An overview of the health economic implications of elective caesarean section.

Science.gov (United States)

Petrou, Stavros; Khan, Kamran

2013-12-01

The caesarean section rate has continued to increase in most industrialised countries, which raises a number of economic concerns. This review provides an overview of the health economic implications of elective caesarean section. It provides a succinct summary of the health consequences associated with elective caesarean section for both the infant and the mother over the perinatal period and beyond. It highlights factors that complicate our understanding of the health consequences of elective caesarean section, including inconsistencies in definitions and coding of the procedure, failure to adopt an intention-to-treat principle when drawing comparisons, and the widespread reliance on observational data. The paper then summarises the economic costs associated with elective caesarean section. Evidence is presented to suggest that planned caesarean section may be less costly than planned vaginal birth in some clinical contexts, for example where the singleton fetus lies in a breech position at term. In contrast, elective caesarean section (or caesarean section as a whole) appears to be more costly than vaginal delivery (either spontaneous or instrumented) in low-risk or unselected populations. The paper proceeds with an overview of economic evaluations associated with elective caesarean section. All are currently based on decision-analytic models. Evidence is presented to suggest that planned trial of labour (attempted vaginal birth) following a previous caesarean section appears to be a more cost-effective option than elective caesarean section, although its cost effectiveness is dependent upon the probability of successful vaginal delivery. There is conflicting evidence on the cost effectiveness of maternal request caesareans when compared with trial of labour. The paucity of evidence on the value pregnant women, clinicians and other groups in society place on the option of elective caesarean section is highlighted. Techniques that might be used to elicit

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....

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.

Exploring full cervical dilatation caesarean sections-A retrospective cohort study.

Science.gov (United States)

Corry, Edward M A; Ramphul, Meenakshi; Rowan, Ann M; Segurado, Ricardo; Mahony, Rhona M; Keane, Declan P

2018-05-01

The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit's electronic database for 2015. The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80-5.33 kg) vs 3.48 kg (1.53-4.40 kg)). There was no difference in neonatal morbidity. Fetal head malposition is

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 ...

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)

[Caesarean section with vacuum extraction of the head].

Science.gov (United States)

Dimitrov, A; Pavlova, E; Krŭsteva, K; Nikolov, A

2008-01-01

The aim of the study is to investigate the benefits and the limits in using the soft cup vacuum extractor on the fetal scalp during the caesarean section. The prospective study includes 19 cases of caesarean sections (group A), with vacuum assisted delivery using the soft cup vacuum extractor on the fetal scalp (diameter 6 cm) and 25 cases (group B) of caesarean sections with usual, manual extraction of the head assisted by fundal compression. All of the patients had undergone a planned caesarean section on term in absence of uterine activity and preserved amniotic membranes. Our results doesn't show differences in the Apgar score on the first and 5-th minute in the newborns of the two groups. The duration of the scalp traction was significantly shorter (30 +/- 4 sec) in comparison to the classical manual extraction (53 +/- 21 sec). The mean duration for applying the vacuum cup was 10 sec and 25 sec for tractions. The total blood loose and total duration of the caesarean sections were shorter than in the control group. The applied traction with the vacuum cup was sufficient for head extraction and there was no need for additional fundal compression. In conclusion we consider that the extraction of the fetal head in high position in caesarean section with vacuum extractor is an easy, non traumatic and rapid method which can put away the need of rough and prolonged fundal compression and its consequences.

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

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)

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

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

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 ...

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...... respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. CONCLUSION: Emergency caesarean section was not associated with childhood asthma. FUNDING: none. TRIAL REGISTRATION: not relevant.......: 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...

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)

Proportion of litters of purebred dogs born by caesarean section.

Science.gov (United States)

Evans, Katy M; Adams, Vicki J

2010-02-01

To describe the frequency of caesarean sections in a large sample of pedigree dogs in the UK. Data on the numbers of litters born in the previous 10 years were available from a cross-sectional study of dogs belonging to breed club members (2004 Kennel Club/BSAVA Scientific Committee Purebred Dog Health Survey). In this survey 151 breeds were represented with data for households that had reported on at least 10 litters (range 10-14,15): this represented 13,141 bitches which had whelped 22,005 litters. The frequency of caesarean sections was estimated as the percentage of litters that were reported to be born by caesarean section (caesarean rates) and are reported by breed. The dogs were categorised into brachycephalic, mesocephalic and dolicocephalic breeds. The 10 breeds with the highest caesarean rates were the Boston terrier, bulldog, French bulldog, mastiff, Scottish terrier, miniature bull terrier, German wirehaired pointer, Clumber spaniel, Pekingese and Dandie Dinmont terrier. In the Boston terrier, bulldog and French bulldog, the rate was > 80%. These data provide evidence for the need to monitor caesarean rates in certain breeds of dog.

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

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

African Journals Online (AJOL)

McRoy

2014-03-30

Mar 30, 2014 ... maintain the rates of caesarean section to a ... perception and attitude toward caesarean delivery are encouraging. ..... This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 ...

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

% of all Nordic deliveries. Information on the comparison population was retrieved from the national medical birth registers. Incidence rate ratios by previous caesarean delivery and intended mode of delivery after caesarean were modelled using Poisson regression. RESULTS: The incidence of uterine rupture......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 intended...... was 7.8/10 000 in Finland and 4.6/10 000 in Denmark. Rates of caesarean (21.3%) and previous caesarean deliveries (11.5%) were highest in Denmark, while the rate of intended vaginal delivery after caesarean was highest in Finland (72%). National rates of uterine rupture were not associated...

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.

Inter-institutional Variation in Use of Caesarean Delivery for Labour Dystocia.

Science.gov (United States)

Riddell, Corinne A; Hutcheon, Jennifer A; Strumpf, Erin C; Abenhaim, Haim A; Kaufman, Jay S

2017-11-01

To establish the degree of variation across hospitals in the use of Caesarean delivery for the indication of labour dystocia before and after accounting for maternal, fetal, and hospital characteristics. This study was a retrospective, population-based cohort study of nulliparous women delivering term singletons in cephalic position following labour. Delivery visits were extracted from three provincial perinatal registries in the Canadian provinces of Ontario, Alberta, and British Columbia, from 2008-2012. Crude hospital-specific rates of Caesarean delivery for labour dystocia were reported, and these rates were then stabilized to account for hospitals with low delivery volumes. Rates were then adjusted for maternal, fetal, and hospital characteristics using hierarchical logistic regression. Among 403 205 women delivering at 170 hospitals, the overall Caesarean delivery rate was 21.0%, and the rate of Caesarean delivery for labour dystocia was 12.7%, indicating that 60% of all Caesarean deliveries were performed in part for this indication. The middle 95% of hospitals had Caesarean delivery rates for labour dystocia ranging from 4.5% to 24.7%. Differences in maternal case mix and hospital characteristics explained only a small proportion of this variation (95% central range 6.3%-21.7%). Considerable inter-hospital variation in rates of Caesarean delivery for labour dystocia remained after accounting for differences in maternal and hospital factors. Reporting systems that monitor variation in inter-institutional rates should incorporate stabilization and adjustment for case-mix differences and consider indication-specific rates of Caesarean delivery to more fairly compare hospital performance and better target interventions to reduce Caesarean delivery for specific indications. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

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 ...

Should women be able to choose caesarean section?

African Journals Online (AJOL)

2006-04-26

Apr 26, 2006 ... important, including fun, fashion, education and my rights (not ... my opinion was formed. Caesareans: how many ... from the two Leeds Teaching Hospitals show that the rate in these ... high caesarean rates: the USA has a higher rate than the UK at ... Brazil that 'wins' with a rate of over 40%.1-5 It is unclear.

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....

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

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

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

Science.gov (United States)

Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola; Kristensen, Kim; Secher, Niels Jørgen

2017-01-01

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. 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. 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) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. Emergency caesarean section was not associated with childhood asthma. none. not relevant.

Post-caesarean analgesia: What is new?

Directory of Open Access Journals (Sweden)

Sukhyanti Kerai

2017-01-01

Full Text Available Adequate post-operative analgesia after caesarean section (CS is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.

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 ...

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 ...

Adaptation, postpartum concerns, and learning needs in the first two weeks after caesarean birth.

Science.gov (United States)

Weiss, Marianne; Fawcett, Jacqueline; Aber, Cynthia

2009-11-01

The purpose of this Roy Adaptation Model-based study was to describe women's physical, emotional, functional and social adaptation; postpartum concerns; and learning needs during the first two weeks following caesarean birth and identify relevant nursing interventions. Studies of caesarean-delivered women indicated a trend toward normalisation of the caesarean birth experience. Escalating caesarean birth rates mandate continued study of contemporary caesarean-delivered women. Mixed methods (qualitative and quantitative) descriptive research design. Nursing students collected data from 233 culturally diverse caesarean-delivered women in urban areas of the Midwestern and Northeastern USA between 2002-2004. The focal stimulus was the planned or unplanned caesarean birth; contextual stimuli were cultural identity and parity. Adaptation was measured by open-ended interview questions, fixed choice questionnaires about postpartum concerns and learning needs and nurse assessment of post-discharge problems. Potential interventions were identified using the Omaha System Intervention Scheme. More positive than negative responses were reported for functional and social adaptation than for physical and emotional adaptation. Women with unplanned caesarean births and primiparous women reported less favourable adaptation than planned caesarean mothers and multiparas. Black women reported lower social adaptation, Hispanic women had more role function concerns and Black and Hispanic women had more learning needs than White women. Post-discharge nursing assessments revealed that actual problems accounted for 40% of identified actual or potential problems or needs. Health teaching was the most commonly recommended postpartum intervention strategy followed by case management, treatment and surveillance interventions. Caesarean-delivered women continue to experience some problems with adapting to childbirth. Recommended intervention strategies reflect the importance of health teaching

The incidence of caesarean sections in the university clinical center of kosovo.

Science.gov (United States)

Elshani, Brikene; Daci, Armond; Gashi, Sanije; Lulaj, Shefqet

2012-12-01

As in most countries of the world also at Kosovo the rate of Cesarean section from year to year is increasing. The main purpose of this paper was to present the incidence of births completed by Caesarean section at the Clinic of Gynecology and Obstetrics of University Clinical Center of Kosovo in Prishtinë. This study is retrospective, namely its made by collecting epidemiological data from patients' histories that completed birth by Caesarean section for the period 2000-2006 in this clinic. During this period, 14 maternal deaths were recorded during or after Caesarean section. Besides this, 14 lethal outcomes, the object of our study was 84 mothers which completed birth by Caesarean section and which are best used as a control group. The average age of mothers who died during or after Caesarean section was 32.1 years (SD ± 4.9). Youngest in this group was 24 years old and oldest 42 years. While the average age of mothers from the control group was 30.6 years (SD ± 5.9). Youngest was 19 and oldest 43 years, without significant difference. Most mothers included in the survey had more than one indication for Caesarean section. The most frequent indication was PIH syndrome with 33.7% and previous Caesarean section in 32.7%. Then with the participation of 12.2% were abruption of the placenta and disproportio feto pelvinea, 11.2% pelvinea and placenta praevia presentation, 10.2% parturiens while other indications were much rarer with less than 10% participation. Based on this we can conclude that the risk of the Caesarean section is high.

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...

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.

International migration and caesarean birth: a systematic review and meta-analysis.

Science.gov (United States)

Merry, Lisa; Small, Rhonda; Blondel, Béatrice; Gagnon, Anita J

2013-01-30

Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences. Reports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a 'fatal flaw' according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed. Seventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth. Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.

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 ...

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 ...

'My pain was stronger than my happiness': experiences of caesarean births from Lebanon.

Science.gov (United States)

Kabakian-Khasholian, Tamar

2013-11-01

the rising trends in caesarean section have been partially attributed to women's requests. Many studies in developed and very few in developing countries have attempted to understand this phenomenon. This qualitative study explores experiences of women having caesarean section on demand in a middle-income country with a private health-care system. an inductive qualitative design, using face-to-face semi-structured interviews. women were identified and recruited through a perinatal database and selected obstetricians' clinics in the Greater Beirut area in Lebanon. a purposive sample of women who had a caesarean childbirth within the four months preceding the interview, were visited for an interview at home using a semi-structured interview guide. Thematic content analysis was conducted on a sub-sample of 22 women who requested a caesarean birth. lack of information about caesarean sections fosters women's fear from labour pain and acts as the main impetus for women to consider caesareans as the pain free alternative. Findings reveal health-care providers' role in reinforcing beliefs about caesarean sections being the way for pain free deliveries by overestimating the safety of the procedure and disregarding postpartum health issues. caesarean birth is presented to women as a safe option for 'pain free' childbirth. This needs to be considered within the cultural context of understanding safety and pain as well as the dynamics of power in maternity care. Health-care professionals need to explore these dimensions and promote women's informed choice as well as encouraging the normality of birth. Copyright © 2012 Elsevier Ltd. All rights reserved.

Elective Caesarean Section for Breech Presentation in First Pregnancy and Subsequent Mode of Labour

International Nuclear Information System (INIS)

Khaskheli, M.; Baloch, S.; Sheeba, A.

2014-01-01

Objective: To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. Study Design: A cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. Methodology: All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned proforma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. Results: Out of the total, 131 (16.92%) women had previous elective caesarean section due to breech presentation while 643 (83.07%) women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 (70.22%) in women with previous breech presentation (n=131) in comparison with 475 (73.87%) women with previous cephalic presentation n=643 (RR=1.04, p=0.32). The vaginal birth rate after elective caesarean section due to breech presentation was 39 (29.77%) in comparison with 168 (26.12%) cases with previous cephalic presentation (RR=0.98, p=0.83). Conclusion: Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section. (author)

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.

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....

Caesarean section and asthma in Malaysian children: a case-control study.

Science.gov (United States)

Nathan, Anna Marie; de Bruyne, Jessie; Khalid, Farah; Arumugam, Kulantheran

2012-09-01

Birth cohort studies in some countries have shown a link between caesarean section and asthma. To determine if there is an association between asthma and delivery via caesarean section in Malaysian children. This is a case-control study involving 156 children aged 3-15 years old, in a tertiary hospital in Kuala Lumpur, Malaysia. Seventy-eight children with a confirmed diagnosis of asthma and seventy-eight age-matched controls (no history of asthma or wheezing) were enrolled. Demographic data including mode of delivery and family history of allergic disorders was obtained. Total serum immunoglobulin E (IgE) was measured and skin prick tests (SPT) to 6 common aeroallergens were performed. The median age of the patients was 8 years old. One hundred and three (66%) children were delivered via normal vaginal delivery, 8 (5.1%) via assisted vaginal delivery and 45 children (28.9%) via caesarean section. Delivery via caesarean section was not significantly associated with asthma (OR = 1.21 [95% CI 0.60-2.41], p = 0.596). Children delivered via caesarean section did not have higher IgE levels nor were they more sensitized to aeroallergens. Multiple logistic regression showed that asthma was significantly associated with a positive family history of atopy (OR = 13.8 [95% CI 5.96, 32.1], p food after 6 months old had a protective effect against asthma (OR = 0.97 [95% CI 0.94, 0.99], p = 0.034). Childhood asthma in Malaysian children was not associated with delivery by caesarean section.

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.

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.

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

Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC).

Science.gov (United States)

Marcotte, Erin L; Thomopoulos, Thomas P; Infante-Rivard, Claire; Clavel, Jacqueline; Petridou, Eleni Th; Schüz, Joachim; Ezzat, Sameera; Dockerty, John D; Metayer, Catherine; Magnani, Corrado; Scheurer, Michael E; Mueller, Beth A; Mora, Ana M; Wesseling, Catharina; Skalkidou, Alkistis; Rashed, Wafaa M; Francis, Stephen S; Ajrouche, Roula; Erdmann, Friederike; Orsi, Laurent; Spector, Logan G

2016-04-01

Results from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery. We pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis. The studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]). Our results suggest an increased risk of

Caesarean section greatly increases risk of scar endometriosis.

Science.gov (United States)

Nominato, Nilo Sérgio; Prates, Luis Felipe Victor Spyer; Lauar, Isabela; Morais, Jaqueline; Maia, Laura; Geber, Selmo

2010-09-01

To estimate the incidence of scar endometriosis after different surgical procedures. A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

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.

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 ...

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.

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.

Emergency inevitable caesarean myomectomy, challenge to ...

African Journals Online (AJOL)

Emergency inevitable caesarean myomectomy, challenge to obstetrician/ ... CASE REPORT Mrs BD is a 34-year-old unbooked G1 Para 0+0 at 38 weeks' gestation ... Obstetric ultrasound done on admission were in keeping with above clinical ...

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

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

Caesarean section in Eisenmenger's syndrome: anaesthetic ...

African Journals Online (AJOL)

pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger's syndrome.

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 ...

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

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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.

Caesarean section wound infiltration with ropivacaine versus ...

African Journals Online (AJOL)

Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up. ... South African Journal of Obstetrics and Gynaecology. Journal Home · ABOUT THIS JOURNAL · Advanced Search ...

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.

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

Thirty years of the World Health Organization's target caesarean section rate: time to move on.

Science.gov (United States)

Robson, Stephen J; de Costa, Caroline M

2017-03-06

It has been 30 years since the World Health Organization first recommended a "maximum" caesarean section (CS) rate of 15%. There are demographic differences across the 194 WHO member countries; recent analyses suggest the optimal global CS rate is almost 20%. Attempts to reduce CS rates in developed countries have not worked. The strongest predictor of caesarean delivery for the first birth of "low risk" women appears to be maternal age; a factor that continues to increase. Most women whose first baby is born by caesarean delivery will have all subsequent children by caesarean delivery. Outcomes that informed the WHO recommendation primarily relate to maternal and perinatal mortality, which are easy to measure. Longer term outcomes, such as pelvic organ prolapse and urinary incontinence, are closely related to mode of birth, and up to 20% of women will undergo surgery for these conditions. Pelvic floor surgery is typically undertaken for older women who are less fit for surgery. Serious complications such as placenta accreta occur with repeat caesarean deliveries, but the odds only reach statistical significance at the third or subsequent caesarean delivery. However, in Australia, parity is falling, and only 20% of women will have more than two births. We should aim to provide CS to women in need and to continue including women in the conversation about the benefits and disadvantages, both short and long term, of birth by caesarean delivery.

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.

Anaesthetic consideration for caesarean delivery of a parturient without ′The Master Gland′

Directory of Open Access Journals (Sweden)

Tuhin Mistry

2015-01-01

Full Text Available We are presenting the management of a patient posted for elective caesarean delivery who conceived after ovulation induction and in vitro fertilisation, 20 years after postsurgical hypopituitarism. She had uneventful pregnancy and delivered a healthy baby by caesarean section under general anaesthesia.

The efficacy and safety of external cephalic version after a previous caesarean delivery.

Science.gov (United States)

Weill, Yishay; Pollack, Raphael N

2017-06-01

External cephalic version (ECV) in the presence of a uterine scar is still considered a relative contraindication despite encouraging studies of the efficacy and safety of this procedure. We present our experience with this patient population, which is the largest cohort published to date. To evaluate the efficacy and safety of ECV in the setting of a prior caesarean delivery. A total of 158 patients with a fetus presenting as breech, who had an unscarred uterus, had an ECV performed. Similarly, 158 patients with a fetus presenting as breech, and who had undergone a prior caesarean delivery also underwent an ECV. Outcomes were compared. ECV was successfully performed in 136/158 (86.1%) patients in the control group. Of these patients, 6/136 (4.4%) delivered by caesarean delivery. In the study group, 117/158 (74.1%) patients had a successful ECV performed. Of these patients, 12/117 (10.3%) delivered by caesarean delivery. There were no significant complications in either of the groups. ECV may be successfully performed in patients with a previous caesarean delivery. It is associated with a high success rate, and is not associated with an increase in complications. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Predicting spinal hypotension during Caesarean section

African Journals Online (AJOL)

There is a significant body of recent work which has looked at the haemodynamic changes which occur under spinal anaesthesia and the effects of various treatment regimens on these changes. It has long been held that the dominant mechanism of hypotension in the patient for Caesarean section is caval compression.9.

Perimortem caesarean section following maternal gunshot wounds

Directory of Open Access Journals (Sweden)

Ozlem Gunevsel

2011-01-01

Full Text Available Perimortem caesarean section is an ethically difficult decision for emergency medicine resuscitation teams. A 34-years-old woman was attacked by her husband with a gunshot. At the time arrival to the emergency room, there was no pulse, no spontaneous breath and blood pressure was unobtainable. Although extensive advanced cardiopulmonary resuscita-tion was performed for 7 minutes, no cardiac activity was regained. During the cardiopulmonary resuscitation efforts, an abdominal ultrasonography was performed and revealed a fetal heart rate with bradycardia. Low segment caesarean section was performed by the obstetrician in the resuscitation room and a female newborn was delivered within less than one minute of the skin incision. Decision on terminating the CPR efforts should not be made in maternal cardiac arrests older than 28 weeks′ gestational age, unless the viability of the fetus had been evaluated.

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth.

Science.gov (United States)

Shimoni, Zvi; Kama, Naama; Mamet, Yaakov; Glick, Joseph; Dusseldorp, Natan; Froom, Paul

2009-11-01

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth. This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth. Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates. In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test. The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P rates decreased from 16.8% (186/1104) to 12.6% (137/1089) after the intervention (relative risk 0.75, 95% confidence interval, 0.61-0.92). Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections.

Anaesthesia Management of Caesarean Section in Two Patients with Eisenmenger's Syndrome

Directory of Open Access Journals (Sweden)

G. Fang

2011-01-01

Full Text Available Recently two parturients with Eisenmenger's syndrome underwent caesarean section at our hospital. They were managed by a multidisciplinary team during their perioperative period. The caesarean sections were uneventfully performed, one under general anaesthesia and one with epidural anaesthesia, with delivery of two newborns with satisfactory Apgar scores. One patient died in the post-partum period, and the other did well. We discuss the anaesthetic considerations in managing these high-risk patients.

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

Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean.

Science.gov (United States)

Horey, Dell; Kealy, Michelle; Davey, Mary-Ann; Small, Rhonda; Crowther, Caroline A

2013-07-30

only would have been eligible for inclusion if data were able to be extracted. Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies. Data were checked for accuracy. We contacted authors of included trials for additional information. All included interventions were classified as independent, shared or mediated decision supports. Consensus was obtained for classifications. Verification of the final list of included studies was undertaken by three review authors. Three randomised controlled trials involving 2270 women from high-income countries were eligible for inclusion in the review. Outcomes were reported for 1280 infants in one study. The interventions assessed in the trials were designed to be used either independently by women or mediated through the involvement of independent support. No studies looked at shared decision supports, that is, interventions designed to facilitate shared decision-making with health professionals during clinical encounters.We found no difference in planned mode of birth: VBAC (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.97 to 1.10; I² = 0%) or caesarean birth (RR 0.96, 95% CI 0.84 to 1.10; I² = 0%). The proportion of women unsure about preference did not change (RR 0.87, 95% CI 0.62 to 1.20; I² = 0%).There was no difference in adverse outcomes reported between intervention and control groups (one trial, 1275 women/1280 babies): permanent (RR 0.66, 95% CI 0.32 to 1.36); severe (RR 1.02, 95% CI 0.77 to 1.36); unclear (0.66, 95% CI 0.27, 1.61). Overall, 64.8% of those indicating preference for VBAC achieved it, while 97.1% of those planning caesarean birth achieved this mode of birth. We found no difference in the proportion of women achieving congruence between preferred and actual mode of birth (RR 1.02, 95% CI 0.96 to 1.07) (three trials, 1921 women).More women had caesarean births (57.3%), including 535 women where it was unplanned (42.6% all

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.

Factors associated with women's intention to request caesarean ...

African Journals Online (AJOL)

audit meetings, engaging mothers in the decision-making process ..... The findings regarding the influence of advanced maternal age, .... emergency caesarean section: A quality assurance analysis by criterion-based audit at two Tanzanian.

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.

Factors associated with women's intention to request caesarean ...

African Journals Online (AJOL)

audit meetings, engaging mothers in the decision-making process ..... of a relatively lower quality of service in these facilities compared with. MNH. .... emergency caesarean section: A quality assurance analysis by criterion-based audit at two ...

Caesarean section – desired rate versus actual need

African Journals Online (AJOL)

Arun Kumar Agnihotri

2016-03-11

Mar 11, 2016 ... If conducted when medically justified, a caesarean section can effectively prevent ... vested interests.4 This lifesaving procedure can be a cause of short and long term ... nervous system depression among infants delivered by ...

[Thinking about the evolution of caesarean section rate at University Teaching Hospital of Dakar between 1992 and 2001].

Science.gov (United States)

Cissé, C-T; Ngom, P-M; Guissé, A; Faye, E-O; Moreau, J-C

2004-03-01

The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar? This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%. Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis. Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

Determinants of caesarean section in Lebanon: geographical differences.

Science.gov (United States)

Carayol, Marion; Zein, Ali; Ghosn, Nada; Du Mazaubrun, Christiane; Breart, Gérard

2008-03-01

This study, based on the Lebanese National Perinatal Survey which included 5231 women, examined the relations between the caesarean section (CS) rate and the characteristics of mothers, children, antenatal care and maternity units in two geographical zones of Lebanon (Beirut-Mount Lebanon and the rest of the country) and then looked at geographical variations. This analysis concerned 3846 women with singleton pregnancies and livebirths at low risk of CS, after exclusion of women with a previous CS, non-cephalic fetal presentations, or delivery before 37 weeks' gestation. The principal end point was caesarean delivery. The relations between the factors studied and CS were estimated by odds ratios (OR), both crude and adjusted, using logistic regression. The rate of CS was higher in the Beirut-Mount Lebanon zone than elsewhere (13.4% vs. 7.6%). After adjustment, several factors remained associated with caesarean delivery in each zone. Common factors were primiparity, gestational age > or = 41 weeks and antenatal hospitalisation. Factors identified only in the Beirut-Mount Lebanon zone were obstetric history and insurance coverage, whereas for the other zones we only found major risk factors for obstetric disease: maternal age > or = 35 years, number of antenatal consultations > or = 4 and birthweight Lebanon (OR = 1.80 [95% CI 1.09, 2.95]). In conclusion, the CS rates in Lebanon were high, with geographical differences that were associated with access to care and with obstetric practices.

CAESAREAN SECTION RATE AT FEDERAL MEDICAL CENTRE ...

African Journals Online (AJOL)

EagleMarkRes

Materials and Method: A three year retrospective study from January 2010 to December 2012 involving all women who had caesarean delivery at the Federal Medical ... knowledge of women and increase safety about the procedure; the CS rate .... centres in Nigeria, where resident doctors on training are allowed to perform ...

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...... 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...

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)

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.

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

International Nuclear Information System (INIS)

Shaheen, N.; Khalil, S.; Iftikhar, P.

2014-01-01

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

THE INCIDENCE OF CAESAREAN SECTIONS IN THE UNIVERSITY CLINICAL CENTER OF KOSOVO

OpenAIRE

Elshani, Brikene; Daci, Armond; Gashi, Sanije; Lulaj, Shefqet

2012-01-01

Introduction: As in most countries of the world also at Kosovo the rate of Cesarean section from year to year is increasing. Aim: The main purpose of this paper was to present the incidence of births completed by Caesarean section at the Clinic of Gynecology and Obstetrics of University Clinical Center of Kosovo in Prishtin?. Material and methods: This study is retrospective, namely its made by collecting epidemiological data from patients? histories that completed birth by Caesarean section ...

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Directory of Open Access Journals (Sweden)

Yasmin Adam

2018-05-01

Full Text Available Abstract:Background:A systematic review concluded that a caesarean section that is performed for medical indications will save lives, but is associated with short and long term complications. The caesarean section rate at CHBAH was 39.78% in 2015. Objectives:To evaluate the indications for caesarean section.Methods:This was a cross-sectional study  in the week 23rd June to the 29th June 2015. Each file was  evaluated for the  correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessmen.Results:The mean age was 27.01 (6.35; range- 15-44. The median parity was 1(IQR=0-2; range=0-4. No co-morbdities was found in 20 (13.61%. Complications occurred in 25 (17.01% women. The median gestational age at delivery was 38.14 (IQR=36.39-40.14; range-28.0-42.4. The median Apgar (5 min was 10 (IQR=9-10; range- 0-10. The median birth weight was 3040 g (IQR=2530-3440; range- 825-4575 g. The most common indications were fetal distress (n=73; 49.66% and dystocia (n=42; 28.57%. There was absolute agreement between the 2 reviewers in the following; retained 2nd twin, APH of unknown origin, placenta previa, severe IUGR, multiple pregnancy, abnormal presentation, eclampsia, two caesarean sections. When the indication was fetal distress, dystocia, 2nd stage caesarean section, or with 1 previous caesarean the absolute agreement was between 73.85% and 90.24%.Conclusion:There were  few absolute disagreements with the indication. There needs to be an evaluation of methods to diagnose fetal distress and dystocia.  

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

African Journals Online (AJOL)

AJRH Managing Editor

ultrasound guided approach with dilatation of uterine cervix and subsequent evacuation of uterine ... Keywords: caesarean scar pregnancy, transrectal ultrasound guided surgical approach. ... a viable embryo with a crown rump length (CRL).

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 ...

The immediate effect of vaginal and caesarean delivery on anal sphincter measurements.

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Karcaaltincaba, Deniz; Erkaya, Salim; Isik, Hatice; Haberal, Ali

2016-08-01

This study evaluated the effects of vaginal and caesarean delivery on internal and external anal sphincter muscle thickness using translabial ultrasonography (TL-US). This prospective cohort study enrolled nulliparous women who either had vaginal or caesarean deliveries. The thickness of the hypoechoic internal anal sphincter (IAS) and hyperechoic external anal sphincter (EAS) at the 12, 3, 6, and 9 o'clock positions at the distal level were measured before delivery and within 24-48 h after delivery. A total 105 consecutive women were enrolled in the study: 60 in the vaginal delivery group and 45 in the caesarean delivery group. The IAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.31 ± 0.74 mm versus 1.81 ± 0.64 mm, respectively). The EAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.42 ± 0.64 mm versus 1.97 ± 0.85, respectively). There was significant muscle thinning of both the IAS and EAS at the 12 o'clock position after vaginal delivery, but not after caesarean delivery. © The Author(s) 2016.

Assessment of block height for satisfactory spinal anaesthesia for caesarean section.

Science.gov (United States)

Ousley, R; Egan, C; Dowling, K; Cyna, A M

2012-12-01

We investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch, pinprick, first cold and icy were: T10 (T7-T12 [T3-L1]); T5 (T4-T6 [C7-L1]); T5 (T4-T6 [C7-L1]); and T3 (T2-T4 [C7-L1]), respectively. Modalities were significantly correlated for: touch and cold, p = 0.0001; touch and icy, p = 0.0007; touch and pinprick, p = 0.0018; cold and icy, p satisfactory anaesthesia despite 76 (81%) having a block to touch below T6. Single modality assessment of block height, particularly using touch, may erroneously indicate inadequate anaesthesia for caesarean section. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Can classic metaphyseal lesions follow uncomplicated caesarean section?

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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.)

Can classic metaphyseal lesions follow uncomplicated caesarean section?

International Nuclear Information System (INIS)

O'Connell, AnnaMarie; Donoghue, Veronica B.

2007-01-01

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.)

Caesarean section in Ancient Greek mythology.

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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.

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 ...

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.

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

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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.

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.

Ectopic pregnancy in a Caesarean section scar: a case study

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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.

Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?

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Halvorsen, Lotta; Nerum, Hilde; Sørlie, Tore; Oian, Pål

2010-02-01

the attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth ('coping attitude'), and the other emphasised that the ultimate choice of mode of birth was the womans' ('autonomy attitude'). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an 'autonomy attitude' to a 'coping attitude' increase the number of women who change their request for a caesarean and who give birth vaginally? the study population consisted of two samples of pregnant women with fear of birth and concurrent request for a caesarean, referred for crisis-oriented counselling at the antenatal clinic, University Hospital of North Norway between 2000-2002 (n=86) and 2004-2006 (n=107). Data were gathered from referral letters, counseling and antenatal, intra- and postpartum records. a coping attitude of the counsellor was positively associated with change in the request for a caesarean and with vaginal birth. A change from an autonomy attitude to a coping attitude was associated with a significant increase in the percentage of women who changed their desire for a caesarean from 77 to 93, and who had a vaginal birth from 42 to 81. a coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results. Copyright 2008 Elsevier Ltd. All rights reserved.

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

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Rodrigo M. Carrillo-Larco

2015-06-01

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

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

Science.gov (United States)

Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

2015-01-01

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

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.

blood transfusion requirement during caesarean delivery: risk factors

African Journals Online (AJOL)

Factors predisposing to increased risk for blood transfusion identified from previous ... This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. ... study which could fall into either of the following conditions: satisfactory post- operative clinical status up to 48 hours ...

STUDY CONCERNING THE COSTS OF BIRTH BY CAESAREAN SECTION COMPARED TO NATURAL BIRTH

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Diana UIVAROȘAN

2016-12-01

Full Text Available The birth by caesarean section has become an expanding phenomenon in the recent years, natural births being more and more rare in Romania. The increasing incidence of these operations has been observed in the recent years, in the conditions of more effective fetal monitoring, modification of the malpractice law and increasing degree of information of the women. In Romania, depending on the hospital, the percentage of births by caesarean section ranges between 20-80%, even 90% (these latter percentage being valid especially in private clinics. The percentage of the operations is higher in big cities, and in Bucharest about 70% of the births are done by C-section. The World Health Organization recommends a maximum percentage surgical intervention of 10-15%. Fearing the labor pain, more and more women are choosing to bring their children into the world by Caesarean section. Also the number of doctors who claim that cesarean section is a better option is increasing. Both persons involved in the birth process have the responsibility of that decision - meaning both mother and doctor. The option of the mother is very important, but the recommendation of the doctor can make the difference. The decision is not only of the doctor, he just presents the information that the mother does not know, mother's wish being the most important. In this paper we conducted a study to determine the comparative costs of the vaginal births with those by Caesarean section. The retrospective study was conducted between 01.01.2015 - 31.12.2015, on 3607 births registered in the Obstetrics and Gynecology Clinics of Clinical Emergency County Hospital Oradea. Gemellary births were excluded from the study. We analyzed the comparative costs of a vaginal birth and of a birth by caesarean section in order to highlight the share of cesarean births compared to vaginal births.

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.

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

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data.

Science.gov (United States)

Ye, J; Zhang, J; Mikolajczyk, R; Torloni, M R; Gülmezoglu, A M; Betran, A P

2016-04-01

Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. Ecological study using longitudinal data. Worldwide country-level data. A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio-economic development by means of human development index (HDI) using fractional polynomial regression models. Maternal mortality ratio and neonatal mortality rate. Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5-10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality. The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality. © 2015 The Authors

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 ...

perspectives on the practice of vaginal birth after caesarean section

African Journals Online (AJOL)

2010-08-08

Aug 8, 2010 ... INTRODUCTION. The overall rate of Caesarean birth is increasing worldwide with wide geographical variations from the developing countries and industrialised nations .... The distribution of the respondents by professional.

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...

External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section.

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Hussin, O A; Mahmoud, M A; Abdel-Fattah, M M

2013-02-01

The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version (ECV) and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif, Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited. ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally (84.1%) and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section (62.7%). Successful ECV reduced the breech and caesarean section rate.

Going public: do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?

Science.gov (United States)

Miller, Yvette D; Prosser, Samantha J; Thompson, Rachel

2012-10-01

women who birth in private facilities in Australia are more likely to have a caesarean birth than women who birth in public facilities and these differences remain after accounting for sector differences in the demographic and health risk profiles of women. However, the extent to which women's preferences and/or freedom to choose their mode of birth further account for differences in the likelihood of caesarean birth between the sectors remains untested. women who birthed in Queensland, Australia during a two-week period in 2009 were mailed a self-report survey approximately 3 months after birth. Seven hundred and fifty-seven women provided cross-sectional retrospective data on where they birthed (public or private facility), mode of birth (vaginal or caesarean) and risk factors, along with their preferences and freedom to choose their mode of birth. A hierarchical logistic regression was conducted to determine the extent to which maternal risk and freedom to choose one's mode of birth explain sector differences in the likelihood of having a caesarean birth. while there was no sector difference in women's preference for mode of birth, women who birthed in private facilities had higher odds of feeling able to choose either a vaginal or caesarean birth, and feeling able to choose only a caesarean birth. Women had higher odds of having caesarean birth if they birthed in private facilities, even after accounting for significant risk factors such as age, body mass index, previous caesarean and use of assisted reproductive technology. However, there was no association between place of birth and odds of having a caesarean birth after also accounting for freedom to choose one's mode of birth. these findings call into question suggestions that the higher caesarean birth rate in the private sector in Australia is attributable to increased levels of obstetric risk among women birthing in the private sector or maternal preferences alone. Instead, the determinants of sector

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.

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.

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

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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

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.

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.

Does amnioinfusion reduce caesarean section rate in meconium-stained amniotic fluid.

Science.gov (United States)

Choudhary, Deepti; Bano, Imam; Ali, S M

2010-07-01

The purpose of our study was to evaluate the safety and efficacy of transcervical amnioinfusion during labour complicated by meconium-stained amniotic fluid, in a setting with limited peripartum facilities, to lower the incidence of caesarean section. A prospective study was conducted in a teaching hospital in north India, which enrolled 292 patients admitted in labour. Patients were randomly divided into two groups after taking their consent. One group received transcervical amnioinfusion, whilst in the other group amnioinfusion was not done. Caesarean sections were performed in either group if there were foetal heart rate abnormalities (bradycardia or irregularity for 10-20 min) or slow progress of labour. The outcomes studied were the incidence of caesarean sections, duration of maternal hospital stay, maternal febrile morbidity (temperature of >38 degrees C, 24 h after delivery), low Apgar score (at 1 and 5 min), respiratory death, MAS and perinatal mortality. There was a statistically significant reduction in the incidence of caesarean sections in the study group compared to the control group (31 vs. 61%). Amnioinfusion was associated with improved neonatal outcome as evidenced by statistically improved Apgar score at 1 min in newborns in the study group compared to the control group (10 vs. 37.2%). Amnioinfusion during labour was not associated with any significant maternal and neonatal complications. The mean hospital stay of the mother was decreased significantly in the study group patients compared to the control group. Transcervical amnioinfusion in labour for meconium-stained amniotic fluid is a simple, safe and easy-to-perform procedure. It can be performed safely in a setup with limited peripartum facilities, especially in developing countries, to decrease intrapartum operative intervention and reduce foetomaternal morbidity and mortality.

[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

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...

Management of emergency caesarean section in a patient with decompensated critical aortic stenosis

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Andrew C Leatherbarrow

2018-01-01

Full Text Available Increasing numbers of congenital heart disease patients are now surviving to child bearing age. This complex patient cohort present a great challenge to the obstetric anaesthetist and multidisciplinary teams. This report describes a rare case of a patient undergoing emergency caesarean section at 31 weeks gestation due to decompensated critical congenital aortic stenosis. The physiological effects of pregnancy in patients with aortic stenosis are discussed along with principles of managing anaesthesia for caesarean section in the presence of this cardiac lesion.

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

Science.gov (United States)

Jikijela, Thobeka P; James, Sindiwe; Sonti, Balandeli S I

2018-01-30

The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis. Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different. 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.

Does a Caesarean section increase the time to a second live birth? A register-based cohort study.

Science.gov (United States)

O'Neill, Sinéad M; Khashan, Ali S; Henriksen, Tine B; Kenny, Louise C; Kearney, Patricia M; Mortensen, Preben B; Greene, Richard A; Agerbo, Esben

2014-11-01

Does a primary Caesarean section influence the rate of, and time to, subsequent live birth compared with vaginal delivery? Caesarean section was associated with a reduction in the rate of subsequent live birth, particularly among elective and maternal-requested Caesareans indicating maternal choice plays a role. Several studies have examined the relationship between Caesarean section and subsequent birth rate with conflicting results primarily due to poor epidemiological methods. This Danish population register-based cohort study covered the period from 1982 to 2010 (N = 832 996). All women with index live births were followed until their subsequent live birth or censored (maternal death, emigration or study end) using Cox regression models. In all 577 830 (69%) women had a subsequent live birth. Women with any type of Caesarean had a reduced rate of subsequent live birth (hazard ratio [HR] 0.86, 95% confidence intervals [CI] 0.85, 0.87) compared with spontaneous vaginal delivery. This effect was consistent when analyses were stratified by type of Caesarean: emergency (HR 0.87, 95% CI 0.86, 0.88), elective (HR 0.83, 95% CI 0.82, 0.84) and maternal-requested (HR 0.61, 95% CI 0.57, 0.66) and in the extensive sub-analyses performed. Lack of biological data to measure a woman's fertility is a major limitation of the current study. Unmeasured confounding and limited availability of data (maternal BMI, smoking, access to fertility services and maternal-requested Caesarean section) as well as changes in maternity care over time may also influence the findings. This is the largest study to date and shows that Caesarean section is most likely not causally related to a reduction in fertility. Maternal choice to delay or avoid childbirth is the most plausible explanation. Our findings are generalizable to other middle- to high-income countries; however, cross country variations in Caesarean section rates and social or cultural differences are acknowledged. Funding was

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

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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

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 ...

Intravenous Magnesium Sulphate for Analgesia after Caesarean Section: A Systematic Review

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Andrew McKeown

2017-01-01

Full Text Available Objective. To summarise the evidence for use of intravenous magnesium for analgesic effect in caesarean section patients. Background. Postcaesarean pain requires effective analgesia. Magnesium, an N-methyl-D-aspartate receptor antagonist and calcium-channel blocker, has previously been investigated for its analgesic properties. Methods. A systematic search was conducted of PubMed, Scopus, MEDLINE, Cochrane Library, and Google Scholar databases for randomised-control trials comparing intravenous magnesium to placebo with analgesic outcomes in caesarean patients. Results. Ten trials met inclusion criteria. Seven were qualitatively compared after exclusion of three for unclear bias risk. Four trials were conducted with general anaesthesia, while three utilised neuraxial anaesthesia. Five of seven trials resulted in decreased analgesic requirement postoperatively and four of seven resulted in lower serial visual analogue scale scores. Conclusions. Adjunct analgesic agents are utilised to improve analgesic outcomes and minimise opioid side effects. Preoperative intravenous magnesium may decrease total postcaesarean rescue analgesia consumption with few side effects; however, small sample size and heterogeneity of methodology in included trials restricts the ability to draw strong conclusions. Therefore, given the apparent safety and efficacy of magnesium, its role as an adjunct analgesic in caesarean section patients should be further investigated with the most current anaesthetic techniques.

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

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......-analysis with a pooled risk estimate because of a variety of methodological differences between the studies. The overall risk for respiratory morbidity, however, seemed to increase about 2 to 3 times, though some studies presented much higher risk estimates. A decreasing risk with increasing gestational age was shown...

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...

Ropivacaine 7.5 mg/mL for Caesarean Section

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N. K. Nguyen

2010-01-01

Full Text Available Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group and group C (control group. All parturients also received spinal sufentanil (2.5 g. Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with <.05, especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min ± 2 h 26 for group R versus 2 h 42 ± 1 h 30 for group C. The P values for the two groups were: <.0001 for paracetamol, <.0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

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

OBJECTIVE: To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. DESIGN: Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark. SETTING: Obstetric department...... and neonatal department of a university hospital in Denmark. PARTICIPANTS: All liveborn babies without malformations, with gestational ages between 37 and 41 weeks, and delivered between 1 January 1998 and 31 December 2006 (34 458 babies). MAIN OUTCOME MEASURES: Respiratory morbidity (transitory tachypnoea...

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

African Journals Online (AJOL)

private hospitals on the basis of higher estimated value of range (R = 0.134) but a higher ... of private hospitals may be contributory factors to the caesarean section rates in private health facilities. ... Expanded fetal indications, law and rules concerning medical liability and development ...... hospitals in Malaysia 2006.

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...

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.

Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2

OpenAIRE

Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

2011-01-01

We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obs...

Successful external cephalic version is an independent factor for caesarean section during trial of labor - a matched controlled study.

Science.gov (United States)

Boujenah, J; Fleury, C; Bonneau, C; Pharisien, I; Tigaizin, A; Carbillon, L

2017-12-01

To assess the mode of delivery and Caesarean Section (CS) rate after successful External Cephalic Version (ECV). A matched case-control study. Data were gathered from a tertiary care university hospital register from 1996-2015. All pregnant women who delivered after successful External Cephalic Version (ECV). Among 643 women who attempted ECV, we identified 198 with successful ECVs and compared them with the next two women who presented for labor management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index, and delivery history using univariate and stepwise logistic regression. The main outcome measure was the risk of caesarean. The caesarean section rate was higher after successful ECV (respectively 20.7% versus 7.07%, P<0.05). Caesarean section for abnormal fetal head position (forehead, bregma, face) was higher after successful ECV (28.6% versus 0%). After adjustment for matching and confounding variables (variation of the caesarean section rate over the study period, gestational maternal complications, antepartum fetal complications, term of delivery, induction of labor, oxytocin use for dystocia, neonatal cephalic perimeter), a successful ECV increased the risk of caesarean section (adjusted OR 3.17, 95% CI 1.86-5.46). By stratifying on week, a trend for increased risk for caesarean section was observed at the week after ECV and at post term (28.6% before 37+6, 14.8% at 38+0-38+6, 13.8% at 39+0-39+6, 14.2% at 40+0-40+6 and 33.3% beyond 41+0 weeks' gestation, P=0.06). Women who have a successful ECV are at increased risk of caesarean section compared with women who experience spontaneous cephalic presentation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

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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.

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

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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.

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)

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.

Epidural anaesthesia for caesarean section in pituitary dwarfism.

Science.gov (United States)

Li, Hongbo; Li, Ruihua; Lang, Bao

2017-04-01

We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituitary dwarfism. In addition to supportive treatment, we offered a postoperative epidural analgesia pump. The patient recovered well without any complications. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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

African Journals Online (AJOL)

Adele

2004-05-03

May 3, 2004 ... where predominantly general anaesthesia for caesarean section is still performed, and ... data is being collected, so that information will be available on ... deaths during obstetric delivery in the United States, 1979-1990.

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 ...

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

African Journals Online (AJOL)

2009-10-05

Oct 5, 2009 ... Conclusion: Trial of vaginal birth after caesarean section in ... continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood ..... poverty level in our environment such that only.

Higher Incision at Upper Part of Lower Segment Caesarean Section

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Yong Shao

2014-06-01

Conclusions: An incision at the upper part of the lower segment reduces blood loss, enhances uterine retraction, predisposes to fewer complications, is easier to repair, precludes bladder adhesion to the suture line and reduces operation time. Keywords: caesarean section; higher incision technique; traditional uterine incision technique.

Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2.

Science.gov (United States)

Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

2011-12-01

We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obstetric complications in these patients include miscarriages, stillbirths, premature rupture of the membranes, preterm labour, uterine prolapse, uterine rupture and severe postpartum haemorrhage. There has been much controversy over the appropriate mode of delivery. Abdominal deliveries are complicated by delayed wound healing and increased perioperative blood loss. Vaginal deliveries may be complicated by tissue friability causing extensive perineal tears, pelvic floor and bladder lesions. Our case highlights that in specific, controlled situations it is possible to have a vaginal delivery even after previous caesarean section in patients with EDS.

Impetigo herpetiformis and pregnancy: Anesthetic management for caesarean delivery

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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.

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

BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether that is th......BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether...... 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...... anesthesia, ephedrine maintains frontal lobe oxygenation and maternal heart rate with a similar increase in fetal heart rate as elicited by phenylephrine. TRIAL REGISTRATION: Clinical trials NCT 01509521 and EudraCT 2001 006103 35....

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.

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.

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.

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.

The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial.

Science.gov (United States)

Hussein, Ahmed M; Dakhly, Dina Mohamed Refaat; Raslan, Ayman N; Kamel, Ahmed; Abdel Hafeez, Ali; Moussa, Manal; Hosny, Ahmed Samir; Momtaz, Mohamed

2018-04-25

To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value .001) varied significantly between the two groups. Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

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)

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)

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

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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

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

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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.

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

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 ...

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

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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.

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

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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.

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.

Emergency Caesarean section in a patient with known sickle-cell ...

African Journals Online (AJOL)

In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under a combined spinal-epidural technique. A level of sensory block of T6 was achieved with 2.8 mL of 0.5% hyperbaric bupivacaine administered intrathecally. Towards the end of surgery, analgesia was supplemented through ...

Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

Science.gov (United States)

Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit; Zimmo, Kaled; Anti, Marit; Sørum Falk, Ragnhild; Vikanes, Åse

2018-01-01

Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics. PMID:29500211

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.

Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants.

Science.gov (United States)

Dahlgren, Leanne S; von Dadelszen, Peter; Christilaw, Jan; Janssen, Patricia A; Lisonkova, Sarka; Marquette, Gerald P; Liston, Robert M

2009-09-01

To determine the risks and benefits of an elective Caesarean section (CS) at term in healthy nulliparous women. We conducted a population-based cohort study of deliveries between 1994 and 2002. Using bivariate and multivariable techniques, we compared maternal and neonatal outcomes in healthy nulliparous women who had undergone elective pre-labour CS (using breech presentation as a surrogate) with those in women who had undergone spontaneous labour with anticipated vaginal delivery (SL) at full term. There were 1046 deliveries in the pre-labour CS group and 38 021 in the SL group. Life-threatening maternal morbidity was similar in each group. Life-threatening neonatal morbidity was decreased in the CS group (RR 0.34; 99% CI 0.12 to 0.97). Subgroup analysis of the SL group by mode of delivery demonstrated the increased neonatal risk was associated with operative vaginal delivery and intrapartum CS but not spontaneous vaginal delivery. An elective pre-labour Caesarean section in a nulliparous woman at full term decreased the risk of life-threatening neonatal morbidity compared with spontaneous labour with anticipated vaginal delivery. However, the 63% of women with spontaneous labour who achieved a spontaneous vaginal delivery would not have benefited from delivery by Caesarean section. Further research is needed to better identify women with an increased likelihood of an operative vaginal or intrapartum Caesarean section, as this may assist maternity caregivers in decision-making about childbirth. Further research is also needed to determine if these findings can be confirmed in a prospective study.

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

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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.

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...

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

Birth by caesarean section and prevalence of risk factors for non-communicable diseases in young adults: a birth cohort study.

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Bernardo L Horta

Full Text Available Conflicting findings on the risk of obesity among subjects born by caesarean section have been published. Caesarean section should also increase the risk of obesity related cardiovascular risk factors if type of delivery is associated with obesity later in life. This study was aimed at assessing the effect of type of delivery on metabolic cardiovascular risk factors in early adulthood.In 1982, maternity hospitals in Pelotas, southern Brazil, were visited and those livebirths whose family lived in the urban area of the city have been followed. In 2000, when male subjects undertook the Army entrance examination (n=2200, fat mass and fat free mass were estimated through bioimpedance. In 2004-2005, we attempted to follow the whole cohort (n=4297, and the following outcomes were studied: blood pressure; HDL cholesterol; triglycerides; random blood glucose, C-reactive protein, waist circumference and body mass index. The estimates were adjusted for the following confounders: family income at birth; maternal schooling; household assets index in childhood; maternal skin color; birth order; maternal age; maternal prepregnancy weight; maternal height; maternal smoking during pregnancy; birthweight and family income at early adulthood.In the crude analyses, blood pressure (systolic, diastolic and mean arterial pressure and body mass index were higher among subjects who were delivered through caesarean section. After controlling for confounders, systolic blood pressure was 1.15 mmHg (95% confidence interval: 0.05; 2.25 higher among subjects delivered by caesarean section, and BMI 0.40 kg/m(2 (95% confidence interval: 0.08; 0.71. After controlling for BMI the effect on systolic blood pressure dropped to 0.60 mmHg (95% confidence interval: -0.47; 1.67. Fat mass at 18 years of age was also higher among subjects born by caesarean section.Caesarean section was associated with a small increased in systolic blood pressure, body mass index and fat mass.

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.

SONOGRAPHIC PREDICTION OF SCAR DEHISCENCE IN WOMEN WITH PREVIOUS CAESAREAN SECTION

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Shubhada Suhas Jajoo

2018-01-01

Full Text Available BACKGROUND Caesarean section (Sectio Caesarea is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after caesarean section was significantly reduced from year to year and the rate of repeated caesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding “cut-off value” for the completion of the delivery method. To better assess the risk of uterine rupture, some authors have proposed sonographic measurement of lower uterine segment thickness near term assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS may increase safety during labour by selecting women with the lowest risk of uterine rupture. The aim of the study is to study the diagnostic accuracy of sonographic measurements of the Lower Uterine Segment (LUS thickness near term in predicting uterine scar defects in women with prior Caesarean Section (CS. We aim to ascertain the best cut-off values for predicting uterine rupture. MATERIALS AND METHODS 100 antenatal women with history of previous one LSCS who come to attend antenatal clinic will be assessed for scar thickness by transabdominal ultrasonography and its correlation with intraoperative findings. This prospective longitudinal study was conducted for 1 year after IEC approval with inclusion criteria previous one LSCS. Exclusion criteria- 1 Previous myomectomy scar; 2 Previous 2 LSCS; 3 Previous hysterotomy scar. RESULTS Our findings indicate that there is a strong association between degree of LUS thinning measured near term and the risk of uterine scar defect at birth. In our study, optimal cut-off value for predicting

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).

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

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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.

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.

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.

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

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Volkov O.O.

2014-06-01

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

A COMPARATIVE STUDY OF TRANEXAMIC ACID VERSUS ETHAMSYLATE USED PROPHYLACTICALLY IN LOWER SEGMENT CAESAREAN SECTION- A PROSPECTIVE RANDOMISED DOUBLE-BLINDED STUDY

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Bondada Suryakumari

2017-09-01

Full Text Available BACKGROUND Recently, caesarean section rates are increased in developing countries like India. Postpartum haemorrhage is more after caesarean section. Most of the maternal mortality is attributed to postpartum haemorrhage. This study was undertaken to find out the drug effective in reducing blood loss in lower segment caesarean section. The aim of the study is to compare the efficacy of ethamsylate versus tranexamic acid in reducing blood loss during and after caesarean section. MATERIALS AND METHODS All women undergoing LSCS were divided in 3 groups, viz. 2 study groups and control group. All were requested for preop and postop Hb%, PCV and TRBC. Tranexamic acid and ethamsylate, 1 g diluted in 10 mL NS were given intravenously for both the study groups and control group with NS, 20 minutes prior to skin incision and blood loss was measured from placental delivery up to 2 hours in all the groups was calculated by weighing pre-weighted pads soaked in blood. RESULTS Statistical analysis was done quantitatively by Student’s t-test. Postoperative blood loss was similar and lower in both the study groups compared to the control group. Hb% change in postop period is significant in control group. CONCLUSION Ethamsylate is safe and effective alternative to tranexamic acid in preventing postpartum haemorrhage after caesarean section.

Planned caesarean in the interventional radiology cath lab to enable immediate uterine artery embolization for the conservative treatment of placenta accreta

International Nuclear Information System (INIS)

Bouvier, A.; Sentilhes, L.; Thouveny, F.; Bouet, P.-E.; Gillard, P.; Willoteaux, S.; Aubé, C.

2012-01-01

Aim: To evaluate the feasibility and efficacy of routine uterine artery embolization (UAE) immediately after planned caesareans performed in the cath lab for conservative treatment of placenta accreta. Materials and methods: A retrospective study included all patients who had a planned caesarean in the cath lab for conservative treatment of placenta accreta at Angers University Hospital, which is a tertiary care centre, from April 2001 to September 2010. Twelve patients underwent UAE immediately after caesarean with the placenta left partially or totally in situ. The success rate of embolization, blood loss, and complications were reported. Results: Diagnosis of abnormal placentation was confirmed by caesarean findings in 14 cases. Four patients had a percreta form with bladder invasion. In seven cases blood loss was insignificant and UAE was prophylactic; no secondary haemorrhage was observed in this group. Postpartum haemorrhage occurred in five cases: control of immediate postpartum bleeding by embolization was successful in three and failed in two leading to hysterectomy. In one case uterine necrosis occurred 6 weeks after embolization, requiring a hysterectomy. Delayed complications resulted in hysterectomy and partial bladder resection 3 months after delivery for one of the patients with placenta percreta. Conclusion: UAE immediately after a caesarean performed in the cath lab is a feasible therapeutic option for conservative treatment of placenta accreta. Advantages include reducing stress and risks associated with transferring women with potentially unstable haemodynamics.

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

Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomised controlled trials.

Science.gov (United States)

Zhu, Y-P; Wang, W-J; Zhang, S-L; Dai, B; Ye, D-W

2014-06-01

Gum chewing has been reported to enhance bowel motility and reduce postoperative ileus (POI). However, the efficacy remains imprecise for women following caesarean section. To summarise and evaluate the current evidence for postoperative gum chewing on the recovery of bowel function following caesarean section. We searched studies from the following electronic databases: PubMed, EMBASE, SCOPUS and Cochrane Library from inception to 30 May 2013. We included randomised controlled trials (RCTs) of women after caesarean section; these RCTs should compared gum chewing with no gum chewing and reported on at least one of the outcomes: time to flatus, time to bowel sound, time to passing stool and length of hospital stay (LOS). Study outcomes were presented as mean differences (for continuous data) with 95% confidence interval (95% CI). The risk of bias in the study results was assessed using the assessment tool from the Cochrane Handbook. Six RCTs including 939 women were included in our meta-analysis. The pooled results demonstrated that gum chewing is superior to no gum chewing with a reduction of 6.42 hours (95% CI -7.55 to -5.29) for time to first flatus, 3.62 hours (95% CI -6.41 to -0.83) for time to first bowel sound, 6.58 hours (95% CI -10.10 to -3.07) for time to first stool and 5.94 hours (95% CI -9.39 to -2.49) for LOS. In addition, no evidence emerged for any side effects caused by gum chewing. The current evidence suggests that gum chewing is associated with early recovery of bowel motility and shorter LOS for women after caesarean section. This safe and inexpensive intervention should be included in routine postoperative care following a caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

Factors associated with women’s intention to request caesarean delivery in Dar es Salaam Tanzania

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B Kamala

2017-09-01

Full Text Available Background. In the past decade, the rate of caesarean section (CS has increased dramatically in many parts of the world. At Muhimbili National Hospital (MNH there has been a dramatic rise in the caesarean section rate over the past decade.Objective. To determine the incidence of maternal request for CS and factors associated with intention to request caesarean section at the MNH antenatal clinic.Methods. We conducted a cross-sectional study from August to October 2014. A structured questionnaire gathered participants’ background and obstetric information, perceptions and opinions regarding a request for caesarean section, and the respective reasons for the request. Confidence intervals were calculated and a p-value <0.05 was considered significant.Results. The incidence of CS on maternal request was about 6%. The intention to request for CS in the index pregnancy was 8%. Higher-level education and formal-sector employment had higher odds for requesting CS (p=0.01 and p=0.05, respectively. Half of the participants agreed that maternal request for CS should be allowed; more private patients agreed that it could affect the doctor-patient relationship (p=0.02; more private patients agreed that request for CS was due to fear of losing a child (p=0.03. Previous history of CS was an independent predictor of maternal request for caesarean section (OR 1.7; 95% CI 1.7 - 15.4 and (OR 5.8; 95% CI 1.6 - 20.1, respectively.Conclusion. Maternal requests for CS exist at the national referral hospital in Tanzania. This was associated with factors other than women’s preferences, including perceived fear of child loss and events associated with previous CS.

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 ...

EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION IN MULTIGRAVIDA PARTURIENTS: A CASE CONTROLLED PROSPECTIVE STUDY

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Gunavathi Kandappan

2016-06-01

Full Text Available OBJECTIVES To study the efficacy of Tranexamic acid in reducing blood loss during and after the lower segment caesarean section in Multigravida parturients. METHODOLOGY A case controlled prospective study was conducted in 50 multigravida parturient women undergoing elective lower segment caesarean section in our hospital after getting Institutional Ethical Committee approval, over a period of two months. 25 of them were given Tranexamic acid 15 mg/kg immediately before caesarean section. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and the second from the end LSCS to 2 hours postpartum. RESULTS Tranexamic acid significantly reduces the quantity of blood loss from the end of LSCS to 2 hours post-partum in multigravida parturients. No complications or side effects are noted in both the groups. CONCLUSION Tranexamic acid significantly reduces the amount of blood loss during and after the lower segment caesarean section in multigravida parturients and its use was not associated with any side effects or complications.

Anaesthesia for a patient with Eisenmenger′s syndrome undergoing caesarean section

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T Gurumurthy

2012-01-01

Full Text Available Eisenmenger′s syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt associated with septal defects or patent ductus arteriosus. The decreased systemic vascular resistance associated with pregnancy increases the degree of right to left shunting, thereby carrying substantial risk to both the mother and the foetus. The maternal mortality rate of pregnancy in the presence of Eisenmenger′s syndrome is reported to be as high as 30-70%. We present a case of a 22-year-old primigravida with Eisenmenger′s syndrome who gave birth at 37 weeks of gestation via caesarean section to a live female baby under general anaesthesia. On the third post-operative day, the patient developed tachycardia, tachypnoea, hypotension and decrease in oxygen saturation despite supplemental oxygen, clinically suspected pulmonary thromboembolism. We describe the anaesthetic management for caesarean section and its complications in a patient with Eisenmenger′s syndrome. Although pregnancy should be discouraged in women with Eisenmenger′s syndrome, it can be successful.

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.

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 < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. The policy has been largely but not fully effective in removing financial barriers for delivery care in 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.

Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

Science.gov (United States)

Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C

2012-04-01

To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Intrathecal isobaric versus hyperbaric bupivacaine for elective caesarean section

International Nuclear Information System (INIS)

Aftab, S.; Ali, H.; Zafar, S.; Sheikh, M.; Sultan, T.

2007-01-01

To compare the results of isobaric bupivacaine (0.5%) with hyperbaric bupivacaine (0.75%) in cases of elective Caesarean Section, in respect of time to sensory analgesia, highest level of sensory block, haemodynamic effects, and complications. Sixty pregnant patients scheduled for elective Caesarean Section. The patients were randomly assigned to receive either 0.5% isobaric bupivacaine (Group-1B) or 0.75% hyperbaric bupivacaine (Group-HB) via intrathecal route. The time of onset of block, highest level of sensory block, cardio-respiratory data, duration of analgesia and complications were recorded during surgery. The time taken to reach T4 sensory analgesia in Group-1B was 6+-6.43 minutes as compared to 6.93+-7.8 minutes in Group-HB, while the highest sensory level achieved in Group-1B was T1 and in Group-HB T2. The lowest systolic blood pressure recorded in Group-1B was 83.27+-12.69 mmHg and in Group-HB 114.33+-13.83 mm Hg, the difference being significant (p<0.05). There was a higher incidence of complications in Group-1B as compared to Group-HB like high spinal analgesia, vomiting and discomfort. Intrathecal block showed a greater reduction in the systolic blood pressure, and associated complications, with Isobaric Bupivacaine as compared to Hyperbaric Bupivacaine. (author)

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

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

Science.gov (United States)

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

2015-11-03

The rate of caesarean sections around the world is rising each year, reaching epidemic proportions. Although many caesarean sections are performed for concerns about fetal welfare on the basis of abnormal cardiotocography, the majority of babies are shown to be well at birth, meaning that the operation, with its inherent short and long term risks, could have been avoided without compromising the baby's health. Previously, fetal scalp blood sampling for pH estimation was performed in the context of an abnormal cardiotocograph, to improve the identification of babies in need of expedited delivery. This test has largely been replaced by lactate measurement, although its validity is yet to be established through a randomised controlled trial. This study aims to test the hypothesis that the performance of fetal scalp blood lactate measurement for women in labour with an abnormal cardiotocograph will reduce the rate of birth by caesarean section from 38 % to 25 % (a 35 % relative reduction). Prospective unblinded randomised controlled trial conducted at a single tertiary perinatal centre. Women labouring with a singleton fetus in cephalic presentation at 37 or more weeks' gestation with ruptured membranes and with an abnormal cardiotocograph will be eligible. Participants will be randomised to one of two groups: fetal monitoring by cardiotocography alone, or cardiotocography augmented by fetal scalp blood lactate analysis. Decisions regarding the timing and mode of delivery will be made by the treating team, in accordance with hospital protocols. The primary study endpoint is caesarean section with secondary outcomes collected from maternal, fetal and neonatal clinical course and morbidities. A cost effectiveness analysis will also be performed. A sample size of 600 will provide 90 % power to detect the hypothesised difference in the proportion of women who give birth by caesarean section. This world-first trial is adequately powered to determine the impact of fetal

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 ...

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

Working Papers on Asian American Studies: Annotated Bibliography on Koreans in America.

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Kim, Christopher

This classified annotated bibliography on Koreans in America includes references on the following topics: (1) Korean American directories, (2) immigration history, (3) deportation cases, (4) Korean students in the U.S., (5) Korean Americans in the Asian American Movement, (6) state and federal legislation affecting Koreans in America, (7) Korean…

High-dose versus low-dose local anaesthetic for transversus abdominis plane block post-Caesarean delivery analgesia: a meta-analysis.

Science.gov (United States)

Ng, S C; Habib, A S; Sodha, S; Carvalho, B; Sultan, P

2018-02-01

The optimal local-anaesthetic (LA) dose for transversus-abdominis-plane (TAP) block is unclear. In this meta-analysis, we aimed to determine whether TAP blocks for Caesarean delivery (CD) with low-dose (LD) LA demonstrated non-inferiority in terms of analgesic efficacy, compared with high-dose (HD) LA. A literature search was performed for randomised controlled trials examining the analgesic efficacy of TAP blocks vs control after CD. The different dosing used in these studies was classified as HD or LD (bupivacaine equivalents >50 or ≤50 mg per block side, respectively). The pooled results of each dose group vs control were indirectly compared using the Q test. The primary outcome was 24 h opioid consumption. Secondary outcomes included 6 and 24 h postoperative pain scores, time to first analgesia, 6 h opioid consumption, opioid-related side-effects, and maternal satisfaction. Fourteen studies consisting of 770 women (389 TAP and 381 control) were included. Compared with controls, the 24 h opioid consumption (milligram morphine equivalents) was lower in HD [mean difference (MD) 95% confidence interval (CI) -22.41 (-38.56, -6.26); P=0.007; I 2 =93%] and LD [MD 95% CI -16.29 (-29.74, -2.84); P=0.02; I 2 =98%] TAP groups. However, no differences were demonstrated between the HD and LD groups (P=0.57). There were also no differences between the HD and LD groups for the 6 h opioid consumption, time to first analgesia, 6 and 24 h pain scores, postoperative nausea and vomiting, pruritus, and maternal satisfaction. Low-dose TAP blocks for Caesarean delivery provide analgesia and opioid-sparing effects comparable with the high-dose blocks. This suggests that lower doses can be used to reduce local anaesthetic toxicity risk without compromising the analgesic efficacy. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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

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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.

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

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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 

Elective caesarean section versus vaginal delivery. Whither the end of traditional obstetrics?

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Husslein, P

2001-11-01

No other topic has dominated the obstetrical discussion to the same extent as caesarean section. Nor has any other aspect of obstetrics been subject to a comparable degree of professional controversy,quite recently the topic has been discussed in this journal by Ludwig and Loeffler. For some caesarean section remains a major surgical procedure with a corresponding level of risk, which must only be employed in the presence of specific complications and in conjunction with a clearly defined set of indications; others consider caesarean section quite simply to be the most efficient and straightforward means to deliver as well as the one attended by the least amount of risk. Opinion among those most immediately affected is likewise divided: For many women the experience of vaginal birth is among the most fulfilling of their entire life - comparable only to sexuality-related moments of ecstasy - other women come to regard birth as the worst thing that ever happened to them an experience attended by pain, fear, loneliness, perhaps even long lasting negative consequences. There can be no doubt that, this question also affects the foundations of patriarchal thinking, still so firmly embedded in peoples' minds: Are doctors to determine what exactly takes place in the delivery room and in the operating theatre, or will the patient - in obstetrics, the parturient - be enabled to assert her right to self-determination also in the medical context; especially in light of the fact that said right can currently be exercised in an almost unlimited fashion throughout the rest of one's adult life? It is against the wider background of this ongoing controversy that the ensuing article will seek to defuse the emotional charge characterising some of the commonly employed arguments and instead revert to a more rational and factually based approach to this question.

Quality of pain treatment after caesarean section : Results of a multicentre cohort study

NARCIS (Netherlands)

Marcus, H.; Gerbershagen, H. J.; Peelen, Linda M.; Aduckathil, S.; Kappen, T. H.; Kalkman, C. J.; Meissner, W.; Stamer, U. M.; Peelen, LM

BackgroundA large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment. MethodsWe analysed pain scores, pain-related

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

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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.

[External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate].

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Lojacono, A; Donarini, G; Valcamonico, A; Soregaroli, M; Frusca, T

2003-12-01

Although term breech presentation is a relatively rare condition (3-5% of all births), it continues to be an important indication for caesarean section and has contributed to its increased use. Risk of complications may be increased for both mother and foetus in such a situation. Vaginal delivery of a breech presenting foetus is complex and may involve many difficulties, so today there is a general consensus that planned caesarean section is better than planned vaginal birth for the foetus in breech presentation at term. External cephalic version is one of the most effective procedures in modern obstetrics. It involves the external manipulation of the foetus from the breech into the cephalic presentation. A successful manoeuvre can decrease costs by avoiding operative deliveries and decreasing maternal morbidity. The aim of the present study is to evaluate the effectiveness of this obstetric manoeuvre to increase the proportion of vertex presentation among foetuses that were formerly in the breech position near term, so as to reduce the caesarean section rate. The safety of the version is also showed. From 1999 to 2002, 89 women with foetal breech presentation underwent external cephalic version at the Department of Obstetrics and Gynaecology of the Brescia University. The gestational age was 36.8+/-0.8 weeks. The following variables have been taken into consideration: breech variety, placental location, foetal back position, parity, amount of amniotic fluid and gestational age. Every attempt was performed with a prior use of an intravenous drip of Ritodrine, and foetal heart rate was monitored continuously with cardiotocogram. The success rate of the procedure was 42.7% (n=38). No maternal or foetal complication or side effects occurred, both during and after the manoeuvre, except a transient foetal bradycardia that resolved spontaneously. Only one spontaneous reversion of the foetus occurred before delivery. Of all the women that underwent a successful version

Midwives' experiences with mother-infant skin-to-skin contact after a caesarean section: 'fighting an uphill battle'.

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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.

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania.

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Dekker, Luuk; Houtzager, Tessa; Kilume, Omary; Horogo, John; van Roosmalen, Jos; Nyamtema, Angelo Sadock

2018-05-15

Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.

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

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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

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

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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.

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

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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...

A Combination of Surgery And Methotrexate for Successful Treatment of a Caesarean Scar Ectopic Pregnancy.

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Tadesse, WG

2018-06-01

Caesarean scar ectopic pregnancy (CSEP) is one of the rarest forms of ectopic pregnancies. With rising caesarean delivery (CD) rates worldwide, there is an increase in the incidence of CSEP. Patients usually present with painless vaginal bleeding and often misdiagnosed as spontaneous miscarriage. The use of ultrasonography with colour flow Doppler helps in the differential diagnosis. Different treatment options are described in the literature, although there is insufficient evidence regarding the best approach. We report the diagnosis and management of a case of CSEP in a woman with four previous CD who presented with vaginal bleeding and lower abdominal cramps at six weeks of gestation. She was treated with laparoscopic and ultrasound guided aspiration of the gestational sac and local injection of methotrexate supplemented by intramuscular methotrexate injection.

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

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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.

Near-miss maternal morbidity from severe haemorrhage at caesarean section: A process and structure audit of system deficiencies in South Africa.

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Maswime, T S; Buchmann, E

2017-10-31

A rising caesarean section rate and substandard peri-operative care are believed to be the main reasons for recent increases in maternal deaths from bleeding during and after caesarean section (BDACS) in South Africa (SA). The Donabedian model assumes that clinical outcomes are influenced by healthcare workers and the healthcare system. To evaluate near-miss cases from BDACS with regard to health system structure (resources and facilities) and process (patient care). A cross-sectional prospective study was conducted in greater Johannesburg, SA. Data of women who had near-miss-related BDACS were collected by means of ongoing surveillance at 13 public hospitals. The World Health Organization intervention criteria were used to identify near-miss cases. A comparison of structure and process between the healthcare facilities was conducted. Of 20 527 caesarean sections , there were 93 near misses and 7 maternal deaths from BDACS. Dominant risk factors for near misses were previous caesarean section (43.9%), anaemia (25.3%) and pregnancy-induced hypertension (28.6%). Eighteen women were transferred to higher levels of care, and 8 (44.4%) experienced transport delays of >1 hour. The caesarean section decision-to-incision interval (DII) was ≥60 minutes in 77 of 86 women, with an average interval of 4 hours. Structural deficiencies were frequently present in district hospitals, and there were serious delays in ambulance transfer and DIIs at all levels of care. The majority of the women had risk factors for BDACS. There were major ambulance delays and lack of facilities, mostly in district hospitals. All women required life-saving interventions, but could not access appropriate care timeously. Prevention and management of BDACS require a fully functional health system.

A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia.

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Tan, Terry T; Teoh, Wendy H L; Woo, David C M; Ocampo, Cecilia E; Shah, Mukesh K; Sia, Alex T H

2012-02-01

Previous studies examining the efficacy of transversus abdominis plane block after caesarean section have mostly been in parturients under spinal anaesthesia. We postulated that the advantage of performing transversus abdominis plane block after caesarean section might be even more obvious after general anaesthesia, resulting in reduced 24-h consumption of morphine. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: In this single centre, randomised double-blind controlled trial, 40 women who underwent caesarean delivery under general anaesthesia were allocated randomly to receive a transversus abdominis plane block or no block. In those who received the block, 20 ml of levobupivacaine 2.5 mg ml was deposited bilaterally into the transversus abdominis plane under ultrasound guidance using a Sonosite Titan (SonoSite, Bothell, Washington, USA) 7-13 MHz linear transducer at the end of surgery when the patient was still anaesthetised. We recorded patient-controlled intravenous morphine use for 24 h, pain scores at rest and activity, sedation, nausea and vomiting, use of antiemetic medication and overall maternal satisfaction. The primary outcome was 24-h morphine consumption. Patients who received the transversus abdominis plane block used significantly less morphine in 24 h than those in the control group [12.3 (2.6) vs. 31.4 mg (3.1), Pplane block reduced morphine consumption following caesarean section under general anaesthesia, with increased maternal satisfaction.

Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

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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). 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.

Influences on decision making among primiparous women choosing elective caesarean section in the absence of medical indications: findings from a qualitative investigation.

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Kornelsen, Jude; Hutton, Eileen; Munro, Sarah

2010-10-01

Patient-initiated elective Caesarean section (PIECS) is increasingly prevalent and is emerging as an urgent issue for individual maternity practitioners, hospitals, and policy makers, as well as for maternity patients. This qualitative study sought to explore women's experiences of the decision-making process leading to elective operative delivery without medical indication. We conducted 17 exploratory qualitative in-depth interviews with primiparous women who had undergone a patient-initiated elective Caesarean section in the absence of any medical indication. The study took place in five hospitals (three urban, two semi-rural) in British Columbia. The findings revealed three themes within the process of women deciding to have a Caesarean section: the reasons for their decision, the qualities of the decision-making process, and the social context in which the decision was made. The factors that influenced a patient-initiated request for delivery by Caesarean section in participants in this study were diverse, culturally dependent, and reflective of varying degrees of emotional and evidence-based influences. PIECS is a rare but socially significant phenomenon. The a priori decision making of some women choosing PIECS does not follow the usual diagnosis-intervention trajectory, and the care provider may have to work in reverse to ensure that the patient fully understands the risks and benefits of her decision subsequent to the decision having been made, while still ensuring patient autonomy. Results from this study provide a context for a woman's request for an elective Caesarean section without medical indication, which may contribute to a more efficacious informed consent process.

First birth Caesarean section and subsequent fertility: a population-based study in the USA, 2000-2008.

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Kjerulff, K H; Zhu, J; Weisman, C S; Ananth, C V

2013-12-01

Is first birth Caesarean delivery associated with a lower likelihood of subsequent childbearing when compared with first birth vaginal delivery? In this study of US women whose first delivery was in 2000, those who had a Caesarean delivery were less likely to have a subsequent live birth than those who delivered vaginally. Some studies have reported lower birth rates subsequent to Caesarean delivery in comparison with vaginal delivery, while other studies have reported no difference. We conducted a retrospective cohort study of 52 498 women who had a first singleton live birth in the State of Pennsylvania, USA in 2000 and were followed to the end of 2008 via Pennsylvania birth certificate records to identify subsequent live births during the 8- to 9-year follow-up period. Birth certificate records of first singleton births were linked to the hospital discharge data for each mother and newborn, and linked to all birth certificate records for each mother's subsequent deliveries which occurred in 2000 to the end of 2008. Poisson regression models were used to evaluate the association between first birth factors and whether or not there was a subsequent live birth during the follow-up period. Over an average of 8.5 years of follow-up, 40.2% of women with a Caesarean first birth did not have a subsequent live birth, compared with 33.1% of women with a vaginal first birth (risk ratio (RR): 1.21, 95% confidence interval (CI): 1.18-1.25). Adjustment for the demographic confounders of maternal age, race, education, marital status and health insurance coverage attenuated the RR to 1.16 (95% CI: 1.13-1.19). Specific pregnancy and childbirth-related complications associated with not having a subsequent live birth included diabetes-related disorders, abnormalities of organs and soft tissues of the pelvis, fetal abnormalities, premature or prolonged rupture of membranes, hypertensive disorders, amnionitis, fetal distress and other maternal health problems. However, adjustment

Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

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Morisaki, N; Ganchimeg, T; Ota, E; Vogel, J P; Souza, J P; Mori, R; Gülmezoglu, A M

2014-03-01

To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible. © 2014 RCOG The World Health Organization retains copyright and all other rights in

Increasing the availability and quality of caesarean section in Tanzania.

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Nyamtema, A; Mwakatundu, N; Dominico, S; Mohamed, H; Shayo, A; Rumanyika, R; Kairuki, C; Nzabuhakwa, C; Issa, O; Lyimo, C; Kasiga, I; van Roosmalen, J

2016-09-01

To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. Before-after intervention study design. Rural Tanzania. Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests. Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia. During the audit period (2012-2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P = 0.02) and from 37 to 20% in hospitals (P availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings. Increasing availability and quality of CS in rural Africa is feasible. © 2016 Royal College of Obstetricians and Gynaecologists.

Rate of caesarean sections according to the Robson classification: Analysis in a French perinatal network - Interest and limitations of the French medico-administrative data (PMSI).

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Lafitte, A-S; Dolley, P; Le Coutour, X; Benoist, G; Prime, L; Thibon, P; Dreyfus, M

2018-02-01

The objective of our study was to determine, in accordance with WHO recommendations, the rates of Caesarean sections in a French perinatal network according to the Robson classification and determine the benefit of the medico-administrative data (PMSI) to collect this indicator. This study aimed to identify the main groups contributing to local variations in the rates of Caesarean sections. A descriptive multicentric study was conducted in 13 maternity units of a French perinatal network. The rates of Caesarean sections and the contribution of each group of the Robson classification were calculated for all Caesarean sections performed in 2014. The agreement of the classification of Caesarean sections according to Robson using medico-administrative data and data collected in the patient records was measured by the Kappa index. We also analysed a 6 groups simplified Robson classification only using data from PMSI, which do not inform about parity and onset of labour. The rate of Caesarean sections was 19% (14.5-33.2) in 2014 (2924 out of 15413 deliveries). The most important contributors to the total rates were groups 1, 2 and 5, representing respectively 14.3%, 16.7% and 32.1% of the Caesarean sections. The rates were significantly different in level 1, 2b and 3 maternity units in groups 1 to 4, level 2a maternity units in group 5, and level 3 maternity units in groups 6 and 7. The agreement between the simplified Robson classification produced using the medical records and the medico-administrative data was excellent, with a Kappa index of 0.985 (0.980-0.990). To reduce the rates of Caesarean sections, audits should be conducted on groups 1, 2 and 5 and local protocols developed. Simply by collecting the parity data, the excellent metrological quality of the medico-administrative data would allow systematisation of the Robson classification for each hospital. Copyright © 2017. Published by Elsevier Masson SAS.

Learning from the Law. A review of 21 years of litigation for pain during caesarean section.

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McCombe, K; Bogod, D G

2018-02-01

The large majority of caesarean sections in the UK are now carried out under neuraxial anaesthesia. Although this technique is widely accepted as being the safest option in most circumstances, the use of regional anaesthesia increases the risk of patients experiencing intra-operative discomfort or pain. Pain during operative obstetric delivery is the commonest successful negligence claim relating to regional anaesthesia against obstetric anaesthetists in the UK. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning pain during caesarean section and consider how anaesthetists might avoid litigation. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

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

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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

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

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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.

On becoming a first-time mother after an emergency Caesarean section: a journey from alienation to symbolic adoption.

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Herishanu-Gilutz, Shirley; Shahar, Golan; Schattner, Emanuel; Kofman, Ora; Holcberg, Gershon

2009-10-01

This qualitative research focused on the significance of subjective experience of mothers who gave birth in an emergency Caesarean section. Ten first-time mothers experiencing emergency Caesarean section were interviewed, and their narrative accounts were analyzed using Giorgi's phenomenological method. Mothers described alienation from the infant on encountering her/him; primal difficulties in holding; a 'mechanistic' pattern of childcare at home; over-apprehension and fear of a cradle-death. A few of the women seemed to cope with these experiences by performing 'a symbolic adoption' of their infants. In the context of object-relations theory, the findings, will potentially inform psychological care in obstetrics and gynaecology.

Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section; Experience of a single tertiary centre in Oman

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Hazel Gonsalves

2016-11-01

Full Text Available 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.

Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis.

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van der Nelson, Helen A; Draycott, Tim; Siassakos, Dimitrios; Yau, Christopher W H; Hatswell, Anthony J

2017-03-01

To determine the economic impact of the introduction of carbetocin for the prevention of postpartum haemorrhage (PPH) at caesarean section, compared to oxytocin. The model is a decision tree conducted from a UK National Health Service perspective. 1500 caesarean sections (both elective and emergency) were modelled over a 12 month period. Efficacy data was taken from a published Cochrane meta-analysis, and costs from NHS Reference costs, the British National Formulary and the NHS electronic Medicines Information Tool. A combination of hospital audit data and expert input from an advisory board of clinicians was used to inform resource use estimates. The main outcome measures were the incidence of PPH and total cost over a one year time horizon, as a result of using carbetocin compared to oxytocin for prevention of PPH at caesarean section. The use of carbetocin compared to oxytocin for prevention of PPH at caesarean section was associated with a reduction of 30 (88 vs 58) PPH events (>500ml blood loss), and a cost saving of £27,518. In probabilistic sensitivity analysis, carbetocin had a 91.5% probability of producing better outcomes, and a 69.4% chance of being dominant (both cheaper and more effective) compared to oxytocin. At list price, the introduction of carbetocin appears to provide improved clinical outcomes along with cost savings, though this is subject to uncertainty regarding the underlying data in efficacy, resource use, and cost. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.

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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

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

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Rogelio González Pérez

2012-04-01

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

Cardiac arrest during a twin birth caesarean delivery.

Science.gov (United States)

Pampín-Huerta, F R; Moreira-Gómez, D; Lozano-Requelme, M L; Molina-Nieto, F; Fontán-García-Boente, L; Moreira-Pacheco, M

2016-04-01

The case of a 35 year-old pregnant woman with a right ovarian vein thrombosis complicated with a floating thrombus in the inferior vena cava reaching the right atrium, is presented. The patient had a cardiac arrest due to a pulmonary embolism during a twin-birth caesarean delivery. Discussion includes the pathophysiology of this condition and management options in a cardiac arrest secondary to this aetiology, recovered with stable blood pressure, highlighting the role of thrombolytic therapy in the Postoperative Care Unit in this situation. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

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

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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.

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

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Mahmud, G.; Javaid, K.; Tasnim, N.; Tabassum, A.; Bangash, K. T. [Pakistan Inst. of Medical Sciences (PIMS), Islamabad (Pakistan). Maternal and Child Health Centre Unit-I

2014-08-15

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

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

Comparison of Morphine Suppository and Diclofenac Suppository for Pain Management After Elective Caesarean Section

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Atossa Mahdavi

2016-12-01

Full Text Available This study investigated efficacy and side effects of Morphine suppository for pain management after the first elective caesarean delivery in comparison to Diclofenac suppository. One hundred women aged 18-40 with term pregnancies undergoing elective caesarean section for the first time participated in this prospective project. Exclusion criteria included drug sensitivity, fetal malformations or defects, and complications during the cesarean operation. After same spinal anesthesia and same surgical techniques and in the recovery room patients consecutively received 100 mg diclofenac suppository or 10 mg morphine suppository. The pain severity was rated by “Numerical Rating Scale.” There was not the difference between two groups in terms of basal information. Pain score was significantly different between two groups in the first 12 hours (5.66 ±1.36 in morphine group and 3.63±0.96 in diclofenac group but not in the second 12 hour period. Considering pain scores every two hours in first 12 hours and every 4 hours in second 12 hours, morphine group had higher scores in comparison to diclofenac group. Also, the morphine group required pethidine injection sooner than the other group. The time giving first pethidine injection was 3.28±2.16 hours after operation in morphine group and 5.24±4.07 hours after operation (P<0.05. This study demonstrated that diclofenac suppository in comparison to morphine suppository decreased subjective pain scores in the first twenty-four hours after elective caesarean section which reached statistical significance in the first twelve hours. Although in diclofenac group, pethidine injection was prescribed significantly later.

A comparison of morbidity associated with placenta previa with and without previous caesarean sections

International Nuclear Information System (INIS)

Baqai, S.; Siraj, A.; Noor, N.

2018-01-01

To compare the morbidity associated with placenta previa with and without previous caesarean sections. Study Design: Retrospective comparative study. Place and Duration of Study: From March 2014 till March 2016 in the department of Obstetrics and Gynaecology at PNS Shifa hospital Karachi. Material and Methods: After the approval from hospital ethical committee, antenatal patients with singleton pregnancy of gestational age >32 weeks, in the age group of 20-40 years diagnosed to have placenta previa included in the study. All patients with twin pregnancy less than 20 years and more than 40 years of age were excluded. The records of all patients fulfilling the inclusion criteria were reviewed. Data had been collected for demographic and maternal variables, placenta previa, history of previous lower segment caesarean section (LSCS), complications associated with placenta previa and techniques used to control blood loss were recorded. Results: During the study period, 6879 patients were delivered in PNS Shifa, out of these, 2060 (29.9%) had caesarean section out of these, 47.3% patients had previous history of LSCS. Thirty three (1.6%) patients were diagnosed to have placenta previa and frequency of placenta previa was significantly higher in patients with previous history of LSCS than previous normal delivery of LSCS i.e. 22 vs. 11 (p=0.023). It was observed that the frequency of morbidly adherent placenta (MAP) and Intensive care unit (ICU) stay were significantly higher in patients with previous history of LSCS than previous history of normal delivery. Conclusion: Frequency of placenta previa was significantly higher in patients with history of LSCS. Also placenta previa remains a major risk factor for various maternal complications. (author)

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

Taxonomy of interstate conflicts: is South America a peaceful region?

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Tássio Franchi

2017-08-01

Full Text Available This article revisits theoretical efforts to classify interstate conflicts. It analyses South America and discuss the adequacy of influential interpretations about the intensity of interstate conflicts in the region as compared to global or other regions ones. The literature takes for granted that South America is a peaceful region. Such interpretation results from the indicators adopted. We argue that traditional indicators do not fully capture latent tensions and the actual level of conflicts in the region. The article suggests an alternative taxonomy that better fits the South America context and argues that a research agenda on the extent and nature of interstate conflics is needed.

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....... To investigate and compare the oral microbial profile between infants delivered vaginally and by C-section. Design. This is a cross-sectional case-control study. Eighty-four infants delivered either vaginally (n = 42) or by C-section (n = 42) were randomly selected from the 2009 birth cohort at the County...

Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid.

Science.gov (United States)

Schoorel, E N C; Vankan, E; Scheepers, H C J; Augustijn, B C C; Dirksen, C D; de Koning, M; van Kuijk, S M J; Kwee, A; Melman, S; Nijhuis, J G; Aardenburg, R; de Boer, K; Hasaart, T H M; Mol, B W J; Nieuwenhuijze, M; van Pampus, M G; van Roosmalen, J; Roumen, F J M E; de Vries, R; Wouters, M G A J; van der Weijden, T; Hermens, R P M G

2014-01-01

To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information. A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria. Obstetric health care in the Netherlands. A multidisciplinary steering group, an expert panel, and 25 future users of the PtDA, i.e. women with a previous caesarean section. The development consisted of a construction phase (definition of scope and purpose, and selection of content, framework, and format) and a pilot testing phase by interview. The process was supervised by a multidisciplinary steering group. Usability, clarity, and relevance. The construction phase resulted in a booklet including unbiased balanced information on mode of birth after caesarean section, a preference elicitation exercise, and tailored risk information, including a prediction model for successful VBAC. During pilot testing, visualisation of risks and clarity formed the main basis for revisions. Pilot testing showed the availability of tailored structured information to be the main factor involving women in decision-making. The PtDA meets 39 out of 50 IPDAS criteria (78%): 23 out of 23 criteria for content (100%) and 16 out of 20 criteria for the development process (80%). Criteria for effectiveness (n = 7) were not evaluated. An evidence-based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision-making on mode of birth after caesarean section. © 2013 Royal College of Obstetricians and Gynaecologists.

Video ethnography during and after caesarean sections: methodological challenges.

Science.gov (United States)

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

2017-07-01

To describe the challenges of, and steps taken to successfully collect video ethnographic data during and after caesarean sections. Video ethnographic research uses real-time video footage to study a cultural group or phenomenon in the natural environment. It allows researchers to discover previously undocumented practices, which in-turn provides insight into strengths and weaknesses in practice. This knowledge can be used to translate evidence-based interventions into practice. Video ethnographic design. A video ethnographic approach was used to observe the contact between mothers and babies immediately after elective caesarean sections in a tertiary hospital in Sydney, Australia. Women, their support people and staff participated in the study. Data were collected via video footage and field notes in the operating theatre, recovery and the postnatal ward. Challenges faced whilst conducting video ethnographic research included attaining ethics approval, recruiting vast numbers of staff members and 'vulnerable' pregnant women, and endeavouring to be a 'fly on the wall' and a 'complete observer'. There were disadvantages being an 'insider' whilst conducting the research because occasionally staff members requested help with clinical tasks whilst collecting data; however, it was an advantage as it enabled ease of access to the environment and staff members that were to be recruited. Despite the challenges, video ethnographic research enabled the provision of unique data that could not be attained by any other means. Video ethnographic data are beneficial as it provides exceptionally rich data for in-depth analysis of interactions between the environment, equipment and people in the hospital environment. The analysis of this type of data can then be used to inform improvements for future care. © 2016 John Wiley & Sons Ltd.

MATERNAL AND FOETAL OUTCOME OF VAGINAL BIRTH AFTER CAESAREAN SECTION

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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

Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

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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.

Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.

Science.gov (United States)

Foureur, Maralyn; Turkmani, Sabera; Clack, Danielle C; Davis, Deborah L; Mollart, Lyndall; Leiser, Bernadette; Homer, Caroline S E

2017-02-01

One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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

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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.

The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice.

Science.gov (United States)

Oladapo, O T; Sotunsa, J O; Sule-Odu, A O

2004-06-01

A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.

The Efficacy of Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Pain After Caesarean Section

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Melike Sakallı

2010-01-01

Full Text Available Background:: The effect of ilioinguinal and iliohypogastric (II-IH nerve block on postoperative pain is well documented when applied before Caesarean section but the efficacy remains unclear when applied after the surgical procedure. Therefore we investigated the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when applied after Caesarean Section. Methods: Sixty ASA I-II patients, scheduled for elective C/S were included in the study. After general anaesthesia was performed, the patients were allocated into 2 groups randomly. In Group I (n=30, bilateral II-IH block had been applied after the skin closure, with 10 ml of 0.5% ropivacaine on each side. In Group II (n=30 sham block had been applied. For postoperative analgesia all patients received tramadol via i.v patient controlled analgesia. VAS scores, tramadol consumption and side effects at 0th, 2nd, 4th, 6th, 8th, 12th, 16th, 20th, 24th hours were noted. Results: There was no difference between groups regarding demographical data. The mean VAS scores in Group I were significantly lower than in Group II at 6th (p=0.003, 8th (p=0.019, 12th (p=0.024, 24th hours (p=0.004 at rest and at 6th (p=0.022, 8th hours (p=0.047 with movement. Tramadol usage in Group I was significantly less than in Group II at all estimated time intervals (P=0.001. Total tramadol consumption was 331 ± 82 mg in Group I and 622±107 mg in group II (P=0.001. Conclusions: We observed that II-IH nerve block when applied after the surgery may reduce analgesic consumption after C/S. Key Words: Caesarean section, postoperative analgesia, Ilioinguinal and Iliohypogastric (II-IH nerve block.

Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

Science.gov (United States)

Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

2016-10-01

Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study.

Science.gov (United States)

Jadon, Ashok; Jain, Priyanka; Chakraborty, Swastika; Motaka, Mayur; Parida, Sudhansu Sekhar; Sinha, Neelam; Agrawal, Amit; Pati, Asit Kumar

2018-05-14

While opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial. One hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management. The median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained. The trial was registered with the Clinical Trial Registry of India ( CTRI/2017/03/008194 ) on 23/03/2017 (trial registered retrospectively).

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

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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

A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section.

Science.gov (United States)

Elfil, H; Crowley, L; Segurado, R; Spring, A

2015-11-01

A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min. Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. Copyright © 2015 Elsevier Ltd. All rights reserved.

AWARENESS UNDER GENERAL ANAESTHESIA IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION USING THIOPENTONE AND KETAMINE AS INDUCTION AGENTS- A RANDOMISED PROSPECTIVE STUDY

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Somashekharappa Basavanneppa Kadur

2016-12-01

Full Text Available BACKGROUND Awareness during general anaesthesia for caesarean section is a big concern because of its serious adverse consequences. It has been reported that ketamine used as induction agent reduces awareness. This study was conducted to compare awareness under general anaesthesia when thiopentone and ketamine are used as induction agents for caesarean section. MATERIALS AND METHODS Fifty healthy mothers scheduled for elective caesarean section were randomly divided into two groups to receive thiopentone (4 mg/kg -1 or ketamine (1.5 mg/kg -1 for induction of anaesthesia. Mothers were examined for intraoperative awareness using isolated forearm technique until the delivery of the baby. Postoperatively, they were spoken about recall and any hallucination by using a set of questionnaire. RESULTS 15% patients who received thiopentone were able to follow the commands compared to 8% patients who received ketamine. 65% patients who received thiopentone made reaching movements of the isolated forearm towards the stimulus compared to 20% patients of ketamine group. None of the patients in thiopentone group experienced any hallucinations compared to 1 patient (4% in ketamine group who exhibited hallucinations. None of fifty patients could recall the intraoperative events like squeezing of hands or the pain of operation. CONCLUSION Ketamine can be used as substitute for thiopentone as an induction agent in a dose equal to 1.5 mg/kg -1 . Having profound analgesic effect, property to maintain foetoplacental exchange better than any other induction agents, ketamine can be used routinely as an induction agent for mothers undergoing caesarean section under general anaesthesia.

Outcomes of planned home births with certified professional midwives: large prospective study in North America.

Science.gov (United States)

Johnson, Kenneth C; Daviss, Betty-Anne

2005-06-18

To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. Prospective cohort study. All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

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.

Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

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Esther Arendt

Full Text Available The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health.We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (<145.0cm, Short (145.0-149.9cm, Short-average (150.0-154.9cm, Average (155.0-159.9cm, Average-tall (160.0-169.9cm and Tall (≥170.0cm. Multivariate logistic regression was used to assess the contribution of maternal stature to the odds ratio of caesarean section delivery, adjusting for other exposures, such as age at index birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index

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

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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.

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

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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.

Red, orange and green Caesarean sections: a new communication tool for on-call obstetricians.

Science.gov (United States)

Dupuis, Olivier; Sayegh, Isabelle; Decullier, Evelyne; Dupont, Corinne; Clément, Henri-Jacques; Berland, Michel; Rudigoz, René-Charles

2008-10-01

To evaluate the effect of a novel communication tool, related to the degree of urgency for Caesarean sections (CSs), on the decision-to-delivery interval for emergency CS. Red CS are very urgent cases corresponding to life-threatening maternal or foetal situations, orange CS are urgent cases and green CS are non-urgent intrapartum CS. We carried out this cohort study in a French maternity hospital. The study included all emergency Caesarean sections during two 6-month periods, before and after introduction of the code. We compared the decision-to-delivery interval of the two study periods. Our study included 174 emergency CS. The mean decision-to-delivery interval after introduction of the code was 31.7 min, significantly shorter (p=0.02) than the 39.6 min interval before introduction of the colour code. Except for the preparation time, each time interval decreased. This included transporting the patient into the operating theatre, and the incision-to-delivery time interval. This study suggests that the use of the three-colour code could significantly shorten the decision-to-delivery interval in emergency CS. Further prospective studies are needed to confirm this result.

Influence of Very Early Exposure of Cefuroxime on Gut Microbiota Composition of Infants Born by Caesarean Section

DEFF Research Database (Denmark)

Krogfelt, Karen Angeliki; Bin Shamzir Kamal, Shamrulazhar; Hyldig, Nana

2016-01-01

Background: Cefuroxime is a broad-spectrum cephalosporin antibiotic. It is standard caesarean section (CS) procedure at many hospitals to administer the mother a single prophylactic dose (1500mg) before skin incision and hence before the umbilical cord is cut, indirectly exposing the foetus...

Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

Science.gov (United States)

Arendt, Esther; Singh, Neha S; Campbell, Oona M R

2018-01-01

The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health. We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index quintile, multiple birth, birth order and country of survey. There was a gradual increase in the rate of caesarean section with decreasing maternal height. Compared to women of Average height (155.0-159.9cm), taller women were protected. The adjusted odds ratio (aOR) for Tall women was 0.67 (95% CI:0.52-0.87) and for Average-tall women was 0

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

Science.gov (United States)

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

2016-01-01

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

Anaesthesia for caesarean section in a patient with acute generalised pustular psoriasis.

Science.gov (United States)

Samieh-Tucker, A; Rupasinghe, M

2007-10-01

We describe a 30-year-old parturient with acute generalised pustular psoriasis who presented for urgent caesarean section. A multidisciplinary team was involved and general anaesthesia was used successfully. Management of this condition is discussed and the literature reviewed. While generalised pustular psoriasis or impetigo herpetiformis is well recognised in pregnancy, it has not hitherto been reported in obstetric anaesthesia literature. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.

Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births.

Science.gov (United States)

Liang, Juan; Mu, Yi; Li, Xiaohong; Tang, Wen; Wang, Yanping; Liu, Zheng; Huang, Xiaona; Scherpbier, Robert W; Guo, Sufang; Li, Mingrong; Dai, Li; Deng, Kui; Deng, Changfei; Li, Qi; Kang, Leni; Zhu, Jun; Ronsmans, Carine

2018-03-05

To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. Observational study. China's National Maternal Near Miss Surveillance System (NMNMSS). 6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016. Obstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time. Caesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government's policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time. China is the only country that

Central neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.

Science.gov (United States)

Caranza, R; Jeyapalan, I; Buggy, D J

1999-04-01

In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). The incidence of nausea or vomiting was significantly higher in SM than ED (73% vs. 41%, P=0.01). In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.

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

Change in primary midwife-led care in the Netherlands in 2000-2008: a descriptive study of caesarean sections and other interventions among 789,795 low risk births.

Science.gov (United States)

Offerhaus, Pien M; de Jonge, Ank; van der Pal-de Bruin, Karin M; Hukkelhoven, Chantal W P M; Scheepers, Peer L H; Lagro-Janssen, Antoine L M

2014-05-01

to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. nationwide descriptive study. the Netherlands Perinatal Registry. 789,795 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008. primary outcome is the caesarean section rate. Vaginal instrumental delivery, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics influenced the caesarean section rate. the caesarean section rate did not increase and was 5.5 per cent (range 4.9-6.3 per cent) for nulliparous women, and 1.0 per cent (range 0.8-1.1 per cent) for multiparous women. After controlling for the decline in planned home births and other maternal characteristics no increase in the caesarean section rate was found. The vaginal instrumental birth rate showed no increase, and was 18.1 per cent (range 17.9-18.5 per cent) for nulliparous women and 1.5 per cent (range 1.4-1.7 per cent) for multiparous women. Augmentation of labour and/or pharmacological pain relief increased from 24.0 to 38.8 per cent for nulliparous women, and from 5.4 to 10.0 per cent for multiparous women. the rise in intrapartum referrals was not accompanied by an increase in caesarean section rate over the period 2000-2008. Despite a considerable rise in the use of pain relief and augmentation, the rate of spontaneous vaginal birth remained high for low risk women who started labour in primary midwife-led care. the current strict role division between primary care midwives and the obstetrician-led team increasingly results in a change in care provider during labour. In a more integrated care system, more women can receive continuous support of labour from their own primary care

Anaestetic management of caesarean section for conjoint-twins: A case report

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Deogaonkar Shrikrishna G, Aditya Prakash

2014-04-01

Full Text Available At Pravara Rural Hospital a 29 year old patient was admitted for delivery. Patient had conjoint-twins diagnosed after sonography and was posted for elective caesarean section. Patient was managed under general anaesthesia after thorough preparation and under multi-disciplinary involvement. Both the twins females were living and were further managed by neonatologists. Though conjoint-twins are rare and patients coming for delivery with conjoint-twins are still rarer because of early diagnosis and termination, anaesthesiologists working in developing countries and working in remote areas may face such patients. There are very few publications for management of delivery in such patients, hence this case report.

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...... characteristics. The coexistence of the classification systems does not lead to a conflict between them. Rather, the systems seem to co-exist in different configurations, through which they are complementary, contradictory and inclusive in different situations-sometimes simultaneously. The systems come...

Vaginal birth after caesarean section prediction models: a UK comparative observational study.

Science.gov (United States)

Mone, Fionnuala; Harrity, Conor; Mackie, Adam; Segurado, Ricardo; Toner, Brenda; McCormick, Timothy R; Currie, Aoife; McAuliffe, Fionnuala M

2015-10-01

Primarily, to assess the performance of three statistical models in predicting successful vaginal birth in patients attempting a trial of labour after one previous lower segment caesarean section (TOLAC). The statistically most reliable models were subsequently subjected to validation testing in a local antenatal population. A retrospective observational study was performed with study data collected from the Northern Ireland Maternity Service Database (NIMATs). The study population included all women that underwent a TOLAC (n=385) from 2010 to 2012 in a regional UK obstetric unit. Data was collected from the Northern Ireland Maternity Service Database (NIMATs). Area under the curve (AUC) and correlation analysis was performed. Of the three prediction models evaluated, AUC calculations for the Smith et al., Grobman et al. and Troyer and Parisi Models were 0.74, 0.72 and 0.65, respectively. Using the Smith et al. model, 52% of women had a low risk of caesarean section (CS) (predicted VBAC >72%) and 20% had a high risk of CS (predicted VBAC <60%), of whom 20% and 63% had delivery by CS. The fit between observed and predicted outcome in this study cohort using the Smith et al. and Grobman et al. models were greatest (Chi-square test, p=0.228 and 0.904), validating both within the population. The Smith et al. and Grobman et al. models could potentially be utilized within the UK to provide women with an informed choice when deciding on mode of delivery after a previous CS. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Measuring vulnerability to shocks in the gas market in South America

International Nuclear Information System (INIS)

Reymond, Mathias

2012-01-01

With a strong global demand for some 30 years, natural gas is a particular challenge for countries of South and Central America since each cubic meter of natural gas that is consumed is produced in this continent. It therefore seems appropriate to consider the risk of a collision gas and its effects on the countries most dependent on gas (either as producers or as consumers). Thus, in this paper, we study the vulnerability of gas in several countries on four ratios developed by Cabalu (2010). Once calculated from empirical data, these ratios helped to determine indicators and to classify countries according to their vulnerability in the event of a gas shock (sudden rise in prices). A picture emerges which represents an indicative classification of the countries. - Highlights: ► In this paper, we study the vulnerability of gas with four indicators. ► We focus on eight countries in South America and Central. ► These indicators helped to classify countries according to their vulnerability. ► The least vulnerable country is Bolivia. ► The most vulnerable countries are Chile and Venezuela.

A study to determine minimum effective dose of oxytocin infusion during caesarean delivery in parturients at high risk of uterine atony

Directory of Open Access Journals (Sweden)

Shashikiran

2017-01-01

Full Text Available Background: Oxytocin, a commonly used drug to prevent uterine atony after caesarean section, should be administered as dilute rapid infusion rather than as a bolus. This study was conducted to calculate ED90 of oxytocin infusion during caesarean delivery in parturients at high risk of postpartum haemorrhage (PPH. Materials and Methods: One hundred and twenty parturients having one or more risk factors for PPH received a blinded infusion of oxytocin following emergency caesarean delivery. The initial dose of oxytocin infusion was started as 0.4 IU min−1. The dose of oxytocin infusion for the next parturient was based on the response of preceding patient in increments or decrements of 0.1 IU min−1 as per a biased-coin design up-down sequential method (UDM. Measurements of non-invasive blood pressure and heart rate were taken at 2 min intervals from the time of oxytocin infusion. Intraoperative blood loss was noted. Side effects such as tachycardia, hypotension, nausea, vomiting, chest pain, headache and flushing were also recorded. Results: The ED90 of oxytocin infusion was found to be 0.405 IU min−1 (95% confidence interval 0.3864–0.4125 as calculated by Firth's penalised likelihood estimation using a biased-coin design UDM. Hypotension was observed for brief period of time in 25.6% of parturients and brief period of tachycardia was observed in 9.4% of parturients. No headache, flushing, chest pain and vomiting were observed in any parturients in our study. The estimated blood loss was within the normal limits. Conclusion: Our study showed that ED90 of oxytocin infusion required to achieve adequate uterine tone (UT after an emergency caesarean delivery in parturients at high risk of uterine atony was 0.405 IU min−1. The higher doses of oxytocin did not result in further improvement of UT. Therefore, early use of alternative uterotonic therapy is preferable to achieve adequate UT.

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

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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 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.

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

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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.

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

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Esteban Puentes-Rosas

2004-02-01

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

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

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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

Secularities, Diversities and Pluralities: Understanding the Challenges of Religious Diversity in Latin America

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Edgar Zavala-Pelayo

2016-04-01

Full Text Available Latin America is experiencing today the greatest religious diversity in its entire history. However, it must also be noted that a large number of the growing religious minorities may be classified into types of Christianity with conservative overtones. In this paper we will suggest that the literature streams on multiple secularities in contemporary (Western societies and religious diversity in Latin America do offer insightful perspectives yet fail to adequately convey the challenges raised by the religious across contemporary Latin America. Addressing Latin America’s historical background, we will distinguish conceptually and empirically among different degrees of secularities, diversities and pluralities and will construct with these distinctions a descriptive-normative model that can guide future analyses of secular and religious phenomena in Latin America. It is only through a comprehensive understanding of diversities, pluralities and secularities that the debates on those human rights crucial for social inclusion—from sexual and reproductive rights to gender and religious equality—can be fruitfully conducted in and beyond Latin America.

Association of Maternal Vitamin D Status with Glucose Tolerance and Caesarean Section in a Multi-Ethnic Asian Cohort: The Growing Up in Singapore Towards Healthy Outcomes Study.

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Loy, See Ling; Lek, Ngee; Yap, Fabian; Soh, Shu E; Padmapriya, Natarajan; Tan, Kok Hian; Biswas, Arijit; Yeo, George Seow Heong; Kwek, Kenneth; Gluckman, Peter D; Godfrey, Keith M; Saw, Seang Mei; Müller-Riemenschneider, Falk; Chong, Yap-Seng; Chong, Mary Foong-Fong; Chan, Jerry Kok Yen

2015-01-01

Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD) with gestational diabetes mellitus (GDM) and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Plasma 25OHD concentrations, fasting glucose (FG) and 2-hour postprandial glucose (2HPPG) concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26-28 weeks' gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section. In total, 388 (41.3%) women had 25OHD inadequacy. Of these, 131 (33.8%), 155 (39.9%) and 102 (26.3%) were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI) = 0.01, 0.14), but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR) = 1.39, 95% CI = 0.95, 2.05) was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33), while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43) and Indian women (OR = 2.41, 95% CI = 1.01, 5.73). 25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency

Association of Maternal Vitamin D Status with Glucose Tolerance and Caesarean Section in a Multi-Ethnic Asian Cohort: The Growing Up in Singapore Towards Healthy Outcomes Study.

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See Ling Loy

Full Text Available Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD with gestational diabetes mellitus (GDM and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO study.Plasma 25OHD concentrations, fasting glucose (FG and 2-hour postprandial glucose (2HPPG concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26-28 weeks' gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section.In total, 388 (41.3% women had 25OHD inadequacy. Of these, 131 (33.8%, 155 (39.9% and 102 (26.3% were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI = 0.01, 0.14, but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR = 1.39, 95% CI = 0.95, 2.05 was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33, while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43 and Indian women (OR = 2.41, 95% CI = 1.01, 5.73.25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency

[Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].

Science.gov (United States)

Kuppens, S M I; Hasaart, T H M; van der Donk, M W P; Huibers, M; Franssen, M J; de Becker, B M J; Wijnen, H A A; Pop, V J M

2008-06-07

Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. Retrospective analysis. In 2003 a standardized protocol of ECV was developed in the outpatient clinic for obstetrics of the Catharina Hospital in Eindhoven, the Netherlands; it was tested in 'version office visits'. Obstetric characteristics of all pregnant women who underwent attempts of ECV in the clinic from January 2004 until June 2006 during these sessions, and the subsequent births, were analysed. 85% of all ECVs were performed by the same hospital midwife and gynaecologist, in accordance with the protocol. ECV was successful in 96 of 209 pregnant women (46%). In 1 pregnant woman an emergency caesarean section was performed after ECV because of partial abruptio placentae. Nulliparity, incomplete breech presentation and low birth weight of the baby were associated with a lower success rate of ECV in this study. In the group with a successful ECV the percentage of caesarean deliveries was substantially lower (9 versus 83%; odds ratio: 0.21; 95% CI: 0.09-0.51). A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.

Elective caesarean operation in the bitch using aglepristone before the pre-partum decline in peripheral progesterone concentration.

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Levy, X; Fontaine, E; Segalini, V; Fontbonne, A

2009-07-01

The aim of this study was to investigate caesarean operation (CO) undertaken before the pre-partum decrease of progesterone but following administration of a progesterone receptor antagonist and to evaluate the innocuity of this procedure for the dam and pups. Thirty seven bitches of 15 different breeds, received an injection of 15 mg/kg aglepristone 59 or 60 days after the estimated day of ovulation, determined by progesterone quantitative assays, and caesarean section (CS) was performed between 20 and 24 h after administration. Progesterone remained above 6 nmol/l at the time of CS (mean = 15.75, SD = 3.84). No post-operative clinical complications were reported in any of the bitches. All bitches were able to nurse and feed their puppies in the first 24 h following surgery. No pups showed any signs of prematurity and 5 out of 188 pups (2.6) died in the first 2 weeks after delivery. This small study demonstrates that a CS may be safely and successfully performed an average of 2 days before the expected date of parturition following the administration of aglepristone, without any harmful consequence for the dam and her neonates.

Association between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy.

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Gil, Francisco; Amezqueta, Ana; Martinez, Diana; Aznal, Elena; Etayo, Veronica; Durá, Teodoro; Sánchez-Valverde, Félix

2017-01-01

Cow milk allergy (CMA) is the most common food allergy in breastfed infants. The aim of this study is to verify whether certain perinatal factors may influence the development of CMA immunoglobulin E (IgE)+. A retrospective, observational study of case and control groups was carried out. Information was collected of patients with CMA IgE+ from our department during the years 1990-2013. Patients of the same age and sex were recruited for the control group. Information on the following variables was collected: sex, age, pregnancy tolerance, duration of pregnancy, type of delivery, isolated doses of formula feeding in hospital (FFH), duration of breastfeeding, and family history of allergy (defined as ≥1 first-degree family member with allergic disease). Statistical analysis was performed using multivariate logistic regression techniques. A total of 211 cases were included in this study. Multivariate analysis showed an influence of duration of breastfeeding, FFH to be a risk factor (OR 4.94; 95% CI 2.68-9.08), especially in caesarean delivery (OR 11.82; 95% CI 2.64-47.50), and prematurity (OR 0.29; 95% CI 0.09-0.92) to be a protective factor. Perinatal factors play a key role in the development of CMA IgE+, with an influence of breastfeeding duration, FFH and caesarean delivery as risk factors and prematurity as a protective factor. While family history had no important role, environmental factors were more decisive. © 2017 S. Karger AG, Basel.

Acute Chest Syndrome in Sickle Cell Disease Patients Post Caesarean Delivery

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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.

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

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Jafar S. Tabrizi

2014-12-01

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

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

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Drake, M J P; Hill, J S

2013-05-01

Upper-arm non-invasive blood pressure measurement during caesarean section can be uncomfortable and unreliable because of movement artefact in the conscious parturient. We aimed to determine whether ankle blood pressure measurement could be used instead in this patient group by comparing concurrent arm and ankle blood pressure measured throughout elective caesarean section under regional anaesthesia in 64 term parturients. Bland-Altman analysis of mean difference (95% limits of agreement [range]) between the ankle and arm was 11.2 (-20.3 to +42.7 [-67 to +102]) mmHg for systolic arterial pressure, -0.5 (-21.0 to +19.9 [-44 to +91]) mmHg for mean arterial pressure and -3.8 (-25.3 to +17.8 [-41 to +94]) mmHg for diastolic arterial pressure. Although ankle blood pressure measurement is well tolerated and allows greater mobility of the arms than measurement from the arm, the degree of discrepancy between the two sites is unacceptable to allow routine use of ankle blood pressure measurement, especially for systolic arterial pressure. However, ankle blood pressure measurement may be a useful alternative in situations where arm blood pressure measurement is difficult or impossible. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

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

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Nanik Handayani

2015-11-01

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

BAT-BORNE RABIES IN LATIN AMERICA

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Luis E. Escobar

2015-02-01

Full Text Available The situation of rabies in America is complex: rabies in dogs has decreased dramatically, but bats are increasingly recognized as natural reservoirs of other rabies variants. Here, bat species known to be rabies-positive with different antigenic variants, are summarized in relation to bat conservation status across Latin America. Rabies virus is widespread in Latin American bat species, 22.5%75 of bat species have been confirmed as rabies-positive. Most bat species found rabies positive are classified by the International Union for Conservation of Nature as “Least Concern”. According to diet type, insectivorous bats had the most species known as rabies reservoirs, while in proportion hematophagous bats were the most important. Research at coarse spatial scales must strive to understand rabies ecology; basic information on distribution and population dynamics of many Latin American and Caribbean bat species is needed; and detailed information on effects of landscape change in driving bat-borne rabies outbreaks remains unassessed. Finally, integrated approaches including public health, ecology, and conservation biology are needed to understand and prevent emergent diseases in bats.

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

DEFF Research Database (Denmark)

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

2008-01-01

AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...

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.

Qualitative website analysis of information on birth after caesarean section.

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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

Tuberculosis-related mortality in people living with HIV in Europe and Latin America

DEFF Research Database (Denmark)

Podlekareva, Daria; Efsen, Anne Marie Werlinrud; Schultze, Anna

2016-01-01

baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. FINDINGS: Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71...... a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. METHODS: Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19...... countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after...

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

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Prerana N Shah

2011-01-01

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

Fractional CO₂ laser treatment of caesarean section scars

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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...

[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.

An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study.

Science.gov (United States)

Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

2017-02-01

In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in

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

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Lokman Soyoral

Full Text Available Abstract 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.

Hybrid classifiers methods of data, knowledge, and classifier combination

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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.

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

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Anil Agarwal

2011-01-01

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

The HysNiche trial: hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial

NARCIS (Netherlands)

Vervoort, A. J. M. W.; van der Voet, L. F.; Witmer, M.; Thurkow, A. L.; Radder, C. M.; van Kesteren, P. J. M.; Quartero, H. W. P.; Kuchenbecker, W. K. H.; Bongers, M. Y.; Geomini, P. M. A. J.; de Vleeschouwer, L. H. M.; van Hooff, M. H. A.; van Vliet, H. A. A. M.; Veersema, S.; Renes, W. B.; van Meurs, H. S.; Bosmans, J.; Oude Rengerink, K.; Brölmann, H. A. M.; Mol, B. W. J.; Huirne, J. A. F.

2015-01-01

A caesarean section (CS) can cause a defect or disruption of the myometrium at the site of the uterine scar, called a niche. In recent years, an association between a niche and postmenstrual spotting after a CS has been demonstrated. Hysteroscopic resection of these niches is thought to reduce

Risk factors and between-hospital variation of caesarean section in Denmark

DEFF Research Database (Denmark)

Wehberg, Sonja; Guldberg, Rikke; Gradel, Kim Oren

2018-01-01

OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions. DESIGN: Historical registry-based cohort study. SETTINGS AND PARTICIPANTS: The study......, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation. RESULTS: The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed...... CSs and one unit fewer CSs than expected. CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk...

Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study.

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Amin, Pina; Zaher, Summia; Penketh, Richard; Cherian, Sobha; Collis, Rachel E; Sanders, Julia; Bhal, Kiron

2018-02-19

To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK. Cohort study of births from 2006 to 2015. A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom. Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA). Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more. During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen. Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

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

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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.

[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.

A COMPARATIVE STUDY OF SINGLE VERSUS DOUBLE LAYER CLOSURE ON LOWER SEGMENT CAESAREAN SCAR

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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.

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

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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...... all women (n = 39 742) recorded in the Danish Medical Birth Registry (DMBR) during a 12-year period (1997–2008) with a singleton pregnancy at term and TOLAC. Among these, all women with a complete uterine rupture were identified (cases). Information from the registry was validated against medical...... of uterine rupture. Conclusion: Single-layer uterine closure did not remain significantly associated to uterine rupture during TOLAC at term after adjustment for confounding factors. Induction of labour with an unfavourable cervix, birth weight ≥ 4000g and indicators of prolonged labour were all major risk...

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...

Access to facility delivery and caesarean section in north-central Liberia: a cross-sectional community-based study

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Gartland, Matthew G; Taryor, Victor D; Norman, Andy M; Vermund, Sten H

2012-01-01

Objective Rural north-central Liberia has one of the world's highest maternal mortality ratios. We studied health facility birthing service utilisation and the motives of women seeking or not seeking facility-based care in north-central Liberia. Design Cross-sectional community-based structured interviews and health facility medical record review. Setting A regional hospital and the surrounding communities in rural north-central Liberia. Participants A convenience sample of 307 women between 15 and 49 years participated in structured interviews. 1031 deliveries performed in the regional hospital were included in the record review. Primary outcomes Delivery within a health facility and caesarean delivery rates were used as indicators of direct utilisation of care and as markers of availability of maternal health services. Results Of 280 interview respondents with a prior childbirth, only 47 (16.8%) delivered their last child in a health facility. Women who did not use formal services cited cost, sudden labour and family tradition or religion as their principal reasons for home delivery. At the regional hospital, the caesarean delivery rate was 35.5%. Conclusions There is an enormous unmet need for maternal health services in north-central Liberia. Greater outreach and referral services as well as community-based education among women, family members and traditional midwives are vital to improve the timely utilisation of care. PMID:23117566

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

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Molofsky, Merle

2018-06-01

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.

The decision delivery interval in emergency caesarean section and its associated maternal and fetal outcomes at a referral hospital in northern Tanzania: a cross-sectional study.

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Hirani, Birjna A; Mchome, Bariki L; Mazuguni, Nicholaus S; Mahande, Michael J

2017-12-07

Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania. This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant. A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40-120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5 th minute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63-1.64) and hospital stay (OR: 1.02; 95% 0.63-1.64). Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the

Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study

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Morris Jonathan M

2011-01-01

Full Text Available Abstract Background Caesarean section (CS rates around the world have been increasing and in Australia have reached 30% of all births. Robson's Ten-Group Classification System (10-group classification provides a clinically relevant classification of CS rates that provides a useful basis for international comparisons and trend analyses. This study aimed to investigate trends in CS rates in New South Wales (NSW, including trends in the components of the 10-group classification. Methods We undertook a cross-sectional study using data from the Midwives Data Collection, a state-wide surveillance system that monitors patterns of pregnancy care, services and pregnancy outcomes in New South Wales, Australia. The study population included all women giving birth between 1st January 1998 and 31st December 2008. Descriptive statistics are presented including age-standardised CS rates, annual percentage change as well as regression analyses. Results From 1998 to 2008 the CS rate in NSW increased from 19.1 to 29.5 per 100 births. There was a significant average annual increase in primary 4.3% (95%CI 3.0-5.7% and repeat 4.8% (95% CI 3.9-5.7% CS rates from 1998 to 2008. After adjusting for maternal and pregnancy factors, the increase in CS delivery over time was maintained. When examining CS rates classified according to the 10-group classification, the greatest contributors to the overall CS rate and the largest annual increases occurred among nulliparae at term having elective CS and multipara having elective repeat CS. Conclusions Given that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.

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

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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).

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

International Nuclear Information System (INIS)

Skjoeldebrand, A.; Eklund, J.; Johansson, H.; Lunell, N.-O.; Nylund, L.; Sarby, B.; Thornstroem, S.

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)

Work, development and waste classifi cation: changes in the past half century

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Sabina Dimarco

2013-01-01

Full Text Available During the last decades in almost the whole Latin America a new social actor has arisen: the organizations of urban classifi ers of residues. The present article analyzes this recent phenomenon taking it as a social fact that condenses two deep structural transformations that they have sealed to the Latin-American continent throughout last half century: on the one hand, the changes in the world of the work (in the labor market and in the form about which there is thought what is the “decent” work; on the other hand, the transformations in the form in which the question of the development is thought about these countries from the emergence of the environmental question and the theories of the sustainable development.

Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial.

Science.gov (United States)

Attilakos, G; Psaroudakis, D; Ash, J; Buchanan, R; Winter, C; Donald, F; Hunt, L P; Draycott, T

2010-07-01

To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH). Double-blind randomised single centre study (1:1 ratio). Teaching hospital in Bristol, UK with 6000 deliveries per annum. Women at term undergoing elective or emergency caesarean section under regional anaesthesia, excluding women with placenta praevia, multiple gestation and placental abruption. Women were randomised to receive either carbetocin 100 microg or oxytocin 5 IU intravenously after the delivery of the baby. Perioperative care was otherwise normal and use of additional oxytocics was at the discretion of the operating obstetrician. Analysis was by intention to treat. The proportion of women in each arm of the trial that needed additional pharmacological oxytocic interventions. Significantly more women needed additional oxytocics in the oxytocin group (45.5% versus 33.5%, Relative risk 0.74, 95% CI 0.57-0.95). The majority of women had oxytocin infusions. There were no significant differences in the secondary outcomes, including major PPH, blood transfusions and fall in haemoglobin. Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.

SpectraClassifier 1.0: a user friendly, automated MRS-based classifier-development system

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Julià-Sapé Margarida

2010-02-01

Full Text Available Abstract Background SpectraClassifier (SC is a Java solution for designing and implementing Magnetic Resonance Spectroscopy (MRS-based classifiers. The main goal of SC is to allow users with minimum background knowledge of multivariate statistics to perform a fully automated pattern recognition analysis. SC incorporates feature selection (greedy stepwise approach, either forward or backward, and feature extraction (PCA. Fisher Linear Discriminant Analysis is the method of choice for classification. Classifier evaluation is performed through various methods: display of the confusion matrix of the training and testing datasets; K-fold cross-validation, leave-one-out and bootstrapping as well as Receiver Operating Characteristic (ROC curves. Results SC is composed of the following modules: Classifier design, Data exploration, Data visualisation, Classifier evaluation, Reports, and Classifier history. It is able to read low resolution in-vivo MRS (single-voxel and multi-voxel and high resolution tissue MRS (HRMAS, processed with existing tools (jMRUI, INTERPRET, 3DiCSI or TopSpin. In addition, to facilitate exchanging data between applications, a standard format capable of storing all the information needed for a dataset was developed. Each functionality of SC has been specifically validated with real data with the purpose of bug-testing and methods validation. Data from the INTERPRET project was used. Conclusions SC is a user-friendly software designed to fulfil the needs of potential users in the MRS community. It accepts all kinds of pre-processed MRS data types and classifies them semi-automatically, allowing spectroscopists to concentrate on interpretation of results with the use of its visualisation tools.

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

Science.gov (United States)

Souza, J P; Betran, A P; Dumont, A; de Mucio, B; Gibbs Pickens, C M; Deneux-Tharaux, C; Ortiz-Panozo, E; Sullivan, E; Ota, E; Togoobaatar, G; Carroli, G; Knight, H; Zhang, J; Cecatti, J G; Vogel, J P; Jayaratne, K; Leal, M C; Gissler, M; Morisaki, N; Lack, N; Oladapo, O T; Tunçalp, Ö; Lumbiganon, P; Mori, R; Quintana, S; Costa Passos, A D; Marcolin, A C; Zongo, A; Blondel, B; Hernández, B; Hogue, C J; Prunet, C; Landman, C; Ochir, C; Cuesta, C; Pileggi-Castro, C; Walker, D; Alves, D; Abalos, E; Moises, Ecd; Vieira, E M; Duarte, G; Perdona, G; Gurol-Urganci, I; Takahiko, K; Moscovici, L; Campodonico, L; Oliveira-Ciabati, L; Laopaiboon, M; Danansuriya, M; Nakamura-Pereira, M; Costa, M L; Torloni, M R; Kramer, M R; Borges, P; Olkhanud, P B; Pérez-Cuevas, R; Agampodi, S B; Mittal, S; Serruya, S; Bataglia, V; Li, Z; Temmerman, M; Gülmezoglu, A M

2016-02-01

To generate a global reference for caesarean section (CS) rates at health facilities. Cross-sectional study. Health facilities from 43 countries. Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. © 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Efficacy of magnesium sulphate and/or fentanyl as adjuvants to intrathecal low-dose bupivacaine in parturients undergoing elective caesarean section

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Shelly Rana

2017-01-01

Full Text Available Background and Aim: Recent developments in the field of intrathecal adjuvants have led to accelerated functional recovery with adequate postoperative analgesia following caesarean section. Encouraging results have been obtained with the use of intrathecal magnesium with or without fentanyl in parturients. This study was conceived to evaluate the effects of adding magnesium sulphate and/or fentanyl to low-dose intrathecal bupivacaine in parturients undergoing caesarean section under subarachnoid block (SAB. Materials and Methods: Ninety, American Society of Anesthesiologists I or II, parturients for the elective caesarean section were enrolled in this prospective randomized, double-blind study. The parturients were randomly assigned to three groups. In Group M, parturients received 8.5 mg (1.7 mL hyperbaric bupivacaine 0.5% with 50 mg (0.1 mL magnesium sulphate and 0.4 mL normal saline. Group F received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg (0.4 mL fentanyl and 0.1 mL of normal saline and Group MF parturients received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg fentanyl added to 50 mg magnesium sulphate. Results: Parturients in the group MF were pain free for longest period (273.70 ± 49.30 min as compared to group M (252.67 ± 40.76 min and group F (239.80 ± 38.45 mins [gp MF vs F and, gp M vs F (P = 0.00]. The total doses of rescue analgesics were least in group MF (2.43 ± 0.56 and maximum in group F (3.30 ± 0.63, with comparable neonatal outcomes in three groups. Conclusion: Our data supports synergistic action of intrathecal magnesium sulphate to fentanyl, and it is concluded that on addition of intrathecal magnesium sulphate and fentanyl to low-dose bupivacaine as adjuvant in subarachnoid block, results in prolonged duration of postoperative analgesia with lesser pain scores and lesser dose of rescue analgesia with better haemodynamic stability.

Free Trade Area of the Americas: The Scope of the Negotiations

OpenAIRE

Herminio Blanco M.; Jaime Zabludovsky

2003-01-01

The purpose of this work is to analyze the negotiation agenda of the Free Trade Area of the Americas (FTAA), its participants¿ main interests and the main conflicts that might arise in the process. Hence, a revision of the core interests pursued by countries in each of the nine FTAA negotiating groups is made. Interests are classified into "defensive" and "offensive". The first, are those pursued by the status quo, generally associated with the protection of the domestic market, and the latte...

Shoulder pain after caesarean section: comparison between general and spinal anaesthesia.

Science.gov (United States)

Zirak, N; Soltani, G; Hafizi, L; Mashayekhi, Z; Kashani, I

2012-05-01

This study investigated shoulder pain as a maternal complication after caesarean section (CS), evaluation of its prevalence and comparison between spinal anaesthesia (SA) and general anaesthesia (GA) groups. A total of 200 women as CS candidates were allocated into two equal groups; SA and GA. The total prevalence of shoulder pain was 39.45%. The two groups were matched according to demographic data. However, the incidence of shoulder pain in the GA group was more than that in the SA group (p =0.004). Shoulder pain in the right shoulder in the GA group was more prevalent than the left shoulder (p <0.001). Moderate severity of shoulder pain was significantly more in the GA group (p =0.000), while in the SA group, the mild severity was significant (p <0.001). Our study revealed that the incidence of shoulder pain after CS is significant. Moreover, shoulder pain was significantly more common in the GA group than the SA group.

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.

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

International Nuclear Information System (INIS)

Teixidor Viñas, M.; Chandraharan, E.; Moneta, M.V.; Belli, A.M.

2014-01-01

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

Re: What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour?

DEFF Research Database (Denmark)

Boie, Sidsel; Glavind, Julie; Uldbjerg, Niels

2017-01-01

The authors pose the question - What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour? and state in their paper that "There is no consensus on the optimal dose regimen of oxytocin for delay in the first stage of labour...... in nulliparous women at term (37-42 weeks’ gestation) to reduce unplanned caesarean section and increase vaginal birth with minimal adverse events". However, they describe only low and high dose oxytocin regimens and fail to acknowledge that no oxytocin at all is associated with a spontaneous delivery just...... as often as when oxytocin is given (1,2) or that discontinuation of oxytocin once the active phase of labour is reached can result in higher spontaneous delivery rates than continuing oxytocin (3,4). The paper in its list of trials (box 2) only describes those addressing high and low dose oxytocin, which...

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.

Emergency caesarean delivery in a patient with cerebral malaria-leptospira co infection: Anaesthetic and critical care considerations

Directory of Open Access Journals (Sweden)

Sukhen Samanta

2014-01-01

Full Text Available Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block, intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa and the role of plasmapheresis in leptospira related jaundice with renal failure.

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

International Nuclear Information System (INIS)

Duan, X.-H.; Wang, Y.-L.; Han, X.-W.; Chen, Z.-M.; Chu, Q.-J.; Wang, L.; Hai, D.-D.

2015-01-01

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

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

Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage.

Science.gov (United States)

De Bonis, Maria; Torricelli, Michela; Leoni, Licia; Berti, Paolo; Ciani, Valentina; Puzzutiello, Rosa; Severi, Filiberto Maria; Petraglia, Felice

2012-06-01

To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.

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

International Nuclear Information System (INIS)

Boota, M.; Haq, I.

2012-01-01

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

Geographically Sourcing Cocaine’s Origin - Delineation of the Nineteen Major Coca Growing Regions in South America

Science.gov (United States)

Mallette, Jennifer R.; Casale, John F.; Jordan, James; Morello, David R.; Beyer, Paul M.

2016-03-01

Previously, geo-sourcing to five major coca growing regions within South America was accomplished. However, the expansion of coca cultivation throughout South America made sub-regional origin determinations increasingly difficult. The former methodology was recently enhanced with additional stable isotope analyses (2H and 18O) to fully characterize cocaine due to the varying environmental conditions in which the coca was grown. An improved data analysis method was implemented with the combination of machine learning and multivariate statistical analysis methods to provide further partitioning between growing regions. Here, we show how the combination of trace cocaine alkaloids, stable isotopes, and multivariate statistical analyses can be used to classify illicit cocaine as originating from one of 19 growing regions within South America. The data obtained through this approach can be used to describe current coca cultivation and production trends, highlight trafficking routes, as well as identify new coca growing regions.

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.

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

LENUS (Irish Health Repository)

Murphy, Deirdre J

2012-02-01

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

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India and Nepal

NARCIS (Netherlands)

M. Neuman (Melissa); G. Alcock (Glyn); K. Azad (Kishwar); A. Kuddus (Abdul); D. Osrin (David); N. Shah More (Neena); N. Nair (Nirmala); P. Tripathy (Prasanta); C. Sikorski (Catherine); N. Saville (Naomi); A. Sen (Aman); T. Colbourn (Tim); A.J. Houweling (Tanja); N. Seward (Nadine); A. Manandhar; B. Shrestha (Bhim); A. Costello (Anthony); A. Prost (Audrey)

2014-01-01

textabstractObjectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design: Cross-sectional study. Setting: 81 community-based geographical clusters in four locations in Bangladesh, India

[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.

Deciding on the mode of birth after a previous caesarean section - An online survey investigating women's preferences in Western Switzerland.

Science.gov (United States)

Bonzon, Magali; Gross, Mechthild M; Karch, André; Grylka-Baeschlin, Susanne

2017-07-01

promoting vaginal births after caesarean section (VBAC) for eligible women and increasing rates of successful VBACs are the best strategies to reduce the number of repeat caesarean sections (CS). Knowledge of factors that are associated with women's decision-making around mode of birth after CS is important when developing strategies to promote VBAC. This study assessed which factors are associated with women's preferences for VBAC versus elective repeat caesarean section (ERCS) in a new pregnancy after one previous caesarean in Switzerland. cross-sectional web-survey. Western Switzerland. French-speaking women living in Western Switzerland, with one previous CS who gave birth subsequently to a child after a complication-free pregnancy were eligible to participate in the survey. Of 393 women who started the survey in November/December 2014, 349 were included: 227 who planned a VBAC and 122 who planned an ERCS at term. univariable and multivariable analyses were conducted to describe and compare women who had planned a VBAC with women who had planned an ERCS in a pregnancy following a CS. Logistic regression modelling was used to investigate predictors that were associated with a preference for a VBAC at term. Analyses were performed with SPSS 22 and Stata 13. of the women planning a VBAC, 62.6% VBAC gave birth vaginally. Predictors which were significantly associated with increased odds of women choosing a VBAC: duration since previous birth in years (OR=1.11 95% CI [1.03-1.20], p=0.010), having had midwifery care during pregnancy (OR=2.09, 95% CI [1.08-4.05], p=0.029), being advised by their healthcare provider to attempt a VBAC (OR=4.20, 95% CI [1.75-10.09], p=0.001), preference for VBAC during the third trimester of their pregnancy (OR=3.98, 95% CI [1.77-8.93], p=0.001), and wishing to let the child choose the moment of birth (OR=1.46, 95% CI[1.22-1.74], p<0.001). The importance of safety for the mother decreased the odds of women preferring a VBAC (OR=0.74, 95

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

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

Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

Directory of Open Access Journals (Sweden)

Shahid Adeel

2017-01-01

Full Text Available Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819. In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000 at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265. Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different

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...

Combined use of hyperbaric and hypobaric ropivacaine significantly improves hemodynamic characteristics in spinal anesthesia for caesarean section: a prospective, double-blind, randomized, controlled study.

Science.gov (United States)

Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

2015-01-01

To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study. Parturients (n = 136) undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A) or hyperbaric ropivacaine (Group B). Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis. Group A had a lower level of sensory blockade (T6 [T6-T7]) and longer time to achieve T8 sensory blockade level (8 ± 1.3 min) than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade. Chinese Clinical Trial Register ChiCTR-TRC-13004622.

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.

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...

Anaesthesia for an emergent caesarean section in a patient with acute transverse myelitis

Directory of Open Access Journals (Sweden)

Samuel A Hunter

2018-01-01

Full Text Available We present a 32-year-old G1P0 woman at 32 weeks and two days gestation with new onset paraplegia, hyperreflexia, and sensory disturbance that gradually progressed over the past month and acutely worsened over the last 24 hours. MRI revealed a demyelinating process of the thoracic spine and diffuse cervicothoracic cord oedema. After 7 days, her foetus developed recurrent heart rate decelerations and an emergent caesarean section was performed. On airway exam, she was Mallampati 3 with a short thyromental distance. She reported fasting overnight and into the morning. Our choice was between performing neuraxial anaesthesia in the setting of an acute demyelinating process of her spinal cord versus general anaesthesia on a patient at risk of aspiration with a potentially difficult airway. Given the potential complications of neuraxial anaesthesia, we utilized rocuronium to perform a rapid sequence induction of general anaesthesia with endotracheal intubation.

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

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.

Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study.

Science.gov (United States)

Brown, S J; Gartland, D; Donath, S; MacArthur, C

2011-07-01

To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. Urinary incontinence 3 months postpartum in women continent before the index pregnancy. Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Fingerprint prediction using classifier ensembles

CSIR Research Space (South Africa)

Molale, P

2011-11-01

Full Text Available ); logistic discrimination (LgD), k-nearest neighbour (k-NN), artificial neural network (ANN), association rules (AR) decision tree (DT), naive Bayes classifier (NBC) and the support vector machine (SVM). The performance of several multiple classifier systems...

Influence of lateral decubitus positioning after combined use of hyperbaric and hypobaric ropivacaine on hemodynamic characteristics in spinal anesthesia for caesarean section

OpenAIRE

Quan, Zhe-Feng; He, Hai-Li; Tian, Ming; Chi, Ping; Li, Xin

2014-01-01

Purpose: Positioning of the patient during and after surgery can have significant implications on recovery. Therefore, the purpose of the present study was to determine the influence of placing patients in a lateral decubitus position for 15 min after combined use of hyperbaric and hypobaric ropivacaine and assess hemodynamic characteristics during spinal anesthesia for caesarean section. Methods: One hundred-forty patients undergoing elective cesarean delivery with combined use of hyperbaric...

Successful anaesthetic management of a case of hypertrophic obstructive cardiomyopathy posted for elective caesarean section using epidural anaesthesia with 0.75% Ropivacaine

Directory of Open Access Journals (Sweden)

Anjali R Bhure

2011-01-01

Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a complex cardiovascular disorder with autosomal dominant inheritance and an incidence of 0.1-0.5% in pregnant females. Anaesthetic management of a pregnant female with HOCM posted for elective caesarean section is a challenge, as even minor hemodynamic insults may lead to life-threatening complications. We report successful management of one such patient using epidural anaesthesia with 0.75% Ropivacaine.

Characterizing commercial oil palm expansion in Latin America: land use change and trade

Science.gov (United States)

Furumo, Paul Richard; Aide, T. Mitchell

2017-02-01

Commodity crop expansion has increased with the globalization of production systems and consumer demand, linking distant socio-ecological systems. Oil palm plantations are expanding in the tropics to satisfy growing oilseed and biofuel markets, and much of this expansion has caused extensive deforestation, especially in Asia. In Latin America, palm oil output has doubled since 2001, and the majority of expansion seems to be occurring on non-forested lands. We used MODIS satellite imagery (250 m resolution) to map current oil palm plantations in Latin America and determined prior land use and land cover (LULC) using high-resolution images in Google Earth. In addition, we compiled trade data to determine where Latin American palm oil flows, in order to better understand the underlying drivers of expansion in the region. Based on a sample of 342 032 ha of oil palm plantations across Latin America, we found that 79% replaced previously intervened lands (e.g. pastures, croplands, bananas), primarily cattle pastures (56%). The remaining 21% came from areas that were classified as woody vegetation (e.g. forests), most notably in the Amazon and the Petén region in northern Guatemala. Latin America is a net exporter of palm oil but the majority of palm oil exports (70%) stayed within the region, with Mexico importing about half. Growth of the oil palm sector may be driven by global factors, but environmental and economic outcomes vary between regions (i.e. Asia and Latin America), within regions (i.e. Colombia and Peru), and within single countries (i.e. Guatemala), suggesting that local conditions are influential. The present trend of oil palm expanding onto previously cleared lands, guided by roundtable certifications programs, provides an opportunity for more sustainable development of the oil palm sector in Latin America.

Caesarean section in a patient with Myasthenia Gravis: A bigger challenge for the anesthesiologist than the obstetrician

Directory of Open Access Journals (Sweden)

Manoj K Sanwal

2012-01-01

Full Text Available Myasthenia Gravis (MG is an acquired, autoimmune disorder affecting neuromuscular junction presenting with easy fatigability, progressive weakness, diplopia, difficulty in speaking and swallowing and even ventilatory failure in severe cases. During pregnancy the disease may go into remission or may exacerbate at any time during first, second and third trimesters or postpartum period. We are reporting the case of a 28 year old primigravida, known case of MG, who underwent caesarean section and developed muscular weakness on third postoperative day. Her neonate also had tachypnoea and hypotonia, Both, the mother and the baby were managed aggressively and responded well to therapy.

Classifying Sluice Occurrences in Dialogue

DEFF Research Database (Denmark)

Baird, Austin; Hamza, Anissa; Hardt, Daniel

2018-01-01

perform manual annotation with acceptable inter-coder agreement. We build classifier models with Decision Trees and Naive Bayes, with accuracy of 67%. We deploy a classifier to automatically classify sluice occurrences in OpenSubtitles, resulting in a corpus with 1.7 million occurrences. This will support....... Despite this, the corpus can be of great use in research on sluicing and development of systems, and we are making the corpus freely available on request. Furthermore, we are in the process of improving the accuracy of sluice identification and annotation for the purpose of created a subsequent version...

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).

Classifiers based on optimal decision rules

KAUST Repository

Amin, Talha M.; Chikalov, Igor; Moshkov, Mikhail; Zielosko, Beata

2013-01-01

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).

Robust Framework to Combine Diverse Classifiers Assigning Distributed Confidence to Individual Classifiers at Class Level

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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.

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...

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.

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 performances of novel classifiers using substitutes of MFPC's geometric mean aggregator are benchmarked in the scope of an image processing application against the MFPC to reveal classification improvement potentials for obtaining higher classification rates....

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

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

Directory of Open Access Journals (Sweden)

Fyfe Elaine M

2012-10-01

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

Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix : a secondary analysis of the HYPITAT and DIGITAT trials

NARCIS (Netherlands)

Bernardes, T. P.; Broekhuijsen, K.; Koopmans, C. M.; Boers, K. E.; van Wyk, L.; Tajik, P.; van Pampus, M. G.; Scherjon, S. A.; Mol, B. W.; Franssen, M. T.; Berg, van den P. P.; Groen, Henk

Objective To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. Design Secondary analysis of data from two randomised clinical trials. Setting Data were collected in two nationwide Dutch

Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study.

Science.gov (United States)

Chen, Shu-Wen; Hutchinson, Alison M; Nagle, Cate; Bucknall, Tracey K

2018-01-17

Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women's decision-making processes and the influences on their mode of birth following a previous CS. A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks' gestation. Stage II involved interviews with pregnant women at 35-37 weeks' gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. Ensuring the safety of mother and baby was the focus of women's decisions. Women's decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians' recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians' professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women's interactions with obstetricians regarding birth choices

J. E. W. Wallin's Diagnostic Theory for Classifying the Feeble-Minded and Backward in Early Twentieth-Century Public Schools in America

Science.gov (United States)

Yoshii, Ryo

2016-01-01

In the late nineteenth and early twentieth centuries, American psychologists began addressing problems related to the intellectual capacity of students enrolled in public schools. This paper focuses on the role and influence of psychologists in addressing these problems, specifically the difficulty of classifying students deemed feeble-minded and…

Composite Classifiers for Automatic Target Recognition

National Research Council Canada - National Science Library

Wang, Lin-Cheng

1998-01-01

...) using forward-looking infrared (FLIR) imagery. Two existing classifiers, one based on learning vector quantization and the other on modular neural networks, are used as the building blocks for our composite classifiers...

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.

Comparison of analgesic efficacy of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol for postoperative pain relief in caesarean section under spinal anaesthesia: A double-blind randomized trial

Directory of Open Access Journals (Sweden)

Roopa Sachidananda

2017-01-01

Full Text Available Background: Caesarean section is one of the most frequently performed surgeries in obstetrics. Optimal pain relief of the mother is possible with multimodal methods. Wound infiltration is one of the simplest and safe methods. The aim of the study was to compare the analgesic efficacy of wound infiltration of bupivacaine, with tramadol and bupivacaine mixture for postoperative pain. Materials and Methods: After obtaining Institutional Ethical Committee approval, 60 pregnant women of age group 18–35 years, undergoing elective caesarean section under spinal anaesthesia were included in the study. The patients were randomized into two groups of 30 each. Patients belonging to group B received bupivacaine 0.25% 0.7 mg/kg (diluted to 20 mL with normal saline, while those belonging to group T received tramadol 2 mg/kg mixed in bupivacaine 0.25% 0.7 mg/kg (diluted to 20 mL with normal saline. The time for first request of analgesia, numerical rating scale score, and cumulative consumption of diclofenac and tramadol in 24 h were compared. Results: The time for first request of analgesia in group T was 386.17 ± 233.84 min compared to group B which was 192.50 ± 134.77 (P < 0.0002. The total diclofenac consumption in the first 24 h was significantly reduced in group T when compared to group B (P < 0.0068. Conclusions: Subcutaneous wound infiltration with tramadol and bupivacaine prolongs the pain-free period and analgesic consumption after caesarean section, while it also enhances the patient satisfaction.

Is the Central America forearc sliver part of the North America plate?

Science.gov (United States)

Guzman-Speziale, M.

2012-04-01

The Central America Forearc sliver is located between the Central America volcanic arc and the Middle America trench. Several authors have suggested that the forearc is being displaced to the northwest with respect to the Caribbean plate; they point to right-lateral, normal-faulting earthquakes along the Central America volcanic arc as prime evidence of this displacement. Apparently, the forearc continues to the northwest into southeastern Mexico, although this portion of the forearc is not being displaced. I present evidence that suggests that the forearc indeed continues into southeastern Mexico and that it belongs to the North America plate. Physiographically, there is a continuity of the forearc into the Coastal plains of southeastern (Chiapas) Mexico, across the Motagua and Polochic faults. Offshore, cross-sections of the Middle America trench are similar along the mexican (Chiapas) segment, and the Central American segment. Furthermore, at the northwestern end of the coastal plain there are no compressive structures, which suggests that the coastal plain is not being displaced to the northwest. As a matter of fact, fault-plane solutions for shallow earthquakes show extension rather than compression. Shallow, interplate earthquakes along the trench show similar parameters along both segments. P-axes and earthquake slip vectors have consistent azimuths, which relate better with Cocos-North America convergence than with Cocos-Caribbean. Azimuth of T-axes for normal-faulting earthquakes also agree well with Cocos-North America convergence. Similarity in several parameters is thus found across both segments, the Chiapas coastal plain and the Central America forearc sliver proper. This suggests that both segments are continuous and probably one and the same, and belonging to the North America plate. Perhaps more properly, the forearc sliver extends into southeastern Mexico and is part of the zone of deformation associated to the Cocos-North America-Caribbean plates

NATURAL AND ANTHROPIC RISK STUDIES IN FOUR DECADES IN THE GEOGRAPHICAL JOURNAL OF CENTRAL AMERICA (1974 - 2015)

OpenAIRE

Quesada-Román, Adolfo

2017-01-01

The aim of this work is to identify the influence of the international and national epistemological trends and the techniques in the risk management of disasters (RMD) in Costa Rica. To do this, the journal papers of the Geographical Journal of Central America between 1974 and 2015 were analyzed -114 included topics related to natural and anthropogenic risks. They were classified into eight thematic classes: seismic hazards, volcanic hazards, slope processes hazards, hydrometeorological hazar...

Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

OpenAIRE

Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

2015-01-01

Purpose To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study. Methods Parturients (n = 136) undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A) or hyperbaric ropivacaine (Group B). Outcome measures were: hemodynamic characteristics, maximum heig...

36 CFR 1256.46 - National security-classified information.

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false National security-classified... Restrictions § 1256.46 National security-classified information. In accordance with 5 U.S.C. 552(b)(1), NARA... properly classified under the provisions of the pertinent Executive Order on Classified National Security...

Class-specific Error Bounds for Ensemble Classifiers

Energy Technology Data Exchange (ETDEWEB)

Prenger, R; Lemmond, T; Varshney, K; Chen, B; Hanley, W

2009-10-06

The generalization error, or probability of misclassification, of ensemble classifiers has been shown to be bounded above by a function of the mean correlation between the constituent (i.e., base) classifiers and their average strength. This bound suggests that increasing the strength and/or decreasing the correlation of an ensemble's base classifiers may yield improved performance under the assumption of equal error costs. However, this and other existing bounds do not directly address application spaces in which error costs are inherently unequal. For applications involving binary classification, Receiver Operating Characteristic (ROC) curves, performance curves that explicitly trade off false alarms and missed detections, are often utilized to support decision making. To address performance optimization in this context, we have developed a lower bound for the entire ROC curve that can be expressed in terms of the class-specific strength and correlation of the base classifiers. We present empirical analyses demonstrating the efficacy of these bounds in predicting relative classifier performance. In addition, we specify performance regions of the ROC curve that are naturally delineated by the class-specific strengths of the base classifiers and show that each of these regions can be associated with a unique set of guidelines for performance optimization of binary classifiers within unequal error cost regimes.

Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative.

Directory of Open Access Journals (Sweden)

Jayleen K L Gunn

Full Text Available In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented.In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89. Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28.This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.

Impact on caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial.

Science.gov (United States)

Lee, Nigel; Mårtensson, Lena B; Homer, Caroline; Webster, Joan; Gibbons, Kristen; Stapleton, Helen; Dos Santos, Natalie; Beckmann, Michael; Gao, Yu; Kildea, Sue

2013-05-03

Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate. A double blind randomised placebo controlled trialSetting: Maternity hospitals in AustraliaParticipants: 1866 women in labour, ≥18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent. Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis' rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively. Proportion of women who have a caesarean section in labour.Randomisation: Permuted blocks stratified by research site.Blinding (masking):Double-blind trial in which participants, clinicians and research staff blinded to group assignment. Funded by the National Health and Medical Research CouncilTrial registration:Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954). Sterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to

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.

Deconvolution When Classifying Noisy Data Involving Transformations.

Science.gov (United States)

Carroll, Raymond; Delaigle, Aurore; Hall, Peter

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.

Just-in-time classifiers for recurrent concepts.

Science.gov (United States)

Alippi, Cesare; Boracchi, Giacomo; Roveri, Manuel

2013-04-01

Just-in-time (JIT) classifiers operate in evolving environments by classifying instances and reacting to concept drift. In stationary conditions, a JIT classifier improves its accuracy over time by exploiting additional supervised information coming from the field. In nonstationary conditions, however, the classifier reacts as soon as concept drift is detected; the current classification setup is discarded and a suitable one activated to keep the accuracy high. We present a novel generation of JIT classifiers able to deal with recurrent concept drift by means of a practical formalization of the concept representation and the definition of a set of operators working on such representations. The concept-drift detection activity, which is crucial in promptly reacting to changes exactly when needed, is advanced by considering change-detection tests monitoring both inputs and classes distributions.

Deconvolution When Classifying Noisy Data Involving Transformations

KAUST Repository

Carroll, Raymond; Delaigle, Aurore; Hall, Peter

2012-01-01

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.

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.

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.

Knowledge, attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a medical college hospital in India

Directory of Open Access Journals (Sweden)

Udita Naithani

2011-01-01

Full Text Available Background : The present audit was initiated to evaluate the knowledge, attitude, perception and acceptance of women toward labor analgesia and caesarean section, in a Medical College Hospital in Udaipur, India. Materials and Methods : A semi-structured interview of 200 antenatal women was conducted, to assess the knowledge, attitude and perception regarding labor analgesia and caesarean section (CS and to estimate the correlation of awareness and acceptability with demographic variables. The data were analyzed using Epi Info 6 and the Likert type scale (0 - 10, as also the chi square test, to calculate the statistical significance. Results : Most of the patients (n = 181, 90.50% were unaware of labor analgesia. When the option of labor analgesia was offered, only 23% (n = 46 accepted it and the most significant reason for refusal was to experience natural child birth (n = 114 / 154, 74.03%. An educational status of the graduate level had a positive impact on knowledge about labor analgesia (P = 0.0001. When the option for CS was offered, 73.50% women (n = 147; P = 0.008 refused and the most common reasons for refusal were fear of operation (53.06%, n = 78 and delay in resuming household work (46.26%, n = 68. Educational status up to the graduate level and previous surgical experience of CS had a positive correlation with preference for CS (P = 0.0092 and P = 0.0001, respectively. Conclusions : Awareness and acceptance for labor analgesia was relatively low among the prospective parturients. A higher level of education had a significant impact on their decisions regarding delivery.

A prospective cohort study evaluating the cost-effectiveness of carbetocin for prevention of postpartum haemorrhage in caesarean sections.

Science.gov (United States)

Luni, Yasmin; Borakati, Aditya; Matah, Arti; Skeats, Katie; Eedarapalli, Padma

2017-07-01

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylaxis with oxytocic medication is recommended by the WHO to prevent its occurrence. Carbetocin is a newer oxytocic, with potential to lower PPH rates, reduce the total use of oxytocic drugs and lead to financial savings. Meta-analyses have confirmed a reduction in the use of additional oxytocic medication with the use of carbetocin compared to oxytocin. However, there are few studies evaluating the costs of carbetocin prophylaxis. We carried out a prospective cohort study evaluating the financial impact of carbetocin, following its introduction at our centre for caesarean section. We collected data for 400 patients in total, making this, to our knowledge, the largest study conducted on this topic. We found a significant reduction in PPH rates and the use of additional oxytocics with projected overall financial savings of £68.93 per patient with the use of carbetocin. Impact statement It is well established that carbetocin reduces the use of secondary oxytocics compared to oxytocin alone in the active management of the third stage of labour. Evidence for reduction of post-partum haemorrhage and its cost effectiveness are more equivocal. Our study demonstrates that carbetocin also reduces post-partum haemorrhage, use of blood and blood products and midwifery recovery time in the setting of caesarean section. We have also demonstrated that despite the increased index cost of carbetocin it delivers an overall substantial cost benefit. The implications of these findings are of reduced morbidity, faster recovery and cost savings in these times of austerity in the UK. It allows more efficient labour distribution of midwives, particularly in the setting of staff shortages across the NHS. A randomised control trial in this area needs to be conducted to determine the cost benefit of carbetocin and with this and post-partum haemorrhage rates as the primary outcome measures.

Comparing classifiers for pronunciation error detection

NARCIS (Netherlands)

Strik, H.; Truong, K.; Wet, F. de; Cucchiarini, C.

2007-01-01

Providing feedback on pronunciation errors in computer assisted language learning systems requires that pronunciation errors be detected automatically. In the present study we compare four types of classifiers that can be used for this purpose: two acoustic-phonetic classifiers (one of which employs

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.

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

A Supervised Multiclass Classifier for an Autocoding System

Directory of Open Access Journals (Sweden)

Yukako Toko

2017-11-01

Full Text Available Classification is often required in various contexts, including in the field of official statistics. In the previous study, we have developed a multiclass classifier that can classify short text descriptions with high accuracy. The algorithm borrows the concept of the naïve Bayes classifier and is so simple that its structure is easily understandable. The proposed classifier has the following two advantages. First, the processing times for both learning and classifying are extremely practical. Second, the proposed classifier yields high-accuracy results for a large portion of a dataset. We have previously developed an autocoding system for the Family Income and Expenditure Survey in Japan that has a better performing classifier. While the original system was developed in Perl in order to improve the efficiency of the coding process of short Japanese texts, the proposed system is implemented in the R programming language in order to explore versatility and is modified to make the system easily applicable to English text descriptions, in consideration of the increasing number of R users in the field of official statistics. We are planning to publish the proposed classifier as an R-package. The proposed classifier would be generally applicable to other classification tasks including coding activities in the field of official statistics, and it would contribute greatly to improving their efficiency.

From upstream to downstream: Megatrends and latest developments in Latin America`s hydrocarbons sector

Energy Technology Data Exchange (ETDEWEB)

Wu, Kang; Pezeshki, S.; McMahon, J.

1995-08-01

In recent years, Latin America`s hydrocarbons sector has been characterized by reorganization, revitalization, regional cooperation, environmental awakening, and steady expansion. The pattern of these changes, which appear to be the megatrends of the region`s hydrocarbons sector development, will continue during the rest of the 1990s. To further study the current situation and future prospects of Latin America`s hydrocarbons sector, we critically summarize in this short article the key issues in the region`s oil and gas development. These megatrends in Latin America`s hydrocarbons sector development will impact not only the future energy demand and supply in the region, but also global oil flows in the North American market and across the Pacific Ocean. Each country is individually discussed; pipelines to be constructed are discussed also.

Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study.

Science.gov (United States)

Pala, Şehmus; Atilgan, Remzi; Başpınar, Melike; Kavak, Ebru Çelik; Yavuzkır, Şeyda; Akyol, Alparslan; Kavak, Burçin

2018-02-01

The aim of this study was to compare the postoperative results of the patients who were treated with Bakri balloon tamponade or hysterectomy for placenta accreta and increta. Patients who were diagnosed with placenta accreta or increta preoperatively and intraoperatively and treated with Bakri balloon tamponade (Group 1) or caesarean hysterectomy (Group 2) were compared in regards to the postoperative results. Among the 36 patients diagnosed with placenta accreta or increta, 19 patients were treated with Bakri balloon tamponade while 17 cases were treated with hysterectomy. Intraoperative blood loss amount was 1794 ± 725 ml in G1, which was lower than that in G2 (2694 ± 893 ml). Blood transfusion amount was 2.7 ± 2.6 units in G1, lower than that in G2 (5.7 ± 2.4 units), too. Operation time was 64.5 ± 29 min and 140 ± 51 min in G1 and G2, respectively, showing significant differences between two groups. The success rate of Bakri balloon was determined as 84.21%. In conclusion, cases with placenta accreta/increta, with predicted placental detachment who are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy is encouraging with its advantages compared with the hysterectomy. Impact statement What is already known on this subject: Invasive placental anomalies are the most common indication of postpartum hysterectomy. Recently, uterine balloon tamponade was also included in the treatment modalities of postpartum haemorrhage.This study aimed to compare the postoperative results of UBT or hysterectomy for patients with placenta accreta and increta. What the results of this study add: In this study, the total amount of blood loss was higher in the caesarean hysterectomy group when compared with the Bakri balloon tamponade group. The mean transfusion requirement, mean operation time and hospitalisation period was significantly longer in the caesarean hysterectomy group. The success

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)

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.

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.

Logarithmic learning for generalized classifier neural network.

Science.gov (United States)

Ozyildirim, Buse Melis; Avci, Mutlu

2014-12-01

Generalized classifier neural network is introduced as an efficient classifier among the others. Unless the initial smoothing parameter value is close to the optimal one, generalized classifier neural network suffers from convergence problem and requires quite a long time to converge. In this work, to overcome this problem, a logarithmic learning approach is proposed. The proposed method uses logarithmic cost function instead of squared error. Minimization of this cost function reduces the number of iterations used for reaching the minima. The proposed method is tested on 15 different data sets and performance of logarithmic learning generalized classifier neural network is compared with that of standard one. Thanks to operation range of radial basis function included by generalized classifier neural network, proposed logarithmic approach and its derivative has continuous values. This makes it possible to adopt the advantage of logarithmic fast convergence by the proposed learning method. Due to fast convergence ability of logarithmic cost function, training time is maximally decreased to 99.2%. In addition to decrease in training time, classification performance may also be improved till 60%. According to the test results, while the proposed method provides a solution for time requirement problem of generalized classifier neural network, it may also improve the classification accuracy. The proposed method can be considered as an efficient way for reducing the time requirement problem of generalized classifier neural network. Copyright © 2014 Elsevier Ltd. All rights reserved.

DECISION TREE CLASSIFIERS FOR STAR/GALAXY SEPARATION

International Nuclear Information System (INIS)

Vasconcellos, E. C.; Ruiz, R. S. R.; De Carvalho, R. R.; Capelato, H. V.; Gal, R. R.; LaBarbera, F. L.; Frago Campos Velho, H.; Trevisan, M.

2011-01-01

We study the star/galaxy classification efficiency of 13 different decision tree algorithms applied to photometric objects in the Sloan Digital Sky Survey Data Release Seven (SDSS-DR7). Each algorithm is defined by a set of parameters which, when varied, produce different final classification trees. We extensively explore the parameter space of each algorithm, using the set of 884,126 SDSS objects with spectroscopic data as the training set. The efficiency of star-galaxy separation is measured using the completeness function. We find that the Functional Tree algorithm (FT) yields the best results as measured by the mean completeness in two magnitude intervals: 14 ≤ r ≤ 21 (85.2%) and r ≥ 19 (82.1%). We compare the performance of the tree generated with the optimal FT configuration to the classifications provided by the SDSS parametric classifier, 2DPHOT, and Ball et al. We find that our FT classifier is comparable to or better in completeness over the full magnitude range 15 ≤ r ≤ 21, with much lower contamination than all but the Ball et al. classifier. At the faintest magnitudes (r > 19), our classifier is the only one that maintains high completeness (>80%) while simultaneously achieving low contamination (∼2.5%). We also examine the SDSS parametric classifier (psfMag - modelMag) to see if the dividing line between stars and galaxies can be adjusted to improve the classifier. We find that currently stars in close pairs are often misclassified as galaxies, and suggest a new cut to improve the classifier. Finally, we apply our FT classifier to separate stars from galaxies in the full set of 69,545,326 SDSS photometric objects in the magnitude range 14 ≤ r ≤ 21.

32 CFR 2400.28 - Dissemination of classified information.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Dissemination of classified information. 2400.28... SECURITY PROGRAM Safeguarding § 2400.28 Dissemination of classified information. Heads of OSTP offices... originating official may prescribe specific restrictions on dissemination of classified information when...

America's Children and the Environment

Science.gov (United States)

... Labs and Research Centers 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 ...

Physical activity interventions in Latin America: what value might be added by including conference abstracts in a literature review?

Science.gov (United States)

Hoehner, Christine; Soares, Jesus; Parra, Diana C; Ribeiro, Isabela C; Pratt, Michael; Bracco, Mario; Hallal, Pedro C; Brownson, Ross C

2010-07-01

This review assessed whether conference abstracts yield useful information on the types and effectiveness of community-based physical activity (PA) interventions in Latin America, beyond that from interventions included in a recent systematic review of peer-reviewed literature. Abstracts from 9 conferences were searched for community-based interventions to promote PA in Latin America and summarized. Three reviewers classified and screened abstracts. Evaluated interventions that were not included in the previous review were assessed. Search of abstracts from 31 proceedings of 9 conferences identified 87 abstracts of studies on community-based interventions focused on increasing PA. Only 31 abstracts reported on studies with a control group and an outcome related to PA. Ten of these abstracts represented interventions that had not been included in the previous review of peer-reviewed literature, but the abstracts were insufficient in number or detail to make a practice recommendation for any single intervention. This review highlighted the challenges and low added value of including conference abstracts in a systematic review of community PA interventions in Latin America. Stronger evaluation design and execution and more published reports of evaluated interventions are needed to build an evidence base supporting interventions to increase PA in Latin America.

Generation of a human induced pluripotent stem cell line (MUSIi001-A from caesarean section scar fibroblasts using Sendai viral vectors

Directory of Open Access Journals (Sweden)

Methichit Wattanapanitch

2018-03-01

Full Text Available We generated a human induced pluripotent stem cell (iPSC line from caesarean section scar fibroblasts of a 33-year-old healthy woman using transgene-free Sendai viral vectors under feeder-free condition. The established iPSC line, designated as MUSIi001-A, exhibited a normal karyotype, expressed pluripotent markers, differentiated into cells of three embryonic germ layers. Further analyses showed that the Sendai viral genome was absent at passage 25. The MUSIi001-A line can serve as a control for studying developmental biology and phenotypic comparison with disease-specific iPSCs.

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

Combined use of hyperbaric and hypobaric ropivacaine significantly improves hemodynamic characteristics in spinal anesthesia for caesarean section: a prospective, double-blind, randomized, controlled study.

Directory of Open Access Journals (Sweden)

ZheFeng Quan

Full Text Available To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study.Parturients (n = 136 undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A or hyperbaric ropivacaine (Group B. Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis.Group A had a lower level of sensory blockade (T6 [T6-T7] and longer time to achieve T8 sensory blockade level (8 ± 1.3 min than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P < 0.001, both. The incidence rates for hypotension, nausea, and vomiting were significantly lower in Group A (13%, 10%, and 3%, respectively than Group B (66%, 31%, and 13%; P < 0.001, P = 0.003, P = 0.028.Combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade.Chinese Clinical Trial Register ChiCTR-TRC-13004622.

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.

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....

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.

Closed-loop double-vasopressor automated system vs manual bolus vasopressor to treat hypotension during spinal anaesthesia for caesarean section: a randomised controlled trial.

Science.gov (United States)

Sng, B L; Tan, H S; Sia, A T H

2014-01-01

Hypotension necessitating vasopressor administration occurs commonly during caesarean section under spinal anaesthesia. We developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive arterial pressure monitoring. A phenylephrine bolus of 50 μg was given at 30-s intervals when systolic blood pressure fell manual boluses of either phenylephrine 100 μg or ephedrine 8 mg, administered at 1-min intervals based on the same thresholds for systolic pressure and heart rate. This randomised, controlled, double-blinded trial involved 213 healthy women who underwent elective caesarean delivery under spinal anaesthesia using 11 mg hyperbaric bupivacaine with 15 μg fentanyl and 100 μg morphine. The automated vasopressor group had better systolic pressure control, with 37/106 (34.9%) having any beat-to-beat systolic pressure reading 120% of baseline, with 8/106 (7.5%) in the automated vasopressor group vs 14/107 (13.1%) in the control group, or total dose of vasopressors. The automated vasopressor group had lower median absolute performance error of 8.5% vs control of 9.8% (p = 0.013), and reduced incidence of nausea (1/106 (0.9%) vs 11/107 (10.3%), p = 0.005). Neonatal umbilical cord pH, umbilical lactate and Apgar scores were similar. Hence, our system afforded better control of maternal blood pressure and reduced nausea with no increase in reactive hypertension when compared with manual boluses. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Carbon classified?

DEFF Research Database (Denmark)

Lippert, Ingmar

2012-01-01

. Using an actor- network theory (ANT) framework, the aim is to investigate the actors who bring together the elements needed to classify their carbon emission sources and unpack the heterogeneous relations drawn on. Based on an ethnographic study of corporate agents of ecological modernisation over...... a period of 13 months, this paper provides an exploration of three cases of enacting classification. Drawing on ANT, we problematise the silencing of a range of possible modalities of consumption facts and point to the ontological ethics involved in such performances. In a context of global warming...

Strategic Intelligence in a globalized world in Latin America: Challenges in the XXI century

Directory of Open Access Journals (Sweden)

Boris Saavedra

2016-02-01

Full Text Available In general, intelligence has been classified as something mysterious due to the historical experiences in Latin America and the general ignorance about the true essence of intelligence as a primary activity of the State. This paper focuses on the analysis of the role of strategic intelligence as a fundamental element of public security and defense policy of a nation in Latin America. The changes occurring at the dawn of this century for the collection and analysis of intelligence are critical. The analysis of power, internet, digital technology, robotics and intelligent computers is responsible for the rapid changes of our history. Strategic Intelligence requires a comprehensive operational reform in five points: 1 Distinction as far as competition of intelligence agencies is concerned. 2 The dependence of the intelligence agencies. 3 Limiting the allocation of responsibility for domestic intelligence. 4 Establishing a coordinating body at the highest level of the State and 5 Effective external controls. These aspects are essential for a strategic intelligence system in line with present and future demands.

Regional Specialization. The Middle Americas: Mexico, Panama, Central America and the Caribbean Basin

National Research Council Canada - National Science Library

Owen, Mark H; Inman, Kenneth A

1997-01-01

.... Generally viewed as lagging in efforts to develop stable governments and self-sustaining economies, Mexico, Central America to include Panama and the Caribbean, henceforth Middle America, have in the...

Local-global classifier fusion for screening chest radiographs

Science.gov (United States)

Ding, Meng; Antani, Sameer; Jaeger, Stefan; Xue, Zhiyun; Candemir, Sema; Kohli, Marc; Thoma, George

2017-03-01

Tuberculosis (TB) is a severe comorbidity of HIV and chest x-ray (CXR) analysis is a necessary step in screening for the infective disease. Automatic analysis of digital CXR images for detecting pulmonary abnormalities is critical for population screening, especially in medical resource constrained developing regions. In this article, we describe steps that improve previously reported performance of NLM's CXR screening algorithms and help advance the state of the art in the field. We propose a local-global classifier fusion method where two complementary classification systems are combined. The local classifier focuses on subtle and partial presentation of the disease leveraging information in radiology reports that roughly indicates locations of the abnormalities. In addition, the global classifier models the dominant spatial structure in the gestalt image using GIST descriptor for the semantic differentiation. Finally, the two complementary classifiers are combined using linear fusion, where the weight of each decision is calculated by the confidence probabilities from the two classifiers. We evaluated our method on three datasets in terms of the area under the Receiver Operating Characteristic (ROC) curve, sensitivity, specificity and accuracy. The evaluation demonstrates the superiority of our proposed local-global fusion method over any single classifier.

Discrimination between underground explosions and earthquakes using discriminant functions: Examples for Eurasia and North America

International Nuclear Information System (INIS)

Nowroozi, A.A.

1986-01-01

Discriminant functions are extensively used as a technical tool in educational and psychological research as well as in some branches of geological sciences. The application of this technique to the problem of discrimination between underground nuclear explosions and earthquakes has been reported. Here we apply this technique to a known population of underground nuclear explosions and earthquakes for the determination of various statistical parameters needed for setting up the discriminant function equations for discrimination between unknown population of earthquakes, anomalous events, and underground explosions, then we classify earthquakes, explosions and anomalous events in Eurasia and North America

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...

Little People of America

Science.gov (United States)

... information. World Dwarf Games 2017 Welcome to Little People of America Little People of America (LPA) is a nonprofit organization that provides support and information to people of short stature and their families. LPA is ...

Balanced sensitivity functions for tuning multi-dimensional Bayesian network classifiers

NARCIS (Netherlands)

Bolt, J.H.; van der Gaag, L.C.

Multi-dimensional Bayesian network classifiers are Bayesian networks of restricted topological structure, which are tailored to classifying data instances into multiple dimensions. Like more traditional classifiers, multi-dimensional classifiers are typically learned from data and may include

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

Recognition of pornographic web pages by classifying texts and images.

Science.gov (United States)

Hu, Weiming; Wu, Ou; Chen, Zhouyao; Fu, Zhouyu; Maybank, Steve

2007-06-01

With the rapid development of the World Wide Web, people benefit more and more from the sharing of information. However, Web pages with obscene, harmful, or illegal content can be easily accessed. It is important to recognize such unsuitable, offensive, or pornographic Web pages. In this paper, a novel framework for recognizing pornographic Web pages is described. A C4.5 decision tree is used to divide Web pages, according to content representations, into continuous text pages, discrete text pages, and image pages. These three categories of Web pages are handled, respectively, by a continuous text classifier, a discrete text classifier, and an algorithm that fuses the results from the image classifier and the discrete text classifier. In the continuous text classifier, statistical and semantic features are used to recognize pornographic texts. In the discrete text classifier, the naive Bayes rule is used to calculate the probability that a discrete text is pornographic. In the image classifier, the object's contour-based features are extracted to recognize pornographic images. In the text and image fusion algorithm, the Bayes theory is used to combine the recognition results from images and texts. Experimental results demonstrate that the continuous text classifier outperforms the traditional keyword-statistics-based classifier, the contour-based image classifier outperforms the traditional skin-region-based image classifier, the results obtained by our fusion algorithm outperform those by either of the individual classifiers, and our framework can be adapted to different categories of Web pages.

Using Neural Networks to Classify Digitized Images of Galaxies

Science.gov (United States)

Goderya, S. N.; McGuire, P. C.

2000-12-01

Automated classification of Galaxies into Hubble types is of paramount importance to study the large scale structure of the Universe, particularly as survey projects like the Sloan Digital Sky Survey complete their data acquisition of one million galaxies. At present it is not possible to find robust and efficient artificial intelligence based galaxy classifiers. In this study we will summarize progress made in the development of automated galaxy classifiers using neural networks as machine learning tools. We explore the Bayesian linear algorithm, the higher order probabilistic network, the multilayer perceptron neural network and Support Vector Machine Classifier. The performance of any machine classifier is dependant on the quality of the parameters that characterize the different groups of galaxies. Our effort is to develop geometric and invariant moment based parameters as input to the machine classifiers instead of the raw pixel data. Such an approach reduces the dimensionality of the classifier considerably, and removes the effects of scaling and rotation, and makes it easier to solve for the unknown parameters in the galaxy classifier. To judge the quality of training and classification we develop the concept of Mathews coefficients for the galaxy classification community. Mathews coefficients are single numbers that quantify classifier performance even with unequal prior probabilities of the classes.

The burden of unscheduled health care for asthma in Latin America.

Science.gov (United States)

Neffen, H; Gonzalez, S N; Fritscher, C C; Dovali, C; Williams, A E

2010-01-01

To determine the level and cost of unscheduled health care resource use in adults and children across all asthma symptom severities in Latin America. The level and cost of health care resource use were analysed for 2074 patients with asthma included in the Asthma Insights and Reality in Latin America (AIRLA) survey from 10 Latin American countries. Health care resource use was multiplied by country-specific unit costs to estimate average per-patient annual costs. Patients were classified as adults (> or = 16 years) or children (asthma symptoms were experienced by 53.1% of patients (50.1% of children and 54.6% of adults). In the year preceding the survey, 57.1% of patients required unscheduled health care resource use and 45.1% reported at least 1 emergency hospital contact. The percentage of patients reporting unscheduled health care resource use was greatest amongst those with severe persistent symptoms (71.9%) but it was also high in those with mild intermittent symptoms (45.7%). An average of 73.2% of annual costs of asthma-related health care for the 10 countries was due to unscheduled health care. Expenditure on unscheduled care was greatest amongst both adults and children with severe persistent asthma symptoms (US $558 and US $769, respectively). Adults and children with mild intermittent symptoms also incurred considerable unscheduled costs (US $204 and US $215, respectively). Poorly controlled asthma imposes a considerable cost burden driven by unscheduled health care resource use in Latin America. Treatments to control asthma and reduce the need for unscheduled health care could reduce this cost in both adults and children.

Classifier fusion for VoIP attacks classification

Science.gov (United States)

Safarik, Jakub; Rezac, Filip

2017-05-01

SIP is one of the most successful protocols in the field of IP telephony communication. It establishes and manages VoIP calls. As the number of SIP implementation rises, we can expect a higher number of attacks on the communication system in the near future. This work aims at malicious SIP traffic classification. A number of various machine learning algorithms have been developed for attack classification. The paper presents a comparison of current research and the use of classifier fusion method leading to a potential decrease in classification error rate. Use of classifier combination makes a more robust solution without difficulties that may affect single algorithms. Different voting schemes, combination rules, and classifiers are discussed to improve the overall performance. All classifiers have been trained on real malicious traffic. The concept of traffic monitoring depends on the network of honeypot nodes. These honeypots run in several networks spread in different locations. Separation of honeypots allows us to gain an independent and trustworthy attack information.

Fast Most Similar Neighbor (MSN) classifiers for Mixed Data

OpenAIRE

Hernández Rodríguez, Selene

2010-01-01

The k nearest neighbor (k-NN) classifier has been extensively used in Pattern Recognition because of its simplicity and its good performance. However, in large datasets applications, the exhaustive k-NN classifier becomes impractical. Therefore, many fast k-NN classifiers have been developed; most of them rely on metric properties (usually the triangle inequality) to reduce the number of prototype comparisons. Hence, the existing fast k-NN classifiers are applicable only when the comparison f...

Feature extraction for dynamic integration of classifiers

NARCIS (Netherlands)

Pechenizkiy, M.; Tsymbal, A.; Puuronen, S.; Patterson, D.W.

2007-01-01

Recent research has shown the integration of multiple classifiers to be one of the most important directions in machine learning and data mining. In this paper, we present an algorithm for the dynamic integration of classifiers in the space of extracted features (FEDIC). It is based on the technique

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 tha...

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.

The Protection of Classified Information: The Legal Framework

National Research Council Canada - National Science Library

Elsea, Jennifer K

2006-01-01

Recent incidents involving leaks of classified information have heightened interest in the legal framework that governs security classification, access to classified information, and penalties for improper disclosure...

Consistency Analysis of Nearest Subspace Classifier

OpenAIRE

Wang, Yi

2015-01-01

The Nearest subspace classifier (NSS) finds an estimation of the underlying subspace within each class and assigns data points to the class that corresponds to its nearest subspace. This paper mainly studies how well NSS can be generalized to new samples. It is proved that NSS is strongly consistent under certain assumptions. For completeness, NSS is evaluated through experiments on various simulated and real data sets, in comparison with some other linear model based classifiers. It is also ...

Energy-Efficient Neuromorphic Classifiers.

Science.gov (United States)

Martí, Daniel; Rigotti, Mattia; Seok, Mingoo; Fusi, Stefano

2016-10-01

Neuromorphic engineering combines the architectural and computational principles of systems neuroscience with semiconductor electronics, with the aim of building efficient and compact devices that mimic the synaptic and neural machinery of the brain. The energy consumptions promised by neuromorphic engineering are extremely low, comparable to those of the nervous system. Until now, however, the neuromorphic approach has been restricted to relatively simple circuits and specialized functions, thereby obfuscating a direct comparison of their energy consumption to that used by conventional von Neumann digital machines solving real-world tasks. Here we show that a recent technology developed by IBM can be leveraged to realize neuromorphic circuits that operate as classifiers of complex real-world stimuli. Specifically, we provide a set of general prescriptions to enable the practical implementation of neural architectures that compete with state-of-the-art classifiers. We also show that the energy consumption of these architectures, realized on the IBM chip, is typically two or more orders of magnitude lower than that of conventional digital machines implementing classifiers with comparable performance. Moreover, the spike-based dynamics display a trade-off between integration time and accuracy, which naturally translates into algorithms that can be flexibly deployed for either fast and approximate classifications, or more accurate classifications at the mere expense of longer running times and higher energy costs. This work finally proves that the neuromorphic approach can be efficiently used in real-world applications and has significant advantages over conventional digital devices when energy consumption is considered.

Bolivia. America = Las Americas [Series].

Science.gov (United States)

Toro, Leonor; Avery, Robert S.

Written for teachers to use with migrant children in elementary grades and to highlight the many Americas, this bilingual English/Spanish social studies resource booklet provides historical and cultural information on Bolivia. A table of contents indicates the language--Spanish or English--in which the topics are written. The quarterly provides an…

76 FR 14101 - Bruss North America; Russell Springs, KY; Bruss North America; Orion, MI; Amended Revised...

Science.gov (United States)

2011-03-15

... America; Russell Springs, KY; Bruss North America; Orion, MI; Amended Revised Determination on... relevant time period at the Orion, Michigan location of Bruss North America, Inc. The Orion, Michigan..., Kentucky facility also led to worker separations at the Orion, Michigan location during the relevant time...

SOUTH AMERICA: INDUSTRIAL ROUNDWOOD SUPPLY POTENTIAL

Directory of Open Access Journals (Sweden)

Ronalds W. Gonzalez

2008-02-01

Full Text Available South America has substantial potential to expand its forest plantations and raw material supply. From 1997 to 2005, South America had a high annual growth rate in the production of industrial roundwood, with Brazil and Chile being the most important countries. In the same period, Asia had the only negative regional production growth rate in the world, and China became the largest round wood importer in the world. This paper summarizes the status of production, consumption, imports, and exports of industrial roundwood and forest products in South America. Produc-tion and exports from South America have continually increased at annual growth rates exceeding the forestry sector in general and the U.S. in particular. Based on timber growing investments to date, a strong timber production and forest products manufacturing sector has developed in the Southern Cone countries of Chile, Brazil, Argentina, and Uruguay, and is increasing in other countries in Latin America. There will be continued opportunities for forest plantations and new manufacturing facilities throughout South America, tempered somewhat by perceived country financial and political risks. These opportunities will allow South America to increase its share of world production and increase imports to North America and to Asia.

Rabies in the Americas

Science.gov (United States)

Rabies in the Americas Search this site Welcome Previous Meetings Steering Committee Contact Sitemap Welcome The Rabies in the Americas (RITA) meeting is an annual event that has been held since 1990 managers of rabies programs, wildlife biologists, laboratory personnel and other people interested in

Verification of classified fissile material using unclassified attributes

International Nuclear Information System (INIS)

Nicholas, N.J.; Fearey, B.L.; Puckett, J.M.; Tape, J.W.

1998-01-01

This paper reports on the most recent efforts of US technical experts to explore verification by IAEA of unclassified attributes of classified excess fissile material. Two propositions are discussed: (1) that multiple unclassified attributes could be declared by the host nation and then verified (and reverified) by the IAEA in order to provide confidence in that declaration of a classified (or unclassified) inventory while protecting classified or sensitive information; and (2) that attributes could be measured, remeasured, or monitored to provide continuity of knowledge in a nonintrusive and unclassified manner. They believe attributes should relate to characteristics of excess weapons materials and should be verifiable and authenticatable with methods usable by IAEA inspectors. Further, attributes (along with the methods to measure them) must not reveal any classified information. The approach that the authors have taken is as follows: (1) assume certain attributes of classified excess material, (2) identify passive signatures, (3) determine range of applicable measurement physics, (4) develop a set of criteria to assess and select measurement technologies, (5) select existing instrumentation for proof-of-principle measurements and demonstration, and (6) develop and design information barriers to protect classified information. While the attribute verification concepts and measurements discussed in this paper appear promising, neither the attribute verification approach nor the measurement technologies have been fully developed, tested, and evaluated

The marketing potential of corporate social responsibility activities: the case of the alcohol industry in Latin America and the Caribbean.

Science.gov (United States)

Pantani, Daniela; Peltzer, Raquel; Cremonte, Mariana; Robaina, Katherine; Babor, Thomas; Pinsky, Ilana

2017-01-01

The aims were to: (1) identify, monitor and analyse the Corporate Social Responsibility (CSR) practices of the alcohol industry in Latin America and the Caribbean (LAC) and (2) examine whether the alcohol industry is using these actions to market their products and brands. Nine health experts from Argentina, Brazil and Uruguay conducted a content analysis of 218 CSR activities using a standardized protocol. A content rating procedure was used to evaluate the marketing potential of CSR activities as well as their probable population reach and effectiveness. The LEAD procedure (longitudinal, expert and all data) was applied to verify the accuracy of industry-reported descriptions. A total of 55.8% of the actions were found to have a marketing potential, based on evidence that they are likely to promote brands and products. Actions with marketing potential were more likely to reach a larger audience than actions classified with no marketing potential. Most actions did not fit into any category recommended by the World Health Organization; 50% of the actions involving classroom and college education for young people were found to have marketing potential; 62.3% were classified as meeting the definition of risk management CSR. Alcohol industry Corporate Social Responsibility activities in Latin America and the Caribbean appear to have a strategic marketing role beyond their stated philanthropic and public health purpose. © 2016 Society for the Study of Addiction.

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.

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.

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

An ensemble classifier to predict track geometry degradation

International Nuclear Information System (INIS)

Cárdenas-Gallo, Iván; Sarmiento, Carlos A.; Morales, Gilberto A.; Bolivar, Manuel A.; Akhavan-Tabatabaei, Raha

2017-01-01

Railway operations are inherently complex and source of several problems. In particular, track geometry defects are one of the leading causes of train accidents in the United States. This paper presents a solution approach which entails the construction of an ensemble classifier to forecast the degradation of track geometry. Our classifier is constructed by solving the problem from three different perspectives: deterioration, regression and classification. We considered a different model from each perspective and our results show that using an ensemble method improves the predictive performance. - Highlights: • We present an ensemble classifier to forecast the degradation of track geometry. • Our classifier considers three perspectives: deterioration, regression and classification. • We construct and test three models and our results show that using an ensemble method improves the predictive performance.

Data characteristics that determine classifier performance

CSIR Research Space (South Africa)

Van der Walt, Christiaan M

2006-11-01

Full Text Available available at [11]. The kNN uses a LinearNN nearest neighbour search algorithm with an Euclidean distance metric [8]. The optimal k value is determined by performing 10-fold cross-validation. An optimal k value between 1 and 10 is used for Experiments 1... classifiers. 10-fold cross-validation is used to evaluate and compare the performance of the classifiers on the different data sets. 3.1. Artificial data generation Multivariate Gaussian distributions are used to generate artificial data sets. We use d...

Pixel Classification of SAR ice images using ANFIS-PSO Classifier

Directory of Open Access Journals (Sweden)

G. Vasumathi

2016-12-01

Full Text Available Synthetic Aperture Radar (SAR is playing a vital role in taking extremely high resolution radar images. It is greatly used to monitor the ice covered ocean regions. Sea monitoring is important for various purposes which includes global climate systems and ship navigation. Classification on the ice infested area gives important features which will be further useful for various monitoring process around the ice regions. Main objective of this paper is to classify the SAR ice image that helps in identifying the regions around the ice infested areas. In this paper three stages are considered in classification of SAR ice images. It starts with preprocessing in which the speckled SAR ice images are denoised using various speckle removal filters; comparison is made on all these filters to find the best filter in speckle removal. Second stage includes segmentation in which different regions are segmented using K-means and watershed segmentation algorithms; comparison is made between these two algorithms to find the best in segmenting SAR ice images. The last stage includes pixel based classification which identifies and classifies the segmented regions using various supervised learning classifiers. The algorithms includes Back propagation neural networks (BPN, Fuzzy Classifier, Adaptive Neuro Fuzzy Inference Classifier (ANFIS classifier and proposed ANFIS with Particle Swarm Optimization (PSO classifier; comparison is made on all these classifiers to propose which classifier is best suitable for classifying the SAR ice image. Various evaluation metrics are performed separately at all these three stages.

Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia.

Science.gov (United States)

Belihu, Fetene B; Small, Rhonda; Davey, Mary-Ann

2017-03-01

Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. Victoria, Australia. 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (OR adj 1.94, 95% CI 1.57-2.47) but less likely to succeed (OR adj 0.54 95% CI 0.41-0.71) in having a VBAC. There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

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

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'

Development of PET in Latin America. Experience of the first PET-Cyclotron Center

International Nuclear Information System (INIS)

Tutor, C.A.; Frias, L.

2002-01-01

Aim: Describe the experience of the first PET-Cyclotron Center in Latin America. Demonstrate the viability of running a PET Center in Argentina despite the economic crisis. Materials and Methods: For this study, we used a UGM/GE Quest 250 PET scan, a RDS 112 cyclotron and a Radiosynthesis Laboratory installed at the (FUESMEN) Nuclear Medicine School Foundation, located in Mendoza City, in the middle-west of Argentina. From January 1999 to March 2002, 741 studies were obtained, 731 were 18 FluorDeoxyGlucose-PET studies and 10 phantoms for calibration purposes. We used acquisition and imaging processing standard protocols, as well as research protocols designed according to the pathology under investigation. To better correlate anatomical and functional images, we used fusion techniques with (CT) Computed Tomography in some (WB) whole-body PET scans. Results: A total of 731 patients were retrospectively analyzed and classified according to statistics variables such as: 1-sex: 317 women and 414 men, 2-type of scan: 439 WB cases, 267 brain studies and 25 cardiac. From this data we divided them as PET indications and resulted in 17 cases as healthy volunteers, 422 oncological cases, 267 neurological studies and 25 cardiac for myocardial viability. According to the origin they were classified as patients coming from Mendoza 544, Buenos Aires 112, other argentine provinces 60 and foreign (Chile, Brazil and Uruguay) 15 cases. In terms of billing, 181 studies were done free of charge, 95 under research protocols were also done free of charge and 451 were charged. Conclusion: Not only the economical and political factors play an important role limiting the advances of PET Imaging in Latin America, but also the lack of a neighboring cyclotron that circumscribe many hospitals to have access to the radiopharmaceutical agent. FUESMEN was established in 1991 by three governmental entities: the (CONEA) National Commission of Atomic Energy, the (UNC) National University of Cuyo and

Frog sound identification using extended k-nearest neighbor classifier

Science.gov (United States)

Mukahar, Nordiana; Affendi Rosdi, Bakhtiar; Athiar Ramli, Dzati; Jaafar, Haryati

2017-09-01

Frog sound identification based on the vocalization becomes important for biological research and environmental monitoring. As a result, different types of feature extractions and classifiers have been employed to evaluate the accuracy of frog sound identification. This paper presents a frog sound identification with Extended k-Nearest Neighbor (EKNN) classifier. The EKNN classifier integrates the nearest neighbors and mutual sharing of neighborhood concepts, with the aims of improving the classification performance. It makes a prediction based on who are the nearest neighbors of the testing sample and who consider the testing sample as their nearest neighbors. In order to evaluate the classification performance in frog sound identification, the EKNN classifier is compared with competing classifier, k -Nearest Neighbor (KNN), Fuzzy k -Nearest Neighbor (FKNN) k - General Nearest Neighbor (KGNN)and Mutual k -Nearest Neighbor (MKNN) on the recorded sounds of 15 frog species obtained in Malaysia forest. The recorded sounds have been segmented using Short Time Energy and Short Time Average Zero Crossing Rate (STE+STAZCR), sinusoidal modeling (SM), manual and the combination of Energy (E) and Zero Crossing Rate (ZCR) (E+ZCR) while the features are extracted by Mel Frequency Cepstrum Coefficient (MFCC). The experimental results have shown that the EKNCN classifier exhibits the best performance in terms of accuracy compared to the competing classifiers, KNN, FKNN, GKNN and MKNN for all cases.

Heart Failure Society of America

Science.gov (United States)

... MACRA Resource Portal The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested ...

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

A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

LENUS (Irish Health Repository)

O’ Hanlon, M

2016-09-01

Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

32 CFR 2400.30 - Reproduction of classified information.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Reproduction of classified information. 2400.30... SECURITY PROGRAM Safeguarding § 2400.30 Reproduction of classified information. Documents or portions of... the originator or higher authority. Any stated prohibition against reproduction shall be strictly...

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

Science.gov (United States)

Tan, T; Ojo, R; Immani, S; Choroszczak, P; Carey, M

2010-01-01

The incidence of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine may be 60-100%, and is a common cause of maternal dissatisfaction. Ondansetron has been shown to reduce pruritus but the effect is short-lived. The objective of this randomized double-blind trial was to evaluate the anti-pruritic efficacy of granisetron compared with ondansetron. Eighty ASA I or II women undergoing elective caesarean section received spinal anaesthesia with 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 microg and preservative-free morphine 150 microg. After delivery of the baby and clamping of the umbilical cord, they were randomised to receive granisetron 3mg i.v. (group G) or ondansetron 8 mg i.v. (group O). The two groups were similar for age, gestational age, height and weight. According to visual analogue pruritus scores, patients in group G experienced less pruritus at 8h (P=0.003) and 24h (P=0.01). Fewer patients in group G (n=8) than group O (n=18) required rescue anti-pruritic medication (P=0.03). Satisfaction scores were also higher in group G than in group O (P=0.03). There was no difference in overall incidence of pruritus, nausea and vomiting, and visual analogue pain scores between the two groups. Administration of granisetron 3mg i.v. reduces the severity of pruritus and the use of rescue anti-pruritic medication, and improves satisfaction but does not reduce the overall incidence of pruritus in women who have received subarachnoid morphine 150 microg compared to ondansetron 8 mg i.v. Copyright 2009 Elsevier Ltd. All rights reserved.

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

LENUS (Irish Health Repository)

Tan, T

2012-02-01

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

Rogue America: Benevolent Hegemon or Occupying Tyrant?

National Research Council Canada - National Science Library

Samuels, Richard P

2008-01-01

.... Based on this working definition, America?s foreign policy history does not support characterization as a rogue state, though its dominant military and some imperialist history are exploited in rogue-America rhetoric...

Three data partitioning strategies for building local classifiers (Chapter 14)

NARCIS (Netherlands)

Zliobaite, I.; Okun, O.; Valentini, G.; Re, M.

2011-01-01

Divide-and-conquer approach has been recognized in multiple classifier systems aiming to utilize local expertise of individual classifiers. In this study we experimentally investigate three strategies for building local classifiers that are based on different routines of sampling data for training.

Classifying countries according to leading causes of death in the world at the beginning of the 21st century

Directory of Open Access Journals (Sweden)

Marinković Ivan

2010-01-01

Full Text Available Cause mortality of a population is an important segment in the analysis of mortality, because it sums up all factors which influence death indicators on a certain territory in a direct way. At the beginning of the 21st century, the situation is not the same everywhere in the world and countries do not share a unique pattern of the causes of deaths. Infectious and parasitic diseases are still dominant in underdeveloped countries, while the leading causes of deaths in developed countries are circulatory disorders and neoplasm. Cardiovascular diseases are the cause of 29% of total mortality in the world, infectious cause 19%, tumors 13% and violent deaths about 9% (based on data from 2002. This paper gives an analysis of the spatial distribution of the leading causes of deaths using the geographic information system (Arc-View GIS, based on the ratio of total mortality and death rates of the population from a certain group of diseases. Based on data analysis, a hypothesis has been set on the significance of the regional factor in forming a picture of population mortality according to causes of death. A regional factor implies a set of physical geographical as well as general social specificities of a certain region which form a pattern of population behavior. Based on death rates, cardiovascular diseases are represented the most in the mortality rates of countries in Eastern and Southeastern Europe. Infectious diseases imperil the population in the Sub-Saharan region of Africa; tumors are most common in Europe, North America and Japan. The highest rates of violent deaths are in countries of the former Soviet Union and the Sub- Saharan zone. Classifying death rates according to leading causes of death represents a prerequisite for forming a final picture of mortality according to causes of death in the world at the beginning of the 'new century'. The method of gathering together the causes of death is possible by applying a statistical model of

Robust Combining of Disparate Classifiers Through Order Statistics

Science.gov (United States)

Tumer, Kagan; Ghosh, Joydeep

2001-01-01

Integrating the outputs of multiple classifiers via combiners or meta-learners has led to substantial improvements in several difficult pattern recognition problems. In this article we investigate a family of combiners based on order statistics, for robust handling of situations where there are large discrepancies in performance of individual classifiers. Based on a mathematical modeling of how the decision boundaries are affected by order statistic combiners, we derive expressions for the reductions in error expected when simple output combination methods based on the the median, the maximum and in general, the ith order statistic, are used. Furthermore, we analyze the trim and spread combiners, both based on linear combinations of the ordered classifier outputs, and show that in the presence of uneven classifier performance, they often provide substantial gains over both linear and simple order statistics combiners. Experimental results on both real world data and standard public domain data sets corroborate these findings.

Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?

Science.gov (United States)

Higgins, L; Mechery, J; Tomlinson, A J

2011-11-01

Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. This study describes a clinical and financial evaluation undertaken at a United Kingdom District General Hospital surrounding the introduction of carbetocin for prophylaxis against postpartum haemorrhage at caesarean deliveries. A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.

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

Economic integration in the Americas

OpenAIRE

Uitdewilligen, G.

1997-01-01

This pioneering study shows that economic integration in the Americas is not simply a matter of removing trade barriers. Economic Integration in the Americas addresses the pervasive effects of economic integration on the economy as a whole.

The decision tree classifier - Design and potential. [for Landsat-1 data

Science.gov (United States)

Hauska, H.; Swain, P. H.

1975-01-01

A new classifier has been developed for the computerized analysis of remote sensor data. The decision tree classifier is essentially a maximum likelihood classifier using multistage decision logic. It is characterized by the fact that an unknown sample can be classified into a class using one or several decision functions in a successive manner. The classifier is applied to the analysis of data sensed by Landsat-1 over Kenosha Pass, Colorado. The classifier is illustrated by a tree diagram which for processing purposes is encoded as a string of symbols such that there is a unique one-to-one relationship between string and decision tree.

Representative Vector Machines: A Unified Framework for Classical Classifiers.

Science.gov (United States)

Gui, Jie; Liu, Tongliang; Tao, Dacheng; Sun, Zhenan; Tan, Tieniu

2016-08-01

Classifier design is a fundamental problem in pattern recognition. A variety of pattern classification methods such as the nearest neighbor (NN) classifier, support vector machine (SVM), and sparse representation-based classification (SRC) have been proposed in the literature. These typical and widely used classifiers were originally developed from different theory or application motivations and they are conventionally treated as independent and specific solutions for pattern classification. This paper proposes a novel pattern classification framework, namely, representative vector machines (or RVMs for short). The basic idea of RVMs is to assign the class label of a test example according to its nearest representative vector. The contributions of RVMs are twofold. On one hand, the proposed RVMs establish a unified framework of classical classifiers because NN, SVM, and SRC can be interpreted as the special cases of RVMs with different definitions of representative vectors. Thus, the underlying relationship among a number of classical classifiers is revealed for better understanding of pattern classification. On the other hand, novel and advanced classifiers are inspired in the framework of RVMs. For example, a robust pattern classification method called discriminant vector machine (DVM) is motivated from RVMs. Given a test example, DVM first finds its k -NNs and then performs classification based on the robust M-estimator and manifold regularization. Extensive experimental evaluations on a variety of visual recognition tasks such as face recognition (Yale and face recognition grand challenge databases), object categorization (Caltech-101 dataset), and action recognition (Action Similarity LAbeliNg) demonstrate the advantages of DVM over other classifiers.

78 FR 2287 - Daimler Buses North America, Inc., a Subsidiary of Daimler North America Corp, Including On-Site...

Science.gov (United States)

2013-01-10

... subsidiary of Daimler North America Corp., including on-site leased workers from Noramtec, First Choice... America, Inc., a Subsidiary of Daimler North America Corp, Including On-Site Leased Workers From Noramtec, First Choice Staffing, Staff Works, and Mr. Santo Lamarco From Wurth Revcar Fasteners, Inc., Oriskany...

41 CFR 105-62.102 - Authority to originally classify.

Science.gov (United States)

2010-07-01

... originally classify. (a) Top secret, secret, and confidential. The authority to originally classify information as Top Secret, Secret, or Confidential may be exercised only by the Administrator and is delegable...

Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment.

Science.gov (United States)

Oláh, K S

2005-02-01

During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.

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

Science.gov (United States)

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

2016-04-01

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 and mortality in a referral hospital in rural Tanzania. Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P audit. © 2016 John Wiley & Sons Ltd.

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

DEFF Research Database (Denmark)

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

2008-01-01

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

Airborne Measurements in Support of the NASA Atmospheric Carbon and Transport - America (ACT-America) Mission

Science.gov (United States)

Meadows, Byron; Davis, Ken; Barrick, John; Browell, Edward; Chen, Gao; Dobler, Jeremy; Fried, Alan; Lauvaux, Thomas; Lin, Bing; McGill, Matt;

Demographic tensions in Central America.

Science.gov (United States)

1986-08-01

This discussion of Central America focuses on the rapid growth of its population, its stagnating economy, and those countries that are socioeconomically advanced. Between 1950-85 the population of Central America tripled, from 9.1 million to 26. 4 million, due to marked mortality declines and the absence of off-setting fertility declines. The distribution of Central Americas's growing populations sets its population growth apart from that of other developing regions. Currently, almost half of all Central Americans live in cities. Although the average growth rate for Central American countries has fallen and is expected to drop further, the decline does not counterbalance the effect of the absolute rise in population numbers. The average annual growth rate of more than 3% annually in the 1960s fell to about 2.6% in recent years, but this decline is due primarily to socioeconomically advanced Costa Rica and Panama. Central America's age structure further complicates the population crisis. About 43% of Central Americans are under the age of 15. When the increasingly larger young population group enters it reproductive years, the potential for future growth (albeit the falling rate of population increase) is unparalleled. UN population projections show the region's population at 40 million by the year 2000. The 1973 oil crisis began a downward spiral for the buoyant post World War II Central American economy. Between 1950-79, real per capita income growth in Central America doubled, with Central American economies growing an average of 5.3% annually. By the early 1980s, overseas markets of the trade-dependent countries of Central America had dried up due to protectionism abroad and slumping basic commodity prices. These and other factors plunged Central America into its current economic malaise of falling real per capita income, rising unemployment, curtailed export led economic growth, and a rising cost of living. In general, economic growth in Central America

Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America.

Science.gov (United States)

Ye, Jiangfeng; Torloni, Maria Regina; Ota, Erika; Jayaratne, Kapila; Pileggi-Castro, Cynthia; Ortiz-Panozo, Eduardo; Lumbiganon, Pisake; Morisaki, Naho; Laopaiboon, Malinee; Mori, Rintaro; Tunçalp, Özge; Fang, Fang; Yu, Hongping; Souza, João Paulo; Vogel, Joshua Peter; Zhang, Jun

2015-12-03

No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000-3499 g [reference group], 3500-3999 g, 4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g) or country-specific birthweight percentile for gestational age (50(th)-74(th) percentile [reference group], 75(th)-89(th), 90(th)-94(th), 95(th)-96(th), and ≥97(th) percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2·00 [95% CI: 1·68, 2·39], 2·42 [95% CI: 2·02, 2·89], 2·01 [95% CI: 1·74, 2·33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1·78 [95% CI: 1·16, 2·74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90(th) percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the

A cardiorespiratory classifier of voluntary and involuntary electrodermal activity

Directory of Open Access Journals (Sweden)

Sejdic Ervin

2010-02-01

Full Text Available Abstract Background Electrodermal reactions (EDRs can be attributed to many origins, including spontaneous fluctuations of electrodermal activity (EDA and stimuli such as deep inspirations, voluntary mental activity and startling events. In fields that use EDA as a measure of psychophysiological state, the fact that EDRs may be elicited from many different stimuli is often ignored. This study attempts to classify observed EDRs as voluntary (i.e., generated from intentional respiratory or mental activity or involuntary (i.e., generated from startling events or spontaneous electrodermal fluctuations. Methods Eight able-bodied participants were subjected to conditions that would cause a change in EDA: music imagery, startling noises, and deep inspirations. A user-centered cardiorespiratory classifier consisting of 1 an EDR detector, 2 a respiratory filter and 3 a cardiorespiratory filter was developed to automatically detect a participant's EDRs and to classify the origin of their stimulation as voluntary or involuntary. Results Detected EDRs were classified with a positive predictive value of 78%, a negative predictive value of 81% and an overall accuracy of 78%. Without the classifier, EDRs could only be correctly attributed as voluntary or involuntary with an accuracy of 50%. Conclusions The proposed classifier may enable investigators to form more accurate interpretations of electrodermal activity as a measure of an individual's psychophysiological state.

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.

Learning to classify wakes from local sensory information

Science.gov (United States)

Alsalman, Mohamad; Colvert, Brendan; Kanso, Eva; Kanso Team

2017-11-01

Aquatic organisms exhibit remarkable abilities to sense local flow signals contained in their fluid environment and to surmise the origins of these flows. For example, fish can discern the information contained in various flow structures and utilize this information for obstacle avoidance and prey tracking. Flow structures created by flapping and swimming bodies are well characterized in the fluid dynamics literature; however, such characterization relies on classical methods that use an external observer to reconstruct global flow fields. The reconstructed flows, or wakes, are then classified according to the unsteady vortex patterns. Here, we propose a new approach for wake identification: we classify the wakes resulting from a flapping airfoil by applying machine learning algorithms to local flow information. In particular, we simulate the wakes of an oscillating airfoil in an incoming flow, extract the downstream vorticity information, and train a classifier to learn the different flow structures and classify new ones. This data-driven approach provides a promising framework for underwater navigation and detection in application to autonomous bio-inspired vehicles.

Bayesian Classifier for Medical Data from Doppler Unit

Directory of Open Access Journals (Sweden)

J. Málek

2006-01-01

Full Text Available Nowadays, hand-held ultrasonic Doppler units (probes are often used for noninvasive screening of atherosclerosis in the arteries of the lower limbs. The mean velocity of blood flow in time and blood pressures are measured on several positions on each lower limb. By listening to the acoustic signal generated by the device or by reading the signal displayed on screen, a specialist can detect peripheral arterial disease (PAD.This project aims to design software that will be able to analyze data from such a device and classify it into several diagnostic classes. At the Department of Functional Diagnostics at the Regional Hospital in Liberec a database of several hundreds signals was collected. In cooperation with the specialist, the signals were manually classified into four classes. For each class, selected signal features were extracted and then used for training a Bayesian classifier. Another set of signals was used for evaluating and optimizing the parameters of the classifier. Slightly above 84 % of successfully recognized diagnostic states, was recently achieved on the test data. 

An ensemble self-training protein interaction article classifier.

Science.gov (United States)

Chen, Yifei; Hou, Ping; Manderick, Bernard

2014-01-01

Protein-protein interaction (PPI) is essential to understand the fundamental processes governing cell biology. The mining and curation of PPI knowledge are critical for analyzing proteomics data. Hence it is desired to classify articles PPI-related or not automatically. In order to build interaction article classification systems, an annotated corpus is needed. However, it is usually the case that only a small number of labeled articles can be obtained manually. Meanwhile, a large number of unlabeled articles are available. By combining ensemble learning and semi-supervised self-training, an ensemble self-training interaction classifier called EST_IACer is designed to classify PPI-related articles based on a small number of labeled articles and a large number of unlabeled articles. A biological background based feature weighting strategy is extended using the category information from both labeled and unlabeled data. Moreover, a heuristic constraint is put forward to select optimal instances from unlabeled data to improve the performance further. Experiment results show that the EST_IACer can classify the PPI related articles effectively and efficiently.

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.

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

Directory of Open Access Journals (Sweden)

Yanjun Zhao

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

Classified facilities for environmental protection

International Nuclear Information System (INIS)

Anon.

1993-02-01

The legislation of the classified facilities governs most of the dangerous or polluting industries or fixed activities. It rests on the law of 9 July 1976 concerning facilities classified for environmental protection and its application decree of 21 September 1977. This legislation, the general texts of which appear in this volume 1, aims to prevent all the risks and the harmful effects coming from an installation (air, water or soil pollutions, wastes, even aesthetic breaches). The polluting or dangerous activities are defined in a list called nomenclature which subjects the facilities to a declaration or an authorization procedure. The authorization is delivered by the prefect at the end of an open and contradictory procedure after a public survey. In addition, the facilities can be subjected to technical regulations fixed by the Environment Minister (volume 2) or by the prefect for facilities subjected to declaration (volume 3). (A.B.)

Defending Malicious Script Attacks Using Machine Learning Classifiers

Directory of Open Access Journals (Sweden)

Nayeem Khan

2017-01-01

Full Text Available The web application has become a primary target for cyber criminals by injecting malware especially JavaScript to perform malicious activities for impersonation. Thus, it becomes an imperative to detect such malicious code in real time before any malicious activity is performed. This study proposes an efficient method of detecting previously unknown malicious java scripts using an interceptor at the client side by classifying the key features of the malicious code. Feature subset was obtained by using wrapper method for dimensionality reduction. Supervised machine learning classifiers were used on the dataset for achieving high accuracy. Experimental results show that our method can efficiently classify malicious code from benign code with promising results.

Joined at the hip? A paleoepidemiological study of developmental dysplasia of the hip and its relation to swaddling practices among indigenous peoples of North America.

Science.gov (United States)

Blatt, Samantha H

2013-01-01

Clinical prevalence of developmental dysplasia of the hip (DDH) is the highest among modern indigenous populations of North America, yet no systematic study of the paleoepidemiology of this group exists. This study discusses the skeletal criteria, epidemiology, pathophysiology, and risk factors for DDH. A range of cases of DDH from an archaeological Native American population are described, and the clinical and prehistoric prevalence of DDH among indigenous populations of North America are calculated and discussed within a biocultural perspective. Pelves of 390 adults from the Late Prehistoric (1490 BP ± 70) Buffalo site, West Virginia were examined for DDH. Morphology of true and false acetabula was classified and other changes of the pelvis, lower limb, and spine were noted along with cranial deformation, providing evidence of infant restriction. Prevalence of DDH among living and archaeological indigenous peoples of North America were calculated and compared. DDH was identified in eighteen adults from Buffalo, resulting in a prevalence of 46.15, within the range reported in modern indigenous groups in North America. However, there is a significant difference between the DDH prevalence in prehistory and today in the target population. Indigenous peoples of North America have the highest reported global prevalence of DDH today and in prehistory. The etiology of DDH suggests that components of both genetic predisposition and swaddling practices have combined to create a high-risk environment for the development of DDH, contributing to its high prevalence within archaeological populations, like Buffalo, and modern Native American/Aboriginal groups within North America. Copyright © 2013 Wiley Periodicals, Inc.

Nuclear options in Latin America

International Nuclear Information System (INIS)

1983-11-01

An account is given of the Treaty of Tlatelolco, 1967, providing for the designation of Latin America as a Nuclear Weapon-Free Zone (NWFZ); additional protocols attached to the Treaty are available for signature by States outside the region. The Treaty is administered by the Organisation for the Prohibition of Nuclear Weapons in Latin America (OPANAL). Reference is made to its latest meeting, held in May 1983. The present paper also discusses the following: Non-Proliferation Treaty (with references to safeguards agreements concluded between each State and the IAEA); nuclear suppliers' group; peaceful nuclear explosions; nuclear energy programmes in Latin America. (U.K.)

Fisher classifier and its probability of error estimation

Science.gov (United States)

Chittineni, C. B.

1979-01-01

Computationally efficient expressions are derived for estimating the probability of error using the leave-one-out method. The optimal threshold for the classification of patterns projected onto Fisher's direction is derived. A simple generalization of the Fisher classifier to multiple classes is presented. Computational expressions are developed for estimating the probability of error of the multiclass Fisher classifier.

Energy market integration in South America

International Nuclear Information System (INIS)

Hammons, T.J.; Franco, N. de; Sbertoli, L.V.; Khelil, C.; Rudnick, H.; Clerici, A.; Longhi, A.

1997-01-01

This article is a summary of presentations made during the 1997 Winter Meeting panel session on Power and Natural Gas in Latin America: Towards an Integrated Market. Reregulation and demand for energy resources to support economic growth are driving international natural gas and electricity exchange initiatives. Panelists focused on the gas and electric power industry in Latin America in terms of the: transport of gas or transmission of electricity; energy market integration in the southern cone of South America; and issues on gas use for electricity generation in South America countries. Countries such as Argentina, Bolivia, and Peru will export natural gas to Brazil, Uruguay, Paraguay and Chile, an the energy matrices of these countries will change

Reducing variability in the output of pattern classifiers using histogram shaping

International Nuclear Information System (INIS)

Gupta, Shalini; Kan, Chih-Wen; Markey, Mia K.

2010-01-01

Purpose: The authors present a novel technique based on histogram shaping to reduce the variability in the output and (sensitivity, specificity) pairs of pattern classifiers with identical ROC curves, but differently distributed outputs. Methods: The authors identify different sources of variability in the output of linear pattern classifiers with identical ROC curves, which also result in classifiers with differently distributed outputs. They theoretically develop a novel technique based on the matching of the histograms of these differently distributed pattern classifier outputs to reduce the variability in their (sensitivity, specificity) pairs at fixed decision thresholds, and to reduce the variability in their actual output values. They empirically demonstrate the efficacy of the proposed technique by means of analyses on the simulated data and real world mammography data. Results: For the simulated data, with three different known sources of variability, and for the real world mammography data with unknown sources of variability, the proposed classifier output calibration technique significantly reduced the variability in the classifiers' (sensitivity, specificity) pairs at fixed decision thresholds. Furthermore, for classifiers with monotonically or approximately monotonically related output variables, the histogram shaping technique also significantly reduced the variability in their actual output values. Conclusions: Classifier output calibration based on histogram shaping can be successfully employed to reduce the variability in the output values and (sensitivity, specificity) pairs of pattern classifiers with identical ROC curves, but differently distributed outputs.

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 ...

Use of information barriers to protect classified information

International Nuclear Information System (INIS)

MacArthur, D.; Johnson, M.W.; Nicholas, N.J.; Whiteson, R.

1998-01-01

This paper discusses the detailed requirements for an information barrier (IB) for use with verification systems that employ intrusive measurement technologies. The IB would protect classified information in a bilateral or multilateral inspection of classified fissile material. Such a barrier must strike a balance between providing the inspecting party the confidence necessary to accept the measurement while protecting the inspected party's classified information. The authors discuss the structure required of an IB as well as the implications of the IB on detector system maintenance. A defense-in-depth approach is proposed which would provide assurance to the inspected party that all sensitive information is protected and to the inspecting party that the measurements are being performed as expected. The barrier could include elements of physical protection (such as locks, surveillance systems, and tamper indicators), hardening of key hardware components, assurance of capabilities and limitations of hardware and software systems, administrative controls, validation and verification of the systems, and error detection and resolution. Finally, an unclassified interface could be used to display and, possibly, record measurement results. The introduction of an IB into an analysis system may result in many otherwise innocuous components (detectors, analyzers, etc.) becoming classified and unavailable for routine maintenance by uncleared personnel. System maintenance and updating will be significantly simplified if the classification status of as many components as possible can be made reversible (i.e. the component can become unclassified following the removal of classified objects)

ACHP | Summary of the Preserve America Initiative

Science.gov (United States)

Initiative Preserve America: Explore and Enjoy Our Heritage (logo) Summary of the Preserve America Initiative Preserve America is a White House initiative that encourages and supports community efforts to preserve and enjoy our priceless cultural and natural heritage. The goals of the initiative include a greater shared

An ensemble of dissimilarity based classifiers for Mackerel gender determination

Science.gov (United States)

Blanco, A.; Rodriguez, R.; Martinez-Maranon, I.

2014-03-01

Mackerel is an infravalored fish captured by European fishing vessels. A manner to add value to this specie can be achieved by trying to classify it attending to its sex. Colour measurements were performed on Mackerel females and males (fresh and defrozen) extracted gonads to obtain differences between sexes. Several linear and non linear classifiers such as Support Vector Machines (SVM), k Nearest Neighbors (k-NN) or Diagonal Linear Discriminant Analysis (DLDA) can been applied to this problem. However, theyare usually based on Euclidean distances that fail to reflect accurately the sample proximities. Classifiers based on non-Euclidean dissimilarities misclassify a different set of patterns. We combine different kind of dissimilarity based classifiers. The diversity is induced considering a set of complementary dissimilarities for each model. The experimental results suggest that our algorithm helps to improve classifiers based on a single dissimilarity.

An ensemble of dissimilarity based classifiers for Mackerel gender determination

International Nuclear Information System (INIS)

Blanco, A; Rodriguez, R; Martinez-Maranon, I

2014-01-01

Mackerel is an infravalored fish captured by European fishing vessels. A manner to add value to this specie can be achieved by trying to classify it attending to its sex. Colour measurements were performed on Mackerel females and males (fresh and defrozen) extracted gonads to obtain differences between sexes. Several linear and non linear classifiers such as Support Vector Machines (SVM), k Nearest Neighbors (k-NN) or Diagonal Linear Discriminant Analysis (DLDA) can been applied to this problem. However, theyare usually based on Euclidean distances that fail to reflect accurately the sample proximities. Classifiers based on non-Euclidean dissimilarities misclassify a different set of patterns. We combine different kind of dissimilarity based classifiers. The diversity is induced considering a set of complementary dissimilarities for each model. The experimental results suggest that our algorithm helps to improve classifiers based on a single dissimilarity

Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.

Science.gov (United States)

Al-Tamimi, Y; Ilett, K F; Paech, M J; O'Halloran, S J; Hartmann, P E

2011-04-01

There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. We conducted an observational study among 20 women. The mean (95% confidence interval) pethidine dose administered was 670 (346-818) mg over 41 (35-46) h. Maternal plasma and milk and neonatal plasma were collected near the time of pethidine cessation and 6h later. Absolute and relative infant doses via milk and infant exposure were calculated. Infant behaviour was assessed using the Neurologic and Adaptive Capacity Score. At first and second sampling times, mean absolute infant doses for pethidine were 20 (14-27) μg/kg/day and 10 (7-13) μg/kg/day, while mean relative infant doses were 0.7 (0.1-1.4)% and 0.3 (0.1-0.5)% respectively. Similar values for norpethidine (expressed as pethidine equivalents) were 21 (16-26) μg/kg/day and 22 (12-32) μg/kg/day; and 0.7 (0.3-1)% and 0.6 (0.2-1)% respectively. Mean pethidine and norpethidine concentrations in neonatal plasma were 3 (0-6.1) μg/L and 0.6 (0.2-1) μg/L. Compared with a time-matched maternal sample, the infant's exposure was 1.4 (0.2-2.8)% for pethidine and 0.4 (0.2-0.6)% for norpethidine. The mean (95% confidence interval) neurologic and adaptive capacity score was 33.6 (32.2-34.9). The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery. Copyright © 2010 Elsevier Ltd. All rights reserved.

Classifying sows' activity types from acceleration patterns

DEFF Research Database (Denmark)

Cornou, Cecile; Lundbye-Christensen, Søren

2008-01-01

An automated method of classifying sow activity using acceleration measurements would allow the individual sow's behavior to be monitored throughout the reproductive cycle; applications for detecting behaviors characteristic of estrus and farrowing or to monitor illness and welfare can be foreseen....... This article suggests a method of classifying five types of activity exhibited by group-housed sows. The method involves the measurement of acceleration in three dimensions. The five activities are: feeding, walking, rooting, lying laterally and lying sternally. Four time series of acceleration (the three...

Naive Bayesian classifiers for multinomial features: a theoretical analysis

CSIR Research Space (South Africa)

Van Dyk, E

2007-11-01

Full Text Available The authors investigate the use of naive Bayesian classifiers for multinomial feature spaces and derive error estimates for these classifiers. The error analysis is done by developing a mathematical model to estimate the probability density...

Sharing regulatory data as tools for strengthening health systems in the Region of the Americas

Directory of Open Access Journals (Sweden)

Varley Dias Sousa

Full Text Available ABSTRACT Regulatory transparency is an imperative characteristic of a reliable National Regulatory Authority. In the region of the Americas, the process of building an open government is still fragile and fragmented across various Health Regulatory Agencies (HRAs and Regional Reference Authorities (RRAs. This study assessed the transparency status of RRAs, focusing on various medicine life-cycle documents (the Medicine Dossier, Clinical Trial Report, and Inspection Report as tools for strengthening health systems. Based on a narrative (nonsystematic review of RRA regulatory transparency, transparency status was classified as one of two types: public disclosure of information (intra-agency data and data- and work-sharing (inter-agency data. The risks/benefits of public disclosure of medicine-related information were assessed, taking into account 1 the involvement and roles of multiple stakeholders (health care professionals, regulators, industry, community, and academics and 2 the protection of commercial and personal confidential data. Inter-agency data- and work-sharing was evaluated in the context of harmonization and cooperation projects that focus on regulatory convergence. Technical and practical steps for establishing an openness directive for the pharmaceutical regulatory environment are proposed to improve and strengthen health systems in the Americas. Addressing these challenges requires leadership from entities such as the Pan American Health Organization to steer and support collaborative regional alliances that advance the development and establishment of a trustworthy regulatory environment and a sustainable public health system in the Americas, using international successful initiatives as reference and taking into account the domestic characteristics and experiences of each individual country.

Sharing regulatory data as tools for strengthening health systems in the Region of the Americas.

Science.gov (United States)

Sousa, Varley Dias; Ramalho, Pedro I; Silveira, Dâmaris

2016-05-01

Regulatory transparency is an imperative characteristic of a reliable National Regulatory Authority. In the region of the Americas, the process of building an open government is still fragile and fragmented across various Health Regulatory Agencies (HRAs) and Regional Reference Authorities (RRAs). This study assessed the transparency status of RRAs, focusing on various medicine life-cycle documents (the Medicine Dossier, Clinical Trial Report, and Inspection Report) as tools for strengthening health systems. Based on a narrative (nonsystematic) review of RRA regulatory transparency, transparency status was classified as one of two types: public disclosure of information (intra-agency data) and data- and work-sharing (inter-agency data). The risks/benefits of public disclosure of medicine-related information were assessed, taking into account 1) the involvement and roles of multiple stakeholders (health care professionals, regulators, industry, community, and academics) and 2) the protection of commercial and personal confidential data. Inter-agency data- and work-sharing was evaluated in the context of harmonization and cooperation projects that focus on regulatory convergence. Technical and practical steps for establishing an openness directive for the pharmaceutical regulatory environment are proposed to improve and strengthen health systems in the Americas. Addressing these challenges requires leadership from entities such as the Pan American Health Organization to steer and support collaborative regional alliances that advance the development and establishment of a trustworthy regulatory environment and a sustainable public health system in the Americas, using international successful initiatives as reference and taking into account the domestic characteristics and experiences of each individual country.

Latin America: population and internal unrest.

Science.gov (United States)

Wiarda, J H; Siqueira Wiarda, I

1985-09-01

This discussion of population and internal unrest in Latin America covers the following: pressures on land and agriculture; economic frustrations; the youth and radicalism; rising social tensions; and political instability. At current growth rates, Latin America's population is projected to increases between 1981 2001 by 225 million people. This staggering population growth is likely to have serious political, economic, social, strategic, and other implications. The strong opposition to family planning which came principally from nationlists, the military, and the church during the 1960s has changed to general support for voluntary family planning programs in much of Latin America. Too rapid population growth now is viewed widely as aggravating the problems of development and putting severe strains on services and facilities. The wish to limit family size is particularly strong among women. Most of Latin America's untapped land is unusable, either so steeply mountainous, densely tropical, or barren of topsoil that it cannot support life at even the most meager level of subsistence. Food production in most of Latin America has not kept pace with population growth. Since most new agricultural production is oriented toward exports rather than home consumption, conditions for most rural populations are worsening. Economic dilemmas facing Latin America include widespread poverty, the world's highest per capita debt, unemployment and underemployment that may reach between 40-50% of the workforce, negative economic growth rates over the past 5 years, immense income inequalities, declining terms of trade, extensive capital flight, little new investment or foreign assistance, increased protectionism on the part of those countriews with whom Latin America must trade, rising prices for the goods Latin America must import, and (in some countries) devastation of the economic infrastrucutre by guerrilla forces. The unprecedent flow from the countryside has made Latin America the

Neural network classifier of attacks in IP telephony

Science.gov (United States)

Safarik, Jakub; Voznak, Miroslav; Mehic, Miralem; Partila, Pavol; Mikulec, Martin

2014-05-01

Various types of monitoring mechanism allow us to detect and monitor behavior of attackers in VoIP networks. Analysis of detected malicious traffic is crucial for further investigation and hardening the network. This analysis is typically based on statistical methods and the article brings a solution based on neural network. The proposed algorithm is used as a classifier of attacks in a distributed monitoring network of independent honeypot probes. Information about attacks on these honeypots is collected on a centralized server and then classified. This classification is based on different mechanisms. One of them is based on the multilayer perceptron neural network. The article describes inner structure of used neural network and also information about implementation of this network. The learning set for this neural network is based on real attack data collected from IP telephony honeypot called Dionaea. We prepare the learning set from real attack data after collecting, cleaning and aggregation of this information. After proper learning is the neural network capable to classify 6 types of most commonly used VoIP attacks. Using neural network classifier brings more accurate attack classification in a distributed system of honeypots. With this approach is possible to detect malicious behavior in a different part of networks, which are logically or geographically divided and use the information from one network to harden security in other networks. Centralized server for distributed set of nodes serves not only as a collector and classifier of attack data, but also as a mechanism for generating a precaution steps against attacks.

Violence and Abuse in Rural America

Science.gov (United States)

... Guide Rural Health Topics & States Topics View more Violence and Abuse in Rural America Violence and abuse ... of harassment, stalking, and bullying? How prevalent is violence and abuse in rural America? According to the ...

Lead-free solder technology transfer from ASE Americas

Energy Technology Data Exchange (ETDEWEB)

FTHENAKIS,V.

1999-10-19

To safeguard the environmental friendliness of photovoltaics, the PV industry follows a proactive, long-term environmental strategy involving a life-of-cycle approach to prevent environmental damage by its processes and products from cradle to grave. Part of this strategy is to examine substituting lead-based solder on PV modules with other solder alloys. Lead is a toxic metal that, if ingested, can damage the brain, nervous system, liver and kidneys. Lead from solder in electronic products has been found to leach out from municipal waste landfills and municipal incinerator ash was found to be high in lead also because of disposed consumer electronics and batteries. Consequently, there is a movement in Europe and Japan to ban lead altogether from use in electronic products and to restrict the movement across geographical boundaries of waste containing lead. Photovoltaic modules may contain small amounts of regulated materials, which vary from one technology to another. Environmental regulations impact the cost and complexity of dealing with end-of-life PV modules. If they were classified as hazardous according to Federal or State criteria, then special requirements for material handling, disposal, record-keeping and reporting would escalate the cost of decommissioning the modules. Fthenakis showed that several of today's x-Si modules failed the US-EPA Toxicity Characteristic Leaching Procedure (TCLP) for potential leaching of Pb in landfills and also California's standard on Total Threshold Limit Concentration (TTLC) for Pb. Consequently, such modules may be classified as hazardous waste. He highlighted potential legislation in Europe and Japan which could ban or restrict the use of lead and the efforts of the printed-circuit industries in developing Pb-free solder technologies in response to such expected legislation. Japanese firms already have introduced electronic products with Pb-free solder, and one PV manufacturer in the US, ASE Americas has used a

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.

Performance of classification confidence measures in dynamic classifier systems

Czech Academy of Sciences Publication Activity Database

Štefka, D.; Holeňa, Martin

2013-01-01

Roč. 23, č. 4 (2013), s. 299-319 ISSN 1210-0552 R&D Projects: GA ČR GA13-17187S Institutional support: RVO:67985807 Keywords : classifier combining * dynamic classifier systems * classification confidence Subject RIV: IN - Informatics, Computer Science Impact factor: 0.412, year: 2013