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  1. Delivery by Cesarean Section

    Science.gov (United States)

    ... Español Text Size Email Print Share Delivery by Cesarean Section Page Content Article Body More than one mother in three gives birth by Cesarean section in the United States (it is also called ...

  2. What Is a Cesarean Delivery?

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    ... are common complications? What is a high-risk pregnancy? What is labor? What is a cesarean delivery? Other FAQs NICHD Research Information Clinical Trials Resources and Publications What is a cesarean delivery? Skip sharing on social media links Share this: Page Content A cesarean delivery ...

  3. Osteogenesis imperfecta: cesarean deliveries in identical twins.

    Science.gov (United States)

    Dinges, E; Ortner, C; Bollag, L; Davies, J; Landau, R

    2015-02-01

    Osteogenesis imperfecta is a congenital disorder resulting in multiple fractures and extremely short stature, usually necessitating cesarean delivery. Identical twins with severe osteogenesis imperfecta each of whom underwent a cesarean delivery with different anesthetic modalities are presented. A review of the literature and anesthetic options for cesarean delivery and postoperative analgesia for women with osteogenesis imperfecta are discussed.

  4. Cesarean delivery technique: evidence or tradition? A review of the evidence-based cesarean delivery.

    Science.gov (United States)

    Encarnacion, Betsy; Zlatnik, Marya G

    2012-08-01

    Cesarean delivery is the most common surgical procedure performed in the United States, yet the techniques used during this procedure often vary significantly among providers. The purpose of this review was to evaluate and outline current evidence behind the cesarean delivery technique. A search of the PubMed database was conducted using the terms cesarean section and cesarean delivery and the technique of interest, for example, cesarean section prophylactic antibiotics. Few aspects of the cesarean delivery were found to have high-quality consistent evidence to support use of a particular technique. Because many aspects of the procedure are based on limited or no data, more studies on specific cesarean delivery techniques are clearly needed. Providers should be aware of which components of the cesarean delivery are evidence-based versus not when performing this procedure.

  5. Management of Cesarean Deliveries and Cesarean Scars With Osteopathic Manipulative Treatment: A Brief Report.

    Science.gov (United States)

    Martingano, Daniel

    2016-07-01

    Cesarean scars pose a unique set of risks for women who have had previous cesarean deliveries. Between 1996 and 2007, the rate of trial of labor after previous cesarean delivery increased, along with reported rates of uterine rupture and other complications. Consequently, trial of labor after previous cesarean delivery and resultant vaginal birth after cesarean delivery have decreased and cesarean delivery has increased. With nearly one-third of women having cesarean delivery, the rate of rare complications such as cesarean scar ectopic pregnancy has also increased. An integration of osteopathic manipulative treatment techniques into the management of cesarean deliveries and cesarean scars has yet to be defined. The author presents 4 cases of cesarean delivery in which osteopathic manipulative treatment was integrated with successful outcomes.

  6. Is non-directive counseling for patient choice cesarean delivery ethically justified?

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    Kalish, Robin B; McCullough, Laurence B; Chervenak, Frank A

    2007-01-01

    The current controversy concerning patient choice cesarean delivery potentially affects all women of child-bearing age and the physicians who care for them. The purpose of this paper is to address three salient issues within the patient choice cesarean delivery controversy. First, is performing patient choice cesarean delivery consistent with good professional medical practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? And, third, should patient choice cesarean delivery be routinely offered to all pregnant women?

  7. Quality of Life after Cesarean and Vaginal Delivery

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    Seyed Abbas Mousavi

    2013-07-01

    Full Text Available Objective: Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery.Methods: This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum.Results: In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65 ± 12.7 and 72.12 ± 11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group (p<0.05. In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical (R2=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350] and social (R2=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023] domains of QOL and the global QOL score (R2=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]. While multiparas, there was no relationship between QOL and type of delivery.Conclusion: In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery.

  8. Risk of Asthma from Cesarean Delivery Depends on Membrane Rupture

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Stokholm, Jakob; Bisgaard, Hans

    2016-01-01

    OBJECTIVE: To assess our prospective mother-child cohort and the national registry data to analyze the risk of asthma by delivery mode and whether cesarean delivery before or after membrane rupture affects this risk differently. STUDY DESIGN: The Copenhagen Prospective Studies on Asthma in Childh......OBJECTIVE: To assess our prospective mother-child cohort and the national registry data to analyze the risk of asthma by delivery mode and whether cesarean delivery before or after membrane rupture affects this risk differently. STUDY DESIGN: The Copenhagen Prospective Studies on Asthma...... in Childhood2000 is a high-risk birth cohort of 411 Danish children. Asthma was diagnosed prospectively by physicians at the research site, and associations with cesarean delivery were investigated using Cox proportional hazard models. From the Danish national prospective registry we included data from 1997......-2010. Childhood asthma was defined from recurrent use of inhaled corticosteroids filled at pharmacies. Cesarean delivery was classified as either before or after rupture of membranes, and the risk of asthma was compared with vaginal delivery. Results were adjusted stepwise for age and calendar year, sex, birth...

  9. Myomectomy at time of cesarean delivery: a retrospective cohort study

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    Tabsh Khalil MA

    2004-07-01

    Full Text Available Abstract Background Myomectomy at time of cesarean delivery is traditionally discouraged because of the risk of hemorrhage. A retrospective cohort study was performed to determine whether myomectomy at time of cesarean delivery leads to an increased incidence of intrapartum and short-term postpartum complications. Methods A computer search of medical records from May 1991 to April 2001 identified a total of 111 women who underwent myomectomy at time of cesarean delivery and 257 women with documented fibroids during the index pregnancy who underwent cesarean delivery alone. Charts were reviewed for the following outcome variables: change in hematocrit from preoperative to postoperative period, length of operation, length of postpartum stay, incidence of postpartum fever, and incidence of hemorrhage. Hemorrhage was defined as a change in hematocrit of 10 points or the need for intraoperative blood transfusion. Results The incidence of hemorrhage in the study group was 12.6% as compared with 12.8% in the control group (p = 0.95. There was also no statistically significant increase in the incidence of postpartum fever, operating time, and length of postpartum stay. No patient in either group required hysterectomy or embolization. Size of fibroid did not appear to affect the incidence of hemorrhage. After stratifying the procedures by type of fibroid removed, intramural myomectomy was found to be associated with a 21.2% incidence of hemorrhage compared with 12.8% in the control group, but this difference was not statistically significant (p = 0.08. This study had 80% power to detect a two-fold increase in the overall incidence of hemorrhage. Conclusion In selected patients, myomectomy during cesarean delivery does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity.

  10. Birth after previous cesarean delivery: short-term maternal outcomes.

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    Lydon-Rochelle, Mona T; Cahill, Alison G; Spong, Catherine Y

    2010-08-01

    An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.

  11. The Brazilian preference: cesarean delivery among immigrants in Portugal.

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    Cristina Teixeira

    Full Text Available OBJECTIVE: To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. STUDY DESIGN: Women delivered of a singleton birth (n = 8228, recruited from five public level III maternities (April 2005-August 2006 during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908, non-Portuguese European (n = 84, African (n = 77 and Brazilian (n = 159. A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR and respective 95% confidence intervals (95%CI. RESULTS: The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008. After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08-1.47. The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12-1.73 and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99-2.06 or during labor (PR = 1.30; 95%CI: 1.07-1.58. CONCLUSIONS: The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services.

  12. Health implications resulting from the timing of elective cesarean delivery

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    Shalev Eliezer

    2010-06-01

    Full Text Available Abstract Background The literature is nearly unanimous in recommending elective cesarean delivery at 39 weeks of gestation because of the lower rates of neonatal respiratory complications compared to 38 weeks. However, elective cesarean delivery at 39 weeks or more may have maternal and other fetal consequences compared to delivery at 38 weeks, which are not always addressed in these studies. Discussion Between 38 and 39 weeks of gestation, approximately 10% - 14% of women go into spontaneous labor; meaning that a considerable number of women scheduled for an elective cesarean delivery at 39 weeks will deliver earlier in an unscheduled, frequently emergency, cesarean delivery. The incidence of maternal morbidity and mortality is higher among women undergoing non-elective cesarean deliveries than among those undergoing elective ones. Complications may be greater among women after numerous repeat cesarean deliveries and among older women. Other than reducing the frequency of non-elective cesarean deliveries, bringing forward the timing of elective cesarean delivery to 38 weeks, may occasionally prevent intrauterine fetal demise which has been shown to increase with increasing gestational age and to avoid other fetal consequences related to the emergency delivery. All these considerations need to be weighed against the medical and the economic impact of the increase in neonatal morbidity resulting from births at 38 weeks compared to 39 weeks. Summary Until prospective randomized trials are conducted, we are unlikely to be able to precisely answer all risk:benefit questions as to the best timing of scheduled elective cesarean delivery. Older women, and women with numerous prior cesarean deliveries, are of particular concern. It is reasonable to inform the pregnant women of the risk of each of the above options and to respect her autonomy and decision-making.

  13. Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

    LENUS (Irish Health Repository)

    Contag, Stephen A

    2010-06-01

    We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks\\' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

  14. Sharp compared with blunt fascial incision at cesarean delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Hare, Kristine J; Krebs, Lone

    2014-01-01

    To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control.......To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control....

  15. Cesarean Delivery for a Life-threatening Preterm Placental Abruption

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    Okafor, II; Ugwu, EO

    2015-01-01

    Placental abruption is one of the major life-threatening obstetric conditions. The fetomaternal outcome of a severe placental abruption depends largely on prompt maternal resuscitation and delivery. A case of severe preterm placental abruption with intrauterine fetal death. Following a failed induction of labor with a deteriorating maternal condition despite resuscitation, emergency cesarean delivery was offered with good maternal outcome. Cesarean delivery could avert further disease progression and possible maternal death in cases of severe preterm placental abruption where vaginal delivery is not imminent. However, further studies are necessary before this could be recommended for routine clinical practice. PMID:27057388

  16. Predictors for Emergency Cesarean Delivery in Women with Placenta Previa

    NARCIS (Netherlands)

    Ruiter, Laura; Eschbach, Sanne J; Burgers, Mara; Rengerink, Katrien Oude; Pampus, Mariëlle G van; Goes, Birgit Y van der; Mol, Ben W J; Graaf, Irene M de; Pajkrt, Eva

    2016-01-01

    Objective The objective of this study was to identify the predictors of emergency delivery in women with placenta previa. Methods This is a retrospective study of pregnancies complicated by placenta previa, scheduled for a cesarean delivery between 2001 and 2011. Using univariable and multivariable

  17. Hematometra Formation- A Rare Complication of Cesarean Delivery

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    Kaur, Gurpreet; Sharma, Abha; Vaid, Neelam Bala

    2014-01-01

    Hematometra resulting from partial or complete obstruction of lower genital tract may be congenital or acquired. Commonest congenital causes are imperforate hymen and transverse vaginal septum. Acquired causes are senile atrophy of endocervical canal, scarring of the isthmus by synechiae, radiation and endocervical malignancy or due to surgical procedures. Various surgical procedures associated with hematometra are dilatation and curettage, cone biopsy, endometrial ablation, cryocoagulation and electrocautery. Hematometra following an abortion or cesarean delivery is rare. We report a case of hematometra following obstruction of outflow tract due to prior cesarean delivery. PMID:25302239

  18. Cesarean delivery on maternal request and childhood intelligence: a cohort study

    Institute of Scientific and Technical Information of China (English)

    LI Hong-tian; YE Rong-wei; PEI Li-jun; REN Ai-guo; ZHENG Xiao-ying; LIU Jian-meng

    2011-01-01

    Background Cesarean section births have been steadily increasing over the past decade and have become an epidemic in China.Cesarean delivery on maternal request is a major contributor to this upward trend,and there has been of much concern about its impact on maternal and child health.Most of mothers believe that cesarean delivery on maternal request can improve the child's intelligence,but direct evidence is sparse.In this cohort study,we aimed to directly assess the impact of cesarean delivery on maternal request on childhood intelligence.Methods Intelligence quotient (IQ) of 4144 preschool children from 21 cities/counties of Zhejiang and Jiangsu province whose mothers were registered in a population-based perinatal surveillance program during 1993-1996 was assessed with Chinese Wechsler Young Children Scale of Intelligence (C-WYCSI) in 2000.The outcomes were full-scale IQ,verbal IQ,and performance IQ of C-WYCSI.Mode of delivery and covariates were obtained from the surveillance program.We estimated unadjusted and adjusted effects of cesarean delivery on maternal request and assisted vaginal delivery on IQ scores compared with spontaneous vaginal delivery using regression analysis.Results The mean full-scale,verbal,and performance IQ for all children was 99.3±16.1,93.6±17.7,and 105.3±14.3.In crude analysis,cesarean delivery on maternal request versus spontaneous vaginal delivery was associated with an increase of 3.9 (95% confidence interval,0.6 to 7.2) points in full-scale IQ,4.8 (1.2 to 8.4) points in verbal IQ,and 2.4(-0.6 to 5.3) points in performance IQ.After adjusting for maternal education,occupation,and IQ,the advantage was reduced to 1.6 (-1.3 to 4.5),2.3 (-0.8 to 5.5),and 0.6 (-2.0 to 3.3) points for full-scale,verbal,and performance IQ,respectively.Assisted vaginal delivery versus spontaneous vaginal delivery was not associated with IQ scores in any analysis.Conclusion Neither cesarean delivery on maternal request nor assisted vaginal delivery

  19. Delivery by Cesarean Section and risk of childhood cancer

    DEFF Research Database (Denmark)

    Momen, Natalie; Olsen, Jørn; Gissler, Mika;

    Introduction Studies suggest delivery by Cesarean section (CS) may impact the development of the immune system. Meta-analyses on CS and risks of type I diabetes mellitus and asthma have found risks increased by 20%. Three different mechanisms have been proposed by which CS may influence immune...

  20. Amnioinfusion among women attempting vaginal birth after cesarean delivery.

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    Strong, T H; Vega, J S; O'Shaughnessy, M J; Feldman, D B; Koemptgen, J G

    1992-05-01

    Eighteen of 901 women (2%) attempting vaginal birth after cesarean delivery (VBAC) received amnioinfusion. No untoward effects occurred in the subjects or their fetuses. We conclude that, though amnioinfusion in the setting of a VBAC attempt is needed only infrequently, it appears to be a reasonable intrapartum management option. The usual safeguards for a VBAC attempt should be followed.

  1. Vaginal delivery versus cesarean section for term breech delivery

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    Babović Ivana

    2010-01-01

    Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

  2. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

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    Tabitha Schrufer-Poland

    2015-04-01

    Full Text Available Introduction - Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description - A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion - Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.

  3. Obesity and gestational weight gain: cesarean delivery and labor complications

    OpenAIRE

    Seligman, Luiz Carlos; Duncan, Bruce Bartholow; Branchtein,Leandro; Gaio, Dea Suzana Miranda; Mengue, Sotero Serrate; Schmidt, Maria Inês

    2006-01-01

    OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications w...

  4. Maternal Vitamin D Status and Delivery by Cesarean

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    Peter Stein

    2012-04-01

    Full Text Available We examined the association of vitamin D deficiency to risk of cesarean delivery using prospective data in a cohort of 1153 low income and minority gravidae. Circulating maternal 25-hydroxyvitamin D and intact parathyroid hormone were measured at entry to care 13.73 ± 5.6 weeks (mean ± SD. Intake of vitamin D and calcium was assessed at three time points during pregnancy. Using recent Institute of Medicine guidelines, 10.8% of the gravidae were at risk of vitamin D deficiency, and 23.8% at risk of insufficiency. Maternal 25-hydroxyvitamin D was related positively to vitamin D and calcium intakes and negatively to circulating concentrations of parathyroid hormone. Risk for cesarean delivery was increased significantly for vitamin D deficient women; there was no increased risk for gravidae at risk of insufficiency. When specific indications were examined, vitamin D deficiency was linked to a 2-fold increased risk of cesarean for prolonged labor. Results were the similar when prior guidelines for vitamin D deficiency (25(OHD < 37.5nmol/L and insufficiency (37.5–80 nmol/L were utilized.

  5. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries.

    Science.gov (United States)

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young; Kwon, Yong Soon

    2015-11-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding.

  6. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial

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    Sahar Assadi

    2016-03-01

    Full Text Available Background: Cesarean delivery is the most common surgical procedure and this prevalence is on the rise. Given these trends, cesarean wound complications, such as disruption or infection, remain an important cause of post-cesarean morbidity. Methods: We conducted a single-center randomized controlled trial that included women with viable pregnancies (≥24 weeks undergoing cesarean delivery at Motahary University Hospital, Urmia, Iran from April to November 2014. All cesarean types were included: scheduled or unscheduled and primary or repeat cesareans. Women were excluded for the following reasons: inability to obtain informed consent, immune compromising disease (e.g. AIDS, chronic steroid use, diabetic mellitus and BMI≥30. Of 266 women, 133 were randomized to staples and 133 women to suture group. Results: The mean±SD age of the staples group was 27.6±5.4 years and mean±SD age of suture was 28.7±5.9 years. Multiparity is the most frequent in both groups that by using Chi-square test, no significant differences were observed between the two groups (P=0.393. The most frequent indication for cesarean section in both groups was history of cesarean section in staple 40 cases (30.1% and suture 32 cases (24.1%. The survey was conducted using the Chi-square test was not significant (P=0.381. Pain at 6 weeks postoperatively was significantly less in the staple group (P=0.001. Operative time was longer with suture closure (4.68±0.67 versus 1.03±0.07 minute, P<0.001. The Vancouver scale score was significantly less in suture closure (6.6±0.8 versus 7.5±0.9, P=0.001. Wound disruption was significantly less in suture closure (3.8% versus 11.3%, P=0.017. Conclusion: The staple group had low pain and operation time but had a significant wound disruption and scar. The patients who have suffered a significant wound disruption were affected by age (P=0.022 and BMI (P=0.001 at compared those who were not affected by factors such as age or high BMI as

  7. Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity

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    Erez O

    2012-03-01

    Full Text Available Offer Erez1, Lena Novack2, Vered Kleitman-Meir1, Doron Dukler1, Idit Erez-Weiss3, Francesca Gotsch4, Moshe Mazor11Department of Obstetrics and Gynecology, Soroka University Medical Center, 2Department of Epidemiology, 3Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 4Obstetrics and Gynecology Departement, Policlinico GB Rossi Azienda Ospedaliera Universitaria Integrata Verona, ItalyPurpose: To determine the effects of vaginal birth after cesarean (VBAC versus repeated cesarean sections (RCS after a primary cesarean section (CS, on the rate of intraoperative and postpartum maternal morbidity.Patients and methods: This is a retrospective population-based cohort study. During the study period (1988–2005 there were 200,012 deliveries by 76,985 women at our medical center; 16,365 of them had a primary CS, of which 7429 women delivered a singleton infant after the primary CS, met the inclusion criteria, were included in our study, and were followed for four consecutive deliveries. Patients were divided into three study groups according to the outcome of their consecutive delivery after the primary CS: VBAC (n = 3622, elective CS (n = 1910, or an urgent CS (n = 1897. Survival analysis models were used to investigate the effect of the urgency of CS and the numbers of pregnancy predating the primary CS on peripartum complications.Results: Women who failed a trial of labor had a higher rate of uterine rupture than those who had a VBAC. Patients who delivered by CS had a higher rate of endometritis than those giving birth vaginally. The rate of cesarean hysterectomy and transfer to other departments increased significantly at the fourth consecutive surgery (P = 0.02 and P = 0.003, respectively. VBAC was associated with a 55% reduction in the risk of intrapartum complications in comparison to a planned CS (hazard ratio [HR] 0.45; 95% confidence interval [CI]: 0.22–0.89. A greater

  8. Determinants of cesarean delivery in the US: a lifecourse approach.

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    Witt, Whitney P; Wisk, Lauren E; Cheng, Erika R; Mandell, Kara; Chatterjee, Debanjana; Wakeel, Fathima; Godecker, Amy L; Zarak, Dakota

    2015-01-01

    This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.

  9. Epidemiology of cesarean delivery: the scope of the problem.

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    Boyle, Annelee; Reddy, Uma M

    2012-10-01

    Approximately one-third of births in the United States are via cesarean delivery (CD). The rate of CD has increased dramatically since the 1990s, reaching a peak of 32.9% in 2009. The increase can be seen among women of all ages and race/ethnicities, in every state, and across all gestational ages. The primary CD rate has increased from 14.5% in 1996 to 23.4% in 2007. Because the primary CD rate has increased and the rate of trial of labor after CD has decreased, the primary cesarean rate has become a major driver in the total CD rate. Also contributing to the high CD rate is an increase in somewhat subjective indications, such as fetal distress or nonreassuring fetal tracing and failure to progress leading to performance of CD in the latent phase of labor. Addressing these factors--as well as focusing on the use of elective induction and management of early labor in the particular subgroup of nulliparous women at term, with singleton fetuses in vertex presentation--may have a significant impact on the total CD rate.

  10. Uterine Closure in Cesarean Delivery: A New Technique

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    K M Babu

    2012-01-01

    Full Text Available Fear of scar rupture is one of risks involved in a post caesarean pregnancy. This had led to an increased rate of repeat cesarean delivery in today′s times. Closure of the uterine incision is a key step in cesarean section, and it is imperative that an optimal surgical technique be employed for closing a uterine scar. This technique should be able to withstand the stress of subsequent labor. In the existing techniques of uterine closure, single or double layer, correct approximation of the cut margins, that is, decidua-to-decidua, myometrium to myometrium, serosa to serosa is not guaranteed. Also, there are high chances of inter surgeon variability. It was felt that if a suturing technique which ensures correct approximation of all the layers mentioned above with nil or minimal possibility of inter operator variability existed, there will not be any thinning of lower segment caesarean section (LSCS. Further, a scarred uterus repaired in this manner will be able to withstand the stress of labor in future. We hereby report a new technique for uterine closure devised by us, which incorporates a continuous modified mattress suture technique as a modification of the existing surgical technique of uterine closure.

  11. Planned cesarean delivery and urinary retention associated with spinal morphine.

    Science.gov (United States)

    DiBlasi, Susan M

    2013-06-01

    Cesarean delivery (CD) is the second most commonly performed surgery in the United States. As such, prevention of complications associated with this procedure is a top priority in nursing care. Nurses at the study institution perceived that postcesarean patients experienced increased urinary retention after use of spinal morphine for postoperative pain relief. This observation prompted a review of the literature indicating that limited research had been conducted in this area. The purpose of this study was to explore the relationship of postelective CD urinary retention and dose of spinal morphine. A retrospective, quasi-experimental, three-group design was used. Records of 150 patients, ages 17 to 39, undergoing elective primary or repeat CD were examined. Morphine doses included 100, 150, and 200 mcg. No statistically significant differences were found between the three groups.

  12. Cesarean delivery in preeclampsia and seasonal variation in a tropical rainforest belt

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    Okafor U

    2010-01-01

    Full Text Available Background: The pathogenesis of preeclampsia is poorly understood and recent evidence suggests that the incidence varies depending upon the season. Aim: This study was carried out to determine whether there is a seasonal variation in the presentation of preeclamptics undergoing cesarean delivery in a tropical rainforest belt. Setting: A university teaching hospital. Study Design: Retrospective. Materials and Methods: The hospital records of consecutive patients (July 1996-June 2006 with preeclampsia, who underwent cesarean delivery in a tertiary care centre, were reviewed. Data collected included patient demographics, total number of deliveries, number of cesarean deliveries, and number of preeclampsia patients and time of presentation for cesarean section. Approval of the local ethical committee was obtained. Statistical Analysis: The EPI info software program was used for statistical analysis. Results: A total of 6798 deliveries were recorded during the study period resulting in 6485 live births. There were 1579 cesarean deliveries during the period. Of these, 196 patients had toxemia of pregnancy (166 with preeclampsia and 30 with eclampsia. One hundred and forty-one patients (9% of cesarean deliveries had cesarean delivery during the rainy season and 55 (3.5% during the dry season (P < 0.05. Amongst preeclampsia patients, 115 presented (7% during the rainy season and 51 (3.2% during the dry season (P < 0.05. In the eclampsia group, 26 (1.65% of cesarean sections presented during the rainy season and four (0.25% during the dry season (P < 0.05. Conclusions: There was a seasonal variation in the cesarean delivery required for preeclampsia/eclampsia patients. This may help in counseling women on when to plan their pregnancy in order to reduce the morbidity and mortality associated with this apparent seasonal disease.

  13. Neonatal morbidity after spontaneous labor onset prior to intended cesarean delivery at term

    DEFF Research Database (Denmark)

    Glavind, Julie; Milidou, Ioanna; Uldbjerg, Niels;

    2017-01-01

    INTRODUCTION: We aimed to investigate if labor onset before planned cesarean delivery (CD) affects the risk of neonatal admission, respiratory distress, or neonatal infectious morbidity. MATERIAL AND METHODS: Our cohort included singleton term pregnant women with intended CD who delivered at Aarhus...... for an immediate CD or for early term CD scheduling. Data were stratified in early term (37-38 weeks) and full term (39-40 weeks) deliveries. The main outcome measures were neonatal admission, respiratory distress, and neonatal infectious morbidity. RESULTS: Among 103 919 live births, 5071 deliveries were non......-labor CDs and 731 were labor onset CDs. Compared to non-labor CD, labor onset CD was associated with similar risks of neonatal admission and respiratory distress, both at early and full term, but with a 2-3 fold increased risk of newborn septicemia or antibiotic treatment at early term. Labor onset at early...

  14. A case of vesicouterine fistula after cesarean section with delivery through the bladder

    DEFF Research Database (Denmark)

    Schroeder, T; Kristensen, J K

    1983-01-01

    We report a case of a vesicouterine fistula subsequent to delivery at cesarean section through the bladder. A first attempt to close the fistula failed but a second operation adhering to the general principles of fistula repair was successful....

  15. Risk factors for cesarean section and instrumental vaginal delivery after successful external cephalic version.

    Science.gov (United States)

    de Hundt, Marcella; Vlemmix, Floortje; Bais, Joke M J; de Groot, Christianne J; Mol, Ben Willem; Kok, Marjolein

    2016-01-01

    Aim of this article is to examine if we could identify factors that predict cesarean section and instrumental vaginal delivery in women who had a successful external cephalic version. We used data from a previous randomized trial among 25 hospitals and their referring midwife practices in the Netherlands. With the data of this trial, we performed a cohort study among women attempting vaginal delivery after successful ECV. We evaluated whether maternal age, gestational age, parity, time interval between ECV and delivery, birth weight, neonatal gender, and induction of labor were predictive for a vaginal delivery on one hand or a CS or instrumental vaginal delivery on the other hand. Unadjusted and adjusted odds ratios were calculated with univariate and multivariate logistic regression analysis. Among 301 women who attempted vaginal delivery after a successful external cephalic version attempt, the cesarean section rate was 13% and the instrumental vaginal delivery rate 6%, resulting in a combined instrumental delivery rate of 19%. Nulliparity increased the risk of cesarean section (OR 2.7 (95% CI 1.2-6.1)) and instrumental delivery (OR 4.2 (95% CI 2.1-8.6)). Maternal age, gestational age at delivery, time interval between external cephalic version and delivery, birth weight and neonatal gender did not contribute to the prediction of failed spontaneous vaginal delivery. In our cohort of 301 women with a successful external cephalic version, nulliparity was the only one of seven factors that predicted the risk for cesarean section and instrumental vaginal delivery.

  16. Obstetricians' choice of cesarean delivery in ambiguous cases

    DEFF Research Database (Denmark)

    Fuglenes, Dorthe; Oian, Pål; Kristiansen, Ivar Sønbø

    2009-01-01

    survey of Norwegian obstetricians (n = 716; response rate, 71%) using clinical scenarios. The risk attitude was measured by 6 items from the Jackson Personality Inventory-Revised. RESULTS: The proportion of obstetricians consenting to the cesarean request varied both within and across the scenarios....... The perceived risk of complaints and malpractice litigation was a clear determinant of obstetricians' choice of cesarean in all of the clinical scenarios, whereas no impact was observed for risk attitude. CONCLUSION: Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably....... Perceived risk of complaints and litigation is associated with compliance with the requested cesarean....

  17. Transverse arrest: a review of outcomes of rotational forceps and cesarean delivery at a single center.

    Science.gov (United States)

    Leo; Odibo; Ling; Rodis; Borgida; Campbell

    1998-07-01

    Objective: To assess whether Kielland forceps rotational delivery causes a significant increase in maternal or perinatal morbidity in comparison with cesarean delivery in the clinical situation of transverse arrest. Rotational forceps delivery has been reported to have unacceptably high maternal and neonatal complication rates when compared with either spontaneous vaginal delivery or non-rotational forceps delivery. Clinically, however, we considered the more relevant comparison between Kielland rotational forceps delivery and cesarean delivery as these are generally the two modes of delivery for the fetus in transverse arrest.Study Design: The charts of all the mothers delivered by Kielland forceps or cesarean delivery for the main indication of transverse arrest between July 1995 and June 1996 were reviewed. The following were evaluated: Apgar scores at 1 and 5 minutes, cord pH, birth weight, neonatal superficial facial laceration or bruising, bone or nerve injuries, maternal injuries, 3rd and 4th degree perineal or vaginal lacerations, post-partum fever. Statistical analysis was by chi(2) (for Apgar scores), two-tailed Fisher Exact test (for post-partum fever), and t test (for birth weight and cord pH). A P value cesarean deliveries were performed. One-minute Apgar scores of less than or equal to 7 were noted in 11.5% and 6.7% of the forceps and cesarean section groups, respectively (P = NS); mean arterial cord pH was 7.26 for both groups; no cases of post-partum fever were noted in the forceps versus 16% in the cesarean group (P cesarean group, respectively (P cesarean delivery.No significant difference in cord pH and Apgar scores were noted between the two groups. The birth weight was greater and post-partum fever was more common in the cesarean section group. Neonatal facial bruising, temporary facial nerve palsy, and maternal perineal and vaginal lacerations were more common in the forceps groups. This study suggests that rotational forceps may be a

  18. The use of quality control performance charts to analyze cesarean delivery rates nationally.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    OBJECTIVE: To examine the use of quality control performance charts to analyze cesarean rates nationally. METHODS: Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis. RESULTS: The mean rates per hospital of elective and emergency cesarean were 12.9+\\/-2.6% (n=9337) and 13.8+\\/-3.0% (n=9989), respectively-giving an overall mean rate of 26.7+\\/-4.2% (n=19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review. CONCLUSION: Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed.

  19. Uterus Wrapping: A Novel Concept in the Management of Uterine Atony during Cesarean Delivery

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    N. Kimmich

    2015-01-01

    Full Text Available Uterine atony during cesarean delivery is a serious cause of maternal morbidity and mortality. Management strategies include medical treatment with uterotonic agents, manual compression of the uterus, and interventional or surgical procedures. A novel technique to compress the uterus by wrapping it with an elastic bandage and its outcome in 3 cases of uterine atony during cesarean section are presented. Our novel method of intermittent wrapping of the uterus during cesarean delivery seems to be a successful additional approach in the management of uterine atony during cesarean delivery and may be an alternative treatment option to other compressing procedures in order to avoid high blood loss and last but not least postpartum hysterectomy.

  20. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital

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    Hassan Boskabadi

    2014-03-01

    Conclusion: The results of this study showed in comparison with cesarean delivery, normal vaginal delivery provides better outcomes in terms of breast problems, breast feeding status, duration of labor and duration of maternal hospitalization for both mother and infant. So, adopting careful instructions in management and administration of deliveries will help the prevalence of making decisions for normal vaginal delivery and the recovery of delivery outcomes.

  1. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    Science.gov (United States)

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  2. Postoperative Infectious Morbidities of Cesarean Delivery in Human Immunodeficiency Virus-Infected Women

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    Helen Cavasin

    2009-01-01

    Full Text Available Objective. To compare the infectious complication rates from cesarean delivery of human immunodeficiency virus (HIV-infected women and HIV-negative women. Materials and Methods. A retrospective analysis was performed on data derived from HIV-infected women and HIV-negative women, who underwent cesarean delivery at two teaching hospitals. Main outcome measures were infectious postoperative morbidity. Descriptive, comparison analysis, and multiple logistic regression analysis were performed. Results. One hundred and nineteen HIV-infected women and 264 HIV-negative women delivered by cesarean section and were compared. The HIV-negative women were more likely than the HIV-infected women to deliver by emergent cesarean section (78.0% versus 51.3%, resp., .05. In a multivariate stepwise logistic analysis, emergent cesarean delivery and chorioamnionitis but not HIV infection were associated with increased rate of post-operative endometritis (odds ratio (OR 4.10, 95% confidence interval (95% CI 1.41–11.91, <.01, and OR 3.02, 95% CI 1.13–8.03, <.05, resp.. Conclusion. In our facilities, emergent cesarean delivery and chorioamnionitis but not HIV infection were identified as risk factors for post-operative endometritis.

  3. Cesarean delivery on maternal request: wise use of finite resources? A view from the trenches.

    Science.gov (United States)

    Druzin, Maurice L; El-Sayed, Yasser Y

    2006-10-01

    Cesarean section rates are rising in the United States and were at an all time high of 29 percent in 2004. Within this context, the issue of cesarean section on maternal request has been described as being part of a "perfect storm" of medical, legal and personal choice issues, and the lack of an opposing view. An increasing cesarean section rate adds an economic burden on already highly stressed medical systems. There is an incremental cost of cesarean section compared to vaginal delivery. The issue of cost must also be considered more broadly. Rising cesarean section rates are associated with a longer length of stay and a higher occupancy rate. This high occupancy rate leads to the diversion of critical care obstetric transports and has dramatically reduced patient satisfaction. These diversions, and the resultant inability to provide needed care to pregnant women, represent a profound societal cost. These critical care diversions and reduced patient satisfaction also negatively impact a health care institution's financial bottom line and competitiveness. The impact of a rising cesarean section rate on both short and long-term maternal and neonatal complications, and their associated costs, must also be taken into account. The incidence of placenta accreta is increasing in conjunction with the rising cesarean section rate. The added costs associated with this complication (MRI, Interventional Radiology, transfusion, hysterectomy, and intensive care admission) can be prohibitive. It has also been demonstrated that infants born by scheduled cesarean delivery are more likely to require advanced nursery support (with all its associated expense) than infants born to mothers attempting vaginal delivery. The practice of maternal request cesarean section, with limited good data and obvious inherent risk and expense, is increasing in the USA. Patient autonomy and a woman's right to choose her mode of delivery should be respected. However, in our opinion, based on the

  4. Is a Vaginal Birth Possible After a Cesarean Delivery?

    Science.gov (United States)

    ... that a woman will have to have an unplanned cesarean after having a trial of labor. The ... benefit in treating mildly low thyroid function in pregnancy, NIH Network study finds Extreme temperatures may increase ...

  5. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations

    Science.gov (United States)

    Tinloy, Jennifer; Zhu, Junjia; Pauli, Jaimey; Kraschnewski, Jennifer L.; Kjerulff, Kristen H.

    2013-01-01

    Background Federal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy. Methods Self-reported weekly exercise was ascertained in 3,006 women during the 3rd trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (at least 150 minutes per week) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, pre-pregnancy BMI weight category, gestational weight gain, and prepregnancy diabetes or hypertension. Results Nearly one-third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes/week was associated with reduced odds of cesarean delivery compared with less than 60 minutes/week, but the finding was not statistically significant (adjusted OR 0.86, 95% CI 0.69 – 1.07). Conclusion In the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery. PMID:24439953

  6. Risk Factors for Cesarean Delivery following Labor Induction in Multiparous Women

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    Corine J. Verhoeven

    2013-01-01

    Full Text Available Objective. To identify potential risk factors for cesarean delivery following labor induction in multiparous women at term. Methods. We conducted a retrospective case-control study. Cases were parous women in whom the induction of labor had resulted in a cesarean delivery. For each case, we used the data of two successful inductions as controls. Successful induction was defined as a vaginal delivery after the induction of labor. The study was limited to term singleton pregnancies with a child in cephalic position. Results. Between 1995 and 2010, labor was induced in 2548 parous women, of whom 80 had a cesarean delivery (3%. These 80 cases were compared to the data of 160 parous women with a successful induction of labor. In the multivariate analysis history of preterm delivery (odds ratio (OR 5.3 (95% CI 1.1 to 25, maternal height (OR 0.87 (95% CI 0.80 to 0.95 and dilatation at the start of induction (OR 0.43 (95% CI 0.19 to 0.98 were associated with failed induction. Conclusion. In multiparous women, the risk of cesarean delivery following labor induction increases with previous preterm delivery, short maternal height, and limited dilatation at the start of induction.

  7. Cortical subarachnoid hemorrhage associated with reversible cerebral vasoconstriction syndrome after elective triplet cesarean delivery.

    Science.gov (United States)

    Albano, Beatrice; Del Sette, Massimo; Roccatagliata, Luca; Gandolfo, Carlo; Primavera, Alberto

    2011-06-01

    Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of disorders characterized by prolonged, but reversible vasoconstriction of the cerebral arteries, usually associated with acute-onset, severe, recurrent headaches, with or without additional neurological signs and symptoms. Various complications of this condition have been observed, such as cortical subarachnoid hemorrhages (cSAH), intracerebral hemorrhages, reversible posterior leukoencephalopathy, ischaemic strokes and transient ischaemic attacks. It is important to include RCVS in thunderclap headache differential diagnosis and among non-aneurismatic subarachnoid hemorrhage causes. In the past years, thanks to the major diffusion of new diagnostic tools such as magnetic resonance, computed tomography and digital subtraction angiography, RCVS have been demonstrated to be more frequent than previously thought. We report an illustrative case of a woman affected by a small cSAH, associated to RCVS, after elective triplet cesarean delivery. To our knowledge, this is the first case of cSAH associated to RCVS after a triplet pregnancy.

  8. Colloid cohydration and variable rate phenylephrine infusion effectively prevents postspinal hypotension in elective Cesarean deliveries

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    Indu Sen

    2013-01-01

    Full Text Available Background: Prevention of post-spinal hypotension in obstetric patients can be accomplished using intravenous fluid expansion and prophylactic use of sympathomimetic drugs. The affect of combination of colloids and phenylephrine infusion on maternal hemodynamics has not been widely studied and there is no consensus about the dosage required and time of starting its administration. Materials and Methods: This prospective, randomized, double-blind study enrolled 90 healthy term parturients undergoing elective Cesarean delivery under lumbar subarachnoid block (0.5% hyperbaric bupivacaine 10 mg with fentanyl 25 μg. Patients in Group A received prophylactic intravenous phenylephrine infusion (60 μg/minute along with hydroxyl-ethyl-starch cohydration (6% HES 130/0.42;15 ml/kg immediately after subarachnoid block. In Group B, patients received 6% HES cohydration and intermittent intravenous 50 μg boluses of phenylephrine. The efficacy of these in maintaining maternal SBP at 90-110% of baseline and neonatal well-being was evaluated. Results: In Group B, 75.5% of patients required rescue phenylephrine boluses to maintain SBP while maternal hemodynamics were well maintained in Group A and rescue drug was not needed. Reactive hypertension occurred in one patient (2.2% and bradycardia in two patients (4.4% in Group A. Six patients complained of nausea in Group B (13.3% compared to one in Group A. All the newborns had normal Apgar scores and Umbilical arterial pH > 7.2. Conclusion: A combination of colloid cohydration and prophylactic phenylephrine infusion initiated at 60 μg/minute maintained maternal hemodynamics and neonatal well-being during Cesarean deliveries requiring minimum interventions by the anesthesiologist.

  9. Development of strategies to reduce cesarean delivery rates in iran 2012-2014: A mixed methods study

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    Razieh Lotfi

    2014-01-01

    Full Text Available Background: With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. Methods: A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. Results: Qualitative data analysis showed four concept related to increased cesarean delivery rates including; "standardization", "education", "amending regulations", and "performance supervision". Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. Conclusions: Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved

  10. The preference of Iranian women to have normal vaginal or cesarean deliveries

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    Najmeh Maharlouei

    2013-01-01

    Full Text Available Background: The cesarean section (C-section has higher risk compared to normal vaginal delivery (NVD. The aim of this population-based study was to evaluate the frequency of mothers′ tendency toward the mode of delivery and the factors that can affect this inclination. Materials and Methods: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20 th to 30 th weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother′s preference for the route of delivery. Results: Of 6921 participants, 2197 (31.7% preferred C-section and 4308 (62.2% favored NVD while 416 (6% had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1% participants was zero, and 1261 women (18.2% achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother′s unacceptable level of knowledge regarding complications of C-section, and mother′s and husband′s positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. Conclusion: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.

  11. Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

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    Da Frè Monica

    2008-06-01

    Full Text Available Abstract In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice. Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging.

  12. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial.

    LENUS (Irish Health Repository)

    McDonnell, John G

    2008-01-01

    The transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing midline abdominal wall incisions. We evaluated its analgesic efficacy over the first 48 postoperative hours after cesarean delivery performed through a Pfannensteil incision, in a randomized controlled, double-blind, clinical trial.

  13. Could Revision of the Embryology Influence Our Cesarean Delivery Technique: Towards an Optimized Cesarean Delivery for Universal Use.

    Science.gov (United States)

    Stark, Michael; Mynbaev, Ospan; Vassilevski, Yuri; Rozenberg, Patrick

    2016-07-01

    Until today, there is no standardized Cesarean Section method and many variations exist. The main variations concern the type of abdominal incision, usage of abdominal packs, suturing the uterus in one or two layers, and suturing the peritoneal layers or leaving them open. One of the questions is the optimal location of opening the uterus. Recently, omission of the bladder flap was recommended. The anatomy and histology as results from the embryological knowledge might help to solve this question. The working thesis is that the higher the incision is done, the more damage to muscle tissue can take place contrary to incision in the lower segment, where fibrous tissue prevails. In this perspective, a call for participation in a two-armed prospective study is included, which could result in an optimal, evidence-based Cesarean Section for universal use.

  14. Could Revision of the Embryology Influence Our Cesarean Delivery Technique: Towards an Optimized Cesarean Delivery for Universal Use

    OpenAIRE

    Stark, Michael; Mynbaev, Ospan; Vassilevski, Yuri; Rozenberg, Patrick

    2016-01-01

    Until today, there is no standardized Cesarean Section method and many variations exist. The main variations concern the type of abdominal incision, usage of abdominal packs, suturing the uterus in one or two layers, and suturing the peritoneal layers or leaving them open. One of the questions is the optimal location of opening the uterus. Recently, omission of the bladder flap was recommended. The anatomy and histology as results from the embryological knowledge might help to solve this ques...

  15. Evidence-based surgery for cesarean delivery: an updated systematic review.

    Science.gov (United States)

    Dahlke, Joshua D; Mendez-Figueroa, Hector; Rouse, Dwight J; Berghella, Vincenzo; Baxter, Jason K; Chauhan, Suneet P

    2013-10-01

    The objective of our systematic review was to provide updated evidence-based guidance for surgical decisions during cesarean delivery (CD). We performed an English-language MEDLINE, PubMed, and COCHRANE search with the terms, cesarean section, cesarean delivery, cesarean, pregnancy, and randomized trials, plus each technical aspect of CD. Randomized control trials (RCTs) involving any aspect of CD technique from Jan. 1, 2005, to Sept. 1, 2012, were evaluated to update a previous systematic review. We also summarized Cochrane reviews, systematic reviews, and metaanalyses if they included additional RCTs since this review. We identified 73 RCTs, 10 metaanalyses and/or systematic reviews, and 12 Cochrane reviews during this time frame. Recommendations with high levels of certainty as defined by the US Preventive Services Task Force favor pre-skin incision prophylactic antibiotics, cephalad-caudad blunt uterine extension, spontaneous placental removal, surgeon preference on uterine exteriorization, single-layer uterine closure when future fertility is undesired, and suture closure of the subcutaneous tissue when thickness is 2 cm or greater and do not favor manual cervical dilation, subcutaneous drains, or supplemental oxygen for the reduction of morbidity from infection. The technical aspect of CD with high-quality, evidence-based recommendations should be adopted. Although 73 RCTs over the past 8 years is encouraging, additional well-designed, adequately powered trials on the specific technical aspects of CD are warranted.

  16. Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety

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    Kinney Michelle A O

    2012-08-01

    Full Text Available Abstract Background Maternal cardiovascular and pulmonary events during labor and delivery may result in adverse maternal and fetal outcome. Potential etiologies include primary cardiac events, pulmonary embolism, eclampsia, maternal hemorrhage, and adverse medication events. Remifentanil patient-controlled analgesia is an alternative when conventional neuraxial analgesia for labor is contraindicated. Although remifentanil is a commonly used analgesic, its use for labor analgesia is not clearly defined. Case presentation We present an unexpected and unique case of remifentanil toxicity resulting in the need for an emergent bedside cesarean delivery. A 30-year-old G3P2 woman receiving subcutaneous heparin anticoagulation due to a recent deep vein thrombosis developed cardiopulmonary arrest during labor induction due to remifentanil toxicity. Conclusion A rapid discussion among the attending obstetric, anesthesia, and nursing teams resulted in consensus to perform an emergent bedside cesarean delivery resulting in an excellent fetal outcome. During maternal cardiopulmonary arrest, a prompt decision to perform a bedside cesarean delivery is essential to avoid significant maternal and fetal morbidity. Under these conditions, rapid collaboration among obstetric, anesthesia, and nursing personnel, and an extensive multi-layered safety process are integral components to optimize maternal and fetal outcomes.

  17. Erb's palsy after delivery by Cesarean section. (A medico-legal key to a vexing problem.).

    Science.gov (United States)

    Iffy, Leslie; Pantages, Pamela

    2005-12-01

    Despite impressive progress in perinatology, fetal injuries from arrest of the shoulders at birth have not decreased in recent decades. Based upon sporadic reports of Erb's palsy in neonates born by Cesarean section, some obstetricians embraced the theory recently that brachial plexus lesions often derive from spontaneous forces acting in utero. Having reviewed three hundred malpractice claims involving fetal injuries attributed to shoulder dystocia at birth, the authors found only two cases connected with abdominal deliveries. One followed manual replacement of the already delivered fetal head into the pelvis after sequential vacuum and forceps procedures and failed manual extraction of the body. The other was an elective repeat Cesarean section where extensive adhesions limited the available space for the lower segment transverse uterine incision. Coincidental fracture of the clavicle and absence of contractures or deformities indicated that the brachial plexus injury was acute, having resulted from forceful traction at delivery.

  18. Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

    Science.gov (United States)

    Rimawi, B. H.; Graybill, W.; Pierce, J. Y.; Kohler, M.; Eriksson, E. A.; Shary, M. T.; Crookes, B.; Soper, D. E.

    2014-01-01

    Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary to Clostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention. PMID:24822140

  19. Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    B. H. Rimawi

    2014-01-01

    Full Text Available Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary to Clostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention.

  20. Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial

    Science.gov (United States)

    Levi, Erika E; Stuart, Gretchen S; Zerden, Matthew L; Garrett, Joanne M; Bryant, Amy G

    2017-01-01

    Objective To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement versus women who planned for interval IUD placement 6 or more weeks postpartum. Methods In this non-blinded randomized trial women who were undergoing a cesarean and desired an IUD were randomized to intracesarean cesarean delivery or interval IUD placement. The primary outcome was IUD use at 6 months postpartum. A sample size of 112 (56 in each group) was planned to detect a 15% difference in IUD use at 6 months postpartum between groups. Results From March 2012 to June 2014, 172 women were screened and 112 women were randomized into the trial. Baseline characteristics were similar between groups. Data regarding IUD use at 6 months postpartum was available for 98 women, 48 and 50 women in the intracesarean and interval groups, respectively. A larger proportion of the women in the intracesarean group were using an IUD at 6 months postpartum ((40/48), 83%) compared to those in the interval group ((32/50) 64%, relative risk [RR]=1.3, 95% confidence interval [CI]: 1.02, 1.66). Among the 56 women randomized to interval IUD insertion, 22 (39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement. Conclusion IUD placement at the time of cesarean delivery leads to a higher proportion of IUD use at 6 months postpartum when compared to interval IUD placement. PMID:26241250

  1. Inevitable cesarean myomectomy and delivery of baby through the same incision

    Directory of Open Access Journals (Sweden)

    Rekha Sachan

    2016-01-01

    Full Text Available Leiomyoma is the commonly encountered benign tumor in women of reproductive age group. Cesarean myomectomy is associated with increased morbidity and mortality mainly due to the risk of associated hemorrhage. Although there are some case series that have demonstrated the safety of myomectomy during cesarean section, a 32-year-old female G2P1 + 0 was referred to the emergency department of obstetrics and gynecology with a complaint of pain in the lower abdomen with amenorrhea of 8 months. Her transabdominal ultrasound report showed a huge fibroid in the lower uterine segment of 16 cm × 12 cm × 14 cm predominantly in the anterior wall of the uterus. Here, cesarean myomectomy was done under spinal anesthesia before the delivery of alive and healthy male baby, weighing 3.0 kg successfully without any complication. Though the cesarean myomectomy is difficult and is associated with increased morbidity because of risk of associated hemorrhage; thus, we do not always recommend but it could be performed in unavoidable conditions

  2. [Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara].

    Science.gov (United States)

    Guzman Sánchez, A; Alfaro Alfaro, N; Pérez García, J F; Martín de Alba, A

    1998-08-01

    Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

  3. Postpartum ovarian vein thrombosis after cesarean delivery: a case report

    Directory of Open Access Journals (Sweden)

    Royo Pedro

    2008-04-01

    Full Text Available Abstract Introduction Postpartum ovarian vein thrombosis is an uncommon complication; incidence varies between 0.002% and 0.05%. It most often occurs during the 2–15 days following delivery. Case presentation A 22-year-old pregnant woman at term presented to hospital with uterine contractions, abdominal pain, nausea and vomiting. After delivery an ovarian vein thrombosis was diagnosed. Conclusion Low-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis.

  4. Postpartum ovarian vein thrombosis after cesarean delivery: a case report

    Science.gov (United States)

    Royo, Pedro; Alonso-Burgos, Alberto; García-Manero, Manuel; Lecumberri, Ramón; Alcázar, Juan Luis

    2008-01-01

    Introduction Postpartum ovarian vein thrombosis is an uncommon complication; incidence varies between 0.002% and 0.05%. It most often occurs during the 2–15 days following delivery. Case presentation A 22-year-old pregnant woman at term presented to hospital with uterine contractions, abdominal pain, nausea and vomiting. After delivery an ovarian vein thrombosis was diagnosed. Conclusion Low-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis. PMID:18400095

  5. Impella™ Left Ventricular Assist Device for Acute Peripartum Cardiomyopathy After Cesarean Delivery.

    Science.gov (United States)

    Padilla, Cesar; Hernandez Conte, Antonio; Ramzy, Danny; Sanchez, Michael; Zhao, Manxu; Park, Donald; Lubin, Lorraine

    2016-07-01

    Peripartum cardiomyopathy is a rare form of heart failure with significant perioperative implications. In this case report, we describe a 34-year-old gravida 5, parity 3, patient who was admitted for an elective cesarean delivery. During the delivery, the patient developed sudden cardiac arrest and was emergently intubated in the operating room. An emergent transesophageal echocardiogram revealed a left ventricular ejection fraction of 10% with global biventricular hypokinesis. Urgent multidisciplinary consultations led to the rapid implementation of the Impella™ 2.5 for ventricular support. The patient recovered ventricular function within 4 days and recovered to baseline function.

  6. Vaginal birth after cesarean delivery: a group practice's approach to minimizing failed trial of labor.

    Science.gov (United States)

    Stedman; Scudder; Joseph

    1998-07-01

    Objective: Among women attempting a trial of labor (TOL) after a prior abdominal delivery, 60-80% accomplish a vaginal birth after cesarean (VBAC). McMahon and coworkers (N Engl J Med, 1996) have indicated that at a 60% success level for TOL, the remaining 40% incurred enough major complications that the scheduled repeat cesarean section group was less morbid overall. The same authors speculated that a success rate of 80% might be necessary for the TOL group's morbidity to be superior. We sought to review our group's patient selection experience during an interval when successful TOL consistently exceeded 80%.Methods: The study interval ranged from January 1995 through June 1997 and was limited to patients with one previous low transverse cesarean section. Rather than using administrative or charge-related diagnoses, we analyzed a departmental database that included each delivering physician's selection of one of four VBAC categories: successful VBAC, unsuccessful VBAC, patient declined trial of labor, or physician advised against trial of labor. All deliveries were at a single institution and were performed by one of seven obstetricians in a group practice.Results: During the study interval, 332 women provided a history of a single previous cesarean delivery. Of these 332, a total of 173 attempted a TOL and 150 of the 173 (87%) were successful. Fifty-eight of the 332 (18%) declined a trial of labor despite being assessed as excellent candidates, and 101 (30%) were advised against a TOL by their physician. Most common reasons for physicians discouraging labor included malpresentation, fetal macrosomia, and clinically small pelvis. Complications for the 23 of 173 (13%) experiencing a failed TOL included 1 asymptomatic partial separation of a uterine scar and 4 cases of puerperal fever; neither transfusion nor hysterectomy was required.Conclusions: This study demonstrates that in a population of women with one prior cesarean delivery, it is possible for a group

  7. Is generalized maternal optimism or pessimism during pregnancy associated with unplanned cesarean section deliveries in China?

    Science.gov (United States)

    Moyer, Cheryl A; Elsayed, Yasmin; Zhu, Yuchun; Wei, Yumei; Engmann, Cyril M; Yang, Huixia

    2010-01-01

    This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

  8. Anesthetic management of a parturient with Stiff person syndrome for urgent cesarean delivery.

    Science.gov (United States)

    Boettcher, B T; Muravyea, M; Kuo, C; Drexler, C; Pagel, P S

    2016-08-01

    Stiff person syndrome is a rare neurologic disorder with an estimated incidence of 1:1000000. The underlying pathophysiology is truncal and proximal limb muscle stiffness resulting from continuous co-contracture of agonist and antagonist muscle groups concomitant with superimposed episodic muscle spasms. Loss of gamma-aminobutyric acid-mediated inhibition creates chronic excitation manifested by tonic agonist-antagonist muscle contraction. To date, only three case reports referred indirectly to the anesthetic management of parturients with Stiff person syndrome. The authors describe their management of a parturient with Stiff person syndrome who underwent urgent cesarean delivery under epidural anesthesia.

  9. Midline versus transverse incision for cesarean delivery in low-income countries

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Aabakke, Anna J M; Secher, Niels J

    2014-01-01

    While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence...... is limited, the literature suggests important advantages of the transverse incision, with lower risk of long-term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change...

  10. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury.

    Science.gov (United States)

    Tawfik, Mohamed Mohamed; Badran, Basma Abed; Eisa, Ahmed Amin; Barakat, Rafik Ibrahim

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby.

  11. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Mohamed Mohamed Tawfik

    2015-01-01

    Full Text Available The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby.

  12. Double Invasive Blood Pressure Monitoring for Cesarean Delivery in a Pregnant Woman With Aortic Coarctation.

    Science.gov (United States)

    Barcellos, Bruno Mendonça; Loureiro, Fernanda Martins; Sampaio, Livia Fernandes; de Resende, Marco Antonio Cardoso

    2016-08-01

    Aortic coarctation is a discrete narrowing of the proximal thoracic aorta. It is poorly tolerated during pregnancy because of its association with hypertension, cerebrovascular accident, and aortic rupture. We report a case of severe uncorrected congenital aortic coarctation in a 31-year-old symptomatic pregnant woman at 29 weeks of gestation who underwent successful cesarean delivery with an epidural anesthetic technique. Transthoracic echocardiography showed a gradient of 75 mm Hg. To avoid undiagnosed arterial hypotension and inadequate uteroplacental flow distal to the coarctation, double (radial and femoral) invasive arterial blood pressure measurement was used to monitor both pre- and postcoarctation arterial blood pressure.

  13. Surgical site wound infection in relation to antibiotic prophylaxis given before skin incision and after cord clamping during cesarean delivery.

    Science.gov (United States)

    Shrestha, B; Marhatha, R; Giri, A; Jaisi, S; Maskey, U

    2014-12-01

    Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby. This was a prospective, hospital based study, in which hundred cases of cesarean deliveries who received antibiotics prophylaxis one hour before the skin incision were compared with another 100 cases where antibiotic was given after cord clamping following delivery of the baby. Surgical site infection occurred in 3% of women who received antibiotics prophylaxis before skin incision as compared to 6% in whom antibiotic was given after cord clamping. It was statistically not significant (p = 0.465).

  14. Effects of Reiki on Post-cesarean Delivery Pain, Anxiety, and Hemodynamic Parameters: A Randomized, Controlled Clinical Trial.

    Science.gov (United States)

    Midilli, Tulay Sagkal; Eser, Ismet

    2015-06-01

    The aim of this study was to investigate the effect of Reiki on pain, anxiety, and hemodynamic parameters on postoperative days 1 and 2 in patients who had undergone cesarean delivery. The design of this study was a randomized, controlled clinical trial. The study took place between February and July 2011 in the Obstetrical Unit at Odemis Public Hospital in Izmir, Turkey. Ninety patients equalized by age and number of births were randomly assigned to either a Reiki group or a control group (a rest without treatment). Treatment applied to both groups in the first 24 and 48 hours after delivery for a total of 30 minutes to 10 identified regions of the body for 3 minutes each. Reiki was applied for 2 days once a day (in the first 24 and 48 hours) within 4-8 hours of the administration of standard analgesic, which was administered intravenously by a nurse. A visual analog scale and the State Anxiety Inventory were used to measure pain and anxiety. Hemodynamic parameters, including blood pressure (systolic and diastolic), pulse and breathing rates, and analgesic requirements also were recorded. Statistically significant differences in pain intensity (p = .000), anxiety value (p = .000), and breathing rate (p = .000) measured over time were found between the two groups. There was a statistically significant difference between the two groups in the time (p = .000) and number (p = .000) of analgesics needed after Reiki application and a rest without treatment. Results showed that Reiki application reduced the intensity of pain, the value of anxiety, and the breathing rate, as well as the need for and number of analgesics. However, it did not affect blood pressure or pulse rate. Reiki application as a nursing intervention is recommended as a pain and anxiety-relieving method in women after cesarean delivery.

  15. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database.

    Directory of Open Access Journals (Sweden)

    Katy B Kozhimannil

    2014-10-01

    Full Text Available BACKGROUND: Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS: Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals. The outcome was cesarean (versus vaginal delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1% among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15. The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]. A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS: Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These

  16. Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery

    DEFF Research Database (Denmark)

    Studsgaard, Anne; Skorstengaard, Malene; Glavind, Julie

    2013-01-01

    intensive care unit admission (adjusted OR 1.9, 95% CI 1.3-2.8). Within the TOLAC group 67% delivered vaginally. In the TOLAC group 1.3% (n = 15) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior...

  17. Cesarean Section: MedlinePlus Health Topic

    Science.gov (United States)

    ... An analysis of variations of indications and maternal-fetal prognosis for... Article: Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia. Article: Optimal Pain Management After Cesarean Delivery. Cesarean Section -- see more ...

  18. The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

    Science.gov (United States)

    Kwon, Ha Yan; Kwon, Ja-Young; Park, Yong Won

    2016-01-01

    Objective To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section. PMID:27200306

  19. Risk of Autism Associated with General Anesthesia during Cesarean Delivery: A Population-Based Birth-Cohort Analysis

    Science.gov (United States)

    Chien, Li-Nien; Lin, Hsiu-Chen; Shao, Yu-Hsuan Joni; Chiou, Shu-Ti; Chiou, Hung-Yi

    2015-01-01

    The rates of Cesarean delivery (C-section) have risen to >30 % in numerous countries. Increased risk of autism has been shown in neonates delivered by C-section. This study examined the incidence of autism in neonates delivered vaginally, by C-section with regional anesthesia (RA), and by C-section with general anesthesia (GA) to evaluate the…

  20. Cesarean section imprints cord blood immune cell distributions

    DEFF Research Database (Denmark)

    Thysen, Anna Hammerich; Larsen, Jeppe Madura; Rasmussen, Mette Annelie;

    2014-01-01

    Immune programming in early life may affect the risk of developing immune-related diseases later in life. Children born by cesarean section seem to be at higher risk of asthma, allergic rhinitis, and type-1 diabetes. We hypothesized that delivery by cesarean section may affect immune maturation...... in newborns. The objective of the study was to profile innate and adaptive immune cell subsets in cord blood of children born by cesarean section or natural birth....

  1. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial

    Science.gov (United States)

    Mokhtar, Ali M.; Elsakka, Ahmed I.; Ali, Hassan M.

    2016-01-01

    Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns. PMID:27746564

  2. When Is a Cesarean Delivery Necessary and What Are the Risks?

    Science.gov (United States)

    ... cesarean may be necessary if a woman is pregnant with twins, including labor starting too early or the fetuses not being in good position within the uterus. The chances of having a cesarean increase with ...

  3. Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.

    Science.gov (United States)

    Samanta, Sukhen; Samanta, Sujay; Ghatak, Tanmoy; Grover, V K

    2014-05-01

    Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.5% 1.8 mL plus 25 μg of fentanyl was used for anesthesia. Chest ultrasonography (US) and transthoracic echocardiography (TTE) were used for monitoring purposes. Spinal-induced preload reduction improved the pulmonary edema, as evidenced by chest US. Chest US and TTE helped in fluid management.

  4. The 2015 Gerard W. Ostheimer Lecture: What's New in Labor Analgesia and Cesarean Delivery.

    Science.gov (United States)

    Arendt, Katherine W

    2016-05-01

    Every year the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review the literature pertinent to obstetric anesthesiology published the previous calendar year. This individual selects the most notable contributions, creates a syllabus of the articles, and then presents his/her overview in an annual lecture named in honor of the late Gerard W. Ostheimer, a pioneering obstetric anesthesiologist from the Brigham and Women's Hospital. This article reviews the literature published in 2014 focusing on the themes of labor analgesia and cesarean delivery. Its contents were presented as the Gerard W. Ostheimer Lecture at the 47th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, May 16, 2015, in Colorado Springs, Colorado. The syllabus is available as Supplemental Digital Content (http://links.lww.com/AA/B397).

  5. Postpartum seizures with posterior reversible encephalopathy syndrome following cesarean delivery for triplets

    Directory of Open Access Journals (Sweden)

    Anita Chhabra

    2014-01-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a recently described clinicoradiologic entity that is associated with several medical conditions like hypertensive encephalopathy and eclampsia. It presents with rapid onset of symptoms including headache, seizures, altered consciousness, and visual disturbance. It is often, but not always associated with high blood pressure. We present a case of 23-year-old patient, with unremarkable antenatal period, who developed convulsions in the immediate postpartum period following elective cesarean delivery of her triplets performed under regional anesthesia. The magnetic resonance imaging brain revealed vasogenic edema suggestive of PRES. She was managed with supportive treatment including mechanical ventilation in the intensive care unit. She recovered completely without neurological sequelae and discharged on the 8 th postoperative day. This case report highlights the importance of awareness, prompt diagnosis and treatment to improve the outcome in this potentially life-threatening, but reversible condition.

  6. Outcome of subsequent delivery after a previous early preterm cesarean section.

    NARCIS (Netherlands)

    Kwee, A.; Smink, M.; Laar, R. van; Bruinse, H.W.

    2007-01-01

    OBJECTIVE: To determine the vaginal birth after cesarean section (VBAC) rate and risk of uterine rupture in women with a previous early preterm cesarean section. METHODS: Women who delivered their first child by cesarean section between 26 and 34 weeks of gestation were included in a retrospective c

  7. Is Generalized Maternal Optimism or Pessimism During Pregnancy Associated with Unplanned Cesarean Section Deliveries in China?

    Directory of Open Access Journals (Sweden)

    Cheryl A. Moyer

    2010-01-01

    Full Text Available This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

  8. The Intention of Delivery Room Staff to Encourage the Presence of Husbands/Partners at Cesarean Sections

    Directory of Open Access Journals (Sweden)

    Yaira Gutman

    2011-01-01

    Full Text Available Objective. In recent years, more and more delivery rooms have allowed husbands/partners to be present during a Cesarean section Nonetheless, many still oppose the idea. The study is designed to investigate the attitudes of Israeli gynecologists, anesthetists, operating-room nurses, and midwives on this issue. Design. The study's theoretical model comes from Fishbein and Ajzen's theory of reasoned action. A self-administered questionnaire was submitted to convenience sample. Subjects. 96 gynecologists, anesthetists, midwives, and operating-room nurses. Results. Significant differences were found between the occupational subgroups. Most of the findings supported the four hypotheses tested and confirmed earlier studies designed to verify the theoretical model. Conclusions. The main conclusion drawn is that delivery and operating-room staff need to be trained in the skills needed to promote the active participation of the baby's father in delivery and, if necessary, in a Cesarean section.

  9. Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

    Science.gov (United States)

    Sentilhes, Loïc; Vayssière, Christophe; Beucher, Gael; Deneux-Tharaux, Catherine; Deruelle, Philippe; Diemunsch, Pierre; Gallot, Denis; Haumonté, Jean-Baptiste; Heimann, Sonia; Kayem, Gilles; Lopez, Emmanuel; Parant, Olivier; Schmitz, Thomas; Sellier, Yann; Rozenberg, Patrick; d'Ercole, Claude

    2013-09-01

    The primary cause of uterine scars is a previous cesarean. In women with a previous cesarean, the risks of maternal complications are rare and similar after a trial of labor after cesarean (TOLAC) and after an elective repeat cesarean delivery (ERCD), but the risk of uterine rupture is higher with TOLAC (level of evidence [LE]2). Maternal morbidity in women with previous cesareans is higher when TOLAC fails than when it leads to successful vaginal delivery (LE2). Although maternal morbidity increases progressively with the number of ERCD, maternal morbidity of TOLAC decreases with the number of successful previous TOLAC (LE2). The risk-benefit ratio considering the risks of short- and long-term maternal complications is favorable to TOLAC in most cases (LE3). Globally, neonatal complications are rare regardless of the mode of delivery for women with previous cesareans. The risks of fetal, perinatal, and neonatal mortality during TOLAC are low. Nonetheless, these risks are significantly higher than those associated with ERCD (LE2). The risks of mask ventilation, intubation for meconium-stained amniotic fluid, and neonatal sepsis all increase in TOLAC (LE2). The risk of transient respiratory distress increases in ERCD (LE2). To reduce this risk, and except in particular situations, ERCD must not be performed before 39 weeks (grade B). TOLAC is possible for women with a previous cesarean before 37 weeks, with 2 previous cesareans, with a uterine malformation, a low vertical incision or an unknown incision, with a myomectomy, postpartum fever, an interval of less than 6 months between the last cesarean delivery and the conception of the following pregnancy, if the obstetric conditions are favorable (professional consensus). ERCD is recommended in women with a scar in the uterine body (grade B) and a history of 3 or more cesareans (professional consensus). Ultrasound assessment of the risk of uterine rupture in women with uterine scars has not been shown to have any

  10. Analysis of Cesarean section delivery at Nova Bila Hospital according to the Robson classification.

    Science.gov (United States)

    Josipović, Ljiljana Bilobrk; Stojkanović, Jadranka Dizdarević; Brković, Irma

    2015-03-01

    An increase in Cesarean section birth rate is evident worldwide, especially in developed and developing countries. Since this trend is rapidly gaining epidemic status with unpredictable consequences regarding the reproductive and overall women's health, there is a need for systematic collection and analysis of Cesarean section occurrence data. At this moment, there is no standardized, internationally accepted classification that would be easy to understand and simple to apply. In 2001, Robson Cesarean section classification in ten groups, which might satisfy good classification criteria, was published. In this paper, we have retrospectively collected and sorted the data on Cesarean section births from the "Dr. Fra Mato Nikolić" Croatian Hospital in Nova Bila, according to Robson classification, for the period from January 1st, 1998 to December 31st, 2007. During this period, 6603 women have given birth. Of these, 1010 opted for Cesarean sec- tion (15.30%). The largest group of women giving birth belongs to group 3 (multiparous, single pregnancy, head down, 37 weeks gestation age or more, spontaneous labor), where 49.74% of all the analyzed births belong. The largest group for those with Cesarean sections is group 5 (previous Cesarean section) with 26.93% of all the Cesarean sections. Our results are similar to the results of studies done elsewhere in the world. Robson classification identifies the risk groups with high Cesarean section percentage and is appropriate for long-term tracking and international comparison of the recognized increase of the Cesarean section trend.

  11. Anesthetic management of super-morbidly obese parturients for cesarean delivery with a double neuraxial catheter technique: a case series.

    Science.gov (United States)

    Polin, C M; Hale, B; Mauritz, A A; Habib, A S; Jones, C A; Strouch, Z Y; Dominguez, J E

    2015-08-01

    Parturients with super-morbid obesity, defined as body mass index greater than 50kg/m(2), represent a growing segment of patients who require anesthetic care for labor and delivery. Severe obesity and its comorbid conditions place the parturient and fetus at greater risk for pregnancy complications and cesarean delivery, as well as surgical and anesthetic complications. The surgical approach for cesarean delivery in these patients may require a supra-umbilical vertical midline incision due to a large pannus. The dense T4-level of spinal anesthesia can cause difficulties with ventilation for the obese patient during the procedure, which can be prolonged. Patients also may have respiratory complications in the postoperative period due to pain from the incision. We describe the anesthetic management of three parturients with body mass index ranging from 73 to 95kg/m(2) who had a cesarean delivery via a supra-umbilical vertical midline incision. Continuous lumbar spinal and low thoracic epidural catheters were placed in each patient for intraoperative anesthesia and postoperative analgesia, respectively. Continuous spinal catheters were dosed with incremental bupivacaine boluses to achieve surgical anesthesia. In one case, the patient required respiratory support with non-invasive positive pressure ventilation. Two cases were complicated by intraoperative hemorrhage. All patients had satisfactory postoperative analgesia with a thoracic epidural infusion. None suffered postoperative respiratory complications or postdural puncture headache. The use of a continuous lumbar spinal catheter and a low thoracic epidural provides several advantages in the anesthetic management of super-morbidly obese parturients for cesarean delivery.

  12. Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery.

    LENUS (Irish Health Repository)

    Robson, Michael

    2015-10-01

    Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. It needs to be clinically relevant, robust, and prospective, and must incorporate epidemiological variables. The 10-Group Classification System (TGCS) is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. The system is demonstrated in the present paper using data for 2013 from the National Maternity Hospital in Dublin, Ireland. Interpretation of the classification can be easily taught. The standard table can provide much insight into the philosophy of care in the population of women studied and also provide information on data quality. With standardization of audit of events and outcomes, any differences in either sizes of groups, events or outcomes can be explained only by poor data collection, significant epidemiological variables, or differences in practice. In April 2015, WHO proposed that the TGCS (also known as the Robson classification) is used as a global standard for assessing, monitoring, and comparing cesarean delivery rates within and between healthcare facilities.

  13. Anesthesia for cesarean delivery in a patient with large anterior mediastinal tumor presenting as intrathoracic airway compression

    Directory of Open Access Journals (Sweden)

    Yatish Bevinaguddaiah

    2014-01-01

    Full Text Available Anterior mediastinal mass is a rare pathology that presents considerable anesthetic challenges due to cardiopulmonary compromise. We present a case that was referred to us in the third trimester of pregnancy with severe breathlessness and orthopnea. An elective cesarean delivery was performed under combined spinal epidural anesthesia with a favorable outcome. We discuss the perioperative considerations in these patients with a review of the literature.

  14. The Effect of Cesarean Delivery Skin Incision Approach in Morbidly Obese Women on the Rate of Classical Hysterotomy

    Directory of Open Access Journals (Sweden)

    Brian E. Brocato

    2013-01-01

    Full Text Available Objective. To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI greater than 40 kg/m2 who underwent a supraumbilical incision at the time of cesarean delivery. Methods. We conducted a retrospective cohort study in women having a BMI greater than 40 kg/m2 who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, or Pfannenstiel (controls, skin incisions. Results. Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.0–66.8, surgical drain placement (OR, 6.5; 95% CI, 2.6–16.2, estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.4–8.4, and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; when compared to subjects with Pfannenstiel incisions (controls. There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.9–8.0. Conclusion. In women with a BMI above 40 kg/m2, supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.

  15. A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Onoh RC

    2015-05-01

    Full Text Available Robinson Chukwudi Onoh,1 Justus Ndulue Eze,2 Paul Olisaemeka Ezeonu,1 Lucky Osaheni Lawani,1 Chukwuemeka Anthony Iyoke,3 Peter Onubiwe Nkwo3 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Abakaliki, 2Department of Obstetrics and Gynaecology, College of Health Sciences, Ebonyi State University, Abakaliki, 3Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria Background: The global rise in cesarean delivery rate has been a major source of public health concern. Aim: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results: Of 14,198 deliveries, 2,323/14,198 (16.4% were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1% per annum from 184/1,512 (12.2% in 2002 to 230/986 (23.3% in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1% were delivered at term, and in 1,576/2,097 (75.2%, the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9% and obstructed labor 331/2,097 (15.8%. There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197 134.7/1,000 births. Also, 129/2,097 (6.1% maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2% and sepsis 41/129 (32.6% were the major causes. Conclusion: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction

  16. [Temperature changes and thermoregulatory responses during epidural anesthesia in women undergoing cesarean delivery].

    Science.gov (United States)

    Negishi, C; Ozaki, M; Suzuki, H; Ohno, T

    1996-05-01

    Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. Sixty minutes after induction, tympanic temperature decreased for 0.52 +/- 0.26 degrees C and average skin temperature increased for 0.56 +/- 0.17 degrees C. Central hypothermia and shivering did not produce a cold sensation. Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.

  17. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study

    Science.gov (United States)

    Geng, Zhi-Yu; Wang, Dong-Xin

    2017-01-01

    Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies. PMID:28218212

  18. Cesarean section without clinical indication versus vaginal delivery as a paradigmatic model in the discourse of medical setting decisions.

    Science.gov (United States)

    Demontis, Roberto; Pisu, Salvatore; Pintor, Michela; D'aloja, Ernesto

    2011-12-01

    Natural childbirth has ceased to be considered the gold standard in the delivery room. For this reason cesarean section on demand is increasing. Many obstetricians justify this phenomenon on evidence-based obstetrical practice. However, other pieces of evidence demonstrate that the data are often a product of the social milieu, and as stated by Wendland, "technology magically wards off the unpredictability and danger of birth". In a recent paper, Kalish pointed out several problems with cesarean deliveries in the absence of medical indications regarding issues of good clinical practice, autonomy, and informed consent. From the late 1990s, the medical community began to speak in favor of women's autonomy in childbirth decisions thus supporting the maternal choice and request for a cesarean section. Starting from these new considerations, it is of primary importance to understand whether emphasizing patient's autonomy is the best, or the only, way to helping the medical decisional process. This general approach may be helpful in all the other cases in which patient's autonomy and physician's responsibility appear to be intertwined in an apparent conflicting manner. We fear that the rhetoric of autonomous choice represents a fundamental shift from medicine-based beneficence toward a perilous relationship founded mainly on patient's wishes, representing a dangerous slippery slope where the physician could be reduced to the role of a functionary delegated to execute patient's claims and demands.

  19. Secular trends of cesarean delivery and medical cesarean indications among primiparous women in a tertiary-level hospital in inner Mongolia during 1990-2010%1990-2010年某三甲医院初产妇剖宫产率和剖宫产指征变化情况

    Institute of Scientific and Technical Information of China (English)

    曾娜; 刘桂兰; 周玉博; 杨晓彦; 李宏田; 冀小平; 刘建蒙

    2016-01-01

    Objective To explore the secular trends of cesarean delivery and medical cesarean indications among primiparous women in a tertiary-level hospital in inner Mongolia. Methods A total of 6 978 primiparous women who delivered babies in 1990,1995,2000,2005 and 2010.Delivery modes (cesarean section/spontaneous birth) and cesarean indications were obtained from medical records.26 cesarean indications,such as cord entanglement,fetal distress,relative cephalopelvic disproportion,maternal request cesarean,breech presentation,multiple pregnancy and gestational hypertension,were identified.Time trends for each indication were linearly modeled to estimate the relative contribution of each indication to the overall increase or decrease in cesarean rates. Results In the five time points during 20-year period,2 494 cesarean deliveries were identified.The prevalence rate of cesarean delivery was 35.7%.The prevalence of cesarean delivery increased by 2 folds from 22.1% in 1990 to 61.7% in 2000;44.0% of the increase was attributable to the rapid increase in three indications,including cord entanglement,fetal distress and relative cephalopelvic disproportion.The prevalence decreased by 40% from 61.7% in 2000 to 37.0% in 2010;79.8% of the decrease was attributable to the rapid decrease of the three indications.Moreover,it is noticeable that the cesarean prevalence related to maternal request,macrosomia,multiple pregnancy and advanced maternal age steadily increased over time. Conclusion Subjective cesarean indications,such as cord entanglement,fetal distress and relative cephalopelvic disproportion, significantly affected cesarean prevalence rates,suggesting that strict diagnoses is likely to reduce cesareans.Cesarean delivery due to maternal request,macrosomia,multiple pregnancy or advanced maternal age increased over time,and accounted for nearly 30% of total cesarean section by 2010,among which maternal requested cesareans is likely preventable.%目的:了解住院分娩初产

  20. Neonatal apgar scores and umbilical blood gas changes in vaginal delivery and cesarean: a comparative study

    Directory of Open Access Journals (Sweden)

    SH. Raafati

    2006-07-01

    Full Text Available Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory. Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40, elective C/S under general anesthesia (n=35 and C/S under spinal anesthesia (n=25. Duration of anesthesia and its effect on blood gas and infants apgar were assessed. Results: In the first group (vaginal delivery mean blood gase parameters were; pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05. Conclusion: There

  1. Research Progress of Reasons for Rising Cesarean Delivery Rate%剖宫产率上升原因研究进展

    Institute of Scientific and Technical Information of China (English)

    商哲一; 宋伟奇

    2014-01-01

    Sustained upward trend in cesarean delivery rate has become a worldwide common phenomenon. At present, the rate of cesarean delivery without any medical indication is rising, the main factors are maternal itself and social fac-tors. The paper reviews the related factors that cause increase of cesarean delivery rate in recent years and the impact of cesarean section on mother and child, which in order to seek ways to reduce the cesarean delivery rate.%剖宫产率持续上升趋势已成为全球范围的普遍现象。目前无医学指征的剖宫产率呈上升趋势,其中产妇自身因素和社会因素是近年来剖宫产率上升的主要因素。文章对近年来造成剖宫产率上升的相关因素及剖宫产对母儿的影响作一综述,以寻求降低剖宫产率的方法。

  2. The Efficacy of Postoperative Wound Infusion with Bupivacaine for Pain Control after Cesarean Delivery: Randomized Double Blind Clinical Trial

    Directory of Open Access Journals (Sweden)

    Azin Alavi

    2007-06-01

    Full Text Available Objective: This study investigated the efficacy of bupivacaine wound infusion for pain control and opioid sparing effect after cesarean delivery.Materials and methods: We conducted a randomized double blind, placebo controlled clinical trial on 60 parturients undergoing cesarean section at a university hospital in Tehran. Patients were randomized to receive a pump infusion system that was filled with either 0.25% bupivacaine or equal volume of distilled water. A catheter was placed above the fascia and connected to electronic pump for 24 hours. Postoperative analog pain scores and morphine consumption were assessed at 6, 12 and 24 hours. Also time interval to first ambulation, length of hospitalization, complications and patient satisfaction were recorded. Data were analyzed using the SPSS software and P < 0.05 was considered statistically significant. Mann-Whitney u-test, student t-test and chi-square were used. Results: There were no differences in patient demographics and length of hospitalization and patient-generated resting pain scores between the two groups. Pain scores after coughing and leg raise during the first 6 postoperative hours were significantly less in the Bupivacaine group (P<0.001. The total dose of morphine consumption during the 24 hours study period was 2.5 ± 2.5 mg vs. 7.3 ± 2.7 mg for the bupivacaine and control groups, respectively (P<0.001. Compared with the control group, time to first ambulation was shorter in the bupivacaine group (11± 5h vs. 16 ± 4h (P< 0.01. Conclusion: Bupivacaine wound infusion was a simple and safe technique that provides effective analgesia and reduces morphine requirements after cesarean delivery.

  3. Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery.

    Science.gov (United States)

    Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

    2016-04-01

    The induction-delivery time during Cesarean section is traditionally conducted under light anesthesia because of the possibility of anesthesia-induced neonatal respiratory depression. The serious consequences of such an approach could be the increased risk of maternal intraoperative awareness and exaggerated neuroendocrine and cardiovascular stress response to laryngoscopy, endotracheal intubation, and surgical stimuli. Here, we briefly discuss the various pharmacological options for attenuation of stress response to endotracheal intubation during Cesarean delivery and then focus on remifentanil, its pharmacokinetic properties, and its use in anesthesia, both in clinical studies and case reports. Remifentanil intravenous bolus doses of 0.5-1 μg/kg before the induction to anesthesia provide the best compromise between attenuating maternal stress response and minimizing the possibility of neonatal respiratory depression. Although neonatal respiratory depression, if present, usually resolves in a few minutes without the need for prolonged resuscitation measures, health care workers skilled at neonatal resuscitation should be present in the operating room whenever remifentanil is used.

  4. The Florida Investigation of Primary Late Preterm and Cesarean Delivery: the accuracy of the birth certificate and hospital discharge records.

    Science.gov (United States)

    Clayton, Heather B; Sappenfield, William M; Gulitz, Elizabeth; Mahan, Charles S; Petersen, Donna J; Stanley, Kara M; Salihu, Hamisu M

    2013-07-01

    (1) Assess the accuracy of public health data sources used to investigate primary late preterm cesarean delivery (PLPCD) and (2) compare differences in data accuracy by hospital PLPCD rate classification. This analysis uses data from the Florida Investigation of Late Preterm and Cesarean Delivery (FILPCD), an investigation of singleton, PLPCD's that occurred from 2006 to 2007 in hospitals classified with either a low or high PLPCD rate (high rate 39.4-58.3 %, low rate 11.9-25.1 %). Three data sources were validated with maternal medical records: birth certificates, hospital discharge data, and combined birth certificate and hospital discharge data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values were calculated. A summary measure of kappa values was compared by hospital PLPCD rate classification using the paired sample Wilcoxon signed rank test. Large variations in accuracy of data elements were found by hospital PLPCD rate classification, with low PLPCD rate hospitals demonstrating higher overall data accuracy. The summary measure of agreement was significantly higher for low PLPCD rate hospitals compared to high PLPCD rate hospitals (0.60 vs. 0.50, p late preterm birth are vital for public health practitioners and policy makers who seek to address the growing concern over recent increases in CD and late preterm birth. Understanding the potential for systematic differences in reporting accuracy by hospital PLPCD rate is important to data quality improvement efforts.

  5. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L; Schuit, E; Liem, S M S; Lim, A C; Bekedam, D J; Goossens, S M T A; Franssen, M T M; Porath, M M; Oudijk, M A; Bloemenkamp, K W M; Duvekot, J J; Woiski, M D; de Graaf, I; Sikkema, J M; Scheepers, H C J; van Eijk, J; de Groot, C J M; van Pampus, M G; Mol, B W J

    2015-01-01

    OBJECTIVE: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. METHODS: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable as

  6. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    Van de Mheen, L.; Schuit, E.; Liem, S. M. S.; Lim, A. C.; Bekedam, D. J.; Goossens, S. M. T. A.; Franssen, M. T. M.; Porath, M. M.; Oudijk, M. A.; Bloemenkamp, K. W. M.; Duvekot, J. J.; Woiski, M. D.; De Graaf, I.; Sikkema, J. M.; Scheepers, H. C. J.; Van Eijk, J.; De Groot, C. J. M.; Van Pampus, M. G.; Mol, B. W. J.

    2015-01-01

    Objective To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. Methods This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable asso

  7. STUDY OF MATERNAL AND FETAL OUTCOME AND FACTORS AFFECTING SUCCESS WITH VAGINAL BIRTH AFTER CESAREAN SECTION IN TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Vijayasree

    2014-01-01

    Full Text Available Cesarean section must be justified only when benefits outweigh harm to the mother and fetus. The impact of Cesarean section on maternal and child health and its high cost compared with vaginal birth represent a public health problem. Cesarean section rate is increasing globally and reported to be 25 - 30% in recent studies . Several factors contribute to this increase , but repeat CS stands as the most relevant factor and contribute to about 29% of performed CS. One of the strategies proposed to reduce the CS rate is to increase the number of trials of labor among women who had previous one lower segment cesarean section. However , concern still remains r egarding associated maternal or neonatal complications and factors that lead to success or failure of VBAC. So , we undertook this study to evaluate the factors affecting success of VBAC. AIMS AND OBJECTIVE: To study maternal and fetal outcomes associated w ith trial of vaginal birth after cesarean section and to evaluate factors associated with its success. MATERIALS AND METHODS : It is an Observational prospective study performed on 100 partu rients in the department of OBG, in Mamata General Hospital , K hammam , Andhra Pradesh. Patients with previous one lower segment Cesarean section and a single fetus with cephalic presentation without cephalo - pelvic disproportion were included in the study. These women were given a trial for vaginal birth with observati on during labor by a partogram and external fetal cardiotocography. RESULTS: Vaginal birth was successful in 50%. Repeat Cesarean section was done in the other 50% due to suspicious scar (62% , fetal distress (24% and failure to progress (14%. Scar Ruptu re occurred in (6% , postpartum hemorrhage in (4% , neonatal incubation in (10% and the neonatal mortality was (2%. Vaginal birth was significantly higher in the age group 20 - 30 years , body mass index in between 20 - 25 , patients with prior vaginal birth , inter - pregnancy interval

  8. Factors affecting home delivery in rural Tanzania.

    OpenAIRE

    Mrisho, Mwifadhi; Schellenberg, Joanna A; Mushi, Adiel K.; Obrist, Brigit; Mshinda, Hassan; Tanner, Marcel; Schellenberg, David

    2007-01-01

    BACKGROUND Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery. METHODS In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were ...

  9. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Chervenak, Frank A

    2017-01-01

    The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, p<.0001) and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13-24.29, p<.0001). Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

  10. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population.

    Science.gov (United States)

    Maykin, Melanie Mai; Mularz, Amanda J; Lee, Lydia K; Valderramos, Stephanie Gaw

    2017-01-01

    Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (65%). The actual versus predicted success rates were compared. Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

  11. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population

    Science.gov (United States)

    Maykin, Melanie Mai; Mularz, Amanda J.; Lee, Lydia K.; Valderramos, Stephanie Gaw

    2017-01-01

    Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal–Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (65%). The actual versus predicted success rates were compared. Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). Conclusion When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

  12. The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

    Institute of Scientific and Technical Information of China (English)

    Fei Xiao; Wen-Ping Xu; Yin-Fa Zhang; Lin Liu; Xia Liu; Li-Zhong Wang

    2015-01-01

    Background:Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery.This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia.Methods:Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized,double-blinded,dose-ranging study.Patients received 6,8,10,12,or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil.Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation.The 50% effective dose (ED50) and 95% effective dose (ED95) were calculated with a logistic regression model.Results:ED50 and ED95 ofintrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA) were 8.28 mg (95% confidence interval [CI]:2.28-9.83 mg) and 12.24 mg (95% CI:10.53-21.88 mg),respectively.Conclusion:When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery,the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg,respectively.In addition,this local anesthetic is unsuitable for emergent cesarean delivery,but it has advantages for ambulatory patients.

  13. 剖宫产切口妊娠的MRI诊断%The MRI diagnosis of the cesarean delivery scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    张立华; 杨琼; 李帅; 刘剑羽

    2013-01-01

    Objective:To study the value of MRI in the diagnosis of cesarean delivery scar pregnancy. Methods:The clinical and imaging materials of 26 patients with pathology proved cesarean delivery scar pregnancy were analyzed retro spectively. Results:The scar pregnancy tissue located at or inferior to the internal cervical orifice, with obvious variation in size and signal intensities of lesions. Of the 26 patients,the signal intensities showed long T1 and long T2 (9 cases) ,relatively long T1 and relatively long T2 (4 cases) , relatively short T1 and short T2 signal (1 case) and mixed signal intensities (12 ca ses). Of the 11 cases had enhanced MRI simultaneously,cases showed various degree of enhancement. Among 3 cases had rupture of cervix isthmus,2 cases showed pregnancy tissue protruded into the isthmus. The thickness of isthmus was 0. 1~ 0. 4cm in non ruptured cases, with the average as (0. 23±0. 14) cm. Of the 26 patients,22 were correctly diagnosed with MRI and the diagnostic accuracy was 84. 62%. Conclusions: High accuracy rate of MRI could be obtained in the diagnosis of cesarean delivery scar pregnancy,the location,size of scar pregnancy could be identified,at the same time the thickness of isthmus could be measured,the relationship between scar pregnancy and adjacent structures could be displayed. MRI plays an important role in the diagnosis of cesarean delivery scar pregnancy.%目的:探讨MRI在剖宫产切口妊娠诊断中的价值.方法:回顾性分析经病理证实的26例切口妊娠患者的临床及影像资料.结果:切口妊娠组织位于宫颈内口水平或偏下水平,大小差异较大;信号特点多变,26例中9例以长T1、长T2信号为主,4例呈稍长T1、稍长T2信号,1例呈略短T1、短T2信号,12例呈混杂信号.11例同时行MRI增强扫描,7例可见不同程度强化;26例中3例峡部发生破裂,其中2例显示妊娠组织突出于峡部,未发生破裂者峡部厚度为0.1~0.4cm,平均(0.23±0.14)cm

  14. Ogilvie′s syndrome following cesarean delivery: The Dubai′s case

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    Strahil Kotsev

    2011-01-01

    Full Text Available We present a case of acute colonic pseudo obstruction (Ogilvie′s Syndrome post Cesarean Section in a 35 years old Arabic patient with co-existing systemic lupus erythematosus. Due to developed complications-perforations of the colon and peritonitis, the patient required laparotomy and right hemicolectomy. To our knowledge, this is the first case of Ogilvie′s syndrome, reported from the Middle East. The possible etiologic factors, pathophysiology, clinical presentation, diagnostic work up and treatment are discussed. The need for awareness about the syndrome and early diagnosis is emphasized.

  15. Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings.

    Science.gov (United States)

    Gui, Benedetta; Danza, Francesco Maria; Valentini, Anna Lia; Laino, Maria Elena; Caruso, Alessandro; Carducci, Brigida; Rodolfino, Elena; Devicienti, Ersilia; Bonomo, Lorenzo

    2016-01-01

    Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.

  16. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off

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    Aluísio J D Barros

    2011-08-01

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

  17. ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

    Institute of Scientific and Technical Information of China (English)

    Fei Xiao; Wen-Ping Xu; Xiao-Min Zhang; Yin-Fa Zhang; Li-Zhong Wang; Xin-Zhong Chen

    2015-01-01

    Background:Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated,and there is no indwelling epidural catheter or contraindication to spinal anesthesia.However,the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients.This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery.Methods:Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized,double-blinded,dose-ranging study.Patients received 4 mg,6 mg,8 mg,or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil.Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section.The ED50 and ED95 were calculated with a logistic regression model.Results:ED50 and ED95 ofintrathecal bupivacaine for successful spinal anesthesia were 5.67 mg (95% confidence interval [CI]:5.20-6.10 mg) and 8.82 mg (95% CI:8.14-9.87 mg) respectively.The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg (P < 0.05).The sensory block was significantly different among groups 10 minutes after intrathecal injection (P < 0.05).The use of lidocaine in Group 4 mg was higher than that in other groups (P < 0.05).The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups (P < 0.05).The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups (P < 0.05).The satisfaction of muscle relaxation in Group 4 mg was lower than other groups (P < 0.05).There was no significant difference in patients' satisfaction and the newborns

  18. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop.

    Science.gov (United States)

    Spong, Catherine Y; Berghella, Vincenzo; Wenstrom, Katharine D; Mercer, Brian M; Saade, George R

    2012-11-01

    With more than one third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean delivery. The available information on maternal and fetal factors, labor management and induction, and nonmedical factors leading to the first cesarean delivery was reviewed as well as the implications of the first cesarean delivery on future reproductive health. Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of "failed induction" should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery are facilitated and encouraged. When discussing the first cesarean delivery with a patient, counseling should include its effect on future reproductive health.

  19. Comparison the Analgesic Effects of Single Dose Administration of Tramadol or Piroxicam on Postoperative Pain after Cesarean Delivery

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    Amir Farshchi

    2010-05-01

    Full Text Available "nA multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. We investigated postoperative pain in a double-blinded, randomized, single-dose comparison of the monoaminergic and µ-opioid agonist tramadol, 100 mg (Group T and piroxicam 20 mg (Group P given IM alone- single dose in 150 patients who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and 24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10, nausea and vomiting. Pain degree was classified as: Painless: 0, Mild: 1-4, Moderate: 5-8, Severe: 9-10. There was no significant difference between the efficacy of tramadol and piroxicam injections (P>0.05. Pain intensity decreased markedly over time in both groups. Mean±SEM pain degrees were as follows: P=7.7±0.5, T=8.2±0.8 after 0 hours; P=5.4±0.6, T=6.1±0.5 after 6 hours; P=3.3±0.4, T=3.4±0.7 after 12 hours; P=1.1±0.4, T=1.3±0.5 after 24 hours of surgery. Side effects were similarly minimal with all treatments. It might be concluded that i.m. injections of 20 mg piroxicam (single dose therapy could relieve postoperative pain after cesarean section as well as tramadol and it could reduce opioid analgesic requirements with less adverse side effects during the first postoperative 24 h.

  20. 社会因素剖宫产的原因及对策分析%Analysis and solutions of cesarean delivery on maternal request

    Institute of Scientific and Technical Information of China (English)

    刘爱英; 韩秋峪

    2013-01-01

    Objective To analyze the cesarean delivery on maternal request(CDMR),probe into the reason of rising rate of cesarean section and put forward feasible solutions to lower the cesarean section rate.Methods A review analysis was conducted on 278 cases of cesarean section due to social factors from January 2010 to December 2011.Result The cases of cesarean section due to social were mostly fear of pain (52.52%) and limited knowledge of vaginal delivery (33.81%).Office ladies with high income and high education background were the majority who choose cesarean section.Conclusion Pertinent measures should be taken based on the specific social factors of pregnant females to support vaginal delivery and lower the rate of cesarean section.%目的 探究影响社会因素剖宫产的原因,提出降低社会因素剖宫产率的对策.方法 回顾性分析我院2010年1月-2011年12月因社会因素行剖宫产术的278例病例,对其社会文化背景和剖宫产原因进行分析比对.结果 以社会因素为指征的剖宫产中,产妇恐惧阴道分娩疼痛(占52.52%)和对阴道分娩认识不足(占33.81%)为选择剖宫产的主要原因;高收入、高学历的知识女性是社会因素剖宫产的主要人群.结论 应结合孕妇自身的社会经济文化背景,以社会参与为先导,以健康教育为基础,以医疗质量为根本,以改善服务为途径,促进和支持自然分娩,降低社会因素剖宫产率.

  1. Effect of maternal death reviews and training on maternal mortality among cesarean delivery : post-hoc analysis of a cluster-randomized controlled trial

    OpenAIRE

    Zongo, A.; Dumont, Alexandre; Fournier, P.; Traore, M.; Kouanda, S.; B. Sondo

    2015-01-01

    Objectives: To explore the differential effect of a multifaceted intervention on hospital-based maternal mortality between patients with cesarean and vaginal delivery in low-resource settings. Study design: We reanalyzed the data from a major cluster-randomized controlled trial, QUARITE (Quality of care, Risk management and technology in obstetrics). These subgroup analyses were not prespecified and were treated as exploratory. The intervention consisted of an initial interactive workshop and...

  2. Update on delivery following prior cesarean section: a 15-year review 1972-1987.

    Science.gov (United States)

    Meehan, F P; Burke, G; Kehoe, J T

    1989-11-01

    Fear of true rupture remains the main indication for repeat section. Between 1972 and 1987 there were 2434 patients with one or more prior section and 1350 (55%) were permitted trial of labor, the remainder, having had two or more previous sections (maximum number, 10), had repeat surgery. Induction was employed in 31% and oxytocin for induction or acceleration in 32% patients. The first period (1972-1982) had 844 and the second period (1982-1987) had 506 trial of labor patients. Improved management resulted in the true rupture rate falling from 0.6% (1:169) to 0.2% (1:506) and the elimination of procedure-related perinatal death. There were two maternal deaths with repeat section and none with trial of labor. We have achieved a plateau for cesarean section (10-11%) and a continuing fall in the uncorrected hospital perinatal mortality, which has averaged 10.6/1000 for the years 1982-1986 inclusive.

  3. Acute Postpartum Pulmonary Edema in a 32-Year-Old Woman Five Days after Cesarean Delivery

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    Masuda Islam Khan

    2013-07-01

    Full Text Available Acute dyspnea after pregnancy is a rare presentation, and a number of important conditions may accompany it. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary edema are some of the potential causes that must be considered. The percentage of pregnancies that are complicated by acute pulmonary edema has been estimated 0.08%. The most common contributing factors include the administration of tocolytic agents, underlying cardiac disease, iatrogenic fluid overload and preeclampsia. Here we report a case of 32- year-old woman of 5th postpartum day following lower uterine cesarean section with acute dyspnea from her first pregnancy who was admitted in coronary care unit with history of one episode of raised blood pressure 160/90 mm Hg and cough on 1st postoperative day. Clinical examination and relevant investigations explored that it was a case of bilateral pulmonary edema. Patient was kept in ventilator and was treated with nitroglycerine (GTN, frusemide and ACE inhibitor. After diuresis, considerable improvement was observed in her respiratory status. From the 4th day, the patient became hemodynamically stable and was weaned off the ventilator. After five days, all the biochemical parameters became normal and she had no dyspnea.

  4. Cesarean Sections

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Cesarean Sections (C-Sections) KidsHealth > For Parents > Cesarean Sections (C-Sections) A A A What's in this ... babies in the United States are delivered via cesarean section (C-section). Even if you're envisioning a ...

  5. Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China.

    Science.gov (United States)

    Xiong, Chao; Zhou, Aifen; Cao, Zhongqiang; Zhang, Yaqi; Qiu, Lin; Yao, Cong; Wang, Youjie; Zhang, Bin

    2016-11-22

    China has one of the highest rates of cesarean sections in the world. However, limited epidemiological studies have evaluated the risk factors for cesarean section among Chinese women. Thus, the aim of this cohort study was to investigate the associations between pre-pregnancy BMI, gestational weight gain (GWG) and the risk of cesarean section in China. A total of 57,891 women with singleton, live-born, term pregnancies were included in this analysis. We found that women who were overweight or obese before pregnancy had an elevated risk of cesarean section. Women with a total GWG above the Institute of Medicine (IOM) recommendations had an adjusted OR for cesarean section of 1.45 (95% CI, 1.40-1.51) compared with women who had GWG within the IOM recommendations. Women with excessive BMI gain during pregnancy also had an increased risk of cesarean section. When stratified by maternal pre-pregnancy BMI, there was a significant association between excessive GWG and increased odds of cesarean section across all pre-pregnancy BMI categories. These results suggest that weight control efforts before and during pregnancy may help to reduce the rate of cesarean sections.

  6. ENTRAPMENT OF AFTER COMING HEAD IN BICORNUATE UTERUS DURING CESAREAN BREECH DELIVERY OF TERM FETUS

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    Vijayalakshmi

    2015-07-01

    Full Text Available INTRODUCTION: The incidence of breech presentation in about 3% in singleton term pregnancies and about 20% in preterm pregnancies. The predisposing factors for breech presentation include uterine distension ( P olyhydramnios, M ultiple gestation , lax uterus ( G rand multiparty , uterine anomalies, pelvic tumors, fetal abnormalities ( A nencephaly, hydrocephalus, low birth weight , previous breech, placenta previa. Breech presentation increases the risk of morbidity and mortality in both fetus and mother. Nowadays majority of breech deliveries are by caesarian section compared with vaginal delivery. Caesarian section can significantly reduce neonatal complications, with a trivial increase in maternal complications. However caesarian section cannot alleviate all the complications. Hereby we present a case with entrapment of after coming head in caesarian breech delivery of a term fetus. According to current clinical practice in 2001 the American college of obstetricians and gynecologists (ACOG recommended that “P atient with a persistent breech presentation at term in a singleton gestation should undergo a planned caesarian delivery”. Nevertheless it stated that “ A planned caesarian delivery does not apply to patients presenting in advanced labour with a fetus in breech presentation in whom deliveries likely to be imminent or in patients where 2 nd twin is non - vertex position” . 1

  7. [Evidence-based cesarean section].

    Science.gov (United States)

    Salo, Heini; Tekay, Aydin; Mäkikallio, Kaarin

    2015-01-01

    Cesarean delivery is the most frequent major surgery in Finland: in 2013 over 16% of the deliveries were via cesarean route. 27% of the mothers are estimated to face complications. Optimal surgical techniques and other operation-related measures aim to reduce the incidence of complications. Recommendations favor preoperative antibiotics, vaginal preparation, transversal skin incision, non-development of bladder flap, blunt cephalo-caudad uterine extension, spontaneous placental removal, late cord clamping, continuous sutures for uterine closure and subcutaneous skin sutures. Optimal measures will not only reduce complications in cesarean deliveries but bring cost savings and unify the clinical routines and training in specialization programs.

  8. Changing trends in eclampsia and increasing cesarean delivery and ndash; an interesting retrospective study from a tertiary care hospital of Raipur, Chhattisgarh, India

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    Abha Singh

    2016-04-01

    Conclusions: Contrary to various studies hypertensive disorder to be the fourth most common cause of maternal death in developing countries, eclampsia came out to be the leading cause of maternal mortality in our study. Better antenatal and peripartum care can reduce its occurrence and related morbidity and mortality. Optimum outcome can be achieved by the speed with which the peripartum care is given. Cesarean delivery is preferable if vaginal delivery is not anticipated within 8 hrs as it gives better fetomaternal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1031-1035

  9. ANALYSIS OF MATERNAL AND FETAL OUTCOME IN SPINAL VERSUS EPIDURAL ANESTHESIA FOR CESAREAN DELIVERY IN SEVERE PRE-ECLAMPSIA

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    Jyothi

    2015-12-01

    Full Text Available AIM Our primary aim is to analyze of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia. MATERIALS AND METHODS Sixty parturients (60 with severe pre-eclampsia posted for cesarean section were randomized into two groups of thirty (30 each for either spinal anesthesia that is group S or epidural anesthesia that is group E. Spinal group (group S, n=30 received 10mg (2ml of 0.5% of hyperbaric bupivacaine solution intrathecally in left lateral decubitus or sitting position at L3-4 lumbar space with 25G quincke-babcock spinal needle. Patients received 6l/min of oxygen through Hudson’s face mask throughout the surgery. In Epidural group (group E, n=30, after thorough aseptic precautions, an 18G Tuohy’s epidural needle inserted at the L3-4 lumbar space with the patient in lateral decubitus or sitting position. Three ml of 1.5% lidocaine with was given as a test dose. After ruling out any intrathecal injection of the drug, initially 8ml of 0.5% isobaric bupivacaine given and the vitals monitored. Then 3ml top-ups of the same bupivacaine solution is given in a graded manner slowly, simultaneously checking the height of block. A blockade upto T4 to T6 is required. Vitals are carefully monitored and oxygen is provided 6l/min throughout the procedure and surgery. Blood pressure (systolic, mean, diastolic, pulse rate, oxygen saturation are recorded immediately after giving anesthesia, every minute for first 10mins, then every 3mins for the rest of the surgery. Then vitals are also noted post-operatively for the first 24hrs. Apgar score after 1 and 5 minutes, of the newborn baby is also recorded. Other parameters noted were incidence and duration of hypotension or hypertension both intra-operatively and post-operatively, any usage of vasopressors (ephedrine and its dose, convulsions, renal failure, pulmonary edema, requirement for ICU stay and the number of days in the mother, and the incidence of

  10. Obesity and gestational weight gain: cesarean delivery and labor complications Obesidade e ganho de peso gestacional: cesariana e complicações de parto

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    Luiz Carlos Seligman

    2006-06-01

    Full Text Available OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9% patients. Cesarean delivery was performed in 164 (53.2% obese, 407 (43.1% pre-obese, 1,045 (35.1% normal weight and 64 (24.5% underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0 compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2. Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.OBJETIVO: Avaliar a associação de obesidade pré-gestacional e ganho de peso excessivo com cesariana e outras complicações do parto. MÉTODOS: Um total de 4.486 mulheres com 20-28 semanas de gravidez do pré-natal geral do Sistema Único de Saúde de seis capitais brasileiras foram

  11. Maternal Satisfaction about Prenatal and Postnatal Cares in Vaginal and Cesarean Section Delivery at Teaching and Non- teaching Hospitals of Tabriz/ Iran

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    Somayyeh Naghizadeh

    2014-02-01

    Full Text Available Objectives: The main goal of care services is provide and promote mankind's health. Patient satisfaction is recognized as an important parameter for assessing the quality of patient care services. Spatially mothers' satisfaction from delivery is very important because it influence on family and society psychological health. The aim of this study was comparing maternal satisfaction about prenatal and postnatal cares in vaginal and cesarean section delivery at teaching and nonteaching hospitals of Tabriz/ Iran. Materials and Methods: This is a descriptive-comparative study. We selected 454 women who had been hospitalized for delivery in Alzahra, Talegani (teaching and 29Bahman (nonteaching Tabriz/Iran hospitals. For data collection, we used a questionnaire. Spss/ver13, Descriptive statistic, Independent t test, ANOVA and correlation tests were used for data analysis. Results: Findings indicated the highest level of satisfaction in both kind of hospitals was about physical and the lowest one was about informational aspect in women who had vaginal delivery, accordingly these rates about cesarean section was about physical and about informational and emotional aspects in labor. The analysis of data showed significant difference between mothers' satisfaction with all aspects of care in the teaching and non- teaching hospitals (P < 0.001. Conclusion: The results showed that the highest rank from mothers' satisfaction was in the physical and the lowest rank was in informational category. Mothers were satisfied from vaginal delivery in all aspects. Rate of satisfaction in nonteaching were more than teaching hospitals.

  12. [Risk factors for cesarean section: epidemiologic approach].

    Science.gov (United States)

    Trujillo Hernández, B; Tene Pérez, C E; Ríos Silva, M

    2000-07-01

    The increase in frequency of cesareans that has been noted through 70's, not diminished--like it was expected--perinatal morbidity and mortality. The most important indications to cesarean are distocias, previous cesarean and fetal stress. In 1998 frequency of cesarean deliveries in our hospital was 35% of the pregnancy attended. The claim of this study was to determine risks factors to cesarean in our hospital. A case-control study was performed, selecting 165 cases (cesareans) and 328 controls (via vaginal). It was determined OR of the risks factors and atribuible fraction. Data were analyzed by X2. The most important indications to cesarean delivery were: distocias (39%, n = 64); previous cesarean (23%, n = 41) and fetal stress (11%, n = 21). There was not significative differences in age, height and rupture membrane time in both groups. History of cesarean delivery gave major risk to another surgical intervention (OR = 12.7, p = < 0.0001, atribuible fraction 92%). Nuliparous (OR = 6.6, p < 0.00000, atribuible fraction 85%), second gestation (OR = 1.8, p = 0.002) or history of abortion (OR = 1.8, p = 0.04) were factors mainly associated to cesarean delivery. We concluded that the precise 'medications of this surgical intervention specially in nuliparous or previous cesarean delivery cases must be replanteated to diminish its elevated frequency.

  13. Comparative analysis of fecal microflora of healthy full-term Indian infants born with different methods of delivery (vaginal vs cesarean): Acinetobacter sp. prevalence in vaginally born infants

    Indian Academy of Sciences (India)

    Prashant Kumar Pandey; Pankaj Verma; Himanshu Kumar; Ashish Bavdekar; Milind S Patole; Yogesh S Shouche

    2012-12-01

    In this study fecal microflora of human infants born through vaginal delivery (VB) and through cesarean section (CB) were investigated using culture-independent 16S rDNA cloning and sequencing approach. The results obtained clearly revealed that fecal microbiota of VB infants distinctly differ from those in their counterpart CB infants. The intestinal microbiota of infants delivered by cesarean section appears to be more diverse, in terms of bacteria species, than the microbiota of vaginally delivered infants. The most abundant bacterial species present in VB infants were Acinetobacter sp., Bifidobacterium sp. and Staphylococcus sp. However, CB infant’s fecal microbiota was dominated with Citrobacter sp., Escherichia coli and Clostridium difficile. The intestinal microbiota of cesarean section delivered infants in this study was also characterized by an absence of Bifidobacteria species. An interesting finding of our study was recovery of large number of Acinetobacter sp. consisting of Acinetobacter pittii (former Acinetobacter genomic species 3), Acinetobacter junii and Acinetobacter baumannii in the VB infants clone library. Among these, Acinetobacter baumannii is a known nosocomial pathogen and Acinetobacter pittii (genomic species 3) is recently recognized as clinically important taxa within the Acinetobacter calcoaceticus–Acinetobacter baumannii (ACB) complex. Although none of the infants had shown any sign of clinical symptoms of disease, this observation warrants a closer look.

  14. Efficacy of the Bilateral Ilioinguinal-Iliohypogastric Block with Intrathecal Morphine for Postoperative Cesarean Delivery Analgesia

    Directory of Open Access Journals (Sweden)

    Manuel C. Vallejo

    2012-01-01

    Full Text Available The ilioinguinal-iliohypogastric (IIIH block is frequently used as multimodal analgesia for lower abdominal surgeries. The aim of this study is to compare the efficacy of IIIH block using ultrasound visualization for reducing postoperative pain after caesarean delivery (CD in patients receiving intrathecal morphine (ITM under spinal anesthesia. Participants were randomly assigned to 1 of 3 treatment groups for the bilateral IIIH block: Group A = 10 mL of 0.5% bupivacaine, Group B = 10 mL of 0.5% bupivacaine on one side and 10 mL of a normal saline (NSS placebo block on the opposite side, and Group C = 10 mL of NSS placebo per side. Pain and nausea scores, treatment for pain and nausea, and patient satisfaction were recorded for 48 hours after CD. No differences were noted with respect to pain scores or treatment for pain over the 48 hours. There were no differences to the presence of nausea (P=0.64, treatment for nausea (P=0.21, pruritus (P=0.39, emesis (P=0.35, or patient satisfaction (P=0.29. There were no differences in pain and nausea scores over the measured time periods (MANOVA, P>0.05. In parturients receiving ITM for elective CD, IIIH block offers no additional postoperative benefit for up to 48 hours.

  15. 兴安县5年10643例剖宫产情况分析及对策%10 643 Cases of Cesarean Delivery Situation Analysis and Countermeasures in 5 Years in Xing’an County

    Institute of Scientific and Technical Information of China (English)

    张苏华

    2015-01-01

    目的:分析2010-2014年兴安县剖宫产率及剖宫产指征变化趋势,找出兴安县剖宫产率居高不下的原因,提出降低剖宫产率的干预措施。方法:回顾性调查2010-2014年5年兴安县4家医疗保健机构10643例剖宫产产妇的临床资料,对剖宫产率及剖宫产指征的变化趋势进行分析。结果:2010-2014年兴安县剖宫产率呈上升趋势,非医学指征剖宫产是增高的主要原因,占剖宫产的12.80%。结论:在行政监管考核同时,应加强医院管理,提倡医德,提高产科质量,严格把握剖宫产手术指征,增加产科人员配备,有效的孕期保健和健康教育,孕妇改变认识,降低剖宫产率。%Objective:To analyze the cesarean delivery rate of Xing’an county in 2010-2014 and cesarean section indications trends,finding out the cause of the high county cesarean section rate,reducing cesarean section rate of intervention measures are put forward.Method:A retrospective survey of five years from 2010 to 2014 the county,four medical and health institutions of the clinical data of 10 643 cases of cesarean section maternal,and the change trend of cesarean section indications for cesarean section rate were analyzed.Result:In 2010-2014,Xing’an county cesarean delivery rate was on the rise,the higher medical indications of cesarean section was the main reason,accounted for 12.80%of cesarean delivery.Conclusion:At the same time of the assessment of administrative supervision,to strengthen hospital management,advocating medical ethics,improving the obstetric quality,increase the obstetric staffing, effective healthy education of pregnant women,pregnant women to change,to take a systems engineering,and reduce the rate of cesarean delivery.

  16. An Analysis of Cesarean Delivery on Maternal Request in Sichuan Province%四川省非医学指征剖宫产现状分析

    Institute of Scientific and Technical Information of China (English)

    吴方银; 张燕; 肖兵; 熊庆

    2012-01-01

    目的:分析四川省非医学指征剖宫产现状及影响因素,寻求降低剖宫产率的对策.方法:随机抽取全省5个市进行调查,每个市随机抽取2个市级、2个县级、2个乡级助产服务机构进行数据收集,每个机构收集100份剖宫产病例,共对2824份有效问卷的剖宫产手术指征及影响因素进行分析.结果:非医学指征剖宫产占剖宫产总数的46.03%;不能忍受自然分娩疼痛、认为剖宫产安全、对自然分娩感到恐惧是选择剖宫产的主要原因;低龄、初产妇、无妊娠并发症、入院至分娩时间≥24小时组非医学指征剖宫产率高(P<0.01),脑力劳动组非医学指征剖宫产率高于体力劳动组(P<0.05).结论:非医学指征剖宫产增加是近年来剖宫产率升高的主要原因.加强自然分娩的健康教育、推广应用分娩镇痛技术和处置难产技术以及政策支持是降低剖宫产率的有效措施.%Objective:To analyze indications for cesarean delivery on maternal request (CDMR) and reveal status quo and influence factors in Sichuan Province, and explore counter-measures to reduce the rate of cesarean section. Methods: Five cities which randomly selected in province-wide were investigated, and 2 midwifery instituets at each levels (municipal, county and township; altogether6 institutes) were selected for data collection in every city randomly. 100 cesarean section cases were collected at each institution, and a total of 2824 cases with effective questionnaire concerning CS indications and influence factors were analyzed. Results:Cesarean delivery on maternal request accounted for 46.03% of the total number of cesarean section. Natural childbirth pain, concerning of safety, fear of natural childbirth are main reasons for the choice of cesarean section. Women of youngage, primipara, no complications of pregnancy, duration of admission to childbirth over 24 hours were main factors in CDMR group ( P <0.01 ). The rate of

  17. Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth

    Directory of Open Access Journals (Sweden)

    Can ONER

    2016-08-01

    Full Text Available Background: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women.Methods: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012–31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used.Results: In multivariate analyses, the place of delivery (OR: 11.2 [2.9-42.46] in private hospital and OR: 6.1 [2.6-14.1] in university hospital; time of the birth (OR: 7.1 [3.1-16.0]; doctor’s effect (OR: 4.0 [1.8-8.95] and husband’s employment status (OR: 2.23 [1.0-4.7] have been identified as factors affecting the caesarean delivery in primiparous women.Conclusion: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures.Keywords: Cesarean sections, Primiparity, Social determinants, Epidemiology 

  18. Survey of risk factors of previous cesarean delivery scar defect%剖宫产疤痕缺损的危险因素调查

    Institute of Scientific and Technical Information of China (English)

    袁秀英; 孙晓岩; 刘小媚; 杨仁东; 刘燕燕; 黄丽娥; 钟春华

    2015-01-01

    Objective To investigate the prevalence of previous cesarean delivery scar defect (PCDSD) and its risk factors.Methods 3500 women who had cesarean delivery in our hospital from Jan.2010 to Dec.2011 were followed up by telephone.Two-dimensional transvaginal ultrasound was used to make a definite diagnosis in women who had clinical symptoms.According to ultrasound,they were divided into defect group and control group.Compared age,gestational age,cesarean delivery times,trial of labor situation,oxytocin augmentation during labor,cesarean section indication,amniotic fluid turbidity,layer number of uterus suture,operative time,blood loss in 24 hours and postpartum breast feeding time of two groups.Results The prevalence of PCDSD was 22.5% (788/3500).The rate of PCDSD was significantly higher among women with cesarean delivery times ≥ 2,oxytocin augmentation during labor,duration of trial of labor ≥ 5 hours,cervix dilation ≥ 5 cm,presenting part below pelvic inlet and postpartum breast feeding time ≤ 3 months.Maternal age,gestational age,cesarean section indication,amniotic fluid turbidity,layer number of uterus suture,operative time,blood loss in 24 hours had no obvious effect on PCDSD.Conclusions Too much cesarean delivery times,oxytocin augmentation during labor,long duration of trial of labor,wide cervix dilation,presenting part below pelvic inlet,and short postpartum breast feeding time are risk factors of PCDSD.We should enhance preoperative assessment and postpartum rehabilitation guidance of cesarean delivery.%目的 了解剖宫产疤痕缺损(Previous Cesarean Delivery Scar Defect,PCDSD)的患病率及其危险因素.方法 对2010年1月至2011年12月在东莞市第三人民医院行剖宫产的妇女(共3500人次)进行电话随访及病历回顾分析,对有症状的患者行阴道B超检查确诊是否存在PCDSD;根据B超检查结果将研究对象分为两组,分别是缺损组和对照组,统计分析母体年龄、孕龄、剖宫产次数

  19. Analgesic Efficacy of Transverse Abdominal Plane Block after Elective Cesarean Delivery – Bupivacaine with Fentanyl versus Bupivacaine Alone: A Randomized, Double-blind Controlled Clinical Trial

    Science.gov (United States)

    John, Roshan; Ranjan, R. V.; Ramachandran, T. R.; George, Sagiev Koshy

    2017-01-01

    Background: The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery remains controversial. In our study, we compared the analgesic efficacy of TAP block using local anesthetic bupivacaine and adjunct fentanyl with bupivacaine alone in patients undergoing elective cesarean section. Methods: Our study was a randomized, double-blind, controlled clinical trial where sixty patients undergoing elective cesarean delivery under subarachanoid block (2 ml of 0.5% bupivacaine) were randomized into two groups, A and B. At the end of the surgical procedure, bilateral TAP block was performed guided by the ultrasound. Group A received 38 ml of 0.25% bupivacaine and 2 ml of 50 μg of fentanyl, whereas Group B received 38 ml of 0.25% bupivacaine + 2 ml of normal saline. The total volume was divided equally and administered bilaterally. Each patient was assessed for 24 h after TAP block, for time to rescue analgesia, pain using visual analog scale (VAS) score at rest and on movement, hemodynamic parameters (heart rate and blood pressure), nausea, vomiting, and sedation. Diclofenac 75 mg was given as rescue analgesia when the patient complained of pain or when VAS score >4. Results: Prolonged postoperative analgesia was noticed with both the groups, with a mean time to rescue analgesia of approximately 6.5 h. There was no significant difference in time to rescue analgesia (6.49 ± 0.477 vs. 6.5 ± 0.480) when both the groups were compared among themselves. The pain scores among the two groups when compared did not show any added benefit. Incidence of nausea, vomiting, and sedation when compared between both the groups showed no difference. Conclusion: The TAP block as a part of a multimodal analgesic regimen definitely has a role in providing superior analgesia in the postoperative period. However, adjunct fentanyl to local anesthetic bupivacaine was found to have no added advantage when quality and duration of analgesia was compared.

  20. Clinical analysis of placenta previa cesarean delivery in 52 cases%前置胎盘剖宫产52例临床分析

    Institute of Scientific and Technical Information of China (English)

    王蕾

    2015-01-01

    目的:探讨前置胎盘剖宫产术中子宫切口方式和出血量之间的关系。方法:2012年1月-2013年1月收治前置胎盘剖宫产孕妇52例,比较不同子宫切口与相应的出血量。结果:直接切开胎盘组出血量最多,切开胎盘组与推开胎盘组和避开胎盘组比较,出血量均有显著性差异。结论:前置胎盘剖宫产术前应做B超检查明确胎盘位置,采用避开胎盘的子宫切口以减少术中出血量,减少母婴并发症。%Objective:To explore the relationship between intraoperative uterine incision approach between bleeding amount of placenta previa cesarean delivery.Methods:52 pregnant women with placenta previa cesarean delivery were selected from January 2012 to January 2013.The different uterine incisions and the corresponding blood amounts were compared.Results:The bleeding amount of directly cutting placenta group was largest,the cutting placenta group was compared with the pushing placenta group and the avoiding placenta group,the bleeding volume were significantly different.Conclusion:Placenta previa cesarean section should make B ultrasound examination before operation to clear the placenta.Using avoiding placenta uterine incision reduce intraoperatve blood volume,reduce the complications of mothers and infants.

  1. [Cesarean section and eye disorders].

    Science.gov (United States)

    Karska-Basta, Izabella; Tarasiewicz, Marta; Kubicka-Trząska, Agnieszka; Miniewicz, Joanna; Romanowska-Dixon, Bożena

    2016-01-01

    Recently, a growing tendency for cesarean birth has been noted both, in Poland and worldwide. Non-obstetric problems constitute a large part of indications for cesarean section. Many ophthalmologists and obstetricians still believe that high myopia, the presence of peripheral retinal degenerations, history of retinal detachment surgery, diabetic retinopathy, or glaucoma are indications for surgical termination of pregnancy. However, these recommendations are not evidence-based. The literature offers no proof that high myopia and previous retinal surgery increase the risk of retinal detachment during spontaneous vaginal delivery. There is only one indication for cesarean section in myopic patients, i.e. the presence of choroidal neovascularization, which can cause subretinal bleeding with acute visual loss. Prolonged and intensified Valsalva maneuver during labor in patients with an active proliferative diabetic retinopathy may be an indication for an elective cesarean section. Uterine contractions during the second stage of vaginal delivery lead to a marked elevation of intraocular pressure. Intraocular pressure fluctuations during the delivery may damage retinal ganglion cells, resulting in further progression of visual field. Thus, glaucoma associated with advanced visual field changes is the next ophthalmic indication for cesarean section. The report presents the current state of knowledge concerning the effect of pregnancy on pre-existing ocular disorders and the influence of physiological changes on the clinical course of these diseases during the stages of natural delivery. The authors discuss also the ophthalmic indications for cesarean section.

  2. [Combined spinal and epidural anesthesia for cesarean delivery in a patient with a cervical fracture at C2].

    Science.gov (United States)

    Mochidome, Mariko; Sakamoto, Akiyuki; Tanaka, Hidenori; Sugiyama, Daisuke; Kawamata, Mikito

    2013-04-01

    There are only a few reports on cesarean section in a patient with cervical fracture without spinal cord injury (SCI). Such patients have high risks for deterioration of SCI following general or regional anesthesia. Here, we present a patient with a fracture of C2 vertebra who underwent cesarean section safely under combined spinal and epidural anesthesia(CSEA). A 30-year-old woman had a fracture of the C2 cervical vertebra (Hangman's fracture) due to a traffic accident at 34 weeks of gestation. Conservative immobilization of the head and neck was done with a neck collar (Philadelphia brace) in order to prevent subsequent SCI after the spine injury. Pre-viability amniorrhexis was seen at 37 weeks' gestation, and an emergency cesarean section was scheduled under combined epidural and spinal anesthesia (CSEA). Her neck and head were carefully fixed before, during and after surgery in order to prevent subsequent SCI. As a result, cesarean section under CSEA was successfully performed in the patient without any deterioration of the spine and/or SCI.

  3. 剖宫产术后再次妊娠分娩方式的临床探讨%Discussion on Clinical Pregnancy Delivery Modes after Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    彭敏; 陈燕桢

    2012-01-01

    目的 探讨剖宫产术后再次妊娠分娩方式的选择.方法 对2005年1月至2010年12月在我院住院的150例剖宫产术后再次妊娠分娩者的临床资料进行回顾性分析,并将其中104例剖宫产术后再次妊娠剖宫产(RCS组)及46例剖宫产术后再次妊娠阴道分娩(VBAC组),与同期104例首次剖宫产(PCS组)及46例非瘢痕子宫阴道分娩(VBNC组)比较.分析各组分娩结局、新生儿Apgar评分以及住院时间等差异.结果 150例剖宫产术后再次妊娠者,再次剖宫产者104例(69.3%),阴道分娩者46例(30.7%).VBAC组与RCS组比较,两组在产时出血量、新生儿Apgar评分以及住院时间方面均有统计学意义(P<0.05).VBAC组与VBNC组相比较,两者在产程时间、产时出血量、新生儿Apgar评分、新生儿窒息数及住院时间方面均无统计学意义(P>0.05).RCS组与PCS组相比较,在手术时间、产时出血量、术后腹腔粘连及住院时间方面均有统计学意义(P<0.05),新生儿Apgar评分无统计学意义(P>0.05).结论 剖宫产术后再次妊娠分娩并非是剖宫产的绝对指征,符合试产条件者在严密监护下阴道试产是安全可行的,且能改善分娩结局.%Objective To discuss the selection of secondary deliver}' mode after cesarean section. Methods A total of 150 cases of second pregnancy after cesarean delivery admitted in our hospital during Jan. 2005 to Dec. 2010 were reviewed, of which 104 cases underwent repeat cesarean section( KCS group ),46 had vaginal birth after cesarean section( VBAC group ). 104 corresponding cases that underwent first cesarean section( PCS )and 46 that had non-scarred uterus with vaginal delivery( VBNC Muring the same period were also selected for comparison of delivery outcomes. Results Of the 150 cases, 104( 69. 3% )had HCS,46 ( 30.7% )had VBAC, and significant differences in blood loss volume, Apgar score, and hospital stay length were observed between the two groups( P 0

  4. 1993至2010年中国部分地区单胎初产妇剖宫产和孕妇要求剖宫产率变化趋势%Secular trends of cesarean delivery and cesarean delivery on maternal request among primiparous women with singleton pregnancy in Southern and Northern China during 1993-2010

    Institute of Scientific and Technical Information of China (English)

    朱逸博; 李宏田; 张亚黎; 李智文; 张乐; 刘建蒙

    2012-01-01

    Objective To explore the secular trends of cesarean delivery and cesarean delivery on maternal request(CDMR)among primiparous women with singleton pregnancy in Southern and Northern China.Methods The Perinatal Healthcare Surveillance System was established in 26 counties/cities of 3 Chinese provinces since 1993.A total of 1 317 774 primiparous women with singleton pregnancy were monitored through the system during the 1993-2010 period.Chi-square tests were performed to assess the linear trends in the prevalence of cesarean delivery and CDMR.Results During the 18-year period,496 054 cesarean deliveries and 129 219 CDMRs were identified.The prevalence rates of cesarean delivery and CDMR were 37.6% and 10.0% respectively.CDMR accounted for 26.0% of all cesarean births.The prevalence of cesarean delivery increased from 29.4% during the 1993-1995 period to 58.7% during the 2006-2010 in Southern urban area,from 18.2% to 58.3% in Southern rural area and from 4.3% to 49.5% in Northern rural area.The prevalence of CDMR increased by 34 folds from 0.6% during the 1993-1995 period to 21.3% during the 2006-2010 period in Southern urban area,by 40 folds from 0.6% to 24.4% in Southern rural area and by 44 folds from 0.6% to 27.3% in Northern rural area.The proportions of CDMR in all cesarean deliveries significantly increased in all three regions.Women aged over 30 years,overweight and well-educated were more likely to experience a cesarean delivery including CDMR.Conclusion The Chinese prevalence rates of cesarean delivery and CDMR increased dramatically during the 1993-2010 period and ranked the highest in the word by 2010.And CDMR became a non-negligible component in all cesarean sections.%目的 了解中国部分地区单胎初产妇女剖宫产和孕妇要求剖宫产率的长期变化趋势.方法 对象为1993至2010年3省26县(市)单胎初产妇1317774名.用趋势卡方检验探讨剖宫产率的时间变化趋势.结果 18

  5. Analysis the Related Factors on Delivery Mode in Repregnant Women after Cesarean Section%剖宫产术后再次妊娠分娩的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    叶秀兰

    2011-01-01

    目的:探讨割宫产术后再次妊娠的适宜分娩方式.方法:回顾分析我院178例剖官产术后再次妊娠妇女的分娩方式,并随机选取同期非瘢痕子宫阴道分娩和再次剖官产孕妇资料进行对比分析.结果:剖宫产再次妊娠阴道试产的成功率为71.3%,其产后表现与正常孕妇相似,产后出血量、住院时间、并发症明显低于再次剖宫产者.结论:剖宫产史作为再次妊娠剖宫产的指征是不合理的,符合试产条件的在严密监护下可试产,以减少再次术后的各种危险和并发症.%Objective: To explore the appropriate delivery mode in repregnant women after cesarean section. Method: 178 cases of repregnant women after cesarean section were analyzed on delivery mode,and compared with uterine scar-grain vaginal delivery( VBNC) and primiparity cesarean section(PCS). Result: The rate of successful labour was 71.3% of vaginal delivery after cesarean section (VBAC). They were identical with normal expectant mother,but the volume of delivery blood loss, days of hospitalization and complication was lower than repeat cesarean section( RCS). Conclusion: We should try the vaginal delivery,which is under suitable condition of vaginal delivery. It can reduce risks and complications.

  6. 剖宫产术后再次妊娠分娩方式分析%Analysis of the delivery mode of secondary pregnancy after cesarean section

    Institute of Scientific and Technical Information of China (English)

    吴玉芳

    2014-01-01

    Objective To analyse the feasibility of vaginal birth after cesarean(VBAC).Methods 54 cases who successed through vaginal delivery after cesarean section(the VBAC group) were retrospectively analyzed.Contrasted the VBAC group with 54 primiparas who successed through vaginal delivery in the same time(the VBOP group).And contrasted the VBAC group with 54 cases of repeated caesarean section in the same time(the RCS group).Results There was no significant difference between the VBAC group and the VBOP group in time of birth process,hemorrhage of intrapartum and neonatal asphyxia(P>0.05).And there was significant difference between the VBAC group and the RCS group in hemorrhage of intrapartum,puerperal infection,The average hospitalization days(P<0.05).Conclusion For secondary pregnancy after cesarean section,on the premise of mastering the contraindications and indications,should be given an opportunitie of vaginal delivery,In order to improve the success rate of vaginal birth after cesarean delivery,reduce the rate of cesarean section,and improve the quality of obstetrics.%目的:分析剖宫产术后再次妊娠经阴道分娩(Vaginal Birth After Cesarean,VBAC)的可行性。方法:回顾性分析剖宫产术后再次妊娠经阴道试产成功的产妇54例(VBAC组)。随机抽取同期经阴道试产成功的初产妇54例(Vaginal Birth Of Primipara, VBOP组)与VBAC组进行对照,又随机抽取同期剖宫产术后再次剖宫产者54例(Repeated Caesarean Section,RCS组)与VBAC组进行对照。结果:VBAC组与VBOP组在产程时间、产时出血量及新生儿窒息发生率等比较上差异无统计学意义(P>0.05)。VBAC组与RCS组在产时出血量、平均住院时间、产褥期感染等比较上差异有统计学意义(P<0.05)。结论:对于剖宫产术后再次妊娠的产妇,在掌握好禁忌证和适应证的前提下,应给予试产的机会,以提高剖宫产术后阴道分娩的成

  7. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    OpenAIRE

    Walid Hamed Nofal; Mohamed Sidky Mahmoud; Azza Atef Abd Al Alim

    2014-01-01

    Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placeb...

  8. Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth)

    Science.gov (United States)

    ONER, Can; CATAK, Binali; SÜTLÜ, Sevinç; KILINÇ, Selçuk

    2016-01-01

    Background: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women. Methods: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012–31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. Results: In multivariate analyses, the place of delivery (OR: 11.2 [2.9–42.46] in private hospital and OR: 6.1 [2.6–14.1] in university hospital); time of the birth (OR: 7.1 [3.1–16.0]); doctor’s effect (OR: 4.0 [1.8–8.95]) and husband’s employment status (OR: 2.23 [1.0–4.7]) have been identified as factors affecting the caesarean delivery in primiparous women. Conclusion: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures. PMID:27648420

  9. A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness.

    Science.gov (United States)

    Bamberg, C; Dudenhausen, J W; Bujak, V; Rodekamp, E; Brauer, M; Hinkson, L; Kalache, K; Henrich, W

    2016-09-14

    Purpose: We undertook a randomized clinical trial to examine the outcome of a single vs. a double layer uterine closure using ultrasound to assess uterine scar thickness. Materials and Methods: Participating women were allocated to one of three uterotomy suture techniques: continuous single layer unlocked suturing, continuous locked single layer suturing, or double layer suturing. Transvaginal ultrasound of uterine scar thickness was performed 6 weeks and 6 - 24 months after Cesarean delivery. Sonographers were blinded to the closure technique. Results: An "intent-to-treat" and "as treated" ANOVA analysis included 435 patients (n = 149 single layer unlocked suturing, n = 157 single layer locked suturing, and n = 129 double layer suturing). 6 weeks postpartum, the median scar thickness did not differ among the three groups: 10.0 (8.5 - 12.3 mm) single layer unlocked vs. 10.1 (8.2 - 12.7 mm) single layer locked vs. 10.8 (8.1 - 12.8 mm) double layer; (p = 0.84). At the time of the second follow-up, the uterine scar was not significantly (p = 0.06) thicker if the uterus had been closed with a double layer closure 7.3 (5.7 - 9.1 mm), compared to single layer unlocked 6.4 (5.0 - 8.8 mm) or locked suturing techniques 6.8 (5.2 - 8.7 mm). Women who underwent primary or elective Cesarean delivery showed a significantly (p = 0.03, p = 0.02, "as treated") increased median scar thickness after double layer closure vs. single layer unlocked suture. Conclusion: A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients.

  10. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial

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    Uma Srivastava

    2015-01-01

    Full Text Available Background: The transverse abdominis plane (TAP block, a regional block provides effective analgesia after lower abdominal surgeries if used as part of multimodal analgesia. In this prospective, randomized double-blind study, we determined the efficacy of TAP block in patients undergoing cesarean section. Materials and Methods: Totally, 62 parturients undergoing cesarean section were randomized in a double-blind manner to receive either bilateral TAP block at the end of surgery with 20 ml of 0.25% bupivacaine or no TAP block, in addition to standard analgesic comprising 75 mg diclofenac 8 hourly and intravenous patient-controlled analgesia (PCA tramadol. Each patient was assessed at 0, 4, 8, 12, 24, 36, and 48 h after surgery by an independent observer for pain at rest and on movement using numeric rating scale of 0-10, time of 1 st demand for tramadol, total consumption of PCA tramadol, satisfaction with pain management and side effects. Results: Use of tramadol was reduced in patients given TAP block by 50% compared to patients given no block during 48 h after surgery (P < 0.001. Pain scores were lower both on rest and activity at each time point for 24 h in study group (P < 0.001, time of first analgesia was significantly longer, satisfaction was higher, and side effects were less in study group compared to control group. Conclusion: Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 48 h after cesarean section when used as adjunctive to standard analgesia.

  11. The short and long-term influence of cesarean delivery on maternal and child%剖宫产对母婴近远期的影响

    Institute of Scientific and Technical Information of China (English)

    王桂兰

    2013-01-01

    目的 探讨剖宫产对母婴近远期的影响.方法 调查504例孕产妇的临床资料,随访至产后10年.并采用丹佛发育筛查测验(DDST)小儿智能发育筛查工具测查生后1岁小儿,学习能力评估测查工具测查学龄期儿童.结果 顺产组产妇在产后第1天的抑郁量表得分低于剖宫产组(t =16.54,P<0.05).顺产组的产时和产后并发症的发生概率均低于剖宫产组(x2 =4.62、4.17、14.62、6.37,均P<0.05).胆红素指数和Apgar评分≤7分的发生率顺产组均低于剖宫产组(t=23.62,x2=4.12,均P<0.05).调查产后10年自然分娩与剖宫产妇女,顺产组宫外孕、子宫内膜异位、继发性不孕、再次妊娠异常例数均显著低于对照组(x2 =1.57、6.78、4.35、4.26、7.34,均P<0.05).顺产组个人与社会、精细动作、语言能力、大运动发育情况均显著优于剖宫产组(x2=13.76、12.75、13.32、15.23,均P<0.05).顺产组过敏性哮喘、多动症、人际交流、社会适应能力差人数均显著低于剖宫产组(x2 =4.58、4.04、6.34,均P<0.05).结论 剖宫产对母儿近远期可产生不同程度影响,应采取有力措施降低剖宫产率,维护妇女儿童身心健康.%Objective To explore the short and long-term influence of cesarean delivery on maternal and child.Methods The clinical data of 504 cases of maternal postpartum were investigated,and followed up for 10 years.The 1-year-old children were given DDST of pediatric mental development screening investigation.The schoolage children were examined by the learning ability assessment and check measurement tools.Results The postpartum depression scale score in the first day of maternal eutocia group was significantly lower than that of the cesarean group (t =16.54,P < 0.05).The probability occurrence of intrapartum and postpartum complications of eutocia group were lower than those of cesarean group(x2 =4.62,4.17,14.62,6.37,all P < 0.05).The bilirubin index and the incidence of

  12. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study.

    Science.gov (United States)

    Chia, Yuan-Yi; Lo, Yuan; Chen, Yan-Bo; Liu, Chun-Peng; Huang, Wei-Chun; Wen, Chun-Hsien

    2016-04-01

    To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.

  13. Mechanisms linking employee affective delivery and customer behavioral intentions.

    Science.gov (United States)

    Tsai, Wei-Chi; Huang, Yin-Mei

    2002-10-01

    Past empirical evidence has indicated that employee affective delivery can influence customer reactions (e.g., customer satisfaction, service quality evaluation). This study extends previous research by empirically examining mediating processes underlying the relationship between employee affective delivery and customer behavioral intentions. Data were collected from 352 employee-customer pairs in 169 retail shoe stores in Taiwan. Results showed that the influence of employee affective delivery on customers' willingness to return to the store and pass positive comments to friends was indirect through the mediating processes of customer in-store positive moods and perceived friendliness. The study also indicated that employee affective delivery influences customers' time spent in store, which, in turn, influences customer behavioral intentions.

  14. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report.

    Science.gov (United States)

    Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Park, Hee-Pyoung; Jeon, Young-Tae; Hwang, Jung-Won

    2014-10-01

    Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.

  15. Vacuum-assisted cesarean section

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    McQuivey RW

    2017-03-01

    Full Text Available Ross W McQuivey,1 Jon E Block2 1Clinical Innovations, Salt Lake City, UT, 2Independent consultant, San Francisco, CA, USA Abstract: There has been a dramatic rise in the frequency of cesarean sections, surpassing 30% of all deliveries in the US. This upsurge, coupled with a decreasing willingness to allow vaginal birth after cesarean section, has resulted in an expansion of the use of vacuum assistance to safely extract the fetal head. By avoiding the use of a delivering hand or forceps blade, the volume being delivered through the uterine incision can be decreased when the vacuum is used properly. Reducing uterine extensions with their associated complications (eg, excessive blood loss in difficult cases is also a theoretical advantage of vacuum delivery. Maternal discomfort related to excessive fundal pressure may also be lessened. To minimize the risk of neonatal morbidity, proper cup placement over the “flexion point” remains essential to maintain vacuum integrity and reduce the chance of inadvertent detachment and uterine extensions. Based on the published literature and pragmatic clinical experience, utilization of the vacuum device is a safe and effective technique to assist delivery during cesarean section. Keywords: cesarean section, vacuum, forceps, birth, delivery

  16. 剖宫产术后再次妊娠经阴道分娩的成败因素探索%Study of Key Success Factors About Vaginal Delivery With Repeated Pregnancy After Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    张海燕; 王天成

    2012-01-01

    目的 探讨剖宫产术后再次妊娠的分娩方式,分析经阴道分娩的可能性.方法 采取回顾性分析法,对2009年3月至2011年12月在南京迈皋桥医院既往有剖宫产史再次分娩的116例孕妇为研究对象,对其进行剖宫产后再次妊娠经阴道分娩(VBAC)的可能性分析(本研究遵循的程序符合南京迈皋桥医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与之签署临床研究知情同意书).结果 116例孕妇中,仅15例(12.9%)接受经阴道试产,10例(66.6%,10/15)阴道分娩成功,106例(91.4%)再次剖宫产分娩终止妊娠.本组具备阴道试产条件但选择择期剖宫产术终止妊娠的孕妇为27例(23.3%);因既往病史不清选择再次剖宫产术分娩的为13例(11.2%).本组实际剖宫产率显著高于有明确剖宫产指针的剖宫产率,且差异有统计学意义(P<0.05).结论 剖宫产术后再次妊娠分娩并非剖宫产的绝对指征,对符合条件的孕妇可以在严密监护下阴道试产.%Objective To investigate the delivery of repeated pregnancy after cesarean section.Evaluate the likelihood of vaginal birth after caesarean(VBAC).Methods There were 116 pregnant women with previous cesarean section delivery who would delivery again from March 2009 to December 2011 in Nanjing Maigaoqiao Hospital.Their outcomes were analyzed by retrospective analysis method.Informed consent was obtained from all participants.Results Among 116 pregnant women of 15 cases (12.9%)of vaginal trial production,10 cases(66.6 %,10/15) were successful.Once again the cesarean section rate was 91.4% (106/116).There were 27 cases(23.3%) who had vaginal production conditions but chose elective cesarean section.Formerly medical history of previous cesarean section delivery were not clear of 13 cases (11.2%) who also chose elective cesarean section.There had significance difference between actual cesarean section rate and indication for

  17. Skills of unarmed delivery head in second cesarean section%第二次剖宫产徒手娩头的技巧

    Institute of Scientific and Technical Information of China (English)

    董立芸

    2013-01-01

    目的 探讨第二次剖宫产术中徒手娩头的手法技巧.方法 回顾性分析556例行第二次剖宫产的术中和术后情况,对照组(n = 280)采用传统的方法娩头,研究组(n = 276)根据胎儿大小在子宫下段弧形剪开适当长度切口,左手或右手伸入羊膜腔内,将胎头旋转为左枕前或右枕前,退出宫腔,以手紧压子宫切口下缘,让胎头缓慢娩出子宫切口,再适当按压宫底,胎儿顺势依次滑脱娩出前或后肩.结果 研究组的子宫切口延长、裂伤,宫颈、阴道、膀胱裂伤,均明显低于对照组(P < 0.05).两组产后出血(含宫缩乏力)、新生儿Apgar评分、手术历时及产后切口愈合无差异(P > 0.05).结论 行第二次剖宫产时,因子宫瘢痕挛缩、弹性差,切开子宫下段后,不宜强行手撕切口,应弧形剪开足够胎儿娩出的子宫切口.本文介绍的方法操作简便,不需要特殊器械,适应任何级医院,值得推广.%Objective To explore the techniques of unarmed delivery head in second cesarean section. Methods The conditions during operation and after operation of 556 cases in second cesarean section were analysed retrospectively. The traditional method of delivery head was used in control group (n = 280), while the study group (n = 276) according to the size of the fetus cut an appropriate length of arc incision in the lower uterine segment, the left hand or right hand reached into the amniotic cavity to turn the fetal head into left anterior or right anterior, and then exit intrauler-ine with hand pressing against the lower edge of the uterine incision, the fetal head slowly delivered from the uterine incision, and appropriately pressed the fundal, fetal homeopathicly slipped and delivered the fore or back shoulder. Results The uterine incision extending or laceration, cervix laceration, vagina laceration and bladder laceration in the study group were significantly lower than those in the control group (P 0.05). Conlusion

  18. Incidência de cesáreas segundo fonte de financiamento da assistência ao parto Incidence of cesarean delivery regarding the financial support source for delivery care

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    Marta Edna Holanda Diógenes Yazlle

    2001-04-01

    Full Text Available OBJETIVO: Estudar os tipos de partos de acordo com a categoria de internação da paciente, bem como as indicações de cesarianas mais freqüentemente referidas. MÉTODOS: A partir dos dados de um sistema de informações hospitalares, foi feita uma análise retrospectiva dos partos ocorridos no município de Ribeirão Preto, São Paulo, Brasil, no período de 1986-1995. Foram estudados: tipo de parto, categoria de admissão e diagnósticos referidos. RESULTADOS: Ocorreram 86.120 partos no período estudado, sendo 5,4% na categoria privada, 28,7% na categoria de pré-pagamento e 65,9% no sistema público (Sistema Único de Saúde -- SUS, observando-se uma diminuição nas categorias privada e SUS e aumento na categoria de pré-pagamento. A percentagem de cesáreas aumentou de 68,3% para 81,8% na categoria privada e de 69,1% para 77,9% na categoria pré-pagamento e diminuiu de 38,7% para 32,1% na categoria SUS. As principais indicações cesarianas referidas foram o sofrimento fetal, cujas incidências foram 9,5%, 10,9% e 9,0%, respectivamente, nas categorias particular, pré-pagamento e SUS; e distócia céfalo-pélvica cujas taxas foram 5,8%, 6,5% e 3,9%, respectivamente, nas mesmas categorias mencionadas. CONCLUSÃO: A incidência de cesariana variou segundo a categoria de internação, observando-se um gradiente crescente à medida que se elevou o padrão social das gestantes, não havendo correspondência com o risco obstétrico.OBJECTIVE: To study the types of delivery according to the category of patient admission and the most frequently reported indications for cesarean sections. METHODS: In a retrospective survey of deliveries performed in the municipality of Ribeirão Preto, São Paulo, Brazil, from 1986 to 1995, the type of delivery, category of admission and recorded diagnoses were assessed. Data were obtained from the Center of Hospital Data Processing of the Department of Social Medicine in the University of São Paulo, Ribeir

  19. Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey

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    Marcos Augusto Bastos Dias

    2016-10-01

    Full Text Available Abstract Background The rate of cesarean delivery (CD in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS. Methods This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. Results The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. Conclusions The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns

  20. 剖宫产术后瘢痕子宫足月分娩结局的影响因素分析%Analysis of the Influence Factors on Full-term Delivery Outcome of Scar Uterus after Cesarean Sec-tion

    Institute of Scientific and Technical Information of China (English)

    曾荣春; 廖亚玲; 冉光琴

    2015-01-01

    目的:探讨剖宫产术后瘢痕子宫足月分娩的方式选择及瘢痕子宫足月分娩对妊娠结局的影响。方法将2010年11月至2013年11月石柱县人民医院收治的103例剖宫产术后瘢痕子宫足月分娩产妇作为观察组,其中阴道分娩45例、再次剖宫产58例。另外选择同期常规妊娠的非瘢痕子宫足月分娩产妇作为对照组。比较阴道分娩组与再次剖宫产组的临床效果及瘢痕子宫对妊娠结局的影响。结果再次剖宫产组与阴道分娩组住院时间、出血量和Apgar评分比较差异均有统计学意义( P<0.01);两组盆腹腔粘连及产后发热方面的差异均有统计学意义( P <0.05或 P <0.01);多元Logistic 回归分析,剖宫产术后瘢痕子宫足月分娩影响妊娠结局的因素为:先兆子宫破裂及社会因素。结论剖宫产术后瘢痕子宫影响妊娠结局的因素较多,应对这些因素进行控制,以改善妊娠结局。%Objective To explore the choice of full-term delivery way with scar uterus after cesarean section and the influencing factors on the pregnancy outcome.Methods During Nov.2010 and Nov.2013 in Chongqing Shizhu People′s Hospital,103 full-term pregnant women with scar uterus after cesarean section were included as observation group, including 45 cases of vaginal delivery,58 cases of cesarean section again.Other normal full-term pregnant women during the same period were included as control group.The clinical effect of vaginal delivery and cesarean section again group and the scar uterus influence on pregnancy outcome were compared and analyzed.Results The hospitalization time and blood loss of cesarean section again and vaginal delivery group had statistically significant difference(P<0.01).The basin celiac adhesion and postpartum fever differences had statistically significant difference(P<0.05 or P<0.01).Multivariate Logistic regression analysis showed the influencing factors of pregnancy

  1. Association Between Sexual Health and Delivery Mode

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    Mihyon Song, MD

    2014-12-01

    Conclusion: This study suggests that routine episiotomies at delivery should be avoided to improve postpartum maternal sexual function. Maternal age and cesarean section were found to affect postpartum sexual health. Song M, Ishii H, Toda M, Tomimatsu T, Katsuyama H, Nakamura T, Nakai Y, and Shimoya K. Association between sexual health and delivery mode. Sex Med 2014;2:153–158.

  2. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

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    Walid Hamed Nofal

    2014-01-01

    Full Text Available Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH, also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Results: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05. Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05. The incidence of sedation was more in gabapentin group 11 (26.19% versus placebo group 3 (6.81%. Neonatal outcomes were statistically insignificant between both groups. Conclusion: Pre-operative administration of gabapentin has no effect on incidence of (PDPH but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby.

  3. A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Brendan Carvalho

    2016-01-01

    Full Text Available Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings could predict pain intensity and analgesic usage following cesarean delivery (CD. Methods. 50 healthy women undergoing scheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated psychological questionnaires (Anxiety Sensitivity Index (ASI, Fear of Pain (FPQ, Pain Catastrophizing Scale, and Eysenck Personality Questionnaire and 3 simple ratings: expected postoperative pain (0–10, anticipated analgesic threshold (0–10, and perceived analgesic needs (0–10. Postoperative outcome measures included post-CD pain (combined rest and movement and opioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage (r=0.349, anticipated analgesic threshold and post-CD pain (r=-0.349, and perceived analgesic needs and post-CD pain (r=0.313. Multiple linear regression analysis found that expected postoperative pain and anticipated analgesic needs contributed to post-CD pain prediction modeling (R2=0.443, p<0.0001; expected postoperative pain, ASI, and FPQ were associated with opioid usage (R2=0.421, p<0.0001. Conclusion. Preoperative psychological tests combined with simple pain prediction ratings accounted for 44% and 42% of pain and analgesic use variance, respectively. Preoperatively determined expected postoperative pain and perceived analgesic needs appear to be useful predictors for post-CD pain and analgesic requirements.

  4. The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.

    Science.gov (United States)

    McKenzie, Christine P; Carvalho, Brendan; Riley, Edward T

    2016-01-01

    Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population.

  5. A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery.

    Science.gov (United States)

    Carvalho, Brendan; Zheng, Ming; Harter, Scott; Sultan, Pervez

    2016-01-01

    Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings could predict pain intensity and analgesic usage following cesarean delivery (CD). Methods. 50 healthy women undergoing scheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated psychological questionnaires (Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale, and Eysenck Personality Questionnaire) and 3 simple ratings: expected postoperative pain (0-10), anticipated analgesic threshold (0-10), and perceived analgesic needs (0-10). Postoperative outcome measures included post-CD pain (combined rest and movement) and opioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage (r = 0.349), anticipated analgesic threshold and post-CD pain (r = -0.349), and perceived analgesic needs and post-CD pain (r = 0.313). Multiple linear regression analysis found that expected postoperative pain and anticipated analgesic needs contributed to post-CD pain prediction modeling (R (2) = 0.443, p pain, ASI, and FPQ were associated with opioid usage (R (2) = 0.421, p pain prediction ratings accounted for 44% and 42% of pain and analgesic use variance, respectively. Preoperatively determined expected postoperative pain and perceived analgesic needs appear to be useful predictors for post-CD pain and analgesic requirements.

  6. Spontaneous Uterine Rupture at 15 Weeks' Gestation in a Patient with a History of Cesarean Delivery after Removal of Shirodkar Cerclage

    Directory of Open Access Journals (Sweden)

    Serika Kanao

    2014-05-01

    Full Text Available A pregnant woman presented with acute upper abdominal pain and nausea at 15 weeks' gestation. She had a history of cesarean delivery for abruption after the removal of a Shirodkar cerclage that was placed because of cervical shortening caused by conization. She became pregnant again 14 months later. Ultrasonography revealed no significant findings, and a single intrauterine pregnancy with positive fetal heart activity was confirmed. An intestinal obstruction was suspected because abdominal radiography showed multiple air–fluid levels in the colon. Over the 3 hours following admission, her symptoms gradually worsened, and plain abdominal computed tomography (CT showed a large hemorrhage in the abdominal cavity, but the uterine wall appeared intact at this time. Subsequently, dynamic CT revealed discontinuity of the uterine muscle layer. During laparotomy, uterine rupture with complete opening of the uterine wall at the site of the previous transverse scar was identified. A dead fetus was located within the amniotic sac in a blood-filled abdominal cavity. She received a total of 10 units of packed red blood cells and 6 units of fresh frozen plasma for the resuscitation. She was discharged on the eighth postoperative day without any complications.

  7. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

    Directory of Open Access Journals (Sweden)

    Hee Young Cho

    Full Text Available The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.Sixty-four patients (46.7% required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1% had placenta previa totalis. The overall success rate was 75% (48/64 for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05. The drainage amount over 1 hour was 500 mL (20-1200 mL in the balloon failure group and 60 mL (5-500 mL in the balloon success group (p<0.01.Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

  8. The term Cesarean Delivery and acute Respiratory Distress Syndrome Clinical Research%足月剖宫产儿急性呼吸窘迫综合征临床研究

    Institute of Scientific and Technical Information of China (English)

    彭冬霞

    2014-01-01

    目的:对足月剖宫产儿急性呼吸窘迫综合征的临床研究进行分析。方法以我院在2010年10月份到2013年10月份收治的19例足月剖宫产儿为对象,所有患儿在临床上均实施临床诊断以及临床特点分析。结果经临床研究结果显示,19例足月剖宫产儿均符合急性呼吸窘迫综合征的诊断标准,所有患儿经过CPAP正压通气、抗感染治疗、呼吸支持以及药物治疗,有18例患儿成功治愈,1例患儿死亡。结论经临床研究结果表明,足月剖宫产儿出现急性呼吸窘迫综合症的发生率较高,对新生儿的生命安全构成严重威胁,临床医师需要加强对急性呼吸窘迫综合症的认识和了解,充分把握剖宫产手术的指征。%Objective Son of full-term cesarean delivery of acute respiratory distress syndrome clinical research were analyzed.Methods Selection our hospital in October 2010 to October 2013 was 19 cases of full-term cesarean section for the object,and all the children in clinic to implement clinical diagnosis and the analysis of the clinical features.Results 19 cases by clinical research results show that the term cesarean delivery are all in line with the diagnostic criteria for acute respiratory distress syndrome,all children with ventilator therapy and anti-infection treatment,respiratory support,and drug treatment,18 cases underwent successful cured,1 cases died.Conclusion The clinical research results show that the term cesarean delivery,a high incidence of acute respiratory distress syndrome,a serious threat to the newborn's life security,clinicians need to strengthen the understanding of acute respiratory distress syndrome and understanding,fully grasp the indications for cesarean section surgery.

  9. Cesarean Births and Attachment Behaviors of Fathers.

    Science.gov (United States)

    1984-01-01

    Apgar scores are 7 or greater at both 1 and 5...status, indications for cesarean delivery, anesthesis, and infant’s gestational age, birth weight, and apgar scores . Prior to meeting the father, the...delivery and attachment score ; highest school grade completed and attachment score ; and age and child care experience of the father and attachment score

  10. Prevalence, Disparities, And Determinants Of Primary Cesarean Births Among First-Time Mothers In Mexico.

    Science.gov (United States)

    Guendelman, Sylvia; Gemmill, Alison; Thornton, Dorothy; Walker, Dilys; Harvey, Michael; Walsh, Julia; Perez-Cuevas, Ricardo

    2017-04-01

    Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.

  11. Comparison of Cord Blood Gas of Newborns between Cesarean Section and Natural Delivery%剖宫产与顺产新生儿脐血血气分析结果的比较

    Institute of Scientific and Technical Information of China (English)

    卢德梅; 尤小燕

    2011-01-01

    目的 探讨两种分娩方式下新生儿脐血血气分析结果的差异.方法 2010年1-10月分娩的252例无妊娠期合并症及并发症新生儿,胎儿超声影像检查正常,根据分娩方式的不同分为剖宫产组和顺产组,对其所测血气分析结果进行比较.结果 剖宫产新生儿脐血的细胞外CO2分压、pH值、细胞外碱剩余、全血碱剩余、HCO3-浓度、H2CO3浓度、CO2总量、氧含量均要高于顺产新生儿,顺产新生儿脐血的血红蛋白浓度、红细胞比容要高于剖宫产新生儿,而在CO2分压、O2分压、血氧饱和度方面的差异无统计学意义.结论 剖宫产和顺产新生儿的脐血血气参数存在差异,有必要分别制定不同分娩方式下血气参数的异常界定值.%Objective To explore the differences of cord blood gas between cesarean section and natural deliveoy. Methods From January to October 2010, 252 newborns with normal fetal ultrasound examination and without complications were divided into cesarean section group and natural delivery group according to their delivery mode. Results p(CO2) in the extracellular, pH value,extracellular bases excess, blood bases excess, HCO3- concentration and the concentration of H2CO3, total CO2 and oxygen content in the cesarean group were higher than those in the natural delivery group, while the concentration of hemoglobin and HCT were lower.However, the indexes ofp(CO2), p(CO2), and SO2 did not show statistical significance. Conclusion There are differences between of fetal cord blood gas between cesarean section and natural delivery, thus it is necessary to develop boundary points separately according to the mode of deliver

  12. Cesarean Section and Chronic Immune Disorders

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Stokholm, Jakob; Bønnelykke, Klaus;

    2015-01-01

    OBJECTIVES: Immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have shown a parallel increase in prevalence during recent decades in westernized countries. The rate of cesarean delivery has also increased in this period and has been associated...... with the development of some of these diseases. METHODS: Mature children born by cesarean delivery were analyzed for risk of hospital contact for chronic immune diseases recorded in the Danish national registries in the 35-year period 1977-2012. Two million term children participated in the primary analysis. We......, or celiac disease. CONCLUSIONS: Cesarean delivery exemplifies a shared environmental risk factor in early life associating with several chronic immune diseases. Understanding commonalities in the underlying mechanisms behind chronic diseases may give novel insight into their origin and allow prevention....

  13. Postmortem Cesarean Section: A Case Report

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    Ülkü Mete Ural

    2013-07-01

    Full Text Available     Postmortem cesarean section is a rare event that usually ends up with the mortality of the fetus. A 32-year-old multigravid woman at 34th week of gestation was transferred to the emergency ward due to cardiopulmonary arrest after a traffic accident. A postmortem cesarean section was performed at the 20th minute of the maternal cardio pulmonary arrest and a live fetus was delivered initially. Because of the potential for the survival of a normal infant, obstetricians must consider a cesarean delivery in any pregnant woman that undergone a cardiopulmonary arrest in the third trimester. In this case report. Indications and prognostic factors for fetal well-being in case of a postmortem cesarean section are discussed.

  14. 选择性剖宫产和阴道分娩对产后盆底功能的影响%Effects of selective cesarean section and vaginal delivery on postpartum pelvic floor function

    Institute of Scientific and Technical Information of China (English)

    张慧敏

    2012-01-01

    目的:探讨不同分娩方式对产后早期盆底功能的影响.方法:随机抽取2011年1~5月在荣成市妇幼保健院分娩的产妇65例,根据不同分娩方式分为选择性剖宫产组(32例)和阴道顺产组(33例).分别于产后6周及12周行POP -Q评分、尿垫试验、超声检测残余尿以及会阴超声检查,比较两组产妇压力性尿失禁(SUI)、盆腔器官脱垂(POP)的发生率及膀胱颈移动度情况.结果:产后6周和产后12周随访时,SUI发生率选择性剖宫产组3.13% (1/32)和0(0/19),顺产组24.24% (8/33)和27.78% (5/18),两组比较差异无统计学意义(P >0.05);POP发生率选择性剖宫产组37.50% (12/32)和36.84% (7/19),顺产组72.73%(24/33)和77.78% (14/18),差异有统计学意义(P<0.05).产后6周和产后12周会阴超声显示选择性剖宫产组与顺产组膀胱颈角度及膀胱颈旋转角度比较差异有统计学意义(P<0.05).结论:选择性剖宫产可降低产后早期POP的发生率,并可减少发生SUI的风险.%Objective: To explore the effects of different delivery modes on early postpartum pelvic floor function. Methods; Sixty -five pregnant women who deliveried in the hospital from January to May in 2011 were selected randomly, then they were divided into selective cesarean section group (32 cases) and vaginal delivery group (33 cases) according to different delivery modes. POP - Q score, pad test, residual urine detection by ultrasonography and perineal ultrasonography were carried out at six and twelve weeks after delivery; the incidences of stress urinary incontinence (SUI) and pelvic organ prolapse ( POP) , and the degree of bladder neck mobility were compared between the two groups. Results: During follow - up at six and twelve weeks after delivery, the incidences of SUI in selective cesarean section group were 3. 13% (1/32) and 0 (0/19), respectively, while the incidences of SUI in vaginal delivery group were 24. 24% (8/33) and 27. 78% (5

  15. Vaginal birth after two or more previous cesarean sections.

    Science.gov (United States)

    Farmakides, G; Duvivier, R; Schulman, H; Schneider, E; Biordi, J

    1987-03-01

    The recommendation from the American College of Obstetricians and Gynecologists is to allow vaginal delivery after one cesarean section. This report is an update of our experience of 57 women with two or more cesarean sections who were allowed to labor.

  16. 循证护理模式对降低剖宫产率的分析%Evidence-based Nursing Mode Analysis on Effect of Reducing the Rate of Cesarean Delivery

    Institute of Scientific and Technical Information of China (English)

    杨学芬

    2013-01-01

    Objective evidence-based nursing mode analysis on ef ect of reducing the rate of cesarean delivery. Methods the data selected from April 2011 to April 2012 in our hospital of obstetrics and gynecology hospital delivery of maternal 420 cases, divided the patients into two groups, 210 cases in each group, the researchers use evidence-based nursing, the control group using ordinary nursing care. Respectively on two groups of cesarean section rate and postpartum hemorrhage were analyzed and the research. Results the group's cesarean delivery rate is 8.57%, the team is 40.95%, significant dif erence, statistical y significant (P<0.05);Team of the postpartum hemorrhage rate was 12.38%, control group is 1.4%, significant dif erence, statistical y significant (P<0.05). Conclusion using evidence-based nursing model to reduce cesarean section rate has a significant ef ect, widely used in clinic.%目的循证护理模式对降低剖宫产率的效果分析。方法资料选自2011年4月~2012年4月在本院妇产科入院待产的孕产妇420例,将患者分为两组,每组各210例,研究者采用循证护理,对照组采用普通护理。分别对两组的剖宫产率及产后出血情况进行分析和研究。结果研究组的剖宫产率是8.57%,研究组是40.95%,差异明显,具有统计学意义(P<0.05);研究组的产后出血率是12.38%,对照组是1.4%,差异明显,具有统计学意义(P<0.05)。结论采用循证护理模式对降低剖宫产率有显著效果,在临床上得到普遍应用。

  17. Current Debate on the Use of Antibiotic Prophylaxis for Cesarean Section

    OpenAIRE

    Lamont, Ronald F.; Sobel, Jack; Kusanovic, Juan Pedro; Vaisbuch, Edi; Mazaki-Tovi, Shali; Kim, Sun Kwon; Uldbjerg, Neils; ROMERO, Roberto

    2011-01-01

    Cesarean delivery is frequently complicated by surgical site infections (SSIs), endometritis and urinary tract infection. Most SSIs occur after discharge from hospital, and are increasingly being used as performance indicators. Worldwide, the rate of cesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics prior to surgical incision. An exception is made for cesarean delivery, where narrow-range antibiotics are administered post umbilical cord...

  18. Impact of a diagnosis-related group payment system on cesarean section in Korea.

    Science.gov (United States)

    Kim, Seung Ju; Han, Kyu-Tae; Kim, Sun Jung; Park, Eun-Cheol; Park, Hye Ki

    2016-06-01

    Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients.

  19. 剖宫产与经阴道分娩对产妇盆底功能的影响%Cesarean Section and Vaginal Delivery Impact on Maternal Pelvic Floor Function

    Institute of Scientific and Technical Information of China (English)

    刘芳华

    2014-01-01

    ObjectiveTo study the effect of cesarean section and vaginal delivery on maternal pelvic floor function.Methods Select 120 cases of lying in women in our hospital received, with different modes of delivery wil be divided into the observation group and the control group, the control group using vaginal delivery, cesarean section was used in the observation group, two groups were compared with POP and pelvic floor muscle condition.Results The patients in the observation group the vaginal and uterine prolapse, pelvic floor muscle tension score were significantly better than the control group (P<0.05).Conclusion Compared with vaginal delivery, cesarean section can effectively reduce the effect of postpartum pelvic floor function on postpartum rehabilitation, but to promote the recovery of pelvic floor function has better effect, so there is no need to be selected as the main part according to mode of delivery.%目的:探讨剖宫产与经阴道分娩对产妇盆底功能的影响。方法选取我院接收的120例产妇,以分娩方式的不同将其分为观察组和对照组,对照组采用经阴道分娩,观察组采用剖宫产,比较两组产妇的POP及盆底肌力情况。结果观察组患者阴道及子宫脱垂情况、产后盆底肌张力评分均明显优于对照组(P<0.05)。结论相较于阴道分娩,剖宫产可有效的减少产后对盆底功能的影响,但产后康复对促进盆底功能恢复有较好的效果,因而无需将其作为选择分娩方式的主要依据。

  20. Clinical analysis of the delivery modes of 341 cases of pregnant women with term pregnancy after cesarean section%341例剖宫产术后妊娠足月的孕妇分娩方式临床分析

    Institute of Scientific and Technical Information of China (English)

    姜金娜

    2015-01-01

    目的:分析剖宫产术后妊娠足月的孕妇的分娩方式.方法:对341例剖宫产术后妊娠足月的孕妇进行回顾性分析,并且对剖宫产术后阴道分娩的孕妇与以瘢痕子宫为手术指征再次剖宫产的孕妇的相关资料进行对比.结果:阴道分娩56例,再次剖宫产手术285例,其中以瘢痕子宫为手术指征193例.剖宫产术后阴道分娩的孕妇的出血量及住院天数明显小于以瘢痕子宫为手术指征再次剖宫产的孕妇(P<0.05).结论:剖宫产手术后再次妊娠的孕妇在产前应该行充分评估及风险告知,产时密切监护,加强产科急救能力,符合试产指征的孕妇行阴道试产是安全的,可降低剖宫产率.%Objective:To analyze the delivery modes of pregnant women with term pregnancy after cesarean section.Methods:341 cases of pregnant women with term pregnancy after cesarean section were given retrospective analysis.The related data of pregnant women with vaginal delivery after cesarean section and pregnant women with scar uterus as a surgical indication of repeat cesarean section were compared.Results:56 cases were given vaginal delivery,285 cases were given repeat cesarean section surgery,193 cases had uterine scar as the surgical indication.The bleeding volume and hospital stay of pregnant women with vaginal delivery after cesarean section were significantly less than those of pregnant women with scar uterus as a surgical indication of repeat cesarean section(P<0.05).Conclusion:The pregnant women with repeat pregnancy after cesarean section should be given adequate assessment and risk informed before prenatal,close monitoring during labor,strengthening the obstetric emergency ability.The pregnant women in accordance with trial-produce indications with vaginal trial production are safe,it tcan reduce the rate of cesarean section.

  1. Effectiveness of Educational Program Based on the Theory of Reasoned Action to Decrease the Rate of Cesarean Delivery Among Pregnant Women in Fasa, Southern Iran

    Directory of Open Access Journals (Sweden)

    Ali Khan-Jeihooni

    2014-06-01

    Full Text Available Introduction: Cesarean section is considered as a major surgery accompanied by several complications. The present study aimed to determine the effect of educational intervention based on the theory of reasoned action to reduce the rate of cesarean section among pregnant women in Fasa, Southern Iran. Materials and Methods: This quasi-experimental study was performed on 100 (50 participants in each of the control and intervention groups primiparous women in the third trimester of pregnancy admitted to health centers of Fasa city, Fars province, Iran. The data-gathering tool was a multipart questionnaire containing demographic variables and the theory of reasoned action structures. After the pretest, the intervention group underwent exclusive training based on the theory of reasoned action. Then, after 3 months, both groups took part in the posttest. Data was analyzed by paired T-test, independent T-test and chi-square using SPSS-18 software. Results: A significant difference was found between the two groups regarding knowledge, evaluations behavioral outcomes, Behavioral beliefs and intention (P<0.001. Chi-square analysis showed a significant difference between the two groups regarding their performance (P<0.001. Conclusion: The present intervention was effective in increasing the pregnant women’s knowledge, evaluation of outcomes, attitude and strengthening their intention as well as performance. Therefore, it is suggested to use this model and other systematic straining for pregnant women to decrease the rate of cesarean section.

  2. 剖宫产后瘢痕子宫再次分娩方式的比较%Compare of the Next Delivery Mode in Scar Uterus after one Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    赖晓岚; 陈茜; 林碧君

    2014-01-01

    Objective To evaluate the safety and complications between two kinds of delivery mode in patients with prior cesarean section. Methods 122 cases of a second time pregnant women with one previous cesarean section ,69 gravidas chose repeat caesarean and 53 gravidas chose vaginal birth after previous caesarean section ,the outcome of two kinds of mode of delivery was compared. Results There is no signiifcant difference with uterine atony, postpartum hemorrhage, neonatal asphyxia, wound infection between vaginal birth and repeat caesarean , but the incidence of anemia with repeat caesarean is higher than that in vaginal birth . Conclusions Woman with one previous cesarean section should be offered a trial of labor with a full assessment.Choosing correct labor techniques,infusing oxytocin carefully, avoiding uterine rupture are very important in delivery course.%目的:比较剖宫产术后再次妊娠不同分娩方式的相关并发症及安全性。方法选取有一次剖宫产史的瘢痕子宫孕妇122例,再次妊娠分娩,其中剖宫产者69例,经阴道顺产者53例,比较两种分娩方式对分娩结局的影响。结果瘢痕子宫经阴道顺产或再次剖宫产的宫缩乏力、产后出血、伤口感染及新生儿窒息发生率无统计学差异,但再次剖宫产组者产后贫血发生率较阴道顺产组升高(P<0.05)。结论一次剖宫产术后,经充分评估后确定符合阴道试产条件者,在严密监护下应予阴道试产,引产时注意引产方式的选择、缩宫素的合理应用及先兆子宫破裂、子宫破裂的密切观察。

  3. Hysteroscopy and suction evacuation of cesarean scar pregnancies: a case report and review.

    Science.gov (United States)

    Fylstra, Donald L

    2014-03-01

    Implantation of a pregnancy into the scar of a prior cesarean is an uncommon type of ectopic pregnancy. The incidence of cesarean scar pregnancy is thought to be one in 1800-2216 pregnancies. The increase in the incidence of cesarean scar pregnancy is thought to be a consequence of the increasing rates of cesarean delivery. The natural history of cesarean scar pregnancy is unknown. However, if such a pregnancy is allowed to continue, uterine scar rupture with hemorrhage and possible hysterectomy seem likely. Two early diagnosed cesarean scar pregnancies were treated with hysteroscopy and suction curettage removal. One required intramuscular methotrexate to resolve a persistent cesarean scar ectopic pregnancy. It would seem reasonable that simple suction evacuation would frequently leave chorionic villi imbedded within the cesarean scar, as the pregnancy is not within the endometrial cavity.

  4. [Changing trends and indications for cesarean section in the last few decades].

    Science.gov (United States)

    Nagy, Sándor

    2014-07-20

    Cesarean section rates are increasing worldwide, which has been paralelled by an increase in primary cesarean delivery and decrease in vaginal birth after cesarean section. Behind the different frequencies there is a number of interrelated factors including advanced maternal age, increasing incidence of obesity, assisted reproductive technologies, and maternal request for non-medical reasons. The sub-optimal management of labor and the concerns about medical liability claims and litigations increase the number of abdominal deliveries. The author reviews the changing indications for cesarean deliveries in the last few decades and summarizes the effects on the obstetrical clinical practice.

  5. Affect of different delivery methods on fetal distress of full-term pregnan-cy in labor%不同分娩方法对足月妊娠临产胎儿窘迫的影响

    Institute of Scientific and Technical Information of China (English)

    田丽; 刘前进

    2015-01-01

    Objective To explore affect of different delivery methods on fetal distress of full-term pregnancy in labor. Methods 120 cases of full term pregnancy women in our hospital from August 2011 to September 2014 were selected and divided into cesarean section group of 40 cases and spontaneous delivery group of 80 cases according to the dif-ferent modes of delivery.The incidence of fetal distress was observed between two groups.While the prognosis of new-born was detected and recorded. Results Cesarean section group had six cases of fetal distress,the incidence rate was 15.0%;natural childbirth group had three cases of fetal distress,the incidence rate was 3.8%,had successfully transferred cesarean section.Incidence rate of fetal distress in natural childbirth group was significantly lower than that in cesarean section group(P<0.05).Newborn’s birth weight in natural childbirth group was significantly heavier than that in cesarean section group (P<0.05).Serum CK and CK-MB level in natural childbirth group was significantly lower than that in ce-sarean section group respectively (P<0.05).The childbirth satisfaction rate in natural childbirth group was 98.8%,the childbirth satisfaction rate in cesarean section group was 80.0%.The childbirth satisfaction rate in natural childbirth group was significantly higher than that in cesarean section group(P<0.05). Conclusion Compared with cesarean,natural childbirth term pregnancy and labor can reduce the incidence rate of fetal distress,improve birth weight,its effect may be related to decreased serum CK and CK-MB level.%目的:探讨不同分娩方法对足月妊娠临产胎儿窘迫的影响。方法选择2011年8月~2014年9月在本院进行分娩的足月妊娠临产产妇120例,根据分娩方式的不同分为剖宫产组40例与自然分娩组80例,观察两组的胎儿窘迫发生情况,同时对新生儿预后情况进行检测与记录。结果剖宫产组发生胎儿窘迫6例,发生率为15.0%;自

  6. Cesarean scar pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Mehmet Sıddık Evsen

    2011-12-01

    Full Text Available Pregnancy implantation to the cesarean scar could be the life threatening, although it is a rare event, its ratio increased along with the increasing rate of cesarean delivery. Early diagnosis and treatment may be lifesaving with preserving fertility in these patients. In transvaginal ultrasonography; presence of an empty uterine and cervical cavity, lack of continuity of myometrial setting at the anterior isthmic region and pregnancy implantation to this region should suggest the diagnosis. In this article, we aimed to present a patient with scar ectopic pregnancy with the review of the literature.

  7. Systematic Evaluation on the Mode of Delivery and Outcome of Repregnancy after Cesarean Section in China%我国剖宫产术后再妊娠分娩方式及结局的系统评价

    Institute of Scientific and Technical Information of China (English)

    徐晨; 刘梅

    2016-01-01

    Objective:To review the present situation and outcomes of pregnant women with different modes of delivery,which was aim to be a reference for clinic.Method:The first author in the domestic and foreign databases for the study of the mode of delivery after cesarean section in our country were retrieved, in accordance with the inclusion and exclusion criteria for the selection and inclusion of the literature.The language was limited to Chinese and English,the basic information and effective data of the literature was extracted and analyzed.All of the above-mentioned works were done by two reviewers independently and the third party made the choice when summary the different views.Evaluation bias toP<0.1 and the outcomes analysis toP<0.05 for the difference was statistically significant.Result:22 chinese studies of recent decades were included,which had 1301 pregnant women in vaginal birth after cesarean delivery(VBAC) group and 3558 caes in repeat cesarean section(RCS) group.From the analysis,the rate of trail of labor(TOL) wasr=0.35, 95%CI(0.28,0.44),P<0.0001;rate of TOL successful wasr=0.76,95%CI(0.71,0.81),P<0.0001.The level of postpartum hemorrhage was SMD=-6.41,95%CI(-6.88,-5.94),P<0.000 01,hemorrhage in labor was SMD=-3.57,95%CI(-4.69,-2.44),P<0.000 01],time of hospitalization was SMD=-6.86,95%CI(-8.12,-5.59),P<0.000 01 and the rate of puerperal infection wasOR=0.37,95%CI(0.21,0.67),P=0.0009.There was no significant difference of two groups in the incidence of uterine severe complicationOR=0.38,95%CI (0.10,1.50),P=0.17.Conclusion:The rate of trail of labor is low but the rate of successful VBAC from TOL is positive.Pregnant women who choose VBAC may have better outcomes for themselves,but the evidence of getting down the rate of uterus of complications is not powerful enough to show statistically significant difference.Some of the inclusive studies do not have enough high quality as well as the others,which may affect the power of the evaluation results,so more

  8. DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

    Institute of Scientific and Technical Information of China (English)

    Lan-zhou Jiao; Jun Zhao; Xi-run Wan; Xin-yan Liu; Feng-zhi Feng; Tong Ren; Yang Xiang

    2008-01-01

    Objective To investigate the early diagnosis and treatment of cesarean sear pregnancy (CSP).Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the le-sion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed.Results CSP constituted 1.05% of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1:1 221. Themean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 weremisdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment. The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging (MRI). The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hyster-ectomy. The conservative treatment was successful in 24 eases. All of the 28 women were cured through individual ther-apies.Conclusions CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP,and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.

  9. Elective cesarean delivery affects gut maturation and delays microbial colonization but does not increase necrotizing enterocolitis in preterm pigs

    DEFF Research Database (Denmark)

    Siggers, R. H.; Thymann, Thomas; Jensen, Bent B.

    2008-01-01

    , and increased brush-border enzyme activities (lactase, aminopeptidases) compared with VD pigs. In particular, VD-FORM pigs showed reduced mucosal proportions, reduced lactase and aminopeptidases, and increased proinflammatory cytokine IL-6 compared with CS-FORM (P 0.06). Despite the initial improvement...

  10. Re-evaluation of cord blood arterial and venous reference ranges for pH, pO(2), pCO(2), according to spontaneous or cesarean delivery.

    Science.gov (United States)

    Kotaska, K; Urinovska, R; Klapkova, E; Prusa, R; Rob, L; Binder, T

    2010-01-01

    Umbilical cord blood gas analysis (pO(2) and pCO(2)) is now recommended in all high-risk baby deliveries and in some centers it is performed routinely following all deliveries. The aim of this study was to re-evaluate cord blood arterial and venous reference ranges for pH, pO(2), pCO(2) in newborns, delivered by spontaneous vaginal delivery (SVD) and by cesarean section (CS) performed in Faculty Hospital Motol. Two groups of subjects were selected for the study. Group I consisted of 303 newborns with SVD. Group II consisted of 189 newborns delivered by cesarean section. Cord blood samples were analyzed for standard blood gas and pH, using the analytical device Rapid Lab 845 and Rapid Lab 865. We obtained reference values expressed as range (lower and upper reference value expressed as 2.5 and 97.5 percentiles) for cord blood in newborns with SVD: arterial cord blood: pH=7.01-7.39; pCO(2)=4.12-11.45 kPa; pO(2)=1.49-5.06 kPa; venous cord blood: pH=7.06-7.44; pCO(2)=3.33-9.85 kPa; pO(2)=1.80-6.29 kPa. We also obtained reference values for cord blood in newborns delivered by CS: arterial cord blood: pH=7.05-7.39; pCO(2)=5.01-10.60 kPa; pO(2)=1.17-5.94 kPa; venous cord blood: pH=7.10-7.42; pCO(2)=3.88-9.36 kPa; pO(2)=1.98-7.23 kPa. Re-evaluated reference ranges play essential role in monitoring conditions of newborns with spontaneous and caesarean delivery.

  11. How membrane permeation is affected by donor delivery solvent.

    Science.gov (United States)

    Binks, Bernard P; Fletcher, Paul D I; Johnson, Andrew J; Elliott, Russell P

    2012-11-28

    We investigate theoretically and experimentally how the rate and extent of membrane permeation is affected by switching the donor delivery solvent from water to squalane for different permeants and membranes. In a model based on rate-limiting membrane diffusion, we derive explicit equations showing how the permeation extent and rate depend mainly on the membrane-donor and membrane-receiver partition coefficients of the permeant. Permeation results for systems containing all combinations of hydrophilic or hydrophobic donor solvents (aqueous solution or squalane), permeants (caffeine or testosterone) and polymer membranes (cellulose or polydimethylsiloxane) have been measured using a cell with stirred donor and re-circulating receiver compartments and continuous monitoring of the permeant concentration in the receiver phase. Relevant partition coefficients are also determined. Quantitative comparison of model and experimental results for the widely-differing permeation systems successfully enables the systematic elucidation of all possible donor solvent effects in membrane permeation. For the experimental conditions used here, most of the permeation systems are in agreement with the model, demonstrating that the model assumptions are valid. In these cases, the dominant donor solvent effects arise from changes in the relative affinities of the permeant for the donor and receiver solvents and the membrane and are quantitatively predicted using the separately measured partition coefficients. We also show how additional donor solvent effects can arise when switching the donor solvent causes one or more of the model assumptions to be invalid. These effects include a change in rate-limiting step, permeant solution non-ideality and others.

  12. COMPARATIVE STUDY OF 6% HYDROXYETHYL STARCH (450/0 . 7 AND RINGER’S LACTATE AS PRELOADING FLUID FOR PREVENTION OF HYPOTENSION DURING SPINAL ANESTHESIA IN ELECTIVE CESAREAN DELIVERY

    Directory of Open Access Journals (Sweden)

    Javid

    2015-09-01

    Full Text Available We compared the efficacy of volume preloading with Ringer’s Lactate and Hydroxyethyl starch (HEAS 6% 450/0 . 7 on the onset and incidence of spinal - induced hypotension in elective cesarean delivery . 60 healthy parturients scheduled for elective cesarean se ction under spinal anesthesia were selected for the study . Group A was preloaded with 1000ml of RL while as group B preloaded with 500ml of 6% HEAS (450/0 . 7 over a period of 10 minutes just prior to the administration of spinal anaesthesia . Immediately af ter the preloading period, subarachnoid block was instituted with 2 . 5ml of Bupivacaine 0 . 5% (heavy at L3 - L4 or L4 - L5 interspace using 26 Gauge Quinke’s spinal needle in sitting position . The patient were then positioned supine with left lateral tilt . Ade quate block was obtained and height of block was tested by pinprick method using blunt needle . Hypotension following spinal anaesthesia was treated with 6 mg bolus doses of Ephedrine and additional rapid infusion of Ringer’s lactate solution . All were admi nistered supplemental oxygen 5L/min by venturi mask throughout the period of surgery . Intraoperatively, heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were monitored every 2 minutes for the first 20 minutes and eve ry 5 minutes thereafter till the end of surgery . Spo2 and ECG were monitored continuously throughout the period of surgery . In addition, height of the block, amount of blood loss, amount of vasopressor required, and amount of i . v fluids used intraoperative ly and any allergic reactions to i . v fluids were noted . All parturients received 10 IU of oxytocin i . v infusion after delivery of baby . These observations were analyzed to get information on the onset and incidence of hypotension, intraoperative requiremen ts of Ephedrine, and i . v fluids, and incidence of adverse effects like nausea and / or vomiting . The incidence of hypotension in group A was 60

  13. Clinical outcome and safety analysis of vaginal delivery after cesarean section%剖宫产术后阴道分娩的临床结局及安全性分析

    Institute of Scientific and Technical Information of China (English)

    李云秀; 纪艳洁; 陈敏红; 祝丽琼

    2015-01-01

    Objective To explore the clinical outcome and safety of vaginal delivery after cesarean section. Methods 512 cases of scarred uterus who delivered in Tangxia Hospital of Dongguan and Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January to December 2014 and had a second pregnancy were retrospectively analyzed. Results Among 512 cases of scarred uterus,163 cases were vaginal trial labour (VBAC group),accounting for 31.84% of scarred uterus delivery.Among them,vaginal trial labourwas carried out successfully in 126 cases,with the successful rate of vaginal trial labour of 77.3%.Trial labourwas failed in 37 cases and switched to cesarean section,with the failure rate of trial labour of 22.7%;Cesarean section without trial labourwas performed in 349 cases (ERCS group),accounting for 68.16% of the scarred uterus pregnancy;386 out of the 512 cases of scarred uterus were given a second cesarean sec-tion(including 37 cases of failed vaginal trial labour),accounting for 75.39%of scarred uterus delivery.In the comparison of pregnancy outcome in VBAC group and ERCS group,VBAC group was higher than ERCS group in the volume and rate of postpartum bleeding,but VBAC group was shorter than ERCS group in the length of stay and lower than ERCS group in the medical expenses,which were statistically different(P0.05). Conclusion As for the pregnant women with a second pregnancy after cesarean section,if the indication of trial labour is properly understood,severe monitoring is performed during the labour,and vaginal trial labour is safe and feasible with a high successful rate,then the rate of cesarean sec-tion can be reduced to a certain extent.%目的:探讨剖宫产术后阴道分娩的临床结局及安全性。方法对东莞市塘厦医院及中山大学孙≥仙纪念医院于2014年1~12月分娩的512例瘢痕子宫再次妊娠者进行回顾性分析。结果512例瘢痕子宫中,阴道试产163例(VBAC组),占瘢痕子宫分娩的31.84%,

  14. Effects of cesarean section on mean platelet volume.

    Science.gov (United States)

    Usluoğullari, Betül; Kaygusuz, Ikbal; Simavli, Serap; Eser, Ayla; Inegol Gumus, İknur

    2015-01-01

    Mean platelet volume (MPV) is a risk factor for cardiovascular complications, cerebrovascular disorders, and low-grade inflammatory conditions prone to arterial and venous thromboses. Cesarean delivery is the most important risk factor for pulmonary embolism, stroke, and intracranial venous thrombosis. The hypothesis is that increase in the prevalence of cesarean section and high MPV may be associated with cardiovascular complications such as stroke along with intracranial complications in addition to known systemic and surgical complications. In this study, platelet counts and MPV for postpartum women who delivered by cesarean section and normal vaginal parturition are compared. The subjects were divided in two groups, one was study group consisting of 118 patients giving birth by cesarean section and the other was the control group consisting 94 patients giving birth by normal vaginal parturition. Peripheral venous blood samples in EDTA tubes were collected from all the subjects 1 week before and after the delivery for their prenatal and postpartum periods, respectively. The values were compared between the groups and also before and after the delivery. In the cesarean group, while the MPV level was 8.60 (1.64) fl in the prenatal period, it increased to 9.10 (2.00) fl in the postnatal period (p cesarean section.

  15. Simplified cesarean section: a strategic surgical approach to minimize postoperative infectious morbidity.

    Science.gov (United States)

    Pelosi

    1998-07-01

    Objective: A simplified method of cesarean delivery aimed at minimizing postoperative morbidity is illustrated.Methods: Two hundred consecutive cesarean deliveries were performed by the authors' simplified cesarean technique. Mean patient age was 27 years (range 17-46), and mean weight was 169 pounds (range 112-414). Indications for cesarean delivery included dystocia or failure to progress in labor (38%), repeat cesarean (32%), malpresentation (11.5%), fetal distress (9.5%), and other (9%).Results: Simplified cesarean delivery was successfully completed in all cases. Mean operating time was 16 minutes (range 9-33), mean blood loss was 460 mL (range 100-1150), and mean postsurgical hospitalization time was 72 hours (range 36-120). No bowel, bladder, or vascular injuries occurred. Postoperative febrile morbidity occurred in one patient (0.5%), ileus occurred in one patient (0.5%), and blood transfusion was administered to one patient (0.5%). No cases of wound infection, wound dehiscence, hematoma, or incisional hernia occurred. All patients were ambulatory on the first postoperative day. All but one patient (99.5%) tolerated a regular diet on the first postoperative day.Conclusions: The authors' technique of cesarean section appears to be a safe and efficient method for cesarean delivery associated with minimal postoperative infectious morbidity and rapid resumption of bowel and ambulatory function.

  16. Applied research of cesarean section and vaginal delivery technique in full - term pregnancy fetal distress in labor%剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

    Institute of Scientific and Technical Information of China (English)

    黄美英

    2012-01-01

    目的:探讨剖宫产与阴道助产术在足月妊娠临产胎儿窘迫中的应用效果.方法:对浙江省安吉县第三人民医院2006年2月~2010年12月120例足月妊娠临产时出现胎儿窘迫的病例按照随机原则,分别采用剖宫产及阴道助产术产钳法进行分娩,比较两种处理方式的母婴结局.结果:剖宫产组与阴道产钳组影响胎儿窘迫的脐带因素、胎盘因素、母体因素、胎儿因素发生率分别为46.03% (29/63)、35.09% (20/57),11.11% (7/63)、15.78% (9/57),9.52% (6/63)、8.77% (5/57),4.76% (3/63)、5.26% (3/57),两组脐带因素、胎盘因素比较差异有统计学意义(P<0.05);胎心监护NST两种方式下的新生儿、胎儿窘迫症状术后改善率分别为80.95% (51/63)、87.72% (50/57),两组比较均具有统计学差异(P<0.05).结论:胎儿窘迫主要发生于临产过程中,应根据孕妇产程进展采取适当的方式,及时抢救新生儿,降低新生儿窒息,在严密监护条件下,阴道助产术可以减少足月妊娠临产胎儿窘迫的发生率.%Objective: To study the clinical effect of cesarean section and vaginal delivery technique in full - term pregnancy fetal distress in labor. Methods; The 120 patients who were full - term pregnancy and fetal distress in labor cases in our hospital from February 2006 to December 2010 were divided into cesarean section group and vaginal midwifery group by random sampling. Then the maternal and neonatal outcomes were compared between the two groups. Results; In the factors of affecting fetal distress, umbilical cord factor, placental factor, maternal factor and fetal factor was46. 03% (29/63) , 11.11% (7/63) , 9. 52% (6/63) , 4. 76% (3/63) respectively in cesarean section group, and 35.09% (20/57), 15.78% (9/57), 8.77% (5/57), 5.26% (3/57) respectively in vaginal forceps group. Umbilical cord factor and placenta factor were significant differences between the two groups ( P < 0.05). The improving

  17. The Feasibility Analysis of Vaginal Delivery in Repeated Pregnancy After Cesarean Section%剖宫产术后再次妊娠经阴道分娩可行性分析

    Institute of Scientific and Technical Information of China (English)

    陈佩芬; 李林娜

    2014-01-01

    Objective:To investigate the feasibility of vaginal delivery in repeated pregnancy after cesar-ean section .Method:The case history information of 323 pregnant women with previous cesarean section de-livery were collected for retrospective study .The average quantity of postpartum hemorrhage ,the rate of post-partum hemorrhage , neonatal asphyxia and puerperalism ,the average of hospitalization days were compared between the vaginal trial production group ( Group A) with 83 cases and the repeate cesarean section group (Group B) with 240 cases.And 83 cases of vaginal trial productio at the same period in non-uterine scar (Group C) were compared also.Result: Among 323 pregnant women, 83 cases (25 7.0%)of vaginal trial production,73 cases(87.95%,73/83) were successful.Repeate cesarean section was 240 (74.30 %,240/323).Ther were no significant difference ( P>0.05) in the rate of postpartum hemorrhage and the rate of neonatal asphyxia ,There's significant difference ( P <0.01) in the average quantity of postpartum hemorrhage and the average of hospitalization days between Group A and Group B .And there's no significant difference between Group A and Group C .The three groups were not concurrent maternal puerperal disease .Conclu-sion: Vaginal trial production is save and feasible in repeated pregnancy after cesarean section delivery by intensive care and need to strictly control the indications .It also can reduce the hospitalization days .%目的:探讨剖宫产术后再次妊娠经阴道分娩的可行性。方法:回顾性分析本院收治的323例具有剖宫产史再次妊娠产妇的临床资料。将剖宫产术后选择经阴道试产组83例与选择再次剖宫产组240例的产后平均出血量、产后出血、新生儿窒息、产褥病、平均住院天数进行比较,并随机抽取同期非疤痕子宫选择经阴道试产组83例进行对照。结果:323例中83例选择阴道试产,占25.70%(83/323),其中73

  18. Use of Lumbar Hemp Cloth versus Paid United Opioids for Cesarean Delivery%布比卡因联合阿片类药物对剖宫产腰麻的影响

    Institute of Scientific and Technical Information of China (English)

    陈金荣

    2016-01-01

    【目的】探讨布比卡因联合阿片类药物在剖宫产腰麻中的麻醉效果。【方法】以本院150例择期剖宫产产妇为观察对象,术前均选择腰麻处理,按照使用麻醉药物不同分成两组,观察组(90例)使用布比卡因联合芬太尼腰麻,对照组(60例)使用布比卡因腰麻,比较两组的麻醉效果。【结果】观察组感觉阻滞起效时间为(12.6±4.2)min,明显短于对照组(15.8±5.2)min,观察组感觉阻滞持续时间(286.4±20.4)min,明显长于对照组(272.6±12.6)min,且两组相比较差异均有显著性(P 0.05)。观察组术中爆发性疼痛发生率为3.3%,对照组爆发性疼痛发生率为11.7%,两组相比较差异有显著性(P 0.05)。观察组皮肤瘙痒发生率较对照组明显升高(P <0.05)。【结论】剖宫产应用布比卡因联合阿片类药物腰麻提供了满意的麻醉效果,降低了爆发性疼痛的发生率。%Objective]To explore the use of Lumbar Hemp Cloth versus Paid United Opioids for cesarean de-livery.[Methods]Organized 1 50 patients from our hospital undergoing elective cesarean delivery women as the subjects of our study.According to the use of anesthetic,the 1 50 women were divided into two groups:the obser-vation group (90 cases)used cloth than paid lumbar hemp joint fentanyl,and the control group (60 cases)used cloth because waist hemp.Afterwards,the narcotic effect of the two groups were compared.[Results]The obser-vation group's sensory blockade working time was (12.6 + 4.2)min,which was significantly shorter than the con-trol group's sensory blockade working time (1 5.8 ±5.2)min.The observation group's sensory blockade duration was (286.4 + 20.4)min,which was significantly longer than control group's which was (272.6±12.6)min.The motor block effect duration times of the two groups were not significantly different.The probability of operative instances of pain was 3.3% in the observation group and 1 1.7% in the control group-the probability in the

  19. 56 Patients with Placenta Previa Cesarean Delivery Operation%前置胎盘患者56例剖宫产手术观察

    Institute of Scientific and Technical Information of China (English)

    刘帅; 刘颖; 刘莉; 刘明盛; 陈娇

    2015-01-01

    目的:探讨剖宫手术在前置胎盘治疗中的临床价值。方法选择我院2011年1月至2014年1月妇产科收治入院的进行剖宫产术的56例前置胎盘患者的临床资料进行回顾性分析。分别比较前置胎盘患者的产后出血量、胎盘前置的不同类型以及胎盘的粘连植入情况,观察患者的手术治疗效果。结果在56例前置胎盘患者中,中央型前置胎盘32例,占57.14%;边缘型前置胎盘9例,占16.07%;部分型前置胎盘15例,26.79%。胎盘发生粘连和(或)植入的患者有33例,占58.93%;中央型前置胎盘患者产后出血量明显多于边缘型与部分型前置胎盘患者(P<0.05);56例患者均为剖宫产术,患者均止血成功,有3例患者因产后出血按摩子宫,注射宫缩药物、结扎子宫动脉和髂内动脉均无效而切除子宫,且全为中央型前置胎盘患者,有2例合并胎盘粘连或植入,1例产后肠梗阻。新生儿57例全部存活。早产儿17例。足月儿39例。2例低体质量儿(35+4周,37+4周)。结论剖宫产术是治疗前置胎盘,保证母儿安全的重要方法。%Objective To study the caesarean section palace in a clinical value in the treatment of placenta previa. Methods Our hospital between January 2011 and January 2014 maternity admitted during the period of cesarean section of the clinical data of 56 patients with placenta previa were retrospectively analyzed. Postpartum haemorrhage amount of patients with placenta previa were compared, the different types of placenta previa and adhesion of the placenta implantation, observe effect of surgical treatment for patients. Results in the 56 patients with placenta previa, central type of placenta previa 32 cases, accounting for 57.14%;borderline placenta previa, 9 cases (16.07%);some type of placenta previa, 15 cases by 26.79%. Placenta conglutination and (or) of patients implanted with 33 cases, accounted for 58.93%;the central

  20. Cesarean section trends in the Nordic Countries - a comparative analysis with the Robson classification

    DEFF Research Database (Denmark)

    Pyykönen, Aura; Gissler, Mika; Løkkegaard, Ellen

    2017-01-01

    INTRODUCTION: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. MATERIAL AND METHODS: Retrospective population-based registry study including all deliveries...

  1. Cesarean section and offspring's risk of multiple sclerosis

    DEFF Research Database (Denmark)

    Nielsen, Nete M; Bager, Peter; Stenager, Egon;

    2013-01-01

    Apart from a recent study reporting a 2- to 3-fold increased risk of multiple sclerosis (MS) among women and men who were delivered by Cesarean section (C-section), little attention has been given to the possible association between mode of delivery and the risk of MS.......Apart from a recent study reporting a 2- to 3-fold increased risk of multiple sclerosis (MS) among women and men who were delivered by Cesarean section (C-section), little attention has been given to the possible association between mode of delivery and the risk of MS....

  2. Vaginal birth after cesarean section (VBAC versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

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    B. S. Dhillon

    2014-06-01

    Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824 cesarean section and (10.1% (n=15664 were the number of previous cesarean section. In 84% (n=13151 had repeat cesarean delivery and 2513 (16% delivered vaginally. A trial of labor was planned in 4035 (25.8% women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7% delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%, foetal distress (25.8%, severe PIH/eclampsia (5.0%, previous 2 CS (0.7%, APH (1.4% and others (2.7%. In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 592-597

  3. Clinical Observation on the Cesarean Delivery Woman Implemented with Psychological Intervention%剖宫产孕妇术前心理干预的临床观察

    Institute of Scientific and Technical Information of China (English)

    杨依慧; 黄娟

    2014-01-01

    目的:探讨术前心理干预对孕妇的心理疗效。方法:随机将36例剖宫产孕妇分为心理干预组和对照组。对照组给予常规护理及术前指导;心理干预组在常规护理和术前指导的基础上接受心理干预,干预措施包括健康宣教、心理、家庭及社会支持,以缓解心理反应,帮助建立良好的社会支持系统。同时采用Zung’s焦虑自评量表(SAS)对孕妇进行评定。结果:心理干预组产妇抑郁情绪发生率明显低于对照组,差异有统计学意义(P<0.01)。结论:剖宫产术前心理干预可明显改善产妇不良心理和降低产妇焦虑情绪的发生率。%Objective:To study the efficacy of preoperative psychological intervention in pregnant women.Method:36 cases of cesarean section were divided into intervention group and controlgroup.The control group was given routine nursing and preoperative instruction;Intervention group accepted the psychological intervention on the basis of care and preoperative instruction.Interventions including health education,psychology,family and social support, helping to ease the psychological response and establish a good social support system.At the same time we adopted Zung’s Self-rating Anxiety Scale(SAS)to assess pregnant women.Result:The depression and anxiety rates of the psychological intervention group were lower than that of the control group obviously.Thus,the difference had statistics significance(P<0.01).Conclusion:The psychological intervention on the puerperal period may obviously improve the pregnant women’s bad psychology and reduce their depression rate.

  4. Preoperative nursing intervention in patients with senile diabetes cesarean delivery%高龄糖尿病剖宫产患者术前护理干预

    Institute of Scientific and Technical Information of China (English)

    李静瑷

    2014-01-01

    Objective to analyze and explore the preoperative nursing intervention in patients with senile diabetes associated clinical effect.Method randomly selected from March 2010 to April 2014 in our hospital during cesarean section 48 cases of senile diabetes patients as the research object, and all the 24 patients were randomly divided into observation group and the control group, the basis of the control group using conventional care, observation group based on regular basis nursing nursing intervention.Results observation group of preoperative fear and postoperative headache patients vomiting is less than that of control group, patients in observation group blood sugar steady significantly more than the control group, the difference was statistically significant (P < 0.05).Conclusion preoperative nursing intervention in patients with senile diabetes associated with good clinical effect, is suitable for popularization and application.%目的:分析并探讨对高龄糖尿病剖宫产患者进行术前护理干预的临床效果。方法:随机选取2010年3月~2014年4月期间在本院进行剖宫产的高龄糖尿病患者48例作为本次研究的对象,并随机分为观察组和对照组各24例,对照组采用常规的基础护理,观察组在常规基础护理基础上给予护理干预。结果:观察组出现术前恐惧的情况和术后头痛呕吐现象的患者明显少于对照组,而术后观察组血糖平稳的患者明显多于对照组,差异有统计学意义(P<0.05)。结论:对高龄糖尿病剖宫产患者进行术前护理干预具有良好的临床效果,适合推广应用。

  5. 全麻对剖宫产胎儿影响的临床研究%Clinical study of the influence of general anesthesia on cesarean delivery fetus

    Institute of Scientific and Technical Information of China (English)

    李莉; 苏利

    2014-01-01

    Objective To compare the influence of general anesthesia and combined spinal-epidural anesthesia on neonatal Apgar score. Methods A total of 65 cases of single pregnancy to full term undergone cesarean section were taken as study subjects. There were 32 cases in the general anesthesia group received general anesthesia due to intraspinal anesthesia taboo, and the other 33 cases in the combined spinal-epidural anesthesia group received combined spinal-epidural anesthesia. The fetal childbirth time, birth weight, and apgar score at 1 min and 5 min were recorded. Results Apgar score at 1 min of general anesthesia group and combined spinal-epidural anesthesia group were (9.5±0.8) points and (9.8±0.6) points respectively, and there was no significant difference between the two groups (P>0.05). Apgar scores at 5 min were all 10 points in the two groups. Conclusion General anesthesia and combined spinal-epidural anesthesia have no obviously variant influences on fetus.%目的:比较剖宫产施行全身麻醉(全麻)和腰硬联合麻醉对新生儿Apgar评分的影响。方法选择足月单胎妊娠行择期剖宫产的产妇65例,椎管内麻醉禁忌而需使用全麻的剖宫产为全麻组32例,其余33例行腰硬联合麻醉作为腰硬联合麻醉组。记录胎儿娩出时间,新生儿体重和1、5 min的Apgar评分。结果全麻组和腰硬联合麻醉组新生儿1 min的Apgar评分分别为(9.5±0.8)分、(9.8±0.6)分,两组差异无统计学意义(P>0.05)。5 min Apgar评分均为10分。结论全麻和硬联合麻醉对胎儿的影响没有明显差异。

  6. Effects of PDCA cycle path on puerperium rehabilitation for cesarean delivery women%PDCA循环路径对剖宫产产妇产褥期康复效果的影响

    Institute of Scientific and Technical Information of China (English)

    章苗芽

    2016-01-01

    目的 探讨PDCA循环路径对出院剖宫产产妇产褥期康复效果的影响.方法 选择2014年1—6月收治的68名产妇为对照组,2014年7—12月收治的72名产妇作为观察组,对照组给予常规的门诊护理,观察组则在常规护理的基础上采用PDCA循环路径进行为期42 d的跟踪护理.比较两组产妇的精神状况、泌乳量、焦虑、抑郁和并发症发生情况.结果 观察组产妇生理机能、社会功能、精神健康、生理职能、情感职能、躯体疼痛、精力、一般健康状况、健康变化方面的得分均高于对照组,差异有统计学意义(P<0.05).观察组产妇产后42 d的泌乳量明显多于对照组,差异有统计学意义(P<0.05).结论 PDCA循环路径可以促进剖宫产产妇产褥期的康复.%Objective To explore the effects of PDCA cycle path on puerperium rehabilitation for discharged cesarean women. Methods A total of 140 cases of cesarean delivery mothers discharged from our hospital between January, 2014 and December, 2014 were selected. A total of 68 cases of maternal who were admitted from January 2014 to June 2014 were treated as control group, whereas another 72 cases who were admitted between July 2014 to December 2014 were selected as observation group. After discharged, puerpera in control group were given conventional outpatient care, in contrast, puerpera in observation group received PDCA cycle path tracking care for 42 days on the basis of conventional nursing. Puerpera′s mental health, lactation, anxiety, depression and complications of two groups were compared. Results In observation group, scores of puerpera′s physiological function, social function, mental health, physical function, emotional function, the body pain, general health status, health change were higher than those in control group (P<0. 05). Puerpera at postpartum 42 days in observation group had an obvious larger lactation volume than that of control group (P<0. 05). Conclusions PDCA

  7. Cesarean section in morbidly obese parturients: Practical implications and complications

    Directory of Open Access Journals (Sweden)

    Lovina SM Machado

    2012-01-01

    Full Text Available The prevalence of obesity has reached pandemic proportions across nations. Morbid obesity has a dramatic impact on pregnancy outcome. Cesarean section in these women poses many surgical, anesthetic, and logistical challenges. In view of the increased risk of cesarean delivery in morbidly obese women, the practical implications and complications are reviewed in this article. A Medline search was conducted to review the recent relevant articles in english literature on cesarean section in morbidly obese women. The types of incisions and techniques used during cesarean delivery, intra-operative and postpartum complications, anesthetic and logistical issues, maternal morbidity and mortality were reviewed. Morbidly obese women with a body mass index (BMI >40 kg/m 2 are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery. Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial. Thromboprophylaxis adjusted to body weight and prophylactic antibiotics help in reducing postpartum morbidity. Morbidly obese women are at increased risk of postpartum infectious morbidity. Weight reduction in the postpartum period and thereafter must be strongly encouraged for optimal future pregnancy outcomes and well-being.

  8. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia.

    Science.gov (United States)

    Senturk, Mehmet Baki; Cakmak, Yusuf; Atac, Halit; Budak, Mehmet Sukru

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients' requests influenced outcome. Trial of labor should take into consideration the patient's preference, together with the proper setting.

  9. Cesarean section in sub-Saharan Africa.

    Science.gov (United States)

    Harrison, Margo S; Goldenberg, Robert L

    2016-01-01

    Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa.

  10. Feasibility of abdominoplasty with Cesarean section [Retraction

    Directory of Open Access Journals (Sweden)

    Thabet WN

    2013-01-01

    Full Text Available The Editor-in-Chief and Publisher of the International Journal of Women’s Health have been alerted by Dr Nadine Sherif, the corresponding author, to unacceptable levels of duplication with a previously published paper: Ali A, Essam A. Abdominoplasty Combined with Cesarean Delivery: Evaluation of the Practice. Aesthetic Plastic Surgery. 2011;35(1:80–86.It is worth noting that this paper was peer-reviewed by two peer-reviewers and the Editor-in-Chief of the International Journal of Women’s Health before publication. The paper concerned is: Thabet WN, Hossny AS, Sherif NA. Feasibility of abdominoplasty with Cesarean section. International Journal of Women’s Health. 2012;4:115–121.

  11. 剖宫产术中缩宫素的应用时机及途径分析%THE PROPER TIME AND WAY OF APPLYING OXYTOCIN IN CESAREAN DELIVERY

    Institute of Scientific and Technical Information of China (English)

    赵立臻; 朱占娜

    2016-01-01

    Objective To explore the effect of applying oxytocin in cesarean delivery on uterine contrac‐tion ,the amount of bleeding and heart rate .Methods 540 cases receiving cesarean section from March , 2015 to September ,2015 were randomly divided into the control group and the observation group ,with 270 cases in each group .In the control group ,intravenous injection of 20μof oxytocin was given after fetal head was delivered ,and then preventive antibiotics was given .In the observation group ,10μ of oxytocin was given after the delivery of baby ,and another 10μof oxytocin was given along with the intravenous drip of 500ml of compound sodium chloride solution ,and then antibiotics was given when good uterine contrac‐tion was got or oxytocin was first used when good uterine contraction was not got .The clinical effect of oxytocin on intraoperative bleeding and the proper time for its application in both groups were compared , and the adverse reactions were also observed .Results The amount of intraoperative bleeding was about (180 ± 80)ml ,and good uterine contraction was got without complaint of discomfort in the observation group .In the contrast group ,the amount of intraoperative bleeding was about (220 ± 100)ml ,and the pa‐tients’ heart rates increased with flushing of face .There existed significant difference between the two groups( P < 0 .05) . Conclusion Intravenous drip of oxytocin can produce good clinical effect after the delivery of baby .%目的:探讨剖宫产术中缩宫素的应用时机及途径对子宫收缩、出血量和患者心率的影响。方法选取2015年3月至2015年9月在沂水中心医院施行剖宫产的患者540例,随机分为对照组和观察组,每组各270例。对照组常规于胎头娩出后静脉推注缩宫素20μ,而后应用预防性抗生素;观察组于胎儿娩出后宫体注射缩宫素10μ,另外10μ加入500 m l复方氯化钠液体中静滴,宫缩好时先滴抗生素,否则先滴缩

  12. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

    Directory of Open Access Journals (Sweden)

    Wei Xiao

    2015-01-01

    Full Text Available Background: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT with LiDCO rapid system can improve well-being of both HDP parturient and their babies. Methods: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer′s solution (LR, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results: The severity of HDP was similar between two groups. The total LR infusion (P < 0.01 and urine output (P < 0.05 were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05 than in the GDFT group. Conclusions: Dynamic responsiveness guided fluid therapy with the LiDCO rapid system

  13. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

    Institute of Scientific and Technical Information of China (English)

    Wei Xiao; Qing-Fang Duan; Wen-Ya Fu; Xin-Zuo Chi; Feng-Ying Wang; Da-Qing Ma; Tian-Long Wang

    2015-01-01

    Background:Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress.The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies.Methods:Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited.After loading with 10 ml/kg lactated Ringer's solution (LR),parturient were randomized to the GDFT and control group.In the GDFT group,individualized fluid therapy was guided by increase in stroke volume (ASV) provided via LiDCOrapid system.The control group received the routine fluid therapy.The primary endpoints included maternal hypotension and the doses ofvasopressors administered prior to fetal delivery.The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events.Results:The severity of HDP was similar between two groups.The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group.Following twice fluid challenge tests,the systolic blood pressure,mean blood pressure,cardiac output and SV in the GDFT group were significantly higher,and the heart rate was lower than in the control group.The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01).There were no differences in the Apgar scores between two groups.In the control group,the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05),and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group.Conclusions:Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to

  14. Cervical dilation at the time of cesarean section for dystocia - effect on subsequent trial of labor

    DEFF Research Database (Denmark)

    Abildgaard, Helle; Diness, Marie; Nickelsen, Carsten

    2012-01-01

    Objective. To investigate the effect of cervical dilation at the time of cesarean section due to dystocia and success in a subsequent pregnancy of attempted vaginal delivery. Design. Retrospective study. Setting. University hospital in Copenhagen capital area. Population. All women with a prior...... cesarean section due to dystocia who had undergone a subsequent pregnancy with a singleton delivery during 2006-2010. Methods. Medical records were reviewed for prior vaginal birth, cervical dilation reached before cesarean section and induction of labor, gestational age, use of oxytocin, epidural...... anesthesia and mode of birth was collected. Results. A total of 889 women were included; 373 had had a trial of labor. The success rate for vaginal birth among women with prior cesarean section for dystocia at 4-8 cm dilation was 39%, but 59% for women in whom prior cesarean section had been done at a fully...

  15. Vaginal birth after cesarean section

    Directory of Open Access Journals (Sweden)

    Vidyadhar B Bangal

    2013-01-01

    Full Text Available Background: The rate of primary cesarean section (CS is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. Aims: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC in selected cases of one previous lower segment CS (LSCS. Materials and Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. Conclusion: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

  16. FETOMATERNAL OUTCOME OF PREGNANCY WITH PREVIOUS CESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Nigamananda

    2014-09-01

    Full Text Available OBJECTIVE: The aim of the study was to see the fetomaternal outcome of pregnancy with previous cesarean section. METHODS: This study was conducted in the department of OBGYN, BARC Hospital, Mumbai from October 2011 to September 2012, a period of one year. All the pregnant women with previous one cesarean section attending ANC clinic for confinement were included in the study group after giving consent. RESULTS: Out of total75 cases, a total of 23 patients (30.67% were given trial of labor. Out of 23 patients given trial of labor, 12 patients (52.17% had successful VBAC. Commonest indication for unsuccessful trial of labor undergoing repeat cesarean section was non-progress of labor (54.55% and failed IOL (36.67%. Out of 12 patients who had successful VBAC, 3 patients (25% had complication like episiotomy hematoma, perineal tear and cervical tear. No patients had major complications. In present study no baby had apgar score <7 at 1min and 5 min in VBAC group and elective LSCS group. CONCLUSION: The current study concludes that women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counseling for trial of labor and proper antepartum and intrapartum monitoring of patients, are key to reducing the cesarean section rates. The antepartum, intrapartum and postpartum complications are more in repeat cesarean section cases. There is no doubt that a trial of labor is a relatively safe procedure, but it is not risk free. Therefore, patient evaluation prior to TOLAC, careful observation throughout labor in a well-equipped unit with around the clock services for emergency surgery and availability of expertise is the backbone for successful VBAC.

  17. Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

    DEFF Research Database (Denmark)

    1994-01-01

    Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... FHM had a 15% higher cesarean section rate (not planned) than units not using FHM (p ... a technology index was calculated for eight regions in Denmark, weighting the index of each unit in a region according to its number of deliveries. There was no association between the technology index in these eight regions in Denmark and their cesarean section rates. Use of FHM, technology index...

  18. Cesarean section and disease associated with immune function

    DEFF Research Database (Denmark)

    Kristensen, Kim; Stokholm, Lonny Merete

    2016-01-01

    BACKGROUND: Earlier studies have shown that delivery by cesarean section (CS) is associated with an increased risk of disease associated with immune function in the offspring, but these studies have generally not discriminated between the effect of acute and elective CS. OBJECTIVE: We sought to f...

  19. The Cause of the Second Labor Cesarean Delivery and Its Influence on Mater and Infant%第二产程剖宫产的原因以及对母婴的影响研究

    Institute of Scientific and Technical Information of China (English)

    沈霞

    2014-01-01

    Objective:To investigate the causes of the second labor cesarean section and its impact on mater and infant,reduce the rate of complications on mater and infant.Method:Two hundred and four cases of parturients give parallel cesarean delivery operation in our hospital from August 2011 to November 2013 were selected as research objects. They were divided into the the first stage and the second stage of labor group. Puerpera clinical data were retrospectively analyzed,surgical indications,complications rate,mater and child condition were compared between the two groups.Result:19 cases of macrosomias and 28 cases of amniotic fluid polluters were seen in the first stage of labor group,while in the second stage of labor group were 31 cases and 44 cases separately.The differences between the two group were significant(P<0.05).The incidence of malpositions in the first stage of labor group was significantly lower than the second stage of labor group(P<0.05).The incidences of complications during(1.8%) and after(1.8%) the operation were also significantly lower than that of the second stage of labor group 19.6%,10.9%for during and after the operation separately(P<0.05).Conclusion:The second line labor cesarean section can damage the mater and newborn in some degree. The incidence of postoperative complications can be increased in this situation. So the parturients should try to avoid the second line labor cesarean section,if not,the experienced doctors are needed for the operation. Avoiding the complications the preoperative sufficient preparation is also needed.%目的:探讨第二产程剖宫产的原因及其对母婴的影响,降低母婴并发症发生率。方法:选取2011年8月-2013年11月于笔者所在医院待产并行剖宫产手术产妇204例为研究对象,将其分为第一产程组与第二产程组两组,对比两组手术指征、并发症发生率、母婴情况等。结果:第一产程组出现巨大儿19例、羊水污染28例,明显

  20. The influence of cesarean section and vaginal delivery on the pelvic floor function and effect of postpartum pelvic floor electromyography stimulation%剖宫产与顺产对盆底功能的影响及产后盆底肌电刺激康复治疗效果对比研究

    Institute of Scientific and Technical Information of China (English)

    袁迎九; 后建丽; 丁文清

    2016-01-01

    目的:观察剖宫产及顺产对产妇盆底功能的影响,分析产后盆底肌电刺激康复治疗对其改善作用。方法300例产妇根据分娩方式分为剖宫产组(n=150)和阴道顺产组(n=150),比较产后两组间盆底功能障碍性疾病(PFD)发生率差异,比较产后6周两组间盆底肌力差异及血清松弛素(RLX)水平及产妇盆底结缔组织中胶原含量差异。选择盆底肌力<3级的产妇进行产后盆底肌电刺激康复治疗,比较治疗前后盆底肌力差异。结果剖宫产盆腔器官脱垂(POP)发生率、盆底肌力受损率及PFD发生率显著低于顺产组;剖宫产组阴道横断面肌力分级显著高于顺产组,神经肌肉刺激治疗仪检测结果显示显示剖宫产组盆底Ⅰ、Ⅱ类肌纤维的肌电压高于顺产组,疲劳度则低于剖宫产组;剖宫产组血清RLX水平显著低于顺产组,产妇盆底结缔组织中胶原含量则显著高于顺产组,组间差异有统计学意义(P<0.05)。接受盆底肌电刺激康复治疗后,剖宫产组和顺产组手测阴道横断面肌力、盆底Ⅰ类肌纤维肌电压、盆底Ⅱ类肌纤维肌电压显著提升,血清RLX水平显著下降,治疗前后差异均有统计学意义(P<0.05)。结论相比于顺产,剖宫产对盆底功能造成的损伤较小,盆底肌电刺激康复治疗能有效改善PFD患者的盆底功能。%Objective To study the influence of cesarean section and vaginal delivery on the pelvic floor function,and to analyze the improvement effect of postpartum pelvic floor electromyography stimulation. Methods 300 women were divided into cesarean section group (n=150) and vaginal delivery group (n=150) according to the mode of delivery,then the difference of incidence of pelvic floor dysfunction disease (PFD) among the two groups were compared,and the differences of the pelvic floor muscle strength and serum levels of RLX,collagen content in the pelvic

  1. Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2007-01-01

    Full Text Available Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections and 91 postpartum hysterectomies (70 or 76.92% after cesarean section in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections and 64 hysterectomies (39 or 60.94 % after cesarean section. The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .

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

    Directory of Open Access Journals (Sweden)

    Gordon C S Smith

    2005-09-01

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

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

    Directory of Open Access Journals (Sweden)

    2005-09-01

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

  4. 介入技术在完全性前置胎盘和胎盘植入中的临床应用价值%Clinical Value of Interventional Radiologic Technique Combined with Cesarean Delivery in Placenta Previa and Placenta Accrete Patients

    Institute of Scientific and Technical Information of China (English)

    谢娅; 张颖; 彭铮

    2014-01-01

    Objective:To investigate the clinical value of interventional radiologic technique combined with cesarean delivery. Method:40 consecutive patients in our hospital with complete placenta previa or suspected placenta accrete were prospectively assessed from June 2011 to December 2013. 20 cases were treated by traditional cesarean delivery methods, termination of pregnancy as the control group. 20 patients were treated by obstetric joint intervention carried out new DSA in the operating room for abdominal aortic balloon placed+cesarean delivery+the iliac artery and uterine artery embolization, as the DSA group,the different outcomes of the two groups were compared. Result:There were no statistical significance in the neonatal Apgar scores of the two groups(P>0.05);intraoperative and postpartum blood loss,blood transfusion amount in the DSA group were significantly lower than the control group,the differences had statistical significance(P0.05);DSA组术中及产后失血量、输血量均明显低于对照组,差异均有统计学意义(P<0.05);DSA组子宫切除率显著低于对照组,母乳喂养率显著高于对照组,差异均有统计学意义(P<0.05)。结论:剖宫产术中腹主动脉放置球囊联合术后髂内动脉子宫动脉栓塞技术能够显著降低产时产后出血量、输血量、子宫切除率,并提高母乳喂养率。

  5. Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury

    DEFF Research Database (Denmark)

    Lund, Ninna Sønderby; Persson, Lisa; Jango, H.

    2016-01-01

    The risk of obstetric anal sphincter injury (OASIS) is increased in vacuum-assisted delivery. However, it remains unclear whether episiotomy may protect against OASIS in this type of delivery. The objective of this study was to assess whether mediolateral or lateral episiotomy affects the risk...... of OASIS in vacuum assisted delivery among primiparous women. Data were found searching The PubMed, Cochrane library and Embase databases electronically. Studies investigating the risk of OASIS in vacuum-assisted delivery with and without the use of mediolateral or lateral episiotomy were considered...... for inclusion. Of the 452 studies found, 15 observational studies were included in this meta-analysis. All authors assessed risk of bias of the included studies using the Scottish Intercollegiate Guideline Network (SIGN) quality score. According to this meta-analysis, mediolateral or lateral episiotomy...

  6. Major risk factors of maternal adverse outcome in women with two or more previous cesarean sections

    Directory of Open Access Journals (Sweden)

    Egić Amira

    2016-01-01

    Full Text Available Background/Aim. Maternal morbidity is defined as any condition that is attributed to or aggravated by pregnancy and childbirth that has a negative impact on the woman's wellbeing. In recent years, a growing trend of cesarean section rates can be seen throughout the world. The aim of this study was to assess factors that might have major impact on maternal adverse outcome in women with two or more previous cesarean sections. Methods. This retrospective study included women with single term pregnancy after two or more cesarean deliveries in a 10-year period (2004−2013 in the University Clinic “Narodni front” in Belgrade, Serbia. Medical records were reviewed for clinical data for maternal intraoperative and early postoperative complications regarding gestational age at delivery, the number of previous cesarean sections and mode of surgery (elective or emergency. Results. A total of 551 patients were included in the study. At 37 completed weeks delivered 14.1%, at 38 delivered 45.2% and at 39 completed weeks 40.7% patients. Women younger than 35 years more often delivered after 39 completed weeks compared with those over 35 years (69.2% vs 30.8%, p < 0.05. The overall rate of maternal complications in the study group was 16.5% with no statistical difference by gestational age at delivery. The overall rate of maternal adverse outcome was significantly less in the patients with three as compared with those with four or more cesareans (10.4% vs 66.7%, p < 0.05. There was a statistically significant difference between these groups of women regarding complications: scar dehiscence, the presence of adhesions, blood transfusion and admission in intensive care unit. Elective cesarean delivery was with less maternal complications compared with emergency cesarean deliveries (12.9% vs 27.3%, p < 0.05. Conclusion. Termination of pregnancy before completed 39 weeks does not decrease maternal morbidity. The major impact on maternal complications has the

  7. Perspectives of cesarean section in buffaloes

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  8. Cimetidine as pre-anesthetic agent for cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K; Holmskov, A

    1985-01-01

    In a prospective randomized study of 39 consecutive cesarean sections, 20 patients received cimetidine 400 mg intramuscularly as a pre-anesthetic, an 19 control patients were given NaCl. No perinatal effects on the infants were observed by cardiotocography before delivery, and K, Na, pH, PCO2, HCO......-3 and glucose values in capillary blood were nearly identical in the two groups 2 hours after birth, the difference being non-significant (p greater than 0.05). No respiratory effects or arrhythmias were observed. In another study comprising 8 elective cesarean sections in patients...

  9. Missile Defense: Ballistic Missile Defense System Testing Delays Affect Delivery of Capabilities

    Science.gov (United States)

    2016-04-28

    Ballistic Missile Defense System Testing Delays Affect Delivery of Capabilities For over half a century , the Department of Defense (DOD) has been...or bi-annually in support of its goals for the defense of regional allies and U.S. forces deployed to Asia -Pacific, the Middle East, and Europe, known

  10. The failure of financial incentive? The seemingly inexorable rise of cesarean section.

    Science.gov (United States)

    Chen, Chin-Shyan; Liu, Tsai-Ching; Chen, Bradley; Lin, Chung-Liang

    2014-01-01

    Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.

  11. 择期再次剖宫产终止妊娠的时机及母儿结局%Timing of elective repeat cesarean delivery and maternal and neonatal outcomes

    Institute of Scientific and Technical Information of China (English)

    刘洪莉; 漆洪波; 罗欣; 于德龙

    2014-01-01

    Objective To explore the optimal timing of termination of pregnancy,we analyzed the different gestational age in repeat cesarean delivery and maternal and neonatal outcomes.Methods This was a retrospective study.The information of cesarean sections was collected from maternal obstetric records in the electronic medical recording system of the First Affiliated Hospital of Chongqing Medical University from June 1,2011 to June 30,2013,and women with intrauterine viable singleton pregnancies delivered after 37 weeks of gestation without prenatal complications were selected.They were divided into five groups with different gestational weeks.Maternal general information,perioperative outcome and rate of neonatal adverse event were analyzed with one way ANOVA analysis and Chi-square test.Results A total of 579 cases of elective repeat cesarean at term were performed.The ratios of cesarean section prior to 39 and 39-39+6 weeks of gestation were 64.6% (374/579) and 29.0% (168/579),respectively.No fetal,neonatal or maternal death occurred.There were no statistically significant differences in the termination of pregnancy at 37-37+6 weeks,38 38+6 weeks,39-39+6 weeks,40 weeks and ≥ 41 weeks between the two time intervals for cesarean section (P>0.05).There were statistically significant differences in the length of hospitalization [(4.9±3.0),(4.3 ± 1.3),(4.3 ± 1.0),(4.5± 1.2) and (4.0±0.7) d,respectively; F=2.849,P<0.05].No significant difference was observed in the maternal BMI,placental membrane residue,maternal perioperative bleeding,premature rupture of membrane (PROM),intensive care unit (ICU) admission and uterine resection (P>0.05).There were statistically significant differences among the five groups in neonatal weight [(3 082.9±479.2),(3 318.1 ±390.8),(3 415.7±431.1),(3 630.5±475.2) and (3 334.0±242.5) g,F=13.798] and length [(48.8± 1.5),(49.3± 1.5),(49.6± 1.5),(50.0± 1.5) and (47.8±3.9) cm,F=7.460; both P<0.05].One min and 5 min Apgar

  12. Challenges in researching violence affecting health service delivery in complex security environments.

    Science.gov (United States)

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  13. Timing cervicovesical fistula repair with repeat cesarean section.

    Science.gov (United States)

    Geoffrion, Roxana; Hyakutake, Momoe T

    2014-08-01

    We present a case in which there was optimal management of recurrent cervicovesical fistula. The patient sustained a fistula shortly after a cesarean for cephalopelvic disproportion in the second stage. She underwent an unsuccessful attempt at vaginal repair 3 months postpartum and continued experiencing intermittent urinary leakage through the vagina. She expressed a wish for further childbearing and was counseled to undergo fistula repair at the time of repeat cesarean section. Twenty-seven months after her first delivery, she had a second healthy pregnancy and the repair of her cervicovesical fistula was performed with collagen graft interposition at the time of her elective cesarean section. This case report highlights the importance of surgical timing and comments on various factors that possibly enhance the success of the fistula repair.

  14. [Non-indicated cesarean section--does the "Golem" counteract?].

    Science.gov (United States)

    Herman, Arie

    2011-11-01

    Cesarean section rate is steadily increasing and in Israel it has risen to 20%. MultipLe and different reasons have led to this phenomenon, among them are non-indicated cesarean sections. Although health care providers disagree whether this development is medically, ethically and publically justified, national associations allow it, while respecting those obstetricians who decline to do so. In Israel there are some hospitals which allow non-indicated cesarean sections, whereas others reject them. When discussing this issue with the patients, documentation is advised concerning the reasons for approval or rejection of the patients' request in order to avoid future complaints in the case of adverse outcome. Low risk vaginal delivery should be regarded as a natural process and not as a medical treatment and keeping balanced and reasonable decisions may help to contain the phenomenon and avoid a situation in which the "Golem" created by the medical system, counteracts.

  15. Cesarean scar pregnancy

    DEFF Research Database (Denmark)

    Petersen, Kathrine Birch; Hoffmann, Elise; Rifbjerg Larsen, Christian

    2016-01-01

    OBJECTIVE: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality. DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): A total of 2,037 women with CSP. INTERVENTION(S): Review of MEDLINE, EMBASE......, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane...... Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments. MAIN OUTCOME MEASURE(S): Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000 m...

  16. Pheochromocytoma after Cesarean Section

    Science.gov (United States)

    Naghshineh, Elham; Shahraki, Azar Danesh; Sheikhalian, Somaye; Hashemi, Leila

    2016-01-01

    Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy. PMID:27076898

  17. Pheochromocytoma after cesarean section

    Directory of Open Access Journals (Sweden)

    Elham Naghshineh

    2016-01-01

    Full Text Available Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy.

  18. The Mount Sinai cesarean section reduction program: an update after 6 years.

    Science.gov (United States)

    Myers, S A; Gleicher, N

    1993-11-01

    A six year follow-up evaluation of our original cesarean section reduction program is presented. While establishing obstetric practice guidelines was accomplished, two prerequisites remain critical: lowering cesarean utilization was to be accomplished without harm to mother or fetus, and a target rate was prospectively determined. The results after 6 years indicate that total cesarean rates of 10-12% can consistently be achieved without adverse outcome. Additionally, operative vaginal procedures were employed less that 3% of cases. Separate analysis of 580 breech deliveries failed to show an effect of route of delivery on mortality. This effort indicates that long-term reductions and cesarean utilization are possible with a comprehensive departmental program designed to accomplish achieving a target rate of 11%.

  19. Safe management of cesarean section in a patient of Eisenmenger syndrome

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    Silvia Minicucci

    2012-01-01

    Full Text Available We report our experience of a 29-year-old female with a complete atrio-ventricular septal defect leading to a single ventricle physiology and Eisenmenger syndrome. The patient successfully underwent spinal anesthesia for cesarean section in the 31 st week of pregnancy. A multidisciplinary approach involving cardiologist, cardiac surgeon, obstetrician, and anesthesiologist was utilized to achieve a safe pregnancy and cesarean for the delivery of the baby. A close clinical assessment is required, especially during the third trimester when the risk of acute right ventricular dysfunction increases. The use of extracorporeal membrane oxygenation (ECMO (as a bridge to recovery or bridge to salvage was planned to support oxygenation and circulation in case of acute biventricular dysfunction. The delivery/cesarean section was performed in a cardiac surgery operating room, and to reduce the time-frame for ECMO institution the femoral vessels were exposed surgically before the cesarean section.

  20. Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: a case report

    Directory of Open Access Journals (Sweden)

    Royo Pedro

    2009-01-01

    Full Text Available Abstract Introduction An imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation. Case presentation A 33-year-old woman (G3, P3 presented referring intense dysmenorrhea and intermenstrual spotting since her third cesarean delivery, 1 year before. A cesarean section dehiscence with utero-peritoneal fistula was diagnosed by transvaginal ultrasound. Conclusion We can conclude that transvaginal two-dimensional power Doppler and three-dimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.

  1. The Delivery Methods and the Factors Affecting Among Giving Birth in Hospitals in Yozgat, Turkey

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    Mahmut Kiliç

    2012-01-01

    Full Text Available Background: The most of pregnant women can have normal vaginal birth. Recently, caesarean section rates are graduallyincreasing both worldwide, and in my country.Objectives: The aim of this study was to establish the delivery preferences among women giving birth in hospitals, and thefactors affecting this preference.Methodology: This cross-sectional study was performed in state (n=674 and private (n=148 hospitals. Data were gatheredby a questionnaire applied by an interviewer. 822 women who had given live birth and gave verbal consent to participate,were included into the study. The data were analyzed by binary logistic regression analysis.Results: Two-thirds of the live births were by caesarean section. According to the binary logistic regression analysis, thepossibility of undergoing caesarean section increased when; mothers’ age increased, they were short, they gave birth in aprivate hospital, they had social security, they were primigravida, they had a previous miscarriage/ curettage/ stillbirth, andthe major factor was found to be, having had a previous delivery by caesarean section. Variables such as; pregnancy week,babies’ weight, mothers’ educational and occupational status, fathers’ educational status, family type, residential area,economical status were found to be insignificant.Conclusion: The facts that 2/3 rds. of the deliveries were by caesarean section, and that all of those who had undergone aprevious caesarean delivery had a consequent caesarean delivery, and that most of the primigravida (60.5% that gave birthby caesarean section were due to doctor’s medical indication, make us think that doctors prefer caesarean delivery.

  2. 拉玛泽分娩减痛训练法对产程及剖宫产率影响的临床研究%Effect of Lamaze Pain-relieving Delivery Method Training on the Birth Process Time and Cesarean Rate during the Late Pregnant Phase

    Institute of Scientific and Technical Information of China (English)

    杨成芬; 黄伟

    2012-01-01

    Objective To observe the effect of Lamaze pain-relieving delivery on the birth process time and Cesarean rate by training the late pregnant phase women with Lamaze pain-relieving delivery technique, and guiding them use it correctly during the delivery. Methods A total of 300 pregnant women were randomly chosen as the observation group,who underwent the Lamaze pain-relieving delivery training before antenatal in Wuxi People's Hospital from March to September in 2011 ,while another 300 pregnant women who didn't undergo Lamaze training were chosen as a control group. The birth process time,the rate of Cesarean, postpartum hemorrhage and ache had been compared between the two groups. Results There were statistically significant differences between the two groups( P < 0. 05 )in terms of the first and second labor process, shortened labor process and relieved ache with a low Cesarean rate as well as a little postpartum hemorrhage were seen in the observation group compared to the control group. Neonatal Apgar evaluation of the observation group was significantly higher than that of the control group( P < 0. 01 ). Conclusion The application of Lamaze pain-relieving delivery during the birth process can effectively relieve the delivery pains, eliminate the fears , strengthen the uterine contraction , promote the birth process , reduce the postpartum hemorrhage , and lower the Cesarean rate, which is a simple, none trauma, none side effect and none pharmacologic pain relief method.%目的 通过助产士对孕晚期孕妇进行拉玛泽分娩减痛技巧的训练,指导孕妇分娩时正确运用,观察拉玛泽分娩减痛法对产程及剖宫产率的影响.方法 将2011年3 ~9月在我院接受拉玛泽分娩减痛训练的300例孕妇为观察组,选择同期分娩的未接受拉玛泽分娩减痛训练的300例孕妇为对照组,比较产程时间、剖宫产率、产后出血、疼痛等.结果 除第3产程外,观察组第1、2产程缩短,疼痛减轻,剖宫产

  3. Analysis on incidence of neonatal respiratory diseases in term infants born by elective cesarean delivery%足月选择性剖宫产新生儿呼吸系统疾病发生情况分析

    Institute of Scientific and Technical Information of China (English)

    朱曦怡; 谢庆玲; 李柳青

    2016-01-01

    目的:分析选择性剖宫产( ECD)足月儿的新生儿呼吸系统疾病的发生情况。方法回顾性分析1139例ECD出生的足月新生儿的临床资料,分析其呼吸窘迫综合征( RDS)、新生儿暂时性呼吸增快( TTN)、新生儿持续性肺动脉高压( PPHN)及自发性气胸的发生率,比较胎龄37周、38周、39周及40周新生儿的呼吸系统疾病发生情况。结果 1139例ECD出生的足月儿中,出现新生儿呼吸系统疾病107例(9.39%);随着胎龄的增加,ECD出生新生儿的呼吸系统疾病发生率呈降低趋势(P<0.05)。新生儿 TTN 的发生率最高,为6.50%,其次为 RDS(2.90%)、自发性气胸(1.23%)、PPHN (0.88%)。随着胎龄的增加,ECD足月儿的RDS、PPHN及自发性气胸发生率均呈降低趋势(P<0.05)。结论 ECD足月儿的新生儿呼吸系统疾病发生率较高,最好在胎龄39周后进行ECD。%Objective To analyze the incidence of neonatal respiratory diseases in term infants born by elective cesarean delivery (ECD).Methods The clinical data of 1139 term infants born by ECD were retrospectively analyzed .The incidences of neonatal respiratory distress syndrome(RDS),transient tachypnea of newborn (TTN),persistent pulmonary hypertension of newborn (PPHN) and spontaneous pneumothorax were analyzed .And the incidences of respiratory diseases were compared among the neonates with gestational ages of 37 weeks, 38 weeks,39 weeks and 40 weeks.Results Of 1139 term infants born by ECD , neonatal respiratory diseases occurred in 107 cases (9.39%),and the incidence of neonatal respiratory diseases decreased with the increase of gestational age (P<0.05).The incidence of neonatal TTN was the highest (6.50%),and the incidences decreased in the order of RDS(2.90%),spontaneous pneumothorax(1.23%) and PPHN(0.88%).The incidences of RDS,PPHN and spontaneous pneumothorax decreased with the increase of gestational

  4. Timing of elective cesarean delivery at term and neonatal outcomes%足月择期剖宫产的时机与新生儿结局分析

    Institute of Scientific and Technical Information of China (English)

    郭琦; 李雷; 边旭明

    2011-01-01

    目的 比较不同孕周行足月择期剖宫产的新生儿结局.方法 自2002年9月至2009年11月根据北京协和医院产科电子数据库系统登记的所有中国人群的孕产妇资料中,选择妊娠满37周后在临产前没有明确妇产科和内科合并症的宫内单胎活产儿的孕妇施行择期剖宫产的病历资料,采用单因素方差分析母亲的一般情况,采用趋势检验方法比较不同孕周组的新生儿不良事件的发生情况,包括新生儿死亡、呼吸系统疾病(呼吸窘迫综合征或短暂的窒息)、感染(包括败血症)、转入新生儿重症监护病房、在新生儿重症监护病房住院>5 d等.结果 共4565例初次和409例再次足月择期剖宫产病例纳入分析.妊娠39周前行手术者和妊娠39~39+6周中初次剖宫产者占所有足月初次择期剖宫产总数的比例分别为48.1%(2194/4565)和40.0%(1828/4565).再次择期剖宫产者中妊娠39周前和妊娠39~39+6周手术者的比例分别为67.2%(275/409)和29.3%(120/409).未发生围产期胎儿或新生儿死亡.与妊娠39~39+6周相比,妊娠37~37+6周和38~38+6周行择期剖宫产均可能增加新生儿不良事件的发生风险:初次剖宫产,妊娠37~37+6周OR=1.4(95% CI:0.9~2.0),38~38+6周OR=1.1(95%CI:0.9~1.4);再次剖宫产,37~37+6周OR=2.5(95% CI:1.1~5.8),38~38+6周OR=1.3(95%CI:0.6~2.7).结论 我院妊娠39周前的择期剖宫产比例较高,但可能增加新生儿呼吸系统疾病等不良事件的发生风险.建议将妊娠39~39+6周作为择期剖宫产的时机以减少新生儿呼吸系统等不良时间的发生风险.%Objective To compare the neonatal outcomes of different gestational age at which elective cesarean sections at term were performed. Methods All the cases of cesarean section registered in Peking Union Medical College Hospital from September 2002 to November 2009 were collected. Women with viable singleton pregnancies delivered before the onset of

  5. 加温输液复合术中镇静对腰硬联合麻醉下剖宫产术中寒战反应的临床研究%Warming Intravenous Fluids Combined with Intraoperative Sedation Alleviation of Shivering during Cesarean Delivery under Combined Spinal-epidural Anaesthesia

    Institute of Scientific and Technical Information of China (English)

    陈远珍; 梁永涛

    2013-01-01

    Objective To research the effects of warming intravenous fluids combined with intraoperative sedation on shivering during cesarean delivery. Methods 90 parturients scheduled for nonemergent cesarean delivery were randomly allocated to 3 groups( 30 cases in each group ). Patients in group I received unwarmed fluids, patients in group Ⅱ and Ⅲ received pre-warmed fluids( 37℃ )throughout the intraoperative period. After fetal birth, anesthesiologist injected intravenously normal saline 5 mL in group Ⅰ , Ⅱ and midazolam 0.04 mg/kg ( diluted to 5 mL with normal saline )in group Ⅲ. Shivering reaction of parturients was observed. Results The overall incidence of chills of group Ⅱ and Ⅲ was lower than group I with statistically significant difference( P <0.05 ). Conclusion Warming intravenous fluids and warming intravenous fluids combined with intraoperative sedation can both reduce the incidence and severity of shivering of parturients during cesarean delivery under combined spinal-epidural anaesthesia,and the combined application is more effective.%目的 探讨加温输液复合术中镇静对腰硬联合麻醉下行剖宫产产妇术中寒战反应的影响.方法将腰硬联合麻醉下择期行剖宫产手术的健康初产妇90例随机分为3 组,各30例.Ⅰ组术中输注未经特殊处理的液体,Ⅱ、Ⅲ组术中输注预先加温至37 ℃的液体;胎儿娩出断脐后即刻Ⅰ、Ⅱ组静脉注射生理盐水5 mL,Ⅲ组静脉注射咪达唑仑0.04 mg/kg(生理盐水稀释至5 mL).观察三组产妇寒战的发生情况.结果 Ⅱ、Ⅲ组寒战总发生率和2级寒战发生率低于Ⅰ组,差异有统计学意义(P<0.05).结论 加温输液和加温输液复合术中镇静均能减轻腰硬联合麻醉下行剖宫产术中产妇寒战的发生率,但加温输液复合术中镇静更为有效.

  6. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    Directory of Open Access Journals (Sweden)

    Senturk MB

    2015-07-01

    Full Text Available Mehmet Baki Senturk,1 Yusuf Cakmak,2 Halit Atac,2 Mehmet Sukru Budak3 1Department of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey; 2Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey; 3Department of Obstetrics and Gynecology, Diyarbakir Research Hospital, Diyarbakir, Turkey Abstract: Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01, but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05. In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of

  7. Cesarean Section - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Cesarean Section URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Cesarean Section - Multiple Languages To use the sharing features on ...

  8. Analytical study of indications of cesarean section

    Directory of Open Access Journals (Sweden)

    Janki M. Pandya

    2015-10-01

    Conclusions: Reduction of number of primary cesarean sections and successful VBAC trials are recommended to keep the rate of cesarean sections to the possible minimum level. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1460-1463

  9. Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: a systematic review and meta-analysis.

    Science.gov (United States)

    Zhou, Y-b; Li, H-t; Zhu, L-p; Liu, J-m

    2014-01-01

    Evidence suggests that cesarean section is likely associated with a reduced placental transfusion and poor hematological status in neonates. However, clinical studies have reported somewhat inconsistent results. We conducted a systematic review and meta-analysis to examine whether cesarean section affects placental transfusion and iron-related hematological indices. Pubmed, Web of Science, ScienceDirect, and Ovid Databases were searched for relevant studies published before April 9, 2013. Mean differences between cesarean section and vaginal delivery in outcomes of interests (placental residual blood volume; hematocrit level, hemoglobin concentration, and erythrocyte count in cord/peripheral blood) were extracted and pooled using a random effects model. We identified 15 studies (n = 8477) eligible for the meta-analysis. Compared with neonates born vaginally, those born by cesarean section had a higher placental residual blood volume [weighted mean difference (WMD), 8.87 ml; 95% confidence interval (CI), 2.32 ml-15.43 ml]; a lower level of hematocrit (WMD, -2.91%; 95% CI, -4.16% to -1.65%), hemoglobin (WMD, -0.51 g/dL; 95% CI, -0.74 g/dL to -0.27 g/dL) and erythrocyte (WMD, -0.16 × 10(12)/L; 95% CI, -0.30 × 10(12)/L to -0.01 × 10(12)/L). Subgroup analysis showed that the WMD for hematocrit in neonate's peripheral blood (-6.94%; 95% CI, -9.15% to -4.73%) was substantially lower than that in cord blood (-1.75%; 95% CI, -2.82%, -0.68%) (P value for testing subgroup differences cesarean section compared with vaginal delivery is associated with a reduced placental transfusion and poor iron-related hematologic indices in both cord and peripheral blood, indicating that neonates delivered by cesarean section might be more likely affected by iron-deficiency anemia in infancy.

  10. The relationship between indicators of socioeconomic status and cesarean section in public hospitals

    Science.gov (United States)

    Faisal-Cury, Alexandre; Menezes, Paulo Rossi; Quayle, Julieta; Santiago, Kely; Matijasevich, Alicia

    2017-01-01

    ABSTRACT OBJECTIVE To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care. METHODS This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother’s characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status. RESULTS Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section. CONCLUSIONS In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.

  11. Magnetic resonance imaging evaluation of incision healing after cesarean sections

    Energy Technology Data Exchange (ETDEWEB)

    Dicle, O. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Kuecuekler, C. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Pirnar, T. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Erata, Y. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey); Posaci, C. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey)

    1997-02-01

    The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months. (orig.). With 6 figs.

  12. Development of Upper Respiratory Tract Microbiota in Infancy is Affected by Mode of Delivery.

    Science.gov (United States)

    Bosch, Astrid A T M; Levin, Evgeni; van Houten, Marlies A; Hasrat, Raiza; Kalkman, Gino; Biesbroek, Giske; de Steenhuijsen Piters, Wouter A A; de Groot, Pieter-Kees C M; Pernet, Paula; Keijser, Bart J F; Sanders, Elisabeth A M; Bogaert, Debby

    2016-07-01

    Birth by Caesarian section is associated with short- and long-term respiratory morbidity. We hypothesized that mode of delivery affects the development of the respiratory microbiota, thereby altering its capacity to provide colonization resistance and consecutive pathobiont overgrowth and infections. Therefore, we longitudinally studied the impact of mode of delivery on the nasopharyngeal microbiota development from birth until six months of age in a healthy, unselected birth cohort of 102 children (n=761 samples). Here, we show that the respiratory microbiota develops within one day from a variable mixed bacterial community towards a Streptococcus viridans-predominated profile, regardless of mode of delivery. Within the first week, rapid niche differentiation had occurred; initially with in most infants Staphylococcus aureus predominance, followed by differentiation towards Corynebacterium pseudodiphteriticum/propinquum, Dolosigranulum pigrum, Moraxella catarrhalis/nonliquefaciens, Streptococcus pneumoniae, and/or Haemophilus influenzae dominated communities. Infants born by Caesarian section showed a delay in overall development of respiratory microbiota profiles with specifically reduced colonization with health-associated commensals like Corynebacterium and Dolosigranulum, thereby possibly influencing respiratory health later in life.

  13. A prova de trabalho e a via de parto em primíparas com uma cesárea anterior Factors associated with mode of delivery among primipara women with one previous cesarean section and undergoing a trial of labor

    Directory of Open Access Journals (Sweden)

    Jacinta Pereira Matias

    2007-04-01

    Full Text Available OBJETIVO: Identificar fatores associados à cesárea em mulheres com um único parto anterior por cesárea e submetidas à prova de trabalho de parto. MÉTODOS: Estudo de corte transversal retrospectivo, incluindo 1746 mulheres com uma cesárea anterior submetidas à prova de trabalho de parto no segundo parto ocorrendo entre 1986 e 1998. Foram excluídos os casos com atual gestação múltipla e/ou com malformações fetais incompatíveis com a vida. Elas foram divididas pelo tipo de parto atual em dois grupos: cesárea (n=731 e parto vaginal após cesárea (PVAC, n=1015. A análise estatística para a identificação de fatores associados ao tipo de parto foi feita por meio do cálculo da razão de prevalência (RP e IC 95%, sendo feito também o ajuste por idade, excluindo-se os casos com informações ignoradas em cada análise. RESULTADOS: A taxa total de parto vaginal após cesárea foi de 58,1%. Os fatores significativamente associados com parto por cesárea foram: maior idade materna, maior altura uterina (RP 1,5; IC 95% 1,19-1,88, rotura prematura de membranas (1,3; 1,08-1,54, líquido amniótico não claro (1,22; 1,04-1,43 ou com quantidade alterada (1,32; 1,01-1,73, alteração dos batimentos cardíacos fetais (1,96; 1,68-2,28, apresentação não cefálica (2,03; 1,54-2,66, indução do parto (1,74; 1,42-2,11 e ausência de analgesia (2,57; 2,11-3,11. CONCLUSÃO: Os fatores associados ao parto por cesárea foram a maior idade, apresentação não-cefálica, rotura prematura de membranas, fetos grandes, necessidade de indução do trabalho de parto, e sinais de comprometimento da vitalidade fetal.OBJECTIVE: To identify factors associated with cesarean section in women with only one previous delivery by cesarean section and undergoing a trial of labor. METHODS: A retrospective cross sectional study was performed from 1986 to 1998 including a total of 1746 women with one prior cesarean section and delivering after a trial of labor

  14. Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China.

    Science.gov (United States)

    Qin, Cheng; Zhou, Min; Callaghan, William M; Posner, Samuel F; Zhang, Jun; Berg, Cynthia J; Zhao, Gengli

    2012-10-01

    This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

  15. Women are designed to deliver vaginally and not by cesarean section: an obstetrician's view.

    Science.gov (United States)

    Visser, Gerard H A

    2015-01-01

    Worldwide, there is a rapid increase in deliveries by cesarean section. The large differences among countries, from about 16% to more than 60%, suggest that the cesarean delivery (CD) rate has little to do with evidence-based medicine. In this review, the background for the increasing CD rate is discussed as well as the limited positive effects on neonatal outcome in both term and preterm neonates. Negative effects of CD, including direct maternal morbidity, complications of subsequent pregnancies and iatrogenic early delivery resulting in increased neonatal morbidity, are discussed in addition to long-term implications for the offspring involving altered development of the immune system. The 'battle' to lower the CD rate will be difficult, but we should not forget that women are designed to deliver vaginally and not by cesarean section.

  16. 高频超声在剖宫产后瘢痕子宫再次妊娠分娩方式选择中的意义%High frequency ultrasound in the choice of delivery mode of scarred uterus after cesarean section

    Institute of Scientific and Technical Information of China (English)

    陶潜; 郑艳莉; 张忠新

    2013-01-01

    目的:探讨高频超声在剖宫产后瘢痕子宫再次妊娠分娩方式选择中的意义。方法:对122例有剖宫产史的孕妇再次妊娠后35周起采用高频探头,观察子宫下段的厚度及结构(其中下段厚度≥3 mm 67例,<3 mm 55例);下段厚度≥3 mm孕妇中32例进行阴道试产;<3 mm适时行再次剖宫产术,于再次剖宫产术中对子宫下段情况进行比较。结果:(1)妊娠晚期瘢痕子宫孕妇子宫下段肌层厚度明显小于无瘢痕子宫孕妇(P<0.05);(2)高频超声显示子宫下段呈“鼠尾状”及“截断状”的病例,子宫不全破裂和瘢痕愈合不良的比例较“均匀一致”组高(χ2=27.99,P<0.05);(3)瘢痕子宫下段厚度≥3 mm且超声呈“均匀一致”孕妇阴道试产率为47.76%,试产成功率为81.25%。结论:通过高频超声检查妊娠晚期瘢痕子宫下段肌层状态,为临床判断是否可以经阴道试产提供重要信息。%Objective: To study association of high frequency ultrasound with the choice of delivery mode of scarred uterus after cesarean section. Methods: The thickness and structure of the lower uterine segment of 122 cases of pregnant women with a history of cesarean section were observed by using high frequency probe after 35 pregnant weeks(67 cases of the thick-ness of lower segment≥3 mm, 55 cases of the thickness of lower segment <3 mm). After communication with pregnant wom-en of the thickness of lower segment ≥3 mm, 32 cases chose vaginal delivery, and 55 cases of the thickness of lower seg-ment<3 mm chose cesarean section. The conditions of lower uterine segment were compared in cesarean section. Results:The thickness of lower uterine segment of scarred uterus in late trimester of pregnancy was significantly less than that of uterus without scar(P<0.05). The incidences of incomplete uterine rupture and poor healing of uterus incision of lower uterine seg-ment appearing in rat caudate and truncation in

  17. Rare complications of cesarean scar

    Directory of Open Access Journals (Sweden)

    Divyesh Mahajan

    2013-01-01

    Full Text Available Cesarean scar pregnancy (CSP and cesarean scar dehiscence (CSD are the most dreaded complications of cesarean scar (CS. As the incidence of CS is increasing worldwide, so is the incidence of CSP, especially in cases with assisted reproduction techniques. It is of utmost importance to diagnose CSP in the early first trimester, as it can lead to myometrial rupture with fatal outcome. On the other hand, CSD may be encountered during pregnancy or in the postpartum period. CSD in the postpartum period is very rare and can cause secondary postpartum hemorrhage (PPH leading to increased maternal morbidity or even death if not diagnosed and managed promptly. Both complications can be diagnosed on ultrasonography (USG and confirmed on magnetic resonance imaging (MRI. These two conditions carry high morbidity and mortality. In this article, we highlight the role of imaging in the early diagnosis and management of these conditions.

  18. New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children's Health.

    Science.gov (United States)

    Kulas, Tomislav; Bursac, Danijel; Zegarac, Zana; Planinic-Rados, Gordana; Hrgovic, Zlatko

    2013-12-01

    Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of 'modern' diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the 'good' maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the 'bad' bacteria that may endanger the child's immune system are frequently present. In children born by vaginal delivery, the 'good' maternal bacteria stimulate the newborn's white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section.

  19. Ultrasound evaluation of the cesarean scar: comparison between one- and two layer uterotomy closure

    DEFF Research Database (Denmark)

    Glavind, Julie; Madsen, Lene Duch; Uldbjerg, Niels;

    -pregnant women with one previous elective cesarean, no post-partum uterine infection or uterine re-operation, and no type 1 diabetes. Scar defect width, depth, and residual myometrial thickness were measured on the sagittal plane, and scar defect length was measured on the transverse plane. Results: The median......Objectives: To compare the residual myometrial thickness and the size of the cesarean scar defect after one- and two layer uterotomy closure. Methods: From July 2010 a continuous two-layer uterotomy closure technique replaced a continuous one-layer technique after cesarean delivery...... at the Department of Obstetrics and Gynecology at Aarhus University Hospital. A total of 149 consecutively invited women (68 women with one-layer and 81 women with two-layer closure) had their cesarean scar examined with 2D transvaginal sonography (TVS) 6-16 months post partum. Inclusion criteria were non...

  20. 空气波压力治疗仪用于产妇剖宫产术后预防双下肢深静脉血栓形成的护理干预%Nursing Intervention of IPC on Deep Vein Thrombosis Prevention After Cesarean Delivery

    Institute of Scientific and Technical Information of China (English)

    黄玉宇

    2016-01-01

    Objective To explore the clinical nursing intervention of IPC on deep vein thrombosis prevention after cesarean delivery. Methods 126 cases of puerpera after cesarean section surgery in our hospital were selected and divided into two groups based on different nursing methods, with 63 cases in each group. The observation group was given IPC nursing, while the control group was given routine massage nursing. The nursing effects of two groups were observed and compared. Results After nursing, the total effective rate of observation group was 100.0%, significantly higher than 88.9% of control group (P <0.05). Conclusions The application of IPC after cesarean delivery of hypercoagulable maternal can effectively prevent the formation of deep vein thrombosis, and improve the clinical effect.%目的 探讨产妇剖宫产术后采用空气波压力治疗仪预防双下肢深静脉血栓形成的临床护理干预. 方法 选取我院收治的行剖宫产手术的产妇126例, 按照护理方式的不同分为观察组和对照组, 每组63例; 观察组产妇术后给予空气波压力治疗仪护理, 对照组产妇术后给予常规按摩护理, 观察比较两组的护理效果. 结果 护理后, 观察组的总有效率为100.0%, 显著高于对照组的88.9%, 差异具有统计学意义 (P<0.05). 结论 产妇剖宫产术后早期应用空气波压力治疗仪并采取相应的护理措施, 可有效地预防产妇术后下肢静脉血栓的形成, 提高临床治疗效果, 疗效显著, 值得临床推广.

  1. 'Postmortem' cesarean section with recovery of both mother and offspring.

    Science.gov (United States)

    DePace, N L; Betesh, J S; Kotler, M N

    1982-08-27

    A 27-year-old primigravida of 37 weeks' gestation suffered cardiopulmonary arrest after massive hemoptysis. After extensive advanced cardiopulmonary resuscitation measures, it was thought that the mother could not be resuscitated and a cesarean section was performed. Immediately after delivery of the fetus, the mother's pulse was palpated, and both the mother and infant are alive without neurological sequelae 20 months later. The reversal of the supine hypotensive syndrome, which was precipitated by massive blood loss, may be the mechanism to account for the restoration of the mother's cardiac output after delivery.

  2. An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 – 2014 at Médecins sans Frontières Operations Centre Brussels Projects

    Science.gov (United States)

    Stewart, Barclay; Wong, Evan; Papillon-Smith, Jessica; Trelles Centurion, Miguel Antonio; Dominguez, Lynette; Ao, Supongmeren; Jean-Paul, Basimuoneye Kahutsi; Kamal, Mustafa; Helmand, Rahmatullah; Naseer, Aamer; Kushner, Adam L.

    2015-01-01

    Background: Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis. Methods: All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression. Results: After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance). Conclusion: Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in ‘steady-state’ healthcare systems, they may not be useful during

  3. Bovine cesarean section in the field.

    Science.gov (United States)

    Newman, Kenneth D

    2008-07-01

    Cesarean section is perhaps one of the more challenging surgical procedures performed on the farm; the veterinarian often has far less control over the patient, availability of assistance, and environmental contaminants. A number of variables may affect the successful outcome of this procedure for both the calf and cow; case selection is the most important and often overlooked variable. In addition, patient and surgeon preparation, surgical technique, calf viability at the time of surgery, and exteriorizing the uterus can affect outcome. Good surgical technique including gentle tissue handling, appropriate suture materials and patterns, adequate infolding of the uterine incision to prevent leakage, combined with antibiotics and anti-inflammatory medication when indicated can help minimize detrimental adhesions that may adversely affect the future reproductive efficiency of the cow.

  4. Evolution & the Cesarean Section Rate

    Science.gov (United States)

    Walsh, Joseph A.

    2008-01-01

    "Nothing in biology makes sense except in the light of evolution." This was the title of an essay by geneticist Theodosius Dobzhansky writing in 1973. Many causes have been given for the increased Cesarean section rate in developed countries, but biologic evolution has not been one of them. The C-section rate will continue to rise, because the…

  5. [Anesthesia for cesarean section in patients with fetal anomaly].

    Science.gov (United States)

    Nakano, S; Tashiro, C; Nishimura, M; Ueyama, H; Uchiyama, A; Kubota, A; Suehara, N

    1991-05-01

    Twenty-two cases of Cesarean section due to fetal anomaly diagnosed prenatally were reviewed in terms of the anesthetic managements. In 6 cases, diazepam 0.3 mg.kg-1, which provides fetal anesthesia for surgery scheduled immediately after birth, was administered intravenously to the mothers with/without fentanyl (2 general anesthesia and 4 regional anesthesia). The diagnosis of their fetuses was congenital diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, gastroschisis or omphalocele. No fetal anesthesia was performed in the other 16 cases (15 spinal anesthesia and 1 general anesthesia). Seven of their fetuses were diagnosed as hydrops. Since the general condition of the diseased newborn is known to be deteriorated after receiving various stress and aerophagia, fetal anesthesia in Cesarean delivery has the advantage of stress reduction and prevention of aerophagia. When the newborn is considered to need immediate neonatal resuscitation or intensive care including surgery, fetal anesthesia may be a choice of anesthetic technique.

  6. [How to reduce the number of cesarean sections?].

    Science.gov (United States)

    Guzmán Sánchez, A; González Moreno, J; González Guzmán, M; Villa Villagran, F

    1997-07-01

    The cesarean section (C) frequency has increased dramatically as high as 62%. This situation has been producing a real preoccupation in all the world as well as in México. Documented bibliography about this subject, is unquestionable. We feel that at this time there is a lack of punctuals strategies in order to reduce the high frequency of C. Our communication analyzes this problem in relation to antecedents, evolution and integrated general strategies in order to reduce the C rates. Special analysis and comments involve amnioinfusion, trials for vaginal deliveries in case of previous cesarean section, prostaglandins, and external version. With these actions, at the Antiguo Hospital Civil de Guadalajara we have achieved 10.8% of C. rates, without any increase in fetomaternal morbility and/or mortality.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Unfavorable conditions associated with cesarean section may influence the risk of type 1 diabetes in offspring, but results from studies are conflicting. We aimed to evaluate the association between prelabor cesarean section and risk of childhood type 1 diabetes. METHODS: A Danish...... contributed 20,436,684 person-years, during which 4,400 were diagnosed with childhood type 1 diabetes. RESULTS: The hazard ratio for childhood type 1 diabetes was increased in children delivered by prelabor cesarean section compared with vaginal delivery when adjusted for year of birth, parity, sex, parental...... age, and education and paternal type 1 diabetes status at childbirth (HR 1.2; 95% CI 1.0 to 1.3), but not after additional adjustment for maternal type 1 diabetes status at childbirth (HR 1.1; 95% CI 0.95 to 1.2). Delivery by intrapartum cesarean section was not associated with childhood type 1...

  8. Endometriosis In Cesarean Scar: A Case Report

    Directory of Open Access Journals (Sweden)

    Nejat Özgül

    2013-11-01

    Full Text Available A patient with surgical scar endometriosis, a rare condition, was presented. The patient was 30 years old, gave birth twice by cesarean section, her last delivery was seven years ago. She appealed to the outpatients’ clinic because of the complaints of pain, swelling and redness on the scar site, her complaints began one year after the last delivery and continued. The complaints did not alter by menstrual cycle. On the examination, there was a painful hyperemic lesion 2x2cm in size which was raised from the skin, located at the right of the scar, assumed to be associated with the fixed fascia and another lesion 2x2cm in size which could not be noticed by inspection but be palpated was found. The lesions described were totally excised. The result of paraffin block examination of the material was reported as endometriosis. Pain on the scar site with menstrual period, enlargement and discoloration of the lesions are classical signs of scar endometriosis. But the patients do not always present these findings. Endometriosis should also be remembered along with other reasons when lesions occur on the scar site after surgery.

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  10. Pregnancy Outcomes of Repeat Cesarean Section in Peking Union Medical College Hospital

    Institute of Scientific and Technical Information of China (English)

    Liang-kun Ma; Na Liu; Xu-ming Bian; Li-rong Teng; Hong Qi; Xiao-ming Gong; Jun-tao Liu; Jian-qiu Yang

    2009-01-01

    Objective To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes.Methods A retrospective clinic-and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group(one previous cesarean section)and MRCS group(two or more previous cesarean sections)] and primary cesarean section(FCS group)at Peking Union Medical College Hospital from January 1998 to December 2007.Results The incidence of repeat cesarean section increased from 1.26% to 7.32% .The mean gestational age at delivery in RCS group(38.1±1.8 weeks)and MRCS group(37.3±2.5 weeks)were significantly shorter than that in FCS group(38.9±2.1 weeks,all P<0.01).The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively,and was significantly higher than that in FCS group(7.9% ,P<0.05).Dense adhesion(13.5% vs.0.4% ,OR=7.156,95% CI:1.7-30.7,P<0.01)and uterine rupture(1.0% vs.0,P<0.05)were commoner in RCS group compared with FCS group.Neonatal morbidity was similar among three groups(P>0.05).Conclusions Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity.However,the incidence of neonatal morbidity is similar to primary cesarean section.

  11. Elective cesarean hysterectomy vs elective cesarean section followed by remote hysterectomy: reassessing the risks.

    Science.gov (United States)

    Bost; Rising; Bost

    1998-07-01

    Objective: The purpose of this study was to compare the risks of elective cesarean hysterectomy with the risks of elective cesarean section followed by remote hysterectomy.Methods: A census of elective cesarean hysterectomies (n = 31) and a random sample of 200 cesarean sections and 200 hysterectomies performed by the authors between 1987 and 1996 were evaluated. Only elective repeat and primary cesarean section patients without labor were selected for study (n = 86). Total abdominal hysterectomies were drawn from the sample (n = 60), excluding cancer cases, patients over 50 years old, and those with ancillary procedures other than adnexectomy and lysis of adhesions. General probability theory was used to calculate a predicted complication rate of cesarean section followed by TAH from the complication rates of the component procedures done independently. This predicted combined complication rate was then compared to the observed rate of complications from cesarean hysterectomy to evaluate the risks of the two alternative treatment regimens.Results: Elective cesarean section and total abdominal hysterectomy had complication rates of 12.8% and 13.4%, respectively. The predicted combined complication rate for elective cesarean section followed by TAH was 24.5%. The observed rate of complications for elective cesarean hysterectomy was much lower (16.1%). Although bleeding complications were similar for the two regimens, the rate of transfusion was higher for cesarean hysterectomy (13.0%) than for cesarean section (0%) and TAH (3.4%) alone. Eighty percent of the cesarean hysterectomy patients would have been candidates for autologous blood donation, had it been available.Conclusions: Elective cesarean hysterectomy has a lower risk of complications than elective cesarean section followed by remote abdominal hysterectomy and should be preferred. Transfusion risks are higher for cesarean hysterectomy but can be decreased by the use of autologous blood.

  12. Cesarean Scar Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Z Vahedpoor

    2015-07-01

    Conclusion: Previous cesarean scar pregnancy if not detected early can be associated with high morbidity and mortality. Therefore, the possibility of this pregnancy should be considered in pregnant women with uterine bleeding, abdominal pain as well as a history of cesarean section. It should be noted that after previous cesarean scar pregnancy was definitely diagnosed via ultrasound examination, treatment necessitates to be started utilizing methotrexate to ensure the future fertility of the mother.

  13. Cesarean section in Shanghai: women’s or healthcare provider’s preferences?

    OpenAIRE

    2014-01-01

    Background Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences. Methods An anonymous questionnaire survey, combined with data...

  14. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

    OpenAIRE

    2015-01-01

    Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterin...

  15. Mode of delivery and subsequent reproductive patterns. A national follow-up study

    DEFF Research Database (Denmark)

    Fussing-Clausen, Caroline; Geirsson, Reynir T; Hansen, Thomas

    2014-01-01

    % CI 0.76-0.787) decreased likelihood for subsequent delivery. Emergency cesarean section meant 16% fewer (95% CI 0.84-0.85), and vaginal instrumental delivery 4% fewer subsequent deliveries (95% CI 0.95-0.96). Hazard ratios were largely unchanged after controlling for parity and year of birth. Small...... births. A first or later delivery by cesarean section implied decreased likelihood of subsequent delivery compared with women with a first vaginal birth....

  16. Maternal postpartum complications according to delivery mode in twin pregnancies

    Directory of Open Access Journals (Sweden)

    Sonia Leme Stach

    2014-07-01

    Full Text Available OBJECTIVE:We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors.METHODS:This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008. The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated.RESULTS:A total of 90 complications were observed in 56/817 (6.9% deliveries: 7/131 (5.3% vaginal, 10/251 (4.0% elective cesarean and 39/435 (9.0% emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34.CONCLUSIONS:Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.

  17. Per operative findings in repeat cesarean section

    Directory of Open Access Journals (Sweden)

    Parul Sinha

    2016-04-01

    Conclusions: Chances of developing adhesions increases with each cesarean section, which leads to increase in morbidity of women. Thus cases of previous cesarean section should be educated about routine antenatal care. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1093-1096

  18. New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children’s Health

    Science.gov (United States)

    Kulas, Tomislav; Bursac, Danijel; Zegarac, Zana; Planinic-Rados, Gordana; Hrgovic, Zlatko

    2013-01-01

    Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of ‘modern’ diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the ‘good’ maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the ‘bad’ bacteria that may endanger the child’s immune system are frequently present. In children born by vaginal delivery, the ‘good’ maternal bacteria stimulate the newborn’s white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section. PMID:25568522

  19. Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions

    Directory of Open Access Journals (Sweden)

    Maria Isabel do Nascimento

    2014-03-01

    Full Text Available OBJECTIVE: To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death (IUFD, and clinical management to anticipate the childbirth. METHODS: It was a retrospective cohort study with 163 mothers with IUFD, at the second half of pregnancy, who were managed to anticipate childbirth using pharmacological preparations and/or a mechanical method (Foley catheter in a teaching hospital in Rio de Janeiro State, Brazil. Cox regression was used to evaluate the effect of the clinical methods on the kind of delivery. RESULTS: The Subgroups A (misoprostol or Oxytocin, B (misoprostol and Oxytocin, and C (Foley catheter alone or combined with misoprostol and/or Oxytocin were formed according to the applied methods. Nine out of 163 cases ended with cesarean section. The incidence of cesarean section was 3.5 per 1,000 people-hours, meaning that a pregnant woman with IUFD had a 15.6% risk of cesarean section during the first 48 hours of clinical management to anticipate childbirth. The conditions significantly associated with the mode of delivery were placental abruption (HR: 44.97, having two or more previous cesarean deliveries (HR: 10.03, and mechanical method with Foley catheter (HR: 5.01. CONCLUSION: Cesarean section was an essential conduct in this cohort and followed previous cesarean delivery and placental abruption. The effect of the mechanical method on the abdominal route suggests that the Foley catheter method was used in the most difficult cases and that the surgery was performed to ensure maternal health.

  20. Educational strategies in performing cesarean section

    DEFF Research Database (Denmark)

    Madsen, Kristine; Grønbeck, Lene; Larsen, Christian Rifbjerg;

    2012-01-01

    Cesarean section is a common operation and one of the first surgeries performed independently by trainees/residents in obstetrics and gynecology. Determination of trainees' technical skills level is dependent upon subjective faculty assessment. Based on three studies on learning curves in cesarean...... section, it is recommended that trainees perform 10-15 to 40 supervised cesarean sections prior to operating independently. Surgical technical skills of trainees/residents may be assessed by Objective Structured Assessment of Technical skills (OSATS), which provides a foundation for constructive feedback...... during surgical training. The Danish, Swedish and British Obstetric and Gynecological Societies' guidelines on cesarean section were reviewed regarding cesarean section surgical technique. Placental removal by traction on the umbilical cord is recommended uniformly, however, the Danish guidelines...

  1. SURGICAL RISK INDEX AND SURGICAL SITE INFECTION IN POSTPARTUM WOMEN SUBMITTED TO CESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Luana Machado Chianca

    2015-07-01

    Full Text Available Backgound and Objectives: Considering the use of active surveillance assists in infection identification and the need for studies that use Surgical Risk Index (SRI for assessment of Surgical Site Infection (SSI in cesareans, this study aims to determine the incidence of SSI and analyze the applicability of SRI in the prediction of SSI in women in the postpartum period after being submitted to a cesarean section at a university hospital between April 2012 and March of 2013. Methods: Prospective cohort study. Information notifying SSI by active surveillance was collected daily from the medical records. After hospital discharge, the mothers were contacted through telephone calls to identify infection criteria within 30 days after the cesarean. Descriptive and comparative analyses were performed. The chi-square test was used to compare groups. Results: 737 cesareans were performed. Telephone contact was achieved with 507 (68.8% women up to 30 days postpartum, with loss of follow-up of 230 cases (31.2%. The medical consultation in the post-partum period occurred with 188 (37.08% women, with whom telephone contact was obtained, on average, 17.28 days (SD=8.39 after delivery. It was verified that 21 patients met the criteria for SSI, with a 4.14% rate. A total of 12 cases (57.1% were classified as superficial SSI, 5 (23.8% as deep and 4 (19.1% as infection of organs and cavities. The SRI and its risk variables were not associated with SSI in patients submitted to cesarean sections. Conclusion: The SRI and the risk variables included in this index were not associated to SSI in patients submitted to cesarean sections. KEYWORDS: Cesarean Section; Surgical Wound Infection; Epidemiological Surveillance; Infection Control; Risk Index; Disease Notification.

  2. Delivery rate affects uptake of a fluorescent glucose analog in murine metastatic breast cancer.

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    Narasimhan Rajaram

    Full Text Available We demonstrate an optical strategy using intravital microscopy of dorsal skin flap window chamber models to image glucose uptake and vascular oxygenation in vivo. Glucose uptake was imaged using a fluorescent glucose analog, 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-ylamino]-2-deoxyglucose (2-NBDG. SO2 was imaged using the differential absorption properties of oxygenated [HbO2] and deoxygenated hemoglobin [dHb]. This study was carried out on two sibling murine mammary adenocarcinoma lines, 4T1 and 4T07. 2-NBDG uptake in the 4T1 tumors was lowest when rates of delivery and clearance were lowest, indicating perfusion-limited uptake in poorly oxygenated tumor regions. For increasing rates of delivery that were still lower than the glucose consumption rate (as measured in vitro, both 2-NBDG uptake and the clearance rate from the tumor increased. When the rate of delivery of 2-NBDG exceeded the glucose consumption rate, 2-NBDG uptake decreased with any further increase in rate of delivery, but the clearance rate continued to increase. This inflection point was not observed in the 4T07 tumors due to an absence of low delivery rates close to the glucose consumption rate. In the 4T07 tumors, 2-NBDG uptake increased with increasing rates of delivery at low rates of clearance. Our results demonstrate that 2-NBDG uptake in tumors is influenced by the rates of delivery and clearance of the tracer. The rates of delivery and clearance are, in turn, dependent on vascular oxygenation of the tumors. Knowledge of the kinetics of tracer uptake as well as vascular oxygenation is essential to make an informed assessment of glucose demand of a tumor.

  3. Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement

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    Subrata Podder

    2015-01-01

    Full Text Available Pregnancy in presence of severe aortic stenosis (AS causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score.

  4. Postoperative Analgesic Effects of Wound Infiltration with Tramadol or Levobupivacaine in Cesarean Delivery Patients%曲马多或左旋布比卡因切口浸润对全身麻醉剖宫产术后疼痛的影响

    Institute of Scientific and Technical Information of China (English)

    马青山; 吴继勇; 袁力勇

    2013-01-01

    Objective To assess the efficacy of wound infiltration with tramadol or levobupivacaine on postoperative analgesic in cesarean delivery patients. Methods ASA Ⅰ~ Ⅱ 90 patients scheduled for emergency or elective cesarean section under general anesthesia were randomly allocated into one of the 3 groups. The levobupivacaine group( group L )received 20 mL local would infiltration with 0. 25% levobupivacaine, the tramadol group( group T )received 20 mL local would infiltration with 1.5mg/kg tramadol within 0.9% saline solution, and the normal saline group(group N )received 20 mL local would infiltration with 0. 9% saline solution. After closure of the uterine incision and the rectus fascia,20 mL solution was infiltrated subcutaneously along the skin wound edges. All patients received 1% tramadol PCIA for postoperative analgesia,and 20~40 mg intravenous parecoxib was used as an additional analgesic. The VAS at awake,and 2, 4, 8, 12, 24 h postoperative were recorded. The 24 h tramadol consumption,parecoxib requirement,itching,vomiting,fever,wound infection were also recorded. Results At time of awake, VAS were lower in group T and group L than that in group N( P0.05);与N组相比,L组、T组24 h内曲马多用量明显减少(P=0.0001),与L组相比,T组曲马多用量明显减少(P=0.007);3组产妇术后24 h内帕瑞昔布用量,以及瘙瘁、呕吐、发热、切口感染等不良反应相似(P>0.05).结论 0.25%左旋布比卡因及1.5 mg/kg曲马多切口浸润能有效降低全射麻醉剖宫产产妇苏醒期疼痛VAS、减少术后24 h内静脉曲马多用量,且不增加术后不良反应;与0.25%左旋布比卡因相比,曲马多切口浸润产妇术后曲马多用量更少.

  5. Feed delivery method affects the learning of feeding and competitive behavior in dairy heifers.

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    Greter, A M; Leslie, K E; Mason, G J; McBride, B W; DeVries, T J

    2010-08-01

    The objective of this study was to determine how different feeding methods may affect the learning of feeding, sorting, and competitive behavior of growing dairy heifers. We hypothesized that heifers previously fed a total mixed ration (TMR) would distribute their feeding time more evenly throughout the day, sort the new ration less, compete less for feed, maintain a more solid fecal consistency, and continue to grow rapidly compared with heifers previously fed a top-dressed ration (TDR). Thirty-two Holstein heifers (237.2+/-21.9 d of age) were divided into 8 groups of 4 and exposed to 1 of 2 treatments for 13 wk: 1) TMR or 2) TDR, with each containing 65% grass/alfalfa haylage and 35% textured concentrate on a dry matter (DM) basis. Following this feeding period, all heifers were switched to an unfamiliar TMR containing 56.1% grass/alfalfa haylage, 21.0% corn silage, 21.0% high-moisture corn, and 1.9% mineral supplement (DM basis) for 7 wk. Group DM intakes were recorded daily throughout the experiment. Feeding behavior, recorded using time-lapse video, and sorting behavior were measured for 7 d during wk 1, 4, and 7 after the dietary change. Feeding competition was measured on d 2, 4, and 6 of each recording week. Sorting activity was determined through particle size analysis of the fresh feed and orts. The particle size separator separated feed into 4 fractions (long, medium, short, and fine). Sorting of each fraction was calculated as actual intake expressed as a percentage of predicted intake. Animals were scored for fecal consistency twice weekly, using a scale from 1 (liquid) to 4 (solid). Heifers were weighed every 2 wk. Neither DM intake (9.0 kg/d) nor average daily gain (1.2 kg/d) differed between treatments. Sorting also did not differ between treatments. Heifers tended to spend more time feeding if they had previously been fed a TDR (198.8 vs. 186.8 min/d). As they had done before the dietary change, heifers previously fed the TDR spent more time at the

  6. 非医学需要剖宫产的危险因素研究%The study on risk factors for cesarean section for non-medical needs

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    徐桂莲

    2015-01-01

    Objective To understand the risk factors for non-medical needs of cesarean section,and to provide evidence for controling non-medical needs of cesarean section. Methods 1070 cases expectant mothers who were gestational age ≥ 24 weeks were collected as the study.They were divided into the vaginal delivery group (control group) and non-medical needs of cesarean group (experimental group) according to the final delivery metheod.Then case-control study was done to them. Results The Proportion of residents in the town,mental and high-income families of the experimental group ware higher than the control group. The pregnant women of the experimental group were more concerned about the safety, body, smart kid, et al. and they worried about the pain and sexual life after childbirth. The pregnant women of the control were more concerned about the cost, the natural physiological processes and the post-natal recovery. Multivariate analysis showed that:a more perfect ending cesarean section,vaginal birth would affect the sex life, the doctor recommended mode of delivery, vaginal birth were natural child birth and quick recovery, pregnancy intention of cesarean section had a significant impact for pregnant women to choose caesarean. Conclusion The cognitive behavioral deviations can lead to non-medical needs of prignant women select cesarean section. Therefore, we shoule strengthen the mission mode of delivery to the pregnant women, Cognitiving advantages and disadvantages of cesarean is the key of reducing the rate of cesarean and improving the quality of obstetric.%目的:了解非医学需要剖宫产的危险因素,为非医学需要剖宫产的控制提供依据。方法收集1070例孕周≥24周的待产产妇为研究对象,根据最终分娩方式分为阴道分娩组(对照组)与非医学需要剖宫产组(试验组),然后进行病例对照研究等统计学分析。结果试验组中镇居民、脑力劳动者、高收入家庭的比例高于对

  7. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus :A Case Report and Literature Review

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    Ibrahima Farikou

    2014-01-01

    Full Text Available Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures. Keywords: Femur fracture; Cesarean section; Fibroid; Breech presentation; Africa.

  8. Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

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    Kulkarni, Kalpana Rajendra; Naik, Amruta Girish; Deshpande, Sunetra Girish

    2016-01-01

    Background: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia. Aims: We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section. Methods: A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P Apgar score were better in group E than in group P delivered babies. Conclusion: Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery. PMID:27746565

  9. Dose-response study of spinal hyperbaric ropivacaine for cesarean section

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin-zhong; CHEN Hong; LOU Ai-fei; L(U) Chang-cheng

    2006-01-01

    Background: Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind,randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods: Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1~L2 vertebral interspace,then lumbar puncture was performed at the L3~L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective ifan upper sensory level to pin prick ofT7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results: ED50 (95% confidence interval)of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23~11.59) mg and ED95 (95% confidence interval) to be 15.39(13.81~23.59) mg. The maximum sensory block levels and the duration of motor block and the rate ofhypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion: The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

  10. Awareness and perceptions of Turkish women towards delivery methods

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    Şükrü Yıldız

    2014-06-01

    Full Text Available Objective: Our aim is to identify the causes of the women’s preferences of vaginal delivery vs. cesarean section and their attitudes for an elective cesarean section. Methods: 400 healthy woman who had applied for antenatal care were included in the study. A questionnaire which is consisted of 21 questions, focused on preference toward mode of delivery and the etiology of these preferences was conducted as a face to face interview. According to history of delivery methods, women have separated into three groups as; women have never given birth/nulliparous (group 1, women who had only vaginal deliveries (group 2, and women who had at least one cesarean deliveries/previous cesarean section (group 3. Results: Of the 400 women questioned, 348 (%87 opted for vaginal delivery, whereas only 52 (%13 opted for an elective caesarean delivery. Ratios of cesarean delivery preference is high in group 3 (%47.5 than group 1( %26 and 2 (%2.7 . Main reasons for vaginal delivery preference: feeling of less pain, fast and easy recovery and less bleeding and infection risc for mothers were the most common preference reasons among all 3 groups. The most common reasons for choosing caesarean delivery were: ‘more comfortable and easy’ in group 1 and ‘tubal ligation demand’ in group 3. ‘Less pain’ and ‘fear of tearing (episiotomy’ also other common reasons for choosing cesarean delivery among all 3 groups. Conclusion: In order to reduce the rate of implemented cesarean section, it is substantially important to encourage educated women and those who have experienced advanced maternal age for increasing the rate of vaginal delivery. J Clin Exp Invest 2014; 5 (2: 173-178

  11. Cesarean section and rate of subsequent stillbirth, miscarriage, and ectopic pregnancy: a Danish register-based cohort study.

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    Sinéad M O'Neill

    2014-07-01

    Full Text Available BACKGROUND: 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. METHODS AND FINDINGS: 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

  12. Características relacionadas ao primeiro e último parto por cesárea Characteristics related to the first and last cesarean delivery among women from a Campinas University Hospital

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    Arlete Maria dos Santos Fernandes

    2007-02-01

    Full Text Available OBJETIVO: Estudar a associação entre a primeira e a última cesáreas e laqueadura tubária; determinar tempo de vida reprodutivo após o primeiro parto. MÉTODOS: Foram entrevistadas 653 mulheres com pelo menos duas gestações, de fevereiro a outubro de 2001 em hospital universitário, 172 com primeira e 294 com última cesárea. As variáveis foram sociodemográficas, obstétricas e características do primeiro e último partos e da laqueadura. Utilizou-se análise bivariada, posteriormente regressão múltipla com cálculo do odds ratio ajustado. Mulheres laqueadas foram separadas em grupos de 25 a 44 e > 45 anos, distribuídas em percentis e aplicou-se o teste de Wilcoxon para análise da idade na laqueadura e tempo de vida reprodutivo após o último parto. O estudo teve aprovação do Comitê de Ética. RESULTADOS: Do total de mulheres, 89% tinham escolaridade 5 salários (OR=2,41, IC 95% 1,42 a 4,08 e idade no primeiro parto > 25 anos (OR=1,80, IC 95% 1,01 a 3,22. A idade média na laqueadura foi de 29 e 33,2 anos nas mulheres com 25 a 44 anos e > 45 anos, respectivamente (pOBJECTIVE: To study the association between first and last caesarian sections with tubal sterilization; to determine length of reproductive life after the first delivery. METHODS: From February to October 2001 in a university hospital, interviews were carried out with 653 women having had at least two pregnancies. Of these women, 172 had a first caesarian section; 294 had a last caesarian section. Variables were social demographic characteristics, obstetric history and characteristics of the first and last deliveries and tubal sterilization. Bivariate analysis was performed, followed by multiple regression analysis calculating the adjusted odds ratio. Women who had undergone tubal sterilization were divided into age groups of 25 to 44 and >45 years in a percentile distribution. The Wilcoxon test was used to analyze age at tubal sterilization and length of

  13. 剖宫产术后影响母乳喂养的因素及护理对策%Affect Factors of Breastfeeding and Nursing Countermeasures after cesarean section

    Institute of Scientific and Technical Information of China (English)

    杨凤先

    2013-01-01

    目的剖宫产后切口疼痛,活动不便;产妇喂奶姿势不正确以及产妇及家庭成员对母乳喂养知识缺乏等原因,使得相当一部分产妇对产后母乳喂养信心不足,态度不积极,影响了母乳喂养的实施。针对这种情况,我们采取了术前早宣教,术中早接触,术后早吸吮,选择舒适哺乳体位等护理对策,使97%的产妇成功实施了母乳喂养。%Because of incision pain after cesarean section, moving difficultly, uncorrect feeding posture and lack of knowledge of breastfeeding , that always make part of puerperant be short of confidenc and produce passive attitude. Aimed at this situation, we adopt preoperative early propagate, intraoperative premature contact , postoperative early suck and comfortable breastfeeding posture and so on which makes 97% of maternal realize breastfeeding sucessfully.

  14. Attempted vaginal birth after cesarean section: a multicenter comparison of outpatient prostaglandin E(2) gel with expectant management.

    Science.gov (United States)

    Rayburn; Lucas; Gittens; Goodwin; Baxi; Gall; Mostello; Heyl

    1998-07-01

    Objective: To compare the clinical effectiveness and safety of outpatient administration of an intracervical prostaglandin (PG) E(2) gel with expectant management for women with an unfavorable cervix who wish to attempt a vaginal birth after cesarean section.Study Design: This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score cesarean section did not differ (P =.68) with use of the gel (61, 42%) or with expectant therapy (48, 45%). The onset of active labor, the duration of labor among those delivering vaginally, and the 1-minute and 5-minute Apgar scores were not different between the two groups. No uterine rupture was apparent, and adverse effects during labor were as likely to occur in the two groups.Conclusions: Although its safety was confirmed for outpatient use and for persons with a prior cesarean delivery, intracervical prostaglandin E(2) gel did not improve the chance of a vaginal birth after a cesarean delivery.

  15. Could elective cesarean sections influence the birth weight of full-term infants?

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    Eddie Fernando Candido Murta

    Full Text Available CONTEXT AND OBJECTIVE: There are no studies on birth weights among full-term infants born by means of elective cesarean section. We aimed to study this in private and public hospitals. DESIGN AND SETTING: Retrospective study at Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. METHODS: Data were collected from the municipal medical birth register of Uberaba from January to December 2000. The data obtained (maternal age, type of delivery, number of prenatal care visits and birth weight, from full-term pregnancy from the university hospital (UH, which is a tertiary hospital that only attends patients within the National Health System (SUS, were compared with data from four private hospitals (PHs that attend health insurance plans and private patients. Student's t test, chi2 test and multiple logistic regression were used for statistical analysis, with the significance level set at p < 0.05. RESULTS: In the PHs, 1,100 out of 1,354 births (81.2% were by cesarean section and in the UH, 373 out of 1,332 (28%. Birth weight increased significantly in association with increasing numbers of prenatal care visits, except for cesarean section cases in PHs. Birth weights among vaginal delivery cases in PHs were greater than in the UH (p < 0.05, but this was not observed among cesarean section cases. Multiple logistic regression showed that there was greater risk of low birth weight in PHs (odds ratio: 2.33; 95% confidence interval: 1.19 to 4.55. CONCLUSION: Elective cesarean section performed in PHs may be associated with low birth weight among full-term infants.

  16. Haemorrhage during cesarean section for parturient with antiphospholipid syndrome

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    Shruti Shah

    2015-01-01

    Full Text Available This case describes a 39-year-old G3P2 parturient with a history of the antiphospholipid syndrome (APS, who experienced severe hemorrhage during her cesarean section (CS delivery of twins. At 36 weeks gestation, the patient was being treated prophylactically with Lovenox and acetylsalicyclic acid. In preparation for delivery, her medications were discontinued 24 h prior to admission. Due to breech presentation, the patient required delivery by CS. The patient received epidural anesthesia and successfully delivered two healthy babies. Following delivery, the patient became hypotensive and unresponsive and experienced uterine atony with profuse bleeding. Based on the patient′s clinical symptoms and history of APS, hemorrhage was suspected. Airway patency was immediately established using rapid sequence intubation, and the patient was placed under general anesthesia for removal of her atonic uterus. Following massive fluid resuscitation and correction of her coagulopathy, the patient stabilized and was transferred to the surgical intensive care unit. Four days later, she was discharged from the hospital without further complications.

  17. Administration routes affect the quality of immune responses: A cross-sectional evaluation of particulate antigen-delivery systems.

    Science.gov (United States)

    Mohanan, Deepa; Slütter, Bram; Henriksen-Lacey, Malou; Jiskoot, Wim; Bouwstra, Joke A; Perrie, Yvonne; Kündig, Thomas M; Gander, Bruno; Johansen, Pål

    2010-11-01

    Particulate delivery systems such as liposomes and polymeric nano- and microparticles are attracting great interest for developing new vaccines. Materials and formulation properties essential for this purpose have been extensively studied, but relatively little is known about the influence of the administration route of such delivery systems on the type and strength of immune response elicited. Thus, the present study aimed at elucidating the influence on the immune response when of immunising mice by different routes, such as the subcutaneous, intradermal, intramuscular, and intralymphatic routes with ovalbumin-loaded liposomes, N-trimethyl chitosan (TMC) nanoparticles, and poly(lactide-co-glycolide) (PLGA) microparticles, all with and without specifically selected immune-response modifiers. The results showed that the route of administration caused only minor differences in inducing an antibody response of the IgG1 subclass, and any such differences were abolished upon booster immunisation with the various adjuvanted and non-adjuvanted delivery systems. In contrast, the administration route strongly affected both the kinetics and magnitude of the IgG2a response. A single intralymphatic administration of all evaluated delivery systems induced a robust IgG2a response, whereas subcutaneous administration failed to elicit a substantial IgG2a response even after boosting, except with the adjuvanted nanoparticles. The intradermal and intramuscular routes generated intermediate IgG2a titers. The benefit of the intralymphatic administration route for eliciting a Th1-type response was confirmed in terms of IFN-gamma production of isolated and re-stimulated splenocytes from animals previously immunised with adjuvanted and non-adjuvanted liposomes as well as with adjuvanted microparticles. Altogether the results show that the IgG2a associated with Th1-type immune responses are sensitive to the route of administration, whereas IgG1 response associated with Th2-type immune

  18. Cesarean section in the People’s Republic of China: current perspectives

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    Feng XL

    2014-01-01

    Full Text Available Xing Lin Feng,1 Ying Wang,1 Lin An,2 Carine Ronsmans3 1Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People’s Republic of China; 2Department of Women, Children and Adolescent Health, School of Public Health, Peking University, Beijing, People’s Republic of China; 3Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England Objective: To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People’s Republic of China. Methods: Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. Findings: Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People’s Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People’s Republic of China. There was a lively debate on whether women’s preferences or providers’ distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People’s Republic of China’s health development approach – focusing on specialized care and marginalizing primary care – that is playing a role. Although 30 articles

  19. The effect of early post cesarean feeding on women’s satisfaction

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    Mohadeseh Adeli

    2010-06-01

    Full Text Available Objective: Satisfaction and postoperative care of women who undergo cesarean section is an important aspect and demand due attention. Hunger and thirst are frequently encountered after cesarean delivery. These increase distressing symptom and unsatisfaction. The aim of this paper was to detect the effect of early post cesarean feeding on mothers' satisfaction.Materials and methods: This study was a controlled trial. The research population was women delivering by cesarean section in Ommolbanin hospital, Mashhad, Iran. The samples consist of 82 women randomly assigned in two groups of study and control. The study group started oral fluids 4 hours after surgery, followed by regular diet after return of bowel sounds. The control group started oral fluids 12 hours after surgery and solid food was allowed after defecation. The groups were compared about satisfaction rate before discharge with VAS scale. Data were analyzed using chi-square, Fisher exact test, Kruskal walis test, t test and Mann Whitney.Results: The mean of women's satisfaction was 96.2 in early feed group and 56.7 in the control group. There was a statistically significant difference between two groups (p=0.000.Conclusion: this study showed that early feeding increases women's satisfaction. It is a safe, easy and enforceable intervention that can be usual in surgical units.

  20. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

    Directory of Open Access Journals (Sweden)

    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  1. Cesarean section rates in Italian regions: 1998-2002

    Directory of Open Access Journals (Sweden)

    Maria Pia Fantini

    2005-06-01

    Full Text Available

    Cesarean section (c-section rates have been increasing in many countries, and too frequently this rise does not seem to be justified by clinical grounds. To reduce c-section rates and achieve a proportion of 20% is among the goals of the Italian National Health Plan.

    In the following paper we provide an update on the distribution of rates amongst Italian regions and describe the association between regional hospital volumes and c-section rates. The national c-section rate increased from 31% in 1998 to 36% in 2002.

    The rates varied among regions and ranged from 20% in the Province of Bolzano to 56% in Campania. A significant association was observed between the regional hospital volumes for deliveries and c-section rates, regions with low hospital volumes performed more c-sections than high volume regions.

  2. 剖宫产术中麻黄碱与去氧肾上腺素对产妇和胎儿影响的比较%Comparison of effects in puerpera and fetus with ephedrine and phenylephrine during a cesarean delivery

    Institute of Scientific and Technical Information of China (English)

    王猛; 韩传宝; 钱燕宁

    2011-01-01

    ) for maintaining maternal blood pressure near baseline during spinal anesthesia for a cesarean delivery. Methods Ninety mature parturient women with single-embryo scheduled for an elective cesarean delivery under spinal anesthesia at our hospital during January - June 2010 were randomly divided into 3 groups (E, E + Ph and Ph, n =30 each). Group E received an infusion of ephedrine (ephedrine 4 g/L), Group E + Ph ephedrine plus phenylephrine (ephedrine 2 g/L + phenylephrine 25 mg/L) and Group Ph phenylephrine (phenylephrine 50 mg/L). The blood pressure was maintained near baseline by adjusting the infusion rate during anesthesia. The maternal blood pressure, heart rate and fetal heart rate were measured at the time points of 1, 3, 5 and 10 min, skin incision and uterine incision after injecting anesthetic into subarachnoid space. Immediately after delivery, maternal arterial, umbilical arterial and umbilical venous blood samples were withdrawn for the measurements of blood gases and plasma concentrations of lactate and glucose. Results The fetal heart rate of groups E and E + Ph significantly increased after infusion[5 min: ( 150 ± 10) times/min vs( 142 ± 13) times/min, ( 146 ± 10)times/min vs( 142 ± 9 ) times/min, both P < 0. 05]while those of group Ph had no significant changes [5 min: ( 143 ± 9 ) times/min vs ( 143 ± 6 ) times/min, P > 0. 05]. The incidence of fetal tachycardia in groups E and E + Ph was greater than that in group Ph. In group E, umbilical arterial and umbilical venous pH and base excess were lower than those in groups E + Ph and Ph [umbilical arterial: 7. 20 ± 0. 10 vs 7.27 ± 0. 05,7. 28 ± 0. 03, ( - 3. 1 ± 3. 1 ) mmol/L vs ( - 0. 9 ± 1.7 ) mmol/L、 ( - 0. 3 ± 1.7 ) mmol/L,umbilical venous:7.29 ±0. 09 vs 7. 34 ± 0. 03,7.34 ± 0. 03, ( - 3.3 ± 2. 9 ) mmol/L vs ( - 2. 0 ± 1.7 )mmol/L,(-0.9 ±1.5) mmol/L, all P < 0.05]. Umbilical arterial PCO2 and plasma concentrations of lactate and glucose in group E were greater than those in

  3. Youssef’s Syndrome following Cesarean Section

    Directory of Open Access Journals (Sweden)

    Ozer Birge

    2015-01-01

    Full Text Available Youssef’s syndrome is characterized by cyclic hematuria (menouria, absence of vaginal bleeding (amenorrhea, and urinary incontinence due to vesicouterine fistula (VUF, the least common of the urogynecological fistulas. Youssef’s syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature.

  4. Primary nonmedically indicated cesarean section ("section on request"): evidence based or modern vogue?

    Science.gov (United States)

    Grisaru, Sorina; Samueloff, Arnon

    2004-09-01

    Cesarean section, initially described as an emergency operative procedure for delivering moribund parturients, is now advocated by many as a routine technique with major advantages over vagi-nal delivery. In fact, it has been suggested that labor and vaginal delivery are no longer the desired consequence of pregnancy, a conclusion that reflects perceived medical advantages and patient and physician convenience. This article systematically reviews the various medical implications to the mother and infant of this procedure in the hope of facilitating a more rational approach to this spreading and controversial phenomenon.

  5. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    DEFF Research Database (Denmark)

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... pregnancies at term. RESULTS: Of Danish specialists in obstetrics and gynecology, 1.1% would prefer an elective cesarean section in an uncomplicated pregnancy at 37 weeks of gestation with fetal weight estimation of 3.0 kg. This rose to 22.5% when the fetal weight estimation was 4.5 kg at 37 weeks. The main...

  6. Effects of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean delivery%全程连续性助产护理对剖宫产术后阴道分娩产妇产痛程度及产程的影响

    Institute of Scientific and Technical Information of China (English)

    陈志芳; 吴宏荷; 孙晓琴; 吴迎春; 刘华华

    2016-01-01

    Objective:To investigate the effect of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean(VBAC)delivery.Methods:A total of 1 12 pregnant women who preferred VBAC were randomly divided into the control group and the observation group,with 56 cases in each group.The control group was given conventional nursing at different phase of ges-tation,and the observation group was applied with continuity midwifery care.The condition of labor pain and anxiety were assessed by visual analog pain scale(VAS)and anxiety visual analog scale(VAS-A).The natural births rate,incidence of fetal distress,postpartum hemorrhage rate,amount of bleeding and duration of labor were observed and compared between two groups.Results:The VAS,VAS-A at 24 h after delivery and amount of bleeding were significant lower in the observation group than those of the control group(P 0.05).The duration of first stage of labor,second stage of labor and total stage of labor were significant shorter in the observation group than those of the controls(P <0.05 or P <0.01 ).Conclusion:The continuity of midwifery care is effective in impro-ving negative emotion and reducing the duration of labor and amount of bleeding in puerpera undergoing VBAC delivery.%目的:探讨全程连续性助产护理对剖宫产术后阴道分娩(VBAC)产妇产痛程度及产程的影响。方法:VBAC 产妇112例随机分为对照组和观察组,各56例。对照组采用常规阶段式护理,观察组采用全程连续性助产护理。采用视觉模拟疼痛量表(VAS)和视觉模拟焦虑量表(VAS-A)分别评估两组产痛和焦虑状况;比较两组自然分娩率、胎儿窘迫率、产后出血率、出血量,以及两组中自然分娩产妇的产程。结果:观察组产后24 h 的 VAS 评分、VAS-A 评分及产后出血量显著低于对照组(P <0.05或 P <0.01)。两组自然分娩率、出血率及胎儿窘迫率无显著差异(P >0

  7. A conceptual model for factors affecting the relationship between supply chain integration and customer delivery performance

    OpenAIRE

    Peyman Ghafari Ashtiani; Elahe Bosak

    2013-01-01

    Supply chain is a widely used concept around the world. Nowadays, companies need to integrate their production processes, from the raw materials to the end-user. Supply chain management is a phenomenon that achieves this in a way that ensures customers get reliable and fast service and high quality products at the lowest possible cost. There is very limited and sporadic research on supply chain integration and how it affects supply chain performance. Therefore there is no real understanding o...

  8. Diagnosis and Treatment of Cesarean Scar Pregnancy%剖宫产术后子宫瘢痕妊娠的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    赵立武

    2011-01-01

    Cesarean scar pregnancy is one of the long-term complications of cesarean section, which mainly refers to implantation of gestational sac in the scar of a previous cesarean delivery, a rare form of ectopic pregnancy. The gestational sac is completely surrounded by myometrium and the fibrous tissue of the scar. But recently,the incidence of cesarean scar pregnancy has increased in paralled with the increasing incidence of cesarean delivery. Cesarean scar pregnancy may cause uterine rupture and uncontrollable vaginal bleeding, which may lead to loss of subsequent fertility, or even maternal death. Therefore the early diagnosis and treatment of cesarean scar pregnancy is very important. The article is a review of the diagnosis and treatment of cesarean scar pregnancy.%剖宫产术后子宫瘢痕妊娠是剖宫产术的一种远期并发症,主要是指妊娠囊种植在子宫瘢痕部位,其外周被子宫肌层和纤维组织包围,是一种罕见的异位妊娠.但是,由于近年来剖宫产率的不断提高,其发生率也有所增加.剖宫产术后子宫瘢痕处的妊娠可引起阴道大出血及子宫破裂,可以导致孕产妇生育能力丧失甚至孕产妇死亡.故早期诊断与治疗剖宫产术后子宫瘢痕妊娠是非常重要的,现就剖宫产术后子宫瘢痕妊娠的诊断与治疗予以综述.

  9. The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate

    Directory of Open Access Journals (Sweden)

    Kaori Michikata

    2016-01-01

    Full Text Available Objective. The improvement of the accuracy of fetal heart rate (FHR pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11% without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1 without increasing the cesarean birth rate due to nonreassuring FHR patterns.

  10. Arterial hemorrhage from cesarean scar: a rare cause of recurring massive uterine bleeding and successful surgical management.

    Science.gov (United States)

    Wang, Chun-Feng; Hu, Min

    2015-02-01

    Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully used in an attempt to control the bleeding. After she was transferred to our hospital, she had another episode of vaginal bleeding that was successfully managed with oxytocin and hemostatic. Diagnostic hysteroscopy performed under anesthesia revealed an abnormal transected artery in the cesarean section scar with a thrombus visible. In the treatment at the beginning of laparoscopic management, we adopted temporary bilateral uterine artery occlusion with titanium clips to prevent massive hemorrhage. Secondly, with the aid of hysteroscopy, the bleeding site was opened, and then the cesarean scar was wedge resected and stitched interruptedly with 1-0 absorbable sutures. The postoperative recovery was uneventful. It would seem that the worldwide use of cesarean section delivery may contribute to the risk of gynecologic disturbances including some unrecognized and complex conditions as seen in this case.

  11. Minimum effective local anesthetic dose of intrathecal hyperbaric ropivacaine and bupivacaine for cesarean section

    Institute of Scientific and Technical Information of China (English)

    GENG Zhi-yu; WANG Dong-xin; WU Xin-min

    2011-01-01

    Background Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for nonobstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.Methods We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine.The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.Results The intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45-10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00-8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95% Cl, 0.74-0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section.Conclusion Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.

  12. Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol.

    Science.gov (United States)

    Doebeli, A; Michel, E; Bettschart, R; Hartnack, S; Reichler, I M

    2013-11-01

    The effects of alfaxalone and propofol on neonatal vitality were studied in 22 bitches and 81 puppies after their use as anesthetic induction agents for emergency cesarean section. After assessment that surgery was indicated, bitches were randomly allocated to receive alfaxalone 1 to 2 mg/kg body weight or propofol 2 to 6 mg/kg body weight for anesthetic induction. Both drugs were administered intravenously to effect to allow endotracheal intubation, and anesthesia was maintained with isoflurane in oxygen. Neonatal vitality was assessed using a modified Apgar score that took into account heart rate, respiratory effort, reflex irritability, motility, and mucous membrane color (maximum score = 10); scores were assigned at 5, 15, and 60 minutes after delivery. Neither the number of puppies delivered nor the proportion of surviving puppies up to 3 months after delivery differed between groups. Anesthetic induction drug and time of scoring were associated with the Apgar score, but delivery time was not. Apgar scores in the alfaxalone group were greater than those in the propofol group at 5, 15, and 60 minutes after delivery; the overall estimated score difference between the groups was 3.3 (confidence interval 95%: 1.6-4.9; P < 0.001). In conclusion, both alfaxalone and propofol can be safely used for induction of anesthesia in bitches undergoing emergency cesarean section. Although puppy survival was similar after the use of these drugs, alfaxalone was associated with better neonatal vitality during the first 60 minutes after delivery.

  13. Ga-67 uptake post cesarean section

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, O.L.; Maisano, E.R.

    1984-02-01

    Gallium-67 distribution in normal patients is well known; it is also known that the concentration in some tissues may vary according to an individual physiologic stimulus. In this report, the case of a young woman is presented who was studied 15 days after a cesarean section and showed physiologic and pathologic Ga-67 accumulation.

  14. Cesarean scar pregnancy:a case report

    Institute of Scientific and Technical Information of China (English)

    李胜平; 汪溦; 唐小丽; 王瑛

    2004-01-01

    @@ Ranking among the rare forms of ectopic pregnancy,Cesarean scar pregnancy is a dangerous condition that can potentially lead to uterine rupture and severe hemorrhaging, or even a secondary abdominal pregnancy.Its early diagnosis can be challenging, and the optimal treatment has not been determined. This case report will be followed by a discussion of treatment options.

  15. Changes in vaginal breech delivery rates in a single large metropolitan area.

    LENUS (Irish Health Repository)

    Hehir, Mark P

    2012-06-01

    Vaginal breech delivery rates have been accepted widely to be in decline and the Term Breech Trial (TBT) has recommended delivery of a breech-presenting infant by elective cesarean section delivery. Our aim was to examine the rate of vaginal delivery of term breech pregnancies in the 8 years before and after the publication of the TBT.

  16. Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery

    OpenAIRE

    2015-01-01

    Key Clinical Message Based on our experience with seven deliveries (five cesarean and two vaginal deliveries) in five women with Moyamoya disease, we discussed the appropriate method of delivery and anesthesia for patients with Moyamoya disease. In certain conditions, women with Moyamoya disease can successfully undergo vaginal delivery.

  17. Clinical Analyses of 66 Cases of Mid-trimester Pregnancy Termination in Women with Prior Cesarean

    Institute of Scientific and Technical Information of China (English)

    Ping Peng; Xin-Yan Liu; Lei Li; Li Jin; Wei-Lin Chen

    2015-01-01

    Background:The rate of cesarean delivery has significantly increased in China in the last decade.Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history.The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.Methods:We conducted this retrospective study of women with prior cesarean section,who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital.The protocol was oral administration ofmifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages.The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy.Logistic regression was used to study the risk factors of uterine rupture.Results:The total rate of successful abortion was 93.9% (62/66).Four patients failed in induction,and one of them received curettage,whereas the other three experienced uterine rupture (4.5%).The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL.There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05).The LUS thickness of<3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio,94.0; 95% confidence interval 4.2-2106.1) after adjusted maternal age,gestational age,interdelivery interval and prior cesarean section.Severe bleeding that required transfusion occurred in one case (1.5%).Conclusions:Both the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid

  18. Clinical Analyses of 66 Cases of Mid-trimester Pregnancy Termination in Women with Prior Cesarean

    Directory of Open Access Journals (Sweden)

    Ping Peng

    2015-01-01

    Full Text Available Background: The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean. Methods: We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture. Results: The total rate of successful abortion was 93.9% (62/66. Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%. The successful rates of abortion were 85.7% (30/35 for women treated with mifepristone-misoprostol and 86.1% (31/36 for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm and the nonrupture group (7.0 ± 3.0 mm (P < 0.05. The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1 after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%. Conclusions: Both the mifepristone-misoprostol and the EL regimens were effective and safe for the

  19. Factors Affecting Nitrate Delivery to Streams from Shallow Ground Water in the North Carolina Coastal Plain

    Science.gov (United States)

    Harden, Stephen L.; Spruill, Timothy B.

    2008-01-01

    An analysis of data collected at five flow-path study sites between 1997 and 2006 was performed to identify the factors needed to formulate a comprehensive program, with a focus on nitrogen, for protecting ground water and surface water in the North Carolina Coastal Plain. Water-quality protection in the Coastal Plain requires the identification of factors that affect the transport of nutrients from recharge areas to streams through the shallow ground-water system. Some basins process or retain nitrogen more readily than others, and the factors that affect nitrogen processing and retention were the focus of this investigation to improve nutrient management in Coastal Plain streams and to reduce nutrient loads to coastal waters. Nitrate reduction in ground water was observed at all five flow-path study sites in the North Carolina Coastal Plain, although the extent of reduction at each site was influenced by various environmental, hydrogeologic, and geochemical factors. Denitrification was the most common factor responsible for decreases in nitrate along the ground-water flow paths. Specific factors, some of which affect denitrification rates, that appeared to influence ground-water nitrate concentrations along the flow paths or in the streams include soil drainage, presence or absence of riparian buffers, evapotranspiration, fertilizer use, ground-water recharge rates and residence times, aquifer properties, subsurface tile drainage, sources and amounts of organic matter, and hyporheic processes. The study data indicate that the nitrate-reducing capacity of the buffer zone combined with that of the hyporheic zone can substantially lower the amount of ground-water nitrate discharged to streams in agricultural settings of the North Carolina Coastal Plain. At the watershed scale, the effects of ground-water discharge on surface-water quality appear to be greatly influenced by streamflow conditions and the presence of extensive riparian vegetation. Streamflow statistics

  20. Abdominal Wall Desmoid Tumor in a Pregnant Woman and Cesarean Section Managment

    Directory of Open Access Journals (Sweden)

    M Mojibian

    2013-08-01

    Full Text Available Increased risk of sporadic desmoid tumor occurs in increased estrogen level (pregnancy and surgical incisions (abdominal and thorasic. The frequency of desmoid tumors in the general population is 2.4 to 4.3 cases. The case is 30 year old woman with history of previous cesarean section. In fourth month of pregnancy,ultrasonography revealed a 5×7 cm mass in lower segment of the uterus(leiomyoma. The tumor diameter was 20 cm in term gestation. The time of cesarean , incision of skin was done above the umbilicus and below the sternum and incision of uterus was done from fondus vertically down. After delivery, the mass which was separated from uterus and located in the abdominal wall was extracted. The histological investigation diagnosed a desmoid tumor.

  1. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

    Science.gov (United States)

    Dominguez-Bello, Maria G.; De Jesus-Laboy, Kassandra M.; Shen, Nan; Cox, Laura M.; Amir, Amnon; Gonzalez, Antonio; Bokulich, Nicholas A.; Song, Se Jin; Hoashi, Marina; Rivera-Vina, Juana I.; Mendez, Keimari; Knight, Rob; Clemente, Jose C.

    2016-01-01

    Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by Cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section are exposed to maternal vaginal fluids at birth. Similar to vaginally delivered babies, the gut, oral, and skin microbiome of these newborns during the first 30 days of life was enriched in vaginal bacteria underrepresented in unexposed C-section infants, albeit similarity to vaginally-delivered infants was higher in oral and skin than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section born infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section delivered babies. PMID:26828196

  2. Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

    DEFF Research Database (Denmark)

    Lidegaard, O; Jensen, L M; Weber, Tom

    1994-01-01

    Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... index (0-10) was calculated for each maternity unit according to its use of ante and intra partum fetal heart rate monitoring (FHM), hormone analysis (human placental lactogen (HPL) and/or estriol (O3)), fetal blood samples (scalp-pH), intrauterine catheter and umbilical cord-pH. Maternity units using......, and unplanned cesarean section rates in the eight regions were all without significant association to the perinatal mortality in the same regions. For births after the 35th completed week of gestation, this study could not confirm a relationship between different degrees of use of birth-related technologies...

  3. [The social and medicolegal aspects of maternal request or non-medically indicated cesarean section].

    Science.gov (United States)

    Fisher, Menachem; Shrem, David; Solt, Ido

    2013-07-01

    Patient choice cesarean or cesarean by maternal request/ demand is a controversial issue. The medical literature contains evidence based data on the medical aspects of patient choice cesarean, risks and benefits to the mother and her newborn. Fewer studies focused on the social and legal aspects of patient choice cesarean. This opinion paper discusses the social and legal aspects of patient choice cesarean.

  4. Parameters affecting the efficient delivery of mesoporous silica nanoparticle materials and gold nanorods into plant tissues by the biolistic method.

    Science.gov (United States)

    Martin-Ortigosa, Susana; Valenstein, Justin S; Sun, Wei; Moeller, Lorena; Fang, Ning; Trewyn, Brian G; Lin, Victor S-Y; Wang, Kan

    2012-02-06

    Applying nanotechnology to plant science requires efficient systems for the delivery of nanoparticles (NPs) to plant cells and tissues. The presence of a cell wall in plant cells makes it challenging to extend the NP delivery methods available for animal research. In this work, research is presented which establishes an efficient NP delivery system for plant tissues using the biolistic method. It is shown that the biolistic delivery of mesoporous silica nanoparticle (MSN) materials can be improved by increasing the density of MSNs through gold plating. Additionally, a DNA-coating protocol is used based on calcium chloride and spermidine for MSN and gold nanorods to enhance the NP-mediated DNA delivery. Furthermore, the drastic improvement of NP delivery is demonstrated when the particles are combined with 0.6 μm gold particles during bombardment. The methodology described provides a system for the efficient delivery of NPs into plant cells using the biolistic method.

  5. Maternal morbidity at first repeat cesarean: a sub-analysis of Interceed™ barrier placed at primary cesarean section

    Directory of Open Access Journals (Sweden)

    Chapa HO

    2013-02-01

    Full Text Available Hector O Chapa, Gonzalo Venegas Women's Specialty Center Dallas, Chapa Medical Consulting, Dallas, TX, USA Objective: The aim of this study was to compare maternal morbidity at repeat cesarean section (CS between use of a Gynecare Interceed™ Absorbable Adhesion Barrier (Gynecare, Somerville, NJ, USA and non-use at primary cesarean delivery. Design: This was a retrospective study of patients in whom an absorbable adhesion barrier was/was not used at their primary CS. Methods: Mean and excessive blood loss, the need for adhesiolysis, and postoperative fever were compared between those in whom a barrier was used at first CS and those in whom a barrier was not used. Visceral injury at repeat cesarean was also compared between the two groups. Results: No statistically significant difference in mean blood loss was noted between the two groups. However, significantly more patients in whom a barrier was not used had excessive intraoperative blood loss (barrier group, 1/53 [1.9%]; no-barrier group, 6/59 [10.1%]; P = 0.04. All seven cases of excessive blood loss had adhesiolysis. Significantly more patients in the no-barrier group underwent adhesiolysis (no-barrier group, 35/59 [59.3%]; barrier group, 7/53 [13.2%]; P = 0.03. No statistical difference in postoperative metritis was noted (1/59 [1.8%] in the barrier group and 1/59 [1.7%] in the no-barrier group; P = 0.99. Only one deserosalization of the bladder dome occurred in a patient in the no-barrier group. Conclusion: Those in whom a barrier was not used at primary CS were more likely to have adhesiolysis and excessive blood loss (>1250 mL at repeat CS. No significant difference in postoperative metritis/fever was noted between groups. Adhesion barrier at primary CS may reduce some aspects of maternal morbidity at repeat CS. Keywords: excessive blood loss, adhesiolysis, postoperative metritis, postoperative fever, visceral injury

  6. Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity

    OpenAIRE

    Erez O; Novack L; Kleitman-Meir V; Dukler D; Erez-Weiss I; Gotsch F; Mazor M

    2012-01-01

    Offer Erez1, Lena Novack2, Vered Kleitman-Meir1, Doron Dukler1, Idit Erez-Weiss3, Francesca Gotsch4, Moshe Mazor11Department of Obstetrics and Gynecology, Soroka University Medical Center, 2Department of Epidemiology, 3Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 4Obstetrics and Gynecology Departement, Policlinico GB Rossi Azienda Ospedaliera Universitaria Integrata Verona, ItalyPurpose: To determine the effects of vaginal ...

  7. Deliveries of Four Healthy Neonates after Multiple Myomectomy

    Directory of Open Access Journals (Sweden)

    Sanam Moradan

    2013-09-01

    Full Text Available Two main risk factors of uterine rupture during pregnancy or labor are prior uterine myomectomy and cesarean section. The risk of uterine scar rupture increases with increase of the size and numbers of incision. Severe complications may occur following uterine scar rupture. We report a case with prior large and multiple myomectomies, repeat cesarean sections, deliveries of 4 normal large, alive fetuses without any complication or uterine scars rupture.

  8. Cesarean scar pregnancy: diagnosis, management, and follow-up.

    Science.gov (United States)

    Uysal, Fatma; Uysal, Ahmet; Adam, Gürhan

    2013-07-01

    Cesarean scar pregnancy is a very rare form of pregnancy and a life-threatening situation. It has become an important and serious problem over the last 10 years, as a result of the worldwide increase in cesarean births. In this retrospective series, the diagnosis of cesarean scar pregnancy, management, treatment methods, risk factors, and possibility of subsequent normal pregnancy are discussed, and case descriptions are presented.

  9. Thromboprophylaxis after cesarean section: decision analysis.

    Science.gov (United States)

    Blondon, Marc

    2011-02-01

    Although venous thromboembolism (VTE) is the leading cause of maternal mortality in developed countries, the usefulness of preventive low-molecular weight heparin (LMWH) after cesarean section remains a matter of controversy. This article will review a recent decision analysis addressing this question, comparing a 7-day LMWH with none in this setting. Prophylaxis with LMWH yielded the highest quality-adjusted life expectancy, with a net gain of 1.5 days per treated patient. Sensitivity analyses showed the incidence of VTE after cesarean section and the haemorrhagic risk related to LMWH to be critical, at threshold values of 0.22% and 0.24% respectively. In the hypothetical cases created by the authors, LMWH was safe but only marginally more effective in women with no risk factors. With the addition of other risk factors, reductions in VTE greatly outnumbered the increase in major hemorrhages. This study highlights the need to assess the individual thrombotic risk in women after a cesarean section.

  10. Epidural anesthesia in repeated cesarean section.

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    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  11. Factors Affecting the Involvement of Day Centre Care Staff in the Delivery of Physiotherapy to Adults with Intellectual Disabilities: An Exploratory Study in One London Borough

    Science.gov (United States)

    Middleton, M. -J.; Kitchen, S. S.

    2008-01-01

    Background: Physiotherapists for adults with intellectual disabilities often work in day centres, relying on care staff to support programmes. This study investigates factors affecting physiotherapy delivery in 4 day centres in one London borough. Materials and Method: Semi-structured interviews were carried out with day centre care staff,…

  12. Application and nursing of ANH in combination with autologous blood transfusion in cesarean section delivery%急性等容血液稀释结合自体采血回输在剖宫产手术中的应用及护理

    Institute of Scientific and Technical Information of China (English)

    徐国梅; 王巧桂

    2016-01-01

    Objective To summarize the nursing cooperation in 28 cases of placenta praevia or dangerous cesarean section delivery in which acute normovolemic hemodilution ( ANH ) in combination with autologous blood transfusion were applied. Methods Before the surgery, autologous blood were collected from 28 cases with smooth anesthesia of ASA classⅠ-Ⅱparturients post general anesthesia, accompanying rapid intravenous infusion of the equivalent colloid solution. The vital sighs and fetal heart of parturients were comprehensive monitored during the collection procedure. When the blood loss reached to 400-600 ml or the hemoglobin ( Hb ) were below 80 g/L during the late phase of surgery, autologous blood was transfused toparturients. Results All 28 cases safely wentthrough the operative period with the mean operation time (69. 00 ±18.81) min, mean blood loss (988.00 ±382.65) ml and mean autologous blood transfusion (387.00 ± 122. 07) ml, respectively. Meanwhile, there were no adverse reactions of parturients during the process of collection and transfusion of autologous blood. Furthermore, the mean 1, 5 min Apgar score of newborn children ranged from 7 to 10. Conclusions ANH in combination with autologous blood transfusion,serving as an effective measure for blood conservation,plays a important role in dealing with postpartum hemorrhage and was not harmful to parturients or fetuses. ANH in combination with autologous blood transfusion, as a safe and efficient blood transfusion mode,attenuated the current shortage of blood for clinical use to a great extent.%目的 回顾性总结28例前置胎盘或凶险剖宫产手术中应用急性等容血液稀释(ANH)结合自体采血回输技术的护理配合.方法 对国际麻醉分级(ASA)Ⅰ~Ⅱ级的28名剖宫产产妇在麻醉平稳后,手术开始前采集自体血,同时快速静脉输注等量胶体液,在手术后期出血量达400~600 ml时或Hb<80 g/L时将自体血回输;采集过程中严密监测产

  13. [Vesical endometriosis after cesarean section: diagnostico-therapeutic aspects].

    Science.gov (United States)

    García González, J I; Extramiana Cameno, J; Esteban Calvo, J M; Díez Rodríguez, J M; Esteban Artiaga, R; Arrizabalaga Moreno, M; Paniagua Andrés, P

    1997-09-01

    Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.

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

    Directory of Open Access Journals (Sweden)

    Aluísio J D Barros

    2011-08-01

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

  15. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review.

    Science.gov (United States)

    Kehl, Sven; Weiss, Christel; Rath, Werner

    2016-09-01

    To systematically review the application of balloon catheters for cervical ripening and labor induction at term after previous cesarean section. All pregnancies at term with previous cesarean section were included when cervical ripening or labor induction was conducted with balloon catheters. MEDLINE, Cochrane database and bibliography of identified articles were searched for English language studies. Reviews and meta-analysis, randomized and non-randomized controlled trials, prospective and retrospective cohort studies as well as case-control studies were considered. A total of 48 potentially relevant studies were identified. The title and abstract were screened for eligibility and 32 articles were excluded. The remaining 16 publications included 1447 women (single-balloon catheter: n=1329, double-balloon catheter: n=118). There were no randomized controlled trials. Most of the trials were retrospective studies (n=10). The rate of uterine rupture after labor induction was low (n=18, 1.2%). Meta-analysis of studies comparing the risk of uterine rupture between labor induction and spontaneous onset of labor found a higher risk after induction (OR 2.45, 95%CI 1.34-4.47, NNH 186). The average rate of oxytocin application was 68.4%, and vaginal birth was achieved in 56.4%. The risk for cesarean delivery was higher when labor was induced (OR 2.63, 95%CI 2.24-3.10). Data on balloon catheters for labor induction after previous cesarean section are limited by small sample size and retrospective analyses. The present data show a moderately increased risk for uterine rupture (OR=2.45) compared to spontaneous onset of labor. However, for evidence based recommendations much more well-conducted trials are needed.

  16. Anesthetic management of patient with Sjogren's syndrome who underwent cesarean section: a case report

    Science.gov (United States)

    Kim, Na Eun; Lee, Jae Hyuk; Lee, Jun Yong

    2016-01-01

    Sjogren's syndrome is one of the most common autoimmune disorders and has a female predominance. Maternal circulating autoantibodies such as anti-Ro/SSA and anti-La/SSB antibodies can cause congenital heart block of fetus, and in severe case, emergency pacemaker implantation may be needed for neonate. Therefore, it is very important to understand maternal and fetal condition and pay attention to the status of the neonate during delivery. In this paper, we present a case of patient with Sjogren's syndrome who underwent cesarean section under spinal anesthesia. PMID:27274376

  17. Pregnancy outcomes, site of delivery, and community schisms in regions affected by the armed conflict in Chiapas, Mexico.

    Science.gov (United States)

    Brentlinger, Paula E; Sánchez-Pérez, Héctor Javier; Cedeño, Marcos Arana; Morales, Lic Guadalupe Vargas; Hernán, Miguel A; Micek, Mark A; Ford, Douglas

    2005-09-01

    The Zapatista armed conflict began in the state of Chiapas, Mexico, in 1994, and overlaps pre-existing local disputes about land, religion, and other issues. Related disruptions in access to and utilization of health services have been alleged to have compromised local health status, particularly in vulnerable subgroups such as indigenous women and infants. The study objective was to measure maternal and perinatal mortality ratios and utilization of pregnancy-related health services in the region affected by the Zapatista conflict, and to describe associations between these primary outcome measures, socioeconomic and demographic factors, and factors associated with inter-party and intra-community conflict. A cross-sectional, population-based survey was conducted in 46 communities in three regions. The study subjects were 1227 women, 13-49 years old, who had been pregnant during the preceding 2 years (1999-2001). Principal outcome measures were maternal and perinatal mortality, and site of delivery. Secondary analyses explored associations between primary outcomes and socioeconomic, demographic, and conflict-related factors. Most births (87.1%) occurred at home. The crude observed maternal and perinatal mortality ratios were 607/100,000 and 23.5/1000 live births, respectively. Those who died had difficulty accessing emergency obstetrical care. Both home birth and mortality were associated with descriptors of intra-community conflict. Observed maternal and perinatal mortality ratios were substantially higher than those officially reported for Mexico or Chiapas. Reduction of high reproductive mortality ratios will require attention to socioeconomic and conflict-related problems, in addition to improved access to emergency obstetrical services.

  18. Cesarean section on maternal request: a societal and professional failure and symptom of a much larger problem.

    Science.gov (United States)

    Klein, Michael C

    2012-12-01

    The scientific literature was silent about a relationship of pelvic floor, urinary, and fecal incontinence and sexual issues with mode of birth until 1993, when Sultan et al's impressive rectal ultrasound studies were published. They showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section. These findings helped to pioneer a new area of research, ultimately leading to increasing support among health professionals and the public that maternal choice of cesarean delivery could be justified-even that maternal choice and autonomous decision-making trump other considerations, including evidence. A growing number of birth practitioners are choosing cesarean section for themselves-usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues. Behind this choice is a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth. Cesarean section on maternal request is a complex issue based on fear and misinformation that is a symptom of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal. Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work-it requires a complete refit.

  19. Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates

    DEFF Research Database (Denmark)

    Henriksen, T B; Sperling, Lene; Hedegaard, M

    1994-01-01

    OBJECTIVE: Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indication...

  20. The Effect of Modes of Delivery on Infants' Feeding Practices

    Directory of Open Access Journals (Sweden)

    Gulshan Saeed

    2011-06-01

    Full Text Available Breast feeding has a great impact on the infant morbidity and mortality. According to Pakistan Demographic and Health survey (PDHS infant mortality rate is 78 deaths per 1,000 live births. World Health Organization recommends that exclusive breast feeding for six months can decrease infant mortality rate by one-third. The objective of the study was to find out how the mode of delivery had impact on the practice of breast feeding. Data were collected for 2500 consecutive patients during a period of two years, and it was seen that maternal initiative to breast feed was low and problems with lactation were much more in cases delivering their babies via cesarean sections than those delivering theirs by normal delivery. Vaginal and cesarean section deliveries took place in 54% and 46% of the case, respectively. Thirty percent of the women studied felt that they had no problems regarding breastfeeding, but 70% of them had some sort of problems with breastfeeding their babies. When the women were matched for the mode of delivery, 58% of women who had breastfeeding problems belonged to the cesarean delivery group and 42% of complaining mothers were from women with normal delivery. The relative risk of having problems with breastfeeding for women subjected to cesarean was 1.38 and the odds ratio was 0.61. The findings of the present study indicate that more in depth counseling sessions are required for women undergoing operative delivery to improve breast feeding among them

  1. Cesarean section distribution in midwifery institutions in Hunan Province in 2012%2012年湖南省助产机构剖宫产率分布情况分析

    Institute of Scientific and Technical Information of China (English)

    陈小英; 吴颖岚; 王华

    2016-01-01

    Objective To analyze the distribution characteristics of cesarean section in midwifery institutions in 2012 (3 + 1) in Hunan province and provide some references for controlling cesarean section.Methods The distribution of cesarean delivery in 2012 (3 + 1) in Hunan province were retrospectively analyzed.Results The peaks of cesarean delivery rate in the midwifery institutions most appeared in the first quarter in 2012.That the county or township institutions hadn't properly control cesarean delivery played a key role in cesarean section rate staying at a high level.Conclusions Strengthening the control regulation and midwives training of county or township midwifery organizations will be the breakthrough for controlling cesarean delivery rate in our province.%目的 分析湖南省2012年度(3+1)模式各级助产机构剖宫产率分布情况,为探讨控制剖宫产率的有效途径提供科学依据.方法 对湖南省2012年(3+1)模式各市州剖宫产率分布情况进行回顾性分析.结果 2012年度各市州助产机构剖宫产率峰值大部分出现在一季度;剖宫产率居高不下的关键在于县级、乡级助产机构剖宫产率的控制不当.结论 加强对县级、乡级助产机构剖宫产率控制的监管及助产人员培训,将是我省控制剖宫产率的突破口.

  2. Fetomaternal hemorrhage in women undergoing elective cesarean section

    DEFF Research Database (Denmark)

    Perslev, Anette; Jørgensen, Finn Stener; Nielsen, Leif Kofoed;

    2010-01-01

    Objective. To investigate the degree of fetomaternal hemorrhage (FMH) caused by elective cesarean section. Design. Descriptive study. Settings. University Hospitals in Copenhagen, Denmark. Population. Women scheduled for elective cesarean section, in the period September 2007 to January 2009......, at the Department of Gynecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Denmark. Methods. Two maternal blood samples were taken, the first before cesarean section and the second immediately after. Both samples were analyzed at the Blood Bank, Rigshospitalet, Copenhagen, for the presence...... of fetal red blood cells (fRBCs) using flow cytometry. FMH associated with cesarean section was defined as the difference between the volumes of fRBCs in the two samples. Main Outcome Measures. The frequency and volume of FMH caused by elective cesarean section. Results. 207 women were included...

  3. SUCCENTURIATE PLACENTA: AN INCIDENTAL FINDING DURING CESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Unmesh

    2015-12-01

    Full Text Available A 30 years, 4th Gravida with 3 abortions with history of 8 months amenorrhea was admitted to the hospital with chief complaints of leaking per vagina since 4 hours and was not associated with pain abdomen or bleeding per vaginum. Perceiving decreased fetal movements since 6 hours. She had 3 previous missed abortions followed by D and E. In the present pregnancy, gestational age was 32 weeks at the time of admission. Patient’s general condition was stable, all other investigation were found to be normal her pulse was 100 beats/min, tachycardia present, BP -100/70mmHg. On obstetric examination, uterus was 30 weeks size, 1-2 contraction lasting for 15- 20 seconds, Breech presentation, FHR was 124 per minute, regular, decreased liquor clinically. On vulvovaginal examination- Frank leaking per vagina present. Ultrasound showed single live intrauterine pregnancy of 29 weeks 3 days with breech presentation with oligohydramnios, Placenta was at fundal region, Biophysical profile was 6/8, FHR 124 bpm. After taking high risk consent in view of fetal prematurity, patient was posted for Emergency LSCS. And extracted a single live preterm female baby of weight of 1.45 kg by breech. During the cesarean section, on opening abdomen lower segment was found to be congested with torturous vessels. So we suspected missed diagnosis of placenta previa. After delivery of the baby, we found succenturiate lobe of the placenta occupying lower uterine segment with vessels running across the membrane.

  4. Tranexamic acid reduces blood loss during and after cesarean section:A double blinded, randomized, controlled trial

    Institute of Scientific and Technical Information of China (English)

    Amr H Yehia; Magdy H Koleib; Ibrahim A Abdelazim; Ahmed Atik

    2014-01-01

    Objective:To evaluate the efficacy of tranexamic acid in reduction of blood loss during and after cesarean section.Methods:Women included in the current double blinded, randomized, controlled trial were recruited from women attending for elective cesarean section and randomized into two groups; study group: received tranexamic acid with induction of anesthesia plus10IU of oxytocin injection after delivery of the baby.Control group: received only oxytocin 10IU injection after delivery of the baby.Results:Twenty four hours post-operative hemoglobin level was significantly higher in study group(11.2±1.5 mg/dL) compared to control(9.6±1.2 mg/dL), also24 hours post-operative hematocrit was significantly higher in study group(30.2±6.6) compared to control(29.2±2.8).Calculated total blood loss from placental delivery till end of cesarean section was significantly less in study group compared to control(369.5±198.0 versus606.8±193.0 mL; respectively), also, calculated vaginal bleeding during first6 hours post-operative was significantly less in study group compared to control(85.0±30.7 mL versus130.8±49.3 mL, respectively).The incidence of post-partum hemorrhage was significantly less in study group compared to control(31.1% versus63.2%; respectively), also the need for iron replacement therapy was significantly less frequent in study group compared to control(0.9% versus6.6%, respectively). Conclusions:Tranexamic acid can be used safely to reduce blood loss during cesarean section. Reduced blood loss after tranexamic acid was associated with improvement of post-operative hemoglobin, hematocrit and with reduction of post-partum need for iron replacement.

  5. Expectant management of heterotopic cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    BAI Xiao-xia; GAO Hui-juan; YANG Xiao-fu; DONG Ming-yue; ZHU Yi-min

    2012-01-01

    Background Heterotopic cesarean scar pregnancy (HCSP) is a very rare but life-threatening entity and there is no optimal management strategy.Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital.@@Methods A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8+4 weeks of gestation.@@Results The patient had mild to moderate bleeding during close monitoring.Three days later,speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage.A healthy male baby was delivered by cesarean section at gestational age of 36+4 weeks.@@Conclusions The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy,when applied under supportive management and with available emergency surgery facilities.

  6. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

    Science.gov (United States)

    Pan, I-Jen; Yi, Hsiao-ye

    2013-05-01

    To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

  7. Analysis of intracranial hemorrhage grade in preterm singleton pregnancies delivered vaginally or by cesarean section

    Directory of Open Access Journals (Sweden)

    Ljuština Saša

    2013-01-01

    Full Text Available Background/Aim. Preterm birth is the leading cause of neonatal mortality. Periventricular hemorrhage-intraventricular hemorrhage (PVH-IVH remains a significant cause of both morbidity and mortality in infants prematurely born. The aim of the study was to evaluate the perinatal outcome regarding IVH of premature babies according to the mode of delivery. Methods. A total of 126 women in preterm singleton pregnancies with vertex presentation and 126 neonates weighted from 750 g to 1,500 g at birth were enrolled. The outcomes of 64 neonates born vaginally were compared to 62 neonates born by cesarean section. Results. There was no significant difference in the incidence of IVH among both groups. Conclusion. Our data is consistent with the hypothesis that the mode of delivery does not influence IVH and consenquently perinatal outcome in preterm neonates.

  8. Effects of Bifidobacterium Breve Feeding Strategy and Delivery Modes on Experimental Allergic Rhinitis Mice.

    Directory of Open Access Journals (Sweden)

    Jian-jun Ren

    Full Text Available Different delivery modes may affect the susceptibility to allergic diseases. It is still unknown whether early intervention with probiotics would counteract this effect.The effect of different delivery modes on immune status and nasal symptoms was investigated on established allergic rhinitis (AR mouse model. In addition, the immunoregulatory effects and mechanisms of different feeding manners with Bifidobacterium breve(B. breve were examined.Live lyophilized B. breve was orally administered to BALB/c mice born via vaginal delivery(VD or cesarean delivery (CD for 8 consecutive weeks, after which they were sensitized by ovalbumin(OVA to establish experimental AR. Nasal symptoms, serum immunoglobulins, cytokines, splenic percentages of CD4(+CD25(+Foxp3(+ regulatory T(Treg cells and nasal eosinophil infiltration were evaluated.Compared with VD mice, mice delivered via CD demonstrated more serious nasal symptoms, higher concentrations of OVA-specific immunoglobulin (Ig E, more nasal eosinophils and lower percentages of splenic CD4(+CD25(+Foxp3(+Treg cells after establishing experimental AR. These parameters were reversed by administering B. breves hortly after birth. However, the effect of B. breve did not differ between different delivery modes.CD aggravates the nasal symptoms of AR mice compared to VD. This is the first report that oral administration of B. breve shortly after birth can significantly alleviate the symptoms of AR mice born via both deliveries, probably via activation of the regulatory capacity of CD4(+CD25(+Foxp3(+Treg cells.

  9. Fetomaternal hemorrhage in women undergoing elective cesarean section

    DEFF Research Database (Denmark)

    Perslev, Anette; Jørgensen, Finn Stener; Nielsen, Leif Kofoed;

    2010-01-01

    , at the Department of Gynecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Denmark. Methods. Two maternal blood samples were taken, the first before cesarean section and the second immediately after. Both samples were analyzed at the Blood Bank, Rigshospitalet, Copenhagen, for the presence...... of fetal red blood cells (fRBCs) using flow cytometry. FMH associated with cesarean section was defined as the difference between the volumes of fRBCs in the two samples. Main Outcome Measures. The frequency and volume of FMH caused by elective cesarean section. Results. 207 women were included...

  10. Effects of acupressure on progress of labor and cesarean section rate: randomized clinical trial.

    Science.gov (United States)

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2015-01-01

    OBJECTIVE To analyze the effects of acupressure at the SP6 point on labor duration and cesarean section rates in parturients served in a public maternity hospital. METHODS This controlled, randomized, double-blind, pragmatic clinical trial involved 156 participants with gestational age ≥ 37 weeks, cervical dilation ≥ 4 cm, and ≥ 2 contractions in 10 min. The women were randomly divided into an acupressure, placebo, or control group at a university hospital in an inland city in the state of Sao Paulo, Brazil, in 2013. Acupressure was applied to the SP6 point during contractions for 20 min. RESULTS The average labor duration was significantly different between the SP6 acupressure group [221.5 min (SD = 162.4)] versus placebo [397.9 min (SD = 265.6)] and versus control [381.9 min (SD = 358.3)] (p = 0.0047); however, the groups were similar regarding the cesarean section rates (p = 0.2526) and Apgar scores in the first minute (p = 0.9542) and the fifth minute (p = 0.7218) of life of the neonate. CONCLUSIONS The SP6 acupressure point proved to be a complementary measure to induce labor and may shorten the labor duration without causing adverse effects to the mother or the newborn. However, it did not affect the cesarean section rate.

  11. Maternal demand for cesarean section: perception and willingness to request by Nigerian antenatal clients

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    Okonkwo NS

    2012-03-01

    likely than those at the SHC or the PHCs to request cesarean section and to favor a woman’s right of autonomy to choose her mode of delivery.Conclusion: The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.Keywords: maternal demand cesarean section, perception, antenatal, clients, Nigeria

  12. Do targeted written comments and the rubric method of delivery affect performance on future human physiology laboratory reports?

    Science.gov (United States)

    Clayton, Zachary S; Wilds, Gabriel P; Mangum, Joshua E; Hocker, Austin D; Dawson, Sierra M

    2016-09-01

    We investigated how students performed on weekly two-page laboratory reports based on whether the grading rubric was provided to the student electronically or in paper form and the inclusion of one- to two-sentence targeted comments. Subjects were registered for a 289-student, third-year human physiology class with laboratory and were randomized into four groups related to rubric delivery and targeted comments. All students received feedback via the same detailed grading rubric. At the end of the term, subjects provided consent and a self-assessment of their rubric viewing rate and preferences. There were no differences in laboratory report scores between groups (P = 0.86), although scores did improve over time (P < 0.01). Students receiving targeted comments self-reported viewing their rubric more often than students that received no comments (P = 0.02), but the viewing rate was independent of the rubric delivery method (P = 0.15). Subjects with high rubric viewing rates did not have higher laboratory report grades than subjects with low viewing rates (P = 0.64). When asked about their preference for the future, 43% of respondents preferred the same method again (electronic or paper rubric) and 25% had no preference. We conclude that although student laboratory report grades improved over time, the rate and degree of improvement were not related to rubric delivery method or to the inclusion of targeted comments.

  13. Two Cases of Tuberculous Meningitis after Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    This article revealed two valuable case reports about two young females suffered tuberculous meningitis after cesarean section. After antituberculous therapy, the condition of one patient improved and the other one became deteriorated.

  14. [IUD insertion during cesarean section and its most frequent complications].

    Science.gov (United States)

    Alvarez Pelayo, J; Borbolla Sala, M E

    1994-11-01

    A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction.

  15. TAP Catheters Versus Intrathecal Morphine for Cesarean Section

    Science.gov (United States)

    2012-05-07

    Abdominal Muscles/Ultrasonography; Adult; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Cesarean Section; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

  16. Estado neurológico e cardiorrespiratório de filhotes de cães nascidos de parto normal ou de cesariana sob anestesia geral inalatória com sevofluorano Neurological and cardiocirculatory investigation of dog neonates born by normal parturition or cesarean section on sevoflurane inhalation anesthesia

    Directory of Open Access Journals (Sweden)

    Daniela Tozadore Gabas

    2006-10-01

    Full Text Available A anestesia obstétrica possibilita um procedimento mais seguro para a mãe e para os fetos. Em medicina veterinária, no entanto, a literatura científica a respeito do assunto é deficiente. Este trabalho teve como objetivo avaliar o grau de depressão neurológica, hemodinâmica e respiratória fetais provocado pelo agente anestésico, em que as mães foram submetidas ao parto normal ou à cesariana, utilizando-se sevofluorano como agente de manutenção anestésica, comparando-o com o parto normal. Foram realizados seis partos normais (GN e seis cesarianas (GC, avaliando-se um total de 36 filhotes. As cesarianas foram realizadas utilizando-se acepromazina, propofol e sevofluorano (GC e os neonatos foram avaliados clinicamente ao primeiro, quinto e décimo minuto de nascimento, nos dois grupos. Observou-se maior depressão respiratória nos filhotes nascidos de cesariana. Contudo, apesar dessa depressão, o protocolo anestésico empregado não comprometeu de maneira importante a viabilidade e a saúde das mães e dos filhotes, demonstrando ser seguro em cadelas gestantes.The obstetric anesthesia must be safe for mother and puppies and about this, the literature is pour. This study was aimed at evaluating the neurological, hemodinamic and respiratory changes in neonates provoked by the anestesic agent as a result of normal parturition and cesarean section employing sevoflurane as the maintenance agent. Six deliveries (GN and six cesarean sections (GC were performed. The cesarean sections were performed under general anesthesia using acepromazina maleate, propofol and sevoflurane. Thirty six puppies were evaluated and the neurologic reflexes were worse in that were born through cesarean section. However, we concluded that despite the anesthetic depression, the protocol employed didn,t affect in any important way the viability and health of the mothers and puppies, being suitable for cesarean sections.

  17. The use of midwives as first assistants in cesarean section.

    Science.gov (United States)

    Marks; Thacher; Camargo

    1998-07-01

    Introduction: In 1997, medical insurance gives limited financial reimbursement to physicians who first assist cesarean sections. Therefore, a formal program was developed at our community teaching hospital using midwives in place of physicians as first assistant in cesarean section. Midwives on the midwifery service were taught the principles and procedures of obstetrical anesthesia, anatomy, and physiology of the gravid abdomen.A team approach using obstetrician/gynecologist, anesthesiologist, midwives, and operating nurses performed the tracking in a 1-day course. A 28-minute video was developed to depict the role of the midwife as first assistant. Additionally, the principles of operation room set-up and instrumentation were taught.Result: All 24 midwives on the midwifery service were involved in the teaching of first assisting an attending obstetrician. After taking the course, nurse-midwives received formal certification from the department of obstetrics and gynecology and were approved by risk management. They also received clinical privileges outlining these guidelines. Their malpractice rates have not increased. The time to complete a cesarean section has not increased for the physician, and an emergency cesarean section is no longer delayed by waiting for an assistant to arrive. Patient satisfaction has increased because of decreased waiting time for a cesarean section and increased familiarity with the entire operating team.Discussion: Midwives can be trained to first assist the obstetrician/gynecologist in a cesarean section. Since the duration of a cesarean section is not prolonged, the patient will not experience increased blood loss or infection secondary to a prolonged procedure. The patient is more relaxed since they know that their provider during labor is also one of their surgeons for the cesarean section.

  18. Cold therapy in the management of postoperative cesarean section pain.

    Science.gov (United States)

    Amin-Hanjani, S; Corcoran, J; Chatwani, A

    1992-07-01

    Sixty-two patients were randomized to receive either localized cold therapy to the cesarean section incision or routine postoperative care. Evaluation of the amount of analgesia requested, infection rate, and length of hospital stay did not show a significant difference between the two groups. There is no objective evidence to show that the use of cold therapy in postoperative cesarean section pain relief is beneficial.

  19. Cancer antigen 125 after delivery in women with a normal pregnancy

    DEFF Research Database (Denmark)

    Szecsi, Pal B; Andersen, Malene R; Bjørngaard, Brian;

    2014-01-01

    OBJECTIVE: To establish reference intervals for cancer antigen 125 (CA-125) in women with expected normal pregnancy, delivery, and early postpartum period. DESIGN: Prospective observational study. SETTING: Department of Clinical Biochemistry and Obstetrics, Copenhagen University Hospital, Gentofte......, Denmark. POPULATION: Eight hundred and one women with expected normal pregnancies were investigated. Of these, 640 delivered vaginally, 82 by emergency cesarean section, and 79 by elective cesarean section; 720 women had uncomplicated pregnancies. METHODS: Samples were collected at gestational weeks 13...

  20. Breech at term--mode of delivery? A register-based study

    DEFF Research Database (Denmark)

    1995-01-01

    . Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total...... of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores......) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply...

  1. Dose de bupivacaína subaracnóidea necessária para cesariana é semelhante em mulheres obesas e com peso normal Las dosis de bupivacaína intratecal necesarias para cesáreas en mujeres obesas son similares a las usadas en mujeres con peso normal Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women

    Directory of Open Access Journals (Sweden)

    Yung Lee

    2009-12-01

    mujeres obesas y con peso normal. MÉTODO: Evaluamos embarazadas con peso normal (IMC 30 kg.m-2, con feto único a término, sometidas a cesáreas de elección. Ese fue un estudio mono ciego y de ubicación secuencial, usando el método up-down (modificado por la regla de Narayana. Todas las pacientes recibieron bloqueo combinado raquiepidural con administración intratecal de dosis variables de bupivacaína hiperbárica a 0.75% más 10 µg de fentanil y 100 µg de morfina. La primera paciente recibió 9 mg de bupivacaína. La anestesia se suplementó cuando fue necesario, a través de un catéter epidural. El éxito de la anestesia, definido como bloqueo sensitivo hasta por lo menos T6, sin necesidad de anestesia suplementaria, fue el objetivo primario. La ED95 para un resultado satisfactorio fue determinada por un modelo logístico sin transformación logarítmica de las dosis. RESULTADOS: Veinte y cuarto embarazadas con peso normal y dieciséis embarazadas obesas participaron en este estudio. La ED95 estimada para todas las pacientes fue de 12,92 mg (IC 95%: 11,49 a 34,77. La ED95 estimada para las embarazadas con peso normal y las embarazadas obesas fue similar, 12,78 mg (IC 95%: 10,75 a + infinito y 11,86 mg (CI 95%: 11,31 a 15,61, respectivamente. CONCLUSIONES: Si la anestesia raquídea con inyección única es utilizada en cesáreas, las pacientes con peso normal y obesas deben recibir dosis parecidas de bupivacaína hiperbárica. A pesar de que no fuimos capaces de determinar con exactitud la ED95 en nuestro estudio, sí que podemos afirmar que es de por lo menos 11,49 mg.BACKGROUND AND OBJECTIVES: The effect of BMI on the spread of intrathecal bupivacaine is controversial. This study assessed the ED95 of intrathecal bupivacaine for elective cesarean delivery in obese and normal weight women. METHODS: We studied normal weight (BMI 30 kg.m-2 women with singleton term pregnancies undergoing elective cesarean delivery. The study was conducted as a single blinded, up

  2. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature.

    Science.gov (United States)

    Porcaro, Antonio B; Zicari, Marianna; Zecchini Antoniolli, Stefano; Pianon, Romeo; Monaco, Carmelo; Migliorini, Filippo; Longo, Michele; Comunale, Luigi

    2002-01-01

    Herein we report on 1 more case of vesicouterine fistula following cesarean section with review and update of the literature concerning this unusual topic. The disease presented with vaginal urinary leakage, cyclic hematuria and amenorrhea. The fistula was successfully repaired by delayed surgery. Actually, all over the world the prevalence of the disease is increasing for the frequent use of the cesarean section. Fistulas may develop immediately after a cesarean section, manifest in the late puerperium or occur after repeated procedures. Spontaneous healing is reported in 5% of cases. Vesicouterine fistulas present with vaginal urinary leakage, cyclic hematuira (menouria), amenorrhea, infertility, and first trimester abortions. The diagnosis is ruled out by showing the fistulous track between bladder and uterus as well as by excluding other more frequent urogenital fistulas. The disease treatment options include conservative treatment as well as surgical repair. Rarely, patients refuse any kind of treatment because of the benignity of symptoms and prognosis of the disease. Conservative management by bladder catheterization for at least 4-8 weeks is indicated when the fistula is discoveredjust after delivery since there is good chance for spontaneous closure of the fistulous track. Hormonal management should be tried in women presenting with Youssef's syndrome. Surgery is the maninstay and definitive treatment of vesicouterine fistulas after cesarean section. Patients scheduled for surgery should undergo pretreatment of urinary tract infections. Surgical repair of vesico-uterine fistulas are performed by different approaches which include the vaginal, transvesical-retroperitoneal and transperitoneal access which is considered the most effective with the lowest relapse rate. Recently, laparoscopy has been proposed as a valid option for repairing vesicouterine fistulas. The endoscopic treatment may be effective in treating small vesicouterine fistulas. The pregnancy

  3. Trends in the modes of delivery and their impact on perinatal mortality rates

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    Duarte Geraldo

    2004-01-01

    Full Text Available OBJECTIVE: To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS: A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS: Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0?, early neonatal mortality (from 30.6 to 9.0?, and perinatal mortality (from 56.4 to 19.3?. CONCLUSIONS: The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.

  4. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

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    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  5. An Intrauterine Device Detected in Ovary during Cesarean Section: A Case Report

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    Fazil Avci

    2015-01-01

    Full Text Available The copper T Intrauterine Device is a common method of contraception used throughout the world. Intrauterine or ectopic pregnancies may be caused by complications with an IUD. The aim of this study was to present an ongoing term pregnancy with a copper T extrauterine device localized in the ovary. Assessment of the clinical features of a term pregnancy complicated by an IUD. A 32-year-old female was fitted with a copper T IUD in October 2009. She was hospitalized due to a term pregnancy with recurrent cesarean history and had the IUD where was not known. Laboratory values and fetal biometry were normal. A viable normal 3750 g male infant with 8/9 Apgar score was delivered by cesarean section without any abnormalities. In pelvic exploration, the IUD was localized in the left ovary and removed. Mother and infant were discharged without any complications after 24 hours. Counselling should be provided about the potential risks of an ongoing pregnancy for all patients with the complication of copper T in place. It is rare to have a successful delivery of a term normal pregnancy complicated with an IUD.

  6. [Reflections on the excessive rates of cesareans in Brazil and the empowerment of women].

    Science.gov (United States)

    Leão, Míriam Rêgo de Castro; Riesco, Maria Luiza Gonzalez; Schneck, Camilla Alexsandra; Angelo, Margareth

    2013-08-01

    The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.

  7. Effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery

    Science.gov (United States)

    Navaee, Maryam; Abedian, Zahra

    2015-01-01

    Background: The number of women who select cesarean section due to fear of childbirth has increased. Role play education seems to be a helpful method to remove or reduce the fear of childbirth. Therefore, this study aimed to investigate the effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery. Materials and Methods: In this blind clinical trial, 67 primiparous women with natural pregnancy at 34–36 weeks of gestational age and with no indication of cesarean section were selected from the health care centers in Mashhad. They were randomly assigned to two groups who underwent pre-test and post-test with the help of delivery attitude questionnaire to investigate their fear of childbirth and a researcher-made pregnant women's decision investigation questionnaire. Education through role play was conducted in the form of three scenarios during seven stages. The findings were analyzed by Fisher's exact test and independent t-test through SPSS. Results: The two groups were significantly different concerning the fear of childbirth after the intervention (P = 0.007), and the fear score showed a higher reduction in the role play group compared to the lecture group. There was a significant difference between the two groups concerning the reduction of elective cesarean section and the decision on the mode of delivery at the time of admission in the labor room (P = 0.000). About 75% in the lecture group and 100% in the role play group selected natural delivery. Conclusions: In the present study, the effect of role play was more in making a decision on natural delivery, reducing the fear of childbirth, and reducing the rate of elective cesarean section. It is suggested to use role play method to educate pregnant women to reduce the rate of cesarean sections. PMID:25709689

  8. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

    Directory of Open Access Journals (Sweden)

    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression. Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  9. Análise dos fatores de risco anteparto para ocorrência de cesárea Analysis of the risk factors for cesarean section

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    Simone Angélica Leite de Carvalho Silva

    2005-04-01

    performed to identify the antepartum risk factors for cesarean section in the period from September 1, 1999 to August 31, 2000. Thereafter an ideal model able to quantify the risk for cesarean section for each patient in the presence of one or more risk factor was created. Then, the model was applied to the patients of the study in order to verify the efficacy of indication for cesarean section. RESULTS: the baseline risk for cesarean section was 15.2%. The concordance between the percentage estimated through logistic model and cesarean delivery was 86.6%. CONCLUSIONS: the logistic model was able to identify the baseline risk for cesarean section and to quantify the increase in risk for cesarean section in each patient when risk factors were introduced in the model. The model can be considered efficient and able to predict cesarean section because the agreemant between the prediction and the correct indication was 86.6%, and 53.6% of the patients who had vaginal delivery did not have any risk factor for cesarean section.

  10. The Effect of Mode of Delivery on Postpartum Sexual Functioning in Primiparous Women

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    Fatemeh Dabiri

    2014-07-01

    Full Text Available Objective: To evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. Methods: In this cross-sectional descriptive study, 150 primiparous women in postpartum period, who attended the family planning or vaccination clinics, were enrolled for the study. Eighty-one had vaginal delivery with episiotomy and 69 had experienced cesarean section. Sexual function was evaluated by the Female Sexual Function Index within 3 and 6 months postpartum. Results: About 29% in vaginal delivery group and 37% in cesarean delivery group had resumed their sexual intercourses four weeks after delivery (p=0.280.There were no significant differences between mode of delivery and sexual functioning, including desire, arousal, lubrication, orgasm, satisfaction and pain. Conclusion: The present study showed that postpartum sexual functioning was not associated with the type of delivery.

  11. The Effect of Mode of Delivery on Postpartum Sexual Functioning in Primiparous Women

    Science.gov (United States)

    Dabiri, Fatemeh; Yabandeh, Asieh Pormehr; Shahi, Arefeh; Kamjoo, Azita; Teshnizi, Saeed Hosseini

    2014-01-01

    Objective To evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. Methods In this cross-sectional descriptive study, 150 primiparous women in postpartum period, who attended the family planning or vaccination clinics, were enrolled for the study. Eighty-one had vaginal delivery with episiotomy and 69 had experienced cesarean section. Sexual function was evaluated by the Female Sexual Function Index within 3 and 6 months postpartum. Results About 29% in vaginal delivery group and 37% in cesarean delivery group had resumed their sexual intercourses four weeks after delivery (p=0.280).There were no significant differences between mode of delivery and sexual functioning, including desire, arousal, lubrication, orgasm, satisfaction and pain. Conclusion The present study showed that postpartum sexual functioning was not associated with the type of delivery. PMID:25170409

  12. A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting

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    Obinna V Ajuzieogu

    2011-01-01

    Full Text Available Objective: To compare the outcome of subarachnoid block (spinal anesthesia and general anesthesia in Cesarean delivery for women with severe pre-eclampsia. Methods: A retrospective study of women with severe pre-eclampsia requiring Cesarean section from January 2005 to June 2009 was carried out. Maternal age, parity, gestational age at delivery, booking status, Apgar scores, maternal and perinatal mortality of the sub-arachnoid block group were compared with those of general anesthesia group using c2 , Student t-test and Fischer exact test. Results: There were no significant difference between the two groups in overall maternal mortality (5.4% vs. 11.9%, P=0.5 and perinatal mortality (2.7% vs. 11.9%, P=0.15. The general anesthesia group had significantly more birth asphyxia than the spinal group (55.9% vs. 27.0%, P=0.0006. Conclusion: There was no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with severe pre-eclampsia who had regional anesthesia and those that had general anesthesia. There was significantly higher proportion of birth asphyxia in babies of women who received general anesthesia.

  13. Sagittal venous sinus thrombosis after cesarean section: a case report

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    Farideh Keypour

    2013-07-01

    Full Text Available Background: Cerebral venous thrombosis (CVT is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.  Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

  14. Differing Levels of Forestry Best Management Practices at Stream Crossing Structures Affect Sediment Delivery and Installation Costs

    Directory of Open Access Journals (Sweden)

    Brian C. Morris

    2016-03-01

    Full Text Available Forestry best management practices (BMPs are used to reduce sedimentation from forest stream crossings. Three BMP treatments (BMP−, BMP-std, and BMP+ were applied to three forest road stream crossings (bridge, culvert, and ford. BMP− did not meet existing BMP guidelines, BMP-std met standard recommendations, and BMP+ treatments exceeded recommendations. Following BMP applications, three simulated rainfall intensities (low, medium, and high were applied in order to evaluate sediment delivery from crossing type and BMP level. During rainfall simulation, sediment concentrations (mg/L were collected with automated samplers and discharge (L/s was estimated to calculate total sediment loading. Costs of stream crossings and BMP levels were also quantified. Mean sediment associated with the three stream crossings were 3.38, 1.87, and 0.64 Mg for the BMP−, BMP-std, and BMP+ levels, respectively. Ford, culvert, and bridge crossings produced 13.04, 12.95, and 0.17 Mg of sediment during construction, respectively. BMP enhancement was more critical for sediment control at the culvert and ford crossings than at the bridge. Respective costs for BMP−, BMP-std, and BMP+ levels were $5,368, $5,658, and $5,858 for the bridge; $3,568, $4,166 and $4,595 for the culvert; and $180, $420 and $1,903 for the ford. Costs and sediment values suggest that current standard BMP levels effectively reduce stream sediment while minimizing costs.

  15. Investigating the Relationship between Demographic Factors and Choice of Delivery Method in Pregnant Women in the City of Savojbolagh.

    Directory of Open Access Journals (Sweden)

    Zahra Dadashi Eynsheykh

    2013-03-01

    Full Text Available To evaluate the increased rate of cesarean section in recent decades and natural desire of women probably due to social, economic& cultural issues in our country. While that in many cases, vaginal delivery can be replaced by unnecessary cesarean. In the absence of need the trend of cesarean section has implications for both future healthy populations and the equitable distribution of maternity resources. The aim of the present study was to investigate demographic factors associated with the choice of delivery method.In this descriptive cross- sectional study with a random sampling, 283 pregnant women who were referred for control of pregnancy to two primary health care centers two health base were interviewed by Completing the questionnaire. After gathering information data by SPSS software &via descriptive statistical indicators were analyzed.35/7% of pregnant women who were studied willing to perform cesarean section. There was a significant relationship between the having a history of cesarean section and referral place for control of pregnancy with selection of the labor type (P 0.001. The reasons for selection of cesarean section were fear of labor pain, Prevention of genital rupture & physician recommendation.The rate of selecting cesarean section is higher than acceptable World Health Organization. Therefore, careful planning should be done to raise awareness, improve attitudes and change false beliefs in pregnant women & their husbands by health service's personnel.

  16. Some medical and other risk factors for current cesarean section in a Jakarta hospital

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    Endang Poedjiningsih

    2001-12-01

    Full Text Available For the last year the prevalence of cesarean section (CS increased in several countries as well as in Indonesia. In Indonesia there was no comprehensive study on risk factors related to CS. This case-control study was conducted at Fatmawati Hospital in Jakarta from 1 July 200 until 31 January 2001. Data was extracted from available medical records. Ceserean section was defined as a delivery through laparotomy. The control group consisted of subjects having vaginal deliveries. For each cases were selected randomly a control based on the date before or after 18 October 2000. Subject who had fetal distress had 544-folds increased risk to be CS relative to those who did not have fetal distress [adjusted odds ratio (OR = 544.86; 95% confidence intervals (CI = 71.85- 4131.78]. Furthermore, relative those who did not have dystocia, those who had dystocia had 143 times increased risk to be CS (adjusted OR = 52.86; 95% CI = 52.86 - 391.17. In term of previous CS, subjects who ever had previous CS had 30 times increased risk to be CS compared with the subjects who never had CS (adjusted OR = 30.23; 95% CI = 12.06 - 75.57. In contrast, compared with those who non cash payment, those who paid in cash had a lowered risk of 80% (adjusted OR = 0.20; 95% CI = 0.11-0.34. In conclusion, previous CS, dystocia, pre eclampsia, other medical indications, fetal distress, and non cash hospitalization expences increased risk of CS. (Med J Indones 2001; 10: 230-4Keywords: cesarean section, risk factors

  17. The vanishing mother: Cesarean section and "evidence-based obstetrics".

    Science.gov (United States)

    Wendland, Claire L

    2007-06-01

    The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.

  18. Elective cesarean hysterectomy for treatment of cervical neoplasia. An update.

    Science.gov (United States)

    Hoffman, M S; Roberts, W S; Fiorica, J V; Angel, J L; Finan, M A; Cavanagh, D

    1993-03-01

    From January 1, 1979, to March 31, 1991, 37 patients underwent elective cesarean hysterectomy for early cervical neoplasia. Thirty-four patients had cervical intraepithelial neoplasia III, and three patients had stage IA-1 squamous cell carcinoma of the cervix. Twenty-eight were primary cesarean sections; nine had obstetric indications. The mean operative time was 128 minutes; mean estimated blood loss was 1,400 mL. One patient experienced an intraoperative hemorrhage (3,500 mL). There were no other recognized intraoperative complications. Four significant postoperative complications included a vaginal cuff abscess, a wound dehiscence and pelvic abscess, one patient with febrile morbidity and an ileus and ligation with partial transection of a ureter. Patients were discharged on a mean of postoperative day 5.7. Although significant complications occurred, we believe that the noncompliant nature of our patient population justifies elective cesarean hysterectomy for treatment of cervical neoplasia.

  19. Patterns of Delivery and Perinatal Outcomes Among Women Delivered at District Hospital of Rural Nepal

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    Amatya YR

    2014-10-01

    Full Text Available Studies have shown increased rate of labour induction and cesarean section (CS with several health consequences for neonates and mothers. Still there is limited data especially in developing countries. A hospital based retrospective cross sectional study was done where all hospital deliveries occurring during the period of 6 months were recorded to assess the patterns of deliveries and their associated perinatal outcomes. Cesarean rate was 18.5%, with meconium- stained liquor being the commonest reason, and 12.5% of deliveries were medically induced. Post dated pregnancies were more likely to have either elective CS or medical induction. Medically induced cases were less likely to have meconium stained liquor however, these cases are at higher odds of emergency CS. Induction of labour is not always without risk as cases lead to more emergency cesarean section. However, this paper highlights that medical induction of labor improve neonatal outcomes which might be attributed to timely intervention in such cases.

  20. Influence factors of cesarean section and interventions to reduce the rate of cesarean section%剖宫产率增高的影响因素及降低剖宫产率的干预措施

    Institute of Scientific and Technical Information of China (English)

    王秋芳

    2016-01-01

    目的 探析剖宫产的影响因素及降低剖宫产率的干预措施.方法 选取2012年1月至12月1 195例产妇为干预前组,选取2014年1月至12月行干预措施的1 280例产妇为干预后组.分析高剖宫产率的影响因素及降低剖宫产率的干预措施的效果.结果 2012年550例剖宫产产妇中胎儿因素220例(40.0%),包括宫内窘迫、巨大儿、双胎、臀位、胎位异常等因素;母亲因素207例(37.6%),包括妊娠并发症、瘢痕子宫、高龄初产、盆骨狭窄、产程异常等;社会因素123例(22.4%).干预前剖宫产率为46.0%,干预后降低至38.0%,干预前后比较差异有统计学意义(P<0.05).结论 阴道分娩为自然生理过程,值得提倡,可通过产前保健、提高产科质量、严格掌握剖宫产指征、心理干预与生理支持等干预措施来降低剖宫产率.%Objective To investigate the influence factors of cesarean section and interventions to reduce the rate of cesarean section.Methods From January 2012 to December 2012, 1 195 pregnant women were selected as the before intervention group, 1 280 pregnant women from January 2014 to December in 2014 were selected as the after intervention group, and to analyze the influence factors of cesarean section and interventions to reduce the rate of cesarean section.Results Among the 550 cases of cesarean seltion in 2012, fetal factors was 220 cases(40%), including fetal distress, fetal macrosomia, twins, breech presentation and abnormal fetal position;maternal factors was 207 cases(37.6%), including pregnancy complication, uterine scar, older primipara, narrow pelvis, abnormal stage;social factors was 123 cases(22.4%).The rate of cesarean section before the intervention was 46.0%, it was 38.0%after the intervention, the difference was statistically significant (P < 0.05).Conclusions Vaginal delivery is a natural physiological process which is worth advocating.The rate of cesarean section can be reduced

  1. Desigualdades sociais nas complicações da cesariana: uma análise hierarquizada Social inequalities in post-cesarean complication rates: a hierarchical analysis

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    Paulo Fontoura Freitas

    2011-10-01

    Full Text Available Com objetivo de investigar associações entre fatores socioeconômicos e complicações da cesariana, uma amostra de 604 puérperas cujos partos ocorreram em duas maternidades no Sul do Brasil foi entrevistada 24 horas pós-parto e na segunda semana do puerpério, por meio de entrevistas hospitalares e domicilio. Regressão de Cox foi aplicada ao modelo hierárquico dos fatores associados ao tipo de parto e às complicações no pós-parto. Complicações foram duas vezes mais frequentes após cesariana, independentemente das condições socioeconômicas. Contudo, a maneira como o parto cesáreo se associou ao risco de complicações mostrou-se mediada pelas circunstâncias socioeconômicas representadas pela categoria do pré-natal e parto, ter ou não o mesmo profissional no pré-natal e parto e ter sua cesariana decidida intraparto. Resultados do estudo evidenciam que complicações pós-cirúrgicas da cesariana têm impacto adverso, principalmente, entre aquelas mulheres vivendo em condições sociais e de saúde menos privilegiadas, as quais, após o parto, retornam para um ambiente de menor suporte, com uma cicatriz abdominal.This study focused on the association between social factors and complications following cesarean sections. A sample of 604 women delivering in the two main maternity hospitals in a city in southern Brazil were interviewed 24 hours after delivery and two weeks postpartum, using in-hospital and home interviews. Cox regression was applied, using a hierarchical framework of factors associated with post-cesarean complications. Post-partum complications were twice as frequent after cesareans as compared to vaginal delivery, independently of socioeconomic conditions. However, the increased the risk of complications associated with cesarean section proved to be mediated by socioeconomic circumstances, as represented by prenatal and childbirth care in the public health system, not having the same physician throughout

  2. Twin delivery: how should the second twin be delivered?

    Science.gov (United States)

    Olofsson, P; Rydhström, H

    1985-11-01

    In a series of 803 pairs of twins born between 1973 and 1982, 0.33% of second twins were delivered by cesarean section after vaginal delivery of the first twin. During the last year the frequency has increased to 7%, calling attention to the problem of declining obstetric skills and experience. This has caused us to update the routines of intrapartum management of twin gestations. In the present program only commonly available obstetric techniques are used. The potentially hazardous twin delivery is excluded from a trial of vaginal delivery. Hopefully, the program will help other obstetricians to decide in favor of vaginal delivery in selected twin gestations.

  3. Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics

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    Al-Kadri HM

    2015-07-01

    Full Text Available Hanan M Al-Kadri,1 Sultana A Al-Anazi,1 Hani M Tamim21Department of Obstetrics and Gynecology, King Abdulaziz Medical City, 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi ArabiaBackground: Cesarean section (CS rate has shown creepy increase. We aimed in this work to identify factors contributing to increasing rate of CS in central Saudi Arabia.Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2. G1 had delivered by CS during the year 2002 (CS rate 12%, and G2 had delivered by CS during the year 2009 (CS rate 20%. We compared the included women’s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of ≤0.05 was considered significant.Results: A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12–0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32–81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02–66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02–1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39–4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06–7.15.Conclusion: CS delivery rate

  4. Role of cardiotocography in high risk pregnancy and its correlation with increase cesarean section rate

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    Manisha Gupta

    2016-12-01

    Full Text Available Background: FHR monitoring plays the most important role in management of labouring patient when incidence of fetal hypoxia and progressive asphyxia increases. Now a day’s cardiotocography (CTG become a popular method for monitoring of fetal wellbeing and it is assisting the obstetrician in making the decision on the mode of delivery to improve perinatal outcome. The aim of the study was to assess the effect of cardiotocography on perinatal outcome and its correlation with caesarean section rate. Methods: In this prospective observational study 201 gravid women with high risk pregnancy in first stage of labour were taken. Result was assessed in the form of Apgar score at five minute, NICU admission, perinatal mortality and mode of delivery. Statistical analysis is done by using Chi square test and p<0.05 is considered as statistically significant. Results: Perinatal morbidity in the form of NICU admission is higher in nonreactive group as compare to reactive group (75.7% v/s 22.8%. Cesarean section rate for fetal distress were higher in nonreactive group (87.8% in comparison to reactive group (20.5%. So this study suggest that there is significant difference in mode of delivery with increasing chances of caesarean section in cases belong to non-reactive traces (p<0.001. Conclusions: Admission test is non-invasive and the best screening test to evaluate the fetal health and to predict the perinatal outcome but it also associated with increase caesarean section rate.

  5. Cesarean section for the second twin

    DEFF Research Database (Denmark)

    Engelbrechtsen, Line; Nielsen, Elise Hoffmann; Perin, Trine

    2013-01-01

    deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score ≤ 7, umbilical cord pH ≤ 7.10, and admission to neonatal intensive care unit for more than 3 days...

  6. Interobserver variation in measurements of Cesarean scar defect and myometrium with 3D ultrasonography

    DEFF Research Database (Denmark)

    Madsen, Lene Duch; Glavind, Julie; Uldbjerg, Niels;

    -16 months after their first Cesarean section with 2D transvaginal sonography and had 3D volumes recorded. Two observers independently evaluated “off-line” each of the 3D volumes stored. Residual myometrial thickness (RMT) and Cesarean scar defect depth (D) was measured in the sagittal plane with an interval...... of Cesarean section scar size and residual myometrium needs further investigation.......Objectives: To evaluate the Cesarean scar defect depth and the residual myometrial thickness with 3-dimensional (3D) sonography concerning interobserver variation. Methods: Ten women were randomly selected from a larger cohort of Cesarean scar ultrasound evaluations. All women were examined 6...

  7. Fatores Associados à Realização de Cesárea em Primíparas com uma Cesárea Anterior Factors Associated with Cesarean Section in Primipara Women with One Previous Cesarean Section

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    José Guilherme Cecatti

    2000-04-01

    Full Text Available Objetivo: avaliar a via de parto em um grupo de gestantes primíparas de baixa renda com uma cesárea anterior e os fatores associados à repetição da cesárea no segundo parto. Pacientes e Métodos: realizou-se um estudo caso-controle com 356 gestantes atendidas de janeiro de 1993 a janeiro de 1996 na Maternidade do CAISM/UNICAMP. Constituíram os casos as 153 gestantes que tiveram o segundo parto por cesárea, e os controles, as 203 que tiveram o segundo parto vaginal. Para a análise utilizaram-se médias, desvio padrão, teste t de Student, teste de Mann-Whitney, chi² e "odds ratio" (OR e IC 95% para cada possível fator associado à realização de cesárea no segundo parto. Resultados: a via do segundo parto foi vaginal em 57% das vezes. Dentre as diversas variáveis estudadas, as que mostraram estar significativamente associadas à realização de cesárea no segundo parto foram: maior idade materna (para mulheres com 35 anos ou mais, OR = 16,4, antecedente de abortamento (OR = 2,09, indução do trabalho de parto (OR = 3,83, rotura prematura de membranas (OR = 2 ,83, a não-realização de analgesia durante o período de dilatação (OR = 5,3, o diagnóstico de algum sinal de vitalidade fetal alterada (OR = 2,7 e a ocorrência do parto à tarde (OR = 1,92. Conclusões: os resultados indicam que os fatores associados à repetição de cesárea em mulheres com uma cicatriz de cesárea nesta população são predominantemente médicos, mas há a possibilidade de se proporem intervenções dirigidas a diminuir o índice de repetição de cesáreas.Purpose: to evaluate the route of delivery in a group of low-income primipara pregnant women with a previous cesarean section, and the factors associated with the repetition of the cesarean section on the second delivery. Patients and Methods: it was a case-control study including 356 women who were assisted at the Maternity of CAISM/UNICAMP during the period between January 1993 and January

  8. Clinical Analysis on Improved New Cesarean Section in 200 Cases%改良的新式剖宫产术200例临床分析

    Institute of Scientific and Technical Information of China (English)

    徐丽

    2013-01-01

    Objective To discuss the clinical effect of improved new cesarean section .Method Various clinical indicators of 200 cases treated with improved new cesarean section and 200 cases treated with the traditional cesarean section were observed and compared .Results The time duration of operation,volume of blood loss, time of fetal delivery,incision pain,discharge of the mother after the operation ,wound healing,and hospitalization days all were improved in patients in the improved group ,and the differences between the two groups were significantly different ( P <0.05).Conclusion The improved new cesarean section is desirable in clinical application and can replace the traditional cesarean section in clinic .%  目的探讨改良的新式剖宫产术临床效果.方法观察对照200例改良的新式剖宫产术与同期200例传统剖宫产术的多项指标.结果改良的新式剖宫产术所需手术时间短,术中出血少,胎儿娩出时间短,术后排气快,术后切口疼痛轻,切口愈合良好,住院天数少.两组比较有统计学意义(P<0.05).结论改良的新式剖宫产术具有较好的临床价值,可以替代传统的剖宫产术.

  9. The standard of knowledge for cesarean section in women who applied to family medicine: Two centered cross-sectional study

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    Metin Canbal

    2014-06-01

    Full Text Available Purpose: We aimed to examine, mothers' level of knowledge about complications of cesarean section and the factors that influence preference for cesarean section in this study Methods: The universe of the study consisted of the women who admitted to the family medicine outdoor clinics in two different regions of Turkey namely Doğansehir State Hospital, Malatya and Kadışehri Entegrated State Hospital, Yozgat. Two hundred and one women included in the study who recruited the family medicine outdoor clinic irrespective of their primary complaint. The data was analyzed by the SPSS program. Results: Statistically significant difference was observed in terms of caesarean section operation rates in high school graduates. 29% of all the participants in this study had caesarean section operation in their first delivery. Conclusion: Personal predilections appear to be an influencing factor in deciding the type of the delivery currently. It is assumed that knowledge may be converted into the behaviors by giving the evidence based information to our patients in consistence with their perceptions along with the shared decision model in a collaborative manner.

  10. Planned Repeat Cesarean Section at Term and Adverse Childhood Health Outcomes: A Record-Linkage Study.

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    Mairead Black

    2016-03-01

    Full Text Available Global cesarean section (CS rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1 planned repeat CS and (2 unscheduled repeat CS with those that follow vaginal birth after CS (VBAC.A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145 were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919 and unscheduled repeat CS (n = 8,847 with those following VBAC (n = 13,379. Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33 and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42 compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively. Risk of obesity at age 5 y and risk of cerebral

  11. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

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    Pınar Solmaz Hasdemir

    2015-01-01

    Full Text Available Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

  12. Non-obstructive cecal dilatation and perforation after cesarean section

    DEFF Research Database (Denmark)

    Sperling, Lene; Schantz, A L; Toftager-Larsen, K

    1990-01-01

    A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo...

  13. Relationship between prenatal psychological status and delivery mode%孕妇产前心理状况与分娩方式的关系研究

    Institute of Scientific and Technical Information of China (English)

    赵生英; 曹夕辉

    2012-01-01

    indication of cesarean section ( t = 2. 751, P = 0. 009 ), and the differences in expected value, educational level and occupation between two groups were statistically significant (X2=6. 582-7. 339,all P<0. 05 ). Age, occupation and expectation were related with some psychological agents scores at different stages ( r = 0. 042-0. 605, all P < 0. 05 ). Conclusion Psychological status such as fear, anxiety and depression will affect the final mode of delivery. The intervention of these adverse psychological conditions is expected to reduce cesarean section rate.

  14. 瘢痕子宫再次剖宫产的并发症分析%Complications of Repeated Cesarean Section in Pregnant Women with Scarred Uterus

    Institute of Scientific and Technical Information of China (English)

    高丽欣; 刘群

    2012-01-01

    Objective To study the complications of repeated cesarean section in pregnant women with scarred uterus, to provide basis for reduction of cesarean caused by social factors or scarred uterus. Methods Complications were compared between 145 scarred uterus pregnant women receiving repeated cesarean section ( study group ) and 388 receiving the operation initially ( control group ). Results The main delivery way of pregnant women with scar uterus was cesarean section, accounting for 70.39% (145/206). The incidences of abdominopelvic cavity adhesion, hysterorrhexis, postpartum haemorrhage, placenta praevia and other complications were higher in study group than in control. Conclusion The repeated cesarean section complications of scarred uterus are significantly high, it is necessary to control cesarean section caused by social factors and initial ones to lower repeated cesarean section of scarred uterus.%目的 分析瘢痕子宫再次剖宫产的并发症,降低社会因素及瘢痕子宫提升的剖宫产率.方法 我科5年来共收治206例瘢痕子宫再次妊娠分娩患者,将其中瘢痕子宫再次剖宫产患者145例(研究组)与初次行剖宫产患者388例(对照组)的并发症进行比较分析.结果 瘢痕子宫再次妊娠分娩方式中再次剖宫产率为70.39%(145/206),其发生盆腹腔粘连率、子宫破裂率、产后出血率、前置胎盘率等并发症均明显高于初次剖宫产患者(P<0.05).结论 瘢痕子宫再次行剖宫产的并发症显著增多,所以应控制社会因素剖宫产,降低初次剖宫产率,进而降低瘢痕子宫再次剖宫产.

  15. [The outcome of trial of labor after cesarean section].

    Science.gov (United States)

    Qu, Z Q; Ma, R M; Xiao, H; Tian, Y Q; Li, B L; Liang, K; Du, M Y; Chen, Z; Geng, L; Yang, M H; Tao, Y P; Zhu, B

    2016-10-25

    Objective: To explore the outcome of trial of labor after cesarean section(TOLAC). Methods: Totally 614 TOLAC were conducted in the First Affiliated Hospital of Kunming Medical University from July 2013 to June 2016. Among them, 586 cases of singleton pregnancy with one prior cesarean section(gestational age≥28 weeks)were studied retrospectively. The maternal and neonatal outcomes among the vaginal birth after cesarean(VBAC)group(481 cases), failed TOLAC group(105 cases)and the elective repeat cesarean section(ERCS)group(1 145 cases)were compared. Multiple logistic regression was used to determine the risk factors of admission to neonatal intensive care unit(NICU). Results: (1)The TOLAC rate was 29.62%(614/2 073)from July 2013 to June 2016, and the VBAC rate was 82.6%(507/614). The cesarean section rate was reduced by VBAC by 3.147%(507/16 112).(2)The comparison of adverse maternal outcomes: in the VBAC group, the postpartum hemorrhage volume was(431±299)ml, the rate of postpartum fever was 6.4%(31/481), the birth weight of the neonates was(3 085± 561)g, and the rate of large for gestational age was 2.9%(14/481). All were significantly lower than those in the failed TOLAC group and the ERCS group(P0.05). Multiple logistic regression showed no association between VBAC and admission to the NICU(OR=0.84, 95%CI: 0.58-1.21). The isolated risk factors for admission to the NICU were preterm birth(OR=16.71, 95% CI: 11.44-24.40), hypertensive disorder complicating pregnamcy(OR=3.89, 95% CI: 2.39-6.35), meconium stained amniotic fluid(OR=2.48, 95% CI: 1.62-3.80), small for gestational age(OR=2.00, 95% CI: 1.19-3.36)and diabetes mellitus(OR=1.69, 95% CI: 1.14-2.50). Conclusions: VBAC reduces cesarean section rate, with good outcomes in both mother and neonate. It is a safe and feasible way of labor in women with only one cesarean section history.

  16. Mode of delivery and cord blood cytokines: a birth cohort study

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    DuBois Andrea M

    2006-09-01

    Full Text Available Abstract Background The mechanisms for the association between birth by cesarean section and atopy and asthma are largely unknown. Objective To examine whether cesarean section results in neonatal secretion of cytokines that are associated with increased risk of atopy and/or asthma in childhood. To examine whether the association between mode of delivery and neonatal immune responses is explained by exposure to the maternal gut flora (a marker of the vaginal flora. Methods CBMCs were isolated from 37 neonates at delivery, and secretion of IL-13, IFN-γ, and IL-10 (at baseline and after stimulation with antigens [dust mite and cat dander allergens, phytohemagglutinin, and lipopolysaccharide] was quantified by ELISA. Total and specific microbes were quantified in maternal stool. The relation between mode of delivery and cord blood cytokines was examined by linear regression. The relation between maternal stool microbes and cord blood cytokines was examined by Spearman's correlation coefficients. Results Cesarean section was associated with increased levels of IL-13 and IFN-γ. In multivariate analyses, cesarean section was associated with an increment of 79.4 pg/ml in secretion of IL-13 by CBMCs after stimulation with dust mite allergen (P Conclusion Cesarean section is associated with increased levels of IL-13 and IFN-γ, perhaps because of lack of labor and/or reduced exposure to specific microbes (e.g., gram-positive anaerobes at birth.

  17. A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings

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    Renee Heffron

    2015-12-01

    Full Text Available Introduction: HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale “safer conception” programmes. Discussion: Through our collective experience and discussions at a multi-disciplinary international World Health Organization–convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1 understanding fertility care and an ability to identify potential fertility problems; (2 providing equity of access to resources enabling informed decision-making about reproductive choices; (3 creating enabling environments that reduce stigma associated with HIV and infertility; and (4 creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with

  18. Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

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    Jae Eun Shin

    Full Text Available To evaluate whether serial change in cervical length (CL over time can be a predictor for emergency cesarean section (CS in patients with placenta previa.This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1, 24 to 28 weeks (CL2, 29 to 31 weeks (CL3, and 32 to 34 weeks (CL4. We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group and elective CS group (control group. The predictive value of change in CL for emergency CS was evaluated.A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973 and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253 were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001, with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

  19. Intrapartum Ultrasound Assessment of Fetal Head Position, Tip The Scale: Natural or Instrumental Delivery?

    Science.gov (United States)

    ADAM, G.; SIRBU, O.; VOICU, C.; DOMINIC, D.; TUDORACHE, STEFANIA; CERNEA, N.

    2014-01-01

    Objectives: The main objective of this study was to observe the behavior of the fetal head position during labor, when starting from occiput anterior or posterior position and also to determine their importance in labor management (if the starting fetal head position can be a strong argument in favour of vaginal or cesarean delivery). Methods:187 patients in labor were included in this study, with gestational age over 37 weeks and estimated fetal weight over 2500 g, singleton pregnancy, cephalic presentation, empty urinary bladder. For these patients the ultrasound assessed parameters were: fetal head position at the beginning of labour and fetal head rotation during labour. Results: 89,18 percent of the patients starting from OTP (occiput transverse or posterior position) had a vaginal birth after an anterior rotation of the fetal head, and only 10,82 % presented persitent occiput posterior requiring cesarean section for delivery. Furthermore, considering only initial occiput posterior position, we observed an increased rate for cesarean section delivery (22,72%) by persistence of this position during labour. None of the patients starting with an anterior fetal head position rotated posteriorly. Conclusions: vaginal delivery in occiput anterior position was the most common result in both OTP and OP fetal head initial position. The main reason for cesarean delivery was persistent OP position. Patients with occiput posterior position were subsequent only to an initial posterior/transverse position. PMID:24791200

  20. Discussion on the Currant Situation of Repeated Cesarean Section in Primary Hospitals%基层医院重复剖宫产现状探讨

    Institute of Scientific and Technical Information of China (English)

    杨茗; 李云秀; 柏智; 纪艳洁

    2015-01-01

    Objective:To analyze the currant situation of repeated cesarean section in primary hospitals and discuss the measures to further reduce the rate of cesarean section.Method:The clinical data of 981 puerperae who had repeated cesarean section admitted to our hospital from 2011 to 2013 were retrospectively analyzed,the changes of repeated cesarean section rates and indications in different periods were statistically analyzed.Result:The repeated cesarean rates of our hospital were 93.64 %,47.30%,76.08% in 2011,2012 and 2013.The average cesarean section rate was 72.34%.The top five of the cesarean section indications were tubal ligation,social factors,preeclampsia,fetal distress,abnormal stage of labor.Conclusion:High repeated cesarean section rate is caused by many factors.It can be reduced by updating the conception of obstetricians and pregnant women,enhancing the propaganda of perinatal health care,encouraging vaginal birth after cesarean section,improving professional skills of midwives and so on,so as to reduce the risk of mother and son from cesarean delivery operation.%目的:分析基层医院重复剖宫产现状并探讨进一步降低剖宫产率的措施。方法:选取本院2011年1月-2013年12月住院分娩重复剖宫产产妇总计981例,统计重复剖宫产率、重复剖宫产指征及所占比例。结果:统计2011-2013年重复剖宫产率分别为93.64%、47.30%、76.08%,平均重复剖宫产率为72.34%,重复剖宫产指征中要求结扎、社会因素、子痫前期、胎儿窘迫、产程异常居前五位。结论:重复剖宫产是多方面因素造成的,提高医患双方对剖宫产后再次妊娠的认识、加大宣传力度、鼓励剖宫产后阴道分娩、提高专业人员助产技术等可以有效降低重复剖宫产率,从而减少剖宫产手术带来的母儿风险。

  1. Association of maternal and neonatal plasma interleukin-6 levels in relation to model of delivery

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    Mahmoud Imani

    2011-07-01

    Full Text Available Background: Cytokines play an important role during labor of full – or pretern delivery. In umbilical cord blood, Interleukin-6 (IL-6 was thought to be a marker of defense to stress, surgery and infection. The aim of this study was to investigate the cytokine IL-6 concentrations in the mother and neonate depends on the mode of the delivery.Materials and Method: This study was done on mothers and neonates in 80 single term deliveries (vaginal and cesarean in Mahdieh Hospital in Tehran. Age of mothers was 21-39 years old, parity was 1 and 2. There wasn't history of underlying disease and drug usage in mothers and neonate was AGA and apgar was more than 8. There wasn't clinical evidence of infection in neonate and mothers. IL-6 was evaluated by enzyme-immunoassays in maternal serum and neonatal umbilical cord. Data were analyzed with SPSS and were applied fishers exact test for compare means.Results: There were 37 vaginal deliveries and 43cesarean section. The mean (±standard error of maternal IL-6 concentration in vaginal delivery (0.18±0.02 was significantly (P=0.000 higher than cesarean section (0.1±0.02 and neonatal IL-6 concentration in vaginal delivery (0.17±0.03 was significantly (P=0.000 higher than cesarean section (0.07±0.01.Conclusion: Results show that vaginal delivery cause to increase IL-6 compared to cesarean section in mother and neonate

  2. No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

    Institute of Scientific and Technical Information of China (English)

    Jia-Jun Zhu; Ying-Ying Bao; Guo-Lian Zhang; Li-Xin Ma; Ming-Yuan Wu

    2014-01-01

    Background: To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery. Methods: In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route. Results: There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P Conclusions: In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.

  3. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

    Science.gov (United States)

    Ayala-Yáñez, Rodrigo; Bayona-Soriano, Paulette; Hernández-Jimenez, Arturo; Contreras-Rendón, Alejandra; Chabat-Manzanera, Paulina; Nevarez-Bernal, Roberto

    2015-01-01

    Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications. PMID:26380111

  4. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

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    Rodrigo Ayala-Yáñez

    2015-01-01

    Full Text Available Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD techniques performed at the ABC Medical Center (Mexico City to evaluate their safety, bearing in mind the importance of decreasing our country’s high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture. The Simpson forceps was the most favored instrument (46% due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8% and significant complications observed were vaginal lacerations (p=0.016, relative risk (RR of 3.4 (95% confidence interval [CI]: 1.15–10.04, and fourth degree perineal tear (p=0.016, RR of 3.4 (95% CI: 1.15–10.04. Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.

  5. Study on Modification of the Misgav Ladach Method for Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    李敏; 邹丽; 朱剑文

    2001-01-01

    172 cases of pregnant women scheduled for delivery by cesarean section were randomly assigned to 59 cases in modification group with modified Misgav Ladach technique, 57 cases in Misgav Ladach group with Misgav Ladach technique and 56 cases in Pfannenstiel group with Pfannenstiel technique from May to Dec. 1999. The modified points included: transversely incising the fascia 2 to 3 cm, then dividing it bluntly; without opening and dissociating the visceral peritoneum; two layers suturing of low transverse uterine incision; closing the skin by continuous suturing. Results showed the average delivery time in the modification group was (3.6±2.6) min and (5.7±2.9) min in the Misgav Ladach group (P0.05). Average blood loss was (128±35) ml in modification group compared with (212±147) ml in the Pfannenstiel group (P<0.05). It was concluded that the modified Misgav Ladach technique not only preserved all advantages of Misgav Ladach method, but also had additional advantages, such as faster in delivering the fetus, less damage, easier mastering for obstetricians.

  6. Delivery type not associated with global methylation at birth

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    Virani Shama

    2012-06-01

    Full Text Available Abstract Background Birth by cesarean delivery (CD as opposed to vaginal delivery (VD is associated with altered health outcomes later in life, including respiratory disorders, allergies and risk of developing type I diabetes. Epigenetic gene regulation is a proposed mechanism by which early life exposures affect later health outcomes. Previously, type of delivery has been found to be associated with differences in global methylation levels, but the sample sizes have been small. We measured global methylation in a large birth cohort to identify whether type of delivery is associated with epigenetic changes. Methods DNA was isolated from cord blood collected from the University of Michigan Women’s & Children Hospital and bisulfite-converted. The Luminometric Methylation Assay (LUMA and LINE-1 methylation assay were run on all samples in duplicate. Results Global methylation data at CCGG sites throughout the genome, as measured by LUMA, were available from 392 births (52% male; 65% CD, and quantitative methylation levels at LINE-1 repetitive elements were available for 407 births (52% male; 64% CD. LUMA and LINE-1 methylation measurements were negatively correlated in this population (Spearman’s r = −0.13, p =0.01. LUMA measurements were significantly lower for total CD and planned CD, but not emergency CD when compared to VD (median VD = 74.8, median total CD = 74.4, p = 0.03; median planned CD = 74.2, p = 0.02; median emergency CD = 75.3, p = 0.39. However, this association did not persist when adjusting for maternal age, maternal smoking and infant gender. Furthermore, total CD deliveries, planned CD and emergency CD deliveries were not associated with LINE-1 measurements as compared to VD (median VD = 82.2, median total CD = 81.9, p = 0.19; median planned CD = 81.9, p = 0.19; median emergency CD = 82.1, p = 0.52. This lack of association held when adjusting for maternal age

  7. 11-Year Experience with Gastroschisis: Factors Affecting Mortality and Morbidity

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    Derya Erdoğan

    2012-09-01

    Full Text Available Objective: The aim of the study was the evaluation of patients treated with a diagnosis of gastroschisis and to establish the factors which affected the morbidity and mortality.Methods: Twenty-nine patients, managed for gastroschisis during 2000-2010 were reviewed retrospectively.Patients were analysed in respect to gestational age, birth weight, associated anomalies, type of delivery,operative procedures, postoperative complications, total parenteral nutrition (TPN related complications.The factors affecting mortality and morbidity were determined.Findings: Associated abnormalities were present in 24% of the patients. Eleven patients underwent elective reduction in the incubator (Bianchi procedure without anesthesia. Eight patients had delayed reduction with silo and ten patients had primary closure. Although the type of delivery had an effect on morbidity but notmortality, gestational age, birth weight, and the operative procedure performed had no effect on morbidity or mortality. Duration until tolerance of oral intake, and of TPN and hospitalization were found to be statistically significantly shorter in the group of babies delivered by cesarean section.Conclusion: In our study the most important cause of mortality was the abdominal compartment syndrome and multi-organ failure in the early years. Long hospitalization periods and sepsis were the main causes of mortality in recent years.

  8. Cesarean section changes neonatal gut colonization

    DEFF Research Database (Denmark)

    Stokholm, Jakob; Thorsen, Jonathan; Chawes, Bo L

    2016-01-01

    colonization patterns in the first year of life in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) birth cohort. METHODS: Seven hundred children from the COPSAC2010 birth cohort participated in this analysis. Fecal samples were collected at age 1 week, 1 month, and 1 year......, and hypopharyngeal aspirates were collected at age 1 week, 1 month, and 3 months and cultured for bacteria. Detailed information on delivery method, intrapartum antibiotics, and lifestyle factors was obtained by personal interviews. RESULTS: Seventy-eight percent of the children were born by means of natural...... oxytoca, Klebsiella pneumoniae, and Staphylococcus aureus at age 1 week, whereas colonization by Escherichia coli was associated with natural birth. At age 1 month, these differences were less prominent, and at age 1 year, they were not apparent, which was confirmed by means of multivariate data...

  9. Maternal and neonatal effects of nalbuphine given immediately before induction of general anesthesia for elective cesarean section

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    Sabry M Amin

    2011-01-01

    Full Text Available Background: Although nalbuphine was studied extensively in labour analgesia and was proved to be acceptable analgesics during delivery, its use as premedication before induction of general anesthesia for cesarean section is not studied. The aim of this study was to evaluate the effect of nalbuphine given before induction of general anesthesia for cesarean section on quality of general anesthesia, maternal stress response, and neonatal outcome. Methods: Sixty full term pregnant women scheduled for elective cesarean section, randomly classified into two equal groups, group N received nalbuphine 0.2 mg/kg diluted in 10 ml of normal saline (n=30, and group C placebo (n=30 received 10 ml of normal saline 1 min before the induction of general anesthesia. Maternal heart rate and blood pressure were measured before, after induction, during surgery, and after recovery. Neonates were assisted by using APGAR0 scores, time to sustained respiration, and umbilical cord blood gas analysis. Result: Maternal heart rate showed significant increase in control group than nalbuphine group after intubation (88.2±4.47 versus 80.1±4.23, P<0.0001 and during surgery till delivery of baby (90.8±2.39 versus 82.6±2.60, P<0.0001 and no significant changes between both groups after delivery. MABP increased in control group than nalbuphine group after intubation (100.55±6.29 versus 88.75±6.09, P<0.0001 and during surgery till delivery of baby (98.50±2.01 versus 90.50±2.01, P<0.0001 and no significant changes between both groups after delivery. APGAR score was significantly low at one minute in nalbuphine group than control group (6.75±2.3, 8.5±0.74, respectively, P=0.0002 (27% of nalbuphine group APGAR score ranged between 4-6, while 7% in control group APGAR score ranged between 4-6 at one minute. All neonates at five minutes showed APGAR score ranged between 9-10. Time to sustained respiration was significantly longer in nalbuphine group than control group (81.8

  10. [The influence of the intrapartum inventions on the maternal and neonatal outcomes of vaginal birth after cesarean].

    Science.gov (United States)

    Wu, S W; He, D; Zhang, W Y

    2017-02-21

    Objective: To investigate the maternal and neonatal outcomes after different intrapartum interventions for vaginal birth after cesarean (Vaginal Birth After Cesarean-section, VBAC). Methods: One hundred and forty three cases in Beijing Obstetrics & Gynecology Hospital, Capital Medical University from January 2015 to November 2016 were selected retrospectively.The relationship between the intrapartum inventions such as induction style, oxytocin usage and spinal analgesia and the maternal and neonatal outcomes such as delivery way, labor time, postpartum hemorrhage and fetal distress were analyzed in pregnant women underwent VBAC. Results: (1) Maternal and neonatal outcomes: No maternal and newborn deaths occurred in the 143 cases of VBAC.One hundred and thirteen cases underwent vaginal delivery (79.0%) and 30 cases underwent operative vaginal delivery (21.0%). Twenty-four cases (16.8%) occurred postpartum hemorrhage, 32 cases (24.3%) fetal distress, and 2 (1.4%) asphyxia.(2) Intrapartum inventions: 123 cases (86.0%) were spontaneous onset of labor and 20 cases (14.0%) induction of labor.41 cases (30.6%) used oxytocin during labor to strengthen contractions, 37 cases (25.9%) underwent spinal analgesia.The operative vaginal delivery rate in the induction labor group was significantly higher than that in natural labor group (P<0.05). The duration of the first stage, second stage and total labor in the group using oxytocin were significantly longer than those in the group not using oxytocin (P<0.05). The rate of operative vaginal delivery in the group using oxytocin was significantly higher than that in the group not using oxytocin (P<0.05). The duration of the first stage, second stage and total labor in analgesia group were significantly longer than those in the group not using analgesia (P<0.05). The incidence of postpartum hemorrhage and operative vaginal delivery in analgesia group was significantly higher than those in the group not using analgesia (P<0

  11. Classic metaphyseal lesion following external cephalic version and cesarean section

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    Lysack, John T.; Soboleski, Don [Department of Diagnostic Radiology, Queen' s University, Kingston General Hospital, 76 Stuart Street, K7L 2V7, Kingston, Ont. (Canada)

    2003-06-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. (orig.)

  12. Surgical Management of the Cesarean Scar Ectopic Pregnancy: A Case Report

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    Anisodowleh Nankali

    2013-01-01

    Full Text Available Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. The diagnosis and treatment of cesarean scar pregnancy (CSP is challenging. The authors reported here a case of cesarean scar pregnancy (CSP with hypovolemic shock that underwent emergency laparotomy with resection of ectopic mass. The patient was discharged from the hospital without any complications.

  13. Myth of the ideal cesarean section rate: commentary and historic perspective.

    Science.gov (United States)

    Cyr, Ronald M

    2006-04-01

    Attempts to define, or enforce, an "ideal" cesarean section rate are futile, and should be abandoned. The cesarean rate is a consequence of individual value-laden clinical decisions, and is not amenable to the methods of evidence-based medicine. The influence of academic authority figures on the cesarean rate in the US is placed in historic context. Like other population health indices, the cesarean section rate is an indirect result of American public policy during the last century. Without major changes in the way health and maternity care are delivered in the US, the rate will continue to increase without improving population outcomes.

  14. A food interaction study of bromfenac, naproxen sodium, and placebo in cesarean section patients.

    Science.gov (United States)

    Sunshine; Olson; Zighelboim; Wajdula

    1998-07-01

    Objective: This double-blind study was to compare the effect of food on the analgesic response to bromfenac, naproxen sodium, and placebo.Methods: Single doses of bromfenac (BRO) 25 mg, naproxen Na (NAP) 550 mg, or placebo (PLA) were given to 284 patients with moderate or severe pain following cesarean section. A standard breakfast was provided for the "fed" patients. "Fasted" patients received no food 3 h before and 1 h after the dose. Treatments were compared over 8 h using standard scales for pain intensity and pain relief. Plasma levels of BRO were measured in 7 fasted and 12 fed patients.Results: BRO and NAP were significantly superior to PLA; food did not affect the response to any treatment: As expected, mean peak plasma levels of bromfenac were reduced by food by about 65%.Conclusion: Food reduces the bioavailability of bromfenac but has no effect on the analgesic response.

  15. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery

    DEFF Research Database (Denmark)

    Foldspang, Anders; Hvidman, Lone; Mommsen, Søren;

    2004-01-01

    Aim.  The aim was to estimate the postpartum urinary incontinence (PP UI) impact of precursory UI during pregnancy (PR UI) and delivery performed by cesarean section (CS) vs. vaginal childbirth (VC). Methods.  Among the members of two population samples, in total 8610 women aged 20–59 years, 1232...

  16. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    .01), and low Apgar scores at 1 minute (45% vs. 36%, p or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p ... complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited....

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

    Institute of Scientific and Technical Information of China (English)

    李湛

    2014-01-01

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

  18. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Larsen, Marcus M.; Bharati, Pratyush

    2013-01-01

    This article examines antecedents and performance implications of global delivery models (GDMs) in global business services. GDMs require geographically distributed operations to exploit both proximity to clients and time-zone spread for efficient service delivery. We propose and empirically show...... digitalized services, time zones increasingly affect....

  19. Mode of Delivery in Drug-Dependent Pregnant Women: A Case Control Study.

    Science.gov (United States)

    Neves, Ana Raquel; Neves, Fabiane; Santos Silva, Isabel; Almeida, Maria do Céu; Monteiro, Pitorra

    2017-01-01

    Objective. To determine the contribution of drug use during pregnancy to the route of delivery. Methods. A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women (n = 236) were compared with a control group of low risk women (n = 228) in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v. 23.0 (IBM Corp.). p values Drug-dependent women presented a lower rate of cesarean delivery (18.2 versus 28.9%, p = 0.006). After adjusting for the factors that were significantly related to the mode of delivery, drug dependency influenced the rate of cesarean section (β = 0.567; 95% CI = 0.328-0.980). Within the drug-dependent group, the mode of delivery was significantly related to previous cesarean or vaginal delivery (p = 0.008 and p drug, route of administration, or substitution maintenance therapy. Conclusions. The drug-dependent group presented a significantly higher rate of vaginal delivery. However, this was not associated with the behavioral factors analyzed. We hypothesize that other social and psychological factors might explain this difference.

  20. Early skin-to-skin contact after cesarean section: A randomized clinical pilot study

    Science.gov (United States)

    Kollmann, Martina; Aldrian, Lisa; Scheuchenegger, Anna; Mautner, Eva; Herzog, Sereina A.; Urlesberger, Berndt; Raggam, Reinhard B.; Lang, Uwe; Obermayer-Pietsch, Barbara; Klaritsch, Philipp

    2017-01-01

    Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial

  1. Clinical analysis of 70 cases of cesarean scar pregnancy%剖宫产瘢痕妊娠70例临床分析

    Institute of Scientific and Technical Information of China (English)

    汤雅玲; 汪燕; 邱娜璇

    2016-01-01

    Objective To investigate the clinical diagnosis , treatment and outcomes of cesarean scar pregnancy .Methods The clinical data of 70 cases of cesarean scar pregnancy women treated in the first affiliated hospital of Xiamen University from January 2012 to December 2014 were analyzed retrospectively .Results 70 cases of cesarean scar pregnancy patients were diagnosed between 5~16 gestational weeks .65 patients whose gestational weeks less than or equal to 12 weeks chose pregnancy termination , in which 24 cases were treated by uterine artery embolization (UAE) and curettage,6 cases received transvaginal lesion resection , 3 cases received hysteroscopic surgery ,4 cases received laparoscopic surgery ,20 cases were treated by drug and curettage ,8 cases were treated by drug only.All these patients were cured,none received hysterectomy.The other 5 patients diagnosed between 14 ~16 gestational weeks continued the pregnancies .One case had hysterectomy due to placenta accrete bleeding and stillbirth in 23 gestational weeks .Four cases were treated by cesarean delivery between 27 to 32 weeks, in which three newborns survived .Conclusion Cesarean scar pregnancy is one kind of serious complications of cesarean delivery .Every case should receive individualized treatment .Though continuing the cesarean scar pregnancy is possible to have a live newborn ,but the risk of hysterectomy due to placenta accrete bleeding increases.%目的:探讨剖宫产瘢痕妊娠( cesarean scar pregnancy ,CSP)临床诊治方法及结局。方法收集2012年1月至2014年12月厦门大学附属第一医院70例CSP患者的临床资料并作回顾性分析。结果70例诊断为CSP的患者孕周为5~16周,孕周≤12周的65例患者选择终止妊娠,其中24例行子宫动脉栓塞+刮宫术,6例行经阴道病灶切除术,3例行宫腔镜手术,4例行腹腔镜手术,20例药物治疗配合刮宫术,8例单纯药物治疗,均达到治愈目的,无1

  2. Factors that affecting mothers’ postnatal comfort

    Directory of Open Access Journals (Sweden)

    Gül Pınar

    2009-01-01

    Full Text Available Aim: The comfort is defined as; “an expected result of a complex conformation of providing peace and help about individual’s needs in a physical, psycho-spiritual, social and environmental entity to overcome the problems”. The aim of this study was to determine the mother’s postnatal comfort and the affecting factors of it.Materials and Methods: This is a sectional and descriptive study. The study was performed on the mothers (n=150 who applied to the delivery service of the Başkent University Ankara Hospital between the date of 30.07.2008 to 31.12.2008. A questionnaire was developed by the investigators to collect data and determine patients’ postnatal comfort scores. Results: The mean age of women was 26.4±3.5 years, the majority of patients had an educational level of high school (68.7% and were multipara (66.0%. It was determined that the mothers had problems and needed help with the fatigue, pain, in standing up, the adverse effect of anesthesia, personal and perineal hygiene that affect their postnatal comfort. The comfort score of the mothers who had spontaneous vaginal birth was higher than those of underwent cesarean delivery (p<0.05.Conclusion: The mothers’ needs and expectations about themselves and their babies were generally supplied by midwifes and the nurses in the postnatal period. Opinion of the mothers about their comfort were influenced to a positive view and the comfort scores increased while the mothers’ satisfaction were augmented (p<0.05.

  3. Obstetrical approach in breech presentation delivery

    Directory of Open Access Journals (Sweden)

    G. Grgić

    2007-02-01

    Full Text Available Although it is accompanied by a higher number of intrapartal complications and a higher rate of prenatal mortality and morbidity the breech presentation is not considered to be an unfavourable presentation for delivery. However, delivery with the breech presentation requires a detailed and very careful approach in assessment of the way delivery is to be conducted and a serious approach of an obstetrician when making a final decision. This often results in a high rate of caesarean sections in certain institutions which has been up to 80-100% of all the breech presentations.The objective of this retrospective study was to establish incidence of deliveries of the breech presentations and to determine a way of completing delivery depending on a parity of mother and a condition of the newborn at delivery in the five-year period. The results have shown that breech presentation occurred in 4.69% of the total number of deliveries. There was no statistically significant difference in the way the delivery had been completed neither in the condition of newborns as a result of the way the delivery was completed. 50.75% of deliveries were completed with cesarean section and 49.25% of women delivered the breech presentation vaginally. An average Apgar score for those delivered vaginally was 8.05 and 7.52 for babies delivered naturally. Breech presentation requires a serious prepartal analysis of delivery factors based on which a significant number of deliveries can be conducted vaginally with a satisfactory condition of newborns at delivery.

  4. Evaluation of the Analgesic Efficacy of Melatonin in Patients Undergoing Cesarean Section Under S pinal Anesthesia: A Prospective Randomized Double-blind Study

    Science.gov (United States)

    Beigom Khezri, Marzieh; Delkhosh Reihany, Morteza; Oveisy, Sonia; Mohammadi, Navid

    2016-01-01

    Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of three groups of 40 each to receive melatonin 3 milligram (mg) (group M3), melatonin 6 mg (group M6) or placebo (group P) sublingually 20 min before the spinal anesthesia. The time to first analgesic request, analgesic requirement in the first 24 h after surgery, hemodynamic variables, anxiety scores nd the incidence of adverse events were recorded. The duration of anesthesia and analgesia didn’t show significant differences between three groups. Total analgesic request during 24 h after surgery was different among the three groups (P = 0.035). The incidence of headache in group M6 was significantly higher than others (P<0.001). However, after adjusting headache between groups of the study, we were unable to show the significant difference in the total analgesic request during 24 h after surgery among the three groups (p = 0.058). Although premedication of patients with 3 mg sublingual melatonin prolonged time to first analgesic request after cesarean delivery compared to placebo group, the difference was not statistically significant. Meanwhile increasing dose of melatonin to 6 mg failed to enhance analgesia and also increase the incidence of headache in patients undergoing cesarean section under spinal anesthesia.

  5. 宫腔镜对剖宫产术后异常子宫出血性疾病的个体化治疗临床分析%Hysteroscopy for abnormal uterine cesarean section hemorrhagic disease of individualized treatment

    Institute of Scientific and Technical Information of China (English)

    崔秀红; 李长东

    2014-01-01

    Objective Discussion of hysteroscopy in the diagnosis of abnormal uterine bleeding after cesarean section of the practical value of individual treatment.Method More than half of one year after cesarean section out has nothing to do with cesarean delivery operation of endometrial polyps and submucous myoma of uterus and endometrial hyperplasia,endometrial cancer and so on 58 patients with abnormal uterine bleeding, admissions and hysteroscopic examination and treatment.Results 58 cases of uterine bleeding in patients with primary reasons:①the cesarean section incision diverticulum and diverticulum cavity hemorrhage in 34 cases; ②12 cases the cesarean section incision polyps; ③5 cases of cesarean scar pregnancy; ④4 cases were cesarean section incision in vascular abnormalities; ⑤lower uterine segment suture residues in 3 patients. Conclusion Hysteroscopy can be used as the first choice for individual treatment of abnormal uterine bleeding after cesarean section, is conducive to correctly judge hemorrhage under the direct cause, to individualized treatment.%目的:讨论宫腔镜在诊断剖宫产术后异常子宫出血的个体治疗的实用价值。方法剖宫产术后半年以上排除与剖宫产手术无关的子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增殖症、子宫内膜癌等的异常子宫出血58例患者,收入院进行宫腔镜检查与治疗。结果58例患者中子宫出血主要原因:①剖宫产切口憩室并憩室腔积血34例;②剖宫产切口息肉12例;③剖宫产瘢痕妊娠5例;④剖宫产切口处血管异常4例;⑤子宫下段缝线残留3例。结论宫腔镜可以作为剖宫产术后异常子宫出血的个体治疗的首选,在直视下有利于正确判断出血病因,以个体化治疗。

  6. Study on the Indications for and Factors Related to Cesarean Section at Three District Hospitals in Shanghai

    Institute of Scientific and Technical Information of China (English)

    Hong LIANG; Li-feng ZHOU; Bing-shun WANG; Ye ZHONG

    2006-01-01

    Objective To understand the indications for and factors related to cesarean section(CS).Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003.Results Among 933 puerperas, the CS rate was 37. 62%. The top four indications for CS were fetal distress (36.5%), social factors (35.9%), relative cephalopelvic disproportion (18.5%) and pregnancy complications (6.3%) respectively. The result of regression analysis showed that puerperas who were overweight before pregnancy,had no confidence in vaginal delivery and had macrosomia were more likely to have CS.Conclusion At present, the CS rate in Shanghai was rather high. The main indications for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas' weight before pregnancy.

  7. Maternal deaths after elective cesarean section for breech presentation in the Netherlands

    NARCIS (Netherlands)

    Schutte, Joke M.; Steegers, Eric A. P.; Santema, Job G.; Schuitemaker, Nico W. E.; Van Roosmalen, Jos

    2007-01-01

    Background and methods. The cesarean section rate for term singleton breech babies in the Netherlands rose from 57 to 81% after the Term Breech Trial in 2000. The Dutch Maternal Mortality Committee registered and evaluated maternal mortality due to elective cesarean section for breech. Results. Four

  8. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Bygbjerg, Ib Christian; Onesmo, Rwakyendela;

    2012-01-01

    To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice.......To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice....

  9. Neonatal viability evaluation by Apgar score in puppies delivered by cesarean section in two brachycephalic breeds (English and French bulldog).

    Science.gov (United States)

    Batista, M; Moreno, C; Vilar, J; Golding, M; Brito, C; Santana, M; Alamo, D

    2014-05-01

    This study tried to define neonatal viability after cesarean section in brachycephalic breeds and the efficacy of an adapted Apgar test to assess newborn survival. Data from 44 cesarean sections and 302 puppies were included. Before surgery (59-61 days after ovulation), an ultrasound evaluation defined the fetal biparietal diameter (BPD). Immediately after the uterine delivery, the pups were evaluated to detect birth defects and then, a modified Apgar score (range: 0-10) was used to define neonatal health at 5min (Apgar 1) and 60min (Apgar 2) after neonatal delivery; puppies were classified into three categories: critical neonates (score: 0-3), moderate viability neonates (score: 4-6) and normal viability neonates (score: 7-10). Mean (±SEM) value of BPD was 30.8±0.1mm and 28.9±0.1mm in English and French Bull-Dog fetus, respectively. The incidence of spontaneous neonatal mortality (4.98%, 14/281) and birth defects (6.95%) were not influenced by the sex; however, congenital anomalies and neonatal mortality were higher (pApgar 1, the percentage of critical neonates, moderate viability neonates and normal viability neonates were 20.5%, 46.3% and 33.1% respectively; sixty minutes after birth, the critical neonates only represented 10.3% of the total puppies. Almost all neonates (238/239) showing moderate or normal viability at Apgar 1, survived for the first 24h after birth. The results of the study showed a direct relationship (pApgar score and neonatal viability. Therefore, the routine performance of the Apgar score would appear to be essential in the assessment of the status of brachycephalic breed puppies.

  10. Single-dose antibiotic prophylaxis during cesarean section.

    Science.gov (United States)

    Gugino; Cimino; Wactawski-Wende

    1998-07-01

    Objective: To compare single-dose antibiotic prophylaxis (cefotetan 1 g vs cefoxitin 2 g) in various subpopulations based upon risk factors for postsurgical infection following cesarean section.Methods: Patients undergoing cesarean section from April 1993 through March 1994 were included in a retrospective analysis if either of the above antibiotics were administered, surgery was non-emergent, gestational age was less than 32 weeks, absence of fever or prior antibiotics therapy within 72 hours, and no history of organ transplantation or HIV. Cases classified as high risk for infection: IDDM, obesity, autoimmune disease, sickle cell disease, or corticosteroid use. Cases classified as high risk for endometritis (any 2 factors): labor >12 hours, >4 vaginal examinations, ruptured membranes >9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A chi(2) analysis was used to test for differences in infection rates between groups (P cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% (P =.056) as was the rate of endometritis (3.2% vs 1.2%, P =.185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P =.003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection (P =.13).Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.

  11. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

    Directory of Open Access Journals (Sweden)

    Shu S

    2015-08-01

    Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

  12. Abdominal Incisional Endometriosis Following Cesarean Section: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Azam Azargoon

    2008-06-01

    Full Text Available Endometriosis is described as the presence of functioning endometrial tissue (glands and stroma outside the uterine cavity. The most common location is within the pelvis. However, extra pelvic endometriosis is a fairly uncommon disorder and difficult to diagnose. It can sometimes occur in a surgical scar. Scar endometriosis is a rare condition and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. It presents as a painful, slowly growing mass in or near a surgical scar. We report two cases of abdominal wall endometriosis following hysterotomy and cesarean section. Consequently the pathogenesis, diagnosis and treatment are discussed.

  13. 剖宫产术后阴道分娩的产程时限研究%Labor Time in Vaginal Birth after Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    姜海利; 王欣

    2016-01-01

    Objective To investigate the labor time in vaginal birth after cesarean section ( VBAC ) so as to get definite evaluating and monitoring points of VBAC. Methods 75 pregnant women who underwent trial of labor after cesarean ( TOLAC)in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2012 to June 2015 were selected. Among them,70 cases(VBAC,93. 3%)had successful vaginal delivery,5 cases(6. 7%)with unsuccessful vaginal trial production underwent cesarean section again. According to the timing of previous cesarean section,70 pregnant women with VBAC were divided into cesarean section after vaginal trial of production group(n=23)and elective cesarean section group(n=47),and their stages of labor were recorded. Results The average age and parity of patients in elective cesarean section group were respectively younger and less than those of patients in cesarean section after vaginal trial of production group ( P﹤0. 05 );the comparison of gestational age,times of pregnancy,pre-pregnancy BMI,prenatal BMI,thickness of lower uterine segment and premature rupture of membrane through ultrasonic testing,and proportion of gestational diabetes and pregnancy complicated with hypertension among pregnant women in two groups was not significantly different ( P ﹥0. 05 ) . There was no significant difference in times of the first stage of labor,the second stage of labor and total stage of labor among pregnant women with no history of vaginal delivery in two groups(P﹥0. 05);there was no significant difference in times of the first stage of labor,the second stage of labor and total stage of labor among term delivery women with no history of vaginal delivery in two groups( P﹥ 0. 05). The amount of postpartum hemorrhage, neonatal weight, neonatal Apgar score, and the proportion of puerperal infection,fetal distress,amniotic fluid Ⅲ, neonatal morbidity, forceps delivery and maternal postpartum hemorrhage among pregnant women in two groups were not

  14. Pregnancy Followed by Delivery May Affect Circulating Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels in Women of Reproductive Age

    Directory of Open Access Journals (Sweden)

    Mehmet Balin

    2012-01-01

    Full Text Available Background/Objective. It is known that menopause or lack of endogenous estrogen is a risk factor for endothelial dysfunction and CAD. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1 is involved inmultiple phases of vascular dysfunction.The purpose of the current study was to determine the association between soluble LOX-1 (sLOX-1 and pregnancy followed by delivery in women of reproductive age. Materials/Methods. Sixty-eight subjects with pregnancy followed by delivery (group 1 and 57 subjects with nongravidity (group 2 were included in this study. Levels of sLOX-1 were measured in serum by EL SA. Results. Plasma levels of sLOX-1 were significantly lower in Group 1 than Group 2 in women of reproductive age (0.52±0.18 ng/mL and 0.78±0.13, resp., <0.001. There were strong correlations between sLOX-1 levels and the number of gravida (=−0.645, <0.001. The levels of sLOX-1 highly correlated with the number of parous (=−0.683, <0.001. Conclusion. Our study demonstrated that serum sLOX-1 levels were associated with pregnancy followed by delivery that might predict endothelial dysfunction. We conclude that pregnancy followed by delivery may delay the beginning and progress of arteriosclerosis and its clinical manifestations in women of reproductive age.

  15. [Informed Consent in the Humanization of the Cesarean: A Preliminary Study].

    Science.gov (United States)

    Castaño Molina, M Ángeles; Carrillo Navarro, Francisco; Pastor, Luis Miguel

    2016-01-01

    The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of ″humanization″ of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals.

  16. Trinidadian women’s knowledge, perceptions, and preferences regarding cesarean section: How do they make choices?

    Directory of Open Access Journals (Sweden)

    K Mungrue

    2010-11-01

    Full Text Available Kameel Mungrue, C Nixon, Y David, D Dookwah, S Durga, K Greene, H MohammedFaculty of Medical Sciences, Department of Paraclinical Sciences, Public Health & Primary Care Unit, The University of the West Indies, St Augustine, Trinidad and TobagoObjectives: The objective of this study is to determine the awareness of perception and attitude toward cesarean section (CS in a high-user setting.Design and methods: A cross-sectional design using multistage sampling methods was used to select participants from antenatal and postnatal clinics in a primary health care setting in north Trinidad. A multi-item structured questionnaire was designed and administered by in-depth interviews. Sociodemographic data and data about history of previous pregnancies and outcomes and about knowledge and perceptions of CSs were collected from women aged 16 years and older.Results: Of the women who were eligible for entry into the study, 368 participated. However, participants chose not to respond to some questions. The majority of women (46.2% were found to have very little information from which to make informed decisions about selecting CS as the preferred choice of delivery. Their preference was significantly associated with the perception of safety (maternal or fetal death, P = 0.001, difficulty (complications to mother and baby, P = 0.001, and pain (P = 0.001. Notwithstanding, persons who received information from health care professionals (odds ratio [OR], 1.9; confidence interval, 1.50–2.33 were more likely to have high or adequate levels of information about CSs. Data were analyzed using SPSS software, and ORs were calculated using logistic regression.Conclusion: The majority of women attending antenatal and postnatal clinics in north Trinidad were not sufficiently knowledgeable about CS to enable them to make informed choices. In addition, the information obtained was from an unreliable source, emphasizing the need for information on CS to form a component of a

  17. The main function of bionic air-bag midwifery skill reducing cesarean section rate%气囊仿生助产对降低剖宫产率的主要作用

    Institute of Scientific and Technical Information of China (English)

    黄崇梅; 王英; 何林清; 张琦

    2014-01-01

    目的:分析我国剖宫产率居高不下的原因,探讨应用气囊仿生助产技术对降低剖宫产率的可行性。方法:对我院未应用气囊仿生助产术前和已使用气囊仿生助产术后在我院分娩的孕产妇,从剖宫产指征、剖产率两方面进行回顾性对照研究。结果:未应用气囊仿生助产术前剖宫产指征中社会因素占56%,医学指征占44%,剖宫产率50%。应用气囊仿生助产术后社会因素占36%,医学指征占64%,剖宫产率下降至35%。讨论:运用气囊助产在分娩过程中缩短产程,减少会阴裂伤等优势。明显减少了剖宫产的社会因素指征,使剖宫产率明显下降。所以气囊仿生助产术是降低剖宫产率的有效措施,值得推广。%Objective: To analyze the reason of high cesarean section rate in our country, to investigate the feasibility of applying bionic air-bag midwifery skil to reduce cesarean section rate.Methods: We use the indication of cesarean section and cesarean section rate to undertake retrospective study about the differences of puerperal women in our hospital who apply bionic air-bag midwifery skil or not.Results: In the indication of cesarean section that puerperal women did not apply bionic air-bag midwifery skil, social factors account for 56% and medical indication accounts for 44%.The cesarean section rate is 50%.However, In the indication of cesarean section that puerperal women apply bionic air-bag midwifery skil, social factors account for 36% and medical indication accounts for 64%.The cesarean section rate drop to 35%.Discussion:Applying bionic air-bag midwifery skil have many advantages such as shortening the stage of labor during delivery and reducing perineal laceration. It makes the social factors of cesarean section and cesarean section rate decline obviously. In summary, bionic air-bag midwifery skil is an effective measure to reduce cesarean section rate and deserves popularity.

  18. Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case

    Directory of Open Access Journals (Sweden)

    Ghodratollah Maddah

    2016-03-01

    Full Text Available A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.

  19. [Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil].

    Science.gov (United States)

    Mandarino, Natália Ribeiro; Chein, Maria Bethânia da Costa; Monteiro Júnior, Francisco das Chagas; Brito, Luciane Maria Oliveira; Lamy, Zeni Carvalho; Nina, Vinícius José da Silva; Mochel, Elba Gomide; de Figueiredo Neto, José Albuquerque

    2009-07-01

    This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

  20. Incidence of uterine torsion during veterinary-assisted dystocia and singleton live births after vaginal delivery inHolstein-Friesian cows at pasture

    Institute of Scientific and Technical Information of China (English)

    Faria N; Simes J

    2015-01-01

    Objective:To determine the incidence of uterine torsion and their association with live births after vaginal delivery at pasture.Methods:A total of 119 veterinary-assisted dystocia, occurred in Holstein-Friesian cows, were accessed between September 2012 and February 2013 from Azores islands (Portugal). The general health status of dam, cause of dystocia, obstetric treatment choice, number and viability of fetus were evaluated.Results:The uterine torsion represented 24.4% (29/119) of total assisted dystocia. The general health status was normal or slowly affected, at delivery time, for 96.6% (28/29) of the cows with uterine torsion. Vaginal delivery after rolling cows, cesarean section or euthanasia were performed in 72.4% (21/29), 24.1% (7/29) and 3.5% (1/29) of dams with uterine torsion, respectively. Singletons were observed in 96.6% (28/29) and 86.7% (78/90) of cows with uterine torsion and remaining dystocia, respectively. After vaginal delivery, the occurrence of singleton live births was more probable to occur in cows with uterine torsion (17/21) than the remaining cows (37/70) of control group (odds ratio=3.79; 95% interval of confidence from 1.16 to 12.41;P<0.05).Conclusions:A high frequency of uterine torsion was observed in Holstein-Friesian cows with normal or slowly affected general health status at delivery time at pasture. The singleton live births prevailed and, in general, their occurrence by vaginal delivery after uterus reposition was most likely to occur in cows with uterine torsion than dams presenting other dystocia.

  1. Pregnancy and Delivery in Ehlers-Danlos Syndrome (Hypermobility Type: Review of the Literature

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    Indranil Dutta

    2011-01-01

    Full Text Available Ehlers-Danlos syndrome (EDS is a group of connective tissue disorders which are divided into various distinguishable phenotypes. The type of EDS determines the potential obstetric complications. Due to the spectrum of clinical manifestation and overlap between phenotypes, there are no standardised obstetric management guidelines. Existing literature illustrates different obstetric management in hypermobility type of EDS, including uneventful term vaginal deliveries as well as preterm cesarean section deliveries. This paper discusses obstetric management of a woman with EDS hypermobility type. Cesarean section was deemed the most appropriate delivery method in this patient due to the possible complications including risk of joint dislocation and pain morbidity. No obstetric complications were experienced, and good maternal and neonatal outcomes were achieved.

  2. Pregnancy and delivery in ehlers-danlos syndrome (hypermobility type): review of the literature.

    Science.gov (United States)

    Dutta, Indranil; Wilson, Helen; Oteri, Odiri

    2011-01-01

    Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders which are divided into various distinguishable phenotypes. The type of EDS determines the potential obstetric complications. Due to the spectrum of clinical manifestation and overlap between phenotypes, there are no standardised obstetric management guidelines. Existing literature illustrates different obstetric management in hypermobility type of EDS, including uneventful term vaginal deliveries as well as preterm cesarean section deliveries. This paper discusses obstetric management of a woman with EDS hypermobility type. Cesarean section was deemed the most appropriate delivery method in this patient due to the possible complications including risk of joint dislocation and pain morbidity. No obstetric complications were experienced, and good maternal and neonatal outcomes were achieved.

  3. Analysis on Indications and Causes of Cesarean Section on Pemba Island of Zanzibar in Africa

    Directory of Open Access Journals (Sweden)

    Liping Zhou

    2013-03-01

    Full Text Available Objective: To explore and analyze the indications and causes of cesarean section on Pemba island of Zanzibar in Africa to improve the quality of obstetrics. Methods: 564 patients performed cesarean section in Abdulla Mzee Hospital of Pemba from January, 2008 to December, 2011 were selected, and statistics was conducted by the method of retrospective analysis. Results: The rate of cesarean section in Abdulla Mzee Hospital of Pemba was 10.01%. The primary causes of cesarean section included cephalopelvic disproportion (27.13%, scar uterus (23.40%, preeclampsia and eclampsia (13.30%, fetal distress in uterus (9.40%, fetal factors (9.75% and complication of pregnancy (6.91%. Conclusion: Cesarean section plays a great role in the treatment of dystocia, some complications of pregnancy and reducing the mortality of pregnant women and perinatal infants, but in the area with relatively undeveloped medical conditions in Africa, cesarean section still takes great risks. Unnecessary cesarean section cannot reduce the incidence of postpartum hemorrhage and neonatal morbidity. The local medical staff should improve the midwifery technique, establish and perfect the formal antenatal examination system to improve the quality of maternity.

  4. Analysis on Indications and Causes of Cesarean Section on Pemba Island of Zanzibar in Africa

    Institute of Scientific and Technical Information of China (English)

    Zhou Liping; Zubeir TS; Hamida SA

    2013-01-01

    Objective: To explore and analyze the indications and causes of cesarean section on Pemba island of Zanzibar in Africa to improve the quality of obstetrics. Methods: 564 patients performed cesarean section in Abdulla Mzee Hospital of Pemba from January, 2008 to December, 2011 were selected, and statistics was conducted by the method of retrospective analysis. Results: The rate of cesarean section in Abdulla Mzee Hospital of Pemba was 10.01%. The primary causes of cesarean section included cephalopelvic disproportion (27.13%), scar uterus (23.40%), preeclampsia and eclampsia (13.30%), fetal distress in uterus (9.40%), fetal factors (9.75%) and complication of pregnancy (6.91%). Conclusion: Cesarean section plays a great role in the treatment of dystocia, some complications of pregnancy and reducing the mortality of pregnant women and perinatal infants, but in the area with relatively undeveloped medical conditions in Africa, cesarean section still takes great risks. Unnecessary cesarean section cannot reduce the incidence of postpartum hemorrhage and neonatal morbidity. The local medical staff should improve the midwifery technique, establish and perfect the formal antenatal examination system to improve the quality of maternity.

  5. Mode of delivery and neurosonographic findings in premature infants

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    Velisavljev-Filipović Gordana

    2007-01-01

    Full Text Available Introduction Fetal and preterm infant brain is especially vulnerable to hemorrhagic and ischemic damage at the end of the second and at the beginning of the third trimester. This is due to vascular, cellular and anatomic characteristics of the brain during development. In premature babies, there is a physiological instability and limited autoregulation of cerebral circulation. Hemorrhagic and ischemic damages often occur together, though pathophysiological processes leading to lesions are different. Material and methods The paper deals with a detailed analysis of 860 ultrasound brain scans of prematurely born children. The examinations were performed at the Ultrasound Department of the Institute of Child and Youth Health Care in Novi Sad. 707 vaginally born premature infants and 153 premature infants born by Cesarean section were examined. The bleeding was graded according to the Papile classification. Results and Discussion Out of 384 children with diagnosed grade I hemorrhage, 75 premature infants (19.5% were born by Cesarean section. In the group of children with grade II hemorrhage, operative deliveries account for 14.7%. From the total of 85 children with grade III hemorrhage, (intraventricular bleeding with chamber dilatation, only 6 premature infants were born by Cesarean section (7%. Intra-parenchymal bleeding was diagnosed in a very small number of premature infants; 0.32% of all diagnosed hemorrhages were grade IV hemorrhages. In this group there were no children born by Cesarean section. The increase of hemorrhage grade is accompanied by a greater rate of pelvic presentation and manual assistance by Bracht. There were 240 prematurely born children with no echosonographically diagnosed hemorrhage, 38% of all examined premature infants. From this number, 13.3% of neonates were born by Cesarean section. Conclusion In the etiology of neonatal intracranial hemorrhage, especially prematurely born ones, apart from the trauma, which plays a

  6. Measuring and decomposing socioeconomic inequality in healthcare delivery: A microsimulation approach with application to the Palestinian conflict-affected fragile setting.

    Science.gov (United States)

    Abu-Zaineh, Mohammad; Mataria, Awad; Moatti, Jean-Paul; Ventelou, Bruno

    2011-01-01

    Socioeconomic-related inequalities in healthcare delivery have been extensively studied in developed countries, using standard linear models of decomposition. This paper seeks to assess equity in healthcare delivery in the particular context of the occupied Palestinian territory: the West Bank and the Gaza Strip, using a new method of decomposition based on microsimulations. Besides avoiding the 'unavoidable price' of linearity restriction that is imposed by the standard methods of decomposition, the microsimulation-based decomposition enables to circumvent the potentially contentious role of heterogeneity in behaviours and to better disentangle the various sources driving inequality in healthcare utilisation. Results suggest that the worse-off do have a disproportinately greater need for all levels of care. However with the exception of primary-level, utilisation of all levels of care appears to be significantly higher for the better-off. The microsimulation method has made it possible to identify the contributions of factors driving such pro-rich patterns. While much of the inequality in utilisation appears to be caused by the prevailing socioeconomic inequalities, detailed analysis attributes a non-trivial part (circa 30% of inequalities) to heterogeneity in healthcare-seeking behaviours across socioeconomic groups of the population. Several policy recommendations for improving equity in healthcare delivery in the occupied Palestinian territory are proposed.

  7. Forceps Delivery

    Science.gov (United States)

    ... delivery. If your health care provider does an episiotomy — an incision in the tissue between the vagina ... the tissue between your vagina and your anus (episiotomy) to help ease the delivery of your baby. ...

  8. A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome

    Directory of Open Access Journals (Sweden)

    Neerja Bhardwaj

    2013-01-01

    Results: The umbilical pH was comparable in all the three groups (P > 0.05. The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in group M (P < 0.05 than in group E and group P. Total drug consumption to meet target blood pressure till delivery was 39.3 ± 14.6 mg in group E, 1.7 ± 0.9 mg in group M, and 283.6 ± 99.8 mcg in group P. The incidence of nausea and vomiting was comparable in the three groups. Conclusion: All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anesthesia for cesarean section without any detrimental effects on fetal and maternal outcome.

  9. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush

    We investigate antecedents and contingencies of location configurations supporting global delivery models (GDMs) in global outsourcing. GDMs are a new form of IT-enabled client-specific investment promoting services provision integration with clients by exploiting client proximity and time......-zone spread allowing for 24/7 service delivery and access to resources. Based on comprehensive data we show that providers are likely to establish GDM configurations when clients value access to globally distributed talent pools and speed of service delivery, and in particular when services are highly...... commoditized. Findings imply that coordination across time zones increasingly affects international operations in business-to-business and born-global industries....

  10. Effects of acupuncture on post-cesarean section pain

    Institute of Scientific and Technical Information of China (English)

    WU Hung-chien; LIU Yu-chi; OU Keng-liang; CHANG Yung-hsien; HSIEH Ching-liang; TSAI Angela Hsin-chieh; TSAI Hong-te; CHIU Tsan-hung; HUNG Chih-jen; LEE Chien-chung; LIN Jaung-geng

    2009-01-01

    Background Post-operation pain is a very subjective phenomenon.The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain.Methods Sixty women,who had had spinal anesthesia during cesarean section at the Department of Obstetrics of China Medical University Hospital,were randomly assigned to the control group,the acupuncture group,and the electro-acupuncture group.After the operation,we applied subjects with acupuncture or electro-acupuncture on the bilateral acupuncture point,San Yin Jiao(Sp6),and the patient controlled analgesia(PCA).The first time of requesting morphine,the frequency of PCA demands in 24 hours,and the doses of PCA used were recorded double blindly.In addition,monitoring the subjects' vital signs,the opioid-related side effects,and the pain scores was done.Results The results showed that the acupuncture group and the electro-acupuncture group could delay the time of requesting morphine up to 10-11 minutes when compared with the control group.The total dose of PCA used within the first 24 hours was 30%-35%less in the acupuncture group and the electro-acupuncture group when compared with the control group,which was indicated in statistical significance.However,there was no significant difference between the acupuncture group and the electro-acupuncture group.The electro-acupuncture group's and the acupuncture group's pain scores were lower than the control group's within the first 2 hours.Both were statistically significant.However,two hours later,there were no significant differences of the visual analogue scale(VAS)scores between either of the treatment groups and the control group.Finally,the incidence of opioid-related side effects,such as dizziness,was less in the acupuncture group and electro-acupuncture group than in the control group.Conclusions This study shows that the application of acupuncture and electro-acupuncture could definitely delay the time of requesting pain relief medication

  11. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    OpenAIRE

    Mohamed Mohamed Tawfik; Basma Abed Badran; Ahmed Amin Eisa; Rafik Ibrahim Barakat

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery...

  12. Indications for cesarean deliveries during a 7-year period in a tertiary hospital.

    Science.gov (United States)

    Costa, Ana; Policiano, Catarina; Clode, Nuno; Graça, Luís M

    2013-01-01

    Introdução: Analisar a evolução da taxa de cesarianas e as principais indicações para cesariana num centro terciário.Material e Métodos: Estudo retrospectivo conduzido num hospital universitário que incluiu 5751 grávidas submetidas a cesariana entre 2005 e 2011. Analisaram-se as taxas de cesarianas, incluindo a taxa de primeiras cesarianas e de cesarianas repetidas. Para avaliar a contribuição relativa de cada uma das indicações na variação da taxa de primeiras cesarianas recorreu-se à regressão linear e determinou-se o valor do r2 ajustado.Resultados: Durante o período do estudo a taxa de cesarianas diminuiu de 30,9% para 27,6%. Esta descida deveu-se à diminuição da taxa de primeiras cesarianas (21,9% para 18,2%), apesar de se ter constatado um ligeiro aumento da taxa de cesarianas repetidas (9,0 para 9,4%). Entre as indicações para primeiras cesarianas, as causas materno-fetais e de apresentação anómala foram as que diminuiram mais, com valores de r2 ajustado de 0,70 e 0,55, respectivamente.Discussão: Os dados coligidos permitiram identificar a hipótese de que a diminuição da taxa de cesarianas se deveria a uma retração detectada sobretudo a nível das primeiras cesarianas, em particular as decorrentes de causas materno-fetais e apresentação anómala.Conclusão: A diminuição da taxa de primeiras cesarianas pode ser atribuída a várias modificações na prática clínica do Departamento, como a implementação da versão cefálica externa, a indução do trabalho de parto a partir das 41 semanas de gestação, em gravidezes de baixo risco e da realização de provas de trabalho de parto em casos de patologia materno-fetal. No entanto, indicações subjectivas, como a paragem de progressão do trabalho de parto e a suspeita de sofrimento fetal são ainda causas major de primeiras cesarianas.

  13. Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996-2011

    Science.gov (United States)

    ... approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol 203(5):449.e1–6. 2010. Association of Women's Health, Obstetric and Neonatal Nurses. 40 reasons to go the ...

  14. Management of Hepatic Rupture Diagnosed after an Emergency Cesarean Section

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    Gianluca Raffaello Damiani

    2014-01-01

    Full Text Available A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management.

  15. 影响黄油生成量因素及黄油的外送方法%Factors affecting output of butter and butter delivery

    Institute of Scientific and Technical Information of China (English)

    宋建东

    2015-01-01

    烯烃生产过程中碱洗塔中会生成黄油。本文针对黄油产生的危害性,介绍了黄油生成的机理,并提出了减少黄油生成的优化方法及黄油外送方法。%The mechanism of butter generated in caustic tower during olefin production is introduced in this paper to provide solutions for reduction of the output and delivery methods of the butter.

  16. Medical students’ personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

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    Watanabe Tatiane

    2012-07-01

    Full Text Available Abstract Background The increase in overall rates of cesarean sections (CS in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students. Methods A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice. Results A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student’s own or a partner’s pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03–8.30. Pain associated with vaginal delivery was usually the reason for choosing a CS. Conclusions A higher number of sixth year students preferred a CS for their own pregnancy (or their partner’s compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen

  17. Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services.

    Science.gov (United States)

    Mmeje, Okeoma; Njoroge, Betty; Akama, Eliud; Leddy, Anna; Breitnauer, Brooke; Darbes, Lynae; Brown, Joelle

    2016-01-01

    Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV-serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and

  18. Cimethidine pre-anesthetic. A prophylactic method against Mendelson's syndrome in cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K

    1983-01-01

    Twenty patients undergoing cesarean section received cimethidine 400 mg intramuscularly as pre-anesthetic approximately 70 minutes prior to gastric aspiration. The average pH was 5.05, as against 2.97 in the control group (p less than 0.01). No significant reduction in the aspirated volumes...... in the infants. Hence, cimethidine is a safe and useful pre-anesthetic for patients undergoing cesarean section, irrespective of indication and, consequently, much to be preferred to oral antacids....

  19. Mixed endometrioid and serous carcinoma developing in abdominal wall endometriosis following Cesarean section

    Energy Technology Data Exchange (ETDEWEB)

    Da Ines, David; Montoriol, Pierre Francois; Petitcolin, Virginie; Garcier, Jean-Marc (Dept. of Radiology and Medical Imaging, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)), email: ddaines@chu-clermontferrand.fr; Bourdel, Nicolas; Canis, Michel (Dept. of Obstetrics and Gynecology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)); Charpy, Cecile (Dept. of Pathology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France))

    2011-06-15

    Abdominal wall endometriosis is unusual and mostly occurs in scars following Cesarean section. Although malignant transformation is rare, it must be recognized in order to benefit from radical resection. We report a very rare case of mixed endometrioid and serous carcinoma developing in a Cesarean section endometriosis scar and the way we managed it using surgery and chemotherapy. 18-FDG PET-CT imaging was performed to correctly stage the disease

  20. Usefulness of bladder dissection in cesarean section: a randomized controlled trial

    OpenAIRE

    Mervat A. Elsersy

    2016-01-01

    Background: There are various different methods of performing a caesarean section. With the increasing rate of repeat cesarean sections, it is necessary to recognize evidence based techniques to improve outcomes and minimize complications. Dissection of a bladder flap was an integral step in standard cesarean section. Cancelation of the bladder dissection is one the modifications that showed to be safe and cost effective. The aim of this study is to perform a randomized controlled clinical tr...

  1. Analysis on 60 Cases of Scarred Uterus with Secondary Cesarean Section%瘢痕子宫二次剖宫产60例分析

    Institute of Scientific and Technical Information of China (English)

    高玉华

    2011-01-01

    Objective To explore the clinical characteristics of scarred uterus with secondary cesarean section. Methods Sixty pregnant women with scarred uterus performed secondary cesarean section in the People's Hospital of Qing-chuan County from January 2009 to January 2011 were enrolled in this study. According to different surgical methods in the first cesarean section, the clinical data of 60 pregnant women were retrospectively analyzed. Results The total operation period, the mean time from the incision to fetal delivery, and intraoperative blood loss in transverse incision group were more than those in longitudinal incision group, and the difference was statistically significant between the two groups (P<0.05). There were statistically significant differences in peritoneal adhesion between the two groups (P<0.05). We compared the clinical outcomes of transverse incision group with longitudinal incision group in the secondary cesarean section, and the results showed that 29 cases were healed and 1 case had poor healing. 7 cases had placenta previa, including 4 cases of central placenta previa and 2 cases of widely implanted placenta previa, and hysterectomy was performed after the various ineffective treatments. No maternal death was found. 2 premature infants died, and the others survived. Conclusions The obstetricians should be skilled in performing secondary cesarean section among pregnant woman with scarred uterus in order to ensure operation safety. It is necessary to enhance the related propaganda, let the patients knowing about sufficient knowledge about surgical risks, and carry out trial of vaginal delivery so as to reduce the rate of secondary cesarean section.%目的 探讨瘢痕子宫二次剖宫产的临床特点.方法 选择青川县人民医院2009年1月- 2011年1月收治的行二次剖宫产的产妇60例,随机依据首次剖宫产采用的不同术式资料进行回顾性分析.结果 手术总时间及手术开始至胎儿娩出时间横切口组

  2. Analysis on 70 Cases of Scarred Uterus With Secondary Cesarean Section%瘢痕子宫二次剖宫产70例分析

    Institute of Scientific and Technical Information of China (English)

    杨帆

    2015-01-01

    目的 探讨瘢痕子宫二次剖宫产的临床特点.方法 选择我院行二次剖宫产的产妇70例,依据首次剖宫产采用的不同术式分为横切口组和纵切口组,每组患者均为35例.结果 手术总时间及手术开始至胎儿娩出时间横切口组长于纵切口组,术中出血量横切口组多于纵切口组,差异有统计学意义(P<0.05),两组在腹腔粘连方面差异有统计学意义(P<0.05).再次剖宫产横切口与纵切口比较,两组均愈合良好34例,愈合不良1例,两组产妇合并前置胎盘7例,其中中央性4例,广泛植入3例,经各种处理无效后行子宫切除术,无产妇死亡,早产儿死亡2例,余全部存活.结论 瘢痕子宫行第二次剖宫产术时,产科医生手术操作应娴熟,以保证手术安全.降低剖宫产率需加大宣传力度,使患者对手术风险有足够的认识,并充分进行试产,以使二次剖宫产率降低%Objective To explore the clinical characteristics of scarred uterus with secondary cesarean section.Methods70 pregnant women with scarred uterus performed secondary cesarean section in our hospital were enroled in this study. According to different surgical methods in the first cesarean section, the clinical data of 70 pregnant women were divided into transverse incision group(35 cases)and longitudinal incision group(35 eases).Results The total operation period,the mean time from the incision to fetal delivery,and intraoperative blood loss in transverse incision group were more than those in longitudinal incision group,and the difference was statistical significant(P<0.05). And there were statistical significant differences in peritoneal adhesion between the two groups(P<0.05). We compared the clinical outcomes of transverse incision group with longitudinal incision group in the secondary cesarean section,and the results showed that 34 cases were healed and 1 cases had poor healing,7 cases had placenta previa,and hysterectomy was performed after the

  3. Maternal goals for childbirth associated with planned vaginal and planned cesarean birth.

    Science.gov (United States)

    Quiroz, Lieschen H; Blomquist, Joan L; Macmillan, Deborah; McCullough, Alexis; Handa, Victoria L

    2011-10-01

    We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P  =  0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P  <  0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience.

  4. Cesarean birth is not associated with early childhood body mass index.

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    Smithers, L G; Mol, B W; Jamieson, L; Lynch, J W

    2016-12-06

    Cesarean birth leads to a markedly different microbiome compared to vaginal birth, and the microbiome has been implicated in childhood obesity. Among mothers who had a previous cesarean, we compared anthropometry of 3- to 6-year-old children who were subsequently born by cesarean section versus vaginal birth. This large population-based study involved linking de-identified administrative perinatal and anthropometric data. Children's weight and height were collected at community-based clinics and converted to age- and sex-adjusted z-scores of height-for-age (HFAz), weight-for-age (WFAz) and BMI-for-age (BMIz). The average treatment effect (ATE) of cesarean versus vaginal birth was calculated from augmented inverse probability weighted analyses accounting for a wide range of confounding variables. There was little evidence of an effect of cesarean birth on HFAz (ATE = 0.26 95%CI -0.35, 0.87, n = 3993), WFAz (ATE = 0.35, 95%CI -0.19, 0.89, n = 4817) or BMIz (ATE = 0.11, 95%CI -0.25, 0.46, n = 3909). Cesarean section was not associated with anthropometry among children aged 3-6 years.

  5. INCIDENCE & CAUSES OF NEONATAL HYPOGLYCEMIA AFTER CESAREAN SECTION IN A RURAL SETUP OF WEST BENGAL

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    Rudradev

    2014-01-01

    Full Text Available Neonatal hypoglycaemia a major cause of morbidity and mortality may lead to permanent brain damage. This is more common in babies delivered by Caesar ean Section. AIMS: A clinico - statistical study was performed among newborns delivered by Caesarean Section for a period of 1 year to find out: 1. The incidence of neonatal hypoglycemia at 48 hrs of birth. 2. Risk factors of neonatal hypoglycemia in case of cesarean section. 3. Incidence of neonatal hypoglycemia in newborns of mothers with obstetrical risks (dribbling, PET, & prolonged labour. 4. Incidence of hypoglycemia among low birth weight babies. SETTINGS AND DESIGN: A cross - sectional observational study was conducted based on deliveries by Caesarean Section over a period of 1 year. METHODS AND MATERI AL: Screening was done by GOD - POD (Glucose Oxidase - Peroxidase method from new born blood (venous at 48 hrs of life. We considered neonatal hypoglycaemia as blood glucose concentration < 50 mg/dl. Gestational age was calculated from LMP (Last Menstrual Pe riod. Additionally low birth weight babies were also considered for the study. STATISTICAL ANALYSIS: The number of newborns suffering from hypoglycaemia in each of the above groups were determined from the blood test and their incidences were calculated with respect to the total number of newborns (221 selected for the study. RESULTS: The overall incidence of neonatal hypoglycemia at 48 hrs was 16.3%.Those suffering from both preterm and dribbling the incidence of neonatal hypoglycemia was 100%. Other ca ses with risk factors had high incidence rates. CONCLUSION: The study reveals the importance of the risk factors for neonatal hypoglycaemia. All high risk cases had high incidence of neonatal hypoglycaemia. We should always be vigilant about those to prev ent neonatal morbidity and mortality.

  6. Evaluation of risk factor and complication of umbilical cord prolapsed in cesarean section

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    Zahra Rezaee

    2015-03-01

    Full Text Available Objectives: Considering the rarity of umbilical cord prolapse (UCP and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition. Patients & Methods: Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients' records and analyzed by SPSS version 18. Results: Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00, engagement 8 times (14% vs 2% -P<0.001, transverse presentation 8 times (6% vs 2%-P<0.002, grand multiparity 3.9 times (4% vs 0-P<0.001, oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001. UCP was more prevalent in post-term deliveries (P<0.043. One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00. Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group. Conclusion: A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.

  7. Administration of a multistrain probiotic product (VSL#3) to women in the perinatal period differentially affects breast milk beneficial microbiota in relation to mode of delivery.

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    Mastromarino, Paola; Capobianco, Daniela; Miccheli, Alfredo; Praticò, Giulia; Campagna, Giuseppe; Laforgia, Nicola; Capursi, Teresa; Baldassarre, Maria E

    2015-01-01

    Probiotic supplementation to a mother during the perinatal period can have a positive impact on the breast milk composition. The aim of our study was to evaluate the effect of oral supplementation with the probiotic VSL#3, during late pregnancy and lactation, on breast milk levels of beneficial bacteria and some functional components (oligosaccharides and lactoferrin) potentially able to have a positive influence on the microbiota. Breast milk microbiota was analyzed by conventional and quantitative real-time PCR. In a double-blind, placebo-controlled, randomized trial, 66 women took daily either the probiotic (n=33) or a placebo (n=33). Intergroup analysis demonstrated that the amounts of both lactobacilli and bifidobacteria were significantly higher in the colostrum and mature milk of the mothers taking VSL#3 in comparison to those taking placebo. The analysis of bacterial strains and species present in breast milk of VSL#3 supplemented mothers indicated that the administered probiotic microorganisms did not pass from maternal gut to mammary gland. In women with vaginal delivery, significantly higher amounts of lactobacilli and bifidobacteria were detected in colostrum and mature milk of probiotic treated group in comparison to placebo group, whereas no significant difference was observed between groups in women who had caesarean section, neither in colostrum nor in mature milk. Milk levels of oligosaccharides and lactoferrin were similar in placebo and probiotic supplemented groups at all timepoints and regardless of the mode of delivery. Our results indicate a probiotic-dependent modulation of breast milk microbiota in vaginally delivering women, possibly exerted through a systemic effect.

  8. [Care plan for women with cesarean section and pre-eclampsia].

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    Sabbagh-Sequera, Miriam; Loidi-García, Jose María; Romero-Vázquez, Gloria Maria

    2015-01-01

    Pregnancy pathologies in general, and pre-eclampsia in particular, are problems usually treated in post-anesthesia recovery and hospitalization units. Pre-eclampsia is the most frequent form of hypertension associated with pregnancy (50%). It affects from 7% to 10% of pregnant women. It is known as pregnancy and puerperium multisystem syndrome. It is due to a reduction of the systemic perfusion generated by the vasospasms and the activation of the coagulation systems. A clinical case is presented of the immediate post-surgery period of a patient, who has been operated on cesarean section after having been diagnosed with pre-eclampsia. A nursing care plan was prepared, based on Marjory Gordon functional patterns and guided by NANDA-NOC-NIC taxonomy, where 6 nursing diagnoses, which are the basis for the fulfillment of this nursing process, are identified: Risk of infection, excess fluid volume, risk of bleeding, insufficient knowledge about its pathological process, severe pain, and anxiety. The application of this care plan leads to an improvement in the patient care and in the work organization.

  9. Monitoring of plethysmography variability index and total hemoglobin levels during cesarean sections with antepartum hemorrhage for early detection of bleeding

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    Ahmed Elsakka

    2017-01-01

    Conclusion: Plethysmography variability index and non invasive hemoglobin monitoring as well can be used for optimization of intravascular volume status during cesarean sections in parturients with antepartum hemorrhage.

  10. Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study.

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    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.

  11. ANALYSIS ON THE MAIN FACTORS OF INCREASING CESAREAN SECTION RATE IN LAST 6 YEARS%6年剖宫产手术指征变迁因素分析

    Institute of Scientific and Technical Information of China (English)

    潘翠金

    2011-01-01

    [Objective] To analyze the main factors of increasing cesarean section rate in recent 6 years, and to seek concrete measures to reduce the rate. [Methods] From 2001 to 2006, all cases of cesarean section in our hospital were analyzed on the composition a