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Sample records for cesarean section delivery

  1. Delivery by Cesarean Section

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    ... 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. 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...

  3. 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

  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. 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....

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

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    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.

  7. Cesarean Section: MedlinePlus Health Topic

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    ... 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 ...

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

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    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.

  9. 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

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

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    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.

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

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    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.

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

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    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.

  13. [Cesarean section and eye disorders].

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    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.

  14. 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.

  15. 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 ...

  16. 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.

  17. 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

  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

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

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    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.

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

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    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.

  1. 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...

  2. [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.

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

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    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.

  4. Pheochromocytoma after Cesarean Section

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    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

  5. Pheochromocytoma after cesarean section

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    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.

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

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    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.

  7. 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.

  8. 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.

  9. Osteogenesis imperfecta: cesarean deliveries in identical twins.

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    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.

  10. 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....

  11. Vaginal birth after cesarean section

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    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.

  12. Evolution & the Cesarean Section Rate

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    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…

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

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    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.

  14. Cesarean Section - Multiple Languages: MedlinePlus

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    ... 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 ...

  15. Analytical study of indications of cesarean section

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    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

  16. [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.

  17. 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.

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  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. 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....

  5. 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.

  6. 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

  7. 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...

  8. 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

  9. 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

  10. 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.

  11. 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....

  12. 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.

  13. 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.

  14. [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.

  15. 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...

  16. 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...

  17. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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

  1. 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.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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...

  9. 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.

  10. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  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 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. 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.

  15. 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.

  16. '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.

  17. [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.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  20. [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.

  1. 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

  2. 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.

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

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    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

  4. 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

  5. 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.

  6. 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...

  7. 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....

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

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    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.

  9. 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.

  10. 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

  11. 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 

  12. 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.

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

    Science.gov (United States)

    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

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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。

  19. 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...

  20. Quality of Life after Cesarean and Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    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.

  1. Uterine Closure in Cesarean Delivery: A New Technique

    Directory of Open Access Journals (Sweden)

    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.

  2. 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

  3. 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%.

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

    Directory of Open Access Journals (Sweden)

    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

  5. 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...

  6. 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。

  7. 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.

  8. Hematometra Formation- A Rare Complication of Cesarean Delivery

    Science.gov (United States)

    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

  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. 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...

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. [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.

  19. 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

  20. Haemorrhage during cesarean section for parturient with antiphospholipid syndrome

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  2. 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.

  3. 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.

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

    Science.gov (United States)

    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?

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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...

  9. 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...

  10. 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...

  11. 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%,

  12. 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…

  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. 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.

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

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    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.

  16. 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...

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

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    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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. SUCCENTURIATE PLACENTA: AN INCIDENTAL FINDING DURING CESAREAN SECTION

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    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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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).

  11. 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

  12. [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.

  13. 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...

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. 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...

  19. 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...

  20. 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

  1. 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...

  2. Classic metaphyseal lesion following external cephalic version and cesarean section

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  6. 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.

  7. 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

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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...

  18. 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

  19. 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.

  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. 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.

  2. 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

  3. 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.

  4. 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....

  5. 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

  6. 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

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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

  10. The standard of knowledge for cesarean section in women who applied to family medicine: Two centered cross-sectional study

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. 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

  14. 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

  15. 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....

  16. Management of Hepatic Rupture Diagnosed after an Emergency Cesarean Section

    Directory of Open Access Journals (Sweden)

    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.

  17. [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.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  20. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Analysis on Indications and Causes of Cesarean Section on Pemba Island of Zanzibar in Africa

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    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.

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. Role of cardiotocography in high risk pregnancy and its correlation with increase cesarean section rate

    Directory of Open Access Journals (Sweden)

    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.

  11. The midwife as first assistant for cesarean section.

    Science.gov (United States)

    Moes, C B; Thacher, F

    2001-01-01

    Across the United States, midwives have expanded their role to include serving as first assistants at cesarean sections. An American College of Nurse-Midwives (ACNM) Position Statement adopted in 1998 recognizes the practice as a "frequently-performed advanced midwifery practice skill." Workshops have been offered nationally in 1997, 1998, 2000, and 2001 as well as locally in some states to educate and guide the midwife in completing the didactic and clinical preparation. Yet, there is a dearth of published literature on the subject. This article reviews the evolution of the role from its origins in perioperative nursing, including the requirements for the Registered Nurse First Assistant as established by the Association of peri-Operative Registered Nurses that are referenced in the regulations of several states in regard to the practice of midwives as surgical assistants. The authors report the results of a survey of state regulatory agencies that reveals a wide variation in laws, regulations, and interpretations ranging from statutory acceptance to prohibition with suggestions on how to effect needed change. This article also includes a process for credentialing that is consistent with the ACNM "Guidelines for the Incorporation of New Procedures into Midwifery Practice." The importance of documentation of the educational and credentialing process from a medico-legal perspective is stressed.

  12. 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...

  13. 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。

  14. Some medical and other risk factors for current cesarean section in a Jakarta hospital

    Directory of Open Access Journals (Sweden)

    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

  15. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    Science.gov (United States)

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

    2012-09-01

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

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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....

  1. 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

  2. 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.

  3. Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics

    Directory of Open Access Journals (Sweden)

    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. Teaching surgical skills in obstetrics using a cesarean section simulator – bringing simulation to life

    Directory of Open Access Journals (Sweden)

    Venkata Sujatha Vellanki

    2010-12-01

    Full Text Available Venkata Sujatha Vellanki1, Sarath Babu Gillellamudi21Department of Obstetrics and Gynaecology 2Department of General Surgery Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda, Andhra Pradesh, IndiaPurpose: Cesarean section is the most common surgery performed in obstetrics. Incorporating a simulation model into training provides a safe, low-stress environment in which students can gain skills and receive feedback. The purpose of this study was to determine the effectiveness of obstetrics simulator training for medical students doing their internship.Methods: Twenty-five students posted in the Department of Obstetrics and Gynecology received a formal lecture on cesarean section and demonstration of the procedure on a mannequin in the first week of their internship, The study group (n = 12 practiced their skills on an obstetrics simulator under the direct supervision of a faculty member. The control group received no simulator-based training (n = 13 or further instruction. All students were asked to complete a prevalidated questionnaire to assess their level of confidence in performing the procedure after the educational session.Results: Compared with their peers in the study, students in the simulator group were significantly more likely to define the steps of cesarean section (91% vs 61.5%, and were comfortable in assisting cesarean section (100% vs 46.15% as they were able to identify the layers of abdomen opened during cesarean section. All 12 students reported this as an excellent experience.Conclusion: We were able to construct an inexpensive cesarean section trainer that facilitates instruction in cesarean section technique in a low-stress environment.Keywords: simulation, obstetrics, medical students

  5. 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

  6. 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

  7. 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.

  8. Evaluation of immune system function in neonatal pigs born vaginally or by Cesarean section

    Science.gov (United States)

    Eight full term crossbred sows were selected for study of the interaction of the immune system, hypothalamus-pituitary-adrenal axis, and growth in pigs born by Cesarean section (C-section) or vaginal-birth (n=4 each for vaginal-birth and C-section). Gestation length and birth weight did not differ b...

  9. Hematocrit changes in healthy periparturient bitches that underwent elective cesarean section.

    Science.gov (United States)

    De Cramer, K G M; Joubert, K E; Nöthling, J O

    2016-09-15

    Hematocrits were measured before each of 406 cesarean sections performed on 324 bitches at term and again after crystalloid fluid therapy administered at 35 mL/kg over 1½-2 hours starting from induction. The mean hematocrit was 44.2% (95% confidence interval [CI] 43.8%-44.6%) before cesarean section and 37.8% (95% CI 37.3%-38.2%) after cesarean section and fluid therapy, with a mean decrease of 6.4% points (95% CI 6.1%-6.7%) over all 406 cesarean sections. These results provide the clinician with clear guidelines of the normal expected ranges of hematocrits in bitches before and after cesarean section. Results of this study show that bitches have hematocrits at term that are at the lower end of the normal reference ranges for nonpregnant dogs and that there is no true anemia of pregnancy. It is therefore suggested that if late term bitches present with anemia, other causes besides pregnancy should be considered.

  10. Vaginal birth after cesarean section: an update on physician trends and patient perceptions.

    Science.gov (United States)

    Penso, C

    1994-10-01

    The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. Changing trends in the management of labor may also contribute to an increase in successful trial of labor with the use of oxytocin for the induction or augmentation of labor, the administration of epidural anesthesia for pain relief, and the instillation of prostaglandin E2 gel for cervical ripening. External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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

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

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    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.

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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

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

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    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.

  6. 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

  7. 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.

  8. 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.

  9. 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

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

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    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.

  11. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  12. 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.

  13. 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

  14. 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.

  15. Cesarean section on maternal request: should it be formally prohibited in Italy?

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    Ugo Indraccolo

    2015-06-01

    Full Text Available BACKGROUND: Cesarean section on maternal request (CSMR could represent an avoidable quota of cesareans. In Italy, this is a topical problem of health-policy, involving ethical, juridical and medical issues. AIM AND METHODS: A 5-questions questionnaire to quantitatively assess the perspectives of medical, juridical and ethical issues of planned CSMR was administered to obstetricians and gynecologists, midwives, lawyers and pregnant women. It was assessed to what extent those issues matter on the final decision of planning a CSMR. RESULTS: Non-homogeneous answers of stakeholders suggest different perspectives about issues on CSMR. The juridical issue seems to have the greatest impact on the final decision. CONCLUSION: Planning a CSMR associates overall with juridical issues in each group of respondents. Therefore, an obstetrician and gynecologist is unable to counsel a patient on CSMR from a medical point of view. The most direct way for reducing cesareans in Italy could be the formal prohibition of CSMR.

  16. Disciplinary discourses: rates of cesarean section explained by medicine, midwifery, and feminism.

    Science.gov (United States)

    Lee, Amy Su May; Kirkman, Maggie

    2008-05-01

    In the context of international concern about increasing rates of cesarean sections, we used discourse analysis to examine explanations arising from feminism and the disciplines of medicine and midwifery, and found that each was positioned differently in relation to the rising rates. Medical discourses asserted that doctors are authorities on birth and that, although cesareans are sometimes medically necessary, women recklessly choose unnecessary cesareans against medical advice. Midwifery discourses portrayed medicine as paternalistic toward both women and midwifery, and feminist discourses situated birth and women's bodies in the context of a patriarchally structured society. The findings illustrate the complex ways in which this intervention in birth is discursively constructed, and demonstrate its significance as a site of disciplinary conflict.

  17. CT finding of ruptured splenic artery aneurysm after cesarean section : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Chang Woo; Kim, Hee Jin [CHA Medical College, Pundang CHA Gerneral Hospital Sungnam, (Korea, Republic of)

    2000-03-01

    Spontaneous rupture of a splenic artery aneurysm during puerperium is rare and is due to the non-specific clinical appearance, diagnosis is difficult. We describe a case of spontaneous rupture of splenic artery aneurysm after a Cesarean section. CT showed high-density ascites localized in the lesser sac and left retroperitoneum.

  18. [Characteristic features of systemic hemodynamics during cesarean section under general anesthesia with ketamine].

    Science.gov (United States)

    Moiseev, V N

    1983-02-01

    On the basis of a comparative investigation of the central hemodynamics by the method of integrative rheography of the body in two groups of women during the operation of cesarean section under general anesthesia with ether or ketamin the author makes a conclusion that ketamin is a good drug for anesthesia in urgent surgical situations.

  19. Prophylactic antibiotics for hysterectomy and cesarean section: amoxicillin-clavulanic acid versus cefazolin

    Directory of Open Access Journals (Sweden)

    Jyoti Malik

    2016-04-01

    Conclusions: Broad spectrum amoxicillin-clavulanic acid was not superior to cefazolin in prevention of post-operative infection when given as prophylaxis in hysterectomy and elective cesarean section. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 980-983

  20. Effect of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on maternal lactation

    Institute of Scientific and Technical Information of China (English)

    Hu Feng; Bao-Xia Chen; Xi Ren; Hong-Xia Zhu

    2016-01-01

    Objective:To observe the effect of application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on the lactation and neonates.Methods:The puerpera who were underwent cesarean section with different analgesia methods were observed. The included puerpera were performed with the cesarean section under combined spinal epidural anesthesia. A total of 30 puerpera who were given ropivacaine in combined with sufentanil epidural analgesia after operation were served as the observation group, while 30 cases who were intermittently given intramuscular injection of pethidine after operation were served as the control group. The postpartum analgesic effects in the two groups were observed. The radioimmunoassay was used to detect the plasma PRL level. The postpartum colostrum time, 24 h lactation number, and NBNA scores in the two groups were compared.Results:The postoperative VAS score in the observation group was significantly lower than that in the control group (P<0.05), while the plasma PRL level was significantly higher than that in the control group (P<0.05). The postoperative colostrum time in the observation group was significantly earlier than that in the control group (P<0.05), while the lactation number was significantly greater than that in the control group (P<0.05).Conclusions:Application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section can effectively alleviate the postoperative pain, and improve the lactation, with no obvious adverse reactions on the neonates and reliable effects.

  1. Análise dos fatores de risco anteparto para ocorrência de cesárea Analysis of the risk factors for cesarean section

    Directory of Open Access Journals (Sweden)

    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.

  2. 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

  3. 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...

  4. 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.

  5. 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...

  6. 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.

  7. 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.

  8. 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.

  9. [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.

  10. 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

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

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    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

  12. Risk adjustment for inter-hospital comparison of primary cesarean section rates: need, validity and parsimony

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    Dallolio Laura

    2006-08-01

    Full Text Available Abstract Background Cesarean section rates is often used as an indicator of quality of care in maternity hospitals. The assumption is that lower rates reflect in developed countries more appropriate clinical practice and general better performances. Hospitals are thus often ranked on the basis of caesarean section rates. The aim of this study is to assess whether the adjustment for clinical and sociodemographic variables of the mother and the fetus is necessary for inter-hospital comparisons of cesarean section (c-section rates and to assess whether a risk adjustment model based on a limited number of variables could be identified and used. Methods Discharge abstracts of labouring women without prior cesarean were linked with abstracts of newborns discharged from 29 hospitals of the Emilia-Romagna Region (Italy from 2003 to 2004. Adjusted ORs of cesarean by hospital were estimated by using two logistic regression models: 1 a full model including the potential confounders selected by a backward procedure; 2 a parsimonious model including only actual confounders identified by the "change-in-estimate" procedure. Hospital rankings, based on ORs were examined. Results 24 risk factors for c-section were included in the full model and 7 (marital status, maternal age, infant weight, fetopelvic disproportion, eclampsia or pre-eclampsia, placenta previa/abruptio placentae, malposition/malpresentation in the parsimonious model. Hospital ranking using the adjusted ORs from both models was different from that obtained using the crude ORs. The correlation between the rankings of the two models was 0.92. The crude ORs were smaller than ORs adjusted by both models, with the parsimonious ones producing more precise estimates. Conclusion Risk adjustment is necessary to compare hospital c-section rates, it shows differences in rankings and highlights inappropriateness of some hospitals. By adjusting for only actual confounders valid and more precise estimates

  13. 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.

  14. The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006

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    Rudge Marilza VC

    2011-11-01

    Full Text Available Abstract Background In 2000, the eight Millennium Development Goals (MDGs set targets for reducing child mortality and improving maternal health by 2015. Objective To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections and maternal/perinatal mortality. Methods Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB and perinatal (/1000 births mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage, with p Results Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births. The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of

  15. 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.

  16. A study on the efficacy of touch therapy in pain relieve after cesarean section

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    Maryam Ravanipour

    2004-09-01

    Full Text Available Supporters of touch therapy claim it can treat and cure a wide variety of illnesses, including heart failure, diabetes and infections. The "theory" is that people who are ill have disturbed "energy fields," and that by moving trained hands over the patient's body (without contact, a touch therapist can detect malalignments and repattern energy fields to create "energy balance." In a quasi- experimental study, 30 subjects in 6 hours post cesarean section state were divided into therapeutic touch or placebo (speech induction groups in a university hospital. In order to assess the pain, Visual Analog scale (VAS was used, before and after intervention. The mean pain score decreased significantly only in the therapeutic touch group (50.66 to 39.53 p<0.01. In conclusion, it is recommended that therapeutic touch , as an attentive technique, can be used in pain relieve after cesarean section.

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

    OpenAIRE

    Okonkwo NS; Ojengbede OA; Morhason-Bello IO; Adedokun BO

    2012-01-01

    Ngozi S Okonkwo1, Oladosu A Ojengbede2, Imran O Morhason-Bello1, Babatunde O Adedokun31Department of Obstetrics and Gynecology, University College Hospital; 2Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan; 3Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, Oyo State, NigeriaBackground: Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand...

  18. Transient unilateral brachial plexopathy and partial Horner′s syndrome following spinal anesthesia for cesarean section

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    Jonathan A Anson

    2014-01-01

    Full Text Available A healthy 21-year-old primigravida presented for elective cesarean section. At 45 min after intrathecal (IT injection of bupivacaine, morphine and fentanyl she developed dysphagia, right sided facial droop, ptosis and ulnar nerve weakness. This constellation of signs and symptoms resolved 2 h later. Based on the time course and laterality of her symptoms, as well as the pharmacologic properties of spinal opioids, we believe her symptoms can be attributed to the IT administration of fentanyl.

  19. Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

    OpenAIRE

    Xu Demin; Guo Changfa; Wang Chunsheng

    2011-01-01

    Abstract Acute aortic type A dissection is a life-threatening disease that requires immediate surgical intervention. When dissection occurs during pregnancy, it is of high risk for both the mother and the fetus. In this study, we reported two cases of acute aortic dissection in late pregnancy at 28 weeks and 32 weeks of gestation respectively. After the two patients underwent a cesarean section and delivered a baby, we performed composite graft replacement of the aortic valve, aortic root and...

  20. 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.

  1. 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.

  2. [Group A streptococcus-induced toxic shock syndrome in pregnancy: a case report of cesarean section].

    Science.gov (United States)

    Yamada, Kumiko; Fukuda, Taeko; Kimura, Maiko; Hagiya, Keiichi; Danmura, Masato; Nakayama, Shin; Ogura, Tsuyoshi; Tanaka, Makoto

    2012-12-01

    Group A streptococcus (GAS)-induced toxic shock syndrome (TSS) in pregnancy is rare, but its clinical course is fulminant. The mortality rates of mother and fetus are reported to be 58 and 66%, respectively. We report a case of GAS-TSS after cesarean section. A 38-year-old pregnant woman of 38 weeks gestation was admitted to our hospital because of vomiting, fever of 39 degrees C, and continuous abdominal pain with scanty genital bleeding. She had complained of sore throat several days before. One hour after admission, external fetal monitoring revealed periodic pulse deceleration to 90 x beats min(-1). The emergent cesarean section was performed under general anesthesia. Approximately 8 hours after the cesarean section, she developed coma, shock and respiratory insufficiency requiring intubation. Streptococcus pyogens were isolated from her blood sample and the patient met criteria for GAS-TSS. She was treated with antibiotics (penicillin and clindamycin), antithrombin III, recomodulin, catecholamins, and continuous hemodialysis with filtration of toxins. Although the patient recovered and was discharged on 63rd day, the infant died on postpartum day 4. Early recognition and intensive treatment for GAS is recommended in a late stage pregnancy with an episode of sore throat, vomiting, high fever, strong labor pain, and DIC signs.

  3. Combined spinal epidural anesthesia for cesarean section in a patient with left lung agenesis.

    Science.gov (United States)

    Babita, G; Rashmi, M; Deb, K

    2001-04-01

    Agenesis of the lung is a rare developmental defect characterized by complete absence of one lung, or hypoplasia of one or both lungs. The majority of reported cases have been associated with other congenital anomalies. It is usually detected in childhood as a result of either pulmonary symptoms or associated anomalies. Although pulmonary agenesis has been reported in adults, there is no report of the management of a pregnant patient for cesarean section in the anesthetic literature. We report the management of a 23-year-old pregnant female at 36 weeks' gestation with oligohydramnios and left lung agenesis for elective cesarean section. She presented with a history of repeated chest infection and was found to have restrictive lung function. She had no other congenital anomalies. Combined spinal epidural anesthesia was administered for cesarean section. The intraoperative course was uneventful except for bradyarrhythmias followed by tachyarrhythmias on manipulation of the uterus. She was given low dose epidural morphine with local anesthetic and intramuscular diclofenac for postoperative analgesia. We believe that normal pregnancy can safely be undertaken in the presence of left lung agenesis. In view of associated congenital anomalies in more than 50% of the cases, anesthetic management should include a particularly careful survey of other systems. The patient should otherwise be managed like any patient with limited pulmonary reserve. Combined spinal epidural anesthesia is safe and appropriate for such patients.

  4. Transcranial Doppler blood flow measurement during cesarean section in two patients with cerebral vascular disease.

    Science.gov (United States)

    Smiley, R M; Ridley, D M; Hartmann, A; Ciliberto, C F; Baxi, L

    2002-07-01

    We present two cases of neurovascular disease in pregnancy in which transcranial Doppler was used to assess the status of the cerebral circulation during cesarean section under regional anesthesia. One woman had been found to have moyamoya disease, following a series of transient ischemic attacks during her first pregnancy, which ended in spontaneous abortion. On this occasion she was delivered by cesarean section under slowly-induced epidural anesthesia, using ephedrine to maintain the blood pressure, and transcranial Doppler revealed no change in signal in her left middle cerebral artery. Both mother and baby had an uneventful post natal course. The second case involved a primiparous woman with a large arteriovenous malformation that had been detected following generalized seizures, which were treated with valproic acid. Her cesarean section was conducted under spinal anesthesia, and her blood pressure maintained with ephedrine. Again transcranial Doppler revealed no change in signal in her middle cerebral artery during the procedure. We believe this is a potentially useful technique to monitor the cerebral circulation intraoperatively in the presence of cerebrovascular disease.

  5. Comparative Study of Intrathecal Dexamethasone with Epinephrine as Adjuvants to Lidocaine in Cesarean Section

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    Fereshteh Naziri

    2013-09-01

    Full Text Available Background: Different additives have been used with local anesthetics to provide prolonged duration of sensory block in spinal anesthesia. The aim of present study was to evaluate the onset and duration of sensory block of intrathecal dexamethasone and epinephrine as adjuvants to lidocaine in patients who were candidate for cesarean section. Materials and Methods: This double-blind clinical trial research was conducted on 90 pregnant women candidate for cesarean section under spinal anesthesia. Patients were randomly allocated to receive intrathecally either 75 mg hyperbaric lidocaine plus 100 μg epinephrine or 75 mg hyperbaric lidocaine plus 4 mg dexamethasone or 75 mg hyperbaric lidocaine. The onset and duration of sensory block as well as postoperative analgesia were assessed. Results: The time to reach the peak sensory block in lidocaine group was shorter than that of other two groups (p<0.001. Duration of sensory block in the control group, dexamethasone group, and epinephrine group were 64.16±7.99 min, 74.79±12.78 min, and 99.30±10.93 min, respectively (p<0.001. Conclusion: The present research shows that intrathecal dexamethasone and intrathecal epinephrine as adjuvant to lidocaine increases sensory block duration in the women candidate for cesarean section.

  6. 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.

  7. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

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    Hala Mostafa Gomaa

    2014-10-01

    Conclusion: Either intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

  8. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section

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    Godrat Akhavanakbari

    2013-01-01

    Full Text Available Background: Cesarean section is one of the common surgeries of women. Acute post-operative pain is one of the recognized post-operative complications. Aims: This study was planned to compare the effects of suppositories, indomethacin, diclofenac and acetaminophen, on post-operative pain and opioid usage after cesarean section. Materials and Methods: In this double-blind clinical trial study, 120 candidates of cesarean with spinal anesthesia and American Society of Anesthesiologists (ASA I-II were randomly divided into four groups. Acetaminophen, indomethacin, diclofenac, and placebo suppositories were used in groups, respectively, after operation and the dosage was repeated every 6 h and pain score and opioid usage were compared 24 h after the surgery. The severity of pain was recorded on the basis of Visual Analog Scale (VAS and if severe pain (VAS > 5 was observed, 0.5 mg/kg intramuscular pethidine had been used. Statistical Analysis Used: The data were analyzed in SPSS software version 15 and analytical statistics such as ANOVA, Chi-square, and Tukey′s honestly significant difference (HSD post-hoc. Results : Pain score was significantly higher in control group than other groups, and also pain score in acetaminophen group was higher than indomethacin and diclofenac. The three intervention groups received the first dose of pethidine far more than control group and the distance for diclofenac and indomethacin were significantly longer (P < 0.001. The use of indomethacin, diclofenac, and acetaminophen significantly reduces the amount of pethidine usage in 24 h after the surgery relation to control group. Conclusions : Considering the significant decreasing pain score and opioid usage especially in indomethacin and diclofenac groups rather than control group, it is suggested using of indomethacin and diclofenac suppositories for post-cesarean section analgesia.

  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. 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.

  11. 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.

  12. 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...

  13. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres.

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    Kathryn Chu

    Full Text Available OBJECTIVES: The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality. METHODS: Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality. RESULTS: 1276 women underwent a Cesarean section, giving a frequency of 6.2% (range 4.1-16.8%. The most common indications were obstructed labor (399, 31%, poor presentation (233, 18%, previous Cesarean section (184, 14%, and fetal distress (128, 10%, uterine rupture (117, 9% and antepartum hemorrhage (101, 8%. Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015, uterine rupture (aOR = 20.5; P = .010, antepartum hemorrhage (aOR = 13.1; P = .045, and pre-eclampsia/eclampsia (aOR = 42.9; P = .017 were associated with maternal death. Uterine rupture (aOR = 6.6, P<0.001, anterpartum hemorrhage (aOR = 3.6, P<0.001, and cord prolapse (aOR = 2.7, P = 0.017 were associated with early neonatal death. CONCLUSIONS: This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care.

  14. 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.

  15. 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。

  16. Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study.

    Directory of Open Access Journals (Sweden)

    Denise N Mesquita

    Full Text Available Cesarean section (CS has been associated with obesity, measured by body mass index (BMI, in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI.To assess the association between CS and indicators of peripheral and central adiposity in young adults.The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC, waist-height ratio (WHtR, waist-hip ratio (WHR, tricipital skinfold (TSF, and subscapular skinfold (SSF. The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR with 95% confidence interval (95%CI, and adjustment for birth variables.Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39 for WC, 1.25 (95%CI 1.10;1.42 for WHtR, 1.45 (95%CI 1.18;1.79 for WHR, 1.36 (95%CI 1.04;1.78 for TSF, and 1.43 (95%CI 1.08;1.91 for SSF.Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

  17. 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.

  18. 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.

  19. Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

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    Mitra Jabalameli

    2014-01-01

    Full Text Available Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control. Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test. Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05 and mean satisfactory (P value = 0.02 was statistically significant between groups. Other parameters were not statistically significant. Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients.

  20. 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 ...

  1. 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).

  2. 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.

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

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    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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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

  7. [Incidence and indications for cesarean section in the Obstetrics Clinic in the University Hospital of Obstetrics and Gynecology "Maichin Dom" in Sofia].

    Science.gov (United States)

    Asenova, D; Stambolov, B

    2005-01-01

    The incidence and the indications for Cesarean section in the Obstetric Clinic of the University Hospital of Obstetrics and Gynecology were analysed and compared to a study carried out 20 years ago In 2003 - 2004 there were 2700 pregnant women treated in the clinic 558 had Cesarean section (incidence 20.7%). For comparison the incidence of Cesarean section in 1985 was 6.67% (160 Cesarean sections for 2096 patients) and for 1986 the incidence was 7.63% (131 Cesarean Sections for 1865 patients. The leading indication for the both studies was "previous Cesarean section" the indication "contracted pelvis" was the second and infertility and breech presentation were on the third and forth place. There was no change in the indications for Cesqarean section in the present study and the study carried out 20 years ago. There was a relative increase of the indications 'contracted pelvis' and 'increased age in a nulliparous patiet' compared to the previous years.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections

    Directory of Open Access Journals (Sweden)

    Safinaz Karabayirli

    2015-01-01

    Full Text Available Background: We aimed to investigate the effects of general, spinal and epidural anesthesia on fetal total antioxidant status (TAS and total oxidant status (TOS, and oxidative stress index (OSI during elective cesarean section in this study. Materials and Methods: Forty-seven parturients scheduled for elective cesarean section were randomly allocated into three groups: Group spinal (n = 15, group epidural (n = 17, and group general (n = 15, This prospective randomized study was performed in Faculty of Medicine, Turgut Ozal University, Turkey. After the baby was delivered; TAS, TOS levels, and arterial blood gases parameters were analyzed in an umbilical arterial blood sample. OSI values are calculated by a ratio of TOS to the TAS. Results: The levels of TAS and TOS in umbilical arterial blood sample were not statistically different among three. However, OSI values were significantly different among the three groups (P = 0.042. Median OSI values is 24 (interquartile range [IQR], 2-37 in group spinal, 19 (IQR, 4-44 in group epidural, and 8 (IQR, 4-36 in group general. There was no significant difference in OSI values in the comparison of group spinal with group general and group epidural, but it was significantly lower in group general when compared with group epidural with Bonferroni correction (P = 0.017. Umbilical cord arterial blood gas values (pH, PaCO 2 , PaO 2 , SaO 2 , HCO 3 , and CtO 2 , glucose, lactate, and hemoglobin levels were similar in three groups. Conclusion: General anesthesia may be more favorable than epidural in those undergoing cesarean section when fetal oxidative status gains importance.

  10. Emergency mitral valve replacement and cesarean section in parturients: Two case reports

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2016-01-01

    Full Text Available Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR after percutaneous transluminal mitral commissurotomy (PTMC due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

  11. The Effect of Subcutaneous Ketamine Infiltration on Postoperative Pain in Elective Cesarean Section under Spinal Anesthesia

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    N. Manouchehrian

    2015-01-01

    Full Text Available Introduction & Objective: Appropriate analgesia after cesarean section helps women feel more comfortable and increase the mobility of the mother's and also their ability to take better care of their newborns. The purpose of this study was to investigate the effects of subcutaneous infiltration of ketamine on postoperative pain reduction and hemodynamic status of patients after elective cesarean section. Materials & Methods: This study was designed as a double blinded prospective, randomized clinical trial and 60 cases of women undergoing elective cesarean section under spinal anes-thesia were randomly assigned into two groups. For 30 cases in the ketamine group, infiltra-tion of subcutaneous ketamine 0.5 mg / kg was administered after closure of surgical inci-sion. 30 patients in the placebo group received subcutaneous infiltration of saline. During the patient's recovery time and after transferring to the ward, the VAS of pain and vital signs were continuously assessed. if VAS ? 3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. Prescribed number of suppositories and pethidine dosage were compared. The complications, such as hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded and compared. Statistical analysis was performed by SPSS16 software and ?2 and t-test. P< 0.05 was considered statistically significant in all of the cases. Results: In the course of systolic blood pressure, heart rate and arterial blood oxygen satura-tion during the first 24 hours, no significant differences were mentioned between the two groups. At the time of arrival to the recovery room and 30 minutes later, the mean VAS was not significantly different in the groups. However, the mean VAS at 1, 2 , 4 , 6 , 8 and 12 hours after surgery were significantly lower in the ketamine group (0.61±059 than in the sa-line group (3.37±096 (P<0.001. The mean

  12. Lower segment cesarean section in a patient with severe thrombocytopenia and pregnancy induced hypertension

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    Minal Harde

    2013-01-01

    Full Text Available Thrombocytopenia in pregnancy carries a major risk of feto-maternal morbidity and mortality. We present a case of hypocellular bone marrow with severe thrombocytopenia with pregnancy induced hypertension (PIH for emergency lower segment cesarean section (LSCS. This disease is characterized by pancytopenia and hypocellular bone marrow with impaired morphology and maturation. Causes of death due to this disease include hemorrhage and infection secondary to thrombocytopenia and neutropenia especially following surgery. We report successful management of emergency LSCS with severe thrombocytopenia with severe PIH.

  13. Outcome predictors for patients delivered by cesarean section for fetal distress.

    Science.gov (United States)

    Harrigan; Muscio

    1998-07-01

    Objective: To determine predictive variables identifying infants admitted to neonatal intensive care (NIC) following cesarean section for fetal distress in labor at term.Methods: Two hundred eight patients were studied. Sixty-six patients delivered by cesarean section at term for fetal distress were compared to 142 term patients not diagnosed as fetal distress. The outcome indicator was admission to NIC. Patients diagnosed as fetal distress were studied to determine variables that increased prediction of adverse outcome. Variables studied were patient age, induction of labor, augmentation of labor, epidural anesthesia, birth weight, antepartum complications, and intrapartum complications. Comparisons were by Fishers Exact text and logistic regression.Results: Twenty-six infants were admitted to NIC. Eleven had a diagnosis of fetal distress and 21 had a diagnosis of antepartum complications. Fetal distress was not associated with admission to NIC (P =.26) and had a low sensitivity (42%) and positive predictive value (17%). Antepartum complications, intrapartum complications, and birth weight were associated with admission to NIC (P =.00001) (P =.04) (P =.05). Antepartum complications had a sensitivity of 81% and a positive predictive value of 33% for admission to NIC. The presence of both fetal distress and antepartum complications increased the positive predictive value to 91%. Only one infant was admitted to NIC with a diagnosis of fetal distress without antepartum complications. Positive predictive value 2.4%, negative predictive value 96%. Birth weight when dichotomized at the 5th percentile (2,606 g) had a sensitivity of 20% and a positive predictive value of 50% for admission to NIC. Five of 10 infants with a birth weight below the 5% percentile were admitted to NIC.Conclusion: Antepartum complications coupled with fetal distress in labor are a strong predictor of adverse outcome, which is not altered by cesarean section. There are two groups of patients with

  14. Intracranial subdural hematoma after spinal anesthesia for cesarean section: Case report and review of literature

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    Uma Srivastava

    2014-01-01

    Full Text Available Subdural hematoma (SDH is a rare but serious complication of spinal anesthesia. We report a case of intracranial SDH in a patient developing 11 days after spinal anesthesia for cesarean section. The patient complained of headache on the 2nd post-operative day that was relieved by analgesics, bed rest and hydration. Later she presented with severe headache, vomiting, dizziness, dysarthria, irritability and somnolence. Diagnosis of the left sided SDH was confirmed radiologically and treated surgically. The patient recovered completely. The report highlights the need of considering the possibility of SDH in patients when postdural puncture headache is prolonged or recurs after a headache free period with neurological symptoms.

  15. Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial

    Science.gov (United States)

    Atashkhoei, Simin; Abedini, Naghi; Pourfathi, Hojjat; Znoz, Ali Bahrami; Marandi, Pouya Hatami

    2017-01-01

    Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S. Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher’s exact test, one-way ANOVA, Mann-Whitney U-test, and student’s t test. Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant (40.47% vs. 61.9%, P=0.08). The duration of hypotension was shorter in the study group (1.6±7.8 min vs. 7.4±12.5 min, P=0.004). The dose of ephedrine was lower in the study group (2.4±6.6 mg vs. 5.3±10.7 mg, P=0.006). The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 (16.66%) of hyperbaric groups (P=0.006). None of the neonates had Apgar score≤7 at 5 min of delivery (P=1.0). Sensory and motor block duration was shorter in the study group (P=0.01). Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S. Trial Registration Number: IRCT201401287013N7

  16. 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。

  17. 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.

  18. 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

  19. Therapeutic results and safety of postoperative radiotherapy for keloid after repeated Cesarean section in immediate postpartum period

    Energy Technology Data Exchange (ETDEWEB)

    Kim Ju Ree; Lee, Sang Hoon [Cheil General Hospital and Women' s Healthcare Center, Kwandong University College of Medicine, Seoul (Korea, Republic of)

    2012-06-15

    To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the fi nal Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.

  20. 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.

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

    Science.gov (United States)

    2017-01-30

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

  2. 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.

  3. 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.

  4. Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Shokoufeh Behdad

    2013-05-01

    Full Text Available Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA, who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group that received either and intravenous bolus of 0.5 µg/kg remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the remifentanil group as compared with the control group (p<0.05. There were no significant differences regarding heart rate between groups at any time (p>0.05. Apgar scores at first and fifth min were not significantly different among groups (p>0.05. No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression. 

  5. Comparison of Intravenous Ranitidine with Pantoprazole in Decreasing Gastric Fluid Acidity in Emergency Cesarean Section

    Directory of Open Access Journals (Sweden)

    Alipour M

    2013-10-01

    Full Text Available Objectives: Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. Materials and Methods: This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups of 20 each. They were allocated into two study and one placebo groups. The study group one and two received intravenous ranitidine (IV 50 mg or IV pantoprazole 40 mg, half an hour before induction of GA, respectively. The placebo group was administered just 5 ml of isotonic saline half an hour before GA induction. After intubation and confirmation of endotracheal tube insertion, the gastric contents were aspirated through a nasogastric tube for evaluation of acidity and volume. Results: A statistical difference between group one and two with the control group was observed in the acidity of gastric contents, but there was no difference in volume. Also, the PH level of gastric contents in patients receiving pantoprazole was significantly higher than the isotonic saline (p

  6. 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

  7. Planned Repeat Cesarean Section at Term and Adverse Childhood Health Outcomes: A Record-Linkage Study.

    Directory of Open Access Journals (Sweden)

    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

  8. The Effect of Honey Gel on Abdominal Wound Healing in Cesarean Section: A Triple Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Maryam Nikpour

    2014-07-01

    Full Text Available Objective: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases and placebo (38 cases groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges was used to assess wound healing. Results: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008 on the 7th day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002 on the 14th day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7th and 14th days. Conclusion: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

  9. 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.

  10. 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

  11. 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.

  12. [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.

  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. Evaluation of immune system function in neonatal pigs born vaginally or by Cesarean section.

    Science.gov (United States)

    Daniel, J A; Carroll, J A; Keisler, D H; Kojima, C J

    2008-07-01

    Full term crossbred sows were selected to study the interaction of the immune system, hypothalamus-pituitary-adrenal axis, and growth in pigs born by Cesarean section (c-section; n=4 sows) or vaginal birth (n=4 sows). Gestation length and birth weight did not differ between vaginal birth and c-section pigs (P=0.34 and 0.62, respectively). Blood and tissue samples were collected from 44 pigs at birth. Forty-five pigs were weaned at 13 d. On d 14, pigs received an i.p. injection of lipopolysaccaride (LPS; 150 microg/kg) or saline at min 0, and blood samples were collected at -20, -10, 0, 5, 10, 20, 40, 60, 90, and 120 min. Vaginal birth pigs had 21% greater average daily gain than c-section pigs on d 14 (Ppigs at birth (P0.22). Basal serum concentrations of TNF-alpha tended to be greater in c-section vs vaginal birth pigs at 14 d (P=0.0967); however, basal serum concentrations of IFN-gamma tended to be lower in c-section pigs vs vaginal birth pigs at 14 d (P=0.0787). Expression of interleukin (IL)-6, IL-6 receptor, IL-1beta, and TNF-alpha mRNA did not differ between vaginal birth and c-section pigs but changed in an age and tissue dependent manner. Thus, reduced growth rate of c-section pigs is associated with altered immune system function.

  15. [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.

  16. 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

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

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    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. A clinical study of rate and indications of cesarean section, maternal and fetal outcomes at tertiary care center in north western Rajasthan

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    Suniti Verma

    2016-08-01

    Conclusions: The rate of cesarean section is progressively increasing in the last 5 years. The most common indication is previous cesarean section. The outcome in elective is better than emergency. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2791-2794

  19. PREDICTORS OF ATTITUDE OF PARTURIENTS SELECTED FOR CESAREAN SECTION TOWARD SPINAL ANESTHESIA

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    M.R. Afhami

    2004-11-01

    Full Text Available There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. Statistical programs used were Student’s t test and Chi square for demographic characteristics. The most important factors which influenced patients’ attitude were nausea and vomiting (27%, fear of pain (34%, fear of needle puncture (15% and discomfort during return of sensory and motor functions (6%. Being awake during surgery and witnessing birth of neonate were the most pleasant stages of anesthesia (19%. It seems that providing enough and appropriate information about the procedure at preoperative visit can increase acceptance of this regional anesthetic technique.

  20. A Novel Atraumatic Tourniquet Technique for Excessive Bleeding during Cesarean Sections

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    Buke, Baris; Akkaya, Hatice; Akercan, Fuat

    2017-01-01

    Objective. Controlling excessive bleeding in cesarean sections which may cause a life-threatening event even under well-prepared conditions. We used a novel atraumatic tourniquet technique to temporary arrest blood flow through the uterine and ovarian vessels and compare with other techniques. Toothless vascular clamps were used as clamp. Methods. Tourniquet technique performed postpartum hemorrhage (PPH) cases (19 out of 37) were compared with 18 other cases with PPH. Results. The difference between preoperative and postoperative hemoglobin values was significantly lower in the study group as well as the number of blood products needed during and after surgery. Conclusions. This technique not only prevented massive bleeding from the uterus but also allowed physicians time to consider the necessity of further interventions.

  1. 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

  2. Cardiovascular collapse after labetalol for hypertensive crisis in an undiagnosed pheochromocytoma during cesarean section.

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    Kuok, Chi-Hang; Yen, Chia-Rong; Huang, Chong-Sin; Ko, Yuan-Pi; Tsai, Pei-Shan

    2011-06-01

    Pheochromocytoma is a catecholamine-producing tumor but rarely delayingly diagnosed until during pregnancy. We reported a pregnant woman who underwent emergent cesarean section because of intrauterine growth retardation, oligohydramnios, and hypertension. The existence of an undiagnosed pheochromocytoma was suspected by the unusual hemodynamic response to spinal anesthesia, abdominal compressions, and operative stimulus. Hypertensive crisis occurred during the operation and she was sent to the intensive care unit for postoperative care. In the intensive care unit, cardiovascular collapse occurred after nonselective β-adrenergic blockade. Unexpected hypertensive crisis during the perioperative period should alert clinicians to the possibility of a pheochromocytoma. For the treatment of choice, nonselective β-adrenergic blockade should not be used before the α-blockade.

  3. A food interaction study of bromfenac, naproxen sodium, and placebo in cesarean section patients.

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    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.

  4. Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

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    Xu Demin

    2011-10-01

    Full Text Available Abstract Acute aortic type A dissection is a life-threatening disease that requires immediate surgical intervention. When dissection occurs during pregnancy, it is of high risk for both the mother and the fetus. In this study, we reported two cases of acute aortic dissection in late pregnancy at 28 weeks and 32 weeks of gestation respectively. After the two patients underwent a cesarean section and delivered a baby, we performed composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries into the graft (Bentall procedure instead of repairing the arch with deep hypothermia and circulation arrest. Both mothers and children survived and recovered well.

  5. Prolonged Paralysis Following Emergent Cesarean Section with Succinylcholine Despite Normal Dibucaine Number.

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    Ellison, Matthew; Grose, Brian; Howell, Stephen; Wilson, Colin; Lenz, Jackson; Driver, Richard

    2016-01-01

    Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome. The enzyme responsible for the metabolism of succinylcholine, pseudocholinesterase, was determined to be low in quantity in this patient but was functionally normal. This low level, by itself, was unlikely to be solely responsible for the prolonged paralysis. The patient likely had an abnormal pseudocholinesterase enzyme variant that is undetectable by standard laboratory tests.

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

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    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.

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

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    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.

  8. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

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    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  9. The Effect of Paracetamol versus Meperidine on Postoperative Pain of Cesarean Section

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    Jarineshin, Hashem; Fekrat, Fereydoon; Kashani, Saeed

    2017-01-01

    Background and Aim: Meperidine and paracetamol are frequently used in postoperative pain control. We evaluated the effect of paracetamol versus meperidine on postoperative pain control of elective cesarean section in patients under general anesthesia. Materials and Methods: In this randomized double-blind study, seventy mothers’ candidate for cesarean section under general anesthesia were randomized in paracetamol group (n = 35), received 1 g paracetamol in 100 ml normal saline, and meperidine group (n = 35), received 25 mg meperidine in 100 ml normal saline and then compared regarding the pain and vomiting severity based on visual analog scale (VAS). Results: Two groups did not show significant difference regarding pain score based on VAS during 30 min after surgery in the recovery room, however, the pain score after 30 min in paracetamol group was significantly more than meperidine group. The difference between two groups regarding pain score in surgery ward at 0, 2, 4, 6 h, were not significant, however, pain score after 6 h in meperidine group was significantly lower than paracetamol group. The score of vomiting based on VAS in the recovery room in meperidine group was marginally more than paracetamol group (P > 0.05). The score of vomiting, based on VAS in meperidine group was significantly more than paracetamol group during the 24 h in the surgery ward. The analgesic consumption in meperidine group during 24 h after surgery was significantly lower than paracetamol group. Conclusion: We indicated that the meperidine decreased postoperative pain score and analgesic consumption more than paracetamol, but increased the vomiting score.

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

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    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

  11. The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section

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    Parisa Golfam

    2016-09-01

    Full Text Available Introduction: Post Dural puncture headache is still a common complication among young women undergone cesarean section, although use of small size spinal needles reduced its prevalence. Several methods have been suggested for prevention and treatment of this side effect; such as complete bed rest, hydration, non-opioid analgesics, caffeine, codeine, which none of them proved to be totally effective. The last option would be epidural blood patch, if headache persist. The aim of this study was evaluation the efficacy of intravenous propofol on post dural puncture headache incidence after cesarean section. Methods: In a randomized clinical trial 120 patients aged 18-45 years old in American Society of Anesthesiologist (ASA class I or II, who had no history of headache, analgesic consumption, substance abuse and drug addiction, candidate for elective cesarean section, were randomly assigned into intervention (propofol and control groups. The anesthesia method for both groups was precisely the same. After spinal anesthesia in the first group 30µg/kg/min of intravenous propofol have been infused slowly. Then at 1, 6, 18, 24 hours and 2nd to 7th days after surgery, anesthesiologist asked groups for presence or absence of headache. The data analyzed with SPSS 16.0 software. Results: Headache incidence rate in the group who receiving propofol was significantly reduced (P.V=0.001. Conclusion: This study showed that 30µg/kg/min of intravenous propofol caused reduced the incidence of post spinal headache in young women undergone elective cesarean section.

  12. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

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    Cuilan Li

    2016-01-01

    Full Text Available Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS, and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05, respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40. Three patients (3/40 = 7.5% developed partial improvement, and 1/40 (2.5% was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

  13. 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

  14. 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

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    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

  15. A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome

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    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.

  16. 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

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    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

  17. Analysis on 60 Cases of Scarred Uterus with Secondary Cesarean Section%瘢痕子宫二次剖宫产60例分析

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    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

  18. 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

  19. 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

  20. 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。

  1. 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.

  2. Influence of anesthesia technique at cesarean section on newborn state assessment and on uterus contraction

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    Олексій Олегович Волков

    2015-09-01

    Full Text Available Anesthetics and anesthesia in whole have an influence on intrauterine state of fetus. All substances that are injected to a pregnant for anesthesia penetrate in organism of fetus in some quantity. It is considered that halogened inhalation anesthetics can moderate the birth activity of uterus and its tonus in quiescence depending on concentration.Aim of research: to study the techniques of anesthesia (inhalation, total intravenous, spinal of cesarean section for assess the state of newborn and uterus contraction.Materials and methods. There were examined 95 women on term of pregnancy 37–42 weeks in 2013–2014 years who underwent cesarean section. They were divided into 3 groups depending on technique of anesthesia. I group (n=30 included women who underwent inhalation anesthesia. The second one (n=34 included women who underwent the total intravenous anesthesia. The third group – the random women (n=31 who underwent the spinal anesthesia. The state of newborns was detected on Apgar score on 1 and 5 minutes after birth. The quality of postnatal uterus contraction was assessed depending on the need of an amount of injected oxytocin and necessity to add another uterotonic preparation after fetus extraction.Results and discussion. At analysis of the state of newborn on Apgar score on 1 minute in 1 group were received 7,73±0,09 point, in 2 group this indicator was 7,4±0,14 point without statistic difference with 1 group (р=0,06. In 3 group points reached 7,55±0,17, without statistic difference with both (р=0,36, and 2 groups (р=0,50. At analysis of the state of newborn on Apgar on 5 minute statistic difference between the groups also was not established. In the 1 group this indicator reached 8,69±0,9 point, in 2 group – 8,47±0,12point, the difference with the first group was unreliable (р=0,16. In 3 group an assessment on Apgar on 5 minute was 8,64±0,12, without statistic difference with 1 and 2 groups (р=0,76 and р=0

  3. 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.

  4. 剖宫产对新生儿近远期的影响%Recent and long-term effection of cesarean section on newborn infants

    Institute of Scientific and Technical Information of China (English)

    吴立志; 周晓玉

    2015-01-01

    Although the cesarean section has become an effective means to solve dystocia,high - risk pregnan-cy and other critical obstetrical disease,but the morbidity rate and hospitalization rate of newborn did not decreased obviously because of the continuous increasing of cesarean section rate. Contrary,in recent years,many domestic and foreign researches have found that,compared with normal vaginal delivery babies,cesarean section newborn infants have higher related disease incidence rate after birth,especially respiratory distress sydrome,transient tachypnea of newborn infants,persistent pulmonary hypertension and infection,and more attention should be paid to the fact that cesarean section children are more prone to allergic and immune system diseases as well as neuropsychiatric related diseases. Therefore,this article aims at integrating the researches and providing an overview on recent and long - term effection on newborn infants.%虽然剖宫产已逐渐成为解决难产和高危妊娠等产科危重症的有效手段,但新生儿疾病的发病率及其 NICU 住院率并未因剖宫产率的不断增高而明显减少,相反,近年来国内外诸多研究发现相比较正常阴道分娩儿,剖宫产儿在出生后有较高的新生儿相关疾病发病率,以呼吸窘迫综合征、新生儿暂时性呼吸困难、持续肺动脉高压、感染等最为常见,更为值得关注的是剖宫产儿在儿童期和成年期也更易于患过敏性及免疫系统疾病和神经精神相关性疾病。现就剖宫产对新生儿近远期的影响进行综述。

  5. Holistic nursing care of patients with cesarean section%剖腹产患者的整体护理

    Institute of Scientific and Technical Information of China (English)

    胡小娟

    2013-01-01

    Objective:Analysis and research the nursing methods of patients after caesarean section. Methods:Summary of our hospital patients with cesarean section were 50 cases, and summarize the nursing experience. Results Al patients through treatment and nursing after operation were cured. Conclusion: Strengthen the holistic nursing care of cesarean section and reduce the incidence of complications.%目的分析研究剖腹产术后患者的护理方法及效果。方法总结我院进行剖腹产术的患者共50例,并总结护理体会。结果所有患者再通过手术治疗和整体护理后均痊愈出院。结论加强剖腹产整体护理的研究和减少并发症的发生。

  6. Morbidade associada a cesariana eletiva em portadoras do HIV Maternal morbidity in HIV patients submitted to an elective cesarean section

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    Regina Rocco

    2003-06-01

    were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient. The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases. The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk was recorded as well as an extended surgery time (3.32 relative risk. The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk. CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.

  7. [Care plan for women with cesarean section and pre-eclampsia].

    Science.gov (United States)

    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.

  8. Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

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    Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)

    2008-08-15

    We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

  9. Post Dural Puncture Headache after Cesarean Section, a Teaching Hospital Experience

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    Farhad Etezadi

    2012-03-01

    Full Text Available Objective: This prospective study examined the frequency of Post-Dural Puncture Headache (PDPH in361 parturient women undergoing spinal anesthesia for cesarean section in a teaching hospital ofTehran University of Medical Sciences.Materials and methods: Spinal anesthesia was performed using 25 gauge Quincke needles in allwomen. Patients were followed up to determine incidence of PDPH and then tried to compare those withor without PDPH using statistical methods to determine risk factors of PDPH.Results: The overall incidence of PDPH was 10.8 percent in this study. In terms of probable risk factorswhich were compared between the two groups of patients, no statistically significant differences werefound.Conclusion: The incidence of PDPH in our study was higher than studies which used pencil - tippedneedles and we determined that the occurrence of PDPH is not associated to some factors like theprevious history of nonspecific headache, Body Mass Index, age, type of local anesthetic, previoushistory of PDPH, experience of operator, history of habitual tea and coffee drinking.

  10. Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia

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    Suman Chattopadhyay

    2014-01-01

    Full Text Available This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5% patients underwent spinal anesthesia (SA and 27 (15.5% patients had general anesthesia (GA. Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P<0.001. Patients receiving GA had a higher mortality (25.9% versus 1.4%; P<0.001. The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P<0.01 and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P<0.05. To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

  11. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography.

    Science.gov (United States)

    Naji, O; Abdallah, Y; Bij De Vaate, A J; Smith, A; Pexsters, A; Stalder, C; McIndoe, A; Ghaem-Maghami, S; Lees, C; Brölmann, H A M; Huirne, J A F; Timmerman, D; Bourne, T

    2012-03-01

    Incomplete healing of the scar is a recognized sequel of Cesarean section (CS) and may be associated with complications in later pregnancies. These complications can include scar pregnancy, a morbidly adherent placenta, scar dehiscence or rupture. To date there is uncertainty relating to the factors that lead to poor scar healing and how to recognize it. In recent years, there has been an increase in studies using ultrasound that describe scars as deficient, or poorly, incompletely or inadequately healed with few data to associate the morphology of the scar with the functional integrity of the lower segment of the uterus. There have been multiple attempts to describe CS scars using ultrasonography. Different terminology, methods and results have been reported, yet there is still no consensus regarding the prevalence, clinical significance or most appropriate method to describe the appearances of these scars. Developing a test that can predict the likelihood of women having problems associated with a CS scar is becoming increasingly important. On the other hand, understanding whether the ultrasound appearances of the scar can tell us anything about its integrity is not well supported by the research evidence. In this article we present an overview of ultrasound-based definitions and methods used to describe CS scars. We also present information relating to the performance of alternative techniques used to evaluate CS scars. Having examined the current evidence we suggest a standardized approach to describe CS scars using ultrasound so that future studies can be meaningfully compared.

  12. Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

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    Fabio Gori

    2010-01-01

    Full Text Available Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear. Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded. Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine 131±42 min, seated 106±29 min, =.02. Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

  13. The Effect of Acupressure on Nausea and Vomiting after Cesarean Section Under Spinal Anesthesia

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    Heydar Noroozinia

    2013-03-01

    Full Text Available Postoperative nausea and vomiting (PONV is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section (C/S under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups (acupressure vs control groups. Subjects in the acupressure group received constant pressure by a specific wrist elastic band (without puncture of the skin on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1st, 2nd and 3rd two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery

  14. The effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia.

    Science.gov (United States)

    Noroozinia, Heydar; Mahoori, Alireza; Hasani, Ebrahim; Gerami-Fahim, Mohsen; Sepehrvand, Nariman

    2013-04-06

    Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section (C/S) under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups (acupressure vs control groups). Subjects in the acupressure group received constant pressure by a specific wrist elastic band (without puncture of the skin) on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1st, 2nd and 3rd two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery.

  15. Anesthetic considerations in a patient of autosomal dominant polycystic kidney disease on hemodialysis for emergency cesarean section

    Directory of Open Access Journals (Sweden)

    Sarita D Fernandes

    2011-01-01

    Full Text Available Renal disease, either preexisting or occurring during gestation may impair maternal and fetal health. A 35-year-old primigravida with autosomal dominant polycystic kidney disease on hemodialysis was scheduled for emergency cesarean section. She was managed successfully with low-dose intrathecal bupivacaine and fentanyl. In the case of pregnancy in such a patient, early involvement of the nephrologists along with the obstetrician can improve maternal and fetal outcome.

  16. Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

    OpenAIRE

    2016-01-01

    Objectives: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. Methods: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnose...

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

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    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.

  18. Ceftriaxone (single dose) versus cefoxitin (multiple doses): success and failure of antibiotic prophylaxis in 1052 cesarean sections.

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    von Mandach, U; Huch, R; Malinverni, R; Huch, A

    1993-01-01

    The efficacy of perioperative antibiotic prophylaxis in cesarean section with a single dose of ceftriaxone, a long-acting cephalosporin not widely used for prophylaxis, was tested. Ceftriaxone as a single dose of 1 g i.v. versus three doses of cefoxitin 1 g i.v. respectively were used in a prospective, randomized, controlled study consisting of 1052 patients undergoing cesarean section. Postoperative infection rate as measured by fever, endometritis and wound infection was 6.5% with ceftriaxone and 6.4% with cefoxitin. Urinary tract infections were significantly more frequent in the cefoxitin than in the ceftriaxone group (17.8% vs. 9.7%, p < 0.001). Enterococci and Escherichia coli accounted for urinary tract infections 1.86-, respectively, 4.3-fold more frequently with cefoxitin than with ceftriaxone. The time of hospitalization in patients with urinary tract infections was significantly lower with ceftriaxone than with cefoxitin (11 vs. 12 days, p < 0.05). The tolerance in both groups was equally satisfactory. A single dose of ceftriaxone, which is simple, reliable (compliance), well tolerated, inexpensive (fewer urinary tract infections and therefore fewer treatment costs than with cefoxitin) and safe (no overgrowth of pathogens) in our opinion is the antibiotic regimen of choice for prophylaxis in cesarean section in the described circumstances.

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

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    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. .

  20. Study of the Effect of Dexamethasone and Normal Saline in Reducing Headache after Spinal Anesthesia in Cesarean Section

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    K Tavakol

    2007-10-01

    Full Text Available Introduction & Objective: Post dural puncture headache (PDPH is a bothersome complication of spinal anesthesia specially in young parturient women after cesarean, which causes not only psychotic and somatic problems, but also increases hospital costs due to delay in patients discharge from hospital. The purpose of this study was to determine the effect of dexamethasone in improvement of complications of PDPH after spinal anesthesia in cesarean section. Materials & Methods: This is a randomised clinical trial in which 35 cases of parturient women, aged 21-44 years, who developed pain in head (PDPH, lumbar, shoulder, or more than one site due to spinal anesthesia after cesarean section in spite of consumption of NSAID drug, opoid, bed rest, rehydration. They received intravenously drip dexamethasone 0.2mg/kg (maximum 16mg in one liter of normal saline for 2 hours. Visual analogue scale (0=no pain, 10=most unbearable pain for patients before and after dexamethasone therapy was used and recorded. Results: The most common complaints of patients were headache (87.5%, low back pain (56.2%, shoulder and neck pain (25%. Results showed that mean of VAS pain score before tretment was 6.5±1.8 and decreased to 1.6±1.2 after treatment indicating a decrease of 77% in pain among the subjects. Conclusion: The advantage of dexamethasone therapy in comparisn with routine supportive therapy is the greater rapidity in pain relief and earlier release of patients from hospital.

  1. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post–cesarean section pain management

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    Adeniji AO

    2013-05-01

    Full Text Available Adetunji Oladeni Adeniji,1 Oluseyi Olaboyede A Atanda21Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; 2Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, NigeriaBackground: Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post–cesarean section pain management.Objective: To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam approach, in the management of post–cesarean section pain.Materials and methods: This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg or tramadol (100 mg as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post–cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.Results: A total of 120 patients were equally and randomly allocated to four study groups – two that received unimodal analgesia (the pentazocine group and the tramadol group and two that received multimodal analgesia (the pentazocine

  2. 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.

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    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.

  3. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

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    Anıl İçel Saygı

    Full Text Available CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50 and spinal anesthesia (n = 50 groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036 and gas discharge time (P = 0.049 were significantly greater and 24th hour hemoglobin difference values (P = 0.001 were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively, urine volume at the first postoperative hour (P < 0.001 and median Apgar score at the first minute (P < 0.0005 were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042, in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

  4. Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study.

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    Kumi Moriyama

    Full Text Available Chronic pain after cesarean section (CS is a serious concern, as it can result in functional disability. We evaluated the prevalence of chronic pain after CS prospectively at a single institution in Japan. We also analyzed perioperative risk factors associated with chronic pain using logistic regression analyses with a backward-stepwise procedure.Patients who underwent elective or emergency CS between May 2012 and May 2014 were recruited. Maternal demographics as well as details of surgery and anesthesia were recorded. An anesthesiologist visited the patients on postoperative day (POD 1 and 2, and assessed their pain with the Prince Henry Pain Scale. To evaluate the prevalence of chronic pain, we contacted patients by sending a questionnaire 3 months post-CS.Among 225 patients who questionnaires, 69 (30.7% of patients complained of persistent pain, although no patient required pain medication. Multivariate analyses identified lighter weight (p = 0.011 and non-intrathecal administration of morphine (p = 0.023 as determinant factors associated with persistent pain at 3 months. The adjusted odds ratio of intrathecal administration of morphine to reduce persistent pain was 0.424, suggesting that intrathecal administration of morphine could decrease chronic pain by 50%. In addition, 51.6% of patients had abnormal wound sensation, suggesting the development of neuropathic pain. Also, 6% of patients with abnormal wound sensation required medication, yet no patients with persistent pain required medication.Although no effect on acute pain was observed, intrathecal administration of morphine significantly decreased chronic pain after CS.

  5. Evaluation of the Adequacy of General Anesthesia in Cesarean Section by Bispectral Index

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    Sayed Mohammad Reza Hadavi

    2013-09-01

    Full Text Available Background: Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS, end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S. Methods: This study was carried out on 60 parturient patients undergoing elective C/S. A standardized anesthetic technique was applied: induction with Thiopental (4-5 mg/kg and Succinylcholine (1.5-2 mg/kg as well as maintenance with O2, N2O, and isoflurane. Electrocardiogram, heart rate, blood pressure, Spo2, end-tidal isoflurane concentration, BIS, and any clinical signs of inadequate depth of anesthesia such as movement, sweating, lacrimation, coughing, and jerking were continuously monitored and recorded at 16 fixed time points during anesthesia. Results: A median BIS of less than 70 (range: 42-68 was obtained on all occasions during surgery; however, at each milestone, at least 20% of the patients had BIS values above 60. Hemodynamic parameters increased significantly in some patients, especially during laryngoscopy and intubation. No patient experienced recall or awareness. Conclusion: The currently used general anesthetic technique in our center appears inadequate in some milestones to reliably produce BIS values less than 60, which are associated with lower risk of awareness. Therefore, with respect to such desirable outcomes as good Apgar and clinical status in neonates, we would recommend the application of this method (if confirmed by further studies through larger dosages of anesthetic agents.

  6. 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

  7. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study

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    Edilaine de Paula Batista Mendes

    Full Text Available ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2 and 25.4 cmH2O (±14.7 in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036 and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010, compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength.

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

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    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.

  9. 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.

  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. 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

    Institute of Scientific and Technical Information of China (English)

    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

  13. Birth by cesarean section and schizophrenia: results from the multicenter FACE-SZ data-set.

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    Fond, G; Bulzacka, E; Boyer, L; Llorca, P M; Godin, O; Brunel, L; Andrianarisoa, M G; Aouizerate, B; Berna, F; Capdevielle, D; Chereau, I; Denizot, H; Dorey, J M; Dubertret, C; Dubreucq, J; Faget, C; Gabayet, F; Le Strat, Y; Micoulaud-Franchi, J A; Misdrahi, D; Rey, R; Richieri, R; Roger, M; Passerieux, C; Schandrin, A; Urbach, M; Vidalhet, P; Schürhoff, F; Leboyer, M

    2016-06-27

    Children born by cesarean section ("c-birth") are known to have different microbiota and a natural history of different disorders including allergy, asthma and overweight compared to vaginally born ("v-birth") children. C-birth is not known to increase the risk of schizophrenia (SZ), but to be associated with an earlier age at onset. To further explore possible links between c-birth and SZ, we compared clinical and biological characteristics of c-born SZ patients compared to v-born ones. Four hundred and fifty-four stable community-dwelling SZ patients (mean age = 32.4 years, 75.8 % male gender) were systematically included in the multicentre network of FondaMental Expert Center for schizophrenia. Overall, 49 patients (10.8 %) were c-born. These subjects had a mean age at schizophrenia onset of 21.9 ± 6.7 years, a mean duration of illness of 10.5 ± 8.7 years and a mean PANSS total score of 70.9 ± 18.7. None of these variables was significantly associated with c-birth. Multivariate analysis showed that c-birth remained associated with lower CRP levels (aOR = 0.07; 95 % CI 0.009-0.555, p = 0.012) and lower premorbid ability (aOR = 0.945; 95 % CI 0.898-0.994, p = 0.03). No significant association between birth by C-section and, respectively, age, age at illness onset, sex, education level, psychotic and mood symptomatology, antipsychotic treatment, tobacco consumption, birth weight and mothers suffering from schizophrenia or bipolar disorder has been found. Altogether, the present results suggest that c-birth is associated with lower premorbid intellectual functioning and lower blood CRP levels in schizophrenia. Further studies should determine the mechanisms underlying this association.

  14. 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

  15. 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.

  16. 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

  17. Investigation on the comprehensive intervention measures to reduce cesarean section rate%探讨降低剖宫产率的综合干预措施

    Institute of Scientific and Technical Information of China (English)

    孟柳

    2016-01-01

    目的:分析综合干预措施降低剖宫产率的效果。方法选取在焦作市妇幼保健院分娩的孕妇共316例为研究对象,随机分为观察组和对照组,每组158例,孕12~18周时建卡,对照组进行常规定期孕检和健康知识指导,观察组进行综合干预措施,包括:孕期知识讲座、定期孕检、孕期心理指导、孕期锻炼、产程指导等。对比分析两组的剖宫产影响因素、剖宫产率以及妊娠相关并发症情况。结果在剖宫产影响因素方面,孕方要求剖宫产、产程异常、胎儿窘迫、及妊娠相关并发症所占比例方面对比差异有统计学意义(P0.05),观察组剖宫产率为32.3%(51/158),对照组剖宫产率为63.3%(100/158),两组对比差异有统计学意义(P0. 05). The observation group of cesarean delivery rate was 32. 3% (51/158), the control group the cesarean delivery rate was 63. 3%(100/158), and they are significantly different (P<0. 05). Conclusions For maternal by prenatal comprehensive inter-vention measures, strictly regulate antenatal examination, pregnancy knowledge lecture psychological guidance, exercise during pregnancy and labor guidance can effectively reduce the cesarean section rate, and can also effectively reduce the complications related to pregnancy, so it is worthy of clinical popularization and application.

  18. 心理护理在剖宫产手术中的应用评价%Evaluation of the application of psychological nursing in cesarean section

    Institute of Scientific and Technical Information of China (English)

    杨英杰

    2015-01-01

    目的 讨论并分析在对剖宫产手术中引入心理护理的效果.方法 选取我院2011年8月~2012年6月收治的实施剖宫产的50例孕妇作为研究对象,随机分成观察组和对照组,对照组行常规护理,观察组患者在常规护理的基础上辅以心理护理,对两组孕妇的护理效果及基本情况进行分析和对比.结果 两组孕妇在产后恢复状况及护理满意度比较,观察组均优于对照组,差异有统计学意义(P<0.05).结论 对剖宫产患者行心理护理能够在一定程度提高产妇的恢复速度及护理满意度.%Objective To discussion and analysis on cesarean section surgery through introduction of the effect of psychological nursing.Methods Selection from August 2011 to June 2012 treated during the implementation of the cesarean delivery of 50 cases as the research object, takes the way of randomized patients were divided into observation group and control group on average, the control group patients with routine nursing care, observation group of patients on the basis of conventional nursing with psychological nursing, nursing effect and the basic condition of two groups of patients were analyzed and compared.Results Two groups of patients in maternal recovery and nursing satisfaction comparison, observation group were better than control group ,the difference was statistically signiifcant (P<0.05). Conclusion Line of psychological nursing in patients with cesarean delivery to a certain degree of improving maternal recovery rate and nursing satisfaction.

  19. Pitfall in Ultrasound Evaluation of Uterine Scar from Prior Preterm Cesarean Section

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    Sarah-Maude B. Laflamme

    2011-09-01

    Full Text Available We report two cases of women with a previous cesarean performed before active labor at 29 weeks of gestation who underwent sonographic measurement of the lower uterine segment (LUS at 36 weeks' gestation in their subsequent pregnancy. In both cases, uterine scar defect was detected on the upper part of the LUS, at ~9 to 11 cm from the cervical os, and was only visualized by the transabdominal approach. We suggest that early gestational age and the absence of labor at previous cesarean can lead to a higher uterine scar location on the LUS and, therefore, increase the risk of uterine rupture in subsequent pregnancy. The heterogeneity of uterine scar location could explain discrepancies observed in studies using the transabdominal versus the transvaginal approach or both regarding the predictive value of LUS measurements for uterine rupture.

  20. 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 and sequence of the main surgical indications by retrospective analysis. [Results]① Cesarean section rate increased year by year; ② Changes in the main factors included: the iincrease of cesarean delivery rate, social factors, oligohydramnios, huge children; and the decrease of fetal distress and the relative cephalopelvic disproportion; few change in fetal abnormalities, pregnancy after cesarean section and narrow pelvis. [Conclusion] Social factors are the main factor about the high cesarean section rate, and the rate must be reduced by full support from the whole society.%[目的]剖析近6年剖宫产率逐步升高的主要影响因素.为寻求降低剖宫产率的具体措施提供依据.[方法]对2001~2006年间某院剖宫产病例的主要手术指征的构成比及主要排序的变化进行回颐性分析.[结果]①剖宫产率呈逐年上升趋势;②剖官产主要手术指征的变迁因素:剖宫产构成比中,社会因素、羊水过少、巨大儿有显著升高;胎儿窘迫、相对头盆不称有所下降;胎位异常、剖宫产再孕、骨盆狭窄变化不大.[结论]社会因素是造成剖宫产率居高不下的主要因素,要降低社会因素造成的剖官产率必须全社会给予大力支持.

  1. Evaluation of the Effect of Intravenous Lidocaein Infusion on Postoperative Analgesia after Cesarean Section under Spinal Anesthesia

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    M. H. Bakhshaei

    2013-04-01

    Full Text Available Introduction & Objective: Many surgical patients still experience moderate to severe pain after surgery despite efforts to administer new drugs and techniques. Postoperative analgesia clearly enhances patient’s satisfaction and facilitates earlier mobilization and rehabilitation. lidocaein has been introduced as part of post operative pain management and clinical studies revealed analgesic actions in patients with chronic neuropathic pain. Our goal in this study was to determine the effect of intravenous lidocaein on post operative pain of women under-going cesarean section under spinal anesthesia. Materials & Methods: In this double blinded clinical trial study, 72 patients candidate for Ce-sarean section under spinal anesthesia were randomly selected and divided in two groups. In the case group, infusion of1.5 mg/kg lidocaein and in the control group infusion of the same volume normal saline started 15 minutes before the beginning of operation. After spinal anes-thesia with definite technique in both groups, infusion of 1.5 mg/kg/h lidocaein in case group and the same volume normal saline in the control group was administered and continued till 0.5 hour after finishing the operation. Data including systolic and diastolic blood pressure, heart rate, analgesic score according VAS and using of analgesic drugs were recorded during 24 hours after the operation. Results: Pain intensity according to VAS score in the time 2,6,12 hours post operation were significantly lower in the case group ( P2= 0.05, P6 = 0.01, P12= 0.05 .Analgesic consumption in form of suppository & IV,24 hours after surgery, was significantly lower in the case group.(P=0.001. Conclusion: Lidocaein infusion can decrease pain intensity & analgesic consumption after ce-sarean section under spinal anesthesia. (Sci J Hamadan Univ Med Sci 2013; 20 (1:9-14

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

    Directory of Open Access Journals (Sweden)

    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. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

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    Fábio Farias de Aragão

    2014-09-01

    Full Text Available Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 μg + 50 μg/min; metaraminol group (0.25 mg + 0.25 mg/min; ephedrine group (4 mg + 4 mg/min. Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

  4. OUTCOME OF CHILDREN AT 1-2 YEARS AND MATERNAL MORB IDITY AFTER CESAREAN SECTION VS VAGINAL BIRTH FOR BREECH PRESENTATION AT OR NEAR TERM

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    Jyoti Ramesh

    2013-02-01

    Full Text Available ABSTRACT: Back ground: In 2000 an international multicentric randomized co ntrol trial of planned vaginal delivery vs planned elective caesarea n section for uncomplicated term breech presentation confirmed that perinatal mortality and s erious neonatal morbidity were significantly lower in planned caesarean group. Seco ndary analysis of Term Breech Trial showed that prelabour caesarean and caesarean during early labour were associated with lowest adverse perinatal outcome due to labour or de livery and that vaginal delivery had the highest risk of adverse outcome AIMS: The purpose of this study is to determine the outco me of children at 1-2 years and maternal morbidity after caesarean section vs. vaginal birth for breech presentation at or near term. SETTINGS AND DESIGN: Prospective observational study from 1 st January 2008-30 th June 2009( 18 months at Institute of Maternal & Child Health , Govt. Medical College Kozhikode. METHODS AND MATERIAL: Outcome of 45 assisted breech deliveries during this period analyzed from case rec ords. 90 Cesarean deliveries during the same period randomly selected as control. STATISTICAL ANALYSIS USED: Data analyzed using SPSS version 16.0.Chi square test was used to compare the outcome. A p value <0.05 was considered to indicate statistical significance. RESULTS : Vaginal delivery group- Five minute Apgar <7 (p=0.019, NICU admission (p=0.00001(RR 4.71 , 95% CI 2.33 to 9.91,Neonatal morbidity (p=0.012RR 2.627,95% CI 1.216 to 5.678 , Prolonged hospitalisation (p=0.005 RR = 2.962 ,95% CI 1.354 to 6.478 statistically signific ant in vaginal delivery group .Caesarean Section group-Elective 30(33.3% Emergency 60(66.6% Neonatal complication( p=0.03 RR=2.57 ,95% CI 1.06 to 6.2, NICU admission ( p=0.01 3 RR=2.86 ,95% CI 1.21 to 6.76. were statistically significant in elective section grou p Maternal morbidity was not associated with type of CS p=0.2 RR = 1.39 ,95% CI 0.447 to 4.307. However the perinatal mortality was

  5. 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.

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

    Science.gov (United States)

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

    2014-06-01

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

  7. 早期干预对剖宫产产妇母乳喂养自我效能的影响%Effect of Early Intervention on Cesarean Section Maternal Breastfeeding Self-efficacy

    Institute of Scientific and Technical Information of China (English)

    赵赞利; 曾娟

    2014-01-01

    Objective To investigate the factors of early intervention after cesarean section on the ef ects of maternal breastfeeding self-ef icacy. Methods Using the questionnaire form to our hospital 290 primiparas were investigated,through "the breastfeeding self ef icacy scale (Chinese version)" (BSES) assessment of maternal self-ef icacy, whether there is difference between vaginal delivery and cesarean section. At the same time through self-designed maternal postpartum questionnaire, analysis the factors of maternal breastfeeding self-ef icacy influence of cesarean section. Results The experimental group of maternal breastfeeding self-ef icacy is higher than that of control group. Conclusion Cesarean section maternal breastfeeding self-efficacy than vaginal delivery; the main influence factors after cesarean section maternal breastfeeding self-ef icacy has the appetite is good or bad, since that insuf icient milk and sleep time.%目的探讨早期干预对剖宫产术后影响产妇母乳喂养自我效能的因素。方法采用调查问卷的形式对我院290例初产妇进行调查,通过叶母乳喂养自信心量表(中文版)》(BSES)评估产妇的自我效能,比较阴道分娩产妇与剖宫产产妇是否存在差异。同时通过自行设计的产妇产后情况调查表,分析影响剖宫产产妇母乳喂养自我效能的因素。结果实验组产妇母乳喂养自我效能高于对照组。结论剖宫产产妇母乳喂养自我效能低于阴道分娩产妇;剖宫产术后产妇母乳喂养自我效能的主要影响因素有食欲的好坏、自认为乳汁不足及睡眠时间。

  8. Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section

    Science.gov (United States)

    Altun, Celalettin; Borazan, Hale; Şahin, Osman; Gezginç, Kazım

    2015-01-01

    Objective We aimed to compare the effects of general and spinal anesthesia on cognitive functions in pregnant patients undergoing elective cesarean section. Material and Methods Seventy-five American Society of Anesthesiology (ASA) I pregnant patients aged 18–40 years who were scheduled to undergo elective cesarean section were divided into three groups. Group sevoflurane (Group S) and Group desflurane (Group D) were administered general anesthesia, whereas Group regional (Group R) was administered spinal anesthesia. Hemodynamic variables, bispectral index, oxygen saturation were measured at baseline, after induction, spinal injection, and during the surgery. Extubation and eye opening time and Aldrete scores were recorded. Mini-mental state examination, Trieger dot test, and clock drawing test were performed one day before the surgery and repeated at the 1st, 3rd and 24th h postoperatively. Results There was no statistically significant difference among the groups in terms of demographic data and duration of surgery (p>0.05). Durations of anesthesia for Group S, Group R, and Group D were significantly different (pAldrete recovery scores and total remifentanil consumption were significantly higher in Group D than in Group S (p<0.05). Extubation and eye opening times were significantly shorter in Group D than in Group S (p<0.01). According to TDT, statistical significance was found among Group S, Group R, and Group D at the 3rd and 24th h postoperatively (p<0.05), and there was a statistically high significant difference in Groups S and R (p<0.0001). Conclusion We concluded that general anesthesia with sevoflurane or desflurane and spinal anesthesia had no effects on cognitive functions in patients undergoing cesarean operation. PMID:26692772

  9. 3380例剖宫产术指征及社会因素分析%Analysis of indications and social factors for 3380 cesarean section cases

    Institute of Scientific and Technical Information of China (English)

    林湖滨; 景宜馨; 景雅

    2015-01-01

    目的总结剖宫产率的变化及影响因素.方法对5年间3380例剖宫产产妇进行回顾性分析.结果剖宫产率呈总体下降趋势, 但平均剖宫产率(42.46%)仍然较高.5年中社会因素、胎儿窘迫、瘢痕子宫始终处于剖宫产指征的前3位;社会因素剖宫产由2009年的34.51%逐年上升到2013年的41.91%, 差异具有统计学意义(P<0.05) ;社会因素中惧怕疼痛(28.34%)和担心母儿安全(22.91%)是主要的原因.结论剖宫产率的升高主要受社会因素的影响, 临床中要合理掌握剖宫产指征, 降低剖宫产率.%ObjectiveTo summarize changes and influencing factors of cesarean section rate. MethodsA retrospective analysis was made on 3380 puerperae of cesarean section.ResultsCesarean section rate showed a generally decreased trend, while the average cesarean section rate (42.46%) was still at the high level. In the recent 5 years, social factors, fetal distress and scarred uterus were the first three indications for cesarean section. Rate of cesarean section by social factors increased gradually from 34.51% in 2009 to 41.91% in 2013, and the difference had statistical significance (P<0.05). The social factors mainly included fear of pain (28.34%) and concern of maternal and fetal safety (22.91%).ConclusionIncreased cesarean section rate is mainly influenced by social factors. Rational control of cesarean section indications in clinic can reduce cesarean section rate.

  10. 剖宫产产钳在腹壁横切口瘢痕子宫剖宫产中的应用%Application of forceps in cesarean section of abdominal transverse incision scar uterus

    Institute of Scientific and Technical Information of China (English)

    钟洁; 杨楠

    2015-01-01

    Objective:To explore the clinical application value of forceps for solving fetal childbirth difficulty in cesarean section of abdominal transverse incision scar uterus.Methods:120 pregnant women with cesarean section of abdominal transverse incision scar uterus were selected.In forceps group with 60 cases,the forceps were used to help fetal head delivery.In the hands group with 60 cases,the hands were used to help the fetal head delivery.We compared the effect of the two groups.Results:Two groups of delivery time and neonatal Apgar score had significant differences(P<0.05).Conclusion:Timely use of forceps in cesarean section of abdominal transverse incision scar uterus can effectively assist the fetus,at the same time,it can reduce the severity injury in operation.%目的:探讨剖宫产产钳在解决腹壁横切口瘢痕子宫再次剖宫产术中胎头娩出困难的临床应用价值。方法:收治腹壁横切口瘢痕子宫妊娠再次行剖宫产术孕妇120例,产钳组60例使用产钳助娩胎头,手娩组60例手取胎头,比较两组效果。结果:两组胎儿娩出时间及新生儿Apgar评分相比差异有统计学意义(P<0.05)。结论:再次腹壁横切口剖宫产术中及时使用剖宫产产钳能有效地辅助胎儿娩出,同时可减少严重的手术损伤。

  11. Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China

    Science.gov (United States)

    Vitonis, Allison; Zou, Liying; Ruan, Yan; Wang, Xin; Zhang, Weiyuan

    2017-01-01

    Background Cesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China’s One Child Policy era (1979–2015) most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD. Methods Univariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR), 99% confidence intervals (CI). Findings Among 108,847 deliveries, 59,415 were CD (54.6%) with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH) (aOR = 0.80, CI = 0.69–0.92) and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy). Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50–1.89) compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06–0.34), neonatal ICU admission (aOR = 0.50, CI = 0.36–0.69), 5-minute ApgarSVD. Now that all Chinese women can have a second child the safety profile may change. PMID:28182668

  12. 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.

  13. Relationship Between Myometrium Closure Methods and the Incidence of Cesarean Scar Defect in Cesarean Section%剖宫产子宫切口缝合术式与子宫切口假腔的关系

    Institute of Scientific and Technical Information of China (English)

    游一平; 阳笑; 唐雅兵; 靳晓丹

    2013-01-01

    [目的]探讨剖宫产子宫切口缝合术式与子宫切口假腔(cesarean scar defect)发生的关系.[方法]应用阴道四维B超观察改良新式剖宫产中“连续套锁缝合(continuous lock catch suture)”及“连续单层缝合(Continuous single-layer closure)”在子宫切口缝合后患者子宫切口假腔发生的情况(阴道B超追踪术后4d、42 d、1年、2年子宫切口情况).计算切口假腔的发生率.[结果]行“连续单层缝合”子宫切口的患者,子宫切口假腔发生率显著低于行“连续套锁缝合”子宫切口的患者(2.74% vs 6.76%,P<0.05).[结论]子宫切口假腔的发生与子宫切口缝合术式相关,“连续单层缝合”子宫切口的缝合术式可有效降低子宫切口假腔的发生.%[Objective] To explore the relationship between myometrium closure methods and the incidence of cesarean scar defect. [Methods] Transvaginal B-ultrasound scan was used to observe the incidence of cesarean scar defect after continuous lock catch suture or continuous single-layer closure in modified new cesarean section. Uterine incision condition at 4d, 42d, 1 year and 2 years after the operation was followed up by using transvaginal B-ultrasound scan. The incidence of cesarean scar defect was calculated. [Results] The incidence of cesarean scar defect in patients undergoing continuous single-layer closure of myometrium was significantly lower than that in patients undergoing continuous lock catch closure of myometrium. [Conclusion] The incidence of cesarean scar defect is related with myometrium closure methods. Continuous single-layer closure can effectively decrease the incidence of cesarean scar defect.

  14. Comparing Propofol with Sodium Thiopental on Neonatal Apgar Score after Elective Cesarean Section

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Dadras

    2013-04-01

    Full Text Available Background: The Apgar score (Appearance, Pulse, Grimace, Activity, and Respiration of newborn babies immediately after birth is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol rather thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ apgar score, mothers’ nausea, vomit and time necessary for mothers’ recovery. Materials and Methods: In this double-blind clinical trial, a total of 230 healthy women who were volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical except the anesthesia induction drug. Babies’ Apgar score 1 and 5 minutes after birth and recovery period, mothers’ nausea and vomiting after operation were recorded. Results: Apgar score I minute 1 (p=0.041 and apgar score in minute 5 (p=0.034 for propofol group were meaningfully higher than those for thiopental group. Recovery time from anesthesia was not different meaningfully in two groups (p=0.67. Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather thiopental group (p=0.028.Conclusion: It seems that in cesarean operations, after sufficient fluid therapy, propofol can be a proper drug to achieve anesthesia. Moreover it exerts less impact on cesarean babies’ apgar and stimulates lower levels of nausea and vomiting in mothers.

  15. Rectal Cancer Diagnosed after Cesarean Section in Which High Microsatellite Instability Indicated the Presence of Lynch Syndrome

    Directory of Open Access Journals (Sweden)

    Tomohiro Okuda

    2015-01-01

    Full Text Available We report a case of rectal cancer with microsatellite instability (MSI that probably resulted from Lynch syndrome and that was diagnosed after Cesarean section. The patient was a 28-year-old woman (gravid 1, para 1 without a significant medical history. At 35 gestational weeks, vaginal ultrasonography revealed a 5 cm tumor behind the uterine cervix, which was diagnosed as a uterine myoma. The tumor gradually increased in size and blocked the birth canal, resulting in the patient undergoing an emergency Cesarean section. Postoperatively, the tumor was diagnosed as rectal cancer with MSI. After concurrent chemoradiation therapy, a lower anterior resection was performed. The patient’s family history revealed she met the criteria of the revised Bethesda guidelines for testing the colorectal tumor for MSI. Testing revealed that the tumor did indeed show high MSI and, combined with the family history, suggested this could be a case of Lynch syndrome. Our findings emphasize the importance of considering the possibility of Lynch syndrome in pregnant women with colorectal cancer, particularly those with a family history of this condition. We suggest that the presence of Lynch syndrome should also be considered for any young woman with endometrial, ovarian, or colorectal cancer.

  16. 2011-2012年海南省临高县中医院剖宫产率影响因素分析%Investigation on the cesarean section rate of puerperants in Hainan Lingao hospital from 2011 to 2012

    Institute of Scientific and Technical Information of China (English)

    陈克芳

    2014-01-01

    目的:分析研究2011至2012年临高县中医院的剖宫产率,并探讨其相关影响因素。方法选取2011年1月至2012年12月该院2248例产妇为研究对象,对其分娩方式进行分析研究,比较不同病理性因素及非病理性因素者的剖宫产率。结果2248例产妇中共有428例剖宫产,剖宫产率为19.04%,其中存在胎儿宫内窘迫、胎位异常、妊娠期并发症、巨大儿的产妇剖宫产率高于其他产妇,低文化程度、高体质量指数、低社会支持程度及初产妇的剖宫产率高于其他产妇,且其均与剖宫产有密切关系(均P<0.05)。结论2011至2012年该院剖宫产率控制相对较好,且其中病理性及非病理性因素均相对较多,应给予针对性干预。%ObjectiveTo analyze and study the cesarean section rate of puerperants in our hospital from 2011 to 2012,and investigate the related influence factors.Methods2248 puerperants in our hospital from January 2011 to December 2012 were selected as research object,and the delivery mode of all the puerperants were analyzed and studied,then the cesarean section rate of puerperants with different pathological factors and non-pathological factors were analyzed and compared.Results428 cases of 2248 puerperants were with cesarean section,the cesarean section rate was 19.04%,and the cesarean section rate of puerperants with fetal distress,abnormal fetal position,pregnancy complications and giant baby were higher than those of other puerperants,the cesarean section rate of lower education degree,higher BMI,lower social support degree and primiparas were higher than those of other puerperants,and those factors all had closed correction to the cesarean section,allP<0.05,there were all significant differences.ConclusionThe cesarean section rate of puerperants in our hospital from 2011 to 2012 is well controlled,and the pathological factors and non-pathological factors are both more,so they should be paid to

  17. Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks’ Gestation

    Directory of Open Access Journals (Sweden)

    Takashi Suzuki

    2015-01-01

    Full Text Available We describe a rare case of Mallory-Weiss tear with massive hematemesis at 38 weeks’ gestation. A 35-year-old woman presented with epigastralgia followed by massive hematemesis. An emergency endoscopy indicated active pulsatile bleeding at the esophagocardial junction. Although an emergency endoscopic hemostasis was successful, late decelerations without acceleration on cardiotocogram were observed. Therefore, the patient underwent emergency cesarean section, along with blood transfusion, following the endoscopic hemostasis. The hemoglobin level just before the operation was 5.1 g/dL. We suspected that massive hematemesis induced maternal acute anemia and hypovolemia, which resulted in a nonreassuring fetal status. Hence, urgent endoscopic hemostasis, adequate blood transfusion, and emergency cesarean section were needed. Mallory-Weiss tear during the third trimester may have a possibility of massive hematemesis and urgent blood transfusion, emergency endoscopic hemostasis, and emergency cesarean section may be needed.

  18. Cesarean section in a patient with non-compaction cardiomyopathy managed with ECMO.

    Science.gov (United States)

    Koster, A A; Pappalardo, F; Silvetti, S; Schirmer, U; Lueth, J U; Dummler, R; Emmerich, M; Schmitt, M; Kirchne, G; Kececioglu, D; Sandica, E

    2013-01-01

    Isolated ventricular non-compaction is a rare cardiomyopathy associated with left heart failure, severe arrhythmias and thromboembolism. We report about our interdisciplinary strategy in a patient with severe isolated ventricular non-compaction cardiomyopathy scheduled for caesarean section in general anaesthesia. Monitoring included placement of an arterial line, a central venous catheter and a pulmonary artery catheter with pacing option. Small introducer gates were placed in the femoral artery and vein to facilitate quick percutaneous institution of extracorporeal life support via extracorporeal membrane oxygenation in case of acute cardiac failure refractory to medical treatment. Inotropic pharmacological therapy with 3 µg/kg/min dobutamine and 0.25 mg/kg/min milrinone was started before surgery. Induction of general anesthesia and rapid sequence intubation was performed with an analgesic dose of 0.5 mg/kg S ketamine, 0.25 mg/kg etomidate and 5 mg rocoronium followed by 1.5 mg/kg succinylcholine. This regimen provided completely stable hemodynamics in this critical period until delivery of the child and continuation of anaesthesia with continuous infusion of propofol and remifentanyl. The current strategies, particularly the preparation for femoro-femoral extracorporeal membrane oxygenation, may be considered in similar cases with a high risk of acute cardiac decompensation which may be refractory to medical treatment. Anaesthesiologist involved in performing caesarean section in women with complex cardiac disease, should encompass extracorporeal membrane oxygenation standby in management of the perioperative period.

  19. Impact of natural birth and cesarean section on female postpartum sexual function and living quality%顺产和剖宫产对女性产后性功能和生活质量的研究

    Institute of Scientific and Technical Information of China (English)

    陈洁; 齐静; 何艺

    2014-01-01

    目的:探讨顺产和剖宫产对女性产后性功能以及生活质量的影响。方法:利用横断面分析法分析2012年12月至2013年12月于我院分娩的200名初产妇的临床资料,按照分娩方式分为顺产组(100名)和剖宫产组(100名),分别对这两组产妇产后45d,3个月,6个月内的性生活恢复比例、性交痛发生率、性生活满意程度以及产后生活质量进行比较。结果:产后45 d和产后3个月,顺产组和剖宫产组在恢复性生活的比例,性交痛发生率,性生活满意程度三方面有显著差异,差异有统计学意义(P<0.05);产后6个月,两组在恢复性生活比例,性交痛的发生率,对性生活满意程度三方面没有显著差异(P>0.05);顺产组的生活质量评分显著高于剖宫产组,差异有统计学意义(P<0.05)。结论:产后3个月内,顺产和剖宫产对女性产后性功能有显著差异;而产后6个月,两种方式对性功能无显著差异;相比于剖宫产组,顺产组生活质量更高。因此,女性为保护性能力而选择剖宫产不科学。%Objectives:To investigate the impact of natural birth and cesarean section on female sexual function and living quality.Methods:A cross-sectional investigation of the clinical data of 200 primipara who delivered live births in our hospital from December 2012 to December 2013 was conducted.According to the different modes of delivery, primipara were divided into natural birth group (100)and cesarean section group (100).The restore ratio of sexual life, incidence of sexual intercourse pain,sexual life and their living quality 45 days,3 months and 6 months after of all pri-mipara was compared respectively.Results:45 days and 3 months after delivery,the difference in restore ratio of sexual life,the incidence of sexual intercourse pain and quality of sexual life between the two groups was statistically significant (P0.05);scores of living

  20. Related Factors of Elective Cesarean Section: A Case-Control Study%选择性剖宫产的相关因素研究

    Institute of Scientific and Technical Information of China (English)

    李艳芳; 李越游; 林黛

    2010-01-01

    目的 总结广州市番禺区妇幼保健院在过去十年剖宫产率的变化和趋势,分析2009年该院病人相关的和医师相关的因素与选择性剖宫产的关系.方法 这是一个病例对照研究,病例是应病人自己要求或手术指征不明确的选择性剖宫产分娩的妇女,对照则是有明确手术指征的剖宫产分娩妇女.PS power软件用于计算样本量,通过分层随机抽样的方法,在4176个2009年住院分娩的病历中随机抽取709个总样本(其中病例数是348个,对照是361个).通过病历回顾,收集所有与病人相关的及与医生相关的非医学因素.采用SPSS 16.0软件进行数据处理,运用卡方检验和Logistic回归方程进行检测.结果 该院的剖宫产率从2000年的41.8%到2009年的59.9%,总体呈一个线性的提高.选择性剖宫产更多发生在正常上班时间,产检次数越多的病人越容易在无手术指征的情况下选择剖宫产.结论 在本研究人群中,产科医师的偏好影响病人对剖宫产的选择,医师便利及害怕医疗纠纷可能是医师选择治疗方式的主要驱动因素.因此,选择性剖宫产率的控制措施应更侧重于改变医师的行为模式,而不仅仅是患者教育.%Objective To summarize the trend of CSR at a district public hospital in Guangzhou in the past decade and to identify patient and physician-related factors for elective cesarean section in 2009.Methods This was a case-control study. All available non-medical risk factors were collected from inpatient medical records. PS power software was used to calculate sample size. Cases were women who underwent Cesarean delivery at maternal recquest or for unclear obstetric indication and controls were women who underwent Cesarean delivery with one or more medical indications. A total sample size of 709 (348 cases and 361 controls) was obtained via stratified random sampling from 4176 in-patient delivery records in 2009.Risk factors for CS were examined

  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. Significant differences in cesarean section rates between a private and a public hospital in Brazil Diferença notável nas taxas de parto cesariano em hospital público e hospital privado no Brasil

    Directory of Open Access Journals (Sweden)

    Sueli de Almeida

    2008-12-01

    Full Text Available This paper evaluates the association of maternal variables and of variables related to prenatal and delivery care with cesarean sections at a public and at a private maternity. A retrospective cross-sectional study was performed at a public maternity clinic (2,889 deliveries and at a private maternity clinic (2,911 deliveries in the city of Ribeirão Preto, São Paulo State, Brazil. The prevalence of cesarean sections was 18.9% at the public maternity clinic and 84.3% at the private one. The factors associated with cesarean sections at both hospitals were: mothers from other cities, aged > 25 years and with hypertension. Having more than one child was a protective factor. At the public hospital, cesarean sections were more frequent on Wednesdays and from 12:00 to 23:59 hours of any day of the week, whereas at the private hospital they occurred on any day, though were less common on Sundays, and at any time except in the early morning. At the private hospital, cesarean sections were more frequent when performed by the doctor who had provided the prenatal care. Non-medical factors were more associated with cesarean sections in the private maternity clinic than biological or clinical factors related to pregnancy.Este artigo avalia a associação de variáveis maternas e aquelas relacionadas ao cuidado pré-natal e ao parto com a ocorrência de cesáreas em um hospital público e em um hospital privado. Um estudo de corte transversal, retrospectivo, foi desenvolvido em uma maternidade pública (2.889 partos e em uma maternidade privada (2.911 partos em Ribeirão Preto, São Paulo, Brasil. A prevalência de cesárea foi 18,9% e 84,3%, respectivamente, na maternidade pública e na particular. Os fatores associados ao parto cesariano nos dois hospitais foram: mães procedentes de outras cidades, com idade > 25 anos e hipertensas. Ter mais de um filho foi fator protetor. No hospital público, a cesárea foi mais freqüente às quartas-feiras e das 12h00

  3. 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。

  4. A study on mode of delivery and conduct of labour in women with vaginal birth after caesarean section in Dhulikhel Hospital.

    Science.gov (United States)

    Tamrakar, S R; Chawla, C D

    2010-06-01

    Vaginal birth after caesarean section is the delivery of a baby through the vagina after a previous cesarean delivery. For this to be conducted safely and responsibly emergency obstetric care must be available. To study the different modes of delivery in Dhulikhel Hospital (DH), evaluate the frequency of attempted and successful vaginal birth after caesarean section and, in the VBAC group, to identify those factors that may influence outcome and safety. The study was a retrospective study of all women who were delivered via different routes and the subgroup who underwent attempted vaginal birth after caesarean section in DH from January 2007 to December 2009. In this study factors associated with the successful VBAC were also analyzed. During the study period a total of 4215 deliveries conducted in DH and a total of 890 lower segment caesarean sections (21.1% of all deliveries) were performed. Of the 890 caesareans performed, 743 were primary and 147 were repeat (69 were repeat elective and 78 were repeat emergency). In this period an additional 33 women with previous lower segment caesarean sections had a successful vaginal delivery. Hence 18.3% (33/180) vaginal birth after caesarean sections was conducted successfully among women with previous caesarean). The results of this study indicate that vaginal birth after caesarean section is a clear feature of obstetric practice in DH. This is possible because of the vigilance in managing these women and the availability in this hospital setting of resources for immediate cesarean section.

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

    Directory of Open Access Journals (Sweden)

    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

  6. Effect of health education combined with comprehensive nursing on decreasing cesarean section rate%健康宣教结合综合护理对降低剖宫产率的分析

    Institute of Scientific and Technical Information of China (English)

    陈雪群

    2016-01-01

    目的:研究社区健康宣教结合综合护理干预在孕产妇中的应用,为降低剖宫产率提供一定的循证依据。方法选择2014年6月~2015年12月于我院产科分娩,且分娩时间为36~38周,并自愿参加本研究的464例孕产妇为本研究对象,按照数字表法随机分为两组,每组各232例孕产妇,实验组实行产前健康宣教及综合护理干预,对照组给予常规产前检查和护理措施。对比分析两组孕产妇产前分娩意向,最终分娩方式及选择剖宫产的原因。结果实验组232例孕产妇产前均自主选择自然分娩,明显高于对照组的76例,两者比较差异具有统计学意义(χ2=235.013,P<0.01)。实验组最终实施剖宫产27例,剖宫产率为11.64%,对照组最终实施剖宫产156例,剖宫产率为67.24%,两者相比,差异具有统计学意义(P<0.01)。实验组27例剖宫产孕产妇中均为有剖宫产医学指征的,对照组156例剖宫产孕产妇中,无医学指征有61例,两组原因分布差异具有统计学意义(P<0.05)。结论健康宣教结合综合护理干预可以有效降低社区孕产妇剖宫产率,提升患者医疗服从性。%Objective To study the application of community health education combined with comprehensive nursing intervention on maternal, and provide certain evidence-based references for reducing cesarean section rate. Methods464 maternal whose delivery time was between 36 and 38 weeks from June 2014 to December 2015 in our hospital were volunteer to be selected as the study objects, who were randomly divided into two groups according to digital table method, 232 cases in each group. The experiment group received the prenatal health education and comprehensive nursing intervention, while the control group received routine prenatal examination and nursing measures. The maternal prenatal childbirth intention, final delivery methods and reasons for choosing cesarean

  7. Case with pyoderma gangrenosum abruptly emerging around the wound of cesarean section for placenta previa with placenta accrete.

    Science.gov (United States)

    Nonaka, Taro; Yoshida, Kunihiko; Yamaguchi, Masayuki; Aizawa, Atsuko; Fujiwara, Hiroshi; Enomoto, Takayuki; Takakuwa, Koichi

    2016-09-01

    A 39-year-old woman underwent emergency cesarean section (CS) due to placenta previa totalis with massive bleeding. Two major problems emerged in this patient after CS was carried out. One was partial retention of the placenta due to placenta accreta. Another major and more serious problem was pyoderma gangrenosum (PG) widely appearing at the skin of the abdomen around the CS wound. Conservative treatment was performed for the retained placenta, and it had completely disappeared by 76 days after the CS. The diagnosis of PG was promptly made in consultation with a plastic surgeon and a dermatologist when a wide ulcer emerged around the CS wound, and high-dose prednisolone was administered as treatment. At 90 days following the CS, near-complete epithelialization was achieved. This extremely rare case reflects the importance of rapid diagnosis and treatment of PG.

  8. Indicação de cesarianas em óbito fetal Cesarean section in fetal death

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    Ânderson Gonçalves Sampaio

    2010-04-01

    determine the factors associated with cesarean section in pregnancies with fetal death at a maternity hospital in Recife, Pernambuco, Brazil. METHODS: a cross-sectional study was performed, which analyzed data from the information system about mortality and medical records, from January 2005 to December 2008, of Hospital Barão de Lucena (HBL. We analyzed women with fetal death diagnosis, with gestational age of 20 weeks or more, in terms of sociodemographic characteristics, causes and types of fetal death, obstetrical precedents and birth characteristics. The associations between the variables were analyzed by the χ2 test of association and Fisher exact test, with the level of significance set at 5%. We calculated the prevalence ratio as the measure of risk and the confidence interval (CI at 95%. Logistic regression analysis was also performed and the Odds Ratio (OR was calculated. RESULTS: among the 258 pregnant women with fetal death, 27.5% (n=71 underwent cesarean section. After multivariate analysis, the factors that remained significantly associated with cesarean section were maternal age below 20 years (OR=0.23; 95%CI=0.06-0.85, history of one or more cesarean sections (OR=7.02; 95%CI=2.29-21.55, multiple gestation (OR=9.06; 95%CI=2.01-40.71, use of misoprostol for birth induction (OR=0.07; 95%CI=0.01-0.32, fetal death occurring during birth (OR=4.01; 95%CI=1.13-14.24, low birth weight (OR=0.33; 95%CI=0.11-0.94, presence of hypertensive disorders (OR=3.7; 95%CI=1.46-9.39 and abruptio placentae (OR=13.9; 95%CI=4.67-41.69. CONCLUSION: in HBL, the risk factors for cesarean section in pregnancies with fetal death were previous cesarean section, multiple gestation, intrapartum deaths, hypertensive disorders and abruptio placentae. The protective factors were teenage pregnancy, use of misoprostol and low birth weight.

  9. Epidural anesthesia in repeated cesarean section. Anestesia epidural en la cesárea iterativa.

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    Norma Mur Villar

    2003-05-01

    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.

    Fundamento: La anestesiología ha experimentado durante los últimos años un desarrollo espectacular en las diferentes áreas de su competencia, entre las que se encuentra sin lugar a dudas, la que centra su actividad asistencial en la paciente obstétrica y todo lo relacionado con su práctica adecuada en estas. Objetivo: Evaluar la eficacia de la anestesia epidural en la cesárea iterativa. Métodos: Estudio descriptivo retrospectivo de una serie de casos (112 en que fue

  10. Risk of selected postpartum infections after cesarean section compared with vaginal birth: A five-year cohort study of 32,468 women

    DEFF Research Database (Denmark)

    Leth, Rita Andersen; Møller, Jens Kjølseth; Thomsen, Reimar Wernich;

    2009-01-01

    Objectives. To compare the risk of postpartum infections within 30 days after vaginal birth, emergency, or elective cesarean section (CS). Design. Register-based cohort study in Denmark. Participants. A total of 32,468 women giving birth in hospitals in the County of Aarhus, Denmark, during...

  11. Study of efficacy of mifepristone as inducing agent for mid trimester medical termination of pregnancy in women with previous cesarean section

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    Shaila Chikkagowdra

    2016-09-01

    Conclusions: Combination regimen has abortion rate as higher as 99-100% and median induction to abortion interval is as low as 6 hours. Second trimester abortion in prior cesarean section women should be carried out with caution. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3051-3055

  12. Where there are no resources : Emergency Cesarean Sections in conflict zones in West Africa performed under Ketamine Anesthesia without intubation are safe

    NARCIS (Netherlands)

    Brommundt, J.; Karl, A.; Scheeren, Thomas

    2013-01-01

    Aim: The aim of this retrospective, observational study was to test the hypothesis that general anesthesia with i.v. ketamine and without intubation as frequently practiced in humanitarian projects in Africa can be used with relative safety for emergency cesarean sections (CS) in a partly evacuated

  13. 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....

  14. Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea.

    Science.gov (United States)

    Lee, Kwangsoo; Lee, Sangil

    2007-05-01

    This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating health care organizations had similar CS rates despite the varied participation periods. The study sample included delivery claims data from the Korean national health insurance program for the year 2003. Risk factors were identified and used in the adjustment model to distinguish the main reason for CS. Their risk-adjusted CS rates were compared by the reimbursement methods, and the organizations' internal and external environments were controlled. The final risk-adjustment model for the CS rates meets the criteria for an effective model. There were no significant differences of CS rates between providers in the DRG and fee-for-service system after controlling for organizational variables. The CS rates did not vary significantly depending on the providers' DRG participation periods. The results provide evidence that the DRG payment system operated by volunteering health care organizations had no impact on the CS rates, which can lower the quality of care. Although the providers joined the DRG system in different years, there were no differences in the CS rates among the DRG providers. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

  15. 健康教育在剖宫产术后疼痛中的应用%Application of health education in pains after cesarean section

    Institute of Scientific and Technical Information of China (English)

    张英

    2011-01-01

    目的 总结健康教育应用于剖宫产术后疼痛患者的体会.方法 评估不同的剖宫产术后疼痛患者心理状况,制定标准教育计划,实施个体化的健康教育.结果 提高剖宫产术后疼痛患者对疼痛的耐受力,使产妇术后疼痛程度减轻,时间缩短.结论 通过健康教育应用于剖宫产术后疼痛的应用,可以使产妇消除紧张、焦虑和恐惧.减轻了患者的痛苦,促进了术后身体的恢复,避免了并发症的发生,促进母乳喂养的成功.使产妇能身心放松,轻松度过剖宫产术后疼痛期.%Objective To evaluate the care experience of health education used in pain after ce-sarean section. Methods To evaluate the different psychological state of patients with pain after ce-sarean section, standard - setting education programs, the implementation of individualized health education. Results To improve pain tolerance, after cesarean section so that the degree maternal pain and reduced time. Conclusions Applied to the application of health education in pains after cesarean section can make the elimination of maternal stress, anxiety and fear,Reduce the patients suffering,promote post - operative recovery of the body, avoid the occurrence of complications and promote breastfeeding success. Giving patients physical and mental relaxation, easily pass through the pain period after cesarean section.

  16. 剖宫产指征10年回顾%Retrospective analysis on the indications of cesarean section from 2000 to 2009

    Institute of Scientific and Technical Information of China (English)

    施华珍; 曹树军; 陈晓玲

    2012-01-01

    目的:分析剖宫产指征变化,探讨剖宫产率居高不下的原因及降低剖宫产率的可行性措施.方法:对松江分院2000年1月1日~2009年12月31日住院剖宫产分娩的8 888例患者的病历资料进行回顾性分析.结果:①在剖宫产指征构成比中,社会因素位居第一,其次依次为胎儿窘迫、头盆不称、疤痕子宫、臀位等.②10年来社会因素剖宫产指征呈快速上升趋势,在3个阶段的剖宫产指征构成比中分别为8.2%、54.4%和37.6%.第三阶段社会因素剖宫产指征构成比较前明显下降,P<0.01,是总剖宫产率明显下降的主要原因,P<0.01,但仍维持在一个较高水平.10年来以疤痕子宫为指征在剖宫产指征构成比中有逐年上升趋势,P<0.05或<0.01.③围产儿死亡率无统计学差异(P>0.05).结论:①降低剖宫产率的关键在于严格掌握剖宫产指征,提高产科质量,提高阴道助产技术水平;加强孕产期保健及其健康教育,提高人们对剖宫产并发症的认识,降低以社会因素为指征的剖宫产率.②剖宫产率在一定范围内降低了围产儿死亡率,但剖宫产率的进一步升高,围产儿死亡率并未随之下降.因此,应合理掌握剖宫产指征,降低剖宫产率.%Objective; To analyze the change of indications of cesarean section, explore the causes of high cesarean section rate and the feasible measures to reduce cesarean section rate. Methods; The medical data of 8 888 hospitalized cases who underwent cesarean section in the hospital from January first, 2000 to December 31st, 2009 were analyzed retrospectively. Results; Among the proportions of indications of cesarean section, social factor ranked the first, followed by fetal distress, cephalopelvic disproportion, scar uterus, and breech presentation, and so on. From 2000 to 2009, cesarean section rate induced by social factor increased rapidly, the proportions among three stages of indications of cesarean section

  17. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

    Directory of Open Access Journals (Sweden)

    Tanmay H. Shah

    2011-08-01

    Full Text Available Patients with Klippel-Feil Syndrome (KFS have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-yearold female, G2P1A0 with KFS (fusion of cervical vertebrae who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiberoptic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus.

  18. Application Effect of Combined Spinal Epidural Anesthesia in Cesarean Section%腰硬联合麻醉在剖宫产中的应用效果分析

    Institute of Scientific and Technical Information of China (English)

    杨忠

    2015-01-01

    目的:分析腰硬联合麻醉(CSEA)在剖宫产中的应用效果。方法将我院93例剖宫产产妇按麻醉方式不同将其分为对照组(n=46)和观察组(n=47),对照组采用硬膜外麻醉(CEA),观察组采用CSEA麻醉,比较两组麻醉效果、起效时间、肌肉松弛程度及不良反应发生率。结果与对照组相比,观察组起效时间更短、麻醉效果更佳、肌肉松弛更明显、不良反应发生率更低(<0.05)。结论宫产中实施腰硬联合麻醉具有起效快、效果好、并发症少等优点。%Objective To explore the ef ect of CSEA for cesarean delivery.Methods 93 cases of cesarean delivery women were randomly divided into the control group (n=46)and the observation group (n=47).The control group used CEA,the observation group used CSEA.Compare the anesthesia ef ect,working time,degree of muscle relaxation and incidence of adverse reactions of two groups.Results Compared with the control group,the anesthesia ef ect,working time,degree of muscle relaxation and incidence of adverse reactions were bet er ( <0.05).Conclusion Application the CSEA in cesarean section has quick ef ect,good ef ect,less complication,etc.

  19. 剖宫产产后出血的原因及临床处理%Etiology and clinical treatment of postpartum hemorrhage following cesarean section

    Institute of Scientific and Technical Information of China (English)

    陈惠萍; 朱月华; 曹卉

    2011-01-01

    Objective To explore the etiology of postpartum hemorrhage following cesarean section and effective therapy.Methods A retrospective analysis was conducted on the clinical data of 76 cases of postpartum hemorrhage following cesarean section.Results The etiology of hemorrhage included: uterine atony in 48 cases ( 63.2% ), placental factors in 17 cases ( 22.4% ), uterine laceration in 8 cases ( 10.5% ) , and coagulative abnormalities in 3 cases (3.9%).There was a higher incidence of hemorrhage in the caesarean section group than in the vaginal delivery group ( 3.5% vs.1.3%, P < 0.01 ).The volumes of hemorrhage ranged from 700 ml to 3 500 ml.The cases with hemorrhage of less than 1000 ml, 1000 to 2 000 ml and more than 2 000 ml group accounted for 67.1%, 26.3% and 6.6%, respectively.The caesarean section group had a higher incidence of hemorrhage volume of 1 000 to 2 000 ml than the vaginal delivery group (P < 0.05).All the patients were successfully rescued, of whom 4 patients underwent hysterectomy (5.3% ).Conclusion Successful reduction of the incidence of postpartum hemorrhage following caesarean section rests on the proper awareness of the indications of cesarcan section; selection of rapid and effective methods targeting the etiology of hemorrhage, improvement of the surgical skills and reinforcement of the postoperative treatment, etc.%目的 探讨剖宫产产后出血的原因及有效的处理方法.方法 对76例剖宫产产后出血患者的临床资料进行回顾性分析.结果 出血原因为子宫收缩乏力 48 例(占63.2%),胎盘因素 17例(占22.4%),切口撕裂8例(占10.5%),凝血功能异常3例(占3.9%).剖宫产组产后出血发生率明显高于阴道产组(3.5% vs.1.3%,P<0.01).产后出血量700~3 500 ml,出血量<1 000 ml、1 000~2 000 ml和>2 000 ml的病例分别占67.1%、26.3%和6.6%.出血量在1 000~2 000 ml发生率剖宫产组高于阴道产组(P<0.05).76例剖宫产出血病

  20. Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis

    Directory of Open Access Journals (Sweden)

    Gurol-Urganci Ipek

    2011-11-01

    Full Text Available Abstract Background Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS at first birth with women who delivered vaginally. Methods Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980. Results The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76. In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46. Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65. Conclusions There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy.

  1. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study 1

    Science.gov (United States)

    Mendes, Edilaine de Paula Batista; de Oliveira, Sonia Maria Junqueira Vasconcellos; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; da Silva, Renata Luana

    2016-01-01

    ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. PMID:27533267

  2. 剖宫产术后再次妊娠分娩方式的探讨%Investigation of the Del ivery Mode of the Re-pregnancy after Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    任喜捷

    2014-01-01

    目的:分析剖宫产术后再次妊娠的分娩方式的最好方法,探讨其对母婴结局的影响。方法:对2012年1月~2013年12月在我院2年间187例剖宫产术后再次妊娠的患者进行分析研究。结果:阴道试产分娩成功63例,试产率33.69%(63/187),试产成功率82.89%(63/76),再次剖宫产成功率66.31%(124/187)。2种分娩方式的孕妇一般情况及围生儿情况,孕妇在年龄、孕周、新生儿窒息率发生率,产褥病率方面比较差异无统计学意义(p<0.05)。结论:本次妊娠无剖宫产指征,应鼓励提倡产妇阴道分娩,并且是安全、经济的。%Objetcive:To analyze the best delivery mode of re -pregnancy and explore it 's influence on maternal and neonatal out-comes .Method:Analyze and researched187 cases of cesarean section patients of our hospital in 2012 January to 2013 December .Re-sults:There were 63 cases succeed through vaginal delivery , trial production rate was33.69%(63/187), trial produce success rate was 82.89%(63/76) and success rate of cesarean section was 66.31%(124/187).General and perinatal infants situation of two kinds of mode of delivery pregnant women, age, gestational age, neonatal asphyxia rate, puerperal infection rate had no significant difference (p<0.05).Conclusion:This pregnancy has no indications of cesarean section , we encourage pregnant women to promote vaginal delivery , it is safe and economic .

  3. Usefulness of bladder dissection in cesarean section: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mervat A. Elsersy

    2016-12-01

    Conclusions: Non dissection of the bladder peritoneum achieved short-term advantages as regards reduction of operating time, incision-delivery duration and decreased blood loss; long-term effects still to be studied. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4317-4320

  4. 自我效能和生育意愿与孕中期妇女剖宫产意愿的相关性研究%Study on the correlation between self- efficacy, fertility desire and intention of cesarean section of the women during the second trimester of pregnancy

    Institute of Scientific and Technical Information of China (English)

    纪红蕾; 杨莉敏; 杨岭岭; 叶茜; 蒋泓; 钱序

    2012-01-01

    Objective: To explore the effects of self - efficacy, fertility desire of vaginal delivery and other known factors on the intention of cesarean section of primiparous women during the second trimester of pregnancy in a certain district of Shanghai city. Methods: A total of 482 primiparous women during the second trimester of pregnancy who went to the only two childbirth hospitals in a certain district of Shanghai city to establish health cards (receiving pregnant examination for the first time) from December 2010 to May 2011 were surveyed by a questionnaire, the contents included self - efficacy, fertility desire, individual general conditions, cognition to delivery modes, delivery intention, and so on. Results; The proportion of intention of cesarean section among the primiparous women during the second trimester of pregnancy was 12. 1%. The comparison of triple - factor logistic regression model showed that self - efficacy of vaginal delivery and one - child intention were two independent factors related to the intention of cesarean section. When the score of self - efficacy of vaginal delivery increased by one, the probability of cesarean section intention increased to 1. 198 times (P <0. 01) . The cesarean section intention of pregnant women who intended to have one child was 2. 143 times more than the cesarean section intention of pregnant women who didn't intend or consider (P < 0. 05) . Besides, the pregnant women with advanced age, maternity insurance, incorrect cognition to delivery modes were more likely to have cesarean section intention. Conclusion: Health care providers should try to improve the self - efficacy of vaginal delivery among the pregnant women, it is recommended to further research the relationship between family planning policy and cesarean section intention and behavior.%目的:探讨阴道分娩自我效能、生育意愿及其他已知因素对上海市某区孕中期初产妇剖宫产意愿的影响.方法:对2010年12月~2011年5

  5. Desigualdade social nas taxas de cesariana em primíparas no Rio Grande do Sul Social inequalities in cesarean section rates in primiparae, Southern Brazil

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    Paulo Fontoura Freitas

    2005-10-01

    Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR of cesarean sections according to social conditions (maternal age and education, newborn skin color/ethnicity and macro-regions, duration of pregnancy, and number of prenatal visits. RESULTS: The overall cesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended to more than six prenatal visits. Crude and adjusted OR show that cesarean rates were negatively associated with all categories of skin color/ethnicity when compared to white newborns, particularly those of native Brazilian (ORadj=0.43; 95% CI: 0.31-0.59, and they were positively associated with higher maternal education (ORadj=3.52; 95% CI: 3.11-3.99, older age (ORadj=6.87; 95% CI: 5.90-8.00 and greater number of prenatal visits (ORadj=2.16; 95% CI: 1.99-2.35. The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region. CONCLUSIONS: High rates of cesarean section rates in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.

  6. Prova de Trabalho de Parto Após uma Cesárea Anterior The Trial of Labor After one Cesarean Section

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    Iracema de Mattos Paranhos Calderon

    2002-01-01

    one previous cesarean section and their 450 newborns. They were divided into two groups - with and without TOL. The minimum sample size was 121 pregnant mothers per group. TOL was considered as an independent variable and vaginal birth and maternal and perinatal complication frequency as dependent variables. Both univariate and multivariate analyses were performed. The comparison of observed frequencies (% was analyzed by the chi-squared test (chi² with 5% significance, and linear regression from the odds ratio (OR and confidence interval of 95% (CI95%. Results: TOL was used in 59.2% of vaginal deliveries. It was less used in women over 40 years (2.7% vs 6.7% and in those with clinical or obstetrical diseases such as arterial hypertension (7.0% and bleeding in the third trimester (0.3%. There was a higher risk for puerperal complications with cesarean deliveries (OR = 3.53, CI 95% = 1.57-7.93, independent of TOL. Perinatal mortality was dependent on neonatal weight and fetal malformations, not on TOL. Newborns from mothers not submitted to TOL were at a higher risk for developing breathing complications (OR = 1.92 CI 95% = 1.20-3.07. Conclusions: The results confirm that trial of labor after a previous cesarean section is a safe method - assisting vaginal delivery in 59.2% of births and not interfering with maternal and perinatal mortality. It is a treatment that should be stimulated.

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

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    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.

  8. Causation on Cesarean Section and Its Influencing Factors from a First Class Hospital%某三甲医院剖宫产原因及其影响因素分析

    Institute of Scientific and Technical Information of China (English)

    郭海玲

    2012-01-01

    section. Conclusion It is an effective control of the cesarean section rate to spread the knowledge of pregnancy and delivery, enhance the benefits of natural childbirth advocacy,reduce the social factors for cesarean section and strictly grasp the indications of caesarean section.

  9. The comparison between suppository diclofenac and pethidine in post-cesarean section pain relief: a randomized controlled clinical trial

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    Ziba Zahiri Soroori

    2006-12-01

    Full Text Available BACKGROUND: Narcotic drugs are usually used for postoperative pain control which could cause several complications such as respiratory depression and apnea. Therefore, replacement of these drugs with safer analgesics is recommended. The aim of this study was to compare the analgesic effects of suppository diclofenac and pethidine in post-cesarean section (C/S patients. METHODS: In this clinical trial, pregnant women who were admitted to Alzahrah Hospital, Isfahan, Iran, between August and February 2004 and met the inclusion criteria were recruited. After obtaining informed consent, the patients were randomly assigned (block randomization to two groups. In group A, 100 mg rectal suppository diclofenac was used after operation at four time points: at the end of operation and 8, 16 and 24 hours after the operation. Group B received pethidine 1 mg/kg intramuscularly at similar time points. The pain scores were assessed at 2, 10, 18 and 26 hours after C/S using the Visual Analogue Scale (VAS. Age, gestational age, parity, history of previous abortion, C/S and abdominal surgery, level of education, pain score, side effects and satisfaction level were assessed. Analysis was carried out with ANCOVA model and χ2 Mantel Haenszel tests by SPSS.10 software. P<0.05 was considered significant. RESULTS: Two hundred forty patients met inclusion criteria. Age, parity, history of previous abortion, history of previous C/S and abdominal surgery, level of education and satisfaction level were similar in the two groups (P>0.05. There was no significant difference between side effects in the two groups except for dizziness in 11 cases in group B. There were significant statistical difference between pain intensity in 10, 18 and 26 hours after C/S in group A and group B (2.05 ± 2.07, 1.4 ± 1.6 and 0.5 ± 1.1 vs. 2.6 ± 2.2, 2.3 ± 2.2 and 1.3 ± 1.9 respectively. CONCLUSIONS: The results of the present study showed that the use of suppository diclofenac is an

  10. Fatores prognósticos para o parto transvaginal em pacientes com cesárea anterior Prognostic factors for vaginal delivery after cesarian section

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    Luiz Carlos Santos

    1998-07-01

    prognostic factors for vaginal delivery in pregnant women after previous cesarean section admitted to CAM-IMIP in labor.Patients and Methods: a case-control study was performed, analyzing all deliveries of patients with previous cesarean section admitted to CAM-IMIP between January 1991 and December 1994. Patients who had a cesarean section (n=156 were considered cases while patients with a vaginal birth were the controls (n=338. Inclusion criteria were: gestational age > 36 weeks, previous cesarean section at least 1 year before, alive fetus, spontaneous labor and vertex presentation. Patients with high-risk pregnancies, acute fetal distress and a previous vaginal delivery after cesarean section were excluded. Statistical analysis was performed with in Epi-Info 6.0 and Epi-Soft, using c² test, Fisher's exact test and Student's "t" test. Odds ratio and its 95% confidence interval was calculated and multiple logistic regression analysis was performed for the control of confounding factors. Results: overall rate of cesarean section was 31.6%. Maternal factors significantly associated with vaginal delivery were age 35 years (OR = 0.54, 95% CI = 0.36-0.82, history of vaginal delivery (OR = 1.6, 95% CI = 1.01-2.55 and complications of pregnancy as indication for previous cesarean section (OR = 3.67, 95% CI =1.19-12.02. A significant association with vaginal delivery could not be detected for other variables: interval between previous cesarean section and present delivery, other indications for cesarean section and type of uterine suture. In a multiple logistic regression model the variables that remained associated with vaginal delivery were maternal age and previous vaginal delivery. Conclusions: maternal age below 20 years, previous cesarean section indicated due to gestational complications and previous vaginal delivery were favorably associated with vaginal delivery in patients with prior cesarean section. Risk of repeated cesarean section is increased in pregnant women aged

  11. 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

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    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.

  12. 剖宫产术中胎盘附着面注射缩宫素的疗效研究%The Clinical Research of the Oxytocin Intramuscular Injection at the Placenta Attachment Surface During Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    陈圣莲; 王敏; 石恒; 黄桂珍

    2014-01-01

    Objective:To evaluate the effect of the oxytocin intramuscular injection at the placenta attachment surface during cesarean section. Method:Randomly controlled clinical trial was adopted which contained 110 cases performed cesarean section.All the cases were injected oxytocin 10 U by intravenous route after the delivery of the baby.The observation group (55 cases) were performed oxytocin 10 U intramuscular injection at the placenta attachment surface,while the control group (55 cases) were injected oxytocin 10 U at the uterine wall but not at the placenta attachment site.The other procedures were the same as the observation group.The time from the baby delivery to the close of the uterine incision(T1),the blood loss during this period(V1),the time from the end up of oxytocin injection at the uterine wall to the placenta delivery(T2),and the postoperative blood loss within 24 hours(V2) were recorded.The data of the test was analyzed with the software SPSS 18.0.Result:The observation group VS the control group:the difference of T1 was no significant difference statistically(P>0.05), the difference of T2 was also no significant difference statistically(P>0.05),the difference of blood loss was statistically significant(P0.05);在V1、V2上差异有统计学意义(P<0.05),观察组优于对照组。结论:剖宫产术中在静脉应用缩宫素的基础上,于胎盘子宫附着面注射缩宫素可减少术中出血及术后出血量。

  13. The Clinical Efficacy and Safety of Acepromazine and Propofol Anesthesia for the Cesarean Section in the Cat

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    Mohammad O. Kalim

    2012-08-01

    Full Text Available A 3-year-old crossbred cat was presented at the clinics. History revealed that the cat had sustained frequent straining for the last 12 hrs. One kitten was found stuck in the birth canal. The cat was premedicated with atropine sulphate @ 0.04 mg/kg b.wt and tranquilized with acepromazine maleate @ 0.1mg/kg b.wt. I/M, and anesthetized with propofol @ 4 mg/kg b.wt. I/V. via the cephalic vein. The abdominal region was aseptically prepared from the umbilicus to the pubis region. A ventral mid line incision of approximately 3.5 cm was made in linea alba between the umbilicus and pubis, caudally. The gravid uterus was exposed through the surgical wound. A longitudinal incision was placed on the uterine body and kittens were taken out slowly one by one. One of the kittens, which was stuck in the vaginal orifice, was taken out slowly by gently manipulating its presentation. A total of four kittens were born. The use of acepromazine and propofol anesthesia for the cesarean section in the cat proved to be an easy and excellent method without any complications. [Arch Clin Exp Surg 2012; 1(4.000: 258-260

  14. 2nd Antibiotic Halves C-Section Infection Rate

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_161230.html 2nd Antibiotic Halves C-Section Infection Rate: Study Two medications ... 29, 2016 (HealthDay News) -- Doctors routinely give an antibiotic before a cesarean-section, the surgical delivery of ...

  15. Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia--a decision analysis.

    Science.gov (United States)

    Culligan, Patrick J; Myers, John A; Goldberg, Roger P; Blackwell, Linda; Gohmann, Stephan F; Abell, Troy D

    2005-01-01

    Our aim was to determine the cost-effectiveness of a policy of elective C-section for macrosomic infants to prevent maternal anal incontinence, urinary incontinence, and newborn brachial plexus injuries. We used a decision analytic model to compare the standard of care with a policy whereby all primigravid patients in the United States would undergo an ultrasound at 39 weeks gestation, followed by an elective C-section for any fetus estimated at > or =4500 g. The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section.

  16. 剖宫产术后产后出血的原因分析及护理%Cause analysis and nursing of postpartum hemorrhage after cesarean section

    Institute of Scientific and Technical Information of China (English)

    秦宗玉

    2015-01-01

    ObjectiveTo investigate cause and nursing measures of postpartum hemorrhage after cesarean section.MethodsAnalysis and summarization were made on hemorrhage causes of 70 patients with postpartum hemorrhage after cesarean section.ResultsAmong the 70 patients with postpartum hemorrhage after cesarean section, there were 66 cases with uterine inertia (94.3%), 3 cases with placental factors (4.3%) and 1 case with coagulation disorders (1.4%). All the cases left the hospital without any death or hysterectomy cases after receiving timely rescue and detailed nursing.ConclusionIncidence of complications and mortality rate of postpartum hemorrhage after cesarean section can be reduced by good prenatal education, effective prevention of postpartum hemorrhage, close monitoring of disease, and timely health education.%目的:探讨剖宫产术后产后出血的原因及护理对策。方法70例剖宫产术后产后出血患者,对其出血的原因进行分析和总结。结果70例剖宫产产后出血患者,宫缩乏力66例(94.3%)、胎盘因素3例(4.3%)、凝血功能障碍1例(1.4%)。经过及时抢救和精心护理,无一例发生死亡或切除子宫,均痊愈出院。结论做好产前教育,对产后出血进行有效预防,密切观察病情变化,及时进行健康教育,可以降低剖宫产术后产后出血并发症发生率及死亡率。

  17. Clinical analysis of 13 cases of cesarean scar pregnancy after cesarean section%剖宫产术后瘢痕妊娠13例临床分析

    Institute of Scientific and Technical Information of China (English)

    王娟

    2014-01-01

    Objective To clinically analyze 13 cases of cesarean scar pregnancy after cesarean section. Methods Type-B ultrasound, tests of biochemical indices and other technologies were applied to analyze the clinical characteristics, early diagnosis, treatment method and prognosis of 13 patients of Cesarean scar pregnancy. Results All 13 patients had a history of Cesarean section and post-menopausal vaginal bleeding; the diagnosis, based on vaginal color Doppler ultrasound, showed the possibility of Cesarean scar pregnancy; 8 patients received a conservative treatment of methotrexate plus mifepristone plus uterus cleaning. 4 patients received resection of scar lesions in lower uterine segment plus uterus repair (2 trans-vaginal, 2 trans-abdominal). 1 patient had hemorrhea after uterus cleaning in another hospital and received subtotal hysterectomy in the emergency clinic. Conclusion Early application of B-type ultrasound helps confirm the diagnosis of cesarean scar pregnancy, determine the treatment method and effectively reduce the risk of hemorrhea, which has a positive clinical significance;trans-vaginal resection of scar lesions in lower uterine segment plus uterus repair has advantages of smaller amount of bleeding, minor injuries, shorter hospitalization and faster decrease of bloodβ-HCG, which is a preferred method for the disease.%目的:探讨13例剖宫术后瘢痕妊娠临床分析。方法采用B超检查及各项生化指标检查的方法或技术手段来分析13例剖宫术后瘢痕妊娠患者的临床特点,早期诊断,治疗方法及预后。结果13例患者均有剖宫术史及停经后阴道流血史;诊断依据经阴道彩超提示剖宫产瘢痕部位妊娠可能;8例行甲氨蝶呤+米非司酮+清宫保守治疗,4例子宫下段瘢痕病灶切除子宫修补术(2例行经阴道,2例经腹部),1例外院清宫术后大出血,急诊行次全子宫切除术。结论剖宫术后瘢痕妊娠早期运用B超检查能明确诊断

  18. Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

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    Katrine Fuglsang

    2012-01-01

    Full Text Available Background. Application of hemostatic fleece (TachoSil directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa. Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing. Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects. Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.