obstetric variables (health provider type, place of prenatal care, and the number of children planned for the future) influenced the decisions made by the women. There was a significant difference between women planning a caesarean and those planning vaginal birth in terms of childbirth knowledge. Significant differences were observed regarding maternal self-efficacy, with women planning a caesarean reporting significantly lower self-efficacy than women planning a vaginal birth. Women planning a caesarean birth were also significantly less likely to perceive themselves as being at risk for caesarean-related side effects than women planning a vaginal birth. Comprehensive childbirth knowledge can lead to positive maternal attitude towards vaginal birth and may improve birth confidence. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  5. 5 CFR 1312.23 - Access to classified information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Access to classified information. 1312.23..., DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Control and Accountability of Classified Information § 1312.23 Access to classified information. Classified information may be made...

  6. Learning algorithms for stack filter classifiers

    Energy Technology Data Exchange (ETDEWEB)

    Porter, Reid B [Los Alamos National Laboratory; Hush, Don [Los Alamos National Laboratory; Zimmer, Beate G [TEXAS A& M

    2009-01-01

    Stack Filters define a large class of increasing filter that is used widely in image and signal processing. The motivations for using an increasing filter instead of an unconstrained filter have been described as: (1) fast and efficient implementation, (2) the relationship to mathematical morphology and (3) more precise estimation with finite sample data. This last motivation is related to methods developed in machine learning and the relationship was explored in an earlier paper. In this paper we investigate this relationship by applying Stack Filters directly to classification problems. This provides a new perspective on how monotonicity constraints can help control estimation and approximation errors, and also suggests several new learning algorithms for Boolean function classifiers when they are applied to real-valued inputs.

  7. Two channel EEG thought pattern classifier.

    Science.gov (United States)

    Craig, D A; Nguyen, H T; Burchey, H A

    2006-01-01

    This paper presents a real-time electro-encephalogram (EEG) identification system with the goal of achieving hands free control. With two EEG electrodes placed on the scalp of the user, EEG signals are amplified and digitised directly using a ProComp+ encoder and transferred to the host computer through the RS232 interface. Using a real-time multilayer neural network, the actual classification for the control of a powered wheelchair has a very fast response. It can detect changes in the user's thought pattern in 1 second. Using only two EEG electrodes at positions O(1) and C(4) the system can classify three mental commands (forward, left and right) with an accuracy of more than 79 %

  8. Hybrid Neuro-Fuzzy Classifier Based On Nefclass Model

    Directory of Open Access Journals (Sweden)

    Bogdan Gliwa

    2011-01-01

    Full Text Available The paper presents hybrid neuro-fuzzy classifier, based on NEFCLASS model, which wasmodified. The presented classifier was compared to popular classifiers – neural networks andk-nearest neighbours. Efficiency of modifications in classifier was compared with methodsused in original model NEFCLASS (learning methods. Accuracy of classifier was testedusing 3 datasets from UCI Machine Learning Repository: iris, wine and breast cancer wisconsin.Moreover, influence of ensemble classification methods on classification accuracy waspresented.

  9. Classifying Transition Behaviour in Postural Activity Monitoring

    Directory of Open Access Journals (Sweden)

    James BRUSEY

    2009-10-01

    Full Text Available A few accelerometers positioned on different parts of the body can be used to accurately classify steady state behaviour, such as walking, running, or sitting. Such systems are usually built using supervised learning approaches. Transitions between postures are, however, difficult to deal with using posture classification systems proposed to date, since there is no label set for intermediary postures and also the exact point at which the transition occurs can sometimes be hard to pinpoint. The usual bypass when using supervised learning to train such systems is to discard a section of the dataset around each transition. This leads to poorer classification performance when the systems are deployed out of the laboratory and used on-line, particularly if the regimes monitored involve fast paced activity changes. Time-based filtering that takes advantage of sequential patterns is a potential mechanism to improve posture classification accuracy in such real-life applications. Also, such filtering should reduce the number of event messages needed to be sent across a wireless network to track posture remotely, hence extending the system’s life. To support time-based filtering, understanding transitions, which are the major event generators in a classification system, is a key. This work examines three approaches to post-process the output of a posture classifier using time-based filtering: a naïve voting scheme, an exponentially weighted voting scheme, and a Bayes filter. Best performance is obtained from the exponentially weighted voting scheme although it is suspected that a more sophisticated treatment of the Bayes filter might yield better results.

  10. Just-in-time adaptive classifiers-part II: designing the classifier.

    Science.gov (United States)

    Alippi, Cesare; Roveri, Manuel

    2008-12-01

    Aging effects, environmental changes, thermal drifts, and soft and hard faults affect physical systems by changing their nature and behavior over time. To cope with a process evolution adaptive solutions must be envisaged to track its dynamics; in this direction, adaptive classifiers are generally designed by assuming the stationary hypothesis for the process generating the data with very few results addressing nonstationary environments. This paper proposes a methodology based on k-nearest neighbor (NN) classifiers for designing adaptive classification systems able to react to changing conditions just-in-time (JIT), i.e., exactly when it is needed. k-NN classifiers have been selected for their computational-free training phase, the possibility to easily estimate the model complexity k and keep under control the computational complexity of the classifier through suitable data reduction mechanisms. A JIT classifier requires a temporal detection of a (possible) process deviation (aspect tackled in a companion paper) followed by an adaptive management of the knowledge base (KB) of the classifier to cope with the process change. The novelty of the proposed approach resides in the general framework supporting the real-time update of the KB of the classification system in response to novel information coming from the process both in stationary conditions (accuracy improvement) and in nonstationary ones (process tracking) and in providing a suitable estimate of k. It is shown that the classification system grants consistency once the change targets the process generating the data in a new stationary state, as it is the case in many real applications.

  11. Features of Metabolic Processes in Children Born by Caesarean Section in the Early Adaptation Period: the Role of Cerebral Ischemia

    Directory of Open Access Journals (Sweden)

    Т. S. Tumaeva

    2015-01-01

    Full Text Available Background: The postnatal adaptation comprises alteration of metabolic processes of a newborn, the disturbance of which can lead to dysfunction, and later — to the development of diseases. Objective: Our aim was to study the bond of cerebral ischemia in full-term children born by Caesarean section with the course of metabolic processes in the early neonatal period. Methods: A retrospective comparative study was conducted. Children born by Caesarean section, who had cerebral ischemia (n =120 and who didn't have it, (n = 150 were examined. Complex examination included an assessment of a number of factors: clinical, biochemical blood tests, acidbase balance, concentration of some hormones. Results: In children after Caesarean section with cerebral ischemia in the early period of adaptation we noted disturbances of the acid-base balance (BE 0.3 ± 1.9 mmol/l; р = 0.038, blood oxygenation (SaO2 79.7 ± 2.8%; р = 0.001, frank lactataemia (4.3 ± 1.8 mmol/l; р = 0.002, signs of a catabolic orientation of metabolism (hypoproteinemia, increased protein metabolism products, frank primary loss of body weight. The considerable changes of activity of the blood enzymes, disturbance of glucose metabolism indicated the lack of energy-dependent processes. Due to this, the hyperbilirubinemia and a hormonal imbalance were more often formed. Conclusion: Cerebral ischemia in children born by Caesarean section is a reason for the development of a metabolic disadaptation. The detection of disturbances of metabolic processes in the early neonatal period is necessary for a timely start of the correctional therapy in order to prevent the development of diseases in more distant periods of a child's life. 

  12. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Qinghua, E-mail: qh-wu77@163.com [The First Affiliated Hospital of Zhengzhou University, Departments of Prenatal Diagnosis, and Obstetrics, Obstetric Critical Treatment Center of Henan Province (China); Liu, Zhuan, E-mail: liuchuan2015ck@163.com; Zhao, Xianlan, E-mail: zxl121292014@163.com; Liu, Cai, E-mail: liucai2015ck@163.com [The First Affiliated Hospital of Zhengzhou University, Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics (China); Wang, Yanli, E-mail: wangyanli2015yfy@163.com; Chu, Qinjun, E-mail: chuqinjun2015@163.com [The First Affiliated Hospital of Zhengzhou University, Department of Anesthesiology (China); Wang, Xiaojuan, E-mail: wangxiaojun2015ck@163.com; Chen, Zhimin, E-mail: chenzhimin2015ck@163.com [The First Affiliated Hospital of Zhengzhou University, Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics (China)

    2016-11-15

    PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.

  13. Midwives' experiences with mother-infant skin-to-skin contact after a caesarean section: 'fighting an uphill battle'.

    Science.gov (United States)

    Zwedberg, Sofia; Blomquist, Josefin; Sigerstad, Emelie

    2015-01-01

    to explore midwives' experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section. qualitative interviews with semi-structured questions. eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth. transcribed material was analysed and interpreted using qualitative content analysis. The analysis yielded the theme 'fighting an uphill battle'. skin-to-skin contact was considered to be important, and something that midwives strove to implement as a natural element of postnatal care. However, in daily practice, midwives experienced many obstacles to such care, such as lack of knowledge among parents and other professionals about the benefits of skin-to-skin contact, the mother's condition after the caesarean section, and other organisational difficulties (e.g. collaboration with other professionals, lack of time). Introducing more skin-to-skin care was a challenge for the midwives, who sometimes felt both dismissed and disappointed when they tried to communicate the benefits of this type of care. skin-to-skin contact is not prioritised because many health care practitioners are unaware of its positive effects, and their care reflects this lack of knowledge. There is a need for education among all health care practitioners involved in caesarean procedures. Another difficulty is that many parents are unaware of the benefits of skin-to-skin contact. Maternity outpatient clinics need to inform parents about the benefits of such care, so mothers will understand the importance of skin-to-skin contact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

    International Nuclear Information System (INIS)

    Wu, Qinghua; Liu, Zhuan; Zhao, Xianlan; Liu, Cai; Wang, Yanli; Chu, Qinjun; Wang, Xiaojuan; Chen, Zhimin

    2016-01-01

    PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.

  15. Holy consent--a dilemma for medical staff when maternal consent is withheld for emergency caesarean section.

    Science.gov (United States)

    Weiniger, C F; Elchalal, U; Sprung, C L; Weissman, C; Matot, I

    2006-04-01

    A parturient (grand multipara) developed arrested labour complicated by severe fetal heart rate decelerations. Senior physicians explained the need for a caesarean section, but she chose to deliver vaginally since rabbinical blessing could not be obtained. Forcing the mother to have a cesarean section without consent is considered "civil battery." The dilemma faced by medical staff and the implications of her refusal for the treating medical staff are described.

  16. Peri-operative management of severe pre-eclampsia with kyphoscoliosis and poliomyelitis for emergency caesarean section

    Directory of Open Access Journals (Sweden)

    Anil K Bhiwal

    2017-01-01

    Full Text Available A 37 years old primigravida, 31 weeks gestation with severe preeclampsia [BP = 180/120 mm Hg] with severe kyphoscoliosis and polio affecting right lower limb was admitted in emergency with complaint of blurring of vision and pedal edema. An emergency caesarean section was conducted under general anaesthesia because of a failed spinal anaesthesia. Perioperative anaesthetic management and her postoperative course are discussed.

  17. Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial

    OpenAIRE

    D. Mannaerts; L. Van der Veeken; H. Coppejans; Y. Jacquemyn

    2018-01-01

    Purpose. To compare the incidence of nausea, vomiting, and arterial hypotension between carbetocin and oxytocin to prevent haemorrhage after caesarean section (CS). Methods. A randomized controlled trial in term pregnant women undergoing planned CS. Groups were randomized to carbetocin or oxytocin. Blood pressure (BP), heart rate, presence of nausea/vomitus, and need for vasopressors were evaluated throughout surgery. Preoperative and postoperative haemoglobin and haematocrit levels were comp...

  18. Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect.

    Science.gov (United States)

    Ng'ang'a, Njoki; Ratzersdorfer, Jonathan; Abdelhak, Yaakov

    2017-06-05

    Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    Science.gov (United States)

    Lundgren, Ingela; Smith, Valerie; Nilsson, Christina; Vehvilainen-Julkunen, Katri; Nicoletti, Jane; Devane, Declan; Bernloehr, Annette; van Limbeek, Evelien; Lalor, Joan; Begley, Cecily

    2015-02-05

    The 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. The 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. 238 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. This 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 the included studies were

  20. Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

    International Nuclear Information System (INIS)

    Ghazi, A.; Karim, F.; Hussain, M.; Ali, T.; Jabbar, S.

    2012-01-01

    Background: In the past 30 years the rate of caesarean section (C/S) has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. Method: It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. Results: There were 50 patients in each group. In group A, 11 (22%) were booked and 33 (66%) were referred cases. In group B, 48 (96%) were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 (20%) patients in group A, and 39 (78%) patients in group B, placenta previa, chorioamionitis, obstructed labour (6, 12% each); pregnancy induced hypertension and eclampsia in 5 (10%) cases in group A only. Intra-operative complications in group A were 48 (96%) vs 15 (30%) in group B (p=0.000). Postoperative morbidity in group A was 50 (100%) and 26 (52%) in group B (p=0.000). Intra-operative complication was haemorrhage in 46 (92%) cases in group A and 11 (22%) in group B. Anaesthetic complications were 40 (80%); prolonged intubation 25 (50%), aspiration of gastric contents 8 (16%), and difficult intubation 7 (14%) in group A. Ten (20%) cases had anaesthetic complications in group B

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

    LENUS (Irish Health Repository)

    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

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

    LENUS (Irish Health Repository)

    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

  3. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania.

    Science.gov (United States)

    Mpogoro, Filbert J; Mshana, Stephen E; Mirambo, Mariam M; Kidenya, Benson R; Gumodoka, Balthazar; Imirzalioglu, Can

    2014-01-01

    Surgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs. This was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11. The overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6-9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%. SSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple

  4. Gene-expression Classifier in Papillary Thyroid Carcinoma: Validation and Application of a Classifier for Prognostication

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Jespersen, Marie Louise; Krogdahl, Annelise

    2016-01-01

    BACKGROUND: No reliable biomarker for metastatic potential in the risk stratification of papillary thyroid carcinoma exists. We aimed to develop a gene-expression classifier for metastatic potential. MATERIALS AND METHODS: Genome-wide expression analyses were used. Development cohort: freshly...

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

    Directory of Open Access Journals (Sweden)

    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

  6. Classifiability-based omnivariate decision trees.

    Science.gov (United States)

    Li, Yuanhong; Dong, Ming; Kothari, Ravi

    2005-11-01

    Top-down induction of decision trees is a simple and powerful method of pattern classification. In a decision tree, each node partitions the available patterns into two or more sets. New nodes are created to handle each of the resulting partitions and the process continues. A node is considered terminal if it satisfies some stopping criteria (for example, purity, i.e., all patterns at the node are from a single class). Decision trees may be univariate, linear multivariate, or nonlinear multivariate depending on whether a single attribute, a linear function of all the attributes, or a nonlinear function of all the attributes is used for the partitioning at each node of the decision tree. Though nonlinear multivariate decision trees are the most powerful, they are more susceptible to the risks of overfitting. In this paper, we propose to perform model selection at each decision node to build omnivariate decision trees. The model selection is done using a novel classifiability measure that captures the possible sources of misclassification with relative ease and is able to accurately reflect the complexity of the subproblem at each node. The proposed approach is fast and does not suffer from as high a computational burden as that incurred by typical model selection algorithms. Empirical results over 26 data sets indicate that our approach is faster and achieves better classification accuracy compared to statistical model select algorithms.

  7. Stress fracture development classified by bone scintigraphy

    International Nuclear Information System (INIS)

    Zwas, S.T.; Elkanovich, R.; Frank, G.; Aharonson, Z.

    1985-01-01

    There is no consensus on classifying stress fractures (SF) appearing on bone scans. The authors present a system of classification based on grading the severity and development of bone lesions by visual inspection, according to three main scintigraphic criteria: focality and size, intensity of uptake compare to adjacent bone, and local medular extension. Four grades of development (I-IV) were ranked, ranging from ill defined slightly increased cortical uptake to well defined regions with markedly increased uptake extending transversely bicortically. 310 male subjects aged 19-2, suffering several weeks from leg pains occurring during intensive physical training underwent bone scans of the pelvis and lower extremities using Tc-99-m-MDP. 76% of the scans were positive with 354 lesions, of which 88% were in th4e mild (I-II) grades and 12% in the moderate (III) and severe (IV) grades. Post-treatment scans were obtained in 65 cases having 78 lesions during 1- to 6-month intervals. Complete resolution was found after 1-2 months in 36% of the mild lesions but in only 12% of the moderate and severe ones, and after 3-6 months in 55% of the mild lesions and 15% of the severe ones. 75% of the moderate and severe lesions showed residual uptake in various stages throughout the follow-up period. Early recognition and treatment of mild SF lesions in this study prevented protracted disability and progression of the lesions and facilitated complete healing

  8. Combining classifiers for robust PICO element detection

    Directory of Open Access Journals (Sweden)

    Grad Roland

    2010-05-01

    Full Text Available Abstract Background Formulating a clinical information need in terms of the four atomic parts which are Population/Problem, Intervention, Comparison and Outcome (known as PICO elements facilitates searching for a precise answer within a large medical citation database. However, using PICO defined items in the information retrieval process requires a search engine to be able to detect and index PICO elements in the collection in order for the system to retrieve relevant documents. Methods In this study, we tested multiple supervised classification algorithms and their combinations for detecting PICO elements within medical abstracts. Using the structural descriptors that are embedded in some medical abstracts, we have automatically gathered large training/testing data sets for each PICO element. Results Combining multiple classifiers using a weighted linear combination of their prediction scores achieves promising results with an f-measure score of 86.3% for P, 67% for I and 56.6% for O. Conclusions Our experiments on the identification of PICO elements showed that the task is very challenging. Nevertheless, the performance achieved by our identification method is competitive with previously published results and shows that this task can be achieved with a high accuracy for the P element but lower ones for I and O elements.

  9. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  10. Public Opinion in America.

    Science.gov (United States)

    Monroe, Alan D.

    The purposes of this book are to summarize and analyze the nature of public opinion in contemporary America and to examine the implications of that nature for the possibility of a functioning democracy. Material in the four sections covers the following topics: "The Study of Public Opinion: Political Theory and Methodology"--opinions and…

  11. America's "Private" Public Schools

    Science.gov (United States)

    Petrilli, Michael J.; Scull, Janie

    2010-01-01

    In this report, the authors identify public schools whose doors are effectively closed to poor children. These institutions--generally found in wealthy urban enclaves or well-heeled suburbs--educate many of the children of America's elite while proudly waving the "public school" flag. But they hardly embody the "common school" ideal. In fact, by…

  12. Western Europe's America Problem

    Science.gov (United States)

    Markovits, Andrei S.

    2007-01-01

    In this article, the author discusses Europe's anti-Americanism stance. He observes that Europe's aversion to America has become greater, louder, and more determined, and that it has unified Western Europeans more than any other political emotion (with the exception of a common hostility toward Israel). The author contends that the many disastrous…

  13. Knight Capital Americas LLC

    DEFF Research Database (Denmark)

    Austin, Robert D.; Meister, Darren

    2015-01-01

    It took 19 years to build Knight Capital Americas LLC into the largest market maker on the New York Stock Exchange, but on August 1, 2012, it took only 45 minutes for the firm to be wiped out by an information technology (IT) problem: a change in the company's software caused it to lose more than...

  14. Language in America.

    Science.gov (United States)

    Postman, Neil, Ed.; And Others

    The essays published in this collection were written in response to the basic question, "To what extent is the language of politics/advertising/psychotherapy/education/bureaucracy/etc. facilitating or impeding our chances of survival?" The general topic here is the contemporary use of language and the semantic environment in America, especially in…

  15. North America [Chapter 5

    Science.gov (United States)

    Ronald L. Trosper; Fred Clark; Patrica Gerez-Fernandez; Frank Lake; Deborah McGregor; Charles M. Peters; Silvia Purata; Teresa Ryan; Alan Thomson; Alan E. Watson; Stephen Wyatt

    2012-01-01

    The colonial history of North America presents a contrast between Mexico and the two predominantly English-speaking countries, the United States and Canada. In Mexico, indigenous and other local communities own considerable forested lands, a consequence of the Mexican Revolution of the early twentieth century. In the United States, forest land is now primarily in...

  16. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

    Full Text Available Abstract Background The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes. Methods A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009 Women with ≥2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS, success rate of vaginal birth after caesarean section (VBAC; proportion on women opting for elective repeat caesarean section (ERCS and their perinatal outcomes. Results A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum was 1.01234. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8% reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH ( Conclusions Besides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

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

    Directory of Open Access Journals (Sweden)

    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

  18. User cost of Caesarean section: case study of Bunia, Democratic Republic of Congo.

    Science.gov (United States)

    Deboutte, Danielle; O'Dempsey, Tim; Mann, Gillian; Faragher, Brian

    2015-01-01

    The study estimated the user cost of Caesarean section (CS), a major component of emergency obstetric care (EmOC), in a post conflict situation in Bunia, DR Congo, 2008. A case control study used a structured questionnaire to compare women who had a CS (cases) with women who had a vaginal delivery (controls). Service information was recorded in 20 facilities providing obstetric care. Maternal and perinatal deaths, including those outside health facilities, were recorded and verified. The user cost of CS was estimated at four hospitals, one of them managed by an international non-governmental organization offering EmOC free of charge, compared to the user cost of women who had a vaginal delivery. Among paying users, the mean healthcare cost was $US68.0 for CS and $US12.1 for vaginal delivery; mean transport cost to and from the hospital was $US11.7 for cases and $US3.2 for controls. The mean monthly family income was $US75.5. The user cost of CS placed an important financial burden on patients and their families. During transition from humanitarian to developmental assistance, donors and the State should shore up the EmOC budget to avoid an increase in maternal and perinatal mortality. Copyright © 2013 John Wiley & Sons, Ltd.

  19. A comparative study of frequency of postnatal depression among subjects with normal and caesarean deliveries

    Directory of Open Access Journals (Sweden)

    Ganraj Bhat Sankapithilu

    2010-07-01

    Full Text Available Background: The prevalence of postnatal depression (PND is 12-15%. Recent studies are equivocal about the earlier inference that PND is higher among caesarian than normal delivery. Objective: The aim of this study is to investigate the frequency of PND among the Indian women and the association between the mode of delivery and PND. Material and method: Fifty subjects each; having delivered normally and by caesarian section was chosen. All the women were within 3 months post delivery and could understand Kannada language. Those who consented were asked to complete the Edinburgh Postnatal Depression Scale (EPDS. Those found to have scores suggestive of depression on EPDS were assessed for depression according to ICD-10. The data was analyzed using paired t test and chi square test. Result and conclusion: Among Post caesarean subjects, depression was diagnosed in 20% (n=10 as compared to 16% (n=8 in subjects that delivered normally. However there was no significant difference in the frequency of depression among the two groups. Due to the small sample size the results cannot be generalized.

  20. Caesarean Section at Full Dilatation and Risk of Major Obstetric Haemorrhage

    LENUS (Irish Health Repository)

    O’Dwyer, V

    2018-03-01

    The purpose of the study was to examine the risk factors for caesarean section (CS) at full dilatation and to assess the risk and management of haemorrhage. The study took place in a tertiary referral maternity hospital. Women who had a CS at full dilatation were included. Clinical and demographic details were recorded. There were 199 cases. The average age was 30.3 years and average BMI was 25.8kg\\/m2. There were 79.9 % (159) primigravidas and 20.1% (40) multigravidas. The average gestation at delivery was 39.4 weeks. Labour was induced in 46.9 % (92) and spontaneous in 53.8% (107). Oxytocin was used in 67.8 % (135). An instrumental delivery was attempted in 46.7 % (93). The rate of malposition was 46.5 % (92). The average birthweight was 3,629g and 9 babies weighed ≥4.5kg. The average estimated blood loss (EBL) was 665mls and 34 had EBL>1L. Most had an oxytocin infusion (141). Other uterotonic agents were used in 70 women. Seven women had blood transfusions. The highest rate of CS at full dilatation was in primigravidas due to malposition. There was a low rate of major obstetric haemorrhage.

  1. A COMPARISON OF SPINAL ANAESTHESIA WITH LEVOBUPIVACAINE AND HYPERBARIC BUPIVACAINE COMBINED WITH FENTANYL IN CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Kurmanadh Kalepalli

    2016-10-01

    Full Text Available BACKGROUND Recent trends in obstetric anaesthesia show increased popularity of regional anaesthesia among obstetric anaesthetists. General anaesthesia in caesarean section is associated with high morbidity and mortality rate when compared with regional anaesthesia. Regional anaesthesia has its own demerits which are primarily related to excessively high spinal blocks and toxicity of local anaesthetics. Reduction in doses and improvement in technique to avoid high level blocks and increased awareness of toxicity of local anaesthetics have contributed to reduction in complications related to regional anaesthesia. The challenges presented by a parturient requiring anaesthesia or analgesia, or both, make the role of obstetric anaesthesiologist both challenging and rewarding. Spinal anesthesia is a popular technique for caesarean delivery. Hyperbaric Bupivacaine in 8% glucose is often used. Plain or glucose-free, Bupivacaine has been frequently referred to as “Isobaric” in the literature, even after Blomqvist and Nilsson demonstrated its hypobaricity. More recently, several studies have confirmed that plain Bupivacaine is indeed hypobaric in comparison with human CSF. Although hyperbaric local anesthetic solutions have a remarkable record of safety, their use is not totally without risk. To prevent unilateral or saddle blocks, patients should move from the lateral or sitting position rapidly to supine position. Hyperbaric solutions may cause sudden cardiac arrest after spinal anesthesia because of the extension of the sympathetic block. The use of truly isobaric solutions may prove less sensitive to position issues. Hyperbaric solutions may cause hypotension or bradycardia after mobilization. Isobaric solutions are favored with respect to their less sensitivity to postural changes. MATERIALS AND METHODS 60 full term parturients of ASA Grade 1 and 2 posted for elective caesarean section under spinal anaesthesia were divided in to two groups. GROUP

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

    LENUS (Irish Health Repository)

    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.

  3. Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Ilona C. Narayen

    2018-02-01

    Full Text Available BackgroundAlthough little data are available concerning safety for newborns, family-centered caesarean sections (FCS are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC, where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA ≥38 weeks and without increased risks for respiratory morbidity.MethodsThe incidence of respiratory pathology, unplanned admission, and hypothermia in infants born after FCS in LUMC were retrospectively reviewed and compared with a historical cohort of standard elective cesarean sections (CS.ResultsFrom June 2014 to November 2015, 92 FCS were performed and compared to 71 standard CS in 2013. Incidence of respiratory morbidity, hypothermia, temperatures at arrival at the department, GA, and birth weight were comparable (ns. Unplanned admission occurred more often after FCS when compared to standard CS (21 vs 7%; p = 0.03, probably due to peripheral oxygen saturation (SpO2 monitoring. There was no increase in respiratory pathology (8 vs 6%, ns. One-third of the babies were separated from their mother during or after FCS.ConclusionUnplanned neonatal admissions after elective CS increased after implementing FCS, without an increase in respiratory morbidity or hypothermia. SpO2 monitoring might have a contribution. Separation from the mother occurred often.

  4. Clonidine versus tramadol for post spinal shivering during caesarean section: A randomized double blind clinical study

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    Velayudha S Reddy

    2011-01-01

    Full Text Available Background : Control of post spinal shivering is essential for optimal perioperative care, which can be achieved either by oral or parental medications. The present study is designed to evaluate the efficacy and safety of intravenous low-dose clonidine and tramadol in the treatment of post spinal shivering. Materials and Methods : In this prospective, a double blind, randomized study, 90 ASA grade I or II, parturients aged 18 - 35 years, undergoing caesarean section under spinal anaesthesia, who subsequently developed shivering grade 3 or 4, were randomized into two groups, to receive either clonidine or tramadol. The efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting, hypotension, bradycardia, dry mouth, sedation, skin rash and headache, if present, were recorded. All data were analyzed by using the Chi square test and the Z-test. Results : There were significant differences in the response rate between the drugs (P < 0.05. Time taken from the starting of treatment to cessation of shivering was significantly less with the tramadol group (P < 0.05, however, the frequency of nausea, vomiting, sedation and headache were also significantly more in the tramadol group Conclusion : In our study we concluded that both clonidine and tramadol control shivering. However, the response rate was higher and time taken to control shivering was lesser with tramadol, but the response rate and the side effects were lesser with clonidine.

  5. Use of oxytocin during Caesarean section at Princess Marina Hospital, Botswana: An audit of clinical practice

    Directory of Open Access Journals (Sweden)

    Billy M. Tsima

    2013-02-01

    Full Text Available Background: Oxytocin is widely used for the prevention of postpartum haemorrhage. In the setting of Caesarean section (CS, the dosage and mode of administrating oxytocin differs according to different guidelines. Inappropriate oxytocin doses have been identified ascontributory to some cases of maternal deaths. The main aim of this study was to audit the current standard of clinical practice with regard to the use of oxytocin during CS at a referral hospital in Botswana.Methods: A clinical audit of pregnant women having CS and given oxytocin at the time of the operation was conducted over a period of three months. Data included indications for CS, oxytocin dose regimen, prescribing clinician’s designation, type of anaesthesia for the CS and estimated blood loss.Results: A total of 139 case records were included. The commonest dose was 20 IU infusion (31.7%. The potentially dangerous regimen of 10 IU intravenous bolus of oxytocin was used in 12.9% of CS. Further doses were utilized in 57 patients (41%. The top three indications forCS were fetal distress (36 patients, 24.5%, dystocia (32 patients, 21.8% and a previous CS (25 patients, 17.0%. Estimated blood loss ranged from 50 mL – 2000 mL.Conclusion: The use of oxytocin during CS in the local setting does not follow recommended practice. This has potentially harmful consequences. Education and guidance through evidencebased national guidelines could help alleviate the problem.

  6. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons.

    Science.gov (United States)

    Ferraro, Federica; Piselli, Pierluca; Pittalis, Silvia; Ruscitti, Luca E; Cimaglia, Claudia; Ippolito, Giuseppe; Puro, Vincenzo

    2016-04-01

    Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive.

  7. [An Intravesical Foreign Body after Caesarean Section and Tissue Fixing System (TFS) Operation : Two Case Reports].

    Science.gov (United States)

    Mori, Kohei; Yanagisawa, Masahiro; Hirai, Kotaro

    2016-10-01

    Foreign body in the bladder is a relatively rare case. We encountered two cases of foreign bodies in the bladder after gynecological surgery. Case 1 was a 72-year-old woman. When she was 70 years old,an operation for her pelvic organ prolapse was performed. She visited our hospital because of discomfort in urination. We performed a transurethral lithotripsy of the bladder stone and detected a foreign body,and it was an anchor used for the Tissue Fixation System(TFS)operation (a pelvic organ prolapse operation). Case 2 was a 34-year-old woman. She delivered a baby by Caesarean section when she was 30 years old. She visited our hospital because of recurring urinary tract infection. The ultrasound examination of the bladder showed high echoic area in the posterior bladder wall. The cystoscope examination showed a small black foreign body that was protruding from the posterior wall of the bladder. The foreign body in the bladder was a surgical suture. The component of the suture was similar to silk. The foreign body in the bladder may have been the cause of infection. Artificial material used for an operation of an organ in the pelvic area sometimes slips into the bladder and causes inflammation. If a patient had undergone an operation for an organ in the pelvic area in the past,and there is recurring urinary tract infection,the presence of a foreign body in the bladder should be suspected.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Classifying cerebral palsy: are we nearly there?

    Science.gov (United States)

    Mandaleson, Avanthi; Lee, Yaozong; Kerr, Claire; Graham, H Kerr

    2015-03-01

    Cerebral palsy (CP) is the most common cause of physical disability in childhood in developed countries and encompasses a wide range of clinical phenotypes. Classification of CP according to movement disorder or topographical distribution is widely used. However, these classifications are not reliable nor do they accurately predict musculoskeletal pathology. More recently, the Gross Motor Function Classification System (GMFCS) has been introduced and its validity, reliability, and clinical utility have been confirmed. In 2005 it was suggested that children should be described and classified according to the GMFCS in all outcome studies involving children with CP, in the Journal of Pediatric Orthopaedics (JPO). This study aimed to describe utilization of the GMFCS in 3 journals: Journal of Bone and Joint Surgery (JBJS Am), JPO, and Developmental Medicine and Child Neurology (DMCN), over a 7-year period (2005 to 2011), and any relationship to the journal's impact factor. A secondary aim was to establish if differences in methodological quality existed between those studies utilizing GMFCS and those that did not. A targeted literature search of the 3 selected journals using the term "cerebral palsy" was conducted using the Medline database. Utilization of the GMFCS was assessed using report of these data in the methods or results section of the retrieved papers. The Methodological Index for Non-Randomized Studies (MINORS) was employed to evaluate the quality of papers published in JPO. One hundred and fifty-four studies met the inclusion criteria and in 85 (68%) the GMFCS was used. Of these, 112 were published in JPO, of which 51 (46%) utilized the GMFCS, compared with 72% for JBJS Am, and 88% for DMCN. In the JPO, utilization of the GMFCS improved from 13% to 80%, over the 7-year study period. Utilization of the GMFCS has increased rapidly over the past 7 years in the JPO but there is room for further improvement. Not applicable.

  10. Counting, Measuring And The Semantics Of Classifiers

    Directory of Open Access Journals (Sweden)

    Susan Rothstein

    2010-12-01

    Full Text Available This paper makes two central claims. The first is that there is an intimate and non-trivial relation between the mass/count distinction on the one hand and the measure/individuation distinction on the other: a (if not the defining property of mass nouns is that they denote sets of entities which can be measured, while count nouns denote sets of entities which can be counted. Crucially, this is a difference in grammatical perspective and not in ontological status. The second claim is that the mass/count distinction between two types of nominals has its direct correlate at the level of classifier phrases: classifier phrases like two bottles of wine are ambiguous between a counting, or individuating, reading and a measure reading. On the counting reading, this phrase has count semantics, on the measure reading it has mass semantics.ReferencesBorer, H. 1999. ‘Deconstructing the construct’. In K. Johnson & I. Roberts (eds. ‘Beyond Principles and Parameters’, 43–89. Dordrecht: Kluwer publications.Borer, H. 2008. ‘Compounds: the view from Hebrew’. In R. Lieber & P. Stekauer (eds. ‘The Oxford Handbook of Compounds’, 491–511. Oxford: Oxford University Press.Carlson, G. 1977b. Reference to Kinds in English. Ph.D. thesis, University of Massachusetts at Amherst.Carlson, G. 1997. Quantifiers and Selection. Ph.D. thesis, University of Leiden.Carslon, G. 1977a. ‘Amount relatives’. Language 53: 520–542.Chierchia, G. 2008. ‘Plurality of mass nouns and the notion of ‘semantic parameter”. In S. Rothstein (ed. ‘Events and Grammar’, 53–103. Dordrecht: Kluwer.Danon, G. 2008. ‘Definiteness spreading in the Hebrew construct state’. Lingua 118: 872–906.http://dx.doi.org/10.1016/j.lingua.2007.05.012Gillon, B. 1992. ‘Toward a common semantics for English count and mass nouns’. Linguistics and Philosophy 15: 597–640.http://dx.doi.org/10.1007/BF00628112Grosu, A. & Landman, F. 1998. ‘Strange relatives of the third kind

  11. Ensemble of classifiers based network intrusion detection system performance bound

    CSIR Research Space (South Africa)

    Mkuzangwe, Nenekazi NP

    2017-11-01

    Full Text Available This paper provides a performance bound of a network intrusion detection system (NIDS) that uses an ensemble of classifiers. Currently researchers rely on implementing the ensemble of classifiers based NIDS before they can determine the performance...

  12. Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.

    Science.gov (United States)

    Binfa, Lorena; Pantoja, Loreto; Ortiz, Jovita; Cavada, Gabriel; Schindler, Peter; Burgos, Rosa Ypania; Maganha E Melo, Célia Regina; da Silva, Lúcia Cristina Florentino Pereira; Lima, Marlise de Oliveira Pimentel; Hernández, Laura Valli; Schlenker Rm, Rosana; Sánchez, Verdún; Rojas, Mirian Solis; Huamán, Betty Cruz; Chauca, Maria Luisa Torres; Cillo, Alicia; Lofeudo, Susana; Zapiola, Sandra; Weeks, Fiona; Foster, Jennifer

    2016-09-01

    over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries. this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set. Maternity units from 6 Latin American countries. the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women. for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22

  13. 32 CFR 2400.31 - Destruction of classified information.

    Science.gov (United States)

    2010-07-01

    ... TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY INFORMATION SECURITY PROGRAM Safeguarding § 2400.31 Destruction of classified information. (a) Classified information... 32 National Defense 6 2010-07-01 2010-07-01 false Destruction of classified information. 2400.31...

  14. Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section: Experience of a single tertiary centre in Oman.

    Science.gov (United States)

    Gonsalves, Hazel; Al-Riyami, Nihal; Al-Dughaishi, Tamima; Gowri, Vaidayanathan; Al-Azri, Mohammed; Salahuddin, Ayesha

    2016-11-01

    This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Most women were 25-35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.

  15. Mosquitoes of Middle America.

    Science.gov (United States)

    1976-09-30

    adeloupe, 1964-1966. S Cova Garcia, Pablo, Division de Endemias Rurales, Ministerio de Sanidad y Asistencia Social , Mara- cay, Venezuela...Central America. Diaz Najerra , Alfonso, Laboratorio de En tomologia, Instituto de Salubridad y Enfermedades Trop- icales.— Mosquitoes of Mexico , loan of...Saneamiento Ambiental. Minister io de Sanidad y Asistencia Social , Caracas , Venezuela. — Organization of topotypic survey of mosquitoes in Vene zuela

  16. Cholera in the Americas.

    Science.gov (United States)

    1991-01-01

    The cholera epidemic 1st hit South America in January 1991 in the coastal town of Chancay, Peru. In 2 weeks, it spread over 2000 km of the Pacific coast. By the end of the 1st month, it had already reached the mountains and tropical forests. By August 1991, cholera cases were reported in order of appearances in Ecuador, Colombia, Chile, Brazil, the US, Mexico, Guatemala, Bolivia, and El Salvador. Health authorities still do not know how it was introduced into South America. The case fatality rate has remained at a low of 1%, probably due to the prompt actions of health authorities in informing the public of the epidemic and what preventive cautions should be taken. This epidemic is part of the 7th pandemic which originated in Celebes, Indonesia in 1961. Cholera can spread relatively unchecked in Latin America because sewage in urban areas is not treated even though they do have sewage collection systems. The untreated wastewater enters rivers and the ocean. Consumption of raw seafood is not unusual and has been responsible for cholera infection in some cases. In fact, many countries placed import restrictions on marine products from Peru following the outbreak at a loss of $US10-$US40 million. Municipal sewage treatment facilities, especially stabilization ponds, would prevent the spread of cholera and other pathogens. In rural areas, pit latrines located away from wells can effectively dispose of human wastes. Most water supplies in Latin America are not disinfected. Disinfection drinking water with adequate levels of chlorine would effectively destroy V. cholera. If this is not possible, boiling the water for 2-3 minutes would destroy the pathogen. Any cases of cholera must be reported to PAHO. PAHO has responded to the outbreak by forming a Cholera Task Force and arranged transport of oral rehydration salts, intravenous fluids, antibiotics, and other essential medical supplies.

  17. Bioeconomy in Latin America.

    Science.gov (United States)

    Sasson, Albert; Malpica, Carlos

    2018-01-25

    This article provides the authors' view on how Latin America has embraced bioeconomy principles in the last two decades with different levels of socio-economic impact. Examples of biodiversity resource valorization in medicine, eco-intensification of agriculture, biotechnology applications in mature sectors such as mining, food and beverage production, bio-refineries and ecosystem services are provided. The importance of participatory and social innovation initiatives is highlighted. Copyright © 2017. Published by Elsevier B.V.

  18. Western North America dynamics

    Science.gov (United States)

    Ghosh, A.; Becker, T. W.; Humphreys, G.; Gérault, M.

    2009-12-01

    Basal shear tractions, as generated by mantle convection, are likely to affect the stress field over western North America, and hence, influence the deformation of the North American lithosphere. Earlier studies (Humphreys & Coblentz (2007)) have argued for the importance of shear tractions beneath the continent, but at a reduced amplitude from those predicted by Becker & O'Connell (2001). However, these tractions did not take into account the existence of lateral viscosity variations (LVVs) beneath North America, resulting from strong cratonic root and weak plate margin. We evaluate the tractions and the resulting stresses over North America by incorporating LVVs in a global, high resolution, finite element convection code, CitcomS. Since our ultimate goal is to match observables, such as plate motions and geoid, in addition to stresses, we perform a global inversion for both radial and lateral viscosity variations and choose the viscosity structures that yield a good fit simultaneously to both the global geoid and plate motions. We evaluate the tractions and corresponding stress field from those models. We also attempt to incorporate the effects of gravitational potential energy (GPE) in our convection model. The combined stress field from GPE and tractions are compared to stress observations, such as the World Stress Map.

  19. [Comparison of pregnancy outcomes Caesarean techniques: modified Misgav-Ladach, Pfannenstiel-Kerr and Kerr-half infraumbilical].

    Science.gov (United States)

    Cardona-Osuna, M E; Avila-Vergara, M A; Peraza-Garay, F; Meneses-Valderrama, V; Flores-Pompa, E; Corrales-López, A

    2016-08-01

    In Mexico, the prevalence of caesarean section is 40.9% in the health sector, the techniques used are the traditional Pfannenstiel-Kerr and Kerr-half infraumbilical and little experience with this new technique Misgav-Ladach modified. To compare pregnancy outcomes (surgical and fetal extraction time, bleeding, postoperative pain, surgical wound infection, maternal and fetal death) caesarean section techniques modified Misgav-Ladach, Pfannenstiel-Kerr and infraumbilical. Clinical trial in primiparous women with term pregnancy treated at the Medical Unit of High Specialty 23 of the Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico. Misgav-Ladach caesarean Caesarean modified and Kerr, the latter subdivided into two groups: infraumbilical Pfannenstiel incision and incision half-Kerr two groups patients were randomized. 137 gilts were studied, with term pregnancy and BMI between 19 and 24.9 kg / m2. Caesarean modified Misgav-Ladach 68 patients and 69 classical Kerr (35 Pfannenstiel-Kerr and 34 infraumbilical) was performed. The surgical time in minutes was lower with modified Misgav-Ladach: 27.8 ± 8.0, Pfannenstiel-Kerr recorded 51.7 ± 12.1 and 12.0 ± infraumbilical media48.3 (p = 0.000). The time in seconds fetal extraction was lower in modified Misgav-Ladach: 96.2 ± 68.3, 474.9 ± Pfannenstiel-Kerr 294.1 and 423.2 ± 398.6 infraumbilical (p = 0.000). The trasoperatory milliliters bleeding was lower with modified Misgav-Ladach: 298.5 ± 57.3, 354.3 ± Pfannenstiel-Kerr 98.0 and 355.9 ± 110.6 infraumbilical (p = 0.001). Postoperative pain assessed with the visual analog scale in the first 24 hours was lower with modified Misgav-Ladach: 4.4 ± 1.9, 5.7 ± Pfannenstiel-Kerr and IK 2.1 6.1 ± 2.0 (p = 0.000). The start of the oral route and ambulation Nwas soon comparing modified Misgav-Ladach against Pfannenstiel-Kerr and Kerr-infraumbilical (p = 0.000). The prevalence of fever was 5.9% with modified Misgav-Ladach, 5.9% Pfannenstiel-Kerr and 32

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

    Science.gov (United States)

    Bamigboye, Anthony A; Hofmeyr, G Justus

    2014-08-11

    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. 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. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 November 2013). Randomised controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked it for accuracy. A total of 29 trials were included in this review and 21 trials (17,276 women) provided data that could be included in an analysis. The quality of the trials was variable. 1. Non-closure of visceral and parietal peritoneum versus closure of both parietal layersSixteen trials involving 15,480 women, were included and analysed, when both parietal peritoneum was left unclosed versus when both peritoneal surfaces were closed. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found between groups (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.76 to 1.29). There was significant reduction in the operative time (mean difference (MD) -5.81 minutes, 95% CI -7.68 to -3.93). The duration of hospital stay in a total of 13 trials involving 14,906 women, was also reduced (MD -0.26, 95% CI -0.47 to -0.05) days. In a trial involving 112 women, reduced chronic pelvic pain was found in the peritoneal non-closure group. 2. Non-closure of visceral peritoneum only versus closure of both peritoneal surfacesThree trials involving 889 women