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Sample records for caesarean section cohort

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation). RESULTS: 2687 infants were delivered by elective caesarean...... section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks' gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks' gestation (3.0, 2.1 to 4.3), and 39 weeks......-eclampsia, and intrauterine growth retardation, or by breech presentation. CONCLUSION: Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased...

  2. Caesarean section and mortality

    African Journals Online (AJOL)

    2015:21(3);17–23) titled, The development of a scoring tool for the measurement of performance in managing hypotension and intraoperative cardiac arrest during spinal anaesthesia for. Caesarean section. I was extremely saddened and shocked by the situation described at your level one and two hospitals. I do not know ...

  3. New Technique for Caesarean Section

    OpenAIRE

    Vejnović, T. R.; Costa, S. D.; Ignatov, A.

    2012-01-01

    Caesarean section is one of the most common operations worldwide and more than 30 % of procedures in perinatal centres in Germany are caesarean sections. In the last few years the technique used for caesarean sections has been simplified, resulting in a lower postoperative morbidity. But persistent problems associated with all caesarean section techniques include high intraoperative loss of blood, the risk of injury to the child during uterotomy and postoperative wound dehiscence of the uteri...

  4. Uroperitoneum after Caesarean Section

    Directory of Open Access Journals (Sweden)

    Antonakopoulos Nikolaos

    2013-01-01

    Full Text Available Intraoperative injuries of the bladder and the attendant vesicouterine and vesicovaginal fistulas formation are reported as rare events, but the rapid increase in the number of caesarean sections has contributed to the emergence of these complications. Early recognition of these complications makes them much easier to deal with, while simple measures intraoperatively can ensure that these complications will not escape attention. We present our rare case of uroperitoneum after cesarean section, the way of diagnosis and treatment, and due to this incident we review in detail the existing literature on the topic.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods

    Science.gov (United States)

    Béhague, Dominique P; Victora, Cesar G; Barros, Fernando C

    2002-01-01

    Objectives To investigate why some women prefer caesarean sections and how decisions to medicalise birthing are influenced by patients, doctors, and the sociomedical environment. Design Population based birth cohort study, using ethnographic and epidemiological methods. Setting Epidemiological study: women living in the urban area of Pelotas, Brazil who gave birth in hospital during the study. Ethnographic study: subsample of 80 women selected at random from the birth cohort. Nineteen medical staff were interviewed. Participants 5304 women who gave birth in any of the city's hospitals in 1993. Main outcome measures Birth by caesarean section or vaginal delivery. Results In both samples women from families with higher incomes and higher levels of education had caesarean sections more often than other women. Many lower to middle class women sought caesarean sections to avoid what they considered poor quality care and medical neglect, resulting from social prejudice. These women used medicalised prenatal and birthing health care to increase their chance of acquiring a caesarean section, particularly if they had social power in the home. Both social power and women's behaviour towards seeking medicalised health care remained significantly associated with type of birth after controlling for family income and maternal education. Conclusions Fear of substandard care is behind many poor women's preferences for a caesarean section. Variables pertaining to women's role in the process of redefining and negotiating medical risks were much stronger correlates of caesarean section rates than income or education. The unequal distribution of medical technology has altered concepts of good and normal birthing. Arguments supporting interventionist birthing for all on the basis of equal access to health care must be reviewed. What is already known on this topicWomen's preferences for caesarean sections are understood to result from lack of knowledge and psychological aptitude to

  7. 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).

  8. Maternal mortality following caesarean sections.

    Science.gov (United States)

    Sikdar, K; Kundu, S; Mandal, G S

    1979-08-01

    A study of 26 maternal deaths following 3647 caesarean sections was conducted in Eden Hospital from 1974-1977. During the time period there were 35,544 births and 308 total maternal deaths (8.74/1000). Indications for Caesarean sections included: 1) abnormal presentation; 2) cephalopelvic disproportion; 3) toxemia; 4) prolonged labor; 5) fetal distress; and 6) post-caesarean pregnancies. Highest mortality rates were among cephalopelvic disproportion, toxemia, and prolonged labor patients. 38.4% of the patients died due to septicaemia and peritonitis, but other deaths were due to preclampsia, shock, and hemorrhage. Proper antenatal care may have prevented anemia and preclampsia and treated other pre-existing or superimposed diseases.

  9. 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 ... areas indirectly compels doctors to provide the best medical care they can, considering that in many instances ...

  10. New Technique for Caesarean Section

    Science.gov (United States)

    Vejnović, T. R.; Costa, S. D.; Ignatov, A.

    2012-01-01

    Caesarean section is one of the most common operations worldwide and more than 30 % of procedures in perinatal centres in Germany are caesarean sections. In the last few years the technique used for caesarean sections has been simplified, resulting in a lower postoperative morbidity. But persistent problems associated with all caesarean section techniques include high intraoperative loss of blood, the risk of injury to the child during uterotomy and postoperative wound dehiscence of the uterine scar. We present here a modification of the most common Misgav-Ladach method. The initial skin incision is done along the natural skin folds and is extended intraoperatively depending on the circumference of the babyʼs head. After blunt expansion of the uterine incision using an anatomical forceps, the distal uterine wall is pushed behind the babyʼs head. The babyʼs head is rotated into the occipito-anterior or posterior position and delivery occurs through the application of gentle pressure on the uterine fundus. Closure of the uterotomy is done using 2 continuous sutures, which are then knotted together resulting in a short double-layer closure. The two ends of the skin suture are left open to allow for natural drainage. Our experience at the University Gynaecological Hospitals in Novi Sad and Magdeburg has shown that this modification is associated with shorter operating times, minimal blood loss and shorter in-hospital stay of patients as well as high rates of patient satisfaction. PMID:25328165

  11. New Technique for Caesarean Section.

    Science.gov (United States)

    Vejnović, T R; Costa, S D; Ignatov, A

    2012-09-01

    Caesarean section is one of the most common operations worldwide and more than 30 % of procedures in perinatal centres in Germany are caesarean sections. In the last few years the technique used for caesarean sections has been simplified, resulting in a lower postoperative morbidity. But persistent problems associated with all caesarean section techniques include high intraoperative loss of blood, the risk of injury to the child during uterotomy and postoperative wound dehiscence of the uterine scar. We present here a modification of the most common Misgav-Ladach method. The initial skin incision is done along the natural skin folds and is extended intraoperatively depending on the circumference of the baby's head. After blunt expansion of the uterine incision using an anatomical forceps, the distal uterine wall is pushed behind the baby's head. The baby's head is rotated into the occipito-anterior or posterior position and delivery occurs through the application of gentle pressure on the uterine fundus. Closure of the uterotomy is done using 2 continuous sutures, which are then knotted together resulting in a short double-layer closure. The two ends of the skin suture are left open to allow for natural drainage. Our experience at the University Gynaecological Hospitals in Novi Sad and Magdeburg has shown that this modification is associated with shorter operating times, minimal blood loss and shorter in-hospital stay of patients as well as high rates of patient satisfaction.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Hematometra following caesarean section for placenta previa

    African Journals Online (AJOL)

    2017-12-08

    Dec 8, 2017 ... 76. CASE REPORT. Hematometra following caesarean section is rare. We present here a case of 23-year-old woman who had undergone caesarean section for placenta previa. She presented with cryptomenorrhoea and hematometra after 5 months of caesarean delivery owing to adhesions in the vagina.

  14. Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study.

    Science.gov (United States)

    Lopez, U; Meyer, M; Loures, V; Iselin-Chaves, I; Epiney, M; Kern, C; Haller, G

    2017-06-02

    Post-traumatic stress disorder (PTSD) occurs in 1-7% of women following childbirth. While having a caesarean section (C-section) is known to be a significant risk factor for postpartum PTSD, it is currently unknown whether coexisting anaesthesia-related factors are also associated to the disorder. The aim of this study was to assess anaesthesia-linked factors in the development of acute postpartum PTSD. We performed a prospective cohort study on women having a C-section in a tertiary hospital in Switzerland. Patients were followed up six weeks postpartum. Patient and procedure characteristics, past morbidity or traumatic events, psychosocial status and stressful perinatal events were measured. Outcome was divided into two categories: full PTSD disease and PTSD profile. This was based on the number of DSM-IV criteria of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) present. The PTSD Checklist Scale and the Clinician Administered PTSD Scale were used for measurement. Of the 280 patients included, 217 (77.5%) answered the questionnaires and 175 (62.5%) answered to an additional phone interview. Twenty (9.2%) had a PTSD profile and six (2.7%) a PTSD. When a full predictive model of risk factors for PTSD profile was built using logistic regression, maternal prepartum and intrapartum complications, anaesthetic complications and dissociative experiences during C-section were found to be the significant predictors for PTSD profile. This is the first study to show in parturients having a C-section that an anaesthesia complication is an independent risk factor for postpartum PTSD and PTSD profile development, in addition to known perinatal and maternal risk factors.

  15. [Spontaneous bilateral tubal pregnancy following caesarean section].

    Science.gov (United States)

    Petersen, Jesper Friis; Ekelund, Charlotte; Settnes, Annette

    2015-03-23

    We describe a rare case of bilateral tubal pregnancy following natural conception in a woman with no other known risk factor than two former caesarean sections. Intraabdominal adhesions following the caesarean sections complicated the salpingectomy thus diminishing certainty of a healthy contralateral tube. The woman was readmitted three weeks later and had an additional salpingectomy on behalf of an unrecognized tubal pregnancy. Considering the rising caesarean section rates clinicians need to be certain of no additional ectopic pregnancy while performing the primary operation.

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

    African Journals Online (AJOL)

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

  17. 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.

  18. Safer caesarean sections at Juba Teaching Hospital

    African Journals Online (AJOL)

    2012-05-02

    May 2, 2012 ... procedures in South Sudan. Following some “powerpoint” teaching on spinal anaesthesia, alongside the provision of practical advice and support, rates of spinal anaesthesia for caesarean section at Juba Teaching Hospital increased significantly. Although the rates for emergency caesarean sections did.

  19. CAESAREAN SECTION RATE AT FEDERAL MEDICAL CENTRE ...

    African Journals Online (AJOL)

    EagleMarkRes

    Department of Internal Medicine, Federal Medical Centre Makurdi, Benue, Benue State. Makurdi. ABSTRACT. Context: Regular auditing of caesarean section rate is important to establish trend, review indications, associated complications and offer possible solutions to improve outcome. Objective: To audit caesarean ...

  20. Emergency Caesarean Section in a Nigerian Tertiary Health Centre ...

    African Journals Online (AJOL)

    This study was done to determine the caesarean section rate, ascertain the trend of emergency caesarean section, indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. Method: A retrospective analysis of the clinical records of all patients ...

  1. Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania

    Directory of Open Access Journals (Sweden)

    Oneko Olola

    2011-07-01

    Full Text Available Abstract Background The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS. Methods We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score Results Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86 and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35 were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16. Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral

  2. 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.

  3. Predicting spinal hypotension during Caesarean section

    African Journals Online (AJOL)

    Hypotension under spinal anaesthesia for Caesarean section is a common and important problem, with significant maternal and foetal implications. The ability to predict which patients are at particular risk for severe hypotension would enable anaesthetists not only to prepare appropriately but potentially also to individualise ...

  4. Primary caesarean section in nulliparous and grandmultiparous ...

    African Journals Online (AJOL)

    However, in order to reduce the high CS rate in these groups of patients,and in our obstetric population in general, it is suggested that CTG be used appropriately in high risk women and that intermittent auscultation is recognized as a valid form of management for most low risk cases. Keywords: Primary caesarean section, ...

  5. 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 ...

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

    Objective: To assess the common methods of analgesia used in our hospital following caesarean section, their effectiveness and patient satisfaction. Design: A prospective descriptive study. Settings: The study was conducted at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria over a period of 18 months ...

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

    African Journals Online (AJOL)

    The data was analyzed using IBM-SPSS windows version 21. A total of 1390 caesarean section were performed out of 4219 deliveries during the period of review giving a caesarean section rate of 32.9%. The commonest indication was previous caesarean section (25.2%), followed by obstructed labour (17.0%). Maternal ...

  10. perspectives on the practice of vaginal birth after caesarean section ...

    African Journals Online (AJOL)

    2010-08-08

    Aug 8, 2010 ... North America (7). The same is true for ..... Rates and implication of Caesarean sections in Latin. America: ... Menacker, F. and Curtin, S. Trends in Caesarean birth and vaginal ... Cochrane Database of Systematic. Reviews ...

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

    African Journals Online (AJOL)

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

  12. 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.

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

    LENUS (Irish Health Repository)

    Robson, Michael

    2013-04-01

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

  14. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

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

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

    African Journals Online (AJOL)

    Sixteen (6.3%) believed that having caesarean section was due to failure of reproductive function of a woman, with 106 (41.7%) citing destiny as reason for caesarean ... The low number of maternal request for caesarean will serve as a benchmark for the future especially with the increasing penchant for smaller family sizes ...

  16. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy.

    Science.gov (United States)

    Wood, S L; Chen, S; Ross, S; Sauve, R

    2008-05-01

    To determine if a previous caesarean section increases the risk of unexplained antepartum stillbirth in second pregnancies. Retrospective cohort study. Large Canadian perinatal database. 158 502 second births. Data were obtained from a large perinatal database, which supplied data on demographics, pregnancy complications, maternal medical conditions, previous caesarean section and pregnancy outcomes. Total and unexplained stillbirth. The antepartum stillbirth rate was 3.0/1000 in the previous caesarean section group compared with 2.7/1000 in the previous vaginal delivery group (P= 0.46). Multivariate logistic regression modelling, including terms for maternal age (polynomial), weight >91 kg, smoking during pregnancy, pre-pregnancy hypertension and diabetes, did not document an association between previous caesarean section and unexplained antepartum stillbirth (OR 1.27, 95% CI 0.92-1.77). Caesarean section in the first birth does not increase the risk of unexplained antepartum stillbirth in second pregnancies.

  17. Effective education to decrease elective caesarean section.

    Science.gov (United States)

    Sanavi, Fariba Shahhraki; Ansari-Moghaddam, Alireza; Shovey, Mehdi Faraji; Rakhshani, Fatemeh

    2014-05-01

    To examine the effect of education on deciding about natural delivery in women opting for elective caesarean section. 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. 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 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. 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.

  18. Maternal obesity, caesarean delivery and caesarean delivery on maternal request: a cohort analysis from China.

    Science.gov (United States)

    Zhou, Yubo; Blustein, Jan; Li, Hongtian; Ye, Rongwei; Zhu, Liping; Liu, Jianmeng

    2015-05-01

    To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. We followed 1,019,576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. During the 18-year period, 404,971 (39.7%) caesareans and 93,927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice. © 2015 John Wiley & Sons Ltd.

  19. Caesarean section – desired rate versus actual need

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    2016-03-11

    Mar 11, 2016 ... in 47.2% of the countries, the caesarean section rate exceeded 15% especially in the countries of Latin America and the. Caribbean along with Europe, North. America and Oceania, and found an inverse association between caesarean section rates and maternal and neonatal mortality for all geographical ...

  20. Pregnancy outcome after one previous caesarean section at a ...

    African Journals Online (AJOL)

    Caesarean section is one of the common surgical interventions to save lives of the mothers and/or the newborns. The rate of caesarean section has increased dramatically world wide over the past three decades (Bailit et al., 2004; Declercq et al., 2006). At Muhimbili National Hospital (MNH), a tertiary and university teaching ...

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

  3. Trends in Regional Anaesthesia for Caesarean Section in a ...

    African Journals Online (AJOL)

    Trends in Regional Anaesthesia for Caesarean Section in a Nigerian Tertiary Health Centre. M.A Lamina. Abstract. BACKGROUND: Most caesarean sections were previously performed under general anaesthesia but there has been an increasing trend worldwide in the use of regional anaesthesia as the preferred method ...

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

    African Journals Online (AJOL)

    Conclusion: It is feasible to reduce the caesarean section rate in Nigerian tertiary care practice if hospital administrators provide the necessary monitoring tools and minimise institutional delays, and if physicians stop practising along planes of least resistance. Key Words: Caesarean Section, Delivery, Rate, Obstetric ...

  5. Caesarean Section in Twin Pregnancies in Enugu, Nigeria ...

    African Journals Online (AJOL)

    Objective: To compare the rates, indications and complications of caesarean section in twin and singleton pregnancies. Methods: A retrospective comparative analysis of caesarean sections done for twin and singleton pregnancies at the University of Nigeria Teaching Hospital, Enugu, Nigeria, over a six-year period.

  6. Determinants and outcome of Caesarean section in twin ...

    African Journals Online (AJOL)

    Background: Caesarean section has become commonplace in modern medical practice as it has become safer and more available, but the optimal mode of delivery for twins is undetermined and as remain controversial in the literature. Aims: To determine the rate, indications and outcome Caesarean sections performed on ...

  7. 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 ...

  8. Uterine incision closure at caesarean section: A randomised ...

    African Journals Online (AJOL)

    ... less blood loss and similar morbidity profile exteriorization of uterus during caesarean section seems to be preferred except where it is not possible because of adhesions and surgeons inexperience. Key words: Caesarean section, Uterine closure, Exteriorisation, Maternal morbidity, Neonatal outcome, Intraperitoneal.

  9. Supplemental oxygen for Caesarean section under spinal anaesthesia

    African Journals Online (AJOL)

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

  10. Caesarean section on request: a survey in The Netherlands.

    Science.gov (United States)

    Kwee, Anneke; Cohlen, Ben J; Kanhai, Humphrey H H; Bruinse, Hein W; Visser, Gerard H A

    2004-04-15

    To determine the opinion of Dutch gynaecologists and registrars on caesarean section (CS) on request. Anonymous postal survey. A structured survey was send to all 900 gynaecologists and registrars in The Netherlands. They were asked to what extent they were willing to accept a request for an elective caesarean section, without evident medical reason. The survey contained eight simulated cases in which the reason for this request differed (obstetrical history and course of the present pregnancy). In two cases, there was no medical indication at all to perform a caesarean section; and in a third case caesarean section was due to excessive maternal weight relatively contraindicated. The response rate was 65%. Willingness to perform an elective caesarean section ranged from 17 to 81% between the cases. Main reasons to perform a caesarean section were: (a). autonomy; (b). an unfavourable course of delivery in the absence of motivation for a natural childbirth; (c). litigation. The main reasons to refuse a request for a caesarean section were: (a). higher maternal morbidity and mortality; (b). no indication for caesarean section. A logistic regression analysis on personal characteristics showed that an experienced doctor is more willing to perform an elective caesarean section then a consultant or registrar with limited experience. The sex of the doctor was of no influence and the same held for the University at which they had been trained. Furthermore, it seems that doctors are more willing to accept the request if it is based upon unfounded, but understandable fear. In The Netherlands, a woman can always find a gynaecologist willing to perform a caesarean section for non medical reasons. This willingness increases with the age of the doctor. There is a need for guidelines when handling these cases.

  11. Caesarean section rates following pelvic fracture: a systematic review.

    Science.gov (United States)

    Riehl, John T

    2014-10-01

    Following pelvic fracture in females of childbearing age, the question of whether or not natural pregnancy and childbirth can occur is often asked by both patients and clinicians. The following is a systematic review of the literature examining caesarean section rate in patients with prior pelvic fracture. An extensive search of the English-language literature was performed to include all articles describing pregnancy outcomes in women with prior pelvic fracture. The primary outcomes analyzed were vaginal delivery and caesarean section. Secondary outcomes investigated included the rate of new caesarean section, indications for caesarean section, and caesarean section rates with operative versus nonoperative treatment of the pelvic fracture. Eight articles assessing 148 patients who underwent childbirth after pelvic fracture were eligible for inclusion. Among the 148 patients who underwent childbirth after pelvic fracture, 79 (53%) delivered vaginally and 69 (47%) underwent caesarean section. When patients who had already undergone a caesarean section prior to their pelvic fracture were excluded, 137 patients remained. Among these 137 patients, 79 (58%) delivered vaginally and 58 (42%) had caesarean section performed. Indications for caesarean section were sporadically listed but in some series did include patient or obstetrician preference as a result of prior pelvic fracture. Prior pelvic fixation had no demonstrable effect on pregnancy outcomes (p>0.05). Patients with prior pelvic fracture undergo caesarean section at a rate greater than those without prior pelvic fracture. The cause for this is not entirely understood but seems to be related at least in part to patient and obstetrician bias rather than solely due to the pelvic fracture and cephalopelvic disproportion. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Who wants a caesarean section? A study of women's personal experience of vaginal and caesarean delivery.

    Science.gov (United States)

    Aslam, M F; Gilmour, K; Fawdry, R D S

    2003-07-01

    The Changing Childbirth report, 1999, explicitly endorsed the right of women to be involved in childbirth decisions and to have a choice in childbirth and it has been suggested that maternal requests for a caesarean birth has been a significant factor in the recently observed increases in caesarean section rates. There have been reports of both obstetrician's views and midwives' views regarding the mode of delivery. However, there is a lack of literature reporting the views of women who have experienced personally both a caesarean section and a vaginal delivery. Fifty women in Milton Keynes who had had at least one vaginal delivery and at least one caesarean section were asked for their opinion.

  13. Caesarean section and subsequent fertility in sub-Saharan Africa.

    Science.gov (United States)

    Collin, S M; Marshall, T; Filippi, V

    2006-03-01

    To determine the impact of caesarean section on fertility among women in sub-Saharan Africa. Analysis of standardised cross-sectional surveys (Demographic and Health Surveys). Twenty-two countries in sub-Saharan Africa, 1993-2003. A total of 35 398 women of childbearing age (15-49 years). Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models. Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery. The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval > or =3 versus caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P= 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth. Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in sub-Saharan Africa are emergency procedures for maternal indication.

  14. Induction of labour in women with one previous caesarean section.

    Science.gov (United States)

    Gupta, P; Elmardi, A; Bathula, U; Chandru, S; Charlesworth, D

    2011-01-01

    We conducted a postal survey of NHS obstetric consultants working in England regarding their own practice and views on induction of labour in women with one previous caesarean section. Out of 480 consultant obstetricians across England, 322 replied, giving a response rate of 67%. Our survey has revealed a wide variation in practice of consultants across England, regarding induction of labour at term or post-term in women with one previous caesarean section. Hence, we feel that there is a need for a national audit of induction of labour in women with one previous caesarean section, with uterine rupture following induction of labour in such women as an auditable standard.

  15. Suture repair of umbilical hernia during caesarean section: a case-control study.

    Science.gov (United States)

    Steinemann, D C; Limani, P; Ochsenbein, N; Krähenmann, F; Clavien, P-A; Zimmermann, R; Hahnloser, D

    2013-08-01

    The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Fourteen patients with a mean age of 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate.

  16. 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...

  17. reduction of caesarean section rate in developing countries

    African Journals Online (AJOL)

    KEY WORDS: caesarean section, vaginal birth, antenatal care, medical auditing. INTRODUCTION ... particularly with the use of electronic fetal monitoring devices with occasional ... The risks and safety of CS in the world differ from place to ...

  18. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    OpenAIRE

    Saxena, Kirti N; Dheeraj Kapoor; Bharti Taneja; Lalit Maini; Shallu Hora

    2008-01-01

    Achondroplasia is the commonest form of dwarfism which results from abnormal cartilage formation at epiphyseal growth plates .It is also known as short-limbed dwarfism. Anaesthetic management of caesarean section in these patients requires a deep understanding of this condition. 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 ...

  19. Fear of childbirth and elective caesarean section: a population-based study.

    Science.gov (United States)

    Størksen, Hege Therese; Garthus-Niegel, Susan; Adams, Samantha S; Vangen, Siri; Eberhard-Gran, Malin

    2015-09-17

    This population-based cohort study aimed to investigate the demographic and psychosocial characteristics associated with fear of childbirth and the relative importance of such fear as a predictor of elective caesarean section. A sample of 1789 women from the Akershus Birth Cohort in Norway provided data collected by three self-administered questionnaires at 17 and 32 weeks of pregnancy and 8 weeks postpartum. Information about the participants' childbirths was obtained from the hospital records. Eight percent of the women reported fear of delivery, defined as a score of ≥85 on the Wijma Delivery Expectancy Questionnaire. Using multivariable logistic regression models, a previous negative overall birth experience exerted the strongest impact on fear of childbirth, followed by impaired mental health and poor social support. Fear of childbirth was strongly associated with a preference for elective caesarean section (aOR 4.6, 95% CI 2.9-7.3) whereas the association of fear with performance of caesarean delivery was weaker (aOR 2.4, 95% CI 1.2-4.9). The vast majority (87%) of women with fear of childbirth did not, however, receive a caesarean section. By contrast, a previous negative overall birth experience was highly predictive of elective caesarean section (aOR 8.1, 95% CI 3.9-16.7) and few women without such experiences did request caesarean section. Results suggest that women with fear of childbirth may have identifiable vulnerability characteristics, such as poor mental health and poor social support. Results also emphasize the need to focus on the subjective experience of the birth to prevent fear of childbirth and elective caesarean sections on maternal request. Regarding the relationship with social support, causality has to be interpreted cautiously, as social support was measured at 8 weeks postpartum only.

  20. Caesarean section in Ancient Greek mythology.

    Science.gov (United States)

    Lurie, Samuel

    2015-01-01

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

  1. Maternal views and experiences regarding repeat Caesarean section

    African Journals Online (AJOL)

    2014-11-28

    Nov 28, 2014 ... countries continue to show strong aversion to cesarean section.[5] On the evidence of recent publications from sub‑Saharan Africa, the willingness of women to accept repeat caesarean delivery is low.[1,5]. A woman's refusal of cesarean section can create a challenging situation for obstetric care providers.

  2. 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...

  3. perspectives on the practice of vaginal birth after caesarean section ...

    African Journals Online (AJOL)

    2010-08-08

    Aug 8, 2010 ... section among maternity service providers in East Africa. Design: A .... complicated without this assurance. Delays in accessing healthcare ... Sentinel National Caesarean Section Audit Report. RCOG Press, 2001. 2. Australian Institute of Health and Welfare. Australia's mothers and babies 2000. Perinatal ...

  4. Induction of twin pregnancy and the risk of caesarean delivery: a cohort study.

    Science.gov (United States)

    Jonsson, Maria

    2015-06-16

    Complications are common in twin pregnancies and induction of labour is often indicated. Most methods for induction are used but data on risks related to induction methods are sparse. The aim of this study was to investigate the association between induction of labour and caesarean delivery in twin pregnancies, and to assess the influence of induction method. Cohort study of twin pregnancies ≥ 34 weeks, planned for vaginal delivery, from two University Hospitals in Sweden. Data were collected from medical records during the periods 1994 (Örebro) and 2004 (Uppsala) to 2013. During the study period there were 78,180 live born births and 1,282 were twin births. Women with previous caesarean section were excluded. Induction methods were categorized into amniotomy, oxytocin and cervical ripening (intra cervical Foley catheter or prostaglandin). Adjusted odds ratios (AOR) with 95 % confidence interval (CI) for caesarean section were calculated by logistic regression and were adjusted for parity, maternal age, gestational length, complications to the pregnancy, infant birth weight and year of birth. Spontaneous labour onsets were used as the reference group. The main outcome measure was caesarean section. In 462 twin pregnancies, 220 (48 %) had induction of labour and 242 (52 %) a spontaneous labour onset. Amniotomy was performed in 149 (68 %) of these inductions, oxytocin was administered in 11 (5 %) and cervical ripening was used in 60 (27 %). The rate of caesarean sections was 21 % in induced and 12 % in spontaneous labours (p 0.01). The absolute risk of caesarean section following induction was: 15 % with amniotomy; 36 % with oxytocin and 37 % with Foley/prostaglandin. Induction of labour increased the risk of caesarean section by 90 % compared with spontaneous labour onset (AOR 1.9, 95 % CI 1.1-3.5) and, when cervical ripening was used, the risk increased more than two fold (AOR 2.5, 95 % CI 1.2-5.3). Induction of labour in twin pregnancies increases the risk of

  5. Intervention for Postpartum Infections Following Caesarean Section

    Science.gov (United States)

    2016-10-14

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  6. Caesarean section wound infiltration with ropivacaine versus placebo

    African Journals Online (AJOL)

    75. Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up. A A Bamigboye,1,2 MMed, FCOG (SA), PhD, Hon DL; J Hofmeyr,2,3 FRCOG, DSc; M Labeodan,4 PhD. 1 Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the ...

  7. How rational are indications for emergency caesarean section in a ...

    African Journals Online (AJOL)

    The rate of caesarean section (CS) at Muhimbili National Hospital (MNH) in Tanzania has been on progressive increase for past three decades. Concerns have been raised if this increase is ... The five most common indications for CS were identified from the obstetric electronic data base. Most common indications included ...

  8. Prolonged labour as indication for emergency caesarean section

    DEFF Research Database (Denmark)

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

    2012-01-01

    OBJECTIVE: To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. DESIGN: A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. SETTING: Two Tanzanian rural mission hospitals...

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

    African Journals Online (AJOL)

    Likewise, morbidity and mortality associated with caesarean section is on the decrease all over the world [3]. ... Brazil 36% in 1996, Latin America 33% in 2005 [9]. The rate is much lower in Africa, Zimbabwe 2.2% to ... talization, complications, maternal and foetal mortality, and cost of surgery were evaluated. The rate of ...

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

    African Journals Online (AJOL)

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

  11. Caesarean section: the perspectives of women in Port Harcourt ...

    African Journals Online (AJOL)

    The aversion of the respondents for caesarean section stem from its stigma factor (52.7%) its ability to limit the number of children a woman could have (68.0%), its cost (63.7%), and the likelihood of morbidity and mortality (51.0%). Some (25.1%) of the respondents felt doctors sometimes recommend the procedure for their ...

  12. Informed consent for caesarean section at a Nigerian university ...

    African Journals Online (AJOL)

    Background: Caesarean section is one of the commonest obstetrics surgery and has become increasingly safer compared with the early 20th century. The practice of informed consent has also become universally adopted for surgical procedures. However, with increasing knowledge about ethics and rights, issues on ...

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

    African Journals Online (AJOL)

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

  14. Management of incidental adnexal masses on caesarean section ...

    African Journals Online (AJOL)

    Background: The reported incidence of adnexal masses during pregnancy vary from 1 in 81 pregnancies to 1 in 8000 pregnancies. There is still a debate on management of incidental adnexal masses during the caesarean section concerning the risk of this additional procedure on postoperative morbidity and mortality.

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

    African Journals Online (AJOL)

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

  16. 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 ...

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

    African Journals Online (AJOL)

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

  18. Decision-delivery interval for emergency Caesarean section and ...

    African Journals Online (AJOL)

    The internationally recommended 30 minutes decision-delivery interval for emergency caesarean section has become a cause for concern in many maternity units especially in developing countries. The aim of this study was to evaluate the feasibility of this recommendation in the University of Calabar Teaching Hospital ...

  19. 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...

  20. Which skin incision for caesarean section? Experiences of patients ...

    African Journals Online (AJOL)

    Background: In South African public hospitals there is still no agreement on the best skin incision for caesarean section (CS). Vertical incisions may be easier to perform, but transverse incisions give better cosmetic results, with reduced risks of wound dehiscence and hernia formation. Objectives: To explore women's views ...

  1. caesarean section in the management of singleton breech delivery ...

    African Journals Online (AJOL)

    J. Udoma, **A. D. Ekanem. Department 0f*()hstetrics andGynaecology, University ofUyo Teaching Hospital, UyoAkwa Ibom State w University afCalabar Teaching Hospital, Calabar, Nigeria . ABSTRACT,. Objective: To establish the role of Caesarean section in reducing perinatal mortality following singleton breech delivery ...

  2. Vaginal breech births in a hospital where caesarean section is ...

    African Journals Online (AJOL)

    SCIENTIFIC LETTER. Objectives. Caesarean section has become the preferred delivery method for breech presentation at Chris Hani Baragwanath Academic ... This study has shown that vaginal breech births continue to occur as unexpected events. ... descriptive study was to understand why and how vaginal breech.

  3. Severe vasovagal attack during regional anaesthesia for caesarean section.

    Science.gov (United States)

    Watkins, E J; Dresner, M; Calow, C E

    2000-01-01

    A patient experienced a severe vasovagal attack during regional anaesthesia for elective Caesarean section. The combination of vagal over-activity and sympathetic block produced profound hypotension that threatened the life of the mother and infant. The vasovagal syndrome is described, and its prevention and management discussed.

  4. Uretero-Cervical Fistula Following Caesarean Section | Ebenuwa ...

    African Journals Online (AJOL)

    A 40-year old female presented with an 8-week history of urinary incontinence following a Caesarean Section and bilateral tubal ligation. Methylene blue dye instilled into the bladder initially did not leak through the vagina or the cervix. A subsequent indigo carmine intravenous dye was excreted into both the bladder and ...

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

    African Journals Online (AJOL)

    Background: The primary objective of this study was to assess whether transversus abdominis plane (TAP) block is effective as part of multimodal pain management following Caesarean section in an area with limited resources. The study also looked at the advantage of this block in reducing the consumption of morphine ...

  6. Systematic review of oxytocin dosing at caesarean section.

    Science.gov (United States)

    Stephens, L C; Bruessel, T

    2012-03-01

    We undertook a systematic review to determine the optimal dose of oxytocin after elective caesarean section or caesarean section in labouring women. We identified seven trials. These trials raise questions about the use of high dose (10 international units; IU) or moderate dose (5 IU) oxytocin in both settings and provide evidence that lower doses are equally effective but associated with significantly fewer side-effects. For elective caesarean section, a slow 0.3 to 1 IU bolus of oxytocin over one minute, followed by an infusion of 5 to 10 IU.h(-1) for four hours represents an evidence-based approach to dosing for women at low risk of postpartum haemorrhage. For the labouring parturient a slow 3 IU bolus of oxytocin, followed by an infusion of 5 to 10 IU.h(-1) for four hours is supported by limited evidence. These doses represent a starting point in the control of postpartum haemorrhage after caesarean section and do not reduce the need for mandatory active observation of the clinical situation, to detect situations that require additional doses of oxytocin or other uterotonic drugs. These doses of oxytocin minimise the risk of adverse haemodynamic changes as well as the unpleasant side-effect of nausea.

  7. Uncomplicated Caesarean section: is prolonged hospital stay necessary?

    Science.gov (United States)

    Fasubaa, O B; Ogunniyi, S O; Dare, F O; Isawumi, A I; Ezechi, O C; Orji, E O

    2000-08-01

    Caesarean section among the Yoruba of western Nigerian is surrounded by a lot of fears, miseries, aversion, guilt and misconceptions for reasons varying from the desire by women to have a natural vaginal birth, fear of surgery, morbidity and deaths from the operation and prolonged hospital stay. To examine issues of reduced hospital stay following Caesarean section with a view of making the operation more acceptable and proffering solution to some of the problems faced by women when Caesarean section is indicated. A prospective case control study. Wesley Guild Hospital, Ilesha, Nigeria from 1st July, 1997 to 30th June, 1998. One hundred consecutive patients who had uncomplicated Caesarean section, randomised into two groups of short (three days) and prolonged (seven to eight days) hospital stay respectively. Observations of patients in both groups were made by an independent observer on day seven post-operation and the main outcomes measured included: wound infection rates, ability to maintain erect posture, mood changes, neonatal sepsis rate, immunisation rate of the neonates and average hospital bills. The findings revealed that wound infection rates of six per cent and ten per cent among the short and prolonged hospitalised patients respectively are not significantly different. Patients with short stay have better erect posture, lower incidence of depressive mood, lower neonatal sepsis rate, lower hospital bill and are more satisfied with early home discharge. Embracing the concept of early home discharge after Caesarean section in uncomplicated cases may remove some of the psychological upsets and economical impediments associated with the operation and make the operation more acceptable.

  8. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-05-15

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

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

    Directory of Open Access Journals (Sweden)

    Piotr Niziurski

    2013-08-01

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

  10. 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.

  11. Introducing caesarean section audit in a regional teaching hospital in The Netherlands.

    Science.gov (United States)

    van Dillen, Jeroen; Lim, Frans; van Rijssel, Evert

    2008-08-01

    The increase in caesarean section rates is considered a reason for serious public health concern. With the objective to create awareness and initiate local discussion, obstetric audit was introduced in a regional teaching hospital in The Netherlands. Caesarean section audit was introduced during the existing daily reports meetings from August 1, 2005 to June 1, 2006 in The Haga hospital, a large teaching hospital in The Hague, The Netherlands. All caesarean sections were discussed with regard to indication, classification and audited for 'lack of necessity'. For comparing intervention rates with the period prior to audit, Chi-square test with Yates correction for 2 x 2 tables was used. Of 1221 deliveries, 228 were caesarean sections (18.7%) while prior to the audit period there were 1216 deliveries with 284 were caesarean sections (23.4%). The caesarean section rate is significantly lower during the audit period. Assisted vaginal deliveries, neonatal outcome, and induction of labor rates were comparable. Concerning the audit question 'could caesarean section have been prevented', there was discussion in 24.4% of cases. In 6.7% of caesarean sections, consensus about lack of necessity was achieved. Introducing caesarean section audit during the existing structure of daily report meetings in a regional teaching hospital is both feasible and practical. It creates awareness and encourages discussion among staff members concerning indications for caesarean sections and lack of necessity. Furthermore, there was a significant decrease in caesarean section rate during the audit period.

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

    Science.gov (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon

    2010-11-01

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

  13. 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.

  14. C1-esterase inhibitor deficiency and elective caesarean section.

    Science.gov (United States)

    Griffiths, R J; O'Sullivan, G

    2005-07-01

    C1-esterase inhibitor deficiency is a rare disorder of the complement system characterised by episodes of cutaneous and mucosal oedema. Life-threatening airway oedema can follow airway instrumentation or minor trauma. We describe the successful management of a 37-year-old primiparous woman with inherited C1-esterase inhibitor deficiency who was admitted at 38 weeks' gestation for elective caesarean section. Whilst undergoing general anaesthesia 18 months previously she had experienced facial and pharyngeal oedema despite prophylaxis (one unit of fresh frozen plasma). On this occasion she underwent elective caesarean section following intrathecal anaesthesia with 0.5% hyperbaric bupivacaine 2 mL and diamorphine 300 microg. Cardiovascular stability was ensured using glycopyrolate and intravenous Hartmann's solution 2 L; a live female infant was delivered successfully. There were no peri- or postoperative complications. Regional anaesthesia is the safest method for providing surgical anaesthesia in the obstetric patient. We believe elective caesarean section under regional anaesthesia should be considered if there are predicted difficulties with vaginal delivery.

  15. Cervical dilation at time of caesarean delivery in nulliparous women: a population-based cohort study.

    Science.gov (United States)

    Riddell, C A; Kaufman, J S; Strumpf, E C; Abenhaim, H A; Hutcheon, J A

    2017-10-01

    Our objective was to describe contemporary practice patterns in the timing of caesarean delivery in relation to cervical dilation, overall and by indication for caesarean. Our secondary objective was to examine how commonly caesarean delivery was performed for labour dystocia at dilations below 4 cm or without the use of oxytocin, overall and between hospitals. Retrospective, population-based cohort study. Ontario, Alberta, and British Columbia, Canada, 2008-2012. Nulliparous women in labour who delivered term singletons in cephalic position. Histograms were used to examine the distribution of cervical dilation at time of caesarean delivery, overall and by indication for caesarean. Funnel plots were used to illustrate variation in hospital-level rates of caesarean deliveries for labour dystocia that were performed early (dilation) or without the use of oxytocin. Cervical dilation (in centimetres) at time of caesarean delivery. The population-based cohort comprised 392 025 women, of whom 18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations dilation or without oxytocin varies substantially across hospitals and suggests the need for institutions to review their practices and ensure that management of labour practice guidelines are followed. Many caesareans for labour dystocia are performed early during labour (dilation) or without oxytocin. © 2016 Royal College of Obstetricians and Gynaecologists.

  16. Behind the myth--few women prefer caesarean section in the absence of medical or obstetrical factors.

    Science.gov (United States)

    Karlström, Annika; Nystedt, Astrid; Johansson, Margareta; Hildingsson, Ingegerd

    2011-10-01

    to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference. mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis. three hospitals in the county of Västernorrland in the middle of Sweden. 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy. a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories. rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way

  17. Rectus Abdominis Endometrioma after Caesarean Section

    Directory of Open Access Journals (Sweden)

    Igor Mishin

    2016-01-01

    Full Text Available Isolated rectus abdominis muscle endometriosis is very uncommon with less than 20 case reports being published to date since its first description in 1984 by Amato and Levitt. We report another case of isolated rectus abdominis endometriosis in a 37-year-old patient with a previous caesarian section. We also discuss the diagnostic and treatment particularities in these patients. In our case, the treatment was only surgical and currently the patient is disease-free during the 24-month follow-up.

  18. Eyelid lacerations secondary to caesarean section delivery.

    Science.gov (United States)

    Timoney, Peter J; Stansfield, Brian; Whitehead, Rick; Lee, H B Harold; Nunery, William R

    2012-01-01

    A 32-week-gestation female was delivered emergently via caesarian section to a mother in premature labor due to placental abruption. On delivery, the neonate was noted to have sustained right upper and lower eyelid full-thickness lacerations extending from the medial canthal area with associated right upper and lower full-thickness canalicular lacerations. The neonate underwent same-day surgical repair of her eyelid lacerations with stenting of her canalicular system with a Crawford tube. At 2 months postoperatively, the child is opening her right upper eyelid without any signs of deprivation ambylopia. This case demonstrates the need to inform expectant mothers of the intrinsic risks of periorbital trauma during the birthing process that may result in visual loss through either ambylopia and/or globe injury.

  19. 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...

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

    Directory of Open Access Journals (Sweden)

    Faúndes Anibal

    2009-10-01

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

  1. 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

  2. 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.

  3. 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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery it is enc......The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery...

  5. Swedish caregivers' attitudes towards caesarean section on maternal request.

    Science.gov (United States)

    Karlström, Annika; Engström-Olofsson, Regina; Nystedt, Astrid; Thomas, Jan; Hildingsson, Ingegerd

    2009-06-01

    Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians' and midwives' attitudes towards CS on maternal request. A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated. The overarching theme was identified as "Caesarean section on maternal request-a balance between resistance and respect". On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.

  6. [Costs of subarachnoid vs. general anaesthesia for caesarean section].

    Science.gov (United States)

    Kwiatosz-Muc, Magdalena; Wdowiak, Leszek; Nestorowicz, Andrzej; Kowalczyk, Michał

    2010-01-01

    Modern medicine is becoming increasingly aware of economic-organizational aspects. In the field of anaesthesiology, the number of agents used markedly increases due to continuous pharmacological progress. A high proportion of them are expensive. The aim of the study was to compare hospital costs of general vs. subarachnoid anaesthesia for Caesarean section. Costs were assessed from the perspective of a service provider. Direct costs were measured using the micro-cost method based on detailed data of the resources used during anaesthetic procedures. Non-medical costs were calculated by the direct allocation method (costs of auxiliary units). Unit costs of hospitalization were determined using the "top-to-bottom" assessment. Costs related to anaesthetic staff work were calculated by the micro-cost method based on duration of anaesthesia. Sensitivity analysis was performed. Mean direct cost of general anaesthesia for Caesarean section was lower than of subarachnoid anaesthesia. Mean personnel cost of subarachnoid anaesthesia was found to be higher compared to general anaesthesia. Costs of pharmaceuticals for general anaesthesia were lower than for subarachnoid one. Costs of medical materials related to the method used were significantly higher in subarachnoid anaesthesia. Subarachnoid anaesthesia takes more time than general one, which results in higher costs of medical staff work. Avoiding inhalation anaesthetics (sevoflurane) makes indirect costs of general anaesthesia lower compared to subarachnoid anaesthesia.

  7. Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population.

    Science.gov (United States)

    Gray, R; Quigley, M A; Hockley, C; Kurinczuk, J J; Goldacre, M; Brocklehurst, P

    2007-03-01

    Two recent studies indicate an increased risk of stillbirth in the pregnancy that follows a pregnancy delivered by caesarean section. In this study, we report an analysis designed to test the hypothesis that delivery by caesarean section is a risk factor for explained or unexplained stillbirth in any subsequent pregnancy. We also report on the proportion of stillbirths in our study population, which may have been attributable to previous delivery by caesarean section. Retrospective cohort study. Linked statistical data set of 81 784 singleton deliveries registered in Oxfordshire and West Berkshire between 1968 and 1989. The crude and adjusted hazard ratios for stillbirth in deliveries following a previous delivery by caesarean section, compared with no previous caesarean, were estimated using Cox regression. Stillbirth. The unadjusted hazard ratios for all, explained, and unexplained stillbirths were 1.54 (95% CI 1.04-2.29); 2.13 (1.22-3.72); and 1.19 (0.68-2.09), respectively. After adjustment for maternal age, parity, social class, previous adverse outcome of pregnancy, body mass indexand smoking the hazard ratios were 1.58 (0.95-2.63), 2.08 (1.00-4.31) and 1.24 (0.60-2.56). Pregnancies in women following a pregnancy delivered by caesarean section are at an increased risk of stillbirth. In our study, the risk appears to be mainly concentrated in the subgroup of explained stillbirths. However, there are sufficient inconsistencies in the developing literature about stillbirth risk that further research is needed.

  8. [Trends in caesarean section rates and places of delivery in Burkina Faso].

    Science.gov (United States)

    Sombié, Issiaka; Clément Méda, Ziemlé; Léon Savadogo, Gueswendé Blaise; Sanou, Gwladys; Dadjoari, Moussa

    2017-03-06

    Objective: The objective of this study was to evaluate the trends, mortality rates and places of caesarean section by level of care in Burkina Faso.Method: A retrospective study was conducted using data from Burkina Faso Ministry of Health annual health statistics and public hospital reports from 2000 to 2014. Linear regression was used to analyse caesarean section trends and mortality rates in District Hospitals (HD), Regional Hospitals (CHR) and University Hospitals (CHU).Results: From 2000 to 2014, the number of caesarean sections performed in Burkina Faso public hospitals increased almost tenfold from approximately 2,365 to 19,081, corresponding to a growth of the caesarean section rate from 0.5 to 2 per 100 deliveries. This growth was linear. Between 2000 and 2006, University Hospitals performed most of these caesarean sections. Starting from 2007, the majority of caesarean sections were performed by HD. The proportion of caesarean sections performed in Regional Hospitals remained almost constant, although the number of caesarean sections increased threefold. In 2014, HD performed 52% of caesarean sections, followed by University Hospitals (25%) and Regional Hospitals (23%). Analysis of mortality rates following caesarean section showed upward and downward trends, oscillating between 1 to 2% before 2008 and 0.15% in 2014. This same mortality trend was observed in each type of hospital.Conclusion: The results show an increase of better quality caesarean section rates, performed closer to the woman’s home in Burkina Faso. The health care services decentralization policy and quality of care approaches have helped to achieve these results.

  9. Effect of excessive gestational weight gain on trial of labour after caesarean: A retrospective cohort study.

    Science.gov (United States)

    McDonald, Anna C E; Wise, Michelle R; Thompson, John M

    2018-02-01

    Counselling women for and managing birth after caesarean section are important. Research is needed on evaluation of antenatal factors that predict likelihood of successful trial of labour after caesarean section (TOLAC). To evaluate the effect of gestational weight gain on mode of delivery in women having TOLAC. A retrospective cohort study of eligible women who underwent TOLAC (January 2012 to July 2015) at a large urban hospital. Gestational weight gain was classified as 'excessive' or 'not excessive' based on calculated pre-pregnancy body mass index. Multivariable logistic regression analysis was performed to estimate the association of gestational weight gain and vaginal birth, adjusting for socio-demographic and pregnancy-related factors. Of 534 women, those who gained excessive weight were less likely to have a vaginal birth as women who did not (adjusted odds ratio (aOR) 0.48, 95% confidence interval (CI) 0.29-0.81)). Women with previous vaginal birth were more likely to have a vaginal birth (aOR 3.74, 95% CI 1.90-7.36), while women ≥35, women who had an epidural, and women who delivered at 40 weeks, were less likely (aOR 0.58, 95% CI 0.35-0.97, aOR 0.12, 95% CI 0.07-0.22, and aOR 0.53, 95% CI 0.31-0.91, respectively). Gaining excessive weight in pregnancy is potentially modifiable, and can be incorporated into individual antenatal counselling, and into risk prediction models, to assist with informed decision making around planned mode of delivery in women with previous caesarean section. Future research could focus on interventions to reduce gestational weight gain in women planning TOLAC. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  11. Caesarean section and subsequent ectopic pregnancy: a systematic review and meta-analysis

    NARCIS (Netherlands)

    O'Neill, S.M.; Khashan, A.S.; Kenny, L.C.; Greene, R.A.; Henriksen, T.B.; Lutomski, J.E.; Kearney, P.M.

    2013-01-01

    BACKGROUND: Caesarean section rates are increasing worldwide, and the long-term effects are unknown. OBJECTIVE: To evaluate the risk of subsequent ectopic pregnancy in women with a previous caesarean section, compared with vaginal delivery. SEARCH STRATEGY: Systematic review of the literature using

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

    African Journals Online (AJOL)

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

  13. 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.

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

    NARCIS (Netherlands)

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

    Background: Caesarean section might be a risk factor for asthma because of delayed microbial colonisation, but the association remains controversial. A study was undertaken to investigate prospectively whether children born by caesarean section are more at risk of having asthma in childhood and

  15. [Anaesthesia for canine caesarean section - an evidence-based approach].

    Science.gov (United States)

    Alef, Michaele

    2017-02-09

    In recent years, several new studies on anaesthesia for caesarean section have been published. This paper refers to these and ground-breaking research on risk factors affecting the puppies. Based on the available evidence, a recommendation for an anaesthetic procedure is given and in addition, alternatives are discussed. Induction with propofol or alfaxalone and maintenance by inhalation anaesthesia appears to be the method with the least risk. Intraoperatively, an adequate and low-risk analgesia is achieved by an epidural anaesthesia. Opioids allow an adequate maternal pain management after delivery of the puppies as well as postoperatively. A stabilisation of the dam before induction and an optimised oxygen supply are additional basal requirements.

  16. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    DEFF Research Database (Denmark)

    Kristensen, Kim; Fisker, Niels; Haerskjold, Ann

    2015-01-01

    BACKGROUND AND OBJECTIVE:: Hospitalization for respiratory syncytial virus (RSV) infection and asthma share common determinants, and meta-analyses indicate that children delivered by caesarean section (CS) are at increased risk of asthma. We aimed to investigate whether birth by CS is associated...... regression with adjustment for prematurity, asphyxia, birth weight, multiple births, single parenthood, maternal smoking during pregnancy, older siblings, and asthma diagnoses up to 2 weeks before hospitalization for RSV infection, to compare the effects of acute or elective CS versus vaginal delivery...... infection in children born by acute CS and by elective CS were 1.09 (1.01 - 1.17) and 1.27 (1.19 - 1.36), respectively. The effect of elective CS remained unchanged throughout the first two years of life (p = 0.53), whereas the effect of acute CS was only present in the second year of life (p = 0...

  17. [Emergency caesarean section for a patient with chronic schizophrenia].

    Science.gov (United States)

    Kudoh, A; Sakai, T; Ishihara, H; Matsuki, A

    1994-09-01

    A 39-year-old female with chronic schizophrenia underwent an emergency caesarean section under general anesthesia at her 39th week of gestation. A diagnosis of schizophrenia was made at 28 years of age and since then oral antipsychotic drugs, haloperidol and levomepromazine had been given orally. She had only taken haloperidol 4 mg per day between the 12th week of gestation and the day of surgery. At the 39th week of gestation, she developed a marked excitement which would have caused fetal distress. We decided to terminate her gestation. As the excitement was diagnosed as psychokinesis, we avoided using phenothiazine which might affect fetus and administered haloperidol 5 mg intramuscularly 210 and 30 minutes before emergency caesarean section. Anesthesia was induced with intravenous thiopental 300 mg and suxamethonium 60 mg. Pentazocine 30 mg in combination with nitrous oxide 70% in oxygen was given for the maintenance of anesthesia. During operation blood pressure was 160-180/80-90 mmHg, the heart rate was 90-100 beats.min-1. Hypertension and tachycardia might have been partially due to preoperative haloperidol. The induction-delivery time was 4 minutes 30 seconds. Plasma haloperidol levels were 23.8 ng.ml-1 in maternal venous blood and 8.8 ng.ml-1 in umbilical vein just after the delivery. The Apgar score was 7 at one minute and 8 at five minutes after delivery. The baby developed slight muscle weakness and poor sucking for two days after delivery and this was supposedly due to effect of preoperative haloperidol.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. 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.

  19. 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......) 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. CONCLUSION: Emergency caesarean section was not associated with childhood asthma. FUNDING: none. TRIAL REGISTRATION: not relevant....

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

    Directory of Open Access Journals (Sweden)

    Thulasi

    2016-04-01

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

  1. Googling caesarean section: a survey on the quality of the information available on the Internet.

    Science.gov (United States)

    Fioretti, B T S; Reiter, M; Betrán, A P; Torloni, M R

    2015-04-01

    To examine the quality and completeness of information on caesarean section in web pages used by laypersons in Brazil, a country with very high rates of caesarean delivery. Cross-sectional study. Brazil. A total of 176 Internet websites. The term 'caesarean delivery' and 25 synonyms were entered into the most popular search engines in Brazil. The first three pages of hits were downloaded and assessed by two independent investigators using the DISCERN instrument and a content checklist. Quality and completeness of information on caesarean section. A total of 3900 web pages were retrieved and 176 fulfilled the selection criteria. The overall average DISCERN score was 43.6 (±8.9 SD), of a maximum score of 75; 30% of the pages were of poor or very poor quality and 47% were of moderate quality. Most pages scored low, especially in questions related to reliability of the information. The most frequently covered topics were: indications for caesarean section (80% of websites), which did not reflect clinical practice; short-term maternal risks (80%); and potential benefits of caesarean section (56%), including maternal and doctor convenience. Less than half of the websites mentioned perinatal risks and less than one-third mentioned long-term maternal risks associated with caesarean section, such as uterine rupture (17%) or placenta praevia/accreta (12%) in future pregnancies. The quality and completeness of web-based resources in Portuguese about caesarean section were poor to moderate. Pending improvement of these resources, obstetricians should warn pregnant women about these facts and encourage them to discuss what they have read on the Internet about caesarean section. The quality and completeness of information about caesareans is poor in 176 websites used by Brazilians. © 2014 Royal College of Obstetricians and Gynaecologists.

  2. A STUDY OF SHORT AND LONG TERM MORBIDITIES FOLLOWING CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Shailaja L

    2017-01-01

    Full Text Available BACKGROUND During the past few decades, the worldwide incidence of Caesarean births has increased markedly. The current range is around 40% of all deliveries. A study of long and short term morbidities following caesarean will create awareness on these adverse outcomes so that efforts can be taken to reduce the high rates of caesarean section. AIM Aim of the study was to assess the short-term and long term morbidities associated with caesarean sections and compare with that of vaginal deliveries. MATERIALS AND METHODS This is a prospective study conducted for 1 year in SATH hospital, Govt. Medical College Trivandrum, a tertiary care center. Women delivered at SATH hospital during this period were included in the study. Sample size calculated as 500 in each group. Of the total 1000 cases studied, 500 cases were caesarean sections, and 500 vaginal deliveries. They were followed up during labour, in the postpartum period, 6 weeks, 6 months and 1 year from the time of delivery and the morbidities were studied. Statistical tests used were mean, percentage, chi square and Fischer’s exact test to assess association of the selected parameters with the type of delivery. RESULTS Majority of caesarean sections (73.4% were emergency. Previous caesarean section (53.6% was the leading indication. Intra operative morbidities like excessive blood loss had significant association with caesarean section. 3.2% in the caesarean group required blood transfusion compared to 1% in vaginal delivery group. Intraoperative complications like broad ligament hematoma, adhesions and bladder injury and anaesthesia complications were present in 7% of cases. Short term morbidities like fever, urinary retention, sepsis were significantly more in the caesarean group (9.2% versus 0.8% in vaginal deliveries. Occurrence of Severe Acute Maternal Morbidity following caesarean section was 0.2-2%. Caesarean section group had longer duration of hospital stay. Long term morbidities like

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

    African Journals Online (AJOL)

    Background: There is an increasing trend in the rate of caesarean section worldwide and this has become a major cause of concern to obstetricians. Despite the increasing safety of anesthesia and surgical technique, caesarean delivery accounts for more maternal morbidity and mortality compared to a normal vaginal ...

  4. 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

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

    Directory of Open Access Journals (Sweden)

    Yibeltal T. Bayou

    2016-03-01

    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.

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

    Science.gov (United States)

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

    2015-08-19

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

  7. 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.

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

    Science.gov (United States)

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

    2013-07-01

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

  9. [Caesarean section by vertical incision of lower uterine segment].

    Science.gov (United States)

    Nikolov, A; Nashar, S; Jankova, Ja; Jarukova, N; Dimitrov, A

    2009-01-01

    The aim of the study is to analyze the use of vertical incision of the lower uterine segment when performing Caesarean section (CS). The study includes 89 pregnant women who delivered by CS. The main group includes 40 cases with vertical incision in lower uterine segment (preliminary intention, but final decision made during surgery) and controls--49 cases with transversal incision of lower uterus segment with difficulties/complications of fetus extraction (30 with uterine lacerations and 19 with T-form incision). The mean gestational age in the main group is 32 g.w. (range 26-39) vs. 31 in control group (27-39). RESULTS. Vertical incision of the uterus is performed in 57.5% due to prematurity and lack of enough space for transversal incision (lower uterine segment not yet formed), in 25 % the cause is situs transverses of the foetus and the rest of the cases are related with technical difficulties in isthmicotransversal approach (myoma praevia, anomalies of the uterus, adhesions of the omentum). C.S. is performed for mean 66 min. in the main group vs. 74 min. with controls (p uterus. Blood loss in main group is 664 ml, vs. 884 ml in control group (p trauma with better final outcome for the newborn.

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

    Science.gov (United States)

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

    2016-08-01

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

  11. Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System.

    Directory of Open Access Journals (Sweden)

    Vilma Tapia

    Full Text Available Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time.Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification.The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001 was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour, 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy and 7 (multiparas with a single breech pregnancy with or without previous scars showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17-1.72; OR 3.53, CI95% 2.95-4.2 and maternal mortality (OR

  12. CAUSES OF INEFFICIENT UTERINE SCARRING AFTER CAESAREAN SECTION AND METHODS OF ITS PREVENTION

    OpenAIRE

    N. A. Shchukina; E. I. Blagina; I. V. Barinova

    2015-01-01

    Increased interest of investigators to the problem of post-caesarean uterine scar is to be explained by changes of obstetric strategies towards significant rise of surgical delivery rates. At present, every fourth pregnant woman in the world delivers by caesarean section. Presence of a uterine scar is often seen as an “automatic” indication to repeat caesarean section, which is associated with 3 to 4-fold higher rate of complications compared to natural deliveries. It is because of this fact ...

  13. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014

    National Research Council Canada - National Science Library

    Betrán, Ana Pilar; Ye, Jianfeng; Moller, Anne-Beth; Zhang, Jun; Gülmezoglu, A Metin; Torloni, Maria Regina

    2016-01-01

    Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs...

  14. 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.

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

    OpenAIRE

    Torloni, Maria Regina; 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 Article...

  16. Management of failed spinal anaesthesia for caesarean section

    Directory of Open Access Journals (Sweden)

    Gavin Wyndham Jones

    2017-07-01

    Full Text Available Background. Failed spinal anaesthesia for caesarean section (CS may be partial or complete and the subsequent discomfort is the most commonly cited cause of litigation in obstetric anaesthesia. Objectives. To determine if there is a standardised approach to: (i testing the level of block of spinal anaesthesia; and (ii the management of failed spinal anaesthesia for CS. Methods. A structured questionnaire to ascertain the current practice of testing the level of block and management of three different scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA. All obstetric anaes­thetic service providers, ranging from interns to specialist anaesthetists, were invited to complete the questionnaire. Results. A total of 375 responses were received from 42 of the 51 hospitals surveyed. Specialist anaesthetists managed failure of spinal anaesthesia significantly differently than other anaesthetic service providers. Specialists were more likely to convert to a general anaesthetic (GA, while others were more likely to repeat spinal anaesthesia or administer intravenous ketamine, midazolam and opioids. Only 212 respondents (56% tested the level of block and there was no difference between the groups with regard to the method of assessment of height (p=0.15. Non-specialists, however, accepted a significantly lower level of block, using pinprick, than specialists (p=0.027, which could lead to a higher failure rate. More than one-third of non-specialists did not consider themselves competent to perform a GA and >90% of respondents agreed that a ‘failed’ spinal algorithm would be useful. Conclusion. There is a need for standardised assessment of the adequacy of spinal anaesthesia for CS in SA, as well as a failed spinal algorithm.

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

    African Journals Online (AJOL)

    McRoy

    2014-03-30

    Mar 30, 2014 ... reproductive function of a woman, with 106 (41.7%) citing destiny as reason for caesarean delivery. Most, 226 (89.0%) ... future especially with the increasing penchant for smaller family sizes among the urban educated elites. ... functional teaching hospital in north eastern. Nigeria while the latter is the only ...

  18. Should women be able to choose caesarean section?

    African Journals Online (AJOL)

    2006-04-26

    Apr 26, 2006 ... are emergencies, but an increasing number are due to patient request. It may sometimes be difficult to distinguish these, as the reason stated in the notes may appear to be a medical one, but in reality the staff may have granted a woman's request for a caesarean by simply lowering the medical threshold at ...

  19. 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.

  20. CAUSES OF INEFFICIENT UTERINE SCARRING AFTER CAESAREAN SECTION AND METHODS OF ITS PREVENTION

    Directory of Open Access Journals (Sweden)

    N. A. Shchukina

    2015-01-01

    Full Text Available Increased interest of investigators to the problem of post-caesarean uterine scar is to be explained by changes of obstetric strategies towards significant rise of surgical delivery rates. At present, every fourth pregnant woman in the world delivers by caesarean section. Presence of a uterine scar is often seen as an “automatic” indication to repeat caesarean section, which is associated with 3 to 4-fold higher rate of complications compared to natural deliveries. It is because of this fact that the problem of quality of reparation of post-caesarean uterine scars is becoming more and more of importance. The review presents data from literature on issues of delivery after a caesarean section. The analysis has shown ambiguity and deficiency of evidence on inefficient uterine scarring after caesarean section that necessitates further research in this field.

  1. Mode of delivery among Swedish midwives and obstetricians and their attitudes towards caesarean section.

    Science.gov (United States)

    Sahlin, Maria; Andolf, Ellika; Edman, Gunnar; Wiklund, Ingela

    2017-03-01

    A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery. The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated. Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses. The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred. No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement "the proportion of caesarean section is too

  2. 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.

  3. Methods of term labour induction for women with a previous caesarean section.

    Science.gov (United States)

    West, Helen M; Jozwiak, Marta; Dodd, Jodie M

    2017-06-09

    Women with a prior caesarean delivery have an increased risk of uterine rupture and for women subsequently requiring induction of labour it is unclear which method is preferable to avoid adverse outcomes. This is an update of a review that was published in 2013. To assess the benefits and harms associated with different methods used to induce labour in women who have had a previous caesarean birth. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2016) and reference lists of retrieved studies. Randomised controlled trials (RCTs) comparing any method of third trimester cervical ripening or labour induction, with placebo/no treatment or other methods in women with prior caesarean section requiring labour induction in a subsequent pregnancy. Two review authors independently assessed studies for inclusion and trial quality, extracted data, and checked them for accuracy. Eight studies (data from 707 women and babies) are included in this updated review. Meta-analysis was not possible because studies compared different methods of labour induction. All included studies had at least one design limitation (i.e. lack of blinding, sample attrition, other bias, or reporting bias). One study stopped prematurely due to safety concerns. Vaginal PGE2 versus intravenous oxytocin (one trial, 42 women): no clear differences for caesarean section (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.22 to 2.03, evidence graded low), serious neonatal morbidity or perinatal death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low), serious maternal morbidity or death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low). Also no clear differences between groups for the reported secondary outcomes. The GRADE outcomes vaginal delivery not achieved within 24 hours, and uterine hyperstimulation with fetal heart rate changes were not reported. Vaginal misoprostol versus intravenous oxytocin (one trial, 38 women): this trial stopped early because one woman who

  4. Factors associated with caesarean sections in Phnom Penh, Cambodia.

    Science.gov (United States)

    Schantz, Clémence; Sim, Kruy Leang; Petit, Véronique; Rany, Heng; Goyet, Sophie

    2016-11-01

    C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the over-usage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Vaginal delivery after previous caesarean section for failure of second stage of labour.

    Science.gov (United States)

    Jongen, V H; Halfwerk, M G; Brouwer, W K

    1998-10-01

    To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery. Retrospective follow up study. Medical Centre Leeuwarden, The Netherlands. All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 19861998. Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour. Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour. In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.

  6. Why do women request caesarean section in a normal, healthy first pregnancy?

    Science.gov (United States)

    Fenwick, Jennifer; Staff, Lynne; Gamble, Jenny; Creedy, Debra K; Bayes, Sara

    2010-08-01

    a growing number of childbearing women are reported to prefer a caesarean section in the absence of a medical reason. Qualitative research describing factors influencing this preference in pregnant women is lacking. to describe Australian women's request for caesarean section in the absence of medical indicators in their first pregnancy. advertisements were placed in local newspapers inviting women to participate in a telephone interview exploring women's experience of caesarean section. Thematic analysis was used to analyse data. two states of Australia: Queensland and Western Australia. a community sample of women (n=210) responded to the advertisements. This paper presents the findings elicited from interviews conducted with 14 women who requested a caesarean section during their first pregnancy in the absence of a known medical indication. childbirth fear, issues of control and safety, and a devaluing of the female body and birth process were the main themes underpinning women's requests for a non-medically-indicated caesarean section. Women perceived that medical discourses supported and reinforced their decision as a 'safe' and 'responsible' choice. KEY CONCLUSIONS AND RECOMMENDATIONS FOR PRACTICE: these findings assist women and health professionals to better understand how childbirth can be constructed as a fearful event. In light of the evidence about the risks associated with surgical birth, health-care professionals need to explore these perceptions with women and develop strategies to promote women's confidence and competence in their ability to give birth naturally. Copyright 2008 Elsevier Ltd. All rights reserved.

  7. 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.

  8. The contribution of anaesthesia modus on reducing blood loss during caesarean section.

    Science.gov (United States)

    Liberis, V; Tsikouras, P; Vogiatzaki, T; Savidis, A; Ammari, A; Iatrou, Ch; Maroulis, G

    2009-01-01

    The purpose of this study was to compare the effects of general anaesthesia (GA) and regional anaesthesia (RA) on the blood loss during caesarean section. We report on 161 patients undergoing both elective and emergency caesarean section at the Obstetrical Department of Democritus University of Thrace. In the majority (113 women, 70.2%) GA was used, while in 48 women (29.8%) RA was used. No significant differences were found in the demographic characteristics of the study women in the two groups. Although the preoperative Hgb and Hct levels did not differ significantly in the two groups RA vs GA, the postoperative Hgb and Hct levels were significantly lower in women who were subjected to GA compared to those who were subjected to RA (p < 0.05). The study showed that there is greater reduction in blood loss with RA compared to GA during caesarean section.

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

    LENUS (Irish Health Repository)

    Khalifeh, A

    2012-02-01

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

  10. multi variate analysis of risk factors for caesarean section in the ...

    African Journals Online (AJOL)

    section rate at a teaching hospital. Method: Retrospective analysis of the made of delivery within a 5 year period as contained in patients' medical records using frequency distribution and cross tabulations of the risk factor. Logistic regression analysis was used to determine the predictors of. Caesarean section.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    H. Virgin, MD

    2016-01-01

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

  13. 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

    ) 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...

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  15. 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

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

    African Journals Online (AJOL)

    2010-03-16

    Mar 16, 2010 ... In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under ... Pregnancy by itself is associated with physiological ..... 16. Ellison J, Thomson AJ, Walker ID, Greer IA. Thrombocytopenia and leucopenia precipitated by pregnancy in a woman with myasthenia gravis.

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

    Directory of Open Access Journals (Sweden)

    Sushma KS

    2015-08-01

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

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

    African Journals Online (AJOL)

    Nicky

    2005-06-14

    Jun 14, 2005 ... Caesarean section (CS) is a very common surgical procedure worldwide. Suturing the peritoneal layers ... trend for analgesia requirement and wound infection tended to favour non-closure, while endometritis results were variable. ... operative procedures, assessment of trial quality was limited to allocation ...

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    African Journals Online (AJOL)

    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 caesarean section rate may not be applicable in these regions with an already low coverage, emphasis should be on adequate birth spacing and ...

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

    2009-10-05

    Oct 5, 2009 ... presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of ...

  3. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran.

    Science.gov (United States)

    Faisal, I; Matinnia, N; Hejar, A R; Khodakarami, Z

    2014-02-01

    to gain a deeper understanding of why Iranian primigravidae request caesarean section without any medical indication. qualitative study. Data were gathered through semi-structured interviews, and thematic analysis was undertaken. four health care centres at Hamadan University of Medical Sciences, Hamadan, Iran. 14 primigravidae who requested caesarean section without any medical indication. reasons for requesting caesarean section were related to fear of childbirth (labour pain, injury to mother or infant), complications after vaginal delivery (vaginal prolapse, urinary incontinence, sexual dysfunction), trust in obstetricians, and lack of trust in maternity ward staff. the main reasons given for requesting caesarean section show that there is urgent need for effective antenatal assessment to enable pregnant women to ask questions and express their concerns. In order to promote vaginal birth, there is a need to develop antenatal education and strategies to enhance women's knowledge, confidence and competence about vaginal birth. Health care providers should be re-educated about the observance of medical ethics and professional rules in their practices, and change their attitudes and behaviours to vaginal birth. Evaluation, improvement and change in maternity care policies are recommended to promote natural childbirth. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    I. J. J. Dons-Sinke

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Zaman Shakila

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gayatri Desai

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

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

    Science.gov (United States)

    Desai, Gayatri; Anand, Ankit; Modi, Dhiren; Shah, Shobha; Shah, Kalpana; Shah, Ajay; Desai, Shrey; Shah, Pankaj

    2017-01-01

    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.

  10. Measuring the course of anxiety in women giving birth by caesarean section: a prospective study.

    Science.gov (United States)

    Hepp, Philip; Hagenbeck, Carsten; Burghardt, Bettina; Jaeger, Bernadette; Wolf, Oliver T; Fehm, Tanja; Schaal, Nora K

    2016-05-18

    Women undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies. This is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery). Peak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure (p anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation (p-values anxiety. The study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.

  11. Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis.

    Science.gov (United States)

    Hua, J; Chen, G; Xing, F; Scott, M; Li, Q

    2013-04-01

    The efficacy of misoprostol versus oxytocin for reducing blood loss during caesarean section remains unclear. To conduct a meta-analysis comparing the efficacy of misoprostol with that of oxytocin in reducing blood loss during caesarean section. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov for randomised controlled trials (RCTs) using the keywords 'misoprostol', 'oxytocin' and 'caesarean section'. Refereed publications examining the efficacy of misoprostol and oxytocin for reducing blood loss during caesarean section. Two of the authors independently abstracted data from original articles. A fixed-effects or random-effects model was used, depending on the heterogeneity of the data, to estimate the risk ratio (RR), risk difference (RD) or weighted mean difference (WMD) with 95% confidence intervals (95% CIs). A total of 646 pregnant women were included in this analysis. There was a significant difference in estimated blood loss between the misoprostol and the oxytocin groups (WMD-64.09; 95% CI-119.86--8.31). However, differences in haemoglobin levels (WMD-0.04; 95% CI-0.18-0.10), additional oxytocic therapy requirements (RD .03; 95% CI -0.04-0.10) and blood transfusion requirements (RD 0.00; 95% CI-0.03-0.02) between the two groups failed to reach statistical significance. The incidence of postoperative shivering/pyrexia was significantly higher in the misoprostol group, compared with the oxytocin group (RR 3.23; 95% CI 1.41-7.39). The results suggest that misoprostol is as effective as oxytocin for reducing blood loss during caesarean section. However, further research into treatment strategies is needed. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

  12. Caesarean section in the absence of need: a pathologising paradox for public health?

    Science.gov (United States)

    Douché, Jeanie; Carryer, Jenny

    2011-06-01

    Caesarean section in the absence of need: a pathologising paradox for public health? This qualitative study explored the discourses constructing women's choice for a caesarean section, in the absence of clinical indication. The research was informed from the theoretical ideas of poststructuralism that presumes people's reality is shaped discursively through the discourses they encounter. A Foucauldian discourse analysis was undertaken of the transcripts of participant's interviews and the texts of both professional and popular media before inductively discerning the prevailing discourses that influence the choice of caesarean in the absence of need. In shaping women's choice in childbirth the discourses of autonomy, convenience and desire alongside fear and risk were identified in the talk and texts of women, childbirth professionals and popular culture. For the purposes of this article we have confined our focus to the findings related to how caesarean is represented in both professional and popular discourse and include feminist discussions around childbirth as an embodied practice. We contend that the discourses of autonomy, desire and risk unite with broader societal discourses to expose a pathologising paradox in which normal bodily performance emerges as abnormal and the abnormal as normal. The trend has implications for both future healthy populations and the equitable distribution of maternity resources. © 2011 Blackwell Publishing Ltd.

  13. Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

    OpenAIRE

    Shweta Pravin Mhambrey; Shital S. Ahire; Sambharan Nayak

    2016-01-01

    Background: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 and micro;g and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5% hyperbaric bupivacaine for caesarean section. Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under s...

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

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

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

  15. Vaginal delivery under caudal analgesia after caesarean section and other major uterine surgery.

    Science.gov (United States)

    Meehan, F P; Moolgaoker, A S; Stallworthy, J

    1972-06-24

    In the absence of a recurring indication for caesarean section vaginal delivery in subsequent pregnancy is a "trial of scar," with potentially serious implications for mother and baby. Labour under caudal analgesia was carefully supervised for 75 women with a surgically scarred uterus-due to lower segment section in 72, abdominal hysterotomy in one, and transcavity myomectomy in two. Every caesarean scar was assessed digitally during labour and every uterus was examined after delivery. Caudal analgesia provided a painless labour and delivery and made scar assessment easy. Controlled intravenous Syntocinon infusion was given to 25 patients. One scar dehiscence occurred early in labour and one in the second stage. Seventy mothers had 71 vaginal deliveries with one pair of twins and one breech. There was one stillbirth and no neonatal death. There were five repeat sections.

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

    Directory of Open Access Journals (Sweden)

    El-Khoury Marianne

    2012-08-01

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

  17. Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women.

    Science.gov (United States)

    Chen, Mei-Man; McKellar, Lois; Pincombe, Jan

    2017-04-01

    Vaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean. This study explored factors affecting Taiwanese women's decisionmaking regarding vaginal birth after cesarean. Ajzen's Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis' method of thematic analysis was used to identify themes and codes. This paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women's decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women's decisions: 'past experience of childbirth', 'anticipating the next experience of normal birth' and 'contemplation on the process of childbirth'. Women who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. Newborn outcomes in british columbia after caesarean section for non-reassuring fetal status.

    Science.gov (United States)

    Jenniskens, Kevin; Janssen, Patricia A

    2015-03-01

    To assess the incidence in British Columbia of severe morbidity in neonates delivered by Caesarean section for non-reassuring fetal status, and to examine the accuracy of Apgar score and umbilical cord gas values in predicting severe neonatal morbidity. We assessed rates of hypoxic ischemic encephalopathy, NICU admission, and ventilator days, individually and as a composite outcome with neonatal death, among a total of 8466 term singletons delivered by Caesarean section for non-reassuring fetal status between January 1, 2007, and December 31, 2011. We calculated the predictive accuracy of Apgar scores and umbilical cord blood gas values using the area under the receiver operating characteristic (ROC) curve and the sensitivity and specificity for each outcome. The incidence of Apgar score at one minute fetal status. Apgar score at one minute Electronic fetal monitoring remains a non-specific method for detection of fetal compromise in the intrapartum period.

  19. The death of Isabella Della Volpe: four eyewitness accounts of a postmortem caesarean section in 1545.

    Science.gov (United States)

    Park, Katharine

    2008-01-01

    This article provides a transcription and translation of four notarized declarations describing the events surrounding a postmortem caesarean section performed in 1545 in Vercelli, a small city in the Duchy of Savoy. After her death in the late stages of pregnancy, Isabella della Volpe's body was opened and her fetus excised by a local barber, aided by a surgeon and a midwife. The article argues that the postmortem caesarean section was a well-known and widely accepted procedure and that it might be motivated by financial and legal as well as religious concerns; not only was it important to baptize the child for its salvation, but the fate of the mother's dowry, as in this case, might depend on whether she died with or without living issue.

  20. Foetal salvage by Caesarean section in a case of maternal burn injury.

    Science.gov (United States)

    Banerjee, Tibar; Karmakar, Anirvan; Adhikari, Souvik

    2012-11-01

    Burn injury sustained during pregnancy is a serious clinical complication that requires individualisation of management. We describe the case of a 30-week pregnant woman who presented to the hospital in a state of shock with approximately 90% burn injuries. Resuscitation was carried out, and the patient's family consented to an emergency Caesarean section in view of the grave prognosis of such burn injuries. A live male infant was delivered via emergency Caesarean section. However, the mother succumbed to her injuries two days after the operation, while the baby was successfully resuscitated and discharged after ten days. This case highlights the importance of timely decision-making and coordination, which are required to salvage a near-term foetus. It also underscores that emergent resuscitation and timely operative procedures might be able to salvage a living foetus, particularly in patients with burns covering more than 60% of total body surface area.

  1. Ceftriaxone versus ampicillin/cloxacillin as antibiotic prophylaxis in elective caesarean section.

    Science.gov (United States)

    Ahmed, E-T S; Mirghani, O A; Gerais, A S; Adam, I

    2004-05-01

    We carried out a prospective, randomized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone (single dose) or ampicillin/cloxacillin (3 doses) intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis (P = 0.34), wound infection (P = 0.44), or other febrile morbidity (P = 0.5). Eleven babies had a low Apgar score (cloxacillin group (P = 0.82). There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer.

  2. Does caesarean section delivery improve neurological outcome in open spina bifida?

    Science.gov (United States)

    Hill, A E; Beattie, F

    1994-12-01

    The antenatal diagnosis of fetuses with myelomeningocele (MMC) has focused the attention of those involved in the perinatal care on caesarean section delivery as a possible method of preserving neurological function. In this paper 25 infants with MMC were studied, 10 delivered by pre-labour caesarean section (PL C/S), and 15 by other methods. No difference in motor function was observed post natally with 50% of each group having neurological levels below L3. The PL C/S group was more heterogeneous. The feasibility of selecting a group of less impaired fetuses with good in utero leg movements for PL C/S in order to preserve neurological function depends on the ability of fetal USS to predict post natal neurological function. This preliminary report leaves unanswered the question whether C/S delivery improves neurological outcome in selected cases of open spina bifida.

  3. 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.

  4. 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...... 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....

  5. A COMPARISON OF SPINAL ANAESTHESIA WITH LEVOBUPIVACAINE AND HYPERBARIC BUPIVACAINE COMBINED WITH FENTANYL IN CAESAREAN SECTION

    OpenAIRE

    Kurmanadh Kalepalli

    2016-01-01

    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 ...

  6. 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.

  7. Rationalised limitation of labour inductions reverses a rising trend of caesarean section rate

    OpenAIRE

    Mesens, Tinne; Van Holsbeke, C.; Kerkhofs, C; C. de Bruyn; Gyselaers, Wilfried

    2013-01-01

    Because of a rising trend of caesarean section (CS) rate in Ziekenhuis Oost Limburg (ZOL) in Genk Belgium, an audit was performed in 2007 using the Robson classification in 10 groups (Table 1). After this, labour induction in term cephalic singleton pregnancies was identified as the most important responsible factor of the rise in CS rate. In 2008, a rationalised change of labour management was introduced by concentrating on the correct diagnosis of labour and reducing non-medical inductions ...

  8. Effect and placental transfer of dexmedetomidine during caesarean section under epidural anaesthesia

    Science.gov (United States)

    Wang, Changsheng; Liu, Shijiang; Han, Chuanbao; Yu, Min; Hu, Youli

    2017-01-01

    Objective To investigate the neonatal effect and placental transfer of dexmedetomidine during caesarean section under epidural anaesthesia. Methods Forty parturients with a single newborn who were scheduled for caesarean section were enrolled. Patients received 0.5 µg/kg dexmedetomidine 10 min after epidural anaesthesia, followed by 0.5 µg/kg/h until abdominal closure (Dex group) or infusion of normal saline (NS group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were monitored before infusion (T0), 10 min after infusion (T1), at delivery (T2), and at the end of the operation (T3). Umbilical vein and artery blood was collected. Apgar scores were evaluated at 1 and 5 min after delivery. Results SBP, DBP, and HR in the Dex group were decreased at T3 compared with T0 (116 ± 10.4 vs 111 ± 9.2 mmHg, 74 ± 6.7 vs 66 ± 7.9 mmHg, 91 ± 12.1 vs 71 ± 8.4 beats/min, respectively, P  0.05). Conclusion Dexmedetomidine during caesarean section under epidural anaesthesia is beneficial to parturients. The placental transfer rate is 0.68. PMID:28449631

  9. The effects of a resistive warming mattress during caesarean section: a randomised, controlled trial.

    Science.gov (United States)

    Chakladar, A; Dixon, M J; Crook, D; Harper, C M

    2014-11-01

    The adverse effects of inadvertent perioperative hypothermia in the surgical population are well established. The aim of this study was to investigate whether a resistive warming mattress would reduce the incidence of inadvertent perioperative hypothermia in patients undergoing elective caesarean section. A total of 116 pregnant women booked for elective caesarean section were randomised to either intraoperative warming with a mattress or control. The primary outcome was the incidence of inadvertent perioperative hypothermia, defined as a temperature warmed group was significantly lower than in the control group (5.2% vs. 19.0%, P=0.043); mean temperatures differed between the two groups, 36.5 °C and 36.3 °C, respectively (P=0.046). There was also a significantly lower mean (± SD) haemoglobin change in the mattress-warmed group at -1.1±0.9 g/dL versus -1.6±0.9 g/dL in the control group (P=0.007). There was no difference in shivering (P=0.798). A resistive warming mattress reduced the incidence of inadvertent perioperative hypothermia and attenuated the fall in haemoglobin. The use of resistive mattress warming should be considered during caesarean section. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Intravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis.

    Science.gov (United States)

    Heesen, M; Böhmer, J; Brinck, E C V; Kontinen, V K; Klöhr, S; Rossaint, R; Straube, S

    2015-04-01

    Intravenous ketamine has been used during general and regional anaesthesia for caesarean section. No systematic review and meta-analysis on the desired effects and adverse effects of ketamine administration during caesarean section have yet been performed. After a systematic literature search a meta-analysis was conducted with the random effects model. Weighted mean difference (WMD) or risk ratio and 95% confidence intervals (CIs) were computed. Twelve randomised controlled double-blind trials comprising 953 patients were included: seven studies reported on spinal anaesthesia and five on general anaesthesia. Significant differences in the aforementioned outcome variables were found only in the spinal anaesthesia studies. In the spinal anaesthesia studies the time to the first analgesic request was significantly longer in ketamine-treated women, the WMD was 49.36 min (95% CI 43.31-55.41); visual analogue scale pain scores at rest 2 h after surgery were significantly lower. No differences were observed for maternal nausea, vomiting, pruritus, and psychomimetic effects. Only few data were found for neonatal outcomes. We conclude that ketamine enhances post-operative analgesia after caesarean section under spinal anaesthesia. There is a paucity of data for several maternal adverse effects as well as for neonatal well-being. Further studies are needed for general anaesthesia. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section.

    Science.gov (United States)

    Hobson, J A; Slade, P; Wrench, I J; Power, L

    2006-01-01

    The primary aim was to investigate whether preoperative anxiety in women undergoing elective caesarean section predicts postoperative maternal satisfaction with the process, perceptions of recovery, analgesic use or length of hospital stay. Other factors that might influence postoperative satisfaction were also explored. In 85 women awaiting elective caesarean section, anxiety, social support and aspects of preparation were measured in the 24 hours preceding surgery. Maternal satisfaction and perceptions of recovery were assessed around the third postoperative day. Satisfaction with the preoperative information from the anaesthetist and postoperative pain relief were also measured at this time. Medical notes were used to gather information on analgesia use and length of hospital stay. Preoperative anxiety scores were comparable with those of general surgical/medical patients. Preoperative trait anxiety and state anxiety were inversely associated with postoperative maternal satisfaction. State anxiety was also inversely associated with better recovery. Preoperative anxiety was not associated with analgesic use or length of hospital stay. Linear regression analysis indicated the degree of satisfaction with information from the anaesthetist and perceived emotional support from the partner explained 52% of the variance in postoperative maternal satisfaction. Lower preoperative anxiety is associated with greater maternal satisfaction with elective caesarean section and better recovery. Information provided by anaesthetists and perceived emotional support are also of importance. It may be possible to identify women with high anxiety and facilitate satisfaction and recovery through providing additional supportive input.

  12. [Caesarean section: History, epidemiology, and ethics to diminish its incidence].

    Science.gov (United States)

    Martínez-Salazar, Gerardo Jesús; Grimaldo-Valenzuela, Pedro Mario; Vázquez-Peña, Gloria Gabriela; Reyes-Segovia, Carlos; Torres-Luna, Gabriela; Escudero-Lourdes, Gabriela Virginia

    2015-01-01

    Cesarean section has become the most performed surgery and it has been enhanced with the use of antibiotics and improvement in surgical techniques. The aim of this systematic review is to describe and clarify some historical and ethical characteristics of this surgery, pointing out some aspects about its epidemiological behavior, becoming a topic that should be treated globally, giving priority to the prevention and identification of factors that may increase the incidence rates. Today, this "epidemic" reported rates higher than fifty percent, so it is considered a worldwide public health problem. Consequently, in Mexico strategies aimed at its reduction have been implemented. However, sociocultural, economic, medicolegal and biomedical factors are aspects that may difficult this goal. As we decrease the percentage of cesarean section in nulliparous patients, we diminish the number of iterative cesarean and its associated complications. This aim must be achieved through the adherence to the guidelines which promote interest in monitoring and delivery care in health institutions of our country.

  13. Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

    Science.gov (United States)

    Castillo, Eliana; McIsaac, Corrine; MacDougall, Bhreagh; Wilson, Douglas; Kohr, Rosemary

    2017-08-01

    Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. Estimate the rate of SSIs and associated predisposing factors. Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting. Copyright © 2017. Published by Elsevier Inc.

  14. 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.

  15. Ropivacaine 7.5 mg/mL for Caesarean Section

    Directory of Open Access Journals (Sweden)

    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.

  16. Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: A qualitative study.

    Science.gov (United States)

    Chaplin, Jacqueline; Kelly, Jennifer; Kildea, Sue

    2016-04-01

    Caesarean delivery rates have increased in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding are well recognised, however breastfeeding problems are common. Review of the literature revealed limited qualitative research relating to the experience of women having difficulties breastfeeding after caesarean section under regional anaesthesia. This study aimed to fill that gap in the literature. Participants were women referred to the hospital Breastfeeding Support Centre with difficulty initiating and establishing breastfeeding. The methodology employed was interpretive phenomenology and purposeful sampling. Data was analysed using van Manen's hermeneutical circular process. Themes identified included Unnatural birth, Natural instincts compromised, Helping mothers to mother and Sabotage and defeat. These themes elicited ten subthemes which were interpreted and reflected upon to reveal key findings. These findings included the emotional and physical effects of the delivery and anaesthetic, the lack of true skin to skin contact, separation of mother and baby, inconsistent information, inadequate support, unnecessary formula supplementation and feelings of failure. Key recommendations included increasing skin to skin contact after caesarean section to support the natural instincts of mother and baby, increasing education on possible effects of surgical delivery on breastfeeding and increasing postnatal breastfeeding support for this group of women. Broader issues of inadequate staffing and a changing postnatal dynamic reflecting increased post-surgical care need further exploration. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  17. Hospital treatment - Is it affordable? A structured cost analysis of vaginal deliveries and planned caesarean sections.

    Science.gov (United States)

    Heer, I M; Kahlert, S; Rummel, S; Kümper, C; Jonat, W; Strauss, A

    2009-11-03

    The analysis of cost effectiveness in hospitals is as difficult as treating the patients properly. We are yet not able to answer the simple question of what costs are caused by a certain diagnosis and its treatment during an average hospital stay. To answer some issues of the global problem of cost effectiveness during hospitalisation, we analysed the costs and the cost structure of a normal obstetrical hospital stay during an uncomplicated vaginal delivery and a planned caesarean section. Cost data was collected and summarized from the patients file, the hospital's computer system gathering all cost centres, known material expenses and expenses of non obstetrical medical services. For vaginal deliveries/planned caesareans we can calculate with a surplus of about 83Euro/1432Euro. About 45% of the summarized costs are calculated on a reliable database. The introduction of the DRG based clearing system in Germany has aggravated the discussion on cost effectiveness. Our meticulous work-up of expenses excluded personal precautionary costs and personnel costs of documentation because no tools are described to depict such costs. If we would add these costs to the known expenses of our study, we strongly suspect that hospital treatment of vaginal deliveries or planned caesarean sections is not cost effective.

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

    Directory of Open Access Journals (Sweden)

    2007-10-01

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

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

    African Journals Online (AJOL)

    Objective: To assess post-operative morbidity in clective versus emergcncy caesarean section. Design: Prospective cohort study. Setting: Department of Obstetrics and Gynaecology University of Abuja Teaching Hospital, Abuja in Nigeria Population : Women who underwent either elective or emergency caesarean sections ...

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

    Science.gov (United States)

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

    2016-09-01

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

  1. Evaluation of a modified "Triple-P" procedure in women with morbidly adherent placenta after previous caesarean section.

    Science.gov (United States)

    Wei, Yanxing; Cao, Yanwen; Yu, Yanhong; Wang, Zhijian

    2017-07-21

    To describe a modified "Triple-P" procedure and evaluate its outcome in women with morbidly adherent placenta (MAP) after previous caesarean section (CS). A retrospective cohort study of 96 women with MAP after CS was recruited with 45 women receiving the modified "Triple-P" procedure as study group and the other 51 cases receiving the conventional managements as the control. The maternal outcomes were compared. The modified "Triple-P" procedure was described in step by step. Women in study group demonstrated reduction of blood loss, transfusion blood volume and operation time, as well as less hospital days and lower hospitalization cost (P P > 0.05). Our modified "Triple-P" procedure for MAP after previous CS maintained the advantages of Chandraharan's "Triple-P" procedure in preservation of uterus for further fertility, less intraoperative blood loss, shorter hospital stays, and lower hospitalization cost but also advanced in feasibility and convenience during introducing into routine clinical practice.

  2. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

    NARCIS (Netherlands)

    Offerhaus, P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Hukkelhoven, C.W.P.M.; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2014-01-01

    Objective 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. Design nationwide descriptive study. Setting the Netherlands Perinatal Registry. Participants 789,795 births of nine year cohorts

  5. 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

    NARCIS (Netherlands)

    Offerhaus, P.M.; de Jonge, J.; de Bruin, K.; Hukkelhoven, C.W.P.M.; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2014-01-01

    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. Design: nationwide descriptive study. Setting: the Netherlands Perinatal Registry. Participants: 789,795 births of nine year cohorts of

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Ayca Tas Tuna

    2017-01-01

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

  9. 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....

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

    Directory of Open Access Journals (Sweden)

    Amin Ebneshahidi

    2012-01-01

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

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

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    Cristiane M. Moreira

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2014-01-01

    Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

  14. Birth by caesarean section and school performance in Swedish adolescents- a population-based study.

    Science.gov (United States)

    Curran, Eileen A; Kenny, Louise C; Dalman, Christina; Kearney, Patricia M; Cryan, John F; Dinan, Timothy G; Khashan, Ali S

    2017-04-17

    Our objective was to assess the impact of obstetric mode of delivery, and in particular birth by Caesarean section (CS), on school performance in adolescents using a large, population-based cohort. We extracted data from the Swedish Medical Birth Register and National School Register. We included all live singleton births in Sweden from 1982-1995 (n = 1,489,925). School grades were reported on a scale from 0 to 320, scores less than 160 (i.e. "pass") were considered to be "poor school performance." Mode of delivery was categorised as: unassisted vaginal delivery (VD), assisted VD, elective CS and emergency CS. We measured the association between mode of delivery and "poor school performance" using logistic regression. We then used quantile regression to assess the association between mode of delivery and school performance across the distribution of scores. We adjusted for maternal age, parity, small and large for gestational age, gestational age, maternal country of birth, maternal depression, non-affective disorder or bipolar disorder, parental income at time of birth, and parental social welfare at time of birth. We also conducted sensitivity analyses to investigate the association further. With logistic regression analysis, the adjusted odds ratio (aOR) of assisted VD and poor school performance, compared to unassisted VD, was 1.06 (95% CI: 1.03-1.08). For elective CS it was 1.06 (95% CI:1.03-1.09) and for emergency CS it was 1.12 (95% CI: 1.09-1.15). With quantile regression, assisted VD showed little difference in scores, when compared to unassisted VD, at any point across the distribution. Elective CS was associated with a 1-3 point decrease in scores, and emergency CS was associated with a 2-5 point decrease in scores. A slight association was found between birth by CS and school performance. However, the effect was quite small and given the complex nature of the relationship, should be interpreted with caution.

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

    NARCIS (Netherlands)

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

    2011-01-01

    textabstractIntroduction: Approximately 25% of all babies in North America are delivered via Caesarean section (C-section). Though a common surgical procedure, C-section recovery can be painful. Opioids, specifically codeine, are commonly used to ease pain; however, its active metabolite, morphine,

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

    Directory of Open Access Journals (Sweden)

    Dewi Y Bisri

    2017-01-01

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

  17. Comparison of pentastarch and Hartmann's solution for volume preloading in spinal anaesthesia for elective caesarean section.

    Science.gov (United States)

    French, G W; White, J B; Howell, S J; Popat, M

    1999-09-01

    We studied 160 patients undergoing elective Caesarean section under spinal anaesthesia who received a preloading volume of 15 ml kg-1 of 10% pentastarch in 0.9% saline, or Hartmann's solution, in a prospective, randomized, double-blind study. We compared the incidence of spinal-induced hypotension in each group. Hypotension was defined as a decrease in systolic arterial pressure to less than 70% of baseline values or < or = 90 mm Hg, whichever was the greater. The groups were comparable in physical characteristics and there was no serious morbidity. Fetal outcome was similar in both groups. Significantly more patients in the Hartmann's group (n = 38, 47.5%) developed hypotension than in the pentastarch group (n = 10, 12.5%) (P < 0.0001). Linear regression analysis showed that the only significant variable was type of fluid used. Blood glucose concentrations were not related to the presence of hypotension. We conclude that starches may be suitable for preloading in Caesarean section under spinal anaesthesia and provide an alternative to the aggressive use of vasoconstrictors.

  18. Urachal adenocarcinoma incidentally discovered in a young woman at elective caesarean section.

    Science.gov (United States)

    Goldman, Hariette; Sowter, Steven

    2016-06-28

    Urachal adenocarcinoma is a rare non-urothelial malignancy that represents only 0.5% of all vesical cancers. Urachal adenocarcinoma most commonly occurs in the 5th to 7th decade. We describe a case of a 35-year-old woman (G3P1) who presented at 20 weeks pregnancy with two episodes of post-coital bleeding. Ultrasound demonstrated a uterine mass measuring 59×43×56 mm, presumed to be a leiomyoma. The decision was made to proceed to caesarean section at 38 weeks, given the progression of the presumed leiomyoma. A 2 cm bladder dome mass was incidentally discovered at the time of the caesarean section and an urgent intraoperative urology consult was sought. Resultantly, the bladder mass was dissected to the dome, and pathology returned urachal adenocarcinoma. This case report considers the treatment decisions involved when faced with urachal adenocarcinoma and reviews the literature surrounding this rare malignancy. 2016 BMJ Publishing Group Ltd.

  19. Allergic reaction to suxamethonium during emergency caesarean section and pseudocholinesterase deficiency in the same patient.

    Science.gov (United States)

    Brozović, Gordana; Mazul Sunko, Branka; Hafner, Tomislav; Bekavac, Ivanka

    2014-07-01

    An allergic reaction during the caesarean section can be harmful for mother and foetus. Our patient has undergone an urgent caesarean section due to the imminent threat of foetal hypoxia. After operation, we applied prolonged mechanical ventilation. The anaesthesia was induced with thiopental and suxamethonium. Suxamethonium is associated with the highest incidence of allergic reactions but it is a neuromuscular blocking agent of choice for an emergency operation. During the operation, about 10 min. after induction, the systolic blood pressure dropped suddenly to 67 mmHg, the heart rate increased to 145 beats per minute and the oxygen saturation dropped to 60 %. A small degree of bronchospasm developed but there wasn't any kind of skin reaction. We thought of an allergic reaction, the obstetrical pulmonary embolism and an acute cardiac failure. The baby was delivered promptly in good condition. Within 10 min. all vital signs normalized. The operation continued without problems. Unexpectedly, during waking up from anaesthesia the patient became dyspnoeic, laryngospasm appeared, the oxygen saturation dropped again, strong facial and tongue oedema appeared and an urgent reintubation had to be performed. The laboratory results pointed out elevated mast cell tryptase level and significant pseudocholinesterase deficiency. About 2 months later, immunologist excluded thiopental and latex, and suggested that suxamethonium was the "trigger" factor. In our case the respiratory insufficiency was caused by two different and unrelated pathological mechanisms: biphasic allergic reaction and prolonged neuromuscular block caused by pseudocholinesterase deficiency.

  20. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience.

    Science.gov (United States)

    Wrench, I J; Allison, A; Galimberti, A; Radley, S; Wilson, M J

    2015-05-01

    The widespread adoption of enhanced recovery programmes in various surgical specialties has resulted in patient benefits including reduced morbidity, reduced length of stay and an earlier return to normal activities. This evidence, along with the increased financial pressures in the UK National Health Service, has led many units to consider introducing such a programme for obstetric surgery. We report our experience in setting up an enhanced recovery programme for women undergoing elective caesarean section and a prospective analysis of factors that influence length of stay. An enhanced recovery pathway was designed by a multidisciplinary team and introduced in March 2012. Factors influencing length of stay were determined using a log normal model. The proportion of women discharged on Day 1 increased from 1.6% in the first quarter of 2012 to 25.2% in the first quarter of 2014. The 30-day readmission rate was 4.4% for those discharged on Day 1 and 5.6% for Day 2. Earlier gestation, multiple birth, intention to breast feed, longer surgery and more time in the post-anaesthesia recovery unit were all independently associated with a longer postoperative stay. Women presenting for obstetric surgery with the indication "one previous caesarean section" were more likely to leave hospital earlier compared to most other indications. An enhanced recovery programme was successfully introduced into our unit. Many of the interventions were straightforward and could be adopted easily elsewhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section.

    Science.gov (United States)

    Gautier, P; De Kock, M; Huberty, L; Demir, T; Izydorczic, M; Vanderick, B

    2003-11-01

    This study aimed to detect if intrathecal (i.t.) ropivacaine and levobupivacaine provided anaesthesia (satisfactory analgesia and muscular relaxation) and postoperative analgesia of similar quality to bupivacaine in patients undergoing Caesarean section. Ninety parturients were enrolled. A combined spinal-epidural technique was used. Patients were randomly assigned to receive one of the following isobaric i.t. solutions: bupivacaine 8 mg (n=30), levobupivacaine 8 mg (n=30), or ropivacaine 12 mg (n=30), all combined with sufentanil 2.5 microg. An i.t. solution was considered effective if an upper sensory level to pinprick of T4 or above was achieved and if intraoperative epidural supplementation was not required. Sensory changes and motor changes were recorded. Anaesthesia was effective in 97, 80, and 87% of patients in the bupivacaine 8 mg, levobupivacaine 8 mg, and ropivacaine 12 mg groups, respectively. Bupivacaine 8 mg was associated with a significantly superior success rate to that observed in the levobupivacaine group (Plevobupivacaine and ropivacaine). The racemic mixture of bupivacaine combined with sufentanil remains an appropriate choice when performing Caesarean sections under spinal anaesthesia.

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

    Science.gov (United States)

    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.

  3. 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.

  4. 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 < 0.05). Caesarean section rate is not an useful indicator to monitor quality of EmOC as a high rate of unnecessary and potentially preventable CS was identified in this audit. © 2016 John Wiley & Sons Ltd.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  6. Utility of multiparametric MRI in Caesarean section scar characterization and preoperative prediction of scar dehiscence: a prospective study.

    Science.gov (United States)

    Kumar, Ishan; Verma, Ashish; Matah, Manjari; Satpathy, Gayatri

    2017-07-01

    Background Post-Caesarean uterine scar rupture during vaginal birth after Caesarean section (VBAC) is a potentially life-threatening complication. Prediction of scar dehiscence and scar rupture is vital in treatment planning and selecting candidates of trial of labor after a Caesarean section (CS). Purpose To assess the accuracy of magnetic resonance imaging (MRI) for evaluation of post-Caesarean uterine scar and to predict scar dehiscence during repeat CS. Material and Methods Thirty patients with a history of at least one previous CS underwent pelvic MRI for assessment of uterine scar during a subsequent gestation, all of whom underwent lower segment Caesarean section (LSCS) subsequently due to one of the established indications of CSs. Thickness, T1, T2 signal intensity ratio (SER), and apparent diffusion coefficient (ADC) value of scar site were charted. The lower uterine segment was assessed and graded intraoperatively and findings were correlated with MRI findings. Results A total of 30 participants were included in this study, of which nine were classified as having an abnormal scar (of various grades) based on surgical observations. T2 SER with a cutoff value of 0.935 showed the highest sensitivity of 100% and scar thickness value of 3.45 mm showed highest specificity of 91% in prediction of abnormal scar. On drawing a receiver operating characteristic (ROC) curve, T2 signal intensity ratio showed the highest area under the curve (AUC) closely followed by scar thickness values. Conclusion MRI derived parameters may be utilized for differentiation of an abnormal post-Caesarean uterine scar from a normal one. Both scar thickness and T2 SER measured on MRI can be used to predict scar dehiscence. However, T2 SER can serve as a more standardized and objective criterion.

  7. Gas chromatographic determination of methoxyflurane in maternal and foetal blood during anaesthesia for Caesarean sections.

    Science.gov (United States)

    Weiss, V; Roth, M

    1975-02-01

    In 50 cases of Caesarean section for various indication, methoxyflurane was administered to two groups of patients in two different dosages by a Pentec-vaporizer. Blood was sampled simultaneously in the radial artery of the mother and in the umbilical vein. The methoxyflurane concentrations of both samples of blood were measured by gas chromatography. With an inspiratory concentration of 0.2 vol.-% methoxyflurane, the mean concentration was 166 mumol/1(2.75 mg/100 ml) in the maternal blood and 69 mumol/1 (1.14 mg/100 ml) in the umbilical vein. With 0.5 vol.-%, the corresponding values were 345 mumol/1 (5.72 mg/100 ml) and 137 mumol/1 (2.25 mg/100 ml) respectively. The condition of the new-born did not appear to be affected by the given doses of methoxyflurane.

  8. Psychiatric morbidity associated with caesarean section: a study from Wesley Guild Hospital, Ilesa, Nigeria.

    Science.gov (United States)

    Ukpong, D I; Owolabi, A T

    2004-11-01

    Fifty-five women who presented at Wesley Guild Hospital, Ilesa, Nigeria, for either elective or emergency caesarean section during a 5-month period (1 December 2003 - 30 April 2004) were recruited consecutively and assessed for psychiatric morbidity using the General Health Questionnaire (GHQ-30), the Beck Depression Inventory (BDI) and the State Version of the State-Trait Anxiety Inventory (STAI). Twenty-two women (40%), were cases on the GHQ, and the BDI was able to pick 11 women with depression in the study sample. The mean anxiety score for the entire study population was 41.7, which was higher than the usually accepted threshold of 40 for clinical disorder on the scale. Thirty-three women (60%) were initially reluctant to give consent for the operation and they had higher mean STAI scores than those who willingly consented to the procedure, and the difference in scores was statistically significant. The implications of these findings are discussed.

  9. [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.

  10. The experiences of parents where pregnancy ended in an unplanned caesarean section

    Directory of Open Access Journals (Sweden)

    C. C. Ceronio

    1995-05-01

    Full Text Available The purpose of this study to determine the experiences of parents prior to, during and following an unplanned caesarean section. Parents who experienced this event had mixed emotions. The related occurrences may have influenced their behaviour and consequently their relationships with their spouses, themselves and their environment. These continually interacted with each other and thus needed to be looked at in context. 'The Nursing of the Whole Person Theory’ ensured a holistic approach to the parents. Unstructured, in-depth interviews held with five mothers and five fathers, respectively, on day three post-delivery, were transcribed and analysed. At six weeks a follow-up semi-structured questionnaire was answered by these same respondents and analysed The experiences of the parents were then compared,

  11. 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.

  12. 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.

  13. A Study of Post-Caesarean Section Wound Infections in a Regional Referral Hospital, Oman

    Directory of Open Access Journals (Sweden)

    Hansa Dhar

    2014-05-01

    Full Text Available Objectives: The aim of this study was to determine the incidence of surgical site infections (SSI in patients undergoing a Caesarean section (CS and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient’s quality of life by increasing morbidity and extending hospital stays. Methods: A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220 were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. Results: The total number of PCS wound infections was 211 (2.66%. There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53% and a three-fold higher incidence of diabetes (32, 15.16% in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27% and the Gram-negative Escherichia coli group (40, 18.95%. The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%, while 47 (22.27% yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Conclusion: Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques.

  14. Membrane Sweeping for Vaginal Birth after Caesarean Section and its Outcome -A Comparative Study.

    Science.gov (United States)

    Ramya, V; Ghose, Seetesh; Pallavee, P

    2015-08-01

    Sweeping of membrane is a method of induction of labour. This is used to avoid prolonged labour. However, there is paucity of data about the use of this method for induction of labour and reducing prolonged labour in pregnancy with previous caesarean section. This study is an effort to find the effect of membrane sweeping in previous caesarean section. To initiate labour in previous LSCS patients by membrane sweeping and maternal outcome. This prospective randomised control study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry between January 2011 to June 2012. Seventy five women were randomly assigned to membrane sweeping and seventy five to control. In study group serial membrane sweeping was done once weekly from 39 weeks of gestation until the onset of labour up to 41weeks of gestation. In control group, no intervention up to 41 weeks of gestation. All the cases were monitored by biophysical profile. The primary outcomes measured were number of patients who had onset of labour. The secondary outcome included the successful vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval and amount of oxytocin required. The onset of labour in study group was 61.3% similar in control group 64% with p 0.736. The mean interval from sweeping to labour onset was 50.15±8 hours. The rate of VBAC was 17.3% in study group in compared to 18.7% in control group and LSCS was 82.7% in study group in compared to 81.3% in control group respectively. The mean gestation age at delivery 40±0.56 weeks for study group compared with 39.92±0.55 weeks for control group. Although membrane sweeping is an easy way of inducing labour, present study failed to demonstrate its beneficial effect on obstetrical outcome.

  15. Anaesthetic management of emergency caesarean section in a patient with seizures and likely raised intracranial pressure due to tuberculous meningitis.

    Science.gov (United States)

    Baidya, D K; Trikha, A; Menon, S; Garg, R

    2011-09-01

    We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.

  16. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study.

    Science.gov (United States)

    Kathirgamanathan, A; Douglas, M J; Tyler, J; Saran, S; Gunka, V; Preston, R; Kliffer, P

    2013-07-01

    Controversy exists as to whether effective spinal anaesthesia can be achieved as quickly as general anaesthesia for a category-1 caesarean section. Sixteen consultants and three fellows in obstetric anaesthesia were timed performing spinal and general anaesthesia for category-1 caesarean section on a simulator. The simulation time commenced upon entry of the anaesthetist into the operating theatre and finished for the spinal anaesthetic at the end of intrathecal injection and for the general anaesthetic when the anaesthetist was happy for surgery to start. In the second clinical part of the study, the time from intrathecal administration to 'adequate surgical anaesthesia' (defined as adequate for start of a category-1 caesarean section) was estimated in 100 elective (category-4) caesarean sections. The median (IQR [range]) times (min:s) for spinal procedure, onset of spinal block and general anaesthesia were 2:56 (2:32-3:32 [1:22-3:50]), 5:56 (4:23-7:39 [2:9-13:32]) and 1:56 (1:39-2:9 [1:13-3:12]), respectively. The limiting factor in urgent spinal anaesthesia is the unpredictable time needed for adequate surgical block to develop. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

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

    Directory of Open Access Journals (Sweden)

    Alma Soxhuku-Isufi

    2015-12-01

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

  18. 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

  19. 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.

  20. 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.

  1. Effects of caesarean section, retained placenta and vaginal or uterine prolapse on subsequent fertility in beef cattle.

    Science.gov (United States)

    Patterson, D J; Bellows, R A; Burfening, P J

    1981-10-01

    Data collected at the Livestock and Range Research Station, Miles City, Montana, on 13,296 calving from the years 1963 through 1977 were used to evaluate subsequent reproductive performance of dams experiencing caesarean section, retained placenta or vaginal or uterine prolapse. A total of 121 caesarean sections (.9% of all calvings) was performed from 1963 through 1977, with the highest incidence reported among first-calf 2- and 3-year-old dams. Fall pregnancy rate among the 105 dams that had caesarean deliveries was 52.4%, which was 26.6% lower (p less than .01) than the herd average. Fetal membranes were retained after 49 natural parturitions. Pregnancy rates among dams retaining fetal membranes were not significantly altered (82.2 vs 79.4%). A total of 153 calvings was associated with prolapse of the reproductive tract, including 124 (81.0%) vaginal prolapses and 29 (19.0%) uterine prolapses. Subsequent pregnancy rate of all dams experiencing prolapse was lower (p less than .01) than the herd average. Pregnancy rates following prolapse among primiparous and multiparous dams were 28.0 and 57.9%, respectively. These data indicate that caesarean section and vaginal or uterine prolapse result in significant reductions in subsequent pregnancy rates of affected dams, with no detrimental effect on dams retaining fetal membranes.

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

    NARCIS (Netherlands)

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

    2014-01-01

    OBJECTIVE: 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. DESIGN: A PtDA was developed and pilot tested

  3. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section

    Science.gov (United States)

    Griffiths, James D; Gyte, Gillian ML; Paranjothy, Shantini; Brown, Heather C; Broughton, Hannah K; Thomas, Jane

    2014-01-01

    Background Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and can also occur in the period following the procedure. Objectives To assess the efficacy of pharmacological and non-pharmacological interventions given prophylactically to prevent nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (27 February 2012) and reference lists of identified studies. Selection criteria We included randomised controlled trials (RCTs) and excluded quasi-RCTs and cross-over studies. Data collection and analysis Review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. Main results Fifty-two studies met the inclusion criteria but only 41 studies, involving 5046 women, provided useable data for the review involving women having caesareans under regional anaesthesia. The majority of the studies involved women undergoing elective caesarean section. Only two studies included emergency surgery, however, they did not stratify data according to type of surgery. The studies covered numerous comparisons, but the majority of studies involved 5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids or acupressure. Studies were mainly small and of unclear quality. Three classes of intervention were found to be effective in at least three out of four of our primary outcomes (intraoperative nausea, intraoperative vomiting, postoperative nausea and postoperative vomiting). These interventions were 5-HT3 antagonists, dopamine antagonists and sedatives. Other classes of intervention were effective for fewer than three of our primary outcomes. With 5-HT antagonists, we found a reduction in intraoperative nausea (average risk ratio (RR) 0.64, 95% confidence interval (CI) 0.46 to 0.88, eight studies

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Balvinder Sagoo

    2015-01-01

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

  6. 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.

  7. Safety and efficacy of airbag midwifery in promoting normal vaginal delivery and reducing caesarean section.

    Science.gov (United States)

    Ma, Jianting; Shao, Huajiang; Lu, Xingren; Zhang, Bo; Zhang, Guanger

    2012-11-01

    Balloon bionic midwifery has been applied in clinical obstetrics in China for 10 years, although played a certain role in controlling and improving the quality of obstetrics and caesarean section rate, but some questions have not been resolved. The aim of this study was to investigate the efficacy and safety of airbag midwifery. Primiparas (2410 cases) with various medical conditions were randomly divided into airbag and control groups undergoing the same obstetrical treatments, but airbag midwifery as a birthing option was chosen twice when the cervix was dilated to 2-4 cm during labor. The duration of the first and second stages, as well as the total delivery process, of the airbag group was shorter than that for the controls. The natural delivery rate of the airbag group was higher than that of the control group. The forcep delivery rate, cesarean section rate, amount of vaginal bleeding within 2 h after delivery, rate of postpartum hemorrhage, fetal distress, and pitocin use in the airbag group were all lower than those in the control group. No significant difference in the rate of maternal and fetal complications was observed in the two groups. The bionic airbag midwifery approach did not contribute to the incidence rate of urine retention, leukocyte count, neutrophil proportion, and level of creactive protein and IL-6 24 h after delivery. Airbag midwifery skill is a simple, effective, and safe procedure.

  8. 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

  9. 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

  10. Admission to neonatal intensive care with respiratory morbidity following 'term' elective caesarean section.

    Science.gov (United States)

    Alderdice, F; McCall, E; Bailie, C; Craig, S; Dornan, J; McMillen, R; Jenkins, J

    2005-06-01

    Delaying the timing of elective caesarean section (ELCS) from 37/38 weeks to 39/40 weeks reduces the risk of respiratory morbidity in otherwise healthy neonates. The aims of this study were to clarify the number and clinical details of term infants delivered by ELCS who were admitted to neonatal intensive care (NIC) from 1st April 2001 to 31st March 2002 in Northern Ireland, to record the level of care required by these infants and to identify infants who were diagnosed with transient tachypnoea of the newborn (TTN) and/or Respiratory Distress Syndrome (RDS). Two hundred and ten (8%) of babies born by ELCS were admitted to NIC. Term infants delivered by ELCS used 343 days of level 1 & 2 care with 230 (68%) of these days being used by infants with RDS/TTN (n=105) the majority of whom were delivered at 37/38 weeks. Definitions of 'term' and clinical indications for ELCS urgently need to be debated to avoid unnecessary morbidity following ELCS in so called 'term' infants.

  11. Foetal responses to dexmedetomidine in parturients undergoing caesarean section: a systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Jian; Zhou, Haibin; Sheng, Kaihua; Tian, Tian; Wu, Anshi

    2017-10-01

    Objective This current meta-analysis was conducted to evaluate effects of dexmedetomidine on neonatal maternal factors. Methods The electronic databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched. The primary outcomes were neonatal parameters, including umbilical blood gases and Apgar scores. The secondary outcomes were maternal parameters. Results We identified six randomized controlled trials (RCTs). No differences in neonatal umbilical blood gases, and Apgar scores at 1 min (WMD: -0.09; 95% CI: -0.21 to 0.04; I(2 )= 0%) and 5 min (weighted mean difference (WMD): 0.03; 95% CI: -0.05 to 0.11; I(2 )= 37%) were observed with dexmedetomidine. For maternal parameters, characteristics of motor and sensory block and postoperative analgesia (standard mean difference (SMD): 3.99; 95% CI: 2.85 to 5.12; I(2 )= 78%) were significantly improved after dexmedetomidine treatment. Adverse events, including nausea/vomiting and shivering (risk ratio (RR): 0.26; 95% CI: 0.11 to 0.60; I(2 )= 0%), were lower after dexmedetomidine treatment. Conclusion This meta-analysis shows that dexmedetomidine is safe for neonates who are delivered by caesarean section. Moreover, dexmedetomidine used in neuraxial anaesthesia can improve the characteristics of motor and sensory block and prolong the maternal pain-free period. Dexmedetomidine can also reduce the maternal incidence of postoperative adverse effects.

  12. Factors associated with mothers selecting general anesthesia for lower segment caesarean section.

    Science.gov (United States)

    Holdcroft, A; Parshall, A M; Knowles, M G; Waite, K E; Morgan, B M

    1995-09-01

    The objective of the study was to investigate the sociodemographic and psychological factors which are associated with choice or refusal of regional anesthesia for lower segment Caesarean section. A semi-structured questionnaire was administered preoperatively to consecutive women presenting for elective operation at two hospital sites in the same health authority. The questionnaires were administered to 39 pregnant women by two anesthetists, one at each site. Sociodemographic and past and present obstetric and anesthetic details were obtained. The Hospital Anxiety and Depression scale and the FEAR questionnaire were used with an additional visual analog scale to assess fearfulness associated with the proposed operation. A 'panic checklist' of ten items was also constructed to identify procedures associated with feelings of panic. Ten women requested general anesthesia. These women had a similar level of anxiety to the others, but were significantly more depressed, had had more pregnancies overall and more without live babies. There were also more aspects of the procedure at which they thought they might panic. Women who have suffered the loss of a conception with its associated grief and often obstetric intervention are more reluctant to be conscious during an operative delivery for a subsequent baby. Preventive measures should be considered at the time of fetal loss to avoid this. However, preoperatively a simple visual analog scale for fearfulness would identify these women so that any unresolved fears could receive full psychological assessment.

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

    Directory of Open Access Journals (Sweden)

    Gowri Vaidyanathan

    2016-02-01

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

  14. Distractions during critical phases of anaesthesia for caesarean section: an observational study.

    Science.gov (United States)

    Jenkins, A; Wilkinson, J V; Akeroyd, M A; Broom, M A

    2015-05-01

    Aviation's 'sterile cockpit' rule holds that distractions on the flight deck should be kept at a minimum during critical phases of flight. To assess current practice at comparable points during obstetric regional anaesthesia, we measured ambient noise and distracting events during 30 caesarean sections in three phases: during establishment of regional anaesthesia; during testing of regional blockade; and after delivery of the fetal head. Mean (SD) noise levels were 62.5 (3.9) dB during establishment of blockade, 63.9 (4.1) dB during testing and 66.8 (5.0) dB after delivery (p 70 dB) noises, non-clinical conversations and numbers of staff present in the operating theatre increased during each of the three phases. Conversely, entrances into, and exits from, theatre per minute were highest during establishment of regional anaesthesia and decreased over the subsequent two time periods (p < 0.001). © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  15. Elective Caesarean section on maternal request in Germany: factors affecting decision making concerning mode of delivery.

    Science.gov (United States)

    Stützer, Paul Philipp; Berlit, Sebastian; Lis, Stefanie; Schmahl, Christian; Sütterlin, Marc; Tuschy, Benjamin

    2017-05-01

    To investigate sociopsychological factors of women undergoing a caesarean section on maternal request (CSMR). Twenty-eight women who underwent CSMR and 29 women with vaginal delivery (VD) filled in standardized questionnaires concerning psychological burden (SCL-R 90), fear of childbirth (W-DEQ, STAI), personality structure (HEXACO-Pi-R) and social support (F-SozU) as well as one questionnaire assessing potential factors influencing their mode of delivery. Women with CSMR were older (36.5 ± 5.4 vs. 30.6 ± 5.2 years; p mode of delivery before pregnancy (CS 61% vs. VD 82%, p = 0.328). In the decision-making process for the mode of delivery, the advice of the partner (85 and 90%) played an important role. 82% of the women who delivered via CSMR did not regret the decision for this mode of delivery. Women who underwent CS had higher fear of childbirth and appraised the birth less negative. The majority did not regret the decision for the CS and would even choose this mode of delivery for their next pregnancy. Although the partner and the physician seem to be important in the decision process for of the mode of delivery, reasons for the choice for CSMR appear to be multifactorial.

  16. [Anesthesia management of caesarean section for pregnant women complicated with Takayasu's arteritis].

    Science.gov (United States)

    Sun, J; Zeng, H; Wang, Y Q; Zhao, Y Y

    2016-02-18

    Takayasu's arteritis is a rare, idiopathic, chronic inflammatory disease. Its course is unpredictable, but slow progression is usual, leading to stenosis, occlusion, or aneurismal degeneration of the aorta or its major branches. We present the anesthesia management of pregnancy in four women admitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu's arteritis and review this disease with special reference to natural history, diagnostic criteria, classification, prognostic factors, and anesthesia considerations. Anesthesiological data were retrospectively analyzed for clinical manifestations, anesthesia process, perioperative complications, and pregnancy outcome. One patient received only epidural anesthesia, while the other three patients received combined spinal and epidural anesthesia (CSEA). Surgeries for all the four patients were successful with stable vital signs. We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diagnosed with Takayasu's arteritis. CSEA and continuous epidural block could be both used as anesthesiological method in patients with Takayasu's arteritis. During the surgery, to avoid rapid hemodynamic fluctuations and protect the major organs' function is very essential to allow for a satisfactory outcome.

  17. Use of oxytocin during Caesarean section at Princess Marina Hospital, Botswana: An audit of clinical practice

    Directory of Open Access Journals (Sweden)

    Billy M. Tsima

    2013-01-01

    Full Text Available Background: Oxytocin is widely used for the prevention of postpartum haemorrhage. In the setting of Caesarean section (CS, the dosage and mode of administrating oxytocin differs according to different guidelines. Inappropriate oxytocin doses have been identified as contributory to some cases of maternal deaths. The main aim of this study was to audit the current standard of clinical practice with regard to the use of oxytocin during CS at a referral hospital in Botswana.Methods: A clinical audit of pregnant women having CS and given oxytocin at the time of the operation was conducted over a period of three months. Data included indications for CS, oxytocin dose regimen, prescribing clinician’s designation, type of anaesthesia for the CS and estimated blood loss.Results: A total of 139 case records were included. The commonest dose was 20 IU infusion (31.7%. The potentially dangerous regimen of 10 IU intravenous bolus of oxytocin was used in 12.9% of CS. Further doses were utilized in 57 patients (41%. The top three indications for CS were fetal distress (36 patients, 24.5%, dystocia (32 patients, 21.8% and a previous CS (25 patients, 17.0%. Estimated blood loss ranged from 50 mL – 2000 mL.Conclusion: The use of oxytocin during CS in the local setting does not follow recommended practice. This has potentially harmful consequences. Education and guidance through evidence based national guidelines could help alleviate the problem.

  18. Granulosa cell tumor of the ovary--an incidental finding during caesarean section--a rare case report.

    Science.gov (United States)

    Roy, J; Babu, A S

    2014-01-01

    Approximately one-fourth of the ovarian neoplasms and cysts are diagnosed incidentally during caesarean section. The possibility of borderline tumor or cancer should be considered although existence of ovarian malignancy in pregnancy is rare. We report a case of a rare solid malignant tumor of the ovary incidentally found during caesarean section. Intraoperatively, it was thought to be a variant of the common ovarian teratoma. Ovariectomy was done but histopathology revealed it to be granulosa cell tumor. The diagnosis changed the prognosis and future treatment plan drastically. Equipped with this knowledge physicians can be made aware of the existence of this little-known ovarian neoplasm along with its rare association with pregnancy. Also one can better manage, counsel and follow-up the patients after delivery, given the knowledge of the tumours' inevitable malignant potential and its high incidence of recurrence.

  19. A COMPARISON OF SPINAL ANAESTHESIA WITH LEVOBUPIVACAINE AND HYPERBARIC BUPIVACAINE COMBINED WITH FENTANYL IN CAESAREAN SECTION

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    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

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

    Directory of Open Access Journals (Sweden)

    Ban Leong Sng

    2016-01-01

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

  1. Features of Metabolic Processes in Children Born by Caesarean Section in the Early Adaptation Period: the Role of Cerebral Ischemia

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    Т. S. Tumaeva

    2015-01-01

    Full Text Available Background: The postnatal adaptation comprises alteration of metabolic processes of a newborn, the disturbance of which can lead to dysfunction, and later — to the development of diseases. Objective: Our aim was to study the bond of cerebral ischemia in full-term children born by Caesarean section with the course of metabolic processes in the early neonatal period. Methods: A retrospective comparative study was conducted. Children born by Caesarean section, who had cerebral ischemia (n =120 and who didn't have it, (n = 150 were examined. Complex examination included an assessment of a number of factors: clinical, biochemical blood tests, acidbase balance, concentration of some hormones. Results: In children after Caesarean section with cerebral ischemia in the early period of adaptation we noted disturbances of the acid-base balance (BE 0.3 ± 1.9 mmol/l; р = 0.038, blood oxygenation (SaO2 79.7 ± 2.8%; р = 0.001, frank lactataemia (4.3 ± 1.8 mmol/l; р = 0.002, signs of a catabolic orientation of metabolism (hypoproteinemia, increased protein metabolism products, frank primary loss of body weight. The considerable changes of activity of the blood enzymes, disturbance of glucose metabolism indicated the lack of energy-dependent processes. Due to this, the hyperbilirubinemia and a hormonal imbalance were more often formed. Conclusion: Cerebral ischemia in children born by Caesarean section is a reason for the development of a metabolic disadaptation. The detection of disturbances of metabolic processes in the early neonatal period is necessary for a timely start of the correctional therapy in order to prevent the development of diseases in more distant periods of a child's life. 

  2. Peri-operative management of severe pre-eclampsia with kyphoscoliosis and poliomyelitis for emergency caesarean section

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    Anil K Bhiwal

    2017-01-01

    Full Text Available A 37 years old primigravida, 31 weeks gestation with severe preeclampsia [BP = 180/120 mm Hg] with severe kyphoscoliosis and polio affecting right lower limb was admitted in emergency with complaint of blurring of vision and pedal edema. An emergency caesarean section was conducted under general anaesthesia because of a failed spinal anaesthesia. Perioperative anaesthetic management and her postoperative course are discussed.

  3. Analysis of caesarean section rates over time in a single Swiss centre using a ten-group classification system.

    Science.gov (United States)

    Mueller, Martin; Kolly, Laura; Bauman, Marc; Imboden, Sara; Surbek, Daniel

    2014-02-19

    Caesarean section (CS) rates have risen over the past two decades. The aim of this observational study was to identify time-dependent variations in CS and vaginal delivery rates over a period of 11 years. All deliveries (13,701 deliveries during the period 1999-2009) at the University Women's Hospital Bern were analysed using an internationally standardised and approved ten-group classification system. Caesarean sections on maternal request (CSMR) were evaluated separately. We detected an overall CS rate of 36.63% and an increase in the CS rate over time (p <0.001). Low-risk profile groups were the two largest populations and displayed low CS rates, with significantly decreasing relative size over time. The relative size of groups with induced labour increased significantly, but this did not have an impact on the overall CS rate. Pregnancies complicated by breech position, multiple pregnancies and abnormal lies did not have an impact on overall CS rate. The biggest contributor to a high CS rate was preterm delivery and the existence of a uterine scar from a previous CS. CSMR was 1.45% and did not have an impact on the overall CS rate. The observational study identified wide variations in caesarean section and vaginal delivery rates across the groups over time, and a shift towards high-risk populations was noted. The biggest contributors to high CS rates were identified; namely, previous uterine scar and preterm delivery. Interventions aiming to reduce CS rates are planned.

  4. 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

  5. Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases; Repeated cross-sectional study from Oman

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    Kaukab Tashfeen

    2017-03-01

    Full Text Available Objectives: In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. Methods: This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of 60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each. Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. Conclusion: The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

  6. Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman.

    Science.gov (United States)

    Tashfeen, Kaukab; Patel, Malini; Hamdi, Ilham M; Al-Busaidi, Ibrahim H A; Al-Yarubi, Mansour N

    2017-02-01

    In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of 60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each). Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

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

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    Huang Kun

    2012-04-01

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

  8. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Salvatore Gizzo

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

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

    Science.gov (United States)

    Zwedberg, Sofia; Blomquist, Josefin; Sigerstad, Emelie

    2015-01-01

    to explore midwives' experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section. qualitative interviews with semi-structured questions. eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth. transcribed material was analysed and interpreted using qualitative content analysis. The analysis yielded the theme 'fighting an uphill battle'. skin-to-skin contact was considered to be important, and something that midwives strove to implement as a natural element of postnatal care. However, in daily practice, midwives experienced many obstacles to such care, such as lack of knowledge among parents and other professionals about the benefits of skin-to-skin contact, the mother's condition after the caesarean section, and other organisational difficulties (e.g. collaboration with other professionals, lack of time). Introducing more skin-to-skin care was a challenge for the midwives, who sometimes felt both dismissed and disappointed when they tried to communicate the benefits of this type of care. skin-to-skin contact is not prioritised because many health care practitioners are unaware of its positive effects, and their care reflects this lack of knowledge. There is a need for education among all health care practitioners involved in caesarean procedures. Another difficulty is that many parents are unaware of the benefits of skin-to-skin contact. Maternity outpatient clinics need to inform parents about the benefits of such care, so mothers will understand the importance of skin-to-skin contact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Spinal anaesthesia for caesarean section: an ultrasound comparison of two different landmark techniques.

    Science.gov (United States)

    Srinivasan, K Kallidaikurichi; Deighan, M; Crowley, L; McKeating, K

    2014-08-01

    Spinal anaesthesia performed at levels higher than the L3-4 intervertebral space may result in spinal cord injury. Our aim was to establish a protocol to reduce the chance of spinal anaesthesia performed at or above L2-3. One hundred and ten consenting patients at 32weeks of gestation or greater scheduled for non-emergency caesarean section under spinal anaesthesia were randomly allocated to have needle insertion performed at an intervertebral space determined by one of two landmark techniques. In Group A, if the intercristal line intersected an intervertebral space, this space was selected or if the intercristal line intersected a spinous process the space immediately above was selected. In Group B, if the intercristal line intersected an intervertebral space or a spinous process, the intervertebral space immediately below was chosen. The actual intervertebral space chosen was identified using ultrasound by a blinded investigator. In Group A, an intervertebral space at or above L2-3 was marked in 25 (45.5%) patients compared with 4 (7.3%) in Group B (P L1-2 whereas this occurred in no patient in Group B. There was no difference between groups in number of needle passes or attempts, onset of block at 5, 10 and 15min or need for rescue analgesia. Our data suggest that when performing spinal anaesthesia in pregnant patients, if the intercristal line intersects an intervertebral space then the space below should be chosen and if the intercristal line intersects a spinous process then the interspace below should be chosen. This will reduce the incidence of spinal anaesthesia performed at or above L2-3. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. What do popular Spanish women's magazines say about caesarean section? A 21-year survey

    Science.gov (United States)

    Torloni, MR; Campos Mansilla, B; Merialdi, M; Betrán, AP

    2014-01-01

    Objectives Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Design Systematic review. Setting Women's magazines printed from 1989 to 2009 with the largest national distribution. Sample Articles with any information on CS. Methods Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Main outcome measures Accuracy, comprehensiveness and sources of information. Results Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. Conclusions The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. PMID:24467797

  14. Safety and effectiveness of labour induction after caesarean section using balloon catheter or oxytocin.

    Science.gov (United States)

    Radan, Anda-Petronela; Amylidi-Mohr, Sofia; Mosimann, Beatrix; Simillion, Cedric; Raio, Luigi; Mueller, Martin; Surbek, Daniel

    2017-11-09

    Induction of labour after previous caesarean section (CS) is a challenge for obstetricians due to the increased risk of uterine rupture. Common methods for labour induction are balloon catheters and oxytocin as they are considered safe. However, the effectiveness remains unclear as currently available data are limited. Therefore, we aimed to determine safety and effectiveness of balloon catheter or oxytocin for labour induction after CS. We included 179 consecutive women with a previous CS and labour induction in this retrospective study. We performed labour induction using a balloon catheter in case of a Bishop score of 6 and/or premature rupture of membranes. The primary outcome was the rate of successful vaginal deliveries. We adjusted for multiple factors that may have impacted on the rate of vaginal delivery as well. The secondary outcomes were the rate of maternal and neonatal morbidities. We detected a vaginal delivery success rate of 45.8% in the catheter and of 63.9% in the oxytocin group. We identified previous vaginal birth as an independent predictive factor for successful vaginal delivery in both groups. Induction using oxytocin was a negative predictive factor for neonatal admissions. Multivariate analysis showed that post-term pregnancy decreased the likelihood of vaginal delivery. We did not detect any factors predicting uterine rupture or uterine dehiscence, which occurred with similar frequency in both groups. Finally, the neonatal admission rate was less likely with higher gestational age and oxytocin as an induction method, whereas previous vaginal birth increased the risk. Our study indicates that induction of labour with balloon catheter or oxytocin seems to be safe in women with previous CS. Labour induction using a balloon catheter in women with previous CS and unfavourable cervix has a disappointingly low success rate. We identified factors influencing vaginal delivery success rates. Women with previous CS and indications for labour

  15. Oxytocin use during Caesarean sections in Denmark - are we getting the dose right?

    Science.gov (United States)

    Kjaer, B N; Krøigaard, M; Garvey, L H

    2016-01-01

    In Denmark, an iv bolus of 10 IU oxytocin was traditionally given after delivery to prevent atony during caesarean sections. Randomized controlled trials have shown that lower iv bolus doses have same efficacy with fewer side effects and many countries now recommend a 5 IU maximum dose. The aims of this study were to investigate whether patients referred for allergy testing after oxytocin exposure had dose-related side effects to oxytocin rather than true allergic reactions and to investigate whether updated international recommendations on lower bolus doses had been implemented in practice. Medical notes of patients tested with oxytocin as part of investigations in the Danish Anaesthesia Allergy Centre from May 2004 to January 2014 were reviewed retrospectively. A telephone survey of on-duty obstetricians at all Danish obstetric departments was performed and most recent online recommendations from the Danish societies of obstetrics and anaesthesia about the use of oxytocin were identified. In total 30 women were tested with oxytocin as part of investigations. None were allergic to oxytocin but 19 had symptoms consistent with dose-related side effects on iv provocation. The telephone survey revealed that iv doses of 10 IU oxytocin were still used and recommendations on the websites were not updated. Too high oxytocin doses are still used in Denmark leading to dose-related side effects mimicking allergic reactions. Coordination between obstetricians and anaesthesiologists on producing common updated guidelines on the administration of oxytocin and dissemination of this information to obstetric and anaesthetic departments in Denmark is needed. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  16. Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany.

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    Matthias David

    Full Text Available The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned and emergency (in-labor caesareans may also vary between immigrants (first generation, their offspring (second- and third-generation women, and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants.A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant and acculturation status were included. Data was linked with information from the expectant mothers' antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status.The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants.Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.

  17. Evaluation of intrathecal bupivacaine alone, bupivacaine with butorphanol and bupivacaine with dexmedetomidine for lower segment caesarean section: a randomized control trial

    OpenAIRE

    Ashem Jack Meitei; Okram Rubina; Laithangbam PKS; Joyshankar Singh I.; Dilip Ingudum; Mithun Raj R.

    2016-01-01

    Background: Following caesarean operation, a painless early ambulation is necessary to mother for caring of the neonate. Aim of the study is to compare more effective analgesic by intrathecal bupivacaine or combination with butorphanol or dexmedetomidine. Methods: Ninety parturients undergoing elective caesarean section were randomly divided into three equal groups (n=30). Group B: received bupivacaine (0.5%) 2 ml + 0.5 ml of normal saline (NS); group BB, bupivacaine (0.5%) 2 ml + 25 mcg b...

  18. A comparison of visual analog scale and Wong Baker facial pain scale for pain measurement in post lower caesarean section case

    OpenAIRE

    Neena Gupta; Sachidanand Gupta; Apurva Agarwal; Shaily Agarwal; Rita Mahto

    2016-01-01

    Background: There is various pain measurement tools commonly used to measure pain intensity. However, no single standard exists for quantifying pain in post caesarean section. In our study, we have divided two groups according to use of pain scales and found one scale is more useful than the other in the post caesarean cases. Methods: The study has been conducted in upper India Sugar Exchange Maternity Hospital department of obstetrics and gynaecology, GSVM Medical College, Kanpur for the ...

  19. Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section.

    Science.gov (United States)

    Yıldırım, İlker; İnal, Mehmet Turan; Memiş, Dilek; Turan, F Nesrin

    2017-09-29

    Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Cross-sectional study. Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95

  20. Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section

    Directory of Open Access Journals (Sweden)

    İlker Yıldırım

    2017-10-01

    Full Text Available Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250 scheduled for caesarean section were analysed. The patients" ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05. The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05. The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    -section). MATERIALS AND METHODS: The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final......-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p

  2. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

    Full Text Available Abstract Background The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes. Methods A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009 Women with ≥2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS, success rate of vaginal birth after caesarean section (VBAC; proportion on women opting for elective repeat caesarean section (ERCS and their perinatal outcomes. Results A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum was 1.01234. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8% reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH ( Conclusions Besides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

  3. 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%, Psuccessful 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.

  4. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

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    A. Valente

    2012-01-01

    Full Text Available Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications.

  5. 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.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Wendy Chaboyer

    2014-09-01

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2013-04-01

    Since the incorporation of workplace-based assessment within the specialty training programme in obstetrics and gynaecology, the assessment of technical competence to carry out caesarean section has been undertaken by the Objective Structured Assessment of Technical Skill tool. This requirement has been formalised in the Matrix of Educational Progression, ensuring that the tool must assess trainees' technical competence in caesarean section procedures of varying levels of complexity throughout training. Trainee feedback suggests that the effectiveness of the tool diminishes as the seniority of the trainee increases, with technical competence assessed less effectively in more complex procedures. This seems to be a result of the generic design of the tool and insufficient training on the part of assessors. Both of these are due to be addressed within a division of the Objective Structured Assessment of Technical Skill tool into explicitly formative and summative assessments of technical skill, following a General Medical Council-led consultation on the future of workplace-based assessment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Labour and Childbirth After Previous Caesarean Section: Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG).

    Science.gov (United States)

    Reif, P; Brezinka, C; Fischer, T; Husslein, P; Lang, U; Ramoni, A; Zeisler, H; Klaritsch, P

    2016-12-01

    The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patient's wishes into account. In view of good success rates (60-85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician.

  12. Mother-young relationships in Belgian Blue cattle after a Caesarean section: characterisation and effects of parity.

    Science.gov (United States)

    Vandenheede, M; Nicks, B; Désiron, A; Canart, B

    2001-05-02

    The systematic use of Caesarean section in "double muscled" Belgian Blue cattle can induce ethical concerns. The aims of the following study was to characterise mother-young relationships in such a situation and to assess the effect of parity. Fifteen heifers and 15 cows of the Belgian Blue breed were observed using video recording when isolated with their calf during the 3 days following Caesarean, a rapid surgery with rare occurrence of aggressive behaviour and no sign of cows' discomfort or weakness. All calves were bottle-fed mother's colostrum once before first suckling occurred. Heifers' calves received a supplementary number of three such artificial meals, while cows' calves needed only one. The overall median time to first licking of the calf by the mother was 3.3min without any effect of parity. The mean licking frequency was 29.2+/-15.8 per 24h: heifers licked their calf less frequently than cows, respectively 23.4+/-15.3 per 24h versus 35.1+/-14.5 per 24h (Pnatural calving. In our study, cows can be considered as better mothers than heifers.

  13. [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.

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

    Science.gov (United States)

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

    Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  15. Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section

    Science.gov (United States)

    2017-01-30

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    Milanez Helaine M

    2010-06-01

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

  18. 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.

  19. Prospective evaluation of systolic arterial pressure control with a phenylephrine infusion regimen during spinal anaesthesia for caesarean section.

    Science.gov (United States)

    Cooper, D; Schofield, L; Hynd, R; Selvan, D; Lloyd, A; Meek, T; Winnard, J

    2012-07-01

    Hypotension and nausea occur frequently during spinal anaesthesia for caesarean section. The aim of this evaluation was to assess systolic arterial pressure control with our routine prophylactic intravenous phenylephrine infusion regimen. We audited a local standard for an incidence of hypotension of ≤ 25% during the first 15 min of anaesthesia. One hundred healthy women undergoing elective caesarean section were assessed. Following intravenous preload with 10 mL/kg Hartmann's solution, 0.5% hyperbaric bupivacaine 2.8 mL combined with diamorphine 400 μg was given intrathecally in the sitting position. Intravenous phenylephrine was then started at 67 μg/min (the maximum rate). Systolic arterial pressure was recorded every 2 min. The infusion was titrated, according to local guidelines, to maintain systolic arterial pressure close to baseline. The median dose of phenylephrine given by infusion was 1000 [interquartile range 670-1000]μg, with 51 patients not requiring any change to the infusion rate. Eleven patients (11%, 95% CI 6-19) developed hypotension, defined as a systolic arterial pressure <80% of baseline. A further four patients were given a bolus of phenylephrine for suspected hypotension. The incidence of hypotension or suspected hypotension was therefore 15% (95% CI 9-24). Thirteen patients (13%, 95% CI 7-21) developed nausea. No patient vomited. Our routine phenylephrine infusion regimen was effective at minimizing hypotension and nausea during relatively high-dose spinal anaesthesia. This was achieved with a low intervention rate, in conjunction with a 2-min rather than a 1-min non-invasive blood pressure cycle time and a relatively low volume of intravenous fluid. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Effect of Supplementing Oxygen with Positive end Expiratory Pressure During Elective Caesarean Section under Spinal Anaesthesia on Foetus

    Science.gov (United States)

    Prabhu, Ramesh; Jayaraj; Shenoy, U Kailasanath

    2010-01-01

    Background: It is known fact that pre-oxygenation with positive end-expiratory pressure (PEEP) improves the Partial pressure of oxygen (PO 2). In this regard not many studies have been done in pregnant women to know its effect on foetus. In this randomised double blind controlled study, we analysed effect of pre-oxygenation with PEEP during caesarean section on foetal umbilical venous PO 2. Patients & Methods: 40 term pregnant women, ASA I or II, undergoing elective Caesarean section under spinal anaes-thesia were randomly divided into PEEP and Non-PEEP groups of 20 each. PEEP group received oxygen flow of 6 L/minute with PEEP of 5 cmH 2O using a modified Mapleson A circuit with fixed unidirectional PEEP valve at the expiratory port during pre-oxygenation and Non PEEP group received same fresh gas flow of oxygen using same breathing circuit without PEEP. Maternal arterial blood samples were collected before applying PEEP and at the end of 5 minutes of facemask application for oxygen analysis. Immediately after baby was delivered umbilical venous samples were taken for blood gas analysis. Results: Both groups were comparable in terms of maternal baseline oxygen saturation (Spo 2) and base line Po 2. After 5 minutes PO 2was higher in PEEP Group than non PEEP group (491.65 + 49.96 vs. 452.08 + 77.61). Umbilical venous Po 2in PEEP group was higher than non PEEP group (34.22 + 6.50 vs. 28.29 + 6.10 mm of Hg). Conclusion: Application of PEEP during pre-oxygenation for spinal anaesthesia can increase foetal umbilical venous PO2. PMID:21547172

  1. 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

  2. Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers.

    Science.gov (United States)

    Karanth, Laxminarayan; Kanagasabai, Sachchithanantham; Abas, Adinegara Bl

    2017-08-04

    the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.

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

    NARCIS (Netherlands)

    Melman, S.; Schoorel, E.N.; Dirksen, C.; Kwee, A.; Smits, L.; Boer, F. de; Jonkers, M.; Woiski, M.D.; Mol, B.W.; Doornbos, J.P.; Visser, H.; Huisjes, A.J.M.; Porath, M.M.; Delemarre, F.M.C.; Kuppens, S.M.; Aardenburg, R.; Dooren, I.M. van; Vrouenraets, F.P.; Lim, F.T.; Kleiverda, G.; Salm, P.C. van der; Boer, K. de; Sikkema, M.J.; Nijhuis, J.G.; Hermens, R.P.M.G.; Scheepers, H.C.J.

    2013-01-01

    BACKGROUND: Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was

  4. Hypotension during epidural analgesia for Caesarean section. Arterial and central venous pressure changes after acute intravenous loading with two litres of Hartmann's solution.

    Science.gov (United States)

    Lewis, M; Thomas, P; Wilkes, R G

    1983-03-01

    The incidence of hypotension occurring in women undergoing Caesarean section with epidural analgesia was investigated in 60 patients receiving an intravenous preload of two litres Hartmann's solution. Hypotension occurred in only 6.7% of patients. Central venous pressure measurements in 20 patients confirmed the safety of the technique. A comparison is made with other preloading techniques.

  5. 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 (PPillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, Ppillow 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.

  6. 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...

  7. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study.

    Science.gov (United States)

    Sahoo, T; SenDasgupta, C; Goswami, A; Hazra, A

    2012-01-01

    Subarachnoid block is the preferred method of anaesthesia for caesarean section, but is associated with hypotension and bradycardia, which may be deleterious to both parturient and baby. Animal studies suggest that in the presence of decreased blood volume, 5-HT may be an important factor inducing the Bezold Jarisch reflex via 5-HT3 receptors located in intracardiac vagal nerve endings. In this study, we evaluated the effect of ondansetron, as a 5-HT3 receptor antagonist, on the haemodynamic response following subarachnoid block in parturients undergoing elective caesarean section. Fifty-two parturients scheduled for elective caesarean section were randomly allocated into two groups. Before induction of spinal anaesthesia Group O (n=26) received intravenous ondansetron 4 mg; Group S (n=26) received normal saline. Blood pressure, heart rate and vasopressor requirements were assessed. Decreases in mean arterial pressure were significantly lower in Group O than Group S from 14 min until 35 min. Patients in Group O required significantly less vasopressor (P=0.009) and had significantly lower incidences of nausea and vomiting (P=0.049). Ondansetron 4 mg, given intravenously 5 min before subarachnoid block reduced hypotension and vasopressor use in parturients undergoing elective caesarean section. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Intensive care nurses' experiences of infants and partners' presence on the postoperative ward after an emergency caesarean section; An interview study.

    Science.gov (United States)

    Zwedberg, Sofia; Huss, Matilda; Karlsson, Emma; Poignant, Marie

    2017-08-01

    It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. To investigate the intensive care nurses' experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. The analysis yields the theme 'The challenges of caring for infants on a postoperative unit' covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. 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

  10. The effect of nefopam on lactation after caesarean section: a single-blind randomised trial.

    Science.gov (United States)

    Baka, N E; Vial, F; Iohom, G; Guerci, P; Hubert, C; Rouabah, M; Bouaziz, H

    2017-05-01

    Nefopam is a centrally acting analgesic which has a theoretical risk of stopping lactation due to its anticholinergic and dopaminergic effects. The aim of this study was to evaluate the effect of nefopam on lactation and to investigate potential adverse effects on newborns. Seventy-two women, scheduled to undergo a caesarean delivery under spinal anaesthesia and wanting to breastfeed, were randomised to one of two groups: nefopam (20mg, six hourly) or paracetamol (1g, six hourly). In both groups, postoperative analgesia was supplemented with ketoprofen (50mg, six hourly) in conjunction with intrathecal morphine 0.1mg. The primary outcome was onset of lactation, estimated by weighing the newborns before and after feeding; by maternal perception of breast fullness and based on serum prolactin concentration 48hours postpartum. Secondary outcomes were neonatal adverse effects evaluated by neurobehavioural score at 12, 24, 48, and 72hours after birth. Statistical analyses were performed using Chi-squared, Fisher exact and Student t tests as appropriate. Partificial milk given to newborns of mothers in the nefopam group on days two and three was significantly greater than for the paracetamol group. Neurobehavioural scores were comparable at each time point. Nefopam does not appear to delay the onset of lactation or present any clear risk to the newborn. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Effect of an anaesthesia information video on preoperative maternal anxiety and postoperative satisfaction in elective caesarean section: a prospective randomised trial.

    Science.gov (United States)

    Eley, V A; Searles, T; Donovan, K; Walters, E

    2013-11-01

    Video-based patient information supplementing clinician interview has been shown to reduce anxiety and improve satisfaction in patients undergoing procedures. In Queensland more than 90% of caesarean sections are performed under regional anaesthesia. We aimed to assess the effect of using an information video about neuraxial blockade in patients having regional anaesthesia for elective caesarean section. Subjects were randomised to undergo usual care (Group C), or to view a video and undergo usual care (Group V). Subjects completed the Spielberger State-Trait Anxiety Inventory preoperatively and the Maternal Satisfaction with Caesarean Section Score questionnaire postoperatively. Satisfaction with, and duration of the preoperative anaesthetic interview, were noted. One-way analysis of variance (ANOVA) and Chi-squared tests were used in statistical analysis. One-hundred and forty three subjects were randomised and 110 completed the protocol and analysis. Group C and Group V were similar in terms demographic and anaesthesia data. There was no difference in anxiety score (41.2 versus 39.8, P=0.50), maternal satisfaction score (118.5 versus 122.7, P=0.22) or interview duration (16.3 versus 15.8 min, P=0.69) between the two groups. The use of an anaesthesia information video does not reduce preoperative anxiety or increase the duration of the anaesthetic interview. Maternal satisfaction with neuraxial blockade for elective caesarean is high and not improved by an anaesthesia information video.

  12. Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec.

    Science.gov (United States)

    Chaillet, Nils; Dubé, Eric; Dugas, Marylène; Francoeur, Diane; Dubé, Johanne; Gagnon, Sonia; Poitras, Lucie; Dumont, Alexandre

    2007-10-01

    To investigate obstetricians perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians solutions for implementing these guidelines in practice. This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients motivations. Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.

  13. Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

    Directory of Open Access Journals (Sweden)

    Kiran Agarwal

    2010-01-01

    Full Text Available The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i bupivacaine (0.125% and buprenorphine (0.075 mg (ii bupivacaine (0.125% and clonidine (37.5 microgram and (iii bupivacaine (0.125% alone, in LSCS cases. The demographic characteristics (age, weight and height of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes alone. The mean highest pain score (VAS scale was significantly lower (3.4 ± 0.6 in group one patients and it was highest in group three (6.7 ± 0.8 patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.

  14. Which Foetal-Pelvic Variables Are Useful for Predicting Caesarean Section and Instrumental Assistance?

    Science.gov (United States)

    Frémondière, P; Thollon, L; Adalian, P; Delotte, J; Marchal, F

    2017-01-01

    To assess the variables useful to predict caesarean delivery (CD) and instrumental assistance, through the analysis of a large number of foetal-pelvic variables, using discriminant analysis. One hundred and fourteen pregnant women were included in this single-centre prospective study. For each mother-foetus pair, 43 pelvic and 18 foetal variables were measured. Partial least squares-discriminant analysis was performed to identify foetal-pelvic variables that could statistically separate the 3 delivery modality groups: spontaneous vaginal delivery (SVD), CD, and instrument-assisted delivery (IAD). For the SVD versus CD model, voluminous foetuses and women with a narrow pelvic inlet had a greater risk for requiring CD. The most efficient variables for discrimination were the transverse diameter and foetal weight. The antero-posterior inlet and obstetric conjugate were considered in this model, with the former being a useful variable but not the latter. For the SVD versus IAD model, the most important variables were the foetal variables, particularly the bi-parietal diameter. Women with a reduced antero-posterior outlet diameter and a narrow pubic arch were more at risk of requiring an IAD. The antero-posterior inlet was an efficient variable unlike the obstetric conjugate. The obstetric conjugate diameter should no longer be considered a useful variable in estimating the arrest of labour. Antero-posterior inlet diameter was a sagittal variable that should be taken into account. The comparison of sub-pubic angle and bi-parietal and antero-posterior outlet diameters was useful in identifying a risk of requiring instrumental assistance. © 2017 S. Karger AG, Basel.

  15. Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.

    Science.gov (United States)

    Begum, Tahmina; Rahman, Aminur; Nababan, Herfina; Hoque, Dewan Md Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

    2017-01-01

    Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. C-section rate in this area was much higher than national average as well as global

  16. Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term.

    Science.gov (United States)

    Adams, Nicole; Gibbons, Kristen S; Tudehope, David

    2017-04-01

    Prelabour caesarean section (CS) at early term (37(0) -38(6)  weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (39(0) -40(6)  weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term. To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term. A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (37(0) -40(6)  weeks) at a single centre encompassing co-located public and private hospitals during 1998-2013 was undertaken. Propensity score analysis was used to adjust for confounding differences between sectors. The primary outcome was Neonatal Critical Care Unit (NCCU) admission with serious morbidity. Secondary outcomes included respiratory distress, vigorous resuscitation and jaundice. The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term. Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  17. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature.

    Science.gov (United States)

    Ferrandina, Gabriella; Palluzzi, Eleonora; Fanfani, Francesco; Gentileschi, Stefano; Valentini, Anna Lia; Mattoli, Maria Vittoria; Pennacchia, Ilaria; Scambia, Giovanni; Zannoni, Gianfranco

    2016-12-03

    Malignant transformation has been reported in approximately 1% of the endometriosis cases; herein, we report a case of clear cell endometrial carcinoma arising from endometriosis foci located within a caesarean section scar. In November 2014, a Caucasian, 44-year-old woman was transferred to our institution because of severe respiratory failure due to massive lung embolism and rapid enlargement of a subcutaneous suprapubic mass. Abdomino-pelvic magnetic resonance showed a 10.5 × 5.0 × 5.0 cm subcutaneous solid mass involving the rectus abdominis muscle. Pelvic organs appeared normal, while right external iliac lymph nodes appeared enlarged (maximum diameter = 16 mm). A whole-body positron emission tomography/computed tomography scan showed irregular uptake of the radiotracer in the 22 cm mass of the abdominal wall, and in enlarged external iliac and inguinal lymph nodes. In December 2014, the patient underwent exploratory laparoscopy showing normal adnexae and pelvic organs; peritoneal as well as cervical, endometrial and vesical biopsies were negative. The patient was administered neo-adjuvant chemotherapy with carboplatin and paclitaxel, weekly, without benefit and then underwent wide resection of the abdominal mass, partial removal of rectus abdominis muscle and fascia, radical hysterectomy, bilateral salpingo-oophorectomy, and inguinal and pelvic lymphadenectomy. The muscular gap was repaired employing a gore-tex mesh while the external covering was made by a pedicled perforator fasciocutaneous anterolateral thigh flap. Final diagnosis was clear cell endometrial adenocarcinoma arising from endometriosis foci within the caesarean section scar. Pelvic and inguinal lymph nodes were metastatic. Tumor cells were positive for CK7 EMA, CKAE1/AE3, CD15, CA-125, while immunoreaction for Calretinin, WT1, estrogen, and progesterone receptors, cytokeratin 20, CD10, alpha fetoprotein, CDX2, TTF1, and thyroglobulin were all negative. Liver relapse occurred

  18. The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates

    Directory of Open Access Journals (Sweden)

    Keisuke Tanaka

    2017-01-01

    Full Text Available Caesarean section (CS rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates. 2625 women who birthed over a 12-month period were analysed using this classification. Women with previous CS (group 5 comprised 10.9% of the overall 23.5% CS rate. Women with one previous CS who did not attempt VBAC contributed 5.3% of the overall 23.5% CS rate. Second largest contributor was singleton nulliparous women with cephalic presentation at term (5.1% of the total 23.5%. Induction of labour was associated with higher CS rate (groups 1 and 3 (24.5% versus 11.9% and 6.2% versus 2.6%, resp.. For postdates IOL we recommend a gatekeeper booking system to minimise these being performed <41 weeks. We suggest setting up dedicated VBAC clinic to support for women with one previous CS. Furthermore review of definition of failure to progress in labour not only may lower CS rates in groups 1 and 2a but also would reduce the size of group 5 in the future.

  19. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section.

    Science.gov (United States)

    Jakobsson, Hedvig E; Abrahamsson, Thomas R; Jenmalm, Maria C; Harris, Keith; Quince, Christopher; Jernberg, Cecilia; Björkstén, Bengt; Engstrand, Lars; Andersson, Anders F

    2014-04-01

    The early intestinal microbiota exerts important stimuli for immune development, and a reduced microbial exposure as well as caesarean section (CS) has been associated with the development of allergic disease. Here we address how microbiota development in infants is affected by mode of delivery, and relate differences in colonisation patterns to the maturation of a balanced Th1/Th2 immune response. The postnatal intestinal colonisation pattern was investigated in 24 infants, born vaginally (15) or by CS (nine). The intestinal microbiota were characterised using pyrosequencing of 16S rRNA genes at 1 week and 1, 3, 6, 12 and 24 months after birth. Venous blood levels of Th1- and Th2-associated chemokines were measured at 6, 12 and 24 months. Infants born through CS had lower total microbiota diversity during the first 2 years of life. CS delivered infants also had a lower abundance and diversity of the Bacteroidetes phylum and were less often colonised with the Bacteroidetes phylum. Infants born through CS had significantly lower levels of the Th1-associated chemokines CXCL10 and CXCL11 in blood. CS was associated with a lower total microbial diversity, delayed colonisation of the Bacteroidetes phylum and reduced Th1 responses during the first 2 years of life.

  20. Central Neuraxial Blockade-Assisted External Cephalic Version in Reducing Caesarean Section Rate: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Ibrahim Bolaji

    2009-01-01

    Full Text Available We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from “excessive force-pain biofeedback loop” induced through motor nerve blockade. We can attribute 30% of cost savings amounting to £42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4. The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended.

  1. The Effect of Channa striatus (Haruan Extract on Pain and Wound Healing of Post-Lower Segment Caesarean Section Women

    Directory of Open Access Journals (Sweden)

    Siti Zubaidah Ab Wahab

    2015-01-01

    Full Text Available Channa striatus has been consumed for decades as a remedy to promote wound healing by women during postpartum period. The objectives of this study were to compare postoperative pain, wound healing based on wound evaluation scale (WES, wound cosmetic appearance based on visual analogue scale (VAS scores and patient satisfaction score (PSS, and safety profiles between C. striatus group and placebo group after six weeks of lower segment caesarean section (LSCS delivery. A randomised, double-blind, placebo-controlled study was conducted. Subjects were randomised in a ratio of 1 : 1 into either the C. striatus group (500 mg daily or placebo group (500 mg of maltodextrin daily. 76 subjects were successfully randomised, with 38 in the C. striatus group and 35 in the placebo group. There were no significant differences in postoperative pain p=0.814 and WES p=0.160 between the C. striatus and placebo groups. However, VAS and PSS in the C. striatus group were significantly better compared with the placebo group (p=0.014 and p<0.001, resp.. The safety profiles showed no significant differences between the groups. In conclusion, six-week supplementation of 500 mg of C. striatus extract showed marked differences in wound cosmetic appearance and patient’s satisfaction and is safe for human consumption.

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

    Science.gov (United States)

    Soxhuku-Isufi, Alma; Shpata, Vjollca; Sula, Hektor

    2016-03-15

    The aim of the study was to examine whether ephedrine and phenylephrine were different in their efficacy for managing maternal hypotension and their effect of adverse maternal and neonatal outcome. A double-blind randomized controlled study in healthy pregnant women ASA physical status 2, which underwent elective caesarian delivery under spinal anesthesia. Patients were randomized to receive an intravenous bolus of either phenylephrine (Ph group) or ephedrine (E group) immediately after the episode of hypotension after spinal anesthesia. Maternal and neonatal outcomes were recorded. Two hundred and two (202) pregnant women at term were entered in this study. There were no differences between group E and group Ph regarding the incidence of hypotension after vasopressor therapy, and the incidence of nausea and vomiting. There was no significant difference between groups in the first-minute and the 5th minute Apgar score, none of the neonates had the true fetal acidosis. Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension.

  3. Extending low-dose epidural analgesia in labour for emergency Caesarean section - a comparison of levobupivacaine with or without fentanyl.

    Science.gov (United States)

    Malhotra, S; Yentis, S M

    2007-07-01

    Women in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 microg.ml(-1) fentanyl followed by 10-15-ml top-ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 microg fentanyl (1.5 ml) or 1.5 ml saline. Further top-ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side-effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife-administered top-ups to patient-controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra-operative nausea/vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra-operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.

  4. Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    D. Mannaerts

    2018-01-01

    Full Text Available 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 compared. Results. Fifty-eight women were randomized (carbetocin n=32; oxytocin n=26. Both medications had hypotensive effect, difference in BP for carbetocin versus oxytocin: systolic (14.4 ± 2.4 mmHg versus 8.5 ± 1.8 mmHg; diastolic (7.8 ± 1.6 mmHg versus 8.9 ± 3.0 mmHg without significant difference between the drugs (p=0.1 and p=0.7. Both groups had similar needs for vasopressors. The presence of nausea was not rare, but the difference was not statistically significant (p=0.4. Average blood loss was slightly lower in the carbetocin group but not statistically significant (p=0.8. Conclusion. In planned CS, a possible clinical significant lower incidence of nausea after carbetocin was noted but this was not statistically significant. There were no differences regarding BP, heart rate, the need for vasopressor, and blood loss. The study was registered in the International Journal of Clinical Trials (ISRCTN 95504420, 2/2017.

  5. 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...

  6. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal–Fetal Medicine Units Network Caesarean Registry†‡

    Science.gov (United States)

    Butwick, A. J.; El-Sayed, Y. Y.; Blumenfeld, Y. J.; Osmundson, S. S.; Weiniger, C. F.

    2015-01-01

    Background Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. Methods Women undergoing Caesarean delivery between 24+0 and 36+6 weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. Results Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7–2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2–1.8), other race (aOR=1.4; 95% CI=1.1–1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2–3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1–3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. Conclusions In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery. PMID:25956901

  7. Health insurance coverage, neonatal mortality and caesarean section deliveries: an analysis of vital registration data in Colombia.

    Science.gov (United States)

    Houweling, Tanja A J; Arroyave, Ivan; Burdorf, Alex; Avendano, Mauricio

    2017-05-01

    Low-income and middle-income countries have introduced different health insurance schemes over the past decades, but whether different schemes are associated with different neonatal outcomes is yet unknown. We examined the association between the health insurance coverage scheme and neonatal mortality in Colombia. We used Colombian national vital registration data, including all live births (2 506 920) and neonatal deaths (17 712) between 2008 and 2011. We used Poisson regression models to examine the association between health insurance coverage and the neonatal mortality rate (NMR), distinguishing between women insured via the contributory scheme (40% of births, financed through payroll and employer's contributions), government subsidised insurance (47%) and the uninsured (11%). NMR was lower among babies born to mothers in the contributory scheme (6.13/1000) than in the subsidised scheme (7.69/1000) or the uninsured (8.38/1000). Controlling for socioeconomic and demographic factors, NMRs remained higher for those in the subsidised scheme (OR 1.09, 95% CI 1.05 to 1.14) and the uninsured (OR 1.16, 95% CI 1.10 to 1.23) compared to those in the contributory scheme. These differences increased in models that additionally controlled for caesarean section (C-section) delivery. This increase was due to the higher fraction of C-section deliveries among women in the contributory scheme (49%, compared to 34% for the subsidised scheme and 28% for the uninsured). Health insurance through the contributory system is associated with lower neonatal mortality than insurance through the subsidised system or lack of insurance. Universal health insurance may not be sufficient to close the gap in newborn mortality between socioeconomic groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Frequency and evaluation of the perceptions towards caesarean section among pregnant women attending public hospitals in Pakistan and the implications.

    Science.gov (United States)

    Ishaq, Rabia; Baloch, Nosheen Sikander; Iqbal, Qaiser; Saleem, Fahad; Hassali, Mohamed Azmi; Iqbal, Javeid; Ahmed, Fiaz Ud Din; Anwar, Mohammad; Haider, Sajjad; Godman, Brian

    2017-08-01

    There is increasing prevalence of caesarean sections (CS) worldwide; however, there are concerns about their rates in some countries, including potential fears among mothers. Consequently, we aimed to determine the frequency of CS, and explore patient's perception towards CS attending public hospitals in Pakistan, to provide future guidance. A two-phased study design (retrospective and cross sectional) was adopted. A retrospective study was conducted to assess the frequency of CS over one year among four public hospitals. A cross sectional study was subsequently conducted to determine patients' perception towards CS attending the four tertiary care public hospitals in Quetta city, Pakistan, which is where most births take place. Overall prevalence of CS was 13.1% across the four hospitals. 728 patients were approached and 717 responded to the survey. Although 78.8% perceived CS as dangerous, influenced by education (p = 0.004), locality (p = 0.001) and employment status (p = 0.001), 74.5% of patients were in agreement that this is the best approach to save mother's and baby's lives if needed. 62% of respondents reported they would like to avoid CS if they could due to post-operative pain, and 58.9% preferred a normal delivery. There was also a significant association with education (p = 0.001) and locality (p = 0.001) where respondents considered normal vaginal delivery as painful. The overall frequency of CS approximates to WHO recommendations, although there is appreciable variation among the four hospitals. When it comes to perception towards CS, women had limited information. There is a need to provide mothers with education during the antenatal period, especially those with limited education, to accept CS where needed.

  9. Prognostic Factors for Niche Development in the Uterine Caesarean Section Scar

    NARCIS (Netherlands)

    Voet, Lucy Lucet F van der; Vaate, A Marjolein J Bij de; Heymans, Martijn W; Brölmann, Hans A M; Veersema, Sebastiaan; Huirne, Judith A F

    In a prospective study on 134 women after their first cesarean section prognostic factors for developing an uterine niche (scar defect) measured with sonohysterography were evaluated. With multivariable logistic regression anlaysis the following prognostic factors were identified; enlarged cervical

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    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.

  12. [The change of acute phase protein haptoglobin in cattle during spontaneous labor and Caesarean section with or without torsio uteri intrapartum].

    Science.gov (United States)

    Schönfelder, Axel; Schrödl, Wieland; Krüger, Monika; Richter, Andreas; Sobiraj, Axel

    2005-01-01

    The change of haptoglobin concentration in cattle with dystocia after torsio uteri which lead to Caesarean section is regarded in contrast to haptoglobin concentrations in cattle at parturitions with undisturbed puerperium and Caesarean section without torsio uteri intra partum. Animals with natural parturition had low haptoglobin concentrations with slight changes, for a slightly increased haptoglobin concentration was seen as physiologic. Also surgical treatment such as Caesarean section did not result in changes of haptoglobin concentration. Thus, the curve of animal patients with anomalies concerning position or with a too large fetus (relatively or absolutly) was nearly identical to the curve of animals with regular parturitions over the first four days after surgery. Not before the fifth day after surgery, a moderate increase of haptoglobin could be observed. Animals with dystocia after torsio uteri intra partum showed significantly higher haptoglobin concentrations in contrast to controls over the time of investigation. The correlation of haptoglobin concentrations in animal patients with torsio uteri bin concentration shortly after surgery an additionally significant increase of haptoglobin concentration could be observed in later fertile cattles but not in later infertile cattle with torsio uteri. In two cows with torsio uteri and ovariohysterectomy haptoglobin concentrations decreased rapidly. Haptoglobin concentration may serve as an indicator for the degree of impairment of the uterus during a parturition as well as a predictor for regenerative potential.

  13. is there a safe limit of delay for emergency caesarean section in ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... groups were assessed using the Log-rank test. Tests with p< 0.05 were considered statistically significant. Statistical analysis was performed using STATA ..... Genzel-Boroviczeny O, Weninger E, et al.: Crash emergency cesarean section: decision-to-delivery interval under 30 min and its effect on Apgar and.

  14. Transversus Abdominis Plane Block in the Management of Acute Postoperative Pain Syndrome after Caesarean Section: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Fusco, Pierfrancesco; Cofini, Vincenza; Petrucci, Emiliano; Scimia, Paolo; Pozone, Tullio; Paladini, Giuseppe; Carta, Gaspare; Necozione, Stefano; Borghi, Battista; Marinangeli, Franco

    2016-01-01

    The international literature is unclear regarding the analgesic efficacy of the transversus abdominis plane block (TAPB) after a Caesarean section (CS). The aim of this study was to determine whether a correctly performed ultrasound-guided TAPB (USG-TAPB) could provide better control of acute postoperative pain during the first 72 hours after CS and if it could provide a faster postoperative recovery. A double-blind, randomized, controlled clinical trial on pregnant women who underwent CS. Pain clinic and Anesthesia and Intensive Care Unit in an academic hospital. A double-blind, randomized, controlled study was conducted with 96 patients who underwent CS. The patients in both groups received subarachnoid anesthesia (SAB) with 13 mg of 0.5% isobaric levobupivacaine. The patients were randomized so that some received USG-TAPB with local anesthetic, and the remainder received USG-TAPB with saline. The patients' demographic information and data regarding anesthesia, hemodynamic changes, side effects, acute rest and incident postoperative pain, painkiller consumption, recovery time of bowel function, and the time of hospital discharge were recorded. Our data reinforce the assumption that if TAP block is performed correctly and is part of a multimodal analgesic scheme, effective pain control is possible both for somatic and visceral acute pain. Furthermore, the need for painkillers is reduced, and their related side effects are moderate, yielding a positive benefit/cost ratio. USG-TAPB provides good analgesia for acute postoperative somatic pain, but opiates were still needed for the management of visceral acute postoperative pain. These results could confirm the assumption that the correct performance of an USG-TAPB as part of a multimodal analgesic treatment could represent a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.Key words: Bowel function, Caesarian section, incident pain, local anesthetics

  15. Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014.

    Directory of Open Access Journals (Sweden)

    Md Nuruzzaman Khan

    Full Text Available Globally the rates of caesarean section (CS have steadily increased in recent decades. This rise is not fully accounted for by increases in clinical factors which indicate the need for CS. We investigated the socio-demographic predictors of CS and the average annual rates of CS in Bangladesh between 2004 and 2014.Data were derived from four waves of nationally representative Bangladesh Demographic and Health Survey (BDHS conducted between 2004 and 2014. Rate of change analysis was used to calculate the average annual rate of increase in CS from 2004 to 2014, by socio-demographic categories. Multi-level logistic regression was used to identify the socio-demographic predictors of CS in a cross-sectional analysis of the 2014 BDHS data.CS rates increased from 3.5% in 2004 to 23% in 2014. The average annual rate of increase in CS was higher among women of advanced maternal age (≥35 years, urban areas, and relatively high socio-economic status; with higher education, and who regularly accessed antenatal services. The multi-level logistic regression model indicated that lower (≤19 and advanced maternal age (≥35, urban location, relatively high socio-economic status, higher education, birth of few children (≤2, antenatal healthcare visits, overweight or obese were the key factors associated with increased utilization of CS. Underweight was a protective factor for CS.The use of CS has increased considerably in Bangladesh over the survey years. This rising trend and the risk of having CS vary significantly across regions and socio-economic status. Very high use of CS among women of relatively high socio-economic status and substantial urban-rural difference call for public awareness and practice guideline enforcement aimed at optimizing the use of CS.

  16. 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

  17. Reliability and validity of using telephone calls for post-discharge surveillance of surgical site infection following caesarean section at a tertiary hospital in Tanzania

    Directory of Open Access Journals (Sweden)

    Boniface Nguhuni

    2017-05-01

    Full Text Available Abstract Background Surgical site infection (SSI is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved. Methodology We conducted an observational cohort study in Dodoma, Tanzania to examine the sensitivity and specificity of telephone calls to detect SSI after discharge from hospital in comparison to a gold standard of clinician review. Women undergoing caesarean section were enrolled and followed up for 30 days. Women providing a telephone number were interviewed using a structured questionnaire at approximately days 5, 12 and 28 post-surgery. Women were then invited for out-patient review by a clinician blinded to the findings of telephone interview. Results A total of 374 women were enrolled and an overall SSI rate of 12% (n = 45 was observed. Three hundred and sixteen (84% women provided a telephone number, of which 202 had at least one telephone interview followed by a clinical review within 48 h, generating a total of 484 paired observations. From the clinical reviews, 25 SSI were diagnosed, of which telephone interview had correctly identified 18 infections; telephone calls did not incorrectly identify SSI in any patients. The overall sensitivity and specificity of telephone interviews as compared to clinician evaluation was 72 and 100%, respectively. Conclusion The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.

  18. 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).

    Science.gov (United States)

    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.

  19. 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

  20. 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

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

    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

  2. A survey of women and health providers about information regarding the timing of driving a car after experiencing a caesarean section.

    Science.gov (United States)

    Sedgley, Jocelyn; Rickard, Kristen; Morris, Jonathan

    2012-08-01

    In NSW, around 30% of women experience a caesarean section. Anecdotally, few receive consistent information regarding driving after a caesarean delivery. The aims were to determine the information provided to women following caesarean section and by whom it was given, and compare this with women's actual driving behaviour. Prior to hospital discharge, 101 consenting women completed a survey of five questions documenting the information they received about when to commence driving. They were telephoned 6-8 weeks postpartum and asked when they drove and whether they experienced any problems. Following this, a staff survey was conducted to establish what information was given to women. Insurance companies and government departments were contacted for relevant polices about when women can drive postcaesarean. 100 women completed both surveys (99% of recruits); 65% were advised to wait for 6 weeks or longer before driving. However, 72% of women reported they had driven by 6 weeks, and 35% by 3 weeks. In our sample, women reported minimal discomfort and rarely discontinued driving. Returned staff surveys (n = 138) revealed inconsistent advice ranging from no advice to 8 weeks of driving abstinence. Other recommendations included following insurance company guidelines (of which there were none specific to postcaesarean) (34%), 'listen to your body and be able to perform an emergency stop' (27%). Women receive conflicting advice, and current recommendations are not reflected in women's behaviour. Women are driving earlier than advised with minimal reported complications. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  3. Prognostic Factors for Niche Development in the Uterine Caesarean Section Scar.

    Science.gov (United States)

    Voet, Lucy Lucet F van der; Vaate, A Marjolein J Bij de; Heymans, Martijn W; Brölmann, Hans A M; Veersema, Sebastiaan; Huirne, Judith A F

    2017-06-01

    In a prospective study on 134 women after their first cesarean section prognostic factors for developing an uterine niche (scar defect) measured with sonohysterography were evaluated. With multivariable logistic regression anlaysis the following prognostic factors were identified; enlarged cervical dilatation and induction of labour. Contractions before labour reduced the risk for niche development. The predictive value of the model made with this prognostic factors was low. The development of a niche is a multifactorial proces and more studies are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. 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.

    Science.gov (United States)

    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

  5. [A case of suspected dry tap during spinal anesthesia for caesarean section].

    Science.gov (United States)

    Adachi, Eriko; Mori, Gakushi; Hashimoto, Yuichi; Saito, Tomoyuki; Okuda, Keiko; Yoshida, Shinji; Arai, Takero; Okuda, Yasuhisa

    2013-08-01

    Spinal anesthesia was attempted in a 21-year-old woman for acute cesarean section with lumbar puncture at L3-4 and L4-5 in another hospital, but it was abandoned after more than 10 attempts because no cerebrospinal fluid (CSF) was seen flowing. She was transferred to our hospital, and we attempted spinal anesthesia at L2-3 and CSF was seen flowing. Although 0.5% hyperbaric bupivacaine 2.0ml was injected, the anesthetic effect was insufficient. At this point we injected 0.5% hyperbaric bupivacaine 1.5 ml in the same space and she developed sensory block up to T3. Surgery proceeded uneventfully. There were no postoperative neurological complications related to spinal anesthesia.

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

    Science.gov (United States)

    Parikh, Suchita; Tavri, Snehlata; Mohite, Shubha

    2016-01-01

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

  7. 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

    endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation. RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared...... section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary...... with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were...

  8. Premedication with midazolam prior to caesarean section has no neonatal adverse effects.

    Science.gov (United States)

    Senel, Ahmet Can; Mergan, Fatih

    2014-01-01

    Like all surgical patients, obstetric patients also feel operative stress and anxiety. This can be prevented by giving patients detailed information about their operation and with preoperative pharmacological medications. Because of depressive effects of sedatives on newborns, pharmacological medications are omitted, especially in obstetric patients. The literature contains few studies concerning preoperative midazolam use in Caesarian section (C/S) patients. Our aim in this study was to help patients undergoing C/S surgery. One group scheduled for elective C/S received midazolam 0.025 mg kg(-1) intravenously, the other received saline. Maternal anxiety was evaluated using Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores, and newborns were evaluated using Apgar and the Neonatal Neurologic and Adaptive Capacity Score (NACS). In conclusion, patients receiving midazolam 0.025 mg kg(-1) as premedication had significantly low anxiety scores, without any adverse effects on the newborns. Midazolam can therefore safely be used as a premedicative agent in C/S surgery. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. Fractional CO2 laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment

    DEFF Research Database (Denmark)

    Karmisholt, Katrine E; Taudorf, Elisabeth H; Wulff, Camilla B

    2017-01-01

    BACKGROUND AND OBJECTIVES: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS......-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue. CONCLUSIONS: Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months...

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

    Science.gov (United States)

    Scott, R

    2000-01-01

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

  11. Package of care for active management in labour for reducing caesarean section rates in low-risk women.

    Science.gov (United States)

    Brown, Heather C; Paranjothy, Shantini; Dowswell, Therese; Thomas, Jane

    2013-09-16

    Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one-to-one support in labour. To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 April 2013). Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. At least two review authors extracted data. We assessed included studies for risk of bias. We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared with the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than 12 hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups

  12. [Apgar status, blood gases and acid base balance of neonates after caesarean sections, using either thiopentone or ketamine for induction of anaesthesia (author's transl)].

    Science.gov (United States)

    Traub, E; Knoche, E; Dick, W; Völschow, E

    1977-04-01

    Apgar status and acid base balance of 206 neonates, delivered by caesarean section under general anaesthesia, were investigated in order to compare the possible effects of either thiopentone- or ketamine-induction on the postpartum adaption. Several other criteria were recorded also, for instance, a possible neonatal asphyxia, the induction-delivery-interval, the maternal age, the administration of other than anaesthetic drugs etc. There were not correlations between the Apgar status and the induction-delivery interval in either groups. The number of neonates within the 3 Apgar-classes, and the asphyxiated neonates, were equally distributed in the thiopentone- and ketamine-groups. There was no correlation between maternal ages and either the thiopentone- or ketamin-babies, but a marked correlation with the number of depressed newborns. Those neonates, who were suspected to be hypoxic before anaesthesia showed a more depressed post-partum respiration after thiopentone- than after ketamine-induction. On the other hand it seems to be that neonatal respiration and total Apgar status was more depressed if the "ketamin mothers" were treated with sedatives, hypnotics and/or analgesics before caesarean section. The blood gas values and the acid base parameters did not show a statistically significant difference between the pH of the thiopentone- and the ketamine-neonates. These differences can be explained as the combination of the nonsignificant changes in PCO2 and standard-bicarbonate values. As far as can be judged from the above mentioned criteria it may be deduced that ketamine or thiopentone can equally well be used for inducation of anaesthesia for caesarean section.

  13. Prague 1337, the first successful caesarean section in which both mother and child survived may have occurred in the court of John of Luxembourg, King of Bohemia.

    Science.gov (United States)

    Pařízek, A; Drška, V; Říhová, M

    An interdisciplinary historical-medical study, analysis of historical sources, and critical interpretation of the indirect evidence surrounding the childbirth of Beatrice of Bourbon, the second wife of the Bohemian King John of Luxembourg. A material-based study founded on a comparative analysis of available private and public sources, particularly surviving letters, and narrative sources. The conclusions are reached based on a textual interpretation according to historical methods. Department of Obstetrics and Gynecology of the First Faculty of Medicine of Charles University and General University Hospital in Prague. Until the second half of the 19th century, medical knowledge of antiseptics and anesthesia was lacking, and techniques for cleaning wounds and staunching bleeding were primitive.Because no effective anesthetics were known before that time, people did not know how to perform painless abdominal surgery. There are a very few credible reports of caesarean sections performed on living women as early as the 17th century. However, before the 19th century, a caesarean section meant almost certain death for the mother, with related mortality as high as 90%. If the woman did not die of stress from the pain of the abdominal surgery, then she usually died of either bleeding or later of sepsis. However, there is some indirect evidence that the first caesarean section that was survived by both the mother and child was performed in Prague in 1337. The mother was Beatrice of Bourbon (1318-1383), the second wife of the King of Bohemia John of Luxembourg (1296-1346). Beatrice gave birth to the kings son Wenceslaus I (1337-1383), later the duke of Luxembourg, Brabant, and Limburg, and who became the half brother of the later King of Bohemia and Holy Roman Emperor, Charles IV (1316-1378). From a historical analysis based on the indirect evidence, it is not possible to unequivocally determine whether a caesarean section that was survived by both the mother and child was

  14. 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 (<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 quintile

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

    Science.gov (United States)

    Kolokotroni, Ourania; Middleton, Nicos; Gavatha, Marina; Lamnisos, Demetris; Priftis, Kostas N; Yiallouros, Panayiotis K

    2012-11-16

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

  16. 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

    OpenAIRE

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

    2009-01-01

    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 be...

  17. A prospective, randomized comparison of the effects of thiopental and propofol on bispectral index during caesarean section till delivery of newborn.

    Science.gov (United States)

    Mercan, Arzu; El-Kerdawy, Hala; Khalil, Mohamed; Al-Subaie, Hannan; Bakhamees, Hassan Salem

    2012-06-01

    Since in caesarean operations skin incision to delivery time is very short, induction agent could be still effective on BIS level till the time of delivery. Therefore this study was designed to analyze the effect on maintaining adequate bispectral index levels till delivery of neonate of propofol and thiopental as an induction agent for caesarean section. Eighty two patients undergoing caesarean section were allocated into two groups. In the group T anesthesia induction was performed with thiopental (5 mg/kg) and in the group P with propofol (2.5 mg/kg). Anesthesia was maintained with sevoflurane. Heart rates, blood pressures and BIS values during significant events of surgery and anesthesia till delivery, durations of surgery, induction to skin incision and to delivery and Apgar scores were recorded. For statistical analysis T-test was used for comparison of means of independent samples. The groups were comparable with respect to age, weight and gestational age. The patients in the group P had significantly lower levels of bispectral index values during uterus incision; 40.6 vs. 59.5 (p = 0.019) and delivery; 41 vs. 62.9 (p = 0.018). Anesthesia induction with propofol in a dose of 2.5 mg/kg maintains lower levels of heart rate, blood pressure and BIS till delivery when compared with thiopental in a dose of 5 mg/kg. There is no financial support taken from any kind of company or person. There are no financial relationships between authors and commercial interests with a vested interest in the outcome of study.

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

    DEFF Research Database (Denmark)

    Basso, Olga; Baird, Donna D.

    2003-01-01

    BACKGROUND: More than 10% of babies are born to couples taking >1 year to conceive (a common definition of infertility). Some evidence indicates that such pregnancies are at increased risk of preterm delivery and other adverse birth outcomes, but the problem has rarely been addressed in large...

  19. High weight gain during pregnancy increases the risk for emergency caesarean section - Population-based data from the Swedish Maternal Health Care Register 2011-2012.

    Science.gov (United States)

    Nilses, Carin; Persson, Margareta; Lindkvist, Marie; Petersson, Kerstin; Mogren, Ingrid

    2017-03-01

    The aim was to investigate maternal background factors' significance in relation to risk of elective and emergency caesarean sections (CS) in Sweden. Population-based, retrospective, cross-sectional study. The Swedish Maternal Health Care Register (MHCR) is a national quality register that collects data on pregnancy, delivery and postpartum period. All women registered in MHCR 2011 to 2012 were included in the study sample (N = 178,716). The risk of elective and emergency caesarean section in relation to age, parity, education, country of origin, weight in early pregnancy and weight gain during pregnancy was calculated in logistic regression models. Multiparous women demonstrated a doubled risk of elective CS compared to primiparous women, but their risk for emergency CS was halved. Overweight and obesity at enrolment in antenatal care increased the risk for emergency CS, irrespective of parity. Weight gain above recommended international levels (Institute of Medicine, IOM) during pregnancy increased the risk for emergency CS for women with normal weight, overweight or obesity. There is a need of national guidelines on recommended weight gain during pregnancy in Sweden. We suggest that the usefulness of the IOM guidelines for weight gain during pregnancy should be evaluated in the Swedish context. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Effect of hypertonic sodium chloride hydroxyethyl starch 40 on ET, TXB2, 6-keto-PGF1α, and ANP of preeclampsia in caesarean section.

    Science.gov (United States)

    Wang, T; Jiang, l H; Zhu, J B; Wei, X Y; Li, L; Liu, B

    2015-01-01

    Preeclampsia is a unique disease of pregnancy. Delivery via caesarean section is the most important way of terminating the pregnancy and treating preeclampsia. Perioperative fluid therapy is performed to maintain the circulatory volume and reduce tissue edema. This study evaluated the effects of hypertonic sodium chloride hydroxyethyl starch 40 (HSH40) as perioperative fluid therapy for preeclampsia patients. Forty preeclamptic women were randomly divided into two groups: the Ringer's solution group and the HSH40 group. Their ECG, HR, MAP, and SPO2 were monitored. Their MVP and HR were recorded at five, eight, and ten minutes after anesthesia induction and at the end of the caesarean section. The corresponding volume of infusion, blood loss, and urine output during the operation were also recorded. Venous samples were collected before HSH40 infusion and 30 min after infusion to measure the plasma concentrations of ET, TXB2, 6-keto-PGF1α, and ANP via a radioimmunoassay. HSH40 infusion significantly decreased the plasma ET levels (p ANP and TXB2 levels (p ANP, TXB2, and 6-keto-PGF1α did not significantly change in the control group. Compared with T1, MAP decreased significantly at T2, T3, T4, and T5 within groups (p ANP) during preeclampsia. It effectively maintains and stabilizes the circulating blood volume, increasing renal blood flow, which improves renal function and increases urine output.

  1. Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Gholipour Baradari, Afshin; Firouzian, Abolfazl; Hasanzadeh Kiabi, Farshad; Emami Zeydi, Amir; Khademloo, Mohammad; Nazari, Zeinab; Sanagou, Masoumeh; Ghobadi, Maedeh; Fooladi, Ensieh

    2017-07-01

    We conducted a randomised double-blind, placebo-controlled trial to assess whether a bolus dose of lidocaine during the induction of general anaesthesia would reduce postoperative pain over 24 h. Level of satisfaction with pain control at 48 h after surgery and Apgar score were also examined. A total of 100 women aged 20-35 years, who were candidates for elective caesarean section (CS) were randomised to receive either 1.5 mg/kg lidocaine or placebo during the induction of general anaesthesia. Results showed that lidocaine decreased pain intensity over 24 h after surgery (p information regarding the efficacy of a bolus dose of lidocaine in patients undergoing caesarean section (CS). In this randomized, placebo-controlled trial the use of a bolus dose of 1.5 mg/kg lidocaine 2%, compared with placebo, during the induction of general anaesthesia for elective CS resulted in a significant decrease in postoperative pain score as well as decreased postoperative morphine consumption over 24 h. Lidocaine use was not associated with any side effect in participants and newborns. • This study provides the first evidence that a bolus dose of lidocaine may be a safe and simple alternative therapeutic intervention for enhanced postoperative recovery in terms of pain and postoperative opioid consumption. Future studies are needed to examine pain reducing effect of perioperative bolus dose of lidocaine after CS under spinal or epidural anesthesia.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  4. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Kolokotroni Ourania

    2012-11-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

    Science.gov (United States)

    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; van den Berg, P P; Groen, H

    2016-08-01

    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. Secondary analysis of data from two randomised clinical trials. Data were collected in two nationwide Dutch trials. Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6. Comparison of outcomes after induction of labour and expectant management. Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH seizures and/or perinatal death. Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32. We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted. Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome. © 2016 Royal College of Obstetricians and Gynaecologists.

  8. Comparison between two phenylephrine infusion rates with moderate co-loading for the prevention of spinal anaeshtesia-induced hypotension during elective caesarean section.

    Science.gov (United States)

    Ansari, Tarek; Hashem, Medhat M; Hassan, Ahmed A; Gamassy, Ahmed; Saleh, Ayad

    2011-10-01

    Phenylephrine induces maternal bradycardia in 50% of mothers when used for prevention and treatment of spinal anaesthesia-induced hypotension during caesarean delivery. Rapid fluid administration immediately after initiation of the spinal block (co-loading) may have a vasopressor sparing effect. The aim of this study was to evaluate the hypothesis that when using rapid crystalloid co-loading, an infusion of 50 mcg/minute of PE could be as effective as 100 mcg/minute in preventing maternal hypotension but with minimal maternal bradycardia and an acceptable fetal outcome. 117 mothers scheduled for elective caesarean section were recruited in this randomized controlled trial. Co-loading with 10 ml/kg of Hartmann's solution started immediately after a standard spinal anaesthesia. Parturients were then randomly allocated into two groups. Group 50 (n = 54) received phenylephrine infusion at 50 microg/min, and group 100 (n=63) 100 microg/min. Rescue phenylephrine boluses (50 mcg) were administered if needed to maintain systolic blood pressure between 80-100% of its baseline values. Systolic blood pressure was not different between mothers in both groups during the study period. All neonatal Apgar scores at 1 minute were > or =7 and at 5 minutes were > or =9. No mother had umbilical arterial pH <7.2. Umbilical arterial and venous blood gas and acid base values were not different between both groups except the umbilical arterial PCO2 that was significantly higher in group 100. There were more frequent episodes of maternal bradycardia in Group 100 than in Group 50 (eleven and one parturients respectively). There was no difference in the incidence of nausea and vomiting in both groups. In combination with rapid co-loading, an infusion rate of 50 microg/min of PE is as adequate as 100 microg/min in prevention of spinal anaesthesia-induced hypotension during elective caesarean section. Both infusions are associated with a similar neonatal outcome. PE infusion of 50 microg

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

    Directory of Open Access Journals (Sweden)

    Yasmine El-Masry

    2015-01-01

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

  10. 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...

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Michael Affolter

    2016-08-01

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

  13. 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

    NARCIS (Netherlands)

    Offerhaus, P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Hukkelhoven, C.W.P.M.; Scheepers, P.L.H.; Lgero-Jansen, A.L.M.

    2014-01-01

    OBJECTIVE: 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. DESIGN: nationwide descriptive study. SETTING: the Netherlands Perinatal Registry. PARTICIPANTS: 789,795 births of nine year

  14. 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

    NARCIS (Netherlands)

    Offerhaus, P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Hukkelhoven, C.W.P.M.; Scheepers, P.L.; Lagro-Janssen, A.

    2014-01-01

    OBJECTIVE: 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. DESIGN: nationwide descriptive study. SETTING: the Netherlands Perinatal Registry. PARTICIPANTS: 789,795 births of nine year

  15. Change in primary midwife-led care in the Netherlands in 2000-2008: A descriptive study of caesarean sections and other interventions among 807,437 low-risk births

    NARCIS (Netherlands)

    Offerhaus, P.M.; Jonge, A. de; Pal-de-Bruin, K.M. van der; Hukkelhoven, C.W.P.M.; Scheepers, P.L.; Lagro-Janssen, A.

    2015-01-01

    OBJECTIVE: 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. DESIGN: nationwide descriptive study. SETTING: The Netherlands Perinatal Registry. PARTICIPANTS: 807,437 births of nine year

  16. Change in primary midwife-led care in the Netherlands in 2000-2008: A descriptive study of caesarean sections and other interventions among 807,437 low risk births

    NARCIS (Netherlands)

    Offerhaus, P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Hukkelhoven, C.W.P.M.; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2015-01-01

    Objective: 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. Design: nationwide descriptive study. Setting: The Netherlands Perinatal Registry. Participants: 807,437 births of nine year

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

    Science.gov (United States)

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

    2016-11-01

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

  18. 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 (ORadj 1.94, 95% CI 1.57-2.47) but less likely to succeed (ORadj 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.

  19. 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 control group used 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 control group (p 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.

  20. Evaluation of psychosocial and biological parameters in women seeking for a caesarean section and women who are aiming for vaginal delivery: a cross-sectional study.

    Science.gov (United States)

    Tuschy, Benjamin; Berlit, Sebastian; Stützer, Paul; Lis, Stefanie; Schmahl, Christian; Baumgärtner, Ulf; Sütterlin, Marc

    2018-01-17

    To investigate psychosocial and biological parameters that may influence decision-making concerning the mode of delivery in women with caesarean section on maternal request (CSMR). Two hundred and two women were enrolled prospectively. The study sample (n = 93) consisted of women who aimed for CSMR, the control sample were women who seeked for vaginal delivery (n = 109). Parturients of both samples were enrolled during the pre-birth counselling at the delivery room at the University Medical Centre Mannheim, University Heidelberg, Germany. Women completed standardised questionnaires regarding psychosocial burden (SCL-R 90), fear of childbirth (W-DEQ) and anxiety (STAI), personality structure (HEXACO-Pi-R), and ambiguity tolerance (PFI, PNS, and NFC), social support (F-SozU) as well as one questionnaire assessing demographic parameters and further factors potentially influencing their choice of the mode of delivery. Hair cortisol concentration as a marker for chronic psychological stress and pressure pain threshold with a pressure algometer was assessed. Women in the CSMR sample had less social support (F-SozU: 2.99 ± 0.52 vs. 3.12 ± 0.32; p = 0.043) and were less educated (high school or university degree: 37 vs. 71%, p = 0.001) compared to parturients of the control sample. Women who underwent CSMR were less open-minded (HEXACO-Pi-R: 3.08 ± 0.57 vs. 3.26 ± 0.50; p = 0.016) and less extroverted (HEXACO-Pi-R: 3.34 ± 0.36 vs. 3.46 ± 0.41; p = 0.041). The control collective showed higher scores in negative appraisal of the birth ('W-DEQ-negative appraisal': 2.5 ± 0.8 vs. 2.2 ± 0.9; p = 0.006), whereas "lack of positive anticipation" was higher in the study collective ('W-DEQ-lack of positive anticipation': 3.2 ± 1.2 vs. 2.8 ± 0.8; p = 0.015). The study collective had higher pressure pain threshold values (5.07 ± 2.06 vs. 4.35 ± 1.38; p = 0.007), while no significant differences were observed in hair cortisol

  1. 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

  2. Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial.

    Science.gov (United States)

    Nooh, Ahmed Mohamed; Abdeldayem, Hussein Mohammed; Ben-Affan, Othman

    2017-05-01

    The objective of this study was to assess effectiveness and safety of the reverse breech extraction approach in Caesarean section for obstructed labour, and compare it with the standard approach of pushing the fetal head up through the vagina. This randomised controlled trial included 192 women. In 96, the baby was delivered by the 'reverse breech extraction approach', and in the remaining 96, by the 'standard approach'. Extension of uterine incision occurred in 18 participants (18.8%) in the reverse breech extraction approach group, and 46 (47.9%) in the standard approach group (p = .0003). Two women (2.1%) in the reverse breech extraction approach group needed blood transfusion and 11 (11.5%) in the standard approach group (p = .012). Pyrexia developed in 3 participants (3.1%) in the reverse breech extraction approach group, and 19 (19.8%) in the standard approach group (p = .0006). Wound infection occurred in 2 women (2.1%) in the reverse breech extraction approach group, and 12 (12.5%) in the standard approach group (p = .007). Apgar score vagina.

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

    Science.gov (United States)

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

    2009-09-01

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

  4. Does elevating the fetal head prior to delivery using a fetal pillow reduce maternal and fetal complications in a full dilatation caesarean section? A prospective study with historical controls.

    Science.gov (United States)

    Seal, S L; Dey, A; Barman, S C; Kamilya, G; Mukherji, J

    2014-04-01

    A caesarean section at full dilatation (CSFD) can be technically demanding and has consistent association with increased intraoperative trauma. There is evidence that the incidence of caesarean sections at full dilation is on the rise. We report on a prospective study of 50 women undergoing CSFD using a fetal pillow (FP) to elevate the fetal head. Data were compared with historical controls of 124 women without FP use on uterine extensions, uterine incision delivery interval, blood loss, need for transfusion, operating time, length of stay, intensive care unit admission. The FP elevated the fetal head in all 50 women (p 1,000 ml and admission to ICU was also lower but were not statistically significant. There were no significant differences in the fetal complications studied, APGAR scores, admission to neonatal intensive care unit, seizures, neonatal injury or death.

  5. Investigation of effect of blood pressure and heart rate changes in different positions (lying and sitting on hypotension incidence rate after spinal anesthesia in patients undergoing caesarean section

    Directory of Open Access Journals (Sweden)

    Nahid Manouchehrian

    2016-07-01

    Full Text Available Due to the relatively high prevalence of hypotension (20% -40% after spinal anesthesia as well as the adverse effects of hypotension on mother and baby, it is better to prevent hypotension as much as possible. Therefore, this study is aimed to determine the relationship between postural blood pressure and heart rate changes and hypotension incidence rate after spinal anesthesia in cesarean section.63 women aging18 to 45years old with fullterm pregnancy, who were candidate for caesarean section with spinal anesthesia, entered the study. Afterwards, the diastolic, systolic, and mean arterial pressures as well as the heart rate (pulse in different positions (sitting, lying, and left lateral were measured. After spinal anesthesia, the patients' blood pressure was measured and recorded every minute until the10thmin, then every 3 minute until the15thmin, and then every 5 minute until the end of cesarean section. Data analysis was performed using SPSS (ver. 19 software, descriptive statistics, one-way ANOVA, and post hoc Bonferroni test. In this study, the hypotension incidence rate was 30% and the orthostatic variation rate of the systolic blood pressure in more than half of the people was between 4.39 to 13.49psi, which showed the highest variation compared to the diastolic pressure, mean arterial blood pressure (or: mean arterial pressure [MAP], and heart(pulse. Considering the correlation coefficient of 0.27, the systolic blood pressure in the lateral position has the highest relationship with the incidence of hypotension. The postural systolic blood pressure changes in patients prior to the spinal anesthesia can be a predictive factor for the post-spinal hypotension incidence.

  6. 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.

  7. 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 ...

  8. Anesthetic management of Wolff-Parkinson-White syndrome in a pregnant patient posted for emergency caesarean section.

    Science.gov (United States)

    Palaria, Urmila; Rasheed, Mohd A; Jain, Geeta; Sinha, A K

    2013-01-01

    The most common arrhythmia seen during pregnancy is paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome accounts for majority of this in such population. The presence of pre-disposing factors may facilitate the onset of tachyarrhythmias in previously asymptomatic parturients with the WPW syndrome such as increased hemodynamic, hormonal, autonomic, and emotional changes. Therefore, meticulous monitoring is essential perioperatively. Epidural anesthesia providing added advantage of hemodynamic stability and post-operative analgesia is preferred in such pregnant patients undergoing emergency cesarean section.

  9. [Emergent Caesarean Section in a Patient with a Mediastinal Tumor and Von Recklinghausen Disease: A Case Report].

    Science.gov (United States)

    Owada, Mayuko; Inomata, Shinichi; Danmura, Masato; Yamada, Kumiko; Tanaka, Makoto

    2016-06-01

    It is rare to encounter a pregnant patient with a mediastinal tumor, and if the tumor size increases as the pregnancy progresses, this increase can cause complications such as airway constriction and vascular occlusion. We report a case of a pregnant patient diagnosed with von Recklinghausen disease at the age of seven and diagnosed with a mediastinal tumors just after her present admission. The impending suffocation progressed and fetal heart rate decreased during her hospitalization. Her trachea was intubated and she was moved to an operating room for an emergent cesarean section under general anesthesia. With this rapid response, we could rescue both patient and infant. If the size of mediastinal tumor increases as pregnancy progresses, the tumor will cause suffocation by airway compression from the outside, in addition to specific airway edema on the inward side. The present case demonstrates that appropriate desisoins must be made for airway manegement and initiation of surgery.

  10. Maternal and anaesthesia-related risk factors and incidence of spinal anaesthesia-induced hypotension in elective caesarean section: A multinomial logistic regression

    Directory of Open Access Journals (Sweden)

    Atousa Fakherpour

    2018-01-01

    Full Text Available Background and Aims: Although spinal anaesthesia (SA is nowadays the preferred anaesthesia technique for caesarean section (CS, it is associated with considerable haemodynamic effects, such as maternal hypotension. This study aimed to evaluate a wide range of variables (related to parturient and anaesthesia techniques associated with the incidence of different degrees of SA-induced hypotension during elective CS. Methods: This prospective study was conducted on 511 mother–infant pairs, in which the mother underwent elective CS under SA. The data were collected through preset proforma containing three parts related to the parturient, anaesthetic techniques and a table for recording maternal blood pressure. It was hypothesized that some maternal (such as age and anaesthesia-related risk factors (such as block height were associated with occurance of SA-induced hypotension during elective CS. Results: The incidence of mild, moderate and severe hypotension was 20%, 35% and 40%, respectively. Eventually, ten risk factors were found to be associated with hypotension, including age >35 years, body mass index ≥25 kg/m2, 11–20 kg weight gain, gravidity ≥4, history of hypotension, baseline systolic blood pressure (SBP 100 beats/min in maternal modelling, fluid preloading ≥1000 ml, adding sufentanil to bupivacaine and sensory block height >T4in anaesthesia-related modelling (P < 0.05. Conclusion: Age, body mass index, weight gain, gravidity, history of hypotension, baseline SBP and heart rate, fluid preloading, adding sufentanil to bupivacaine and sensory block hieght were the main risk factors identified in the study for SA-induced hypotension during CS.

  11. Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study.

    Science.gov (United States)

    Różańska, Anna; Jarynowski, Andrzej; Kopeć-Godlewska, Katarzyna; Wójkowska-Mach, Jadwiga; Misiewska-Kaczur, Agnieszka; Lech, Marzena; Rozwadowska, Małgorzata; Karwacka, Marlena; Liberda, Joanna; Domańska, Joanna

    2018-01-01

    Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Betrán, Ana Pilar; Vindevoghel, Nadia; Souza, Joao Paulo; Gülmezoglu, A Metin; Torloni, Maria Regina

    2014-01-01

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

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

    Science.gov (United States)

    Jacob, Louis; Taskan, Sevil; Macharey, George; Sechet, Ingeborg; Ziller, Volker; Kostev, Karel

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jacob, Louis

    2016-06-01

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

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

    African Journals Online (AJOL)

    data were pooled and used to analyse the clinical information. Results: There were ... These high rates are probably due to large proportions of high-risk patients .... heart rate monitoring by cardiotocograph (CTG). The patient was not in ..... of CPD and medical complications in pregnancy, and cultural attitudes towards CS.

  16. [Preoperative risk factors analysis of pulmonary hypertension crisis during perioperative period for caesarean section of woman with severe pulmonary hypertension].

    Science.gov (United States)

    Zhang, Chunlei; Liu, Yaguang; Qing, Enming; Ma, Jun

    2017-05-01

    To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not. Through the case management system, age, height, weight, gestational age, pregnancy time, type of PAH, emergency or selective surgery, New York Heart Association (NYHA) cardiac function classification, and preoperative ultrasound left ventricular ejection fraction (LVEF), left ventricular diastolic final diameter (LVEDD), the pulmonary artery systolic pressure (sPAP) estimated by ultrasonic TI method, radial artery systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2) without oxygen, oral sildenafil ingestion, having Swan-Ganz catheter placement or not, and whether used norepinephrine or not, as well as the occurrence of perioperative PHC and clinical outcomes were collected. Possible preoperative risk factors were compared between the two groups by single factor and multiple factors logistic regression analysis. The receiver-operating characteristic curve (ROC) was plotted to assess the diagnostic value of various risk factors. A total of 152 patients were screened. Ten patients got heart surgery under general anesthesia at the same time, and 4 patients experiencing cesarean section with general anesthesia were excluded. 138 patients were enrolled finally, 27 patients underwent perioperative PHC (19.57%), and 17 patients died with a mortality of 62.96%. Compared with non-PHC group, the patients in PHC group were older (years: 25.07±3.55 vs. 27.64±4.82), had a poor cardiac function (NYHA cardiac function

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

    African Journals Online (AJOL)

    AJRH Managing Editor

    Mots-clés: grossesse de la cicatrice césarienne, approche chirurgicale guidée de l'échographie transrectale. Introduction. Caesarean scar pregnancy (CSP) occurs when an embryo implants in a previous caesarean section scar. It has a reported incidence of 1 in 18001 and was first reported by Larson and Solomon in ...

  18. 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 ...

  19. Emergency Caesarean delivery in prolonged obstructed labour as ...

    African Journals Online (AJOL)

    Birth fractures predominantly affect the clavicle, humerus or femur. Brachial plexus injury may co-exist with humeral or clavicular fractures. From January 2002 to December 2010, 8 neonates with fractures after caesarean section were treated under the supervision of the first author following obstructed labour and caesarean ...

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

    African Journals Online (AJOL)

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

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

    Directory of Open Access Journals (Sweden)

    Melman Sonja

    2013-01-01

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

  2. The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Anette Hein

    2017-11-01

    Full Text Available Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS. A Decision to Delivery Interval (DDI <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA, spinal anaesthesia (SPA with opioid supplementation, or “top-up” of labour epidural analgesia (tEDA with local anaesthesia and fentanyl mixture and work shift for ECS at Danderyds Hospital, Sweden. Methods: A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday – Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. Results: In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005. DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5’ was more commonly seen in ECS having GA (11 out of 64 compared to SPA (2/30 and tEDA (1/41 (p<0.05. Conclusion: GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI.

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

    African Journals Online (AJOL)

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

  4. Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002-2014

    DEFF Research Database (Denmark)

    Orbaek, M.; Thorsteinsson, K.; Helleberg, M.

    2017-01-01

    OBJECTIVES: We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS: All WLWH giving birth to live...... in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective......, more than half of WLWH planned to deliver vaginally. Prior caesarean section was associated with ECS (aOR 11.0; 95% CI 4.5-26.8). No mother-to-child transmission occurred. CONCLUSIONS: Increasing numbers of WLWH deliver vaginally. Despite virological suppression, more WLWH plan and deliver by ECS than...

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

    DEFF Research Database (Denmark)

    Laursen, M; Johansen, C; Hedegaard, M

    2009-01-01

    OBJECTIVES: To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress. DESIGN: Prospective cohort study. SETTING: Danish National Birth Cohort. POPULATION: A total of 25 297 healthy...

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

    Directory of Open Access Journals (Sweden)

    Kidanto Hussein L

    2009-07-01

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

  7. Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth.

    OpenAIRE

    Tully, Kristin P.; Ball, Helen L.

    2014-01-01

    Background: breast-feeding outcomes are often worse after caesarean section compared to vaginal childbirth. Objectives: this study characterises mothers' breast-feeding intentions and their infant feeding experiences after caesarean childbirth. Methods: data are from 115 mothers on a postnatal unit in Northeast England during February 2006–March 2009. Interviews were conducted an average of 1.5 days (range 1–6 days) after the women underwent unscheduled or scheduled caesarean. Result...

  8. The effect of an electronic cognitive aid on the management of ST-elevation myocardial infarction during caesarean section: a prospective randomised simulation study.

    Science.gov (United States)

    St Pierre, Michael; Luetcke, Bjoern; Strembski, Dieter; Schmitt, Christopher; Breuer, Georg

    2017-03-20

    Cognitive aids have come to be viewed as promising tools in the management of perioperative critical events. The majority of published simulation studies have focussed on perioperative crises that are characterised by time pressure, rare occurrence, or complex management steps (e.g., cardiac arrest emergencies, management of the difficult airway). At present, there is limited information on the usefulness of cognitive aids in critical situations with moderate time pressure and complexity. Intraoperative myocardial infarction may be an emergency to which these limitations apply. Anaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. The primary aim of this study was to compare cognitive aid versus memory for intraoperative ST-elevation myocardial infarction (STEMI) management in a simulation of caesarean delivery under spinal anaesthesia. We identified nine evidence-based metrics of essential care from current guidelines and subdivided them into mandatory (high level of evidence; no interference with surgery) and optional (lower class of recommendation; possible impact on surgery) tasks. Six clinically relevant tasks were added by consensus. Implementation of these steps was measured by scoring task items in a binary fashion (yes/no). The interval between the diagnosis of STEMI and the first contact with the cardiac catheterisation lab was measured. To determine whether or not the cognitive aid had prompted an action, participants from the cognitive aid group were interviewed during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey. The presence of the cognitive aid did not shorten the time interval until the cardiac catheterisation lab was contacted. The availability of the cognitive aid improved task performance in the tasks identified from the guidelines (93% vs. 69%; p management of intraoperative ST

  9. Cesáreas en siete hospitales públicos de Lima: análisis de tendencia en el periodo 2001-2008 Caesarean section among seven public hospitals at Lima: trend analysis during 2001-2008 period

    Directory of Open Access Journals (Sweden)

    Antonio M. Quispe

    2010-03-01

    Full Text Available Objetivo. Analizar la tendencia de la "tasa de cesáreas" (TC mensual en todos los hospitales de la Dirección de Salud (DISA V Lima-Ciudad desde el año 2001 al 2008, y determinar los patrones característicos. Material y métodos. Estudio de tipo ecológico en el que se revisaron los reportes mensuales de todos los hospitales que prestan atención de partos en la DISA V Lima-Ciudad y se analizó la tendencia de la razón mensual de cesáreas o TC mensual (TCM = total de partos cesáreas atendidos en un mes * 100 / total de recién nacidos en el mismo mes con el objeto de identificar sus patrones característicos. Resultados. Se encontró que durante el periodo total del estudio la TCM promedio fue de 36,9 % ± 9,1% (rango: 16,5%-71,4%. Entre los años 2001 (TCM: 33,5% ± 6,9%, y 2008 (TCM: 39,7% ± 8,3% se registró un incremento promedio del 6,9% ± 7,0%, alcanzándose un incremento del 7,7% ± 6,4% en el año 2007 (TCM: 43,5% ± 9,8%. En la mayoría de los hospitales, se registró un aumento significativo de la TCM entre los años 2004 y 2005. Analizando la variación anual de las TCM se observó que éstas tienden a incrementarse en los meses de abril (37,9% ± 9,7% y septiembre (40,2% ± 8,9%, ciclo que se ha repetido en la mayoría de los centros hospitalarios bajo estudio. Conclusiones. La TCM de los hospitales de la DISA V Lima-Ciudad supera largamente el límite recomendado por la Organización Mundial de la Salud (OMS y durante los años de estudio ha mantenido una tendencia significativamente creciente.Objective. To analyze the trend of the monthly "caesarean section rate" (CSR at the DISA V Lima-Ciudad Hospitals during the period 2001 - 2008. Material and methods. Ecological study that aim to analyze the monthly reports of all DISA V Lima-Ciudad Hospitals that attends childbirths, and by analyzing the trend of theirs monthly caesarean section ratio or monthly CSR (TCM = total caesarean births in a month * 100 / total number of

  10. Emergency caesarean delivery in prolonged obstructed labour as risk factor for obstetric fractures--a case series.

    Science.gov (United States)

    Ogbemudia, Alfred O; Ogbemudia, Ehimwenma J

    2012-09-01

    Birth fractures predominantly affect the clavicle, humerus or femur. Brachial plexus injury may co-exist with humeral or clavicular fractures. From January 2002 to December 2010, 8 neonates with fractures after caesarean section were treated under the supervision of the first author following obstructed labour and caesarean delivery. The most classical of the cases is a vertex-presenting neonate who was delivered by caesarean section for obstructed labour in a primipara in whom ipsilateral klumpke's palsy and fractures of the clavicle and humerus were confirmed. Literature review did not consider emergency caesarean delivery as one of the predisposing factors for such birth injuries. This case series, in addition to presenting emergency caesarean section as a predisposing factor for birth injuries, offers to suggest a manoeuvre that may reduce severity and rate of birth injuries in caesarean section for obstructed labour in our environment where obstructed labour is still rife.

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

    African Journals Online (AJOL)

    The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5). Conclusion: Women who have one previous C.section face a markedly increased risk of repeat caesarean sections and feto.maternal complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of ...

  12. Assessment of an updated double-vasopressor automated system using Nexfin for the maintenance of haemodynamic stability to improve peri-operative outcome during spinal anaesthesia for caesarean section.

    Science.gov (United States)

    Sng, B L; Wang, H; Assam, P N; Sia, A T

    2015-06-01

    Hypotension occurs commonly during spinal anaesthesia for caesarean section, associated with maternal and fetal adverse effects. We developed a double-vasopressor automated system with a two-step algorithm and continuous non-invasive haemodynamic monitoring using the Nexfin device. The system delivered 25 μg phenylephrine every 30 s when systolic blood pressure was between 90% and 100% of baseline, or 2 mg ephedrine at this blood pressure range and heart rate anaesthesia. Twenty-seven (47.4%) had at least one reading of hypotension defined as systolic blood pressure < 80% baseline. Systolic blood pressure was within 20% of the baseline in a mean (SD) of 79.8 (20.9)% of measurements. Fifty-three (93.0%) women required phenylephrine before delivery while 10 (17.5%) required ephedrine. Six women (10.5%) experienced nausea and three (5.3%) vomited. The system was able to achieve a low incidence of maternal hypotension with good maternal and fetal outcomes. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  13. Ability of non-invasive intermittent blood pressure monitoring and a continuous non-invasive arterial pressure monitor (CNAP™) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia.

    Science.gov (United States)

    McCarthy, T; Telec, N; Dennis, A; Griffiths, J; Buettner, A

    2012-03-01

    We compared the ability of automated non-invasive intermittent oscillometric blood pressure monitoring with a new device, CNAP(TM) (continuous non-invasive arterial pressure) to provide a new blood pressure reading in each 1-min interval between spinal anaesthesia and delivery during caesarean section. We also compared the accuracy of continuous non-invasive arterial pressure readings with non-invasive blood pressure measurements before spinal anaesthesia. Fifty-nine women participated. The non-invasive and continuous non-invasive monitors displayed new blood pressure readings in a mean of 82% (11%) and 83% (13%) (p = 0.97) of the one-minute intervals between spinal anaesthesia and delivery, respectively. Continuous non-invasive arterial pressure was more likely to fail on two or more consecutive minutes (p=0.001). From the pre-spinal readings, the mean bias, defined as non-invasive-continuous non-invasive arterial pressure, and limits of agreement (±2SD mean bias) for systolic, diastolic and mean blood pressure respectively were +1.3 (±26.0), -2.9 (±21.8) and +2.6 (±20.4) mmHg. The new monitor has disadvantages compared with conventional non-invasive intermittent blood pressure monitoring. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  14. The impact of colloid infusion prior to spinal anaesthesia for caesarean section on the condition of a newborn--a comparison of balanced and unbalanced hydroxyethyl starch 130/0.4.

    Science.gov (United States)

    Marciniak, Andrzej; Wujtewicz, Maria; Owczuk, Radosław

    2013-01-01

    Fluid therapy is the most commonly used treatment to prevent hypotension associated with spinal anaesthesia. The aim of this study was to test the hypothesis that a balanced solution of 6% hydroxyethyl starch will have a more beneficial impact on the condition of newborns at birth than an unbalanced 6% solution of HES. The study participants included 51 healthy parturients undergoing elective caesarean section with spinal anaesthesia. Patients received a transfusion of 500 mL of unbalanced 6% HES (Voluven) or balanced 6% HES (Tetraspan) prior to anaesthesia. The condition of the newborn was assessed using the Apgar score, and the acid-base balances of venous and arterial umbilical cord blood were also measured. The incidence of hypotension after spinal anaesthesia was 80% in Group A and 76.9% in Group B (P = 1.0). There were no differences between the two groups in the total doses of ephedrine and no differences between treatment groups in Apgar scores. Also, no differences in acid-base balance parameters (pH, H(+), pCO(2), pO(2), HCO(3)(-), BE) were found. A balanced 6% solution of hydroxyethyl starch (HES 130/0.42) did not significantly influence the condition of the newborns at birth or the acid-base and electrolyte concentration of newborns compared to an unbalanced solution of 6% hydroxyethyl starch (HES 130/0.4).

  15. Trial of labour in twin pregnancies: a retrospective cohort study.

    Science.gov (United States)

    de Castro, H; Haas, J; Schiff, E; Sivan, E; Yinon, Y; Barzilay, E

    2016-05-01

    To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section. A retrospective cohort study. A tertiary medical centre. A total of 2194 women with twin pregnancies not complicated with very low birthweight. Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts. Rate of vaginal twin delivery. Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery. The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before. The rate of vaginal delivery of twins can be high, especially in women who have delivered before. © 2015 Royal College of Obstetricians and Gynaecologists.

  16. The natural caesarean: a woman-centred technique.

    Science.gov (United States)

    Smith, J; Plaat, F; Fisk, N M

    2008-07-01

    Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.

  17. [Caesarean delivery in Andalusia, Spain: relationship with social, clinical and health services factors (2007-2009)].

    Science.gov (United States)

    Márquez-Calderón, Soledad; Ruiz-Ramos, Miguel; Juárez, Sol; Librero López, Julián

    2011-01-01

    Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.

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

    Directory of Open Access Journals (Sweden)

    Susmita Bhattacharyya

    2017-01-01

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

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

    African Journals Online (AJOL)

    within three hours of second-stage labour in comparison to two hours in those without regional analgesia.3,4 More importantly, the extension of time given to the second stage of labour has been shown to increase the overall rate of vaginal ..... National Sentinel Caesarean Section Audit Report. London; 2001. Available from ...

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

    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, ...

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

    OpenAIRE

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

    2015-01-01

    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 W...

  5. 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.

  6. Private-sector caesarean sections in perspective

    African Journals Online (AJOL)

    2005-02-28

    Feb 28, 2005 ... the mechanics of the REF to also equalise for maternity rates.17. However, the quantum that schemes receive will be based on a composite amount that incorporates the cost of both vaginal and operative delivery, and in calculating that amount the CS rate will definitely not be set at current levels of 60%.

  7. Intervention for postpartum infections following caesarean section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    2012-01-01

    seeks to elucidate the health economic cost and consequences of this type of infection and treatment. Background: Obesity is an increasing problem in the health care system. Today more than 12% of all pregnant women in Denmark are obese (BMI >30). There is a significant association between obesity...... treatment of post-CS infection requires hospital re-admission and re-operation for opening and debridement of the infected wounds under regional- or general anesthesia. The wound is normally re-sutured on the fourth day. NPWT is an alternative method of conservative wound management, which uses negative...... with NPWT and one having the conventional treatment). One woman (NPWT) was re-operated several times and her wound healed subsequently from the inside, which lasted approximately three months. The poor wound healing probably resulting from extreme obesity (BMI >47). An economic calculation has shown...

  8. Private-sector caesarean sections in perspective

    African Journals Online (AJOL)

    2005-02-28

    Feb 28, 2005 ... use of nevirapine in HIV post exposure for 2 health care workers [Letters]. .... appropriate rate? There is already agreement around standard maternal and fetal indications for either elective or emergency CS, viz. fetal distress, cephalopelvic .... guidelines for the CS that is not medically necessary, one can.

  9. ORIGINAL ARTICLES Caesarean section wound infiltration with ...

    African Journals Online (AJOL)

    Local anaesthetics, from lidocaine to the more recent ropivacaine, have been used as pre-emptive analgesics since the 1980s. Clinical trials were only published in the early. 1990s. Local anaesthetic has been used in women receiving general anaesthesia and regional anaesthesia, and rarely local anaesthesia alone has ...

  10. Hematometra following caesarean section for placenta previa

    African Journals Online (AJOL)

    2017-12-08

    Dec 8, 2017 ... findings were confirmed and the lower part of the uterus was found to be dilated and ballooned. The urine pregnancy test was negative. and her full blood count ... Sims᾽ posterior vaginal wall specula. As the cervix was not visualised, the cervix could not be held with any instrument but gentle pressure.

  11. Intervention for Postpartum Infections following Caesarean Section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    treatment for one change with NPWT to be cost effective. Concussion: The preliminary results indicate that NPWT reduce the risk of re-rupture significantly. The benefit of the treatment is expected to be twofold: a) A reduction in health care costs (inpatient bed days and readmissions) b) An increase...

  12. An investigation of differing levels of experience and indices of task management in relation to scrub nurses' performance in the operating theatre: analysis of video-taped caesarean section surgeries.

    Science.gov (United States)

    Koh, Ranieri Y I; Park, Taezoon; Wickens, Christopher D

    2014-09-01

    Literature has identified failures in task management as direct determinants leading to accidents in the operating theatre. However, very few studies have investigated the factors underlying task management that directly influence the performance of the scrub nurses. The traditional belief that expertise is a general indicator of performance has been empirically investigated with varying results, but none has attempted to identify the task management determinants affecting performance, as influenced by the level of expertise. (1) To examine any difference on task management behaviours between differing levels of experience during surgeries. (2) To correlate indices of task management with levels of performance evaluated by subject matter experts. 10 experienced and 10 novice scrub nurses were randomly selected from the Obstetrics and Gynaecology Department of a teaching hospital in Singapore. All nurses partook in a caesarean section surgery each, and their work processes were recorded via a scene camera donned by themselves. 20 scrub nurses. Two human factors experts independently mapped the task management processes onto a task management timeline, where individual tasks were coded, tallied and compared between levels of expertise. Reactive task management (task interruptions, task prioritizations), pro-active task management (anticipation, failures in anticipation), SPLINT scores (performance). Novice nurses showed lower resistance to interruptions during their tasks (58% more interruptions), especially to interruptions which were not triggered by the surgeon during their surgical counts (90% more interruptions). The novice nurses also displayed poorer/less ability to anticipate the surgeons' needs, taking longer time to handover instruments (39% longer) and making more mistakes (371% more errors). Subject matter experts rated the experienced nurses significantly higher in their cognitive non-technical skills performance than the novice nurses (32% higher

  13. Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study: (a prospective cohort study to assess the PFMS by perineometry and digital vaginal palpation during pregnancy and following vaginal or caesarean childbirth).

    Science.gov (United States)

    Caroci, Adriana de Souza; Riesco, Maria Luiza Gonzalez; Sousa, Wesllanny da Silva; Cotrim, Ana Carolina; Sena, Edinéia Maria; Rocha, Nelly Lima; Fontes, Cintia Najara Caroci

    2010-09-01

    To compare the measurements of women's pelvic floor musculature strength (PFMS) during pregnancy and postpartum period. Pregnancy and childbirth can have an influence on the muscles and pelvic floor and can cause morbidities of women's genito-urinary tract. A prospective cohort study. There were included 226 primigravidae women, attended by community health services in the city of Itapecerica da Serra, Sao Paulo, Brazil. The participants were followed in four stages: (1) within 12 weeks of pregnancy; (2) between 36-40 weeks of pregnancy; (3) within 48 hours after childbirth; (4) 42-60 days after childbirth. Data were collected from February 2007-August 2008. The pelvic floor musculature strength was evaluated by perineometry and digital vaginal palpation in stages 1, 2 and 4. The final sample included 110 women who completed all four stages of the study. The pelvic floor musculature strength of the women did not change significantly during pregnancy or after delivery (anova: p = 0·78). In all three examined stages, a low-intensity pelvic floor musculature strength was prevalent (in mmHg: stage 1 = 15·9; stage 2 = 15·2, stage 4 = 14·7), with scores from 0-3 on the Oxford scale. The pelvic floor musculature strength did not differ in relation to maternal age, skin colour, conjugal status, dyspareunia, stool characteristics, type of delivery, or conditions of the perineum. An interaction between maternal nutritional state and newborn's weight may affect the pelvic floor musculature strength (manova: p = 0·04). Pregnancy and childbirth did not reduce significantly pelvic floor musculature strength. The perineometry and digital vaginal palpation used to assess the pelvic floor musculature strength were well accepted by the women. In clinical practice, digital vaginal palpation is effective for supporting the diagnosis of urinary, intestinal and sexual dysfunctions. Perineometry use is particularly important together with the performance of perineal exercises with

  14. Pharmacological anti-thrombotic prophylaxis after elective caesarean delivery in thrombophilia unscreened women: should maternal age have a role in decision making?

    Science.gov (United States)

    Gizzo, Salvatore; Noventa, Marco; Anis, Omar; Saccardi, Carlo; Zambon, Alessandra; Di Gangi, Stefania; Tormene, Daniela; Gangemi, Michele; D'Antona, Donato; Nardelli, Giovanni Battista

    2014-05-01

    In obstetrical practice, the best prevention strategy for pregnant women aged >35 years without known thrombosis risk factors who underwent elective caesarean delivery (CD) is controversial. We performed an observational-longitudinal cohort study on pregnant women aged >35 years who delivered at term by elective caesarean section after a physiological single pregnancy to evaluate the role of maternal age in the decision-making process of whether or not to perform low-molecular-weight heparin (LMWH) prophylaxis during the post-partum period after elective CD in healthy women with unknown inherited thrombophilia status. During the 6 post-partum weeks, we followed two groups: GROUP-A (349 women treated for 7 days with low-molecular-weight heparin) and GROUP-B (180 women not treated with LMWH treatment). The outcomes were as follows: onset of thromboembolic events during the post-partum period; non-obstetrical-linked maternal haemorrhage; blood transfusion; re-laparotomy; detection of a surgical site haematoma; length of hospitalisation; and treatment suspension because of decreased platelet count. Except for the parity number, the two groups were homogeneous with regard to general features. In both the groups, we reported no cases of thromboembolic events during the follow-up period. Maternal haemorrhage requiring transfusion occurred in 16 women in GROUP-A and none in GROUP-B. Among the GROUP-A women, 11 demonstrated a surgical site haematoma and 4 required re-laparotomy. No cases of treatment suspension were reported. Pneumatic compression stockings represent a better, low cost and safe way to prevent post-partum venous thromboembolic episodes after elective caesarean section in an unscreened population. Pharmacological prophylaxis after elective caesarean section should be performed only in case of clear and known adjunctive risk factors, independent of maternal age.

  15. Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth.

    Science.gov (United States)

    Tully, Kristin P; Ball, Helen L

    2014-06-01

    breast-feeding outcomes are often worse after caesarean section compared to vaginal childbirth. this study characterises mothers' breast-feeding intentions and their infant feeding experiences after caesarean childbirth. data are from 115 mothers on a postnatal unit in Northeast England during February 2006-March 2009. Interviews were conducted an average of 1.5 days (range 1-6 days) after the women underwent unscheduled or scheduled caesarean. thematic analysis of the data suggested was mostly considered the 'right thing to do,' preferable, natural, and 'supposedly healthier,' but tiring and painful. Advantages of supplementation involved more satiated infants, feeding ease, and longer sleep bouts. The need for 'thinking about yourself' was part of caesarean recovery. Infrequent feeding was concerning but also enabled maternal rest. Other breast-feeding obstacles were maternal mobility limitations, positioning difficulties, and frustration at the need for assistance. Participants were confused about nocturnal infant wakings, leading many to determine that they had insufficient milk. Mothers were surprised that sub-clinically poor infant condition was common following caesarean section. Some breast-feeding difficulty stemmed from 'mucus' expulsion that had to occur before the infants could be 'interested' in feeding. Women who cited motivations for breast feeding that included benefit to themselves were more likely to exclusively breast feed on the postnatal unit after their caesareans than those who reported infant-only motivations. for the majority of mothers, breast feeding after a caesarean is affected by interrelated and compounding difficulties. Provision of more relational breast-feeding information may enable families to better anticipate early feeding experiences after caesarean section childbirth. © 2013 Elsevier Ltd. All rights reserved.

  16. Pregnant women’s preference for vaginal or caesarean childbirth

    Directory of Open Access Journals (Sweden)

    Lígia Ebner Melchiori

    2009-10-01

    Full Text Available The study investigated the preference for delivery in 40 pregnant women using a semi-structured interview. Most women (75% reported a preference for vaginal delivery, mainly because they believe it will result in a speedy recovery and be better for them and/or their babies. Of the women interviewed, 15% preferred a caesarean section because they considered it be less painful. These preferences, in general, were influenced by friends. Most women said they had fear of parturition due to: feelings of pain/suffering, concern of something happening to them or their babies and because the situation is unknown or assessed in a negative fashion. The presence of trusted people, like one’s husband, mother or doctor, could minimize this fear. These results reinforce the contributions of health professionals, such as psychologists, in answering the psychosocial needs of pregnant women in situations of delivery and birth.   Keywords: vaginal birth; caesarean section; pregnancy; health psychology.

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

    African Journals Online (AJOL)

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

  18. Inevitable Caesarean Myomectomy: A Case Report. | Ojule ...

    African Journals Online (AJOL)

    The intramural fibroids, enchroaching into the uterine incision, made closure impossible, necessitating a caesarean myomectomy under a high dose oxytocin infusion before successfully closing the incision. She did remarkably well and was discharged home on the 7th post-operative day. Caesarean myomectomy can ...

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

    Science.gov (United States)

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

    2015-08-01

    Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care. © 2014 Wiley Publishing Asia Pty Ltd.

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

    Science.gov (United States)

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

    2018-03-01

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

  1. Trial of labour after caesarean (TOLAC) is associated with increased risk for instrumental delivery.

    Science.gov (United States)

    Inbar, Rotem; Mazaaki, Shali; Kalter, Anat; Gat, Itai; Sivan, Eyal; Schiff, Eyal; Hendler, Israel

    2017-01-01

    We compared the rates of instrumental delivery in a cohort of nulliparous women at term (n = 19,416), to primiparous women who attempted labour after prior caesarean (TOLAC) (n = 1747). The rate of instrumental deliveries was higher in the TOLAC group compared to nulliparous gravidas (17.3 vs. 15% respectively, p = 0.001). The difference was more prominent for women who eventually had successful vaginal delivery (TOLAC: 23.9% vs. 17.1%, p < 0.0001 respectively). Based on our results, previous caesarean whether urgent or elective was associated with an increased risk of instrumental delivery in the subsequent pregnancy.

  2. Unavoidable caesarean myomectomy: a case report | Agboghoroma ...

    African Journals Online (AJOL)

    operative haemorrhage. Outcome for mother and baby were satisfactory. Caesarean myomectomy can be safely undertaken in experienced hands whilst applying measures to reduce intra-operative and post-operative blood loss. Keywords: uterine ...

  3. Anaesthesia for caesarean deliveries and maternal complications in a Nigerian teaching hospital.

    Science.gov (United States)

    Rukewe, A; Fatiregun, A; Adebayo, K

    2014-03-01

    The aim of this audit was to evaluate the frequency of caesarean delivery, anaesthetic techniques employed, investigate potential trends and the rate of maternal complications associated with general or regional anaesthesia in our institution. We reviewed data collected on all deliveries from patients' medical records, anaesthetic charts and relevant surgical notes from 1 January 2008 to 31 December 2010. A total of 10,911 deliveries were conducted during the study period and there were 3389 caesarean sections, giving a rate of 31.1%; which showed an upward trend from 27.8% in the first year to 34% in the third year. Our data showed a predominant use of regional anaesthesia for caesarean section generally (86.2%) and 83.8% for emergency caesarean deliveries in line with global trends. The overall complication rate was 10.5%. However, 34.5% of parturients who had general anaesthesia in contrast with 6.7% who had regional techniques had anaesthesia-related complications, postoperative intensive care unit admission rather than recovery room care, intra-operative cardiac arrest and haemorrhage exceeding 1200 ml (p = 0.001). Haemodynamic fluctuations were the most common anaesthesia-related complication. Our data revealed that general anaesthesia was a significant risk factor for maternal complications. Obstetric general anaesthesia is low in our hospital. Our result showed that general anaesthesia was a significant risk factor for maternal complications during caesarean section.

  4. Polysomnographic Findings and Clinical Correlates in Huntington Disease: A Cross-Sectional Cohort Study

    Science.gov (United States)

    Piano, Carla; Losurdo, Anna; Della Marca, Giacomo; Solito, Marcella; Calandra-Buonaura, Giovanna; Provini, Federica; Bentivoglio, Anna Rita; Cortelli, Pietro

    2015-01-01

    Study Objectives: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). Design: Cross-sectional cohort study. Setting: Sleep laboratory. Patients: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). Interventions: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). Measurements and Results: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m2. No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P Marca G, Solito M, Calandra-Buonaura G, Provini F, Bentivoglio AR, Cortelli P. Polysomnographic findings and clinical correlates in Huntington disease: a cross-sectional cohort study. SLEEP 2015;38(9):1489–1495. PMID:25845698

  5. 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.

  6. 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.

  7. Swedish couples' attitudes towards birth, childbirth fear and birth preferences and relation to mode of birth - a longitudinal cohort study.

    Science.gov (United States)

    Hildingsson, Ingegerd

    2014-06-01

    Little is known if couples hold similar or different attitudes towards birth or what impact these have on the actual mode of birth. The aim of this study was to compare couples' personal and general attitudes towards birth. An additional aim was to study the relationship between attitudes, birth preferences, and fear of birth in relation to mode of birth. This study is part of a longitudinal cohort study of 1074 pregnant women and their partners recruited during one year in three hospitals in the middle-north part of Sweden. Data was collected by questionnaires. Chi-square test, t-tests and multinominal regression analysis were used in the analyses. Women held stronger attitudes about the importance of a safe and less stressful birth for the baby, while their partners were most concerned about the woman's health. Women who preferred a caesarean section and reported childbirth fear often prioritized a safe and stressful birth for themselves, wanted to avoid pain, plan the date, and decide about birth themselves and did not view birth as natural. Some of these attitudes were also found in partners who preferred a caesarean section. Birth preference and fear were strongly associated with mode of birth. Special attention should be directed towards parents with a caesarean section preference and parents with childbirth related fear as they have certain attitudes to birth and are more likely to have caesarean section for the birth of the baby. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. 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.

    2015-01-01

    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. PMID:26593932

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

    Directory of Open Access Journals (Sweden)

    Kaundinya Kiran Bharatam

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dörthe Brüggmann

    2015-11-01

    Full Text Available 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.

  11. Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study

    Science.gov (United States)

    Kanayama, Gen; DeLuca, James; Meehan, William P.; Hudson, James I.; Isaacs, Stephanie; Baggish, Aaron; Weiner, Rory; Micheli, Lyle; Pope, Harrison G.

    2016-01-01

    Background Accumulating case reports have described tendon rupture in men using anabolic-androgenic steroids (AAS). However no controlled study, to our knowledge, has assessed history of tendon rupture in a large cohort of AAS users and comparison nonusers. Hypothesis We hypothesized that men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture as compared to non-AAS-using bodybuilders. Study Design Cross-sectional cohort study. Methods We obtained medical histories from 142 experienced male bodybuilders age 35–55, recruited in the course of two studies. Of these men, 88 reported at least two years of cumulative lifetime AAS use and 54 reported no history of AAS use. In men reporting a history of tendon rupture, we recorded circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use if applicable. We also obtained surgical records for most participants. Results Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers reported at least one lifetime tendon rupture. The hazard ratio (95% confidence interval) for a first ruptured tendon in AAS users versus nonusers was 9.0 (2.5, 32.3); P sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically with complete or near-complete ultimate restoration of function. Conclusions AAS abusers, as compared to otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper body tendon rupture. Clinical relevance Tendon rupture represents a major adverse consequence of AAS abuse and a substantial public health problem. PMID:26362436

  12. [German-speaking midwifes prefer vaginal mode of delivery to elective Caesarean].

    Science.gov (United States)

    Harder, U; Reutter, R; Luyben, A; Gross, M M

    2002-04-01

    Increasing ceasarean section rates are a world wide concern in obstetrics. One of the latest contributing factors is the elective caesarean section in uncomplicated singleton pregnancy at term. The preference for this mode of delivery was primarily brought forward by obstetric practitioners (Al Mufty, McCarthy, Fisk 1996). A questionnaire, which mainly aimed to ask germanspeaking midwifes in Austria, Germany and Switzerland about their personal choice of delivery mode, was included in one of the issues of the German-language midwifery journal "Die Hebamme". This questionnaire contained 5 half-closed/half open questions describing specific obstetric occurrences. The midwifes were asked to express their preferred mode of delivery and describe their reason for choosing. 446 questionnaires (12 %) were returned. The majority (100 %) of the german speaking midwifes preferred a normal vaginal delivery in an uncomplicated singleton pregnancy at term with a child in cephalic presentation. The rating was about the same (97 %) in the presence of general risk factors which don't indicate a primary caesarean section. Breech presentation and macrosomia are a matter of concern to the midwifes. Midwifes arguing for a first child in breech presentation or with macrosomia > 4.5 kg vote highly significantly more frequently for elective caesarean section than midwifes arguing for at least the second child. The first-rate reasons for the preference of vaginal delivery concern the natural and physiological way of delivery, the personal experience of delivery, the higher risks of caesarean section and the possibility of a later caesarean section in case of fetal distress during first or second stage of labour. Concerns are expressed about the maintenance of competence amongst practitioners, thus influencing the choice of mode of delivery in obstetrics.

  13. 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

  14. Mode of childbirth and neonatal outcome after external cephalic version: A prospective cohort study.

    Science.gov (United States)

    Rosman, A N; Vlemmix, F; Ensing, S; Opmeer, B C; Te Hoven, S; Velzel, J; de Hundt, M; van den Berg, S; Rota, H; van der Post, J A M; Mol, B W J; Kok, M

    2016-08-01

    to assess the mode of childbirth and adverse neonatal outcomes in women with a breech presentation with or without an external cephalic version attempt, and to compare the mode of childbirth among women with successful ECV to women with a spontaneous cephalic presentation. prospective matched cohort study. 25 clusters (hospitals and its referring midwifery practices) in the Netherlands. Data of the Netherlands perinatal registry for the matched cohort. singleton pregnancies from January 2011 to August 2012 with a fetus in breech presentation and a childbirth from 36 weeks gestation onwards. Spontaneous cephalic presentations (selected from national registry 2009 and 2010) were matched in a 2:1 ratio to cephalic presentations after a successful version attempt. Matching criteria were maternal age, parity, gestational age at childbirth and fetal gender. Main outcomes were mode of childbirth and neonatal outcomes. of 1613 women eligible for external cephalic version, 1169 (72.5%) received an ECV attempt. The overall caesarean childbirth rate was significantly lower compared to women who did not receive a version attempt (57% versus 87%; RR 0.66 (0.62-0.70)). Women with a cephalic presentation after ECV compared to women with a spontaneous cephalic presentation had a decreased risk for instrumental vaginal childbirth (RR 0.52 (95% CI 0.29-0.94)) and an increased risk of overall caesarean childbirth (RR 1.7 (95%CI 1.2-2.5)). women who had a successful ECV are at increased risk for a caesarean childbirth but overall, ECV is an important tool to reduce the caesarean rate. ECV is an important tool to reduce the caesarean section rates. Copyright © 2016. Published by Elsevier Ltd.

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

    African Journals Online (AJOL)

    Administrator

    appropriate measures are taken to maintain the tonicity of the uterus during the procedure. Selected cases of Caesarean myomectomy could ... Leiomyoma also known as myoma or uterine fibroid, is a common tumour of the genital tract. It .... preservation without loss of function stimulated the interest in myomectomy during ...

  16. Caesarean Hysterectomy | Okeke | Nigerian Journal of Medicine

    African Journals Online (AJOL)

    Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind. CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery ...

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

    Science.gov (United States)

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

    2016-01-01

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

  18. A Rare Case Report of Caesarean Scar Ectopic Pregnancy.

    Science.gov (United States)

    Deepika; Gupta, Taru; Wahi, Sonika

    2017-08-01

    Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. It is defined as when a blastocyst implants on a previous Caesarean scar. The incidence of Caesarean scar ectopic has increased due to increase in number of Caesarean deliveries. Early diagnosis of this can be done by using sonography. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Magnetic Resonance Imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. We are reporting a rare case of G3P2l2 with previous two Caesarean deliveries, diagnosed as Caesarean scar ectopic pregnancy with the help of sonography and MRI. Patient underwent laparotomy and on histopathological examination Caesarean scar pregnancy was confirmed.

  19. Evaluating effects of a prenatal breastfeeding education programme on women with caesarean delivery in Taiwan.

    Science.gov (United States)

    Lin, Chien-Hui; Kuo, Su-Chen; Lin, Kuan-Chia; Chang, Tse-Yun

    2008-11-01

    The aims of this study were: (1) to evaluate the effectiveness of a prenatal breastfeeding education programme for primigravida women who have elected caesarean section as a model of delivery and (2) to evaluate its effectiveness for encouraging a positive attitude to breastfeeding and rooming-in and to increase exclusive breastfeeding rates within hospital and at one month postpartum. Prenatal preparation for pregnant women about breastfeeding enhances their practical knowledge and skills about breastfeeding techniques, which prepares them when encountering possible difficulties. A quasi-experimental design was used. The targeted population was primigravidas at 36-39 weeks and who had chosen to deliver by caesarean section. The study consisted of approximately 100 individuals; the control group consisted of 46 subjects and the following 54 made up the experimental group. The study was conducted at a hospital in Taiwan. The results of the study show that the subjects of the experimental group exhibited a more positive breastfeeding attitude (88.9 vs. 79.8, t = 7.40, p education booklets, videos and telephone interview on breastfeeding prior to a caesarean delivery may contribute to breastfeeding attitude and improved rooming-in and exclusive breastfeeding rates. This breastfeeding education programme has proven to be successful in aiding women breastfeeding after a caesarean delivery and provides health care professionals with an evidence-based intervention.

  20. [Complications related to epidural catheter in caesarean delivery].

    Science.gov (United States)

    Leykin, Y; Lucca, M

    2001-09-01

    A review of complications related to epidural catheters in caesarean delivery is presented. Catheters for prolongation of nerve blocks were first used in 1940s. Thereafter, there has been steady development in the design and plastic material technology of the different catheters. In the last decade the regional anaesthesia for caesarean section became very popular, as well as continuous increase in the use of epidural catheters. The anatomical changes of pregnancy like marked distension of the epidural veins resulted in increased risk of the complications due to the epidural catheter placement. It is likely that permanent neurologic sequelae due to regional anaesthesia in obstetrics almost never occur, while minor self-limiting complications do occur. The possible complications of epidural catheter techniques are: trauma, malposition and migration of the catheter, knotting and breaking, radiculopathy, dural puncture, subdural injection, abscess and infection, haematoma and wrong solution injection. Most of the malpositions of the epidural catheter can be avoided by a careful technique, advancing the catheter with no forceful movement and not more than 3 to 4 cm into epidural space. Broken parts of the catheters should be left as a rule within the spinal space. Test dose should be always done for continuous epidural anaesthesia. Early diagnosis and prompt appropriate treatment will usually lead to complete resolution of the neurological deficit even in cases of epidural haematoma or abscess.

  1. Comorbidities of obesity in school children: a cross-sectional study in the PIAMA birth cohort

    Directory of Open Access Journals (Sweden)

    Sanders Elisabeth A

    2010-04-01

    Full Text Available Abstract Background There is ample evidence that childhood overweight is associated with increased risk of chronic disease in adulthood. The aim of this study was to investigate associations between childhood overweight and common childhood health problems. Methods Data were used from a general population sample of 3960 8-year-old children, participating in the Dutch PIAMA birth cohort study. Weight and height, measured by the investigators, were used to define BMI status (thinness, normal weight, moderate overweight, obesity. BMI status was studied cross-sectionally in relation to the following parental reported outcomes: a general health index, GP visits, school absenteeism due to illness, health-related functional limitations, doctor diagnosed respiratory infections and use of antibiotics. Results Obesity was significantly associated with a lower general health score, more GP visits, more school absenteeism and more health-related limitations, (adjusted odds ratios around 2.0 for most outcomes. Obesity was also significantly associated with bronchitis (adjusted odds ratio (aOR and 95% confidence intervals (95%CI: 5.29 (2.58;10.85 and with the use of antibiotics (aOR (95%CI: 1.79 (1.09;2.93. Associations with flu/serious cold, ear infection and throat infection were positive, but not statistically significant. Moderate overweight was not significantly associated with the health outcomes studied. Conclusion Childhood obesity is not merely a risk factor for disease in adulthood, but obese children may experience more illness and health related problems already in childhood. The high prevalence of the outcomes studied implies a high burden of disease in terms of absolute numbers of sick children.

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

    Directory of Open Access Journals (Sweden)

    Tuula Oksanen

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

  3. Cesarean section and risk of obesity in childhood, adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts.

    Science.gov (United States)

    Barros, Fernando C; Matijasevich, Alicia; Hallal, Pedro C; Horta, Bernardo L; Barros, Aluísio J; Menezes, Ana B; Santos, Iná S; Gigante, Denise P; Victora, Cesar G

    2012-02-01

    The number of cesarean sections (CSs) is increasing in many countries, and there are concerns about their short- and long-term effects. A recent Brazilian study showed a 58% higher prevalence of obesity in young adults born by CS than in young adults born vaginally. Because CS-born individuals do not make contact at birth with maternal vaginal and intestinal bacteria, the authors proposed that this could lead to long-term changes in the gut microbiota that could contribute to obesity. We assessed whether CS births lead to increased obesity during childhood, adolescence, and early adulthood in 3 birth cohorts. We analyzed data from 3 birth-cohort studies started in 1982, 1993, and 2004 in Southern Brazil. Subjects were assessed at different ages until 23 y of age. Poisson regression was used to estimate prevalence ratios with adjustment for ≤15 socioeconomic, demographic, maternal, anthropometric, and behavioral covariates. In the crude analyses, subjects born by CS had ∼50% higher prevalence of obesity at 4, 11, and 15 y of age but not at 23 y of age. After adjustment for covariates, prevalence ratios were markedly reduced and no longer significant for men or women. The only exception was an association for 4-y-old boys in the 1993 cohort, which was not observed in the other 2 cohorts or for girls. In these 3 birth cohorts, CSs do not seem to lead to an important increased risk of obesity during childhood, adolescence, or early adulthood.

  4. X-linked adrenoleukodystrophy in women: a cross-sectional cohort study.

    Science.gov (United States)

    Engelen, Marc; Barbier, Mathieu; Dijkstra, Inge M E; Schür, Remmelt; de Bie, Rob M A; Verhamme, Camiel; Dijkgraaf, Marcel G W; Aubourg, Patrick A; Wanders, Ronald J A; van Geel, Bjorn M; de Visser, Marianne; Poll-The, Bwee T; Kemp, Stephan

    2014-03-01

    X-linked adrenoleukodystrophy is the most common peroxisomal disorder. The disease is caused by mutations in the ABCD1 gene that encodes the peroxisomal transporter of very long-chain fatty acids. A defect in the ABCD1 protein results in elevated levels of very long-chain fatty acids in plasma and tissues. The clinical spectrum in males with X-linked adrenoleukodystrophy has been well described and ranges from isolated adrenocortical insufficiency and slowly progressive myelopathy to devastating cerebral demyelination. As in many X-linked diseases, it was assumed that female carriers remain asymptomatic and only a few studies addressed the phenotype of X-linked adrenoleukodystrophy carriers. These studies, however, provided no information on the prevalence of neurological symptoms in the entire population of X-linked adrenoleukodystrophy carriers, since data were acquired in small groups and may be biased towards women with symptoms. Our primary goal was to investigate the symptoms and their frequency in X-linked adrenoleukodystrophy carriers. The secondary goal was to determine if the X-inactivation pattern of the ABCD1 gene was associated with symptomatic status. We included 46 X-linked adrenoleukodystrophy carriers in a prospective cross-sectional cohort study. Our data show that X-linked adrenoleukodystrophy carriers develop signs and symptoms of myelopathy (29/46, 63%) and/or peripheral neuropathy (26/46, 57%). Especially striking was the occurrence of faecal incontinence (13/46, 28%). The frequency of symptomatic women increased sharply with age (from 18% in women 60 years of age). Virtually all (44/45, 98%) X-linked adrenoleukodystrophy carriers had increased very long-chain fatty acids in plasma and/or fibroblasts, and/or decreased very long-chain fatty acids beta-oxidation in fibroblasts. We did not find an association between the X-inactivation pattern and symptomatic status. We conclude that X-linked adrenoleukodystrophy carriers develop an

  5. Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study.

    Directory of Open Access Journals (Sweden)

    Denise N Mesquita

    Full Text Available Cesarean section (CS has been associated with obesity, measured by body mass index (BMI, in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI.To assess the association between CS and indicators of peripheral and central adiposity in young adults.The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC, waist-height ratio (WHtR, waist-hip ratio (WHR, tricipital skinfold (TSF, and subscapular skinfold (SSF. The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR with 95% confidence interval (95%CI, and adjustment for birth variables.Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39 for WC, 1.25 (95%CI 1.10;1.42 for WHtR, 1.45 (95%CI 1.18;1.79 for WHR, 1.36 (95%CI 1.04;1.78 for TSF, and 1.43 (95%CI 1.08;1.91 for SSF.Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

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

    Science.gov (United States)

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

    2014-06-01

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

  7. Temperament and Early Stuttering Development: Cross-Sectional Findings from a Community Cohort

    Science.gov (United States)

    Kefalianos, Elaina; Onslow, Mark; Ukoumunne, Obioha C.; Block, Susan; Reilly, Sheena

    2017-01-01

    Purpose: The purpose of this study was to ascertain if there is an association between stuttering severity and behaviors and the expression of temperament characteristics, including precursors of anxiety. Method: We studied temperament characteristics of a prospectively recruited community cohort of children who stutter (N = 173) at ages 3, 4, and…

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

    Science.gov (United States)

    Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

    2011-03-01

    We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

  9. Accuracy of blood loss estimation at caesarean delivery | Jagun ...

    African Journals Online (AJOL)

    Objective: Inaccurate estimation of blood loss during caesarean delivery may be associated with inappropriate decisions in transfusing patients and this may lead to increased maternal morbidity. The study aimed at comparing the accuracy of blood loss estimation by obstetricians and anaesthetists at caesarean delivery.

  10. 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 ...

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

    African Journals Online (AJOL)

    Post caesarean wound infection is a common cause of maternal morbidity and mortality especially in developing countries where strict adherence to infection control procedures is low. The aim of the present study is to establish the spectrum of microbes causing post caesarean wound infection and antibiotic sensitivity ...

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

    LENUS (Irish Health Repository)

    Vaughan, DA

    2013-06-12

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

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

    Directory of Open Access Journals (Sweden)

    Ashwini H Ramaswamy

    2014-12-01

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

  14. 'Zuoyuezi' after caesarean in China: an interview survey.

    Science.gov (United States)

    Cheung, Ngai Fen; Mander, Rosemary; Cheng, Linan; Chen, Vivian Yan; Yang, Xiu Qun; Qian, Hong Ping; Qian, Jie Yan

    2006-02-01

    While studying caesarean decision-making in China, the increasing popularity of 'zuoyuezi' emerged. This paper addresses this development, the reasons and implications. We tape-recorded semi-structured interviews in three industrial cities in China. The three groups of informants comprised women in the first-week after caesarean, women eight months after caesarean and health-workers/others. Mandarin or local dialects were used. The data were transcribed and analysed in Chinese and then selected quotes were translated into English. We found that the re-emergence and social modification of zuoyuezi is closely associated with the rising caesarean rate. This custom has been regarded as a crucial rite-of-passage for the woman's recovery and transition to motherhood after childbirth. Its particular importance after caesarean became apparent in this study. Conclusions are drawn about the place of ritual and tradition in 21st century China.

  15. Caesarian Section Rate at Federal Medical Centre, Makudi, Revisited

    African Journals Online (AJOL)

    Context: Regular auditing of caesarean section rate is important to establish trend, review indications, associated complications and offer possible solutions to improve outcome. Objective: To audit caesarean section rate done over a 3 year period from January 2010 to December 2012 and to compare such with the last ...

  16. Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study.

    Science.gov (United States)

    Kanayama, Gen; DeLuca, James; Meehan, William P; Hudson, James I; Isaacs, Stephanie; Baggish, Aaron; Weiner, Rory; Micheli, Lyle; Pope, Harrison G

    2015-11-01

    Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers. Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non-AAS-using bodybuilders. Cohort study; Level of evidence, 3. Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants. Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture. © 2015 The Author(s).

  17. 'I wanted desperately to have a natural birth': mothers' insights on vaginal birth after Caesarean (VBAC).

    Science.gov (United States)

    Phillips, Emma; McGrath, Pam; Vaughan, Grahame

    There is scant research available on the psycho-social aspects of births subsequent to Caesarean Section (CS). In particular, there is little psycho-social research available in regard to women who seek to have a Vaginal Birth After Caesarean (VBAC). To address this lack of information in the literature, this article explores, from a phenomenological perspective, the reasons motivating women to try for a VBAC, from the perspectives of four women who have tried for or achieved a VBAC. The findings indicate that these mothers differed to other women interviewed in the study who opted for repeat CS. The VBAC mothers expressed a strong belief in the importance of a natural birth as the best start for their infant, strived to reduce where possible drug interventions during labour and birth and believed in the importance of breastfeeding. The VBAC mothers viewed achieving a natural birth as a significant aspect of their femininity and a major life event for a woman.

  18. Social media use in German visceral surgeons: a cross-sectional study of a national cohort.

    Science.gov (United States)

    Boßelmann, C M; Griffiths, B; Gallagher, H J; Matzel, K E; Brady, R R W

    2018-02-01

    Engagement in social media is increasing. Medical professionals have been adapting LinkedIn, a professional networking site, and Twitter, a microblogging service, for a number of uses. This development has been described for a number of medical specialties, but there remains a paucity of European data. A study was undertaken to measure the engagement and activity of German visceral surgeons on social media platforms. Visceral surgeons were identified from 15 regional Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) opt-in registers. A manual search was subsequently performed across key professional social media platforms. The presence of a profile and key markers of use were recorded. In total, 575 visceral surgeons were identified. 523 (93%) were men. 183 (31%) surgeons engaged in professional social media. 22 (3.8%) used Twitter, producing a mean of 16.43 tweets with a mean of 7.57 followers. 137 (24%) surgeons had a profile on LinkedIn with a mean of 46.36 connections. Female surgeons were less connected on LinkedIn (P social media between surgeons from Eastern and Western Germany (P = 0.262) or male and female surgeons (P = 0.399). German visceral surgeons are less engaged and less active on social media than previously examined cohorts. Loco-regional, cultural, demographic and regulatory matters may have a significant influence on uptake. If this surgical cohort wishes to have a wider international presence then education on the potential benefits of these tools may be needed. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  19. A cross sectional analysis of the role of the antimicrobial peptide cathelicidin in lung function impairment within the ALIVE cohort.

    Directory of Open Access Journals (Sweden)

    Allison A Lambert

    Full Text Available Vitamin D deficiency is associated with reduced lung function. Cathelicidin, an antimicrobial peptide regulated by vitamin D, plays a role within the innate immune system. The association of cathelicidin with lung function decrement and respiratory infection is undefined. We determined the independent relationship of cathelicidin with lung function.In a cross-sectional analysis of 650 participants in an urban observational cohort with high smoking prevalence, plasma 25(OH-vitamin D and cathelicidin levels were measured from stored samples obtained within 6 months of spirometry study visits. Multivariable linear regression was used to determine the independent association between low cathelicidin (defined as the lowest quartile of the cohort and absolute forced expiratory volume in 1 second (FEV1.The mean age of the cohort was 49 years; 91% were black, 35% female and 41% HIV-infected. Participants with low cathelicidin had a 183 mL lower FEV1 compared to higher cathelicidin (p = 0.009; this relationship was maintained (115 ml lower; p = 0.035 after adjusting for demographics, BMI, and smoking. Neither HIV serostatus, heavy smoking history, nor 25(OH-vitamin D levels were associated with cathelicidin levels. Participants with low cathelicidin had a greater prevalence of prior bacterial pneumonia (21% versus 14%; p = 0.047. Inclusion of pneumonia in adjusted models did not substantially reduce the FEV1 decrement observed with low cathelicidin (104 mL lower FEV1; p = 0.05. Lung function decrements associated with low cathelicidin were greatest among individuals with lower 25(OH-vitamin D levels.In a cohort at risk for airflow obstruction, low cathelicidin was independently associated with lower FEV1. These clinical data support a mechanistic link between 25(OH-vitamin D deficiency and lung function impairment, independent of pneumonia risk.

  20. Cohort profiles of the cross-sectional and prospective participant groups in the second Diabetes MILES-Australia (MILES-2) study

    DEFF Research Database (Denmark)

    Browne, Jessica L; Holmes-Truscott, Elizabeth; Ventura, Adriana D

    2017-01-01

    and social aspects of diabetes. The aim of the MILES-2 study was to provide a (1) longitudinal follow-up of the original MILES 2011 study cohort; (2) cross-sectional assessment of a new cohort. PARTICIPANTS: Eligible participants were English-speaking Australians with type 1 or type 2 diabetes, aged 18....... The final sample included N=2342 eligible respondents (longitudinal cohort: n=504; 2015 new cohort: n=1838); 54% had type 2 diabetes. FINDINGS TO DATE: Survey respondents were from an advantaged socioeconomic background compared to the general population. Respondents with type 1 diabetes were over...

  1. Cesarean section and rate of subsequent stillbirth, miscarriage, and ectopic pregnancy: a Danish register-based cohort study.

    Science.gov (United States)

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

    2014-07-01

    With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested

  2. The differences between pregnant women who request elective caesarean and those who plan for vaginal birth based on Health Belief Model.

    Science.gov (United States)

    Darsareh, Fatemeh; Aghamolaei, Teamur; Rajaei, Minoo; Madani, Abdoulhossain; Zare, Shahram

    2016-12-01

    Although vaginal birth is the safest type of childbirth, sometimes caesarean is necessary for the safety of the mother or the infant. The problem is that low-risk, healthy women are choosing caesarean as a birth option despite the fact that it is fraught with possible complications. To determine the differences and identify the predictors for the way women plan their childbirth based on Health Belief Model. A cross-sectional study was conducted in Bandar abbas city, Iran, from May to October 2015. The study recruited eligible women who self identified themselves as requesting a caesarean or vaginal birth in their response to a questionnaire. Of 470 recruited women, 183 (38.9%) planned to have a caesarean without medical indication. Maternal characteristics (age, level of education, occupational status, involvement in a medical profession, and household income) and obstetric variables (health provider type, place of prenatal care, and the number of children planned for the future) influenced the decisions made by the women. There was a significant difference between women planning a caesarean and those planning vaginal birth in terms of childbirth knowledge. Significant differences were observed regarding maternal self-efficacy, with women planning a caesarean reporting significantly lower self-efficacy than women planning a vaginal birth. Women planning a caesarean birth were also significantly less likely to perceive themselves as being at risk for caesarean-related side effects than women planning a vaginal birth. Comprehensive childbirth knowledge can lead to positive maternal attitude towards vaginal birth and may improve birth confidence. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jyoti V. Dube

    2014-01-01

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

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

    African Journals Online (AJOL)

    Figure 3) and coarctation of the descending aorta. (Figure 4). Based on these findings, a diagnosis of Shone's syndrome and rheumatic heart disease with recoarctation of the aorta was made. An obstetric examination revealed a single.

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

    African Journals Online (AJOL)

    McRoy

    labour pains were the commonly cited reasons for preferring C/S.[11] However, this is in contrast to a study in UK where 80% who request for C/S did so out of fear of perineal damage leading to stress incontinence and anal sphincter damage.[12]. A recent study from south-eastern Nigeria revealed that only 1.4% viewed ...

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

    African Journals Online (AJOL)

    South African Journal of Obstetrics and Gynaecology. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 15, No 2 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file ...

  7. Emergency caesarean section in low risk nulliparous women

    DEFF Research Database (Denmark)

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

    2012-01-01

    and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate...

  8. Indications for Caesarean Section at a Nigerian District Hospital

    African Journals Online (AJOL)

    Alasia Datonye

    Though it is a life saving procedure, it also carries a higher morbidity and mortality than vagina delivery. Method: This is a retrospective study conducted from. January 2005 to December 2006 at a secondary health facility located in a rural setting in Nigeria. The maternity ward and theatre registers were the sources of data.

  9. Successful Pregnancy Outcome by Caesarean Section in a Woman ...

    African Journals Online (AJOL)

    Pregnancy in a woman with AMC is at high risk due to diminished pulmonary reserve, increased risk of thromboembolism and anesthesia. Successful pregnancy in patients with AMC is very rare and only five cases have been reported in literature. Present case is being reported due to its rarity (Afr. J. Reprod. Health 2010 ...

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

    African Journals Online (AJOL)

    1983-01-01

    Jan 1, 1983 ... injection she was laid flat at 15° left lateral tilt with a pillow under her head. The abdomen was then prepared and draped, and the level of analgesia assessed. Local abdominal anaesthesia was then employed using 0,75% lignocaine with adrenaline. (1:200000) to extend the level of anaesthesia as ...

  11. Caesarean section wound infiltration with local anaesthetic for ...

    African Journals Online (AJOL)

    spraying with local anaesthetic after CS under general anaesthesia (1 study, 100 participants) had a reduced need for opioid rescue (risk ratio (RR) 0.51; 95% CI 0.38 to 0.69). The numerical pain score (0 -10) within the first hour was also reduced (mean difference (MD) -1.46; 95% CI –2.60 to –0.32). Women with regional ...

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

    African Journals Online (AJOL)

    cDepartment of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India. *Corresponding ... An obstetric examination revealed a single .... general management of cardiac disease in pregnancy. Curr Opin Crit. Care. 2005;11:430–4. 9. Krzysztof M, Kuczkowski MD. Anesthesia for the parturient with.

  13. Cerebrospinal fluid loss at lumbar puncture for caesarean section ...

    African Journals Online (AJOL)

    Background Post dural puncture headache (PDPH) is an unpleasant complication of spinal anaesthesia. Several studies have attempted explanation of its pathophysiology. A widely held view is that it results from loss of cerebrospinal fluid volume resulting from leak following a hole left in the dura after the puncture.

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

    African Journals Online (AJOL)

    Objective: To determine if perinatal outcome is affected by the route of delivery in breech-breech and breech-transverse twin gestations. Design: Prospective observational study. Setting: Umtala General Hospital, a referral hospital for approximately 32 rural hospitals throughout the former Transkei. Subjects: Twin gestations ...

  15. Uterine incision cloSure at caesarean section: A randomised ...

    African Journals Online (AJOL)

    nylon suture size 0. The only difference between the two groups was on the method of closure of uterine incision i.e. intraperitoneal closure or closure after temporary exteriorisation. Intraperitoneal closure. After delivery of the baby and the placenta, the uterine incision is closed with the uterus within the abdominal cavity.

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

    African Journals Online (AJOL)

    up for readmission or development of sepsis, including telephone calls 14 days after delivery. Puerperal sepsis was defined as fever (temperature ≥38°C) with vaginal bleeding, malodorous discharge or pain. Women who telephonically ...

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

    African Journals Online (AJOL)

    Methods. A longitudinal descriptive study was done on women undergoing CS, with follow-up for readmission or development of sepsis, including telephone calls 14 days after delivery. Puerperal sepsis was defined as fever (temperature ≥38°C) with vaginal bleeding, malodorous discharge or pain. Women who ...

  18. Should women be able to choose caesarean section?

    African Journals Online (AJOL)

    2006-04-26

    Apr 26, 2006 ... medical student, just entering into the scary world of responsibility. Due to ... but possible factors include women's socio-economic status, the influence .... some would argue that the mother is being selfish in that she is putting ...

  19. Booking status and caesarean section outcome in LAUTECH ...

    African Journals Online (AJOL)

    Background: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. Quality of care varies across health facilities; the booking status of the women who deliver would have influence on the pregnancy outcome. Method: A comparative study ...

  20. Caesarean Sections at Juba Teaching Hospital 2008 - 2009

    African Journals Online (AJOL)

    Ann Burgess

    were performed using a general anaesthetic or ketamine (79% for emergency and 62% for elective surgery). These rates are much ... Surgical operations performed in each of the three operating .... Handwashing at critical times – including after using the toilet and before eating or preparing food – can reduce diarrhoea ...