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Sample records for cesarean section scar

  1. 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.

  2. The cosmetic outcome of the scar formation after cesarean section

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Möller-Christensen, T; Steele, R E

    1994-01-01

    to significantly narrower scars compared with percutaneous closure, 4.5 versus 11.1. Thus, even better results can be expected as experience with the technique increases. Observer and patient satisfaction with the cosmetic outcome were measured independently on a 'Lasa-line'. Their opinions coincided; the order...

  3. 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 ...

  4. Cesarean Scar Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Z Vahedpoor

    2015-07-01

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

  5. Cesarean scar pregnancy

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Rare complications of cesarean scar

    Directory of Open Access Journals (Sweden)

    Divyesh Mahajan

    2013-01-01

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

  8. 阴式子宫下段加固术治疗剖宫产瘢痕妊娠%Vaginal Reinforcement of Cesarean Section Scar for Cesarean Scar Pregnancy

    Institute of Scientific and Technical Information of China (English)

    李环; 杨将; 杜辉; 胡艳; 魏蔚霞; 吴瑞芳

    2016-01-01

    目的:探讨阴式子宫下段加固术治疗剖宫产瘢痕妊娠( cesarean scar pregnancy , CSP )的临床效果。方法2014年12月~2015年6月采用阴式子宫下段加固术治疗20例CSP,打开膀胱宫颈间隙,暴露子宫下段薄弱部位,避开膀胱后行B超引导下清宫术,B超引导及扩宫棒、手指引导下,加固缝合子宫下段薄弱部位。结果所有手术均顺利完成,手术时间30~120 min,(53.4±26.0)min;术中出血量中位数50 ml(20~400 ml);术后住院时间2~18 d,平均4.6 d;术后监测血hCG降至正常时间中位数46 d(4~90 d)。结论阴式子宫下段加固术治疗CSP具有操作简便、创伤小、增加子宫肌层厚度等优点。%Objective To investigate the clinical effect of vaginal reinforcement of cesarean section scar in the treatment of cesarean scar pregnancy (CSP). Methods Twenty female patients with CSP from December 2014 to June 2015 were recruited.All the patients were treated with vaginal reinforcement of cesarean section scar .The vesicocervical space was opened to expose the thin part of the scar .Dilation and curettage was carried out under surveillance of sonography after drawing back the bladder .The low thin part of the uterine was reinforced under the guidance of cervical dilator , finger and sonography . Results All the surgical procedures were successfully performed.The duration of surgery was 30-120 min (53.4 ±26.0 min).The median of intraoperative hemorrhage was 50 ml (20-400 ml).The length of hospital stay was 2-18 d (4.6 ±3.3 d).The median time of serum hCG dropped to normal was 46 d (4-90 d). Conclusions Vaginal reinforcement of cesarean section scar has privileges for treating CSP , especially for patients with extensive thin part of scar .The procedure is characterized by easy performance , minimal invasion , and increasing the muscular sickness of scar .

  9. 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.

  10. Endometriosis In Cesarean Scar: A Case Report

    Directory of Open Access Journals (Sweden)

    Nejat Özgül

    2013-11-01

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

  11. Delivery by Cesarean Section

    Science.gov (United States)

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

  12. 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.

  13. Expectant management of heterotopic cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  14. Interobserver variation in measurements of Cesarean scar defect and myometrium with 3D ultrasonography

    DEFF Research Database (Denmark)

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

    -16 months after their first Cesarean section with 2D transvaginal sonography and had 3D volumes recorded. Two observers independently evaluated “off-line” each of the 3D volumes stored. Residual myometrial thickness (RMT) and Cesarean scar defect depth (D) was measured in the sagittal plane with an interval...... of Cesarean section scar size and residual myometrium needs further investigation.......Objectives: To evaluate the Cesarean scar defect depth and the residual myometrial thickness with 3-dimensional (3D) sonography concerning interobserver variation. Methods: Ten women were randomly selected from a larger cohort of Cesarean scar ultrasound evaluations. All women were examined 6...

  15. Care to prevent scar uterus abdominal distension after cesarean section%预防瘢痕子宫剖宫产术后腹胀的护理

    Institute of Scientific and Technical Information of China (English)

    李萍

    2015-01-01

    Objective Summarize nursing intervention to prevent scar uterine cesarean section abdominal distension. Methods 245 cases of uterine cesarean section scar patients were divided into control group and experimental group to implement the nursing intervention. Results Incidence of abdominal distension, anal exhaust time, discharge time, complication rates is better than that in control group. Conclusions Scar uterine cesarean section to take comprehensive measures to reduce abdominal distention, reduce maternal discomfort, shorten hospitalization time.%目的:总结预防瘢痕子宫剖宫产术腹胀的护理干预。方法:对245例瘢痕子宫剖宫产术后患者分为对照组和实验组实施护理干预。结果:实验组腹胀发生率、肛门排气时间、出院时间、并发症发生率方面优于对照组。结论:瘢痕子宫剖宫产术后采取一些综合措施可减少腹胀发生,减轻产妇不适,缩短住院时间。

  16. Cesarean scar pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Mehmet Sıddık Evsen

    2011-12-01

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

  17. Cesarean scar pregnancy:a case report

    Institute of Scientific and Technical Information of China (English)

    李胜平; 汪溦; 唐小丽; 王瑛

    2004-01-01

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

  18. Incision cesarean section scar pregnancy version of the intervention of nursing%剖宫产切口瘢痕妊娠介入治疗的护理

    Institute of Scientific and Technical Information of China (English)

    葛忠玲

    2012-01-01

      Objective:To expcore incision cesarean section scar pregnancy intervention treatment nuring key points. Methods:Summarize 10 cases of cesarean section scar pregnancy nursing intervention treatment,before the number of tiems must then,patient decubitus choice|. disease observation,the postoperative complications prevention.Results:10 cases in cision cesaren section scar pregnancy after uterine artery embocism after treatment,aii one-time success,after the qing dynasty palace without a massive haemorrhage.Conclusion:After uterive qrtery interventional therapy in cision scar pregnancy,carry of comprehensive care,than traditional conservative treatment offect is good,the risk small,can effectively control hemorrhage,shorten hospitalization time,to qvoid the relevant risk factors%  目的:探讨剖宫产切口瘢痕妊娠介入治疗的护理要点。方法:总结10例剖宫产瘢痕妊娠的护理,术前物品准备,术中患者卧位选择、病情观察。术后并发症预防结果:10例剖宫产切口瘢痕妊娠经子宫动脉栓塞治疗后,均一次性成功,术后清宫无一例大出血。结论:经子宫动脉介入治疗瘢痕妊娠,进行护理干预比传统保守治疗效果好,风险小,能有效控制出血,缩短了住院时间,避免了相关危险因素。

  19. 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

  20. 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.

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

    Institute of Scientific and Technical Information of China (English)

    高玉华

    2011-01-01

    Objective To explore the clinical characteristics of scarred uterus with secondary cesarean section. Methods Sixty pregnant women with scarred uterus performed secondary cesarean section in the People's Hospital of Qing-chuan County from January 2009 to January 2011 were enrolled in this study. According to different surgical methods in the first cesarean section, the clinical data of 60 pregnant women were retrospectively analyzed. Results The total operation period, the mean time from the incision to fetal delivery, and intraoperative blood loss in transverse incision group were more than those in longitudinal incision group, and the difference was statistically significant between the two groups (P<0.05). There were statistically significant differences in peritoneal adhesion between the two groups (P<0.05). We compared the clinical outcomes of transverse incision group with longitudinal incision group in the secondary cesarean section, and the results showed that 29 cases were healed and 1 case had poor healing. 7 cases had placenta previa, including 4 cases of central placenta previa and 2 cases of widely implanted placenta previa, and hysterectomy was performed after the various ineffective treatments. No maternal death was found. 2 premature infants died, and the others survived. Conclusions The obstetricians should be skilled in performing secondary cesarean section among pregnant woman with scarred uterus in order to ensure operation safety. It is necessary to enhance the related propaganda, let the patients knowing about sufficient knowledge about surgical risks, and carry out trial of vaginal delivery so as to reduce the rate of secondary cesarean section.%目的 探讨瘢痕子宫二次剖宫产的临床特点.方法 选择青川县人民医院2009年1月- 2011年1月收治的行二次剖宫产的产妇60例,随机依据首次剖宫产采用的不同术式资料进行回顾性分析.结果 手术总时间及手术开始至胎儿娩出时间横切口组

  2. Analysis on 70 Cases of Scarred Uterus With Secondary Cesarean Section%瘢痕子宫二次剖宫产70例分析

    Institute of Scientific and Technical Information of China (English)

    杨帆

    2015-01-01

    目的 探讨瘢痕子宫二次剖宫产的临床特点.方法 选择我院行二次剖宫产的产妇70例,依据首次剖宫产采用的不同术式分为横切口组和纵切口组,每组患者均为35例.结果 手术总时间及手术开始至胎儿娩出时间横切口组长于纵切口组,术中出血量横切口组多于纵切口组,差异有统计学意义(P<0.05),两组在腹腔粘连方面差异有统计学意义(P<0.05).再次剖宫产横切口与纵切口比较,两组均愈合良好34例,愈合不良1例,两组产妇合并前置胎盘7例,其中中央性4例,广泛植入3例,经各种处理无效后行子宫切除术,无产妇死亡,早产儿死亡2例,余全部存活.结论 瘢痕子宫行第二次剖宫产术时,产科医生手术操作应娴熟,以保证手术安全.降低剖宫产率需加大宣传力度,使患者对手术风险有足够的认识,并充分进行试产,以使二次剖宫产率降低%Objective To explore the clinical characteristics of scarred uterus with secondary cesarean section.Methods70 pregnant women with scarred uterus performed secondary cesarean section in our hospital were enroled in this study. According to different surgical methods in the first cesarean section, the clinical data of 70 pregnant women were divided into transverse incision group(35 cases)and longitudinal incision group(35 eases).Results The total operation period,the mean time from the incision to fetal delivery,and intraoperative blood loss in transverse incision group were more than those in longitudinal incision group,and the difference was statistical significant(P<0.05). And there were statistical significant differences in peritoneal adhesion between the two groups(P<0.05). We compared the clinical outcomes of transverse incision group with longitudinal incision group in the secondary cesarean section,and the results showed that 34 cases were healed and 1 cases had poor healing,7 cases had placenta previa,and hysterectomy was performed after the

  3. 剖宫产术后疤痕处妊娠的治疗%Treatment of scar pregnancy after cesarean section

    Institute of Scientific and Technical Information of China (English)

    仲秀梅

    2015-01-01

    Objective:To explore the method and effect of treatment of scar pregnancy after cesarean section.Methods:In recent years treated40 cases after cesarean section scar pregnancy patients, all patients were taken bilateral uterine artery methotrexate infusion chemotherapy and embolization with gelfoam particles and, and curettage in 3 to 7 days after operation, intraoperative bleeding volume and scrapings send disease physical examination, uterine curettage after 1 week of transvaginal color Doppler ultrasound examination, review of serum beta hCG.Results:All40 patients were successfully treated by interventional therapy, and the vaginal bleeding after operation, the pregnancy capsule was significantly decreased, and the serum -HCG was significantly decreased. Postoperative curettage with reduced bleeding, scrapings for pathological examination showed villus tissue, have different degrees of degeneration and necrosis;color Doppler ultrasound in the diagnosis of uterine scar, no abnormal echo and blood fiow signal. Conclusion:For bilateral uterine artery methotrexate combined with embolization therapy given to patients with scar pregnancy after cesarean section, and curettage can receive good treatment effect, obviously reduces the gestational sac, effectively reduce the level of serum beta hCG; maximum control uterine bleeding, for patients to preserve the uterus, an effective method for treatment of cesarean section after caesarean scar pregnancy, it is worth in clinical application.%目的:探究剖宫产术后疤痕处妊娠治疗的方法及效果。方法选取近五年收治的40例剖宫产术后疤痕处妊娠患者,所有患者均采取双侧子宫动脉甲氨蝶呤灌注化疗及明胶海绵颗粒栓塞,并在术后3~7天进行清宫术,记录术中的出血量,并将刮出物送病理进行检查,清宫术结束后1周进行阴道彩超检查,复查血β-HCG。结果40例患者均顺利完成介入治疗,术后阴道

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

    Science.gov (United States)

    Uysal, Fatma; Uysal, Ahmet; Adam, Gürhan

    2013-07-01

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

  5. 瘢痕子宫与非瘢痕子宫二次剖宫产并发症分析%Analysis of the complications of two times cesarean section in scar uterus and non scar uterus

    Institute of Scientific and Technical Information of China (English)

    罗力冰; 吴婷

    2014-01-01

    目的 对瘢痕子宫孕妇二次剖宫产并发症发生情况进行分析,为临床医师合理掌握剖宫产指征提供依据.方法 选取160例瘢痕子宫孕妇二次剖宫产作为研究对象(研究组),另选取同期进行剖宫产手术分娩的80例非瘢痕子宫孕妇作为对照组,对两组孕妇的临床资料进行回顾性分析.结果 研究组术中出血量、手术时间、手术费用、术后出血量、子宫切除率、新生儿窒息发生分别为(432±331)mL、(64±21) min、(0.91±0.11)万元、(262±187) mL、4.4%、11.9%,对照组分别为(361±209) mL、(44±16)min、(0.63±0.0)万元、(184±132) mL、1.3%、6.3%,两组差异均有统计学意义(=2.52、8.19、26.10、4.00,x2=3.98、4.76,均P<0.05),两组周围脏器损伤情况差异无统计学意义(P>0.05).结论 瘢痕子宫孕妇二次剖宫产手术容易导致手术出血量及术后出血量增加、手术时间延长、子宫切除率增加、新生儿窒息发生率增加等并发症.对于瘢痕子宫二次妊娠孕产妇应严格掌握手术指征.%Objective To analyze the complications of pregnant secondary cesarean in scar uterus,to provide theoretical guidance for cesarean section.Methods 160 pregnant women of secondary cesarean uterine scar were chosen as the study group.80 pregnant women of non-scar uterine were chosen as the control group.Results The bleeding volume during operation,operation time,operation fee,postoperative bleeding,uterine resection rate,neonatal asphyxia in study group were (432 ± 331) mL,(64 ± 21) min,(0.91 ± 0.11) million,(262 ± 187) mL,4.4%,11.9%,which in the control group were (361 ± 209) mL,(44 ± 16) min,(0.63 ± 0) million,(184 ± 132) mL,1.3%,6.3% respectively,the differences were significant (t =2.52,8.19,26.10,4,4.76,x2 =3.98,all P < 0.05).The two groups had no statistically significant difference in organ damage situation (P > 0.05).Conclusion Secondary cesarean uterine scar easily lead to maternal

  6. Successful pregnancy after excision of cesarean scar endometriosis with uterovesicocutaneous fistula: A rare case report

    Science.gov (United States)

    Juneja, Sunil Kumar; Tandon, Pooja; Chopra, Isha

    2016-01-01

    Scar endometriosis is an infrequent type of extrapelvic endometriosis. The most common extrapelvic form of endometriosis is cutaneous endometriosis, involving scar tissues occurring after obstetric or gynecologic procedures such as episiotomy, hysterotomy, cesarean section, and even laparoscopic surgery. The clinical presentation of scar endometriosis, i.e., tender swellings, mimics other dermatological and/or surgical conditions and delays the diagnosis. Scar endometriosis very rarely can get complicated with uterocutaneous fistula with a reported incidence of very few cases in world literature. We report a case of a 36-year-old woman presenting with scar endometriosis with complicated uterocutaneous fistula 11 years after her last lower segment cesarean section, managed successfully with laparotomy-fistulectomy and sleeve resection of the bladder with repair followed by successful subsequent spontaneous conception and pregnancy terminated by lower segment cesarean section. PMID:27857904

  7. Pheochromocytoma after Cesarean Section

    Science.gov (United States)

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

    2016-01-01

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

  8. Pheochromocytoma after cesarean section

    Directory of Open Access Journals (Sweden)

    Elham Naghshineh

    2016-01-01

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

  9. 瘢痕子宫再次剖宫产手术方式对盆腹腔粘连的影响分析%Analysis of the influence of second cesarean section operation in scar uterus for peritoneal adhesion

    Institute of Scientific and Technical Information of China (English)

    赵琦

    2015-01-01

    目的:探讨瘢痕子宫再次剖宫产手术方式对盆腹腔粘连的影响。方法:收治瘢痕子宫再次妊娠产妇60例,随机分成子宫下段剖宫产术组和斯塔克(Stark)剖宫产术组。结果:子宫下段剖宫产术组Ⅰ类盆腔粘连4例(13.3%),Ⅱ类盆腔粘连19例(63.3%),Ⅲ类盆腔粘连6例(20.0%),Ⅳ类盆腔粘连1例(3.3%)。Stark剖宫产术组Ⅰ类盆腔粘连1例(3.3%),Ⅱ类盆腔粘连17例(56.7%),Ⅲ类盆腔粘连10例(33.3%),Ⅳ类盆腔粘连2例(6.7%)。两组Ⅰ类盆腔粘连和Ⅲ类盆腔粘连比较差异有统计学意义(P<0.05),Ⅱ类和Ⅳ类盆腔粘连比较差异无统计学意义(P>0.05)。结论:下段剖宫产术对瘢痕子宫再次剖宫产导致的盆腹腔粘连程度低于Stark剖宫产术,下段剖宫产术是瘢痕子宫再次剖宫产的首选方法。%Objective:To explore the influence of second cesarean section operation in scar uterus for peritoneal adhesion. Methods:60 cases of re pregnant women with scar uterus were selected.They were randomly divided into the low cesarean section group and stark(Stark) cesarean section group.Results:In the low cesarean section group,4 cases(13.3% ) were Ⅰ type pelvic adhesions,19 cases(63.3%) were Ⅱ type pelvic adhesions,6 cases(20.0%) were Ⅲ type pelvic adhesion,1 case(3.3%) was Ⅳ type pelvic adhesions.In the stark cesarean section group,1 cases(3.3%) was Ⅰ type pelvic adhesions,17 cases(56.7%) were Ⅱ type pelvic adhesions,10 cases(33.3%) were Ⅲ type pelvic adhesion,2 cases(6.7%) were Ⅳ type pelvic adhesions.There was statistical significance in Ⅰ type pelvic adhesions and Ⅲ type pelvic adhesions of the two groups(P0.05).Conclusion:Abdominal adhesion degree caused by second cesarean section operation in scar uterus was lower than that of stark cesarean section.The low cesarean section was the preferred method for second cesarean section operation in scar uterus.

  10. 剖宫产术子宫瘢痕妊娠的超声图像特征分析%Analysis of ultrasonographic imaging features of cesarean section scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    杨必健; 李灿

    2009-01-01

    目的 探讨经阴道彩色多普勒超声在剖宫产子宫瘢痕妊娠诊断中的价值.方法 采用经阴道彩超,对29例剖宫产术后子宫下段瘢痕妊娠患者进行检查,观察妊娠物着床的位置及与剖宫产切口的关系、子宫切口部位的回声、血流情况.结果 所有患者在子宫下段切口部位可见胚囊或混合回声包块,根据超声像图特征把它们分为2种类型:(1)胚囊型20例;(2)混合回声包块型9例.结论 经阴道彩超检查对剖宫产术后子宫瘢痕妊娠的诊断有着重要的价值.%Objecteve To explore the value of transvagina1 color Doppler ultrasound in the diagnosis of cesarean section scar pregnancy.Methods Twenty-nine cases in regnaney with cesarean section scar underwent transvaginal color Doppier ultrasound.The relationship of the nidation location of gestational cyst and U-D,the echo of uterine isthmus os and splendid color Doppler flow signals were observed.Results A gestational cyst or mixed echo mass attached to the scar.There were two types as follow:mbryo-sac type(20 cases),mixed echo mass type(9 cases).conclusions Transvaginal color Doppler ultrasound is highly valuable in the diagnosis of pregnancy into the cesarean section scar.

  11. Vaginal birth after cesarean section

    Directory of Open Access Journals (Sweden)

    Vidyadhar B Bangal

    2013-01-01

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

  12. Cesarean Section: MedlinePlus Health Topic

    Science.gov (United States)

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

  13. Clinical analysis on 15 cases with scar pregnancy after cesarean section%剖宫产子宫瘢痕部位妊娠52例临床分析

    Institute of Scientific and Technical Information of China (English)

    侯玉兰; 郭端英; 范毅

    2011-01-01

    目的:探讨剖宫产子宫瘢痕部位妊娠(CSP)的早期诊断方法及评估子宫动脉灌注栓塞术用于治疗CSP的临床疗效.方法:回顾性分析2004年1月~2009年12月收治的52例CSP病例的临床表现、超声检查及治疗效果.结果:45例经彩超检查提示瘢痕妊娠,33例行子宫动脉灌注栓寒术,6例因β-hCG水平较低采用MTX治疗,5例因瘢痕部位破裂行病灶切除及子宫修补术,5例因瘢痕部位包块较大行开腹手术治疗,3例经腹腔镜探查明确诊断及手术治疗.术后监测血β-hCG于2~5周均降至正常水平.结论:彩色多普勒超声检查可用丁早期诊断CSP,子宫动脉灌注栓塞术具有微创、止血迅速、病灶萎缩快等优点,对于CSP是一种安全有效的治疗方法.%Objective: To explore the method of early diagnosis of scar pregnancy after cesarean section, evaluate the clinical efficacy of uterine arterial perfusion and embolization in treatment of scar pregnancy after cesarean section. Methods: The clinical manifestations, ultrasonic examination and clinical efficacy of 52 cases with scar pregnancy after cesarean section who were treated in the hospital from January 2004 to December 2009 were analyzed retrospectively. Results: 45 cases were diagnosed as scar pregnancy after cesarean section by color Doppler ultrasonography, 33 cases received uterine arterial perfusion and enbolization, 6 cases were treated with MTX because of low level of β - hCG, 5 cases received focal lesion excision and uterine repair because of rupture, 5 cases received laparotomy because of scar large mass, 3 cases were diagnosed definitely by laparoscopy, and operation was performed; 'after operation, serum β - hCG decreased to normal level. Conclusion: Color Doppler ultrasonography can be used for early diagnosis of scar pregnancy after cesarean section, uterine arterial perfusion and embolization has the advantages of minimal invasion, quickly to stop bleeding, fast atrophy of

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

    Science.gov (United States)

    Fylstra, Donald L

    2014-03-01

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

  15. [Cesarean section and eye disorders].

    Science.gov (United States)

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

    2016-01-01

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

  16. Expectant management of cesarean scar pregnancy: a case report and a review of literature

    Institute of Scientific and Technical Information of China (English)

    Liu Hai-Yuan; Shi Hong-hui; Liu Zhu-Feng; Leng Jin-hua; Lang Jing-he

    2012-01-01

    Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy.Little is known about its natural history and optimal management.All literatures except one reported that the expectant treatments for such patients were unsuccessful or led to complication.This paper presents one case of cesarean scar pregnancy (CSP)with expectant management,and discusses the value of this expectant management.The paper also appears a glimpse of the natural courses of certain cesarean scar pregnancies.A 32-year-old woman with a history of cesarean section presented to our outpatient clinic with amenorrhea and bleeding.Sonography and magnetic resonance imaging (MRI) revealed the diagnosis of CSP without viable gestation sac.The patient opted for expectant treatment.We closely monitored the patient with a detailed plan.The patient had mild bleeding during monitoring and her serum β-hCG levels dropped quickly to normal range after seven weeks.She was fully recovered with total absorption of the mixed mass in the scar of the anterior wall of uterus.If patient with CSP has no viable gestation sac and serum β-hCG levels are rapidly decreased,she can be expectantly treated.Such cesarean scar pregnancies may be naturally demised.Patient with CSP should be followed up strictly.Medical or surgical therapy should be considered prior to rupture to remove the gestational sac and retain the patient future fertility.

  17. Treatment and prevention of poor wound healing of scar incision cesarean section again%瘢痕切口再次剖宫产术切口愈合不良的处理及防范

    Institute of Scientific and Technical Information of China (English)

    陶芳; 骆骏

    2014-01-01

    目的:探讨瘢痕切口再次剖宫产术,术后发生切口愈合不良的处理及防范措施。方法:收治瘢痕切口再次剖宫产术发生切口愈合不良患者12例。切口愈合不良分为切口感染和切口脂肪液化两种,根据渗液的多少采取不同的处理方法。结果:仅3例经换药后,渗液减少后进行了Ⅱ期缝合,其他9例均经换药后,达到Ⅰ期愈合,收效良好。结论:加强防范,积极处理,尽量减少瘢痕切口再次手术后切口愈合不良的发生,以促进切口的早期愈合。%Objective:To investigate the treatment and prevention of poor wound healing of scar incision cesarean section again. Methods:12 patients with poor wound healing of scar incision cesarean section again were selected.The poor wound healing was divided into two kinds of incision infection and incision fat liquefaction,we took a different approach according to how much fluid. Results:Only 3 cases were given Ⅱ period suture when the drainage decrease after dressing change,the other 9 cases achieve Ⅰperiod healing after dressing change,with good results.Conclusion:If we want to promote the early healing of incision,we must strengthen the prevention,active treatment,and minimize to occur poor wound healing of scar incision cesarean section again.

  18. 剖宫产术后子宫疤痕处妊娠29例超声诊断%Ultrasound Diagnosis of 29 Patients with Cesarean Section Scar Pregnancy

    Institute of Scientific and Technical Information of China (English)

    成宇璐; 韦德湛; 陈勇霞

    2012-01-01

      Objective: To explore the value of ultrsound in the diagnosis and follow-up of cesarean section scar pregnancy. Method: The clinical data of 29 patients with cesarean section scar pregnancy were retrospectively analyzed from Jul 2006 to Jul 2011. Results: Among the 29 cases, ultrasound detected gestational sac type in 18 cases and 1 was misdiagnosed as normal intrauterine gestational sac, mass type in 10 cases and 2 were cases misdiagnosed as incomplete abortion, rupture type in 1 case. Conclusion: Ultrasound diagnosis of cesarean section scar pregnancy is a simple and safe method, and reliable findings are obtained.%  目的:探讨超声在剖宫产术后子宫瘢痕处妊娠的诊断与随访中的临床应用价值。方法:回顾性分析2006年7月至2011年7月诊断的剖宫产术后子宫瘢痕妊娠患者29例的临床资料。结果:29例中,超声检出妊娠囊型18例(1例误诊为正常宫内孕囊),包块型10例(2例误诊为不全流产),破裂型l例。结论:超声对剖宫产术后子宫瘢痕妊娠的诊断简便安全,结果可靠。

  19. 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。

  20. 彩色多普勒超声在切口妊娠诊断和治疗中的应用%Value of color Doppler ultrasound in diagnosis and treatment of cesarean section scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    屠菊红

    2013-01-01

    Objective To investigate the value of color Doppler ultrasound in the diagnosis and treatment of cesarean section scar pregnancy. Methods The imaging feature and clinical history of 40 patients with cesarean section scar pregnancy were retrospectively analyzed, and the ultrasound characteristics of cesarean section scar pregnancy were investigated. Results Gestational sac type and mixed mass type were divided based on the sonograms. Non-hemorrhage type, little hemorrhage type, massive hemorrhage type and post-abortion type were classified according to the symptoms. Different types had different ultrasonographic features, and were treated by different clinical treatment schemes. Conclusion Color Doppler ultrasound can accurately diagnose cesarean section scar pregnancy and may have significant value in guiding the treatment.%目的 探讨彩色多普勒超声在切口妊娠诊断和治疗中的应用价值.方法 回顾性分析40例切口妊娠患者的影像学和病史资料,分析子宫切口妊娠的声像图特征.结果 根据声像图病例分为孕囊型26例和不均质肿块型14例;根据症状病例分为无出血型10例,少量出血型17例,大量出血型5例,流产后出血型8例,发现不同症状类型的患者具有不同的超声图像特点,根据患者停经时间和孕囊体积采取不同的临床处理方案.39例患者在超声引导下行清宫术成功;1例患者因肿块较大,清宫术后又行全子宫切除术.结论 彩色多普勒超声可准确诊断切口妊娠,对临床治疗有重要的指导意义.

  1. Evolution & the Cesarean Section Rate

    Science.gov (United States)

    Walsh, Joseph A.

    2008-01-01

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

  2. 瘢痕子宫产妇剖宫产术出血量分析%Analysis of clinical data of blood loss during and after cesarean section in women with scarred uterus

    Institute of Scientific and Technical Information of China (English)

    王桂青; 夏敏; 徐爱群

    2009-01-01

    Objective To explore the clinic value of blood loss during and after cesarean section in women with scarred uterus. Methods From July 2007 to December 2008, thirty-six women with scarred uterus received weighing methods to evaluate the actual blood loss during and after cesarean section in Yuhuangding hospital, while 98 cases without pregnant complications were chosen as control. Results In women with scarred uterus, the blood loss during operation Was (372.4 ± 180.0) ml, and the total amount after 2 hours and 24 hours were (444.7± 228.2) ml and (527.4 ±251.6) ml respectively, which were higher than corresponding values in control group (P 0. 05). Conclusions Scarred uterus may be one of the important reasons which lead to postpartum hemorrhage. The clinical treatment of pregnant women with scarred uterus should focus on the prevention of blood loss during the cesarean section.%目的 观察剖宫产术的瘢痕子宫产妇术中、术后出血量的变化.方法 对36例剖宫产分娩的瘢痕子宫产妇,采用称重法精确测量术中、术后出血量,同期选取98例剖宫产分娩的正常产妇作为对照.结果 瘢痕子宫组术中出血量为(372.4±180.0)ml,术后2 h内总出血量为(444.7±228.2)ml,术后24 h内总出血量为(527.4±251.6)ml,均高于对照组(P0.05).结论 瘢痕子宫是导致剖宫产产后出血增加的重要原因,临床处理需加强剖宫产术中失血的防治.

  3. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.

    Science.gov (United States)

    Tower, Amanda M; Frishman, Gary N

    2013-01-01

    The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation.

  4. DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  5. 瘢痕子宫再次剖宫产术后出血因素临床分析%Clinical analysis of postoperative bleeding after cesarean section in scar uterus

    Institute of Scientific and Technical Information of China (English)

    牛萍

    2015-01-01

    目的:探讨瘢痕子宫再次剖宫产术后出血的临床因素,并拟定预防对策。方法:收治瘢痕子宫行再次剖宫产术的产妇864例,其中发生产后出血39例,按照出血原因分为胎盘因素组8例,宫缩乏力组21例,切口裂开组9例。结果:比较剖宫术中出血量,上述3组组间差异有统计学意义(P<0.05)。针对宫缩乏力组和切开裂开组,比较其术中出血量,组间差异有统计学意义(P<0.05)。结论:瘢痕子宫再次剖宫产大多数是因为胎盘因素导致的产后出血,也是产后出血的重要危险因素,因此,需要及时给予处理预防。%Objective:To explore the clinical factors of postoperative bleeding after cesarean section in scar uterus,and to develop preventive measures.Methods:864 pregnant women with cesarean section in scar uterus were selected,and 39 cases had postoperative bleeding.According to the causes of hemorrhage,they were divided into the placenta factor group with 8 cases, uterine inertia group with 21 cases,dehiscence of incision group with 9 cases.Results:We compared the amount of bleeding in cesarean section,and the difference among the 3 groups was significant(P<0.05).For uterine inertia group and dehiscence of incision group,we compared the amount of bleeding in operation,the difference was significant(P<0.05).Conclusion:Most postpartum hemorrhage of cesarean section in scar uterus were caused by placental factors.It was also an important risk factor for postpartum hemorrhage,therefore it need to be treated and prevented in time.

  6. 剖宫产术后瘢痕处妊娠的高危因素探讨%Study on high risk factors of pregnancy at the scar after cesarean section

    Institute of Scientific and Technical Information of China (English)

    刘小媚; 袁秀英; 刘燕燕

    2014-01-01

    目的:探讨剖宫产术后瘢痕处妊娠的高危因素,提高诊断水平。方法剖宫产手术史且合并瘢痕处妊娠的患者34例纳入瘢痕妊娠组,同期在我院接受剖宫产手术但未合并瘢痕处妊娠的产妇34例,纳入对照组。比较两组的手术指征、人工流产次数、手术医院级别等。结果两组的产程延长例次、胎儿宫内窘迫例次、产科合并症例次、剖宫产次数及反复宫腔操作例次比较,差异均有统计学意义。两组接受最近一次剖宫产手术的医院级别、人工流产平均次数比较,差异有统计学意义。 Logistic回归分析结果显示,产程延长、胎儿窘迫、产科合并症、反复宫腔操作、剖宫产2次以上均是影响瘢痕处妊娠的高危因素。结论产程延长、胎儿窘迫、产科合并症、剖宫产次数、反复宫腔操作均是影响瘢痕处妊娠的高危因素。%Objective To explore the high risk factors of pregnancy at the scar after cesarean section ,and improve the diagnostic level. Methods A total of 34 patients of cesarean section operation with scar pregnancy were arranged in scar pregnancy group,in the same period,34 patients who received cesarean operation but not with scar pregnancy were arranged in the control group. Results The production process extension number,fetal distress number,obstetric com-plications number,fetal breech number,repeated uterine cavity operation number ,comparison difference had statistics significance. Recent cesarean operation of hospital level , the average number of artificial abortion of two groups had statistical significance differences. The results of logistic regression analysis display, prolonged labor, fetal distress, obstetric complications, recurrentuterine cavity operation, cesarean section 2 above are all risk factors influencing the scar pregnancy. Conclusion Prolonged labor, fetal distress, obstetric complications, breech presentation,recurrent u

  7. Vacuum-assisted cesarean section

    Directory of Open Access Journals (Sweden)

    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

  8. Cesarean Section - Multiple Languages: MedlinePlus

    Science.gov (United States)

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

  9. Analytical study of indications of cesarean section

    Directory of Open Access Journals (Sweden)

    Janki M. Pandya

    2015-10-01

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

  10. Clinical analysis of 30 cases on cesarean section of placenta previa with scarred uterine%前置胎盘合并瘢痕子宫剖宫产30例临床分析

    Institute of Scientific and Technical Information of China (English)

    丁卫

    2011-01-01

    Objective To analyze the harm of placenta previa with scarred uterine on mother and neonate,and improve the understanding of it. Methods 108 cases with placent previa from January 2008 to May 2010 in our hospital were analyzed retrospectively, among which there were 30 cases of scarred uterine, 78 cases of non-scarred uterine. Results 108 patients were terminated pregnancy through cesarean section. The Postpartum hemorrhage in scarred uterine's group was significantly higher than the group of non-scarred uterine (P<0.05). The incidences of placenta accreta, placenta adhesion, hysterectomy were significantly higher than non-scarred uterine group(P<0.05). However the birth weight was significantly lower than non-scarred uterus group (P<0.05).Preterm, fetal distress, neonatal asphyxia, perinatal mortality were significantly higher than non-scarred uterus group (P<0.05). Conclusion Placenta previa with the scarred uterine increased significantly the maternal and perinatal complications and risk.%目的 分析前置胎盘合并瘢痕子宫对孕产妇及围生儿的危害,提高对前置胎盘合并瘢痕子宫的认识.方法回顾性分析终止妊娠的前置胎盘108例,其中既往有剖宫产史30例(瘢痕子宫组),无剖宫产史78例(非瘢痕子宫组).结果:108例均行剖官产术终止妊娠.瘢痕子宫组产后出血量大于非瘢痕子宫组,其胎盘植入、胎盘粘连、子宫切除的发生率均高于非瘢痕子宫组,差异有统计学意义(P<0.05).瘢痕子宫组新生儿体质量低于非瘢痕子宫组,其早产、胎儿窘迫、新生儿窒息、围生儿死亡均高于非瘢痕子宫组,差异有统计学意义(P<0.05).结论 前置胎盘合并瘢痕子宫明显增加孕产妇及围生儿的并发症和危险性.

  11. Clinical analysis of hysteroscopic examination and laparoscopic repair of uterine scar diverticulum after cesarean section%剖宫产后子宫瘢痕憩室宫腹腔镜治疗临床分析

    Institute of Scientific and Technical Information of China (English)

    孙启建; 尹笋

    2014-01-01

    探讨剖宫产后子宫瘢痕憩室的病因及宫腹腔镜联合手术治疗效果。方法:对2010年10月至2013年12月在我院行宫腹腔镜联合修复剖宫产后子宫瘢痕憩室的11例患者进行回顾性分析和随访。结果:7例患者剖宫产术后经期延长、淋漓不净;3例月经量增多、经间期出血;1例继发不孕。术后随访3~16月。9例症状得到改善,经期缩短为(7.3±2.2)天,有效率81.8%(9/11)。结论:宫腹腔镜联合修复子宫瘢痕憩室安全,有效,可以明显改善患者的症状。%objective to investigate the cause of uterine cesarean section scar diverticulum and palace laparoscopy combined therapeutic effect. Methods in October 2010 to December 2013 in our hospital xanadu joint laparoscopic repair of uterine cesarean section scar diverticulum in 11 patients were retrospectively analyzed and follow-up. Results 7 cases of patients with cesarean section menstrual extension, dripping wet is not clear; 3 cases of menstrual quantity increased, the interphase bleeding; 1 case of secondary infertility. Followed up for 3 ~ 16 months after surgery. 9 cases symptoms improved and period shorten is (7.3 + 2.2) days, the effective rate was 81.8% (9/11). Conclusion palace joint laparoscopic repair of uterine scar diverticulum safe, effective, can obviously improve the symptoms of patients.

  12. Surgical Management of the Cesarean Scar Ectopic Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Anisodowleh Nankali

    2013-01-01

    Full Text Available Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. The diagnosis and treatment of cesarean scar pregnancy (CSP is challenging. The authors reported here a case of cesarean scar pregnancy (CSP with hypovolemic shock that underwent emergency laparotomy with resection of ectopic mass. The patient was discharged from the hospital without any complications.

  13. 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.

  14. 子宫瘢痕憩室致异常子宫出血156例临床分析%Clinical analysis of 156 abnormal uterine bleeding cases due to cesarean section scar diverticulum

    Institute of Scientific and Technical Information of China (English)

    龙英丽; 孙亚玲; 于景荣; 秦玉静

    2015-01-01

    目的:分析子宫瘢痕憩室引起异常子宫出血患者的临床表现、检查方法,为预防及治疗提供依据。方法回顾性分析因剖宫产术后子宫憩室引起异常子宫出血患者156例的临床资料,对检出率、患者临床症状出现时间及相关影响因素、检查情况、误诊情况进行分析。结果2010年异常出血者中发现憩室12例(5.6%),2011年发现憩室30例(10.5%),2012年发现憩室26例(8.6%),2013年发现憩室37例(14.4%),2014年发现憩室51例(17.7%)。48例患者症状出现时间为术后恢复月经1~6个月,89例为术后恢复月经6个月至2年,19例为术后恢复月经2年后。98例(62.82%)患者多次超声检查未发现明显异常,43例患者行诊断性刮宫,后位子宫与前位、中位子宫相比阴道流血时间明显延长。结论剖宫产子宫切口憩室致异常子宫出血发病率虽低,但是有较高的误诊、漏诊率,需进一步提高其诊断率,进一步研究其预防及治疗方法。%Objective To investigate the clinical manifestation and inspection method about abnormal uter-ine bleeding due to cesarean section scar diverticulum.Methods retrospective analysis of 156 abnormal uterine bleeding cases due to cesarean section scar diverticulum.Analysis the relevance ratio,the starting time of clinical symptom,related influencing factors,the information of examine and misdiagnose.Results there are 12 cases cesare-an section scar diverticulum in 2010;30 cases in 2011;26 cases in 2012;37 cases in 2013;51 cases in 2014.The starting time of clinical symptom is 1 ~6 month pose menstrual in 48 cases;6 months to 2 years pose menstrual in 89 cases,2 years later pose menstrual in 19 cases.98 cases don′t have evidential abnormality even through many times ultrasonograph.43 patients subjected diagnosis curettage.The uterine bleeding time obviously longer comparing retro-position of uterus with

  15. 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.

  16. 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

  17. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

    Directory of Open Access Journals (Sweden)

    Shu S

    2015-08-01

    Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

  18. 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

  19. 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...

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

    Science.gov (United States)

    Wang, Chun-Feng; Hu, Min

    2015-02-01

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

  1. [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.

  2. The value of ultrasound in the diagnosis of uterine incision scar pregnancy after cesarean section%子宫切口瘢痕妊娠的超声诊断价值

    Institute of Scientific and Technical Information of China (English)

    张建华; 丁政

    2015-01-01

    目的:探讨剖宫产术后子宫切口瘢痕妊娠的超声诊断价值。方法选取重庆市南川区妇幼保健院2010年2月~2014年3月收诊的30例剖宫产术后子宫下段瘢痕切口妊娠患者的超声声像图特征做回顾性分析。仪器和方法使用飞利浦彩超诊断仪,采用经阴道及经腹超声联合扫查,主要采用经阴道超声扫查,探头频率5.5~7.0MHz;经腹扫查为辅助扫查,主要观察瘢痕妊娠位置与子宫下段、宫体、宫颈的关系。常规扫查子宫、宫腔、双侧附件及盆腔。经阴道彩超可清晰显示子宫下段切口的位置,主要扫查子宫峡部(切口)处有无异常回声(妊娠物),确定妊娠物与子宫下段切口瘢痕的关系,观察妊娠物的形态、回声、大小、局部血流滋养情况,并测量其与子宫浆膜层之间的厚度。结果30例子宫切口妊娠病例中,诊断符合26例,误诊2例,漏诊2例,诊断正确率86%。结论经阴道彩超对子宫切口妊娠的诊断是一种可靠的诊断方法,能明确妊娠囊着床位置,具有重要的临床价值,值得在子宫瘢痕妊娠临床治疗中推广应用。%Objective To investigate the value of ultrasound in the diagnosis of uterine incision scar pregnancy after cesarean section.MethodsThe ultrasonographic features of 30 cases of cesarean section scar pregnancy after cesarean section were selected from February 2010 to March 2014.Apparatus and method for using Philips color Doppler diagnostic instrument,using transvaginal and transabdominal ultrasound combined scanning,the main use of transvaginal ultrasound scan and probe frequency 5.5-7.0MHz;The transabdominal assisted scanning,mainly to observe scar pregnancy uterine position and relationship under section,uterine body and cervix.Routine scan of the uterus,uterine cavity,bilateral annex and pelvis.By transvaginal color Doppler ultrasound can clearly display the location of the incision of

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

    DEFF Research Database (Denmark)

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

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

  4. Postmortem Cesarean Section: A Case Report

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    赵立武

    2011-01-01

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

  6. Youssef’s Syndrome following Cesarean Section

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    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.

  7. 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

  8. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature.

    Science.gov (United States)

    Api, Murat; Boza, Aysen; Gorgen, Husnu; Api, Olus

    2015-01-01

    Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment.

  9. 经阴道彩超诊断及鉴别诊断子宫疤痕妊娠的价值%Value of color Doppler transvaginal ultrasonography in the diagnosis and differential diagnosis of ectopic pregnancy in previous cesarean section scar

    Institute of Scientific and Technical Information of China (English)

    刘静华; 范义; 刘滨月; 鄂占森; 陈金华; 刘宇清; 李玉芳

    2012-01-01

    Objective: To evaluate the value of color Doppler transvaginal ultrasonography in the diagnosis and differential diagnosis of ectopic pregnancy in previous cesarean section scar. Methods: From 2004 to 2009, 32 cases of cesarean scar pregnancy who underwent ultrasonic examination and treat in our hospital were retrospectively studied; the accuracy of color Doppler transvaginal ultrasound and B - scan or color Doppler transabdominal ultrasound in the diagnosis of ectopic pregnancy in previous cesarean section scar were compared. Results: The ultrasonic images of cesarean cicatrix pregnancy were summarized, all images were divided into two types; gestation cyst type (14 cases) and mass type (18 cases) ; the accuracy of color Doppler transvaginal ultrasound was higher than that of B - scan or color Doppler transabdominal ultrasound in the diagnosis of gestation cyst type ( P < 0. 05 ) . Conclusion: The color Doppler transvaginal ultrasound is highly valuable in the diagnosis and differential diagnosis of ectopic pregnancy in previous cesarean section scar.%目的:评价经阴道彩超对于剖宫产术后瘢痕处妊娠的诊断与鉴别诊断价值.方法:回顾性分析32例剖宫产术后疤痕部位妊娠患者的超声检查结果及疤痕妊娠的图像特点,比较经阴道彩超与B超或经腹彩超对疤痕妊娠诊断的准确率.结果:根据声像图特征将疤痕妊娠分为孕囊型和包块型;经阴道彩超对孕囊型妊娠的诊断准确率明显高于B超或经腹彩超(P<0.05).结论:经阴道彩超对剖宫产术后子宫切口瘢痕妊娠的诊断及鉴别诊断有重要价值.

  10. 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

  11. 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.

  12. 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.

  13. A Case of Misdiagnosed Cesarean Scar Pregnancy with a Viable Birth at 28 Weeks

    Directory of Open Access Journals (Sweden)

    Sakiko Nukaga

    2014-01-01

    Full Text Available We report our experience with a case of presumptive cesarean scar pregnancy, based on detection of a gestational sac (GS in early pregnancy at the site of a previous cesarean scar. The GS grew into the uterine cavity as the pregnancy progressed, showing an ultrasound image similar to that of a normal pregnancy. Thus, the pregnancy continued, resulting in a viable birth at 28 weeks of gestation. Cesarean scar pregnancy is classified as myometrial implantation or implantation growth into the uterine cavity. In the latter type, the gestational sac moves upward with increasing gestational weeks and it shows the same ultrasound image as a normal pregnancy. Therefore, the diagnosis must be made in the early pregnancy.

  14. 产前高频超声检查在剖宫产瘢痕子宫胎盘植入的临床应用%Clinical application of high frequency prenatal ultrasound in the diagnosis of placenta increta in cesarean section scar uterine

    Institute of Scientific and Technical Information of China (English)

    樊树华

    2013-01-01

    Objective To investigate the prenatal ultrasonographic features of placenta increta in cesarean section scar uterus using high frequency color ultrasound, so as to increase the diagnostic accuracy of placenta increta. Methods Color ultrasonographic data of 32 cases of placenta increta in cesarean section scar uterus confirmed by pathology or clinical information were analyzed retrospectively. The data in our hospital were collected from October 2009 to May 2013.Results Of the 32 cases, 3 cases were false negative, so the diagnosis accuracy rate was 90.6%. Conclusion To grasp the ultrasonographic characteristics of placenta increta in cesarean section scar uterus can increase the detection rate.%目的:探讨剖宫产瘢痕子宫胎盘植入的产前高频彩超声像图特征,以提高产前超声检查瘢痕子宫胎盘植入的准确率。方法回顾性分析2009年10月~2013年5月在我院经产后病理或临床证实为瘢痕子宫胎盘植入的32例患者彩超资料。结果32例胎盘植入患者中,产前高频彩超诊断29例,漏诊3例,诊断准确率90.6%。结论准确掌握瘢痕子宫胎盘植入的产前高频超声声像图特点,能提高胎盘植入的检出率。

  15. B-test in late pregnancy on the thickness of the lower uterine segment cesarean section scar significance%B超检测妊娠晚期子宫下段瘢痕厚度对再次剖宫产的意义

    Institute of Scientific and Technical Information of China (English)

    张春风

    2014-01-01

    Objective To investigate the B-test trimester uterine segment cesarean section scar vicious value again. Methods In accordance with scar thickness is<3mm, 94 cases of cesarean section will be divided into maternal<3mm group and ≥ 3mm each group 47 cases. Comparison of two blood loss, the number of cases of postpartum hemorrhage and oxytocin usage to re-evaluation of the value of B-test cesarean scar thickness. Results <3mm group blood loss was 336.9 ± 118.4mL, the number of cases of postpartum hemorrhage in 9 cases (19.15%), oxytocin usage was 90.1±18.7 U, significantly higher than the index≥3mm group(P<0.05). Conclusion B-test scar thickness can effectively guide cesarean section has important clinical significance.%目的:探讨B超检测妊娠晚期子宫下段瘢痕厚度对再次剖宫产的价值。方法将94例再次剖宫产孕产妇按照子宫下段瘢痕厚度分为<3 mm组和≥3 mm组各47例,比较2组术中出血量、产后出血例数和缩宫素使用量,以评价B超检测瘢痕厚度对再次剖宫产的价值。结果<3 mm组术中出血量为(336.9±118.4)mL,产后出血例数有9例(19.15%),缩宫素使用量为(90.1±18.7)U,均明显高于≥3 mm组(P<0.01)。结论通过B超检测子宫瘢痕厚度可以有效地指导再次剖宫产,具有重要的临床意义。

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

    Directory of Open Access Journals (Sweden)

    Liping Zhou

    2013-03-01

    Full Text Available Objective: To explore and analyze the indications and causes of cesarean section on Pemba island of Zanzibar in Africa to improve the quality of obstetrics. Methods: 564 patients performed cesarean section in Abdulla Mzee Hospital of Pemba from January, 2008 to December, 2011 were selected, and statistics was conducted by the method of retrospective analysis. Results: The rate of cesarean section in Abdulla Mzee Hospital of Pemba was 10.01%. The primary causes of cesarean section included cephalopelvic disproportion (27.13%, scar uterus (23.40%, preeclampsia and eclampsia (13.30%, fetal distress in uterus (9.40%, fetal factors (9.75% and complication of pregnancy (6.91%. Conclusion: Cesarean section plays a great role in the treatment of dystocia, some complications of pregnancy and reducing the mortality of pregnant women and perinatal infants, but in the area with relatively undeveloped medical conditions in Africa, cesarean section still takes great risks. Unnecessary cesarean section cannot reduce the incidence of postpartum hemorrhage and neonatal morbidity. The local medical staff should improve the midwifery technique, establish and perfect the formal antenatal examination system to improve the quality of maternity.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  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. Intrauterine endometriotic cyst at the site of previous cesarean scar; scar endometriosis.

    Science.gov (United States)

    Isci, H; Gonenc, G; Yigiter, A B; Guducu, N; Dünder, I

    2015-01-01

    Uterine scar endometriosis is an extremely rare entitiy. As the surgical procedures of the uterus increases through time, scar endometriosis may be diagnosed more often in the future. A case of uterine scar endometriosis is presented with complaints of menstruation lasting one day with associated pelvic pain. When a cystic mass in the site of previous surgery is diagnosed, scar endometriosis must be considered.

  3. 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.

  4. Diagnosis value of transvaginal ultrasound inspection for the uterine scar after cesarean section with early pregnancy%经阴道超声检查对剖宫产后子宫疤痕早期妊娠的诊断价值

    Institute of Scientific and Technical Information of China (English)

    聂娅; 刘玉英; 黄惠甜; 丘玲

    2012-01-01

    目的 探讨剖宫产术后子宫下段疤痕早期妊娠的声像图特征,评价经阴道超声检查对子宫下段疤痕妊娠的诊断价值.方法 采用经阴道超声检查对15例子宫下段疤痕妊娠进行检查,观察妊娠囊的位置、子宫切口部位的同声、疤痕处肌层厚度、妊娠囊与子宫切口两者的关系以及血流分布.结果 15例子宫疤痕妊娠病例超声诊断正确14例,误诊1例,诊断符合率为93.3%.所有患者宫腔内未见妊娠囊,在子宫下段疤痕处见周边有滋养层强回声的妊娠囊声像,经CDFI观察疤痕处滋养层内见较丰富的血流信号,测其RI为低阻血流,平均RI值低于0.5.根据声像特征将子宫下段疤痕早期妊娠分为妊娠囊完整嵌于疤痕处胚囊型、妊娠囊向宫腔内生长的“茄”型、流产后宫腔内混合性回声三型.结论 经阴道超声检查在剖宫产术后子宫下段疤痕妊娠的早期有重要的诊断价值.%Objective To explore sonographic features of the lower uterine segment cesarean section scar with early pregnancy,and to evaluate the diagnosis value of transvaginal ultrasound for lower uterine segment scar pregnancy.Methods The transvaginal color Doppler ultrasound was used in 15 cases of uterine scar pregnancy to check the next section to observe the location of the gestational sac,uterine incision site of the echo,the thickness of muscle scars,gestational sac and the uterine incision,and the relationship between blood flow distribution.Results In 15 cases of uterine scar pregnancy,ultrasound correctly diagnosed,14 cases of misdiagnosis,diagnostic coincidence rate was 93.3%.All patients with no intrauterine gestational sac surrounded by the trophoblast echogenic gestational sac audio and video,showed the lower uterine segment scar.We observed the scars were seen in the trophoblast with more abundant blood flow signals,measured by the CDFI RI of low resistance to blood flow,mean RI values less than 0.5.The

  5. 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...

  6. 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....

  7. 剖宫产瘢痕妊娠的临床研究进展%Clinical research of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    梁婵玉(综述); 谭毅(审校)

    2016-01-01

    剖宫产瘢痕妊娠( cesarean scar pregnancy,CSP)是一种比较少见的异位妊娠,随着剖宫产率的增加,其发生率呈现了增长的趋势,并引起了产科医师的关注。该文对其临床研究的进展情况作一简要的介绍。%Cesarean scar pregnancy ( CSP) is a relatively rare ectopic pregnancy.With the increase of cesar-ean section rate, the incidence of CSP shows a growing trend, which causes the attention of the obstetricians.In this paper, the progress of its clinical research is reviewed.

  8. 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

  9. 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。

  10. 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.

  11. [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.

  12. 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

  13. 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

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

    Science.gov (United States)

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

    1998-08-01

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

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

    Science.gov (United States)

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

    1987-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Egić Amira

    2016-01-01

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

  17. Correlative evaluation between the volume of postcaesarean section scar defects after cesarean section and abnormal uterine bleeding by transvaginal three-dimensional ultrasound%三维超声容积测量对剖宫产切口憩室与异常子宫出血的相关性评价

    Institute of Scientific and Technical Information of China (English)

    兰莉; 汤飞云; 岳婷; 郑华敏; 郑磊; 周梦林

    2016-01-01

    目的:探讨经阴道三维超声检查剖宫产切口憩室(PCSD)形态大小与子宫异常出血的关系。方法:分析72例PCSD患者超声图像的深度肌层比值、憩室容积、宽度、高度、长度,对比月经正常组与异常子宫出血组的PCSD参数特点。结果:本组患者均是剖宫产后经阴道三维超声检查发现PCSD,异常子宫出血组PCSD 深度肌层比值、憩室容积、宽度、高度、长度均大于月经正常组(P<0.05),通过多因素logistic回归分析, PCSD容积是剖宫产后异常子宫出血的危险因素(OR=2.211,P<0.01)。结论:经阴道三维超声能重建PCSD选定切面的容积,PCSD容积是子宫异常出血的危险因素。%Objective: To explore the correlation between the size of post-caesarean section scar defects (PCSD) after cesarean section and abnormal uterine bleeding by transvaginal three-dimensional ultrasound. Methods: Seventy two patients with PCSD of ultrasound images with regard to the PCSD of deep muscle layer ratio, volume of the diverticulum, width, height and length were analyzed, compared with the parameters of PC-SD in the normal group and the abnormal utrine bleeding group.Results: All patients in this group with PCSD were found by transvaginal three-dimensional ultrasound examination. The abnormal uterine bleeding group was greater than the normal menstruation group in regard of PCSD of deep muscle layer ratio, volume of the diver-ticulum, width, height and length (P<0.05). By multivariate logistic regression analysis, PCSD volume was the risk factor for abnormal uterine bleeding after cesarean section (OR=2.211,P<0.01).Conclusion: Transvaginal three-dimensional ultrasound can reconstruct the volume of selected sections of PCSD, which is a risk factor for abnormal uterine bleeding.

  18. 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.

  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. Cesarean scar pregnancy: uterine artery embolization combined with a hysterectomy at 13 weeks' gestation--a case report and review of the literature.

    Science.gov (United States)

    Kwaśniewska, Anna; Stupak, Aleksandra; Krzyzanowski, Arkadiusz; Pietura, Radoslaw; Kotarski, Jan

    2014-12-01

    A cesarean scar pregnancy is a pregnancy located within the uterine muscle after previous cesarean sections. Recent years have shown a significant increase in the rate of CS and an improvement in the ultrasound diagnosis, and therefore a trend towards an increase in the rate of CSP cases has been reported in many countries. We report on a case of CSP diagnosed using ultrasound at 5/6 weeks'gestation and confirmedbymagnetic resonance imaging. The patient underwent surgical management at 13 weeks, combined with the chemioembolization of the uterine arteries. The current review aims to update the knowledge of the available treatment modalities.

  1. Diagnostic Value of Uterine Cesarean Scar Using Magnetic Resonance Imaging%MRI在剖宫产后子宫瘢痕妊娠中的诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐焱; 李彩霞; 陈波

    2015-01-01

    目的 探讨MRI在剖宫产后子宫瘢痕妊娠中的应用价值.方法 分析12 例临床剖宫产后子宫瘢痕妊娠的MRI影像.结果 12 例病灶位于子宫前下壁切口处,为圆形、类圆形;为不均匀信号,为高低不等T1、T2 信号,其中见多发囊状长T1 长T2 信号,DWI为高低不等信号.典型MRI分为孕囊型、混合包块型.结论 MRI能准确诊断剖宫产术后子宫瘢痕妊娠,为其诊断和治疗提供有效的依据.%Objective To investigate the application value of MRI in uterine cesarean section scar pregnancy.Methods The MRI image 12patients with uterine cesarean scar confirmed by clinic after cesarean section were analyzed.Results Al the lesions were located in the anterior inferior wal of uterus, and showed rounded and round-like shapes with Unequal height T1 、T2 signal, especialy multiply bubbly long T1 and long T2 signals,DWI showed heterogeneous hyperintensity Typical MR features with CSP included two types: Gestational sac and mixed masses.Conclusion MRI is useful in diagnosis of cesarean scar pregnancy,which can reflect pathology of cesarean scar pregnancy.

  2. 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...

  3. 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.

  4. [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.

  5. 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

  6. 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.

  7. 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.

  8. 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....

  9. Correlation of the expressions of MMPs-9, TIMP-1 and TIMP-2 with cesarean section scar%基质金属蛋白酶9和基质金属蛋白酶组织抑制剂1,2在子宫剖宫产疤痕中的表达和相关性

    Institute of Scientific and Technical Information of China (English)

    李琼; 郭遂群; 柳大烈; 冯淑英; 魏清柱

    2012-01-01

    目的 研究基质金属蛋白酶9(MMPs-9)和基质金属蛋白酶组织抑制剂1,2(TIMP-1,2)在子宫剖宫产疤痕愈合中的影响.方法 收集2009年8月~2011年11月在我院收治的有严重并发症的疤痕子宫妊娠病人22例(子宫剖宫产疤痕早期8例妊娠(CSP)、因胎盘粘连或植入而行子宫切除术的疤痕子宫足月妊娠病例14例);选择同期孕期检查正常无并发症疤痕子宫足月妊娠病人38例作为对照1组;同期孕期检查正常、无任何并发症因社会因素要求剖宫产的足月妊娠病人32例作为对照2组.采用免疫组织化学EnVision二步法检测3组中MMPs-9和TIMP-1,2的表达,并对其表达进行相关性分析.结果 MMPs-9、TIMP-1在3组间的表达差异有统计学意义(P<0.05).TIMP-2在3组间的表达差异无统计学意义(P>0.05).Spearman等级相关分析显示,在疤痕组织中MMPs-9的表达随疤痕愈合不良呈正相关,相关系数分别是0.309、0.643.随着疤痕愈合不良程度加重,MMPs-9的表达逐渐增强,差异有统计学意义(P<0.05).结论 子宫疤痕愈合不良、CSP可能和损伤修复中MMPs-9、TIMP-1的表达失衡有关.%Objective To investigate the roles of MMPs-9, TIMP-1 and TIMP-2 in cesarean section scar healing. Methods The expressions of the MMPs-9, TIMP-1 and TIMP-2 were detected by EnVision immunohistochemistry in 22 pregnant women with serious complications of the uterine scar, including 8 with early caesarean scar pregnancy (CSP) and 14 with full-term pregnancy undergoing hysterectomy for placenta previa or implanted placenta. Thirty-eight full-term pregnant women without serious complications of the uterine scar and 32 normal full-term pregnant women served as the control I and control II groups, respectively. Results The expressions of MMPs-9 and TIMP-1 differed significantly between the 3 groups (P0.05). Spearman rank correlation analysis showed that the expression of MMPs-9 in the uterine scar tissues was

  10. 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.

  11. 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.

  12. 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.

  13. 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....

  14. Efficacy comparison of combined spinal epidural anesthesia and epidural anesthesia in the scarred uterus during cesarean section%腰麻-硬膜外联合麻醉和硬膜外麻醉在瘢痕子宫剖宫产术中的比较

    Institute of Scientific and Technical Information of China (English)

    裘剑波; 裘宁辉; 刘超; 林家燕; 张毅

    2012-01-01

    Objective To compare the anesthetic effect and safety of combined spinal epidural anesthesia (CSEA) and epidural anesthesia (EA) in the scarred uterus during cesarean section.Methods One hundred and twenty cases of the scar uterine pregnant woman aged 23-42,were randomly divided into two groups,EA group (60 cases)and CSEA group(60 cases).In each group,patient were given EA or CSEA before cesarean section,and the ECG,BP,HR,RR and SpO2 were monitored.The pain disappear plane by acupuncture was determined,and the sensory block onset time (when the sensory block parts have fever or numbness after the drug delivery time) was recorded.The lower limb motor block effects were indentified by the improved Browage grading,the Apgar scores of the newborns were recorded and the adverse reactions such as headache,vomiting after anesthesia were observed.Results The sensory block onset time of EA group was significantly slower than that of CSEA group (P < 0.05),the pain disappear plane of CSEA group was higher than that of EA group (P < 0.05),the limb motor block effect of EA group was much lower than that of CSEA group (P < 0.01).Because of insufficient anesthesia,7 cases in EA group could not tolerate the surgery,and had to add assisted local infiltration anesthesia or intravenous analgesics to complete the operation,2 of them changed to general anesthesia.None of the patients in CSEA group had assisted intravenous analgesics or changed to general anesthesia,the anesthetic effect was significantly better than EA group (P <0.01).There were no cases of headache or neurological complications occurred in CSEA group after anesthesia.The Apgar scores of the newborns when the baby was delivered and 1 min after birth in CSEA group were significantly better than those in EA group (P < 0.05),and there was no significant difference in the Apgar scores 5 min or 10 min after birth between the two groups (P > 0.05).Conclusions By small doses of anesthetics,strictly controling the

  15. Sagittal venous sinus thrombosis after cesarean section: a case report

    Directory of Open Access Journals (Sweden)

    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.

  16. [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.

  17. 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...

  18. 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.

  19. 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.

  20. 剖宫产术后瘢痕妊娠的超声诊断%Ultrasound diagnosis of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    范玉志

    2013-01-01

    Objective To improve the understanding of the ultrasound performance of cesarean section scar pregnancy. Methods To analysis ultrasound features of 5 cases patients of cesarean scar pregnancy. Observation gestational sac location, size, internal structure and blood flow, as wel as the partial anterior uterine thickness. And dynamic observation of clinical sonographic changes. Results 5 cases of cesarean section scar pregnancy cases of uterine and cervical canal showed no gestational sac, but see in the lower uterine segment anterior wal of the gestational sac or mass. Including three cases of gestational sac type, see the gestational sac. 2 cases of mass type,to find in the lower uterine cavity and anterior wal scar messy echogenic mass, rich blood flow signals around the wal of the uterus. Conclusion Ultrasound has a very important clinical value to diagnose the cesarean scar pregnancy .%  目的提高剖宫产后瘢痕妊娠的超声表现的认识。方法分析5例经临床证实的剖宫产术后瘢痕妊娠的超声特点,观察妊娠囊位置、大小、内部结构及血流情况,局部子宫前壁的厚度等,并追踪观察临床治疗后声像图的变化。结果5例剖宫产术后瘢痕妊娠病例宫腔及宫颈管内均未见孕囊,子宫下段前壁内见孕囊或包块。其中3例孕囊型,见妊娠囊,2例示包块型,子宫下段宫腔及前壁疤痕处杂乱光团,周围宫壁血流信号丰富。结论超声对瘢痕妊娠的诊断具有非常重要的临床使用价值。

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

    Directory of Open Access Journals (Sweden)

    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.

  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. 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...

  4. 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...

  5. 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...

  6. [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.

  7. 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

  8. Diagnosis and treatment of cesarean scar pregnancy%剖宫产疤痕部位妊娠诊治分析

    Institute of Scientific and Technical Information of China (English)

    颜为红; 陈奎喜; 马超

    2011-01-01

    目的 探讨预防、诊断和治疗剖宫产术后子宫切口疤痕部位妊娠的有效方法.方法 对2006年6月~2010年7月收治的20例剖宫产疤痕部位妊娠患者的临床资料进行回顾性分析.结果 超声检查是诊断子宫切口疤痕妊娠的主要依据.明确诊断后的患者治疗效果,明显优于未确诊就开始治疗的效果.借助于妊娠部位血流阻断的处理方式好于直接进行吸宫,差异有统计学意义(χ2=9.714,P<0.05).结论 早期诊断是成功治疗剖宫产术后子宫切口疤痕部位妊娠的关键,介入治疗是最快捷有效的方法,经腹或经腹腔镜保守手术,以及全身或局部使用甲氨蝶呤后,吸宫的治疗效果明显优于单纯吸宫.%Objective To explore effective methods to diagnose and treat cesarean scar pregnancy after cesarean section. Methods The clinical data of 20 patients with uterine scar pregnancy after cesarean section ( cesarean scar pregnancy, CSP) who admitted to our hospital in a period from June, 2006 to July, 2010 were analyzed retrospectively. Resuits Colar Doppler ultrasonography for pelvic cavity was an important method to diagnose CSP early. Therapeutic effect of those patients who had a determined diagnosis of CSP was better than that of those patients whose diagnosis of CSP was not determined yet, and therapeutic effect of procedure of blocking blood flow in scar site of the uterus was better than that of direct uterine aspiration, the difference was significant ( P < 0.05 ). Conclusion Early diagnosis of CSP is the key to successfully treat the disease. Detailed observation of the location, size and vascularity of the pregnancy are important for making a clear diagnosis and for differentiating an abortion in progress from CSP. Interventional therapy is the most effective way. After abdominal or laparoscopic conservative operation and local or systemic use of MTX, the therapeutic effect of uterine aspiration is significantly better than that of

  9. 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

  10. [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.

  11. 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.)

  12. [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.

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

    Directory of Open Access Journals (Sweden)

    Maria Pia Fantini

    2005-06-01

    Full Text Available

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

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

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

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

    Science.gov (United States)

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

    2015-03-01

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

  15. 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.

  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. Diagnostic Value of MRI on Cesarean Scar Pregnancy%MRI对剖宫产瘢痕妊娠的诊断价值

    Institute of Scientific and Technical Information of China (English)

    明建中; 钟文新; 沈比先; 相呈县; 楚二伟; 保莲; 黄岸容

    2012-01-01

    目的 探讨MRI诊断剖宫产后瘢痕妊娠(cesarean scar pregnancy,CSP)的价值.方法 回顾性分析2008年1月至2011年9月间经MRI诊断为CSP的23例患者的MR图像特征及术后结果.结果 23例CSP患者全部行手术治疗,MRI正确诊断20例,准确率86.96%( 20/23).误诊3例(宫颈妊娠1例、滋养细胞疾病1例、不全流产1例).典型MRI图像表现为孕囊型、混合包块型.结论 MRI是诊断CSP的有效手段,能较好地反映CSP病理学特点,为临床诊断和治疗提供重要影像学依据.%Objective To investigate the value of MR in the diagnosis of cesarean scar pregnancy(cap). Methods The MRI data of 23 patients with cesarean scar pregnancy were retrospectively analyzed and compared with postoperative pathological features from Jan 2008 to Sep 2011. Results Among 23 patients with cesarean scar pregnancy, MR definitely diagnosed 20 cases and misdiagnosed 3 cases (1 case as cervix pregnancy, 1 case as trophoblastic disease, 1 case as incomplete abortion), the diagnostic accuracy of MRI was 86. 96%. Typical MR features with CSP included two types; Gesta-tional sac and mixed masses. Conclusion MRI is useful in diagnosis of cesarean scar pregnancy, which can reflect pathology of cesarean scar pregnancy.

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

  2. Resection of Cesarean Scar Pregnancy at Six Weeks of Gestation with Laminaria Cervical Dilatation under Sonographic and Hysteroscopic Guidance

    Directory of Open Access Journals (Sweden)

    Tatsuji Hoshino

    2015-01-01

    Full Text Available In cases of fetal heartbeat- (FHB- positive cesarean scar pregnancy (CSP, the embryo and placenta grow rapidly week by week. We experienced an FHB-positive CSP case at 6 weeks of gestation and assessed the CSP in detail with transvaginal ultrasound and transabdominal ultrasound (TAUS, preoperatively. We performed Laminaria cervical dilatation under TAUS guidance and performed hysteroscopic resection of the pregnancy conceptus and curettage under hysteroscopic and TAUS guidance. We identified the gestational sac attached to the cesarean scar pouch with small plane, decidua basalis, and chorionic villi and present the clinical history and other findings. We also reviewed the related literature and found 76 previous studies, with six cases of FHB-positive CSP that contained hysteroscopic color images of the CSP. We present a review of selected cases. The implantation site was the anterior wall in almost all cases. Cervical dilatation was mainly performed using a Hegar dilator; ours was the only case using Laminaria dilatation. Transcervical resections were performed mainly under ultrasound guidance, with only one case undergoing laparoscopy. Electrocoagulation was performed in three of the six cases.

  3. [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.

  4. 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.

  5. 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

  6. 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

  7. 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....

  8. 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.

  9. [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.

  10. 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...

  11. Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature.

    Science.gov (United States)

    Cheung, Vincent Y T

    2015-01-01

    The objective of this study was to determine the outcome of using ultrasound-guided local methotrexate injection as the first-line treatment of cesarean scar pregnancy (CSP). A literature review was performed on all eligible reports using this modality as the first-line treatment of CSP. Relevant publications were obtained from the PubMed electronic database from inception to December 2014. Ninety-six cases from 95 women reported in 17 articles were reviewed. The success rate was 73.9% after a single local methotrexate injection. An accumulated success rate of 88.5% could be achieved after additional local or intramuscular methotrexate administration. Eleven cases (11.5%) failed methotrexate treatment and required surgical interventions. Except for women with serum human chorionic gonadotropin levels higher than 100 000 IU/L, ultrasound-guided local methotrexate injection could be considered as a first-line treatment modality for CSP.

  12. 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 

  13. 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...

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

    Institute of Scientific and Technical Information of China (English)

    袁秀英; 孙晓岩; 刘小媚; 杨仁东; 刘燕燕; 黄丽娥; 钟春华

    2015-01-01

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

  17. 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.

  18. 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.

  19. SUCCENTURIATE PLACENTA: AN INCIDENTAL FINDING DURING CESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Unmesh

    2015-12-01

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

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

    OpenAIRE

    Mervat A. Elsersy

    2016-01-01

    Background: There are various different methods of performing a caesarean section. With the increasing rate of repeat cesarean sections, it is necessary to recognize evidence based techniques to improve outcomes and minimize complications. Dissection of a bladder flap was an integral step in standard cesarean section. Cancelation of the bladder dissection is one the modifications that showed to be safe and cost effective. The aim of this study is to perform a randomized controlled clinical tr...

  1. 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.

  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. 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.

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

    Directory of Open Access Journals (Sweden)

    Piotr Niziurski

    2013-08-01

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

  5. 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

  6. 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....

  7. 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....

  8. 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.

  9. 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.

  10. 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.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    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

  14. 彩色多普勒超声在剖宫产疤痕妊娠诊断中的应用%Application of color Doppler ultrasound in the diagnosis of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    何敬海; 安霞; 王聪; 韩友东; 田丽元; 王少春; 陈东风

    2012-01-01

    目的:探讨彩色多普勒超声对剖宫产疤痕妊娠(Cesarean scar pregnancy,CSP)的诊断价值.方法:对我院2008年12月-2011年10月妇产科诊治的21例CSP患者的资料进行回顾性分析,分析总结其声像图特征.结果:21例患者中超声正确诊断CSP 18例,诊断正确率85.7%;误诊1例,病理证实为滋养细胞疾病,误诊率4.8%;漏诊2例,超声诊断为宫颈妊娠1例、不全流产1例,漏诊率9.5%.20例CSP患者声像图表现:典型孕囊型10例,孕囊样结构型5例,混合性包块型5例.结论:彩色多普勒超声检查对CSP具有较高的诊断价值,可以为临床诊断和治疗提供重要的参考信息.%Objective: To evaluate the value of color Doppler ultrasound in diagnosis of cesarean scar pregnancy. Methods: We analyzed retrospectively the data of 21 patients who were diagnosed as a cesarean scar pregnancy from December, 2008 to October, 2011 at affiliated hospital of Jining medical college and analyzed the ultrasonographic features of cesarean scar pregnancy. Results: Eighteen of 21 cases were correctly diagnosed of cesarean scar pregnancy by ultrasound. The accuracy of ultrasound diagnosis of cesarean scar pregnancy was 85.7%(18/21). One case misdiagnosed as cesarean scar pregnanly was trophoblastic disease confirmed by pathology. The misdiagnose rate was 4.8%(1/21). Two cases of cesarean scar pregnancy were missed and diagnosed as cervical pregnancy and incomplete abortion respectively by ultrasonography. The missed diagnose rate was 9.5%(2/21). The ultrasonography of cesarean scar pregnancy can be divided into three types: gestational sac type (10 cases), gestational sac-like structure type (5 cases) and mixed mass type (5 cases). Conclusion: Color Doppler ultrasound is important in the diagnosis of cesarean scar pregnancy, and can provide important reference information for early clinical diagnosis and treatment.

  15. Discussion of therapeutic method of cesarean scar pregnancy%瘢痕部位妊娠治疗方式的探讨

    Institute of Scientific and Technical Information of China (English)

    李蕾; 庄雅丽; 汪海妍; 张莉; 朱婷婷; 吴芳

    2015-01-01

    目的:近年来剖宫产瘢痕妊娠(CSP)发生率不断提高,该文对比研究CSP各种治疗方法的优缺点。方法:回顾性分析37例剖宫产CSP患者的临床资料,对比3种治疗方法(A:B超引导下囊内注射甲氨蝶呤(MTX)+5-FU静滴+B超下清宫术;B:腹腔镜下子宫切口处妊娠组织取出术;C:经阴道切口妊娠物取出术)的治疗效果及费用、愈后等。结果:B、C治疗方法明显优于A方法,而C不需要腹腔镜等特殊设备。结论:经阴道切口妊娠物取出术更适合在广大基层医院开展应用。%The morbidity of cesarean scar pregnancy (CSP) is increasing in recent years, but the effects of differ-ent therapeutic methods are little known. In this study, the clinical data of 37 cesarean scar pregnancy patients from 2009 to 2014 were collected and divided into three groups according to their therapies:group A (received injection of methotrexate (MTX), 5-FU intravenous infusion and surgery curettage), group B (received laparoscopic surgery) and group C (received cesarean scar pregnancy tissue taking-out technique through vaginal incision). Through compara-tive analysis, we found the cure rates and the decreased ratios of HCG of group B and group C were significantly higher than that of group A. Laparoscopic surgery and cesarean scar pregnancy tissue taking-out technique through vaginal incision were both safe and effective therapies for CSP treatment. But cesarean scar pregnancy tissue taking-out technique through vaginal incision do not need special medical devices, such as laparoscope, and easily to operate. So it is more suitable to carry out in primary hospitals.

  16. 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.

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

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    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

  18. Clinical analysis of 70 cases of cesarean scar pregnancy%剖宫产瘢痕妊娠70例临床分析

    Institute of Scientific and Technical Information of China (English)

    汤雅玲; 汪燕; 邱娜璇

    2016-01-01

    Objective To investigate the clinical diagnosis , treatment and outcomes of cesarean scar pregnancy .Methods The clinical data of 70 cases of cesarean scar pregnancy women treated in the first affiliated hospital of Xiamen University from January 2012 to December 2014 were analyzed retrospectively .Results 70 cases of cesarean scar pregnancy patients were diagnosed between 5~16 gestational weeks .65 patients whose gestational weeks less than or equal to 12 weeks chose pregnancy termination , in which 24 cases were treated by uterine artery embolization (UAE) and curettage,6 cases received transvaginal lesion resection , 3 cases received hysteroscopic surgery ,4 cases received laparoscopic surgery ,20 cases were treated by drug and curettage ,8 cases were treated by drug only.All these patients were cured,none received hysterectomy.The other 5 patients diagnosed between 14 ~16 gestational weeks continued the pregnancies .One case had hysterectomy due to placenta accrete bleeding and stillbirth in 23 gestational weeks .Four cases were treated by cesarean delivery between 27 to 32 weeks, in which three newborns survived .Conclusion Cesarean scar pregnancy is one kind of serious complications of cesarean delivery .Every case should receive individualized treatment .Though continuing the cesarean scar pregnancy is possible to have a live newborn ,but the risk of hysterectomy due to placenta accrete bleeding increases.%目的:探讨剖宫产瘢痕妊娠( cesarean scar pregnancy ,CSP)临床诊治方法及结局。方法收集2012年1月至2014年12月厦门大学附属第一医院70例CSP患者的临床资料并作回顾性分析。结果70例诊断为CSP的患者孕周为5~16周,孕周≤12周的65例患者选择终止妊娠,其中24例行子宫动脉栓塞+刮宫术,6例行经阴道病灶切除术,3例行宫腔镜手术,4例行腹腔镜手术,20例药物治疗配合刮宫术,8例单纯药物治疗,均达到治愈目的,无1

  19. 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%.

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  4. 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

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

    Science.gov (United States)

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

    2016-09-14

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

  6. Comparison of scar thickness measurements using trans-vaginal sonography and MRI in cases of pregnancy with previous caesarean section. Do they correlate with actual scar thickness?

    Science.gov (United States)

    Singh, N; Tripathi, R; Mala, Y M; Dixit, R; Tyagi, S; Batra, A

    2013-11-01

    The aim of this study was to evaluate scar thickness in cases of pregnancy with previous caesarean section, by trans-vaginal sonography (TVS) and magnetic resonance imaging (MRI), and to correlate precision of radiologically-measured scar thickness with actual measurement of scar thickness. A total of 35 pregnant patients with previous caesarean section planned for elective caesarean section, were evaluated prospectively. Their scar thickness was measured by TVS and MRI on the day of elective repeat caesarean section. These measurements were correlated with each other and with scar thickness measured during elective repeat caesarean section by using a caliper. The correlation coefficients between scar thickness measured by TVS and MRI with peroperative evaluation with a caliper, were +0.72 and +0.59, respectively. The study concluded that as MRI is a costlier modality and TVS has better correlation coefficient with actual scar thickness, TVS can be considered to be the better modality for antenatal scar thickness measurement.

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

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    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

  9. Effectiveness of Onion Extract Gel on Surgical Scars in Asians

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    Kumutnart Chanprapaph

    2012-01-01

    Full Text Available Background. Onion extracts have been shown in vitro to accelerate wound healing. Results from clinical studies on surgical scars in Caucasians were disappointing. The aim of this study is to evaluate the effectiveness of onion extract gel in improving the cosmetic and symptoms of surgical scars in Asians. Patients/Methods. Twenty Asians who had new Pfannenstiel’s cesarean section scars were recruited in this prospective double-blinded, split-scar study. Each side was randomly assigned treatment with onion extract gel or placebo at 7 days after surgery. The product was applied three times daily for 12 weeks. Subjects were evaluated at baseline and 4th and 12th weeks. Scar redness was assessed by calorimeter, scar height and pliability were assessed by blinded investigators, and scar symptoms and overall cosmetic improvement were assessed by subjects. Results. Sixteen subjects completed the study. A statistically significant difference between two sides of scar in terms of scar height and scar symptoms was found. There was no statistically significant difference in scar redness, scar pliability, and overall cosmetic appearance between two sides. Conclusions. The early use of topical 12% onion extract gel on Pfannenstiel’s cesarean section scar in Asians resulted in the improvement of scar height and scar symptoms.

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

    Science.gov (United States)

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

    2016-11-22

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

  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. 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.

  13. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

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

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    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.

  16. [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.

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

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    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

  18. 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.

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

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    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

  20. 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.

  1. 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.

  2. Clinical analysis of 38 cesarean scar pregnancy cases%剖宫产瘢痕妊娠38例临床分析

    Institute of Scientific and Technical Information of China (English)

    张磊; 关华; 胡金菊

    2015-01-01

    Objective To investigate choice of treatment strategies for uterine lower segmental cesarean scar pregnancy, and to provide method and reference for rationally clinical diagnosis and treatment. Methods Clinical data of 38 patients with cesarean scar pregnancy were retrospectively analyzed, along with their diagnosis and treatment process. Results Menolipsis occurred in all the 38 cases. There were 32 cases with vaginal bleeding (84.2%), 6 cases with vaginal bleeding and complicated mild lower abdominal pain (15.8%), and all of the cases with increased human chorionic gonadotropin (HCG). Pelvic color Doppler ultrasound was used in detection and diagnosis for all the 38 cases. There were 32 cases receiving drug therapy + uterine curettage, while 1 case among them received hysterectomy. The other 6 cases received laparoscopic removal of cesarean scar pregnancy with successful process. Conclusion Among multiple treatment methods for uterine lower segmental cesarean scar pregnancy, uterine curettage after decreased HCG to 1000 U/L by gestational sac injection of methotrexate (MTX) and laparoscopic lesion resection can provide few bleeding and precise effect. Improvement of clinical diagnosis for cesarean scar pregnancy, early diagnosis and treatment are necessary for avoiding occurrence of severe adverse reactions, and guaranteeing fertility function and health in patients.%目的:探讨子宫下段剖宫产瘢痕妊娠治疗策略的选择,为临床合理诊治提供方法及依据。方法回顾性分析38例剖宫产瘢痕妊娠患者的临床资料,分析其诊断及其治疗过程。结果38例患者均有停经,阴道流血者有32例(84.2%),6例表现为阴道流血伴下腹部轻微疼痛(15.8%),全部伴有血人绒毛膜促性腺激素(HCG)升高。38例均由盆腔彩超检测诊断,32例行药物治疗+清宫术,其中1例行子宫切除术;6例行腹腔镜下子宫切口瘢痕妊娠清除术,过程顺利。结论子宫下段剖宫产瘢痕妊娠的治

  3. Avaliação ultrassonográfica de cicatriz uterina pós-cesariana segmentar transversa Ultrasound evaluation of uterine scar after segmental transverse cesarean surgery

    Directory of Open Access Journals (Sweden)

    Jorgete Maria Buso Bazzo

    2012-05-01

    Full Text Available OBJETIVO: Avaliar a medida do segmento uterino inferior pela ultrassonografia transvaginal em um grupo de mulheres não grávidas e descrever os achados morfológicos na cicatriz daquelas submetidas à cesárea. MÉTODOS: Estudo retrospectivo para o qual foram avaliadas 155 imagens de ultrassonografias transvaginais obtidas de mulheres no menacme, não grávidas. Os exames foram realizados entre janeiro de 2008 e novembro de 2011. Foram selecionados três grupos: mulheres que nunca ficaram grávidas (Grupo Controle I, mulheres com partos vaginais anteriores (Grupo Controle II e mulheres com cesárea prévia (Grupo de Estudo. Foram excluídas as mulheres com útero em retroflexão, usuárias de dispositivo intrauterino, gestantes e mulheres com menos de um ano do último evento obstétrico. Os dados obtidos foram submetidos à análise estatística com o programa Statistica®, versão 8.0. Para a comparação dos grupos em relação às variáveis quantitativas foram utilizados os testes ANOVA e LSD. Para a comparação entre a espessura do istmo anterior e posterior utilizou-se o teste t de Student. Para a associação entre variáveis quantitativas estimou-se o coeficiente de correlação de Spearman. Valores pPURPOSE: To evaluate the thickness of the lower uterine segment by transvaginal ultrasound in a group of non-pregnant women and to describe the morphologic findings in the scar of those submitted to cesarean section. METHODS: A retrospective study of 155 transvaginal ultrasound images obtained from premenopausal and non-pregnant women, conducted between January 2008 and November 2011. the subjects were divided into three groups: women who were never pregnant (Control Group I, women with previous vaginal deliveries (Control Group II and women with previous cesarean section (Observation Group. We excluded women with a retroverted uterus, intrauterine device users, pregnant women and those with less than one year of tsince the last

  4. 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

  5. 子宫切口瘢痕妊娠42例临床分析%Clinical analyses of forty-two cases of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    韩秀青; 高丹丽; 李桂荣

    2011-01-01

    目的 探讨子宫切口瘢痕妊娠的早期诊断及其对预后的影响.方法 2006年5月至2011年2月我院妇科收治子宫切口瘢痕妊娠患者42例,回顾性分析其临床资料.结果 42例患者均行B超检查,提示子宫前壁下段有孕囊或不均质回声包块.39例保守治疗成功,3例行病灶清除加修补术.结论 子宫切口瘢痕妊娠的早期诊断依靠B超检查,彩色超声是诊断的可靠依据.绒毛种植在瘢痕部位且向宫腔发展,B超监测下人工流产术,出血量多即行子宫动脉栓塞,术后行清宫术;绒毛种植在瘢痕凹陷处向宫壁发展,子宫动脉栓塞术后B超监测下清宫术是一种安全且有效的治疗方法.%Objective To investigate the early period cesarean scars pregnancy diagnosis and its influence on prognosis. Methods Clincal data of 42 cases diagnosed as cesarean scar pregnancy from May 2006 to February 2011 treated in our hospital were retrospective analysed. Results All cases underwent B ultrasound examination,which showed gestational sacs or inhomogeneous echo-enclosed mass in the lower segment of anterior wall of uterus. Thirty-nine cases were successfully eonservatively treated,3 cases underwent cleanrance of focal lesion and neoplasty. Conclusion The cesarean scar pregnancy diagnosis depends on a B ultra-sound examination, and the color Doppler ultra sound is reliable for the diagnosis. Floss plants in the crater of scar and developed to uterus wall. Curettage guided by B ultra-sound after uterine artery embolization is a safe and efficient treatment method.

  6. 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.

  7. Fatores Associados à Realização de Cesárea em Primíparas com uma Cesárea Anterior Factors Associated with Cesarean Section in Primipara Women with One Previous Cesarean Section

    Directory of Open Access Journals (Sweden)

    José Guilherme Cecatti

    2000-04-01

    1996. The cases were 153 women whose second delivery was through a cesarean section and the controls were 203 women whose second delivery was vaginal. For analysis, means, standard deviation, Student's t-test, Mann-Whitney test, chi² test and odds ratio (OR with 95% CI for each factor possibly associated with cesarean section on the second delivery were used. Results: the route of the second delivery was vaginal for 57% of the women. Among the several variables studied, those which showed to be significantly associated with a cesarean section on the second delivery were: higher maternal age (for women over 35 years, OR = 16.4, previous abortions (OR = 2.09, induced labor (OR = 3,83, premature rupture of membranes (OR = 2.83, not having an epidural analgesia performed during labor (OR = 5.3, the finding of some alteration in fetal well-being (OR = 2.7 and the delivery occurring during the afternoon (OR = 1.92. Conclusions: these results indicate that the factors associated with the repetition of cesarean section in women with a previous scar of cesarean section in this population are predominantly medical; however, there is still the possibility of proposing interventions directed to decreasing the rates of repeated cesarean sections.

  8. [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.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND AND OBJECTIVES: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS......-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue. CONCLUSIONS: Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months...... follow-up, the benefit of AFXL treatment on c-section scars emerges. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc....

  10. 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

  11. 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...

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

    Directory of Open Access Journals (Sweden)

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

    Science.gov (United States)

    Iffy, Leslie; Pantages, Pamela

    2005-12-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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...

  16. 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...

  17. 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...

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

    Directory of Open Access Journals (Sweden)

    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. [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.

  1. 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.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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.

  5. Scar Endometriosis: a Case Report with Literature Review.

    Science.gov (United States)

    Gupta, Pratiksha; Gupta, Sangeeta

    2015-12-01

    Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting one case of scar endometriosis involving rectus sheath following cesarean section. The patient required wide surgical excision of the lesion. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed.

  6. Quantitative study of scars in the boundary section of the stadium billiard

    CERN Document Server

    Simonotti, F P; Saraceno, M; Simonotti, Fernando P.; Vergini, Eduardo; Saraceno, Marcos

    1997-01-01

    We construct a semiclassically invariant function on the boundary of the billiard, taken as the Poincare section in Birkhoff coordinates, based on periodic orbit information, as an ansatz for the normal derivative of the eigenfunction. Defining an appropriate scalar product on the section, we can compute the scar intensity of a given periodic orbit on an eigensate, as the overlap beetween the constructed function and the normal derivative on the section of the eigenstate. In this way, we are able to investigate how periodic orbits scar the spectrum and how a given eigenstate decompose into scar functions. We use this scheme on the Bunimovich stadium.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. 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.

  12. The clinical value of intrahminal ultrasound in diagnosis of cesarean scar pregnancy%腔内超声检查诊断剖宫产术后瘢痕妊娠的价值

    Institute of Scientific and Technical Information of China (English)

    刘滨月; 陈莹; 刘宇清; 陈金华; 黄雪兰

    2011-01-01

    Objective To investigate the diagnosis value of intracardiac echocardiography in cesarean section scar pregnancy. Methods Cavity ultrasound was applied in patients of cesarean scar pregnancy with sonographic features and treatment. Results In 52 patients, ultrasound diagnosed accurately in 45 cases, diagnosis accurate rate was 86.5% (45/52). Sonogram showed gestational sac simply type in 16 cases, mixed echo-type( or mass-based) of 36cases. In 52 cases of CSP, according to their clinical and sonographic features ,2 cases of uterine scar lined laparotomy and the uterus excision repair;three cases of laparoscopic removal of uterine scar pregnancy lesion repair. 6 patients to methotrexate;five cases of abdominal surgery;36 routine uterine arterial embolization in the ultrasound monitor after curettage. Conclusion Ultrasound could apply in cesarean scar pregnancy timely,and accurate diagnosis was made;sonographic features according to the patients,help choose the appropriate clinical treatment,and assess efficacy.%目的 探讨腔内超声诊断剖官产瘢痕妊娠的价值。方法 应用腔内超声观察剖宫产术后瘢痕妊娠患者的声像图特点和治疗效果。结果 52例患者中,超声诊断45例,诊断符合率86.5% (45/52)。声像图表现为单纯妊娠囊型16例,混合回声型(或包块型)36例。52例剖宫术后子宫瘢痕妊娠患者根据其临床情况及声像图特征:2例行子宫剖腹探查术行瘢痕病灶切除子宫修补术;3例腹腔镜下清除瘢痕妊娠病灶修补子宫;6例患者予甲氨蝶呤治疗;5例开腹手术;36例行子宫动脉灌注栓塞治疗后在超声引导监视下行清官术。结论 超声检查可以对剖官产术后切口瘢痕妊娠及时、准确作出诊断;根据患者声像图特征,有助于临床选择恰当的治疗方案,并评估疗效。

  13. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Is scar tenderness a reliable sign of scar complications in labor?

    Directory of Open Access Journals (Sweden)

    Isha Gutgutia

    2012-12-01

    Full Text Available Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG, severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor. Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor

  16. 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.

  17. Analysis of related factors of indications for cesarean section%剖宫产手术指征相关因素分析

    Institute of Scientific and Technical Information of China (English)

    姜娜

    2014-01-01

    目的:分析剖宫产手术指征的相关因素。方法:按实施剖宫产的主要原因及人数进行分析统计,计算其所占百分比。结果:行剖宫产的116例患者中,胎儿窘迫38例(32.7%),社会因素15例(12.9%),胎位不正,头盆不称23例(19%),巨大儿10例(8%),产程异常11例(9.4%),瘢痕子宫10例(8%),其他9例(7%)。结论:降低剖宫产率要加强孕期教育指导,使孕妇对妊娠及分娩有正确认识,合理饮食,适当运动,控制体重,提高产科及相关方面技术水平,合理掌握剖宫产指征。%Objective:To analyze the related factors of indications for cesarean section.Methods:According to the reason and number of patients with the cesarean section to statistical analysis,calculating the percentage.Results:116 patients with cesarean section,38 cases(32.7% )of fetal distress,15 cases(12.9% ) of social factors,23 cases(19% ) of malposition,head disproportion,10 cases(8%)of huge children,11 cases(9.4%)of labor abnormalities,10 cases(8%)of uterine scar,9 cases(7%)of others.Conclusion:Reducing the cesarean section rate should strengthen pregnancy education guidance,make the pregnant woman has a correct understanding on pregnancy and childbirth,proper diet,adequate exercise,weight control,improve obstetric and related technical level,reasonable grasp indications for cesarean section.

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

    Science.gov (United States)

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

    2013-01-01

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

  19. 腹腔镜治疗剖宫产瘢痕妊娠%Clinical research of laparoscopy in the treatment of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    胡碧洪; 黄浩; 李莉芳; 王帅

    2014-01-01

    Objective To investigate the application value of laparoscopy on cesarean scar pregnancy(CSP). Methods Four-teen patients with CSP in this hospital from June 2009 to June 2011 were selected. Six of them had β-HCG average 24 271. 5 U/ L in blood. Their transvaginal sonography showed large uterus and gestational Sac or hypoechonic masses which were 3. 3 ~ 4. 8 cm (4. 1 cm average)with rich blood. The clinical data and treatment outcome of 6 patients with laparoscopic wedge resection of the lesion + uterine scar repair to treatments cesarean scar pregnancy were retrospectively analyzed. Results Six patients were suc-cessfully operated with less bleeding and hysterectomy,minimally invasive,effective,quick recovery treatment. Conclusion Ce-sarean scar pregnancy underwent laparoscopic resection of local lesions of uterine repair can not only effectively terminate the preg-nancy,and can also repair scar defect and repair the uterus to retain reproductive function,so it is a very valuable method.%目的:探讨腹腔镜技术治疗剖宫产瘢痕妊娠(CSP)的价值。方法回顾性分析2009年6月至2011年6月在南方医科大学附属南海人民医院住院治疗的14例剖宫产瘢痕妊娠患者,其中6例患者因血β-人绒毛膜促性腺激素较高,平均24271.5 U/ L,阴道彩超提示:子宫增大,剖宫产切口部位见孕囊或不均质中低回声包块,长径3.3~4.8 cm,平均4.1 cm,包块周围有丰富血流信号,均突向浆膜层。6例患者均采用腹腔镜下子宫瘢痕部位病灶切除术+子宫修补术治疗。结果6例均顺利完成手术,出血少,避免子宫切除术,达到微创、有效、恢复快的治疗效果。结论 CSP 行腹腔镜下局部病灶切除+子宫修补术不仅可以有效终止妊娠,同时可以修补瘢痕缺陷、修复子宫,保留生育功能,是一种有价值的方法。

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. 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...

  3. The Evaluation of Diagnoses and Management in Cesarean Scar Pregnancy with Color Doppler Ultrasound%彩色超声在子宫疤痕妊娠诊治中的作用

    Institute of Scientific and Technical Information of China (English)

    张小英; 彭艳丽; 陈涛; 朱亚利; 魏金铭; 王燕; 贾娟

    2011-01-01

    目的 评价彩色超声在疤痕妊娠诊治中的作用.方法 使用经阴道超声诊断疤痕妊娠病例进行保留生育能力的保守治疗.记录子宫疤痕孕囊时间、超声结果、β-hCG、经阴道彩色超声血流情况和手术方式及经腹超声在术中监测情况.结果 孕囊诊断时间约6周左右,剖腹产时间至疤痕妊娠时间为9 - 126月.经阴道超声诊断疤痕妊娠如下:孕囊大小0.8cm×0.4cm×0.5cm至2.2cm×2.1cm×1.0cm,有胎心,头臀径0.3cm至0.7cm,前壁肌层厚度0.5cm,血流显像丰富.对患者进行如下处理:子宫动脉栓塞后24小时在超声监测下行官腔镜吸官人流术2例,子官动脉栓塞失败+系统MTX化疗,经阴道超声检查孕囊仍存活,患者自动出院,后随访得知官腔镜下行吸官人流术,证实疤痕妊娠1例.结论 经阴道超声是子宫疤痕妊娠早期诊断非常有用手段,在经腹超声术中监测,明显缩短手术时间,减少盲目性,保证了手术安全.%Objecive To evaluate our experience and diagnosis of cesarean scar pregnancy(CSP) with color doppler ultrasound. Msthods From March 2006 to June 2010, 3 cases of cesarean scar pregnancy were diagnosed using color doppler sonography and treated conservatively to preserve fertility. Gastational age, sonographic findings, /3-human chorionic gonadotropin(/3-hCG) levels, flow profiles of transvaginal color Doppler ultrasound, and trasabdominal sonography during treatment were recorded. Results The gastational sac(GS) ages were diagnosed for about 6 weeks. The time interval from the Cesarean section to the diagnosis of Cesarean scar pregnancy was from 9 months to 126 months. Embryonic period diagnosed by color doppler sonography were as follow: the sizes of GS ranged from 0.8cm X 0.4cmx0.5cm to 2.2cm X2.1cmxl. 0cm, all with cardiac activity, the crown-rump length ranged from 0.3cm to 0.7cm, the anterior myometrial thickness to the csp were measured 0.5cm with rich color flow show. The patients were

  4. 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

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

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    Mairead Black

    2016-03-01

    Full Text Available Global cesarean section (CS rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1 planned repeat CS and (2 unscheduled repeat CS with those that follow vaginal birth after CS (VBAC.A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145 were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919 and unscheduled repeat CS (n = 8,847 with those following VBAC (n = 13,379. Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33 and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42 compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively. Risk of obesity at age 5 y and risk of cerebral

  6. [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.

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

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    Okonkwo NS

    2012-03-01

    Full Text Available 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 for cesarean section (MDCS seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics.Methods: A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs, Adeoyo Maternity Hospital (SHC, and UCH Ibadan (THC, representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary.Results: The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001. Doctors were major sources of information on MDCS (30.8% as well as friends (24.3%. Common reasons reported for MDCS were fear of labor pains (68.9%, and fear of poor labor outcome (60.1%, and fear of fecal (20.2% and urinary incontinence (16.8%. More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001. However, willingness to request MDCS was low (6.6%. More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more

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

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    Sinéad M O'Neill

    2014-07-01

    Full Text Available BACKGROUND: With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. METHODS AND FINDINGS: We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996, with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28 was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI of 0.03% for stillbirth, and a number needed to harm (NNH of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31 and elective cesarean (HR 1.11, 95% CI 0.91, 1.35, although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15 and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21, yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85. Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment

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

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

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    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  11. 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.

  12. Clear cell carcinoma derived from an endometriosis focus in a scar after a caesarean section--a case report and literature review.

    Science.gov (United States)

    Dobrosz, Zuzanna; Paleń, Piotr; Stojko, Rafał; Właszczuk, Paweł; Niesłuchowska-Hoxha, Anna; Piechuta-Kośmider, Ilona

    2014-10-01

    Endometriosis is defined as the occurrence of endometrial glands and endometrial stromal cells outside their typical localization within the uterus. Malignant transformation of endometriosis foci in a scar after a caesarean section (cc) is very rare--until 2013 (in a span of 40 years), about 40 such cases have been described. In our article, we describe a case of a 42-year-old woman with a tumour localized in a scar after a caesarean section. The tumour was diagnosed as clear cell carcinoma derived from an endometriosis focus. The long time interval--17 years in average (from 3 to 39 years) between the surgery (cesarean section in most cases) and the tumor diagnosis is characteristic. In the case we describe, the patient was diagnosed 16 years after the endometriosis focus in the scar had arised. Even though endometriosis is a benign lesion, it has many features distinctive for invasive carcinoma; it may itself undergo a malignant transformation as well as increase the risk of endometrial carcinoma or clear cell ovarian carcinoma. Maybe in future, more exhaustive studies will allow establishing a therapeutic protocol in patients with extra-ovarian malignant transformation of endometriosis foci.

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

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    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.

  14. 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

  15. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  17. 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

  18. 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.

  19. 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。

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

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    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.

  1. A study of degeneration, scar formation and regeneration after section of the optic nerve in the frog, Rana pipiens.

    OpenAIRE

    Scott, T. M.; Foote, J

    1981-01-01

    Degeneration, scar formation and regeneration have been studied after section of the optic nerve in the frog. In the normal optic nerve two types of macroglial cell were identified: astrocytes and oligodendroglia. Degeneration after injury proceeded rapidly in comparison with mammals but did not lead to the production of a dense scar. Before much scarring had developed, regenerating axons penetrated the lesioned area.

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

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    Metin Canbal

    2014-06-01

    Full Text Available Purpose: We aimed to examine, mothers' level of knowledge about complications of cesarean section and the factors that influence preference for cesarean section in this study Methods: The universe of the study consisted of the women who admitted to the family medicine outdoor clinics in two different regions of Turkey namely Doğansehir State Hospital, Malatya and Kadışehri Entegrated State Hospital, Yozgat. Two hundred and one women included in the study who recruited the family medicine outdoor clinic irrespective of their primary complaint. The data was analyzed by the SPSS program. Results: Statistically significant difference was observed in terms of caesarean section operation rates in high school graduates. 29% of all the participants in this study had caesarean section operation in their first delivery. Conclusion: Personal predilections appear to be an influencing factor in deciding the type of the delivery currently. It is assumed that knowledge may be converted into the behaviors by giving the evidence based information to our patients in consistence with their perceptions along with the shared decision model in a collaborative manner.

  3. 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.

  4. 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

  5. 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.

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

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    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. 

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

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    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

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

    Science.gov (United States)

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

    2010-01-01

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

  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. 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...

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

    Science.gov (United States)

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

    2016-01-01

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

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

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    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.

  13. 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.

  14. 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.

  15. 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.

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

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    Endang Poedjiningsih

    2001-12-01

    Full Text Available For the last year the prevalence of cesarean section (CS increased in several countries as well as in Indonesia. In Indonesia there was no comprehensive study on risk factors related to CS. This case-control study was conducted at Fatmawati Hospital in Jakarta from 1 July 200 until 31 January 2001. Data was extracted from available medical records. Ceserean section was defined as a delivery through laparotomy. The control group consisted of subjects having vaginal deliveries. For each cases were selected randomly a control based on the date before or after 18 October 2000. Subject who had fetal distress had 544-folds increased risk to be CS relative to those who did not have fetal distress [adjusted odds ratio (OR = 544.86; 95% confidence intervals (CI = 71.85- 4131.78]. Furthermore, relative those who did not have dystocia, those who had dystocia had 143 times increased risk to be CS (adjusted OR = 52.86; 95% CI = 52.86 - 391.17. In term of previous CS, subjects who ever had previous CS had 30 times increased risk to be CS compared with the subjects who never had CS (adjusted OR = 30.23; 95% CI = 12.06 - 75.57. In contrast, compared with those who non cash payment, those who paid in cash had a lowered risk of 80% (adjusted OR = 0.20; 95% CI = 0.11-0.34. In conclusion, previous CS, dystocia, pre eclampsia, other medical indications, fetal distress, and non cash hospitalization expences increased risk of CS. (Med J Indones 2001; 10: 230-4Keywords: cesarean section, risk factors

  17. 早孕期剖宫产瘢痕妊娠的MRI诊断价值%Diagnostic Value of Early Uterine Cesarean Scar Pregnancy Using Magnetic Resonance Imaging

    Institute of Scientific and Technical Information of China (English)

    石慧; 孙庚喜; 李胜华; 马海锋; 冯咏辉

    2015-01-01

    目的:探讨早孕期剖宫产术后子宫瘢痕妊娠MRI表现及诊断价值。方法回顾性分析总结10例经临床、病理证实剖宫产术后子宫瘢痕妊娠患者的MRI表现。结果10例病灶均行手术治疗,9例诊断正确,1例误诊为滋养细胞肿瘤。病灶均位于子宫前下壁,呈圆形或椭圆形,8例病灶可见完整的妊娠囊,2例呈混杂包块状,表现为混杂长T1混杂长T2信号影。6例妊娠囊主要向宫腔内生长,植入子宫壁较浅,与局部子宫肌层分界清晰;4例妊娠囊种植于瘢痕深部,主要向肌层深部生长并向外膨隆,妊娠处子宫壁明显较薄;10例均行 DWI,表现为环状或混杂高信号。结论剖宫产子宫瘢痕妊娠的 MRI 影像表现有一定的特异性,有助于临床分型及术式选择。%Objective To evaluate MRI findings and diagnosis value in the early diagnosis of cesarean scar pregnancy(CSPs). Methods The MRI manifestations of 10 cases which were diagnosed as CSPs on the basis of surgery and pathology were retrospectively analyzed.Results Among 10 patients all had been underwent surgery. 9 cases were deifnitely diagnosed by MRI and misdiagnosed in 1 cases as trophoblastic disease. All the lesions were located in the anterior inferior wall of uterus, and showed rounded or round-like shapes, 8 cases belonged to Gestational sac type and 2 seemed like mixed masses with long T1 and long T2 heterogeneous signal. 6 cases of gestation sac grew into the uterine cavity mainly, and embedded in the uterine wall superifcially and had clear margin with the local uterine muscular layer. 4 cases of gestation sac embedded in the deep area of scar, grew mainly toward the uterine muscular layer and protruded out of the uterine outline, the muscular layer at the lesion became thin. All 10 patients received DWI and showed ring-like or heterogeneous hyperintensity.Conclusion The MRI features of uterine cesarean scar were speciifc, which was useful

  18. 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.

  19. 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...

  20. 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

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

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    Ibrahima Farikou

    2014-01-01

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

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

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    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. 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.

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

    Science.gov (United States)

    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.

  5. 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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Sunshine; Olson; Zighelboim; Wajdula

    1998-07-01

    Objective: This double-blind study was to compare the effect of food on the analgesic response to bromfenac, naproxen sodium, and placebo.Methods: Single doses of bromfenac (BRO) 25 mg, naproxen Na (NAP) 550 mg, or placebo (PLA) were given to 284 patients with moderate or severe pain following cesarean section. A standard breakfast was provided for the "fed" patients. "Fasted" patients received no food 3 h before and 1 h after the dose. Treatments were compared over 8 h using standard scales for pain intensity and pain relief. Plasma levels of BRO were measured in 7 fasted and 12 fed patients.Results: BRO and NAP were significantly superior to PLA; food did not affect the response to any treatment: As expected, mean peak plasma levels of bromfenac were reduced by food by about 65%.Conclusion: Food reduces the bioavailability of bromfenac but has no effect on the analgesic response.

  8. 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.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

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    Subrata Podder

    2015-01-01

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

  13. 剖宫产瘢痕处早期妊娠的特点及临床诊治进展探讨%Investigation of characteristics and clinical progress of early cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    何红瑞

    2015-01-01

    Objective To investigate the clinical characteristics and the value of ultrasonic diagnosis for patients with early cesarean scar pregnancy.Methods Forty-three patients with early cesarean scar pregnancy in recent years who were confirmed by pathology were selected.Summarized the characteristics of different types of cases and calculate the ultrasonic diagnostic imaging efficiency.Results Among the fourty-three cases of patients, 40 cases were diagnosed with ultrasound diagnosis, accounting for 93.02%;Three cases misdiagnosed were trophoblastic disease, normal intrauterine pregnancy, cervical pregnancy.Conclusions Early ultrasound diagnosis of cesarean scar pregnancy can help understand the status and location of scar pregnancy by imaging featuies, and the diagnostic accuracy rate is high, with a clinical value of being promotion.%目的 研究剖宫产瘢痕处早期妊娠患者的临床特点以及超声诊断价值.方法 选取浚县人民医院近年收治的剖宫产瘢痕处早期妊娠患者43例,均经病理学证实.总结不同类型病例影像学特征并计算其超声诊断有效率.结果 43例患者中采用超声诊断确诊40例,占93.02%;另3例分别误诊为滋养细胞疾病、正常宫内早孕、宫颈妊娠.结论 对剖宫产瘢痕处早期妊娠患者行超声诊断能够通过影像学特征有效了解患者瘢痕妊娠状态、位置,诊断正确率较高,具有临床推广价值.

  14. 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.

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

    Science.gov (United States)

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

    1989-11-01

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

  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. 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...

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

    Science.gov (United States)

    Klein, Michael C

    2012-12-01

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

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

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    Manisha Gupta

    2016-12-01

    Full Text Available Background: FHR monitoring plays the most important role in management of labouring patient when incidence of fetal hypoxia and progressive asphyxia increases. Now a day’s cardiotocography (CTG become a popular method for monitoring of fetal wellbeing and it is assisting the obstetrician in making the decision on the mode of delivery to improve perinatal outcome. The aim of the study was to assess the effect of cardiotocography on perinatal outcome and its correlation with caesarean section rate. Methods: In this prospective observational study 201 gravid women with high risk pregnancy in first stage of labour were taken. Result was assessed in the form of Apgar score at five minute, NICU admission, perinatal mortality and mode of delivery. Statistical analysis is done by using Chi square test and p<0.05 is considered as statistically significant. Results: Perinatal morbidity in the form of NICU admission is higher in nonreactive group as compare to reactive group (75.7% v/s 22.8%. Cesarean section rate for fetal distress were higher in nonreactive group (87.8% in comparison to reactive group (20.5%. So this study suggest that there is significant difference in mode of delivery with increasing chances of caesarean section in cases belong to non-reactive traces (p<0.001. Conclusions: Admission test is non-invasive and the best screening test to evaluate the fetal health and to predict the perinatal outcome but it also associated with increase caesarean section rate.

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

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    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.

  1. Trinidadian women’s knowledge, perceptions, and preferences regarding cesarean section: How do they make choices?

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    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

  2. 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

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

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    Al-Kadri HM

    2015-07-01

    Full Text Available Hanan M Al-Kadri,1 Sultana A Al-Anazi,1 Hani M Tamim21Department of Obstetrics and Gynecology, King Abdulaziz Medical City, 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi ArabiaBackground: Cesarean section (CS rate has shown creepy increase. We aimed in this work to identify factors contributing to increasing rate of CS in central Saudi Arabia.Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2. G1 had delivered by CS during the year 2002 (CS rate 12%, and G2 had delivered by CS during the year 2009 (CS rate 20%. We compared the included women’s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of ≤0.05 was considered significant.Results: A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12–0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32–81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02–66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02–1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39–4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06–7.15.Conclusion: CS delivery rate

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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。

  9. [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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

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

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    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.

  19. 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...

  20. ABDOMINAL SCAR ENDOMETRIOSIS: REPORT OF 28 CASES

    Institute of Scientific and Technical Information of China (English)

    向阳; 郎景和; 王友芳; 黄荣丽; 连丽娟

    1995-01-01

    Twenty-eight cases of abdominal scar endometriosis from Janurary,1989 to December,1993 are reported.Of these patients,twenty-four underwent term cesarean section,and four underwent a midtrimester abortion by abdominal hysterotomy.The majority of patients manifested symptoms 1 year after the operation.The most common was a painful mass of scar tissue that became swollen and tender during menstruation.The pathogenesis,diagnosis and treatment are discussed.In correlation with the pathological findings,the effects of drug therapy are evaluated.It was found that surgical excision is the best method of treatment.

  1. The clinical analysis of laparoscopy and hysteroscopy of ectopic pregnancy in 39 cases with the cesarean scar%宫腔镜及宫腹腔镜联合治疗39例剖宫产瘢痕妊娠的临床分析

    Institute of Scientific and Technical Information of China (English)

    梅立; 岳军; 谢兰

    2012-01-01

    Objective The feasibility and outcome of laparoscopy and hysteroscopy for patients with ectopic pregnancy in the cesarean section scar was studied. Methods From January 2006 to December 2011 , 39 patients diagnosed with ectopic pregnancy in a previous cesarean section scar underwent laparoscopic or hysteroscopic removal of the gestational sac at our department. All the cases were divided into two types; A and B. A retrospective review of medical records of these patients was performed. Results In all of them, the ectopic gestational sacs of type 1 were removed by hysteroscopy, those of type II were removed by hyste-roscopy and laparoscopy without converting to laparoctomy and the scar defect was repaired by intracorporeal sutures. All the cases had a steady decline of the serum β-hCG level. The lasting time of the serum β-hCG level in Type B was shorter than that in Type A (P<0. 05)o All the patients required additional methotrexate administration postoperatively. Conclusion Hysteroscopic/ Laparoscopic and hysteroscopic removal of ectopic gestational sac within a cesarean scar seems to be a feasible and safe procedure that might be considered as a treatment option.%目的 探讨宫腔镜及宫腹腔镜联合治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者的临床疗效.方法 回顾性分析我院2006~2011年诊治的CSP患者39例,根据孕囊生长的方向分为内生型(A)组和外生型(B)组,A组23例,B组16例,A组采用宫腔镜下清宫术,配合药物辅助治疗;B组行宫腹腔镜联合妊娠病灶切除+子宫瘢痕修补术,配合药物辅助治疗.结果 治疗/后两组血hCG值的差异无统计学意义(P>0.05),而B组血HCG恢复正常的时间较A组短,差异有统计学意义(P<0.05).结论 对于CSP患者,采用积极手术干预配合药物治疗的方法,治疗周期短,效果确切,有利于提高患者生活质量.术前如充分分析患者病情,明确诊断及CSP类型,均能采用不同的保留子宫的保守性手术治疗.

  2. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

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    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

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

    Science.gov (United States)

    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.

  4. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

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    Pınar Solmaz Hasdemir

    2015-01-01

    Full Text Available Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

  5. Scar Endometriosis: a Case Report with Literature Review

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    Pratiksha Gupta

    2015-12-01

    Full Text Available Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting one case of scar endometriosis involving rectus sheath following cesarean section. The patient required wide surgical excision of the lesion. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed.

  6. 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.

  7. 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

  8. Analysis of Correlated Risk Factors of Postpartum Hemorrhage after Cesarean Section%剖宫产产后出血相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    马春艺; 刘增佑; 张小平

    2015-01-01

    Objective To explore the risk factors of postpartum hemorrhage after cesarean section . Methods A total of 5210 cases of cesarean section from Shenzhen City Nanshan People′s Hospital from Jan.2011 to Dec.2013 were selected,including 89 cases of postpartum hemorrhage,which were assigned to case group,and another 89 cases without postpartum hemorrhage were assigned to control group.The risk fac-tors of postpartum hemorrhage were analyzed .Results The influencing factors of postpartum hemorrhage after cesarean section included in multiple pregnancy(OR=2.568,95%CI 1.411-3.724),placenta praevia (OR=7.199,95%CI 4.663-9.736),placental adherence or implantation or placental abruption (OR =2.951,95%CI 1.735-4.166),uterus scar(OR =2.881,95%CI 1.683-4.078),uterine inertia(OR =8.207,95%CI 5.902-10.512),inhibitor of antepartum uterine contraction (OR =4.865,95%CI 3.073-6.656) and coagulation disorders (OR =3.004,95%CI 1.771-4.237).Conclusion The incidence of postpartum hemorrhage after cesarean section is still high .Preventive measures at the risk factors should be a-dopted to lower the incidence of the complication .%目的:探讨剖宫产产后出血的相关危险因素。方法选择2011年1月至2013年12月在深圳市南山人民医院妇产科实施剖宫产产妇5210例,术后发生出血89例,以发生产后出血的患者为病例组,同时选择未出血的89例剖宫产患者为对照组,研究可能影响产后出血的相关危险因素。结果影响产后出血的因素包括多胎妊娠(OR =2.568,95%CI 1.411~3.724)、前置胎盘(OR =7.199,95%CI 4.663~9.736)、胎盘粘连或植入或早剥(OR=2.951,95%CI 1.735~4.166)、子宫瘢痕(OR=2.881,95%CI 1.683~4.078)、子宫收缩乏力(OR=8.207,95%CI 5.902~10.512)、产前子宫收缩抑制剂( OR =4.865,95%CI 3.073~6.656)、凝血功能障碍( OR =3.004,95%CI 1.771~4.237)。

  9. Changes of cesarean section rate and indications in recent seven years%医院近七年剖宫产率及剖宫产指征的变化

    Institute of Scientific and Technical Information of China (English)

    王婷婷; 杨海澜; 韩方

    2014-01-01

    Objective To study the changes of cesarean section rate,to evaluate the indications for cesarean section and to discuss how to reduce cesarean section rate.Methods Medical records of 6 402 cases of cesarean section were retrospectively analyzed.The rate of cesarean section and the percentage of various indications of cesarean section were observed.Results Cesarean section rate had been decreasing.The rate decreased from 71.7% (703/980) in 2006 to 61.1% (860/1407) in 2008.Cesarean rate increased slightly to 63.6% (963/1514) in 2009 ; cesarean section rate dropped from 58.3% (1047/1797) in 2010 to 45.9% (999/2176) in 2012.Social factors,pregnancy-associated complications and fetal distress were the 3 main cesarean section indications in 2006,2007,2009,2010.Social factors,pregnancy-associated complications and dystocia were the 3 main cesarean section indications in 2008.Social factors,pregnancy-associated complications and uterus scar were presented in the first 3 of cesarean section indications in 2011,2012.Pregnancy-associated complications consisted of hypertensive disorders complicating pregnancy,pregnancy combined with external and internal diseases,placenta previa and placental abruption,diabetes mellitus,gestational,intrahepatic cholestasis of pregnancy.Conclusions Pregnancy-associated complications,social factors and fetal distress are the key reasons of cesarean section indications.It is important to strengthen prenatal checks and health awareness,reduce the occurrence of pregnancy-associated complications,grasp the medical indication strictly,as well as to decrease the cesarean of social factors.%目的 探讨剖宫产率的变化,分析剖宫产各项指征的合理性.方法 对2006年1月至2012年12月山西医科大学第一医院产科6 402例行剖宫产手术分娩产妇的病历资料进行回顾性分析,计算每年剖宫产率及各项剖宫产指征所占比例.结果 2006-2008年剖宫产率从71.7%(703/980)下降到61.1% (860

  10. The Diagnostic Value and Imaging Findings of MRI and Ultrasonography for Cesarean Scar Pregnancy%剖宫产切口瘢痕妊娠的MRI、超声表现及诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐优文; 郭银珍

    2016-01-01

    Objective To analyze the MRI and ultrasonographic findings of cesarean scar pregnancy and to evaluate the diagnostic value.Methods The clinical data of 44 cases of patients with cesarean scar pregnancy confirmed by surgery and pathology in our hospital were retrospectively analyzed. All patients completed CT and MRI examination and the imaging data were complete.Results In the 44 cases of patients with cesarean scar pregnancy, 34 cases were detected by transvaginal ultrasonography and the accuracy rate was 77.27%. Among them, there were 19 cases detected of simple gestational sac type, 15 cases of heterogeneous mass type, 10 cases misdiagnosed and 4 cases misdiagnosed as cervical pregnancy and 6 cases misdiagnosed as intrauterine pregnancy; MRI detected that there were 43 cases of cesarean scar pregnancy and the accuracy rate was 97.73%. There were 27 cases of simple gestational sac type, 1 cases of missed diagnosis and 15 cases of heterogeneous mass type detected. The detection rate of MRI in simple gestational sac type and general diagnostic coincidence rate were higher than those of transvaginal ultrasonography (P<0.05).Conclusion In the clinical diagnosis of patients with cesarean scar pregnancy, to adopt MRI, the diagnostic accuracy rate is higher than that of transvaginal ultrasonography. MRI can be taken as an auxiliary means of transvaginal ultrasonography in diagnosis.%目的 分析剖宫产切口瘢痕妊娠的MRI及超声表现,评估其诊断价值.方法 回顾性分析我院收治的经手术及病理证实为剖宫产切口瘢痕妊娠的44例患者的临床资料,所有患者均完成CT及MRI检查.结果 44例剖宫产切口瘢痕妊娠患者,阴道超声检出34例,准确率77.27%,其中单纯孕囊型检出19例,不均质包块型检出15例,误诊10例,4例误诊为宫颈妊娠,6例误诊为宫内妊娠;MRI检出剖宫产切口瘢痕妊娠43例,准确率为97.73%,检出单纯孕囊型27例,漏诊1例,15例不均质包块型均检出.MRI单纯

  11. Clinic and pathological characteristics observation of early pregnancy cesarean scar pregnancy%早孕期剖宫产瘢痕妊娠的临床及病理特点观察

    Institute of Scientific and Technical Information of China (English)

    蒯莉莉

    2015-01-01

    目的:探讨早孕期剖宫产瘢痕妊娠不同分型的临床与病理学特点。方法:收治剖宫产瘢痕妊娠患者60例,回顾性分析其临床资料及病理学特点。结果:50例患者经超声检查确诊,诊断率83.33%,另10例患者通过MRI检查确诊;40例患者的病理标本发生病理变化,病理变化概率66.67%;40例患者中外生型28例,内生型12例,外生型的病理改变率明显高于内生型(P<0.05)。结论:内生型与外生型剖宫产瘢痕妊娠的临床症状及病理特点存在较大不同,而平滑肌肌层缝隙是导致剖宫产瘢痕妊娠产生的首要因素。MRI检查可明确诊断剖宫产瘢痕妊娠的临床分型,同时还可借助病理组织检查结果为疾病确诊提供支持。%Objective:To explore the clinic and pathological characteristics of early pregnancy cesarean scar pregnancy in different type.Methods:60 patients with cesarean scar pregnancy were selected.The clinical data and pathological characteristics were retrospectived analyzed.Results:50 patients were diagnosed by ultrasound examination,and the diagnosis rate was 83.33%. Other 10 patients were diagnosed by MRI examination.The pathological specimens of 40 patients had pathological changes,and the probability of pathological changes was 66.67%.In 40 patients,28 cases were exogenous type,and 12 cases were endogenous type.The pathological change rate of exogenous type was significantly higher than that of endogenous type(P<0.05).Conclusion:The clinical symptoms and pathological characteristics of endogenous type and exogenous type cesarean scar pregnancy are quite different,and the smooth muscle layer crack is the main cause of cesarean scar pregnancy.MRI examination can confirm the diagnosis of cesarean scar pregnancy clinical typing,but also with the histopathologic examination results provide support for the disease diagnosis.

  12. Application of ultrasound in the diagnosis and treatment for cesarean scar pregnancy%超声在剖宫产瘢痕妊娠诊治中的应用

    Institute of Scientific and Technical Information of China (English)

    贾保霞; 刘滨月; 刘宇清; 陈金华; 于淑敏

    2011-01-01

    目的 探讨超声在剖宫产瘢痕妊娠诊治中的应用价值.方法 回顾性分析42例剖宫产瘢痕妊娠患者的声像图特征及超声辅助下的治疗方法.结果 42例患者中,超声正确诊断35例(83.3%,35/42).声像图表现:单纯妊娠囊型15例,混合回声型(或包块型)22例,部分位于宫腔型5例.根据患者临床情况及声像图特征,采取子宫动脉栓塞术、超声引导下病灶清除加子宫修补术2例,经腹超声引导下清官术15例,保守治疗20例,综合治疗5例.治疗过程中,超声检查显示病灶逐渐缩小,血流逐渐减少到消失,血β-人绒毛膜促性腺激素逐渐降低到正常.结论 超声检查可以对剖宫产瘢痕妊娠及时、准确地做出诊断;根据患者声像图特征,有助于临床选择恰当的治疗方案,并评估疗效.%Objective To explore the application value of ultrasound in the diagnosis and treatment for cesarean scar pregnancy. Method The ultrasonic features, clinical treatment of 42 cases of cesarean scar pregnancy were reviewed retrospectively. Results Among 42 patients,35 patients (83.3% ,35/42) were diagnosed accurately by ultrasound. The sonographic appearance showed 15 cases were gestational sac-type and 22 cases were mixed mass-type,the other 5 cases were classified into type three in which the gestational sac mostly located at the uterine cavity and only the inferior part implanted in the cesarean scar. Uterine artery embolisation and suction curettage with the sonographic guidance with 2 cases, intra-amniotic administration of MTX under sonographic guidance with 15 cases, expectant treatment with 20 cases or complex treatment with 5 cases. During treatment,ultrasonography showed focus of infection was shrinked gradually and blood flow disappeared, blood (3 -human chorionic gonadotrophin was decreased to normal level. ConclusionUltrasound can diagnose cesarean scar pregnancy promptly and accurately, proportionate treatment would be selected according

  13. 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.

  14. 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.

  15. 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

  16. Clinical analysis of the best choice for uterine incision for cases of multiple cesarean section%多次剖宫产最佳切口选择的临床分析

    Institute of Scientific and Technical Information of China (English)

    曹蓉; FERTOUT; 谭琼

    2016-01-01

    目的 探讨瘢痕子宫行多次剖宫产时最佳切口的选择.方法 回顾性分析2013年1月至2014年10月在阿尔及利亚赛义达省妇产医院施行多次剖宫产的543例患者的临床资料.以1cm为等差,根据瘢痕子宫手术切口位置分成4组.136例子宫下段原瘢痕处进入宫腔为A组;135例高于瘢痕1cm处进入宫腔为B组;137例高于瘢痕2cm处进入宫腔为C组;135例高于瘢痕3 cm处进入宫腔为D组.对术中出血、手术时间、术后住院时间、新生儿评分、术中术后并发症进行比较分析.结果 C组与其它各组在术中出血、手术时间进行比较,均P=0.000<0.01.与A组在并发症方面比较,P=0.001<0.05.新生儿评分与A组比较,P=0.014<0.05,与D组比较,P=0.002<0.01,差异有统计学意义.结论 多次剖宫产子宫切口一般应选择位于子宫下段原切口瘢痕上2cm进入宫腔为宜.%Objective To explore the best incision of scar uterus for cases of multiple cesarean section.Methods Clinical data of 543 cases of multiple cesarean section performed during the period of January 2013 to October 2014 in Algeria Saiyida Provincial Maternity Hospital were analyzed retrospectively.Based on 1cm arithmetic, the cases were divided into four groups according to the operation incision of scar uterus.The incision in group A (136 cases) was at scar uterus, that in group B (135 cases) was 1cm higher than the scar, that in group C (137 cases) was 2cm higher than the scar, and that in group D (135 cases) was 3cm higher than the scar.Four groups were compared in intraoperative bleeding, surgery duration, postoperative hospital stay, neonatal score and intraoperative and postoperative complications. Results Compared with other groups, group C was significantly different in intraoperative bleeding and operation duration (all P=0.000<0.01), and it was different from group A in complications (P=0.001<0.05).In neonatal score group C was significantly different from group A (P=0

  17. 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.

  18. 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.

  19. 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.

  20. Early skin-to-skin contact after cesarean section: A randomized clinical pilot study

    Science.gov (United States)

    Kollmann, Martina; Aldrian, Lisa; Scheuchenegger, Anna; Mautner, Eva; Herzog, Sereina A.; Urlesberger, Berndt; Raggam, Reinhard B.; Lang, Uwe; Obermayer-Pietsch, Barbara; Klaritsch, Philipp

    2017-01-01

    Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial

  1. 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.

  2. [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.

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

    Science.gov (United States)

    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.

  4. Evaluating trial of scar in patients with a history of caesarean section

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    Aliya Islam

    2011-01-01

    Full Text Available Aims: To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar. Patients and Methods : The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose. Results : The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required with syntocinon infusion. 60 patients were induced with prostaglandin E 2 vaginal tablet. Conclusion : This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.

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

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    Denise N Mesquita

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

  6. 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

  7. 剖宫产瘢痕部位妊娠的超声诊断及临床价值分析%Analysis of ultrasound diagnosis and clinical value of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    公茂梅

    2016-01-01

    Objective:To analyze the ultrasound diagnosis and clinical value of cesarean scar pregnancy.Methods:60 patients with cesarean scar pregnancy were selected.According to the different parts of the diagnosis scheme,they were divided into the control group and the observation group with 30 cases in each.The control group was given abdominal ultrasound diagnosis.The observation group was given transvaginal ultrasound diagnosis.The sonogram,CDFI result and diagnosis coincidence of two groups were compared.Results:20 cases found mixed type package with clear boundary in the uterine incision area after operative abortion.3 cases of gestation sac were in incision at menopause 36 days.4 cases of CDFI did not appear flow.The diagnosis coincidence rate of the observation group was higher than that of the control group(P<0.05).Conclusion:The value of transvaginal ultrasound diagnosis is higher in patients with cesarean scar pregnancy,it can improve the diagnosis coincidence rate.%目的:分析剖宫产瘢痕部位妊娠超声诊断和其临床价值。方法:收治剖宫产瘢痕部位妊娠患者60例,根据不同部位诊断方案分成对照组和观察组各30例。对照组给予腹部超声诊断,观察组给予阴道超声诊断。比较两组患者的声像图表现、CDFI 结果及诊断符合情况。结果:20例人流手术后在子宫切口区域发现混合型包块,且边界清晰;3例停经36 d妊娠囊在切口之中;有4例CDFI未出现血流;观察组诊断符合率高于对照组(P<0.05)。结论:剖宫产瘢痕部位妊娠患者行经阴道超声诊断价值较高,能够提高诊断符合率。

  8. Analysis on influencing factors and indications of conversion to cesarean section during vaginal trial production in 150 cases%150例阴道试产中转剖宫产影响因素和指征分析

    Institute of Scientific and Technical Information of China (English)

    胡春霞; 李跃萍; 吴小妹; 华少萍; 凌奕; 莫秀兰; 郑小妹; 周璟; 金松

    2013-01-01

    Objective: To explore the relationship between various influencing factors and conversion to cesarean section during vaginal trial production.Methods: A case control study was conducted to investigate the basic data of cases of conversion to cesarean section during vaginal trial production and cases of spontaneous labor, then the influencing factors of cesarean section were analyzed and screened by univariate and raultivariate logistic regression analysis.Results: Conditional logistic analysis showed that maternal age, parity, and neonatal weight were correlated with conversion to cesarean section during vaginal trial production, but pregnancy complications (gestational diabetes mellitus, pregnancy combined with hypothyroidism, preeclampsia) , fetal distress, arrested labor, cephalopelvic disproportion, scarred uterus, and unsuccessful induced labor accounted for 59.3% of objective factors of cesarean section during vaginal trial production, subjective factors (including intolerant pain, twin, precious babies, worrying about maternal and infantile safety) accounted for 42.0% of the factors of cesarean section during vaginal trial production.Conclusion: The increase of cesarean section during vaginal trial production is the results of objective factors and subjective factors, which should be treated with a comprehensive approach.%目的:探讨各种影响因素与阴道试产中转剖宫产的关系.方法:采用病例对照研究的方法,调查阴道试产中转剖宫产和顺产两组人群的相关信息,经单因素和多因素分析筛选剖宫产的影响因素.结果:条件Logistic分析表明孕妇年龄、生产次数、新生儿体重3个因素与阴道试产中转剖宫产有关,而临床诊断中妊娠合并症(如妊娠期糖尿病、妊娠合并甲低、妊娠合并甲亢、子痫前期等)、胎儿窘迫、产程停滞、头盆不称、疤痕子宫及引产失败占阴道试产中转剖宫产客观原因的59.3%,另有42.0%的主观因素(包括

  9. 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

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

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    Walid Hamed Nofal

    2014-01-01

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

  11. 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.

  12. Analysis on maternal and fetal outcomes in 73 cases re-pregnant women with cesarean scar uterus complicating placenta previa%瘢痕子宫再次妊娠并发前置胎盘73例母婴结局分析

    Institute of Scientific and Technical Information of China (English)

    马红柳; 罗欣; 漆洪波; 彭方亮

    2016-01-01

    Objective To explore the maternal and fetal perioperative outcomes of re-pregnant women with cesarean scar uterus complicating placenta previa and its influential factors. Methods Seventy-three cases of cesarean scar uterus complicat-ing placenta previa delivered in the First Affiliated Hospital of Chongqing Medical University from January 2014 to December 2015 were retrospectively analyzed. The maternal general condition ,intraoperative situation as well as maternal and fetal outcome were compared. Seventy-three pregnant women were grouped according to whether complicating dangerous placenta previa occur-rence and whether previous pregnancy being elective cesarean section. Results (1)The probability of complicating dangerous placenta previa in re-pregnancy women with previous elective cesarean section was higher than that in re-preganat women with ce-sarean section after vaginal trial labor failure,the difference was statistically significant[40.00%(18/45) vs. 28.57%(8/28),P<0.01]. (2)The occurrence rates of placenta implantation,postpartum hemorrhage,hysterectomy,DIC,blood transfusion and poor neona-tal outcomes in the pregnant women with complicating dangerous placenta previa were significantly higher than those in the preg-nant women with non-dangerous placenta previa,the difference was statistically significant(P<0.05). Conclusion Re-pregnant women with cesarean scar uterus are easier to develop placenta previa;re-pregnancy women with previous elective cesarean sec-tion have the high occurrence rates of complicating dangerous placenta previa and poor maternal and neonatal outcomes;strictly mastering the indication of first cesarean section is the key to reduce the poor maternal and neonatal outcomes of re-pregnancy.%目的:探讨前次剖宫产后瘢痕子宫再次妊娠并发前置胎盘的母婴围生期结局及其影响因素。方法回顾性分析2014年1月至2015年12月于重庆医科大学附属第一医院住院分娩的瘢痕子宫(前次剖

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

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    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

  14. 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

    In the second cesarean section, due to uterine scar contracture, poor flexibility, the incision should not be forced shredded after lower uterine segment incision, while should be curved cut an enough uterine incision for delivery. The method described in this paper is simple and does not require special equipment, adapt any level hospitals, worthy of promotion.

  15. 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%,

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

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    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.

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

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    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.

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

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    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.

  19. 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

    目的 探讨某三甲医院产科剖宫产的原因及影响因素.方法 对2008年1月至2009年1月在某三甲医院产科526例产妇的临床资料进行收集和整理.结果 279例行剖宫产的产妇中,剖宫产手术指征前5位分别为胎儿因素(占25.45%)、社会因素(占20.07%)、异常妊娠分娩史(占20.07%)、胎位异常(占12.90%)、胎盘羊水异常(占8.96%);剖宫产排前5位的医学因素手术指征分别为瘢痕子宫(占24.66%)、胎儿宫内窘迫(占18.83%)、臀位(占8.97%)、巨大儿(占5.38%)、羊水过少(占4.93%);主要社会因素为产妇怕痛(占41.07%),担心顺产不成功,又要剖宫产,不想多受罪(占32.14%)而拒绝阴道试产;经多因素Logistic回归分析发现年龄、初产妇、产时出血量≥220 mL、有合并症或者并发症是剖宫产的危险因素.结论 普及妊娠分娩的知识,加强自然分娩益处的宣传,减少社会因素所致剖宫产,严格掌握剖宫产的指征可有效地控制剖宫产率.%Objective To investigate the causes of cesarean section and its influencing factors from a first class hospital. Methods Clinical data of 526 cases of puerpera were collected and surveyed in maternity department in a hospital from January 2008 to January 2009. Results The top 5 factors ranked among the 279 cases of cesarean section were:fetal factors( 25. 45% ), social factors( 20. 07% ),abnormal parturition history( 20.07% ),abnormal fetal position( 12.90% ),abnormal placenta and amniotic fluid( 8.96% ). The top five medical indications were:scar uterus( 24. 66% ),fetal distress( 18. 83% ),breech birth( 8.97% ), fetal macrosomia( 5. 38% ),hypamnion( 4. 93% ). The main social factor was the fear of maternal pains ( 41.07% ),the parturient did not want to surfer both natural parturition and cesarean section( 32.14% ),and so on. Univariate logistic analysis showed that age,primipara,blood loss when giving birth≥220 mL and and the complications were the risk factors for cesarean

  20. Curative effect analysis of hysteroscopic curettage for the treatment of cesarean scar pregnancy%宫腔镜下清宫术治疗剖宫产瘢痕妊娠的疗效分析

    Institute of Scientific and Technical Information of China (English)

    毛丽丽; 杨亚培

    2014-01-01

    目的:探讨宫腔镜下行清宫术对于治疗剖宫产瘢痕部位妊娠的效果。方法:收治剖宫产子宫切口瘢痕妊娠患者32例,均接受宫腔镜下清宫术,对其临床病例资料进行回顾性分析。术中宫颈注射缩宫素及垂体后叶素,术毕给予甲氨蝶呤宫颈注射,术后复查血β-HCG及盆腔彩超检查。结果:32例患者均一次性手术成功,无中转开腹、子宫穿孔发生。二者瘢痕厚度、血β-HCG值及血流阻力指数(RI)比较,差异均无统计学意义(P>0.05);术后3天血β-HCG下降平均(85.1%±10.3%);术后血β-HCG在7~23天降至正常。结论:宫腔镜下清宫术对于治疗剖宫产瘢痕妊娠具有创伤小、手术时间短、出血少、术后恢复快、住院时间短的特点,是微创、直接、准确、有效的治疗方法。%Objective:To explore the effect of hysteroscopic curettage for the treatment of cesarean scar pregnancy.Methods:32 patients with cesarean scar pregnancy were selected,they underwent hysteroscopic curettage.The clinical data of these patients were retrospectively analyzed.In the operation,all the patients were given the cervical injection of oxytocin and vasopressin;after operation,all the patients were given methotrexate cervical injection;after the operation,we checked the blood β-HCG and pelvic ultrasonography.Results:32 patients were all one-time successful without conversion to laparotomy and perforation of the uterus. The scar thickness,serum β-HCG and blood flow resistance index(RI) were compared,the differences were not significant(P>0.05).At 3 days after operation,serum β-HCG was decreased by an average of 85.1%±10.3%;at 7 to 23 days after operation, serum β-HCG was decreased to normal.Conclusion:There are many characteristics of application of hysteroscopic curettage for the treatment of cesarean scar pregnancy,such as little trauma,short operation time,less bleeding,faster postoperative recovery and

  1. 剖宫产后疤痕妊娠阴式手术临床效果观察%Cesarean scar pregnancy after vaginal surgery Clinical Efficacy

    Institute of Scientific and Technical Information of China (English)

    叶红杏; 洪小娟; 陈美凤

    2014-01-01

    Objective compare the treatment of caesarean scar pregnancy, explore the advantage of Yin type surgery. Methods enrolled 38 patients of caesarean scar pregnancy, compare the treatment methods, and summarize the advantage of Yin type surgery. Results Yin type surgery has the advantages of quicker recovery, shorter patient stay and less cost. in addition, there is no scar left in abdominal wall. Conclusions the Yin type surgery is the best way to treat of caesarean scar pregnancy.%目的:比较剖宫产后疤痕妊娠治疗方法,探讨阴式手术的优点,总结阴式手术围术期护理要点。方法对38例剖宫产后疤痕妊娠患者进行治疗方法及效果比较。结果阴式手术具术后康复快、住院时间短、腹壁不留疤痕、医疗费用低等优点。做好围手术期的护理可以提高手术成功率。结论剖宫产后疤痕妊娠阴式手术治疗方法优于其他治疗方法。做好围手术期的护理可以促进患者手术后康复。

  2. 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

    Full Text Available OBJETIVOS: criar um modelo preditivo para ocorrência de cesárea na Maternidade Professor Monteiro de Morais após avaliação dos fatores de risco anteparto das gestantes que pariram no período de 1 de setembro de 1999 a 31 de agosto de 2000, e posteriormente verificar a eficiência do serviço na indicação de cesárea. MÉTODOS: foi realizado estudo longitudinal, do tipo caso-controle com 3626 gestantes, no qual se verificou quais os fatores anteparto foram considerados de risco para cesárea, no período de 1 de setembro de 1999 a 31 de agosto de 2000. Posteriormente, criou-se modelo preditivo ideal, o qual permitiu quantificar o risco de cesárea para cada paciente na presença de um ou mais fatores de risco. A seguir, aplicou-se o modelo à amostra do estudo a fim de verificar o grau de concordância entre o risco previsto de cesárea e a realização do ato cirúrgico, ou seja, a eficácia na indicação de cesariana. RESULTADOS: aplicando-se o modelo preditivo na amostra, verificou-se que na ausência dos fatores de riscos anteparto, o risco basal de cesárea foi de 15,2%. O grau de concordância entre o previsto pelo modelo logístico e a ocorrência de cesárea foi de 86,6%. CONCLUSÕES: o modelo logístico permitiu identificar o risco basal de cesárea e quantificar a probabilidade de cesárea a partir da introdução do fator de risco. O modelo pode ser considerado útil e eficaz, uma vez que houve concordância entre o acerto e o previsto em 86,6% para cesariana, e 53,6% das pacientes submetidas ao parto normal, de fato, não tinham fator de risco para cesárea.PURPOSE: to create a predictive model for cesarean section at the "Professor Monteiro de Morais Maternity" after evaluation of antepartum risk factors of the pregnant women who delivered from September 1, 1999 to August 31, 2000, and then, to verify the efficacy of indication for cesarean section. METHODS: a longitudinal, case control study with 3.626 pregnant women was

  3. 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.

  4. 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.

  5. Maternal and neonatal effects of nalbuphine given immediately before induction of general anesthesia for elective cesarean section

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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...

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

    Directory of Open Access Journals (Sweden)

    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

  11. 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

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

    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.

  13. Clinical Experience of Cesarean Scar Pregnancy on 12 Cases with Uterine Artery Embolism Combined Curettage Therapy%子宫动脉栓塞加清宫术治疗疤痕妊娠12例临床体会

    Institute of Scientific and Technical Information of China (English)

    李媛媛; 李宁; 徐上

    2014-01-01

    Objective: To discuss the effectiveniss on cesarean scar pregnancy with uterine artery embolism combined curettage therapy. Methods: The clinical data of 12 cases with cesarean scar pregnancy were analyzed retrospectively.Which included method of treatment,effect,prognosis and adverse reactions by bilateral artery catheterization,injection methotrexate and gelatin sponge. Results: 12 cases were successful hemostasis and retained the uterus.Then they underwent curettage after in a week, None of them occurred uterine infection and uterine cavity adherence. After 1~3 months,they had normal menstruation.The pathologic examination showed the chorionic tissues,There was no obvious difference compared with preoperative of blood routine and heptic and renal functions,the serum HCG and homones become normal range in 3 to 6 weeks.Conclusion: Uterine artery embolism combined curettage were micro-invasive,signiifcant effect,hige success rate and little side effects for the treatment of micro-invasive,signiifcant effect,hige success rate and little side effects.%目的:探讨子宫动脉栓塞加清宫术治疗剖宫产子宫疤痕妊娠(CSP)临床效果。方法:回顾性分析12例CSP患者的临床资料,内容包括患者采用双侧股动脉穿刺插管,灌注甲氨蝶呤+明胶海绵颗粒的治疗方法,治疗效果、预后情况及不良反应。结果:12例患者均成功栓塞,1周内行清宫术,无宫腔感染及黏连的发生,术后1~3月阴道出血停止,月经恢复正常,均成功的保留了生育功能,病理检查清除组织显示绒毛组织,不同程度变性、坏死。随访复查血常规及肝肾功能与术前无明显差异。激素水平及血尿HCG值3~6周内回复正常。结论:子宫动脉栓塞加清宫术治疗CSP具有微创、有效,不良反应及并发症小成功率高的优点。

  14. Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars.

    Science.gov (United States)

    Francica, G; Scarano, F

    2009-09-01

    Sommario INTRODUZIONE: Scopo dello studio è valutare le caratteristiche ecografiche e cliniche di endometriomi in prossimità di cicatrice di Pfannenstiel in rapporto a ritardo diagnostico segnalato da dimensioni ≥ 30 mm al momento della diagnosi istologica. METODI: Sono stati confrontati i dati clinico-anamnestici, ecografici e Color Doppler di 13 pazienti (età media 31.3 anni) con 13 endometriomi ≥ 30 mm (Ø medio 41.8 mm; range 30–60 mm) e di 17 pazienti (età media 30.7 anni) con 19 endometriomi morfologia ovalare, aree liquide interne, tramiti fistolosi e multipli poli vascolari con aumentata vascolarizzazione intralesionale. CONCLUSIONI: Il ritardo nella diagnosi dell'endometrioma su cicatrice di Pfannenstiel, segnalato da una storia clinica più lunga e complessa, modifica i caratteri ecostrutturali più tipici dell'endometrioma e può rendere ancora più difficile il riconoscimento di questa condizione patologica.

  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. 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.

  17. 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。

  18. 剖宫产后再次妊娠不完全性子宫破裂分析%Analysis of incomplete uterine rupture during pregnancy after cesarean section

    Institute of Scientific and Technical Information of China (English)

    李婧; 岳亚飞

    2012-01-01

    Objective To explore the high risk factors of incomplete uterine rupture during pregnancy again after cesarean section. Methods Twenty-six cases of scarred uterus who had secondary pregnancy and hospitalized in Xi' an Qujiang Obstetric Hospital from March to December 2011 were retrospectively studied, including 9 cases of incomplete uterine rupture and 17 cases of unruptured uterine. SPSS 11.5 was used to analyze the previous surgical incision healing, incision position, uterine cavity operation, thickness of the scar and operation intervals. Results The differences in uterine cavity operation and thickness of the scar at late trimester of pregnancy between two groups were statistically significantly ( t value was 2. 425 and - 3. 732, respectively, both P < 0. 05 ). Conclusion Poor wound healing after the first surgery, uterine cavity operation for many times and thickness of the scar < 3mm are the high risk factors of incomplete uterine rupture. Strictly mastering the indications of the first cesarean section, improving operation technology, guiding contraception and testing scar state with auxiliary means are the effective measures to prevent the incidence of incomplete uterine rupture.%目的 探讨剖宫产术后再次妊娠不完全性子宫破裂的高危因素.方法 回顾分析2011年3至12月期间西安曲江妇产医院的26例瘢痕子宫再次妊娠剖宫产资料,其中不完全性子宫破裂9例,未破裂17例,对前次手术切口愈合情况、切口位置、多次宫腔操作、术前瘢痕厚度及再次妊娠间隔时间等进行比较分析.结果 宫腔操作次数、妊娠晚期瘢痕厚度子宫破裂组和未破裂组间比较差异均存在统计学意义(t值分别为2.425、-3.732,均P<0.05).结论 首次手术后伤口愈合差,多次宫腔操作及瘢痕厚度<3mm是发生不完全性子宫破裂的高危因素.严格掌握第1次剖宫产指征,提高手术技术,指导避孕,通过辅助手段检测瘢痕状态,是防

  19. Observation on treatment and effect in 75 cases of cesarean scar pregnancy%剖宫产术后瘢痕妊娠75例的治疗及效果观察

    Institute of Scientific and Technical Information of China (English)

    黄利琼; 赵纯全

    2013-01-01

    目的 探讨剖宫产术后子宫瘢痕妊娠(CSP)的治疗及效果.方法 回顾性分析该院自2008年1月到2012年5月收治的75例CSP患者的临床资料.结果分别采用了10种治疗方法使69例患者痊愈出院.结论 CSP误诊率高,超声检查是其早期诊断方法,宫腔镜治疗迅速有效,超声消融(HIFU)联合宫腔镜治疗有望成为最安全有效的方式.%Objective To study the treatment and effect of cesarean scar prcgnancy(CSP). Methods The clinical data of 75 cases of CSP in this hospital from January 2008 to May 2012 were analyzed retrospectively. Results 69 cases of CSP were respectively treated by 10 kinds of treatment method and discharged from hospital. Conclusion The misdiagnosis rate of CSP is high. Ultrasound is the early diagnostic method. The hysteroscopic treatment is fast and effective. High intensity focused ultrasound(HIFU) combined with hysteroscopy will expect to be a fastest and most effective treatment way.

  20. Clinical Curative Effect Observation of Methotrexate+Mifepristone Treatment of Cesarean Scar Pregnancy%甲氨蝶呤米非司酮药物治疗剖宫产术后瘢痕妊娠的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱天波; 吕燕玲; 容俊; 朱云翠

    2013-01-01

    Objective The clinical efficacy studies of methotrexate and mifepristone treatment after cesarean section scar pregnancy. Methods 15 cases of cesarean section scar pregnancy were the object of study will be divided into two groups by their respectively methotrexate combined with mifepristone and methotrexate simple method of treatment. Results The patients treated with treatment was significantly better than control group patients. Conclusion The use of methotrexate and mifepristone treatment effect on patients after cesarean section scar pregnancy.%  目的 研究甲氨蝶呤联合米非司酮药物治疗剖宫产术后瘢痕妊娠的临床疗效。方法 以15例剖宫产术后瘢痕妊娠的患者为研究对象,将所其分为两组,分别采用甲氨蝶呤联合米非司酮和单纯甲氨蝶呤的方法进行治疗。结果 治疗组患者的治疗有效率明显优于对照组患者。结论 运用甲氨蝶呤联合米非司酮的方式对剖宫产术后瘢痕妊娠患者进行治疗的效果明显。

  1. 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

  2. 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.

  3. 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

    Full Text Available OBJETIVO: determinar se a cesariana eletiva na 38ª semana de gestação para pacientes portadoras do vírus HIV, com a finalidade de reduzir a transmissão vertical, aumenta a morbiletalidade materna. MÉTODOS: foram incluídas 58 pacientes portadoras do vírus submetidas ao protocolo ACTG 076 completo (associação da zidovudina oral no pré-natal com a forma venosa no momento do parto, que foram submetidas a cesariana eletiva na 38ª semana de gravidez. O grupo controle constituiu-se de 226 grávidas não infectadas (as quatro pacientes submetidas a cesariana eletiva após cada cesariana em paciente portadora do HIV. As variáveis analisadas nos dois grupos foram: atonia uterina, febre puerperal, infecções de parede abdominal, infecções urinárias, endometrite, perda sangüínea, tempo operatório e tempo de internação. A análise estatística foi feita com o teste do c² (teste de Fisher quando havia caselas com menos de 5 casos. O risco relativo (RR foi calculado com o programa Epi-Info 6.0. RESULTADOS: os resultados mostram que a cesariana eletiva realizada em pacientes portadoras do HIV, quando comparada com o grupo controle, não apresentou maior incidência de atonia uterina (p=1,6, de febre puerperal (p=0,6, de infecções de parede abdominal (p=0,6, de infecções urinárias (p=0,2 e de endometrite (p=0,3. No entanto, houve maior perda sangüínea (risco relativo de 2,2, e maior tempo operatório (risco relativo de 3,3. A paciente portadora do HIV permaneceu menos tempo internada que aquela do grupo controle (risco relativo de 0,3. CONCLUSÃO: conclui-se que não houve aumento da morbidade materna ao se optar pela cesariana como desfecho da gestação da paciente portadora do vírus HIV.PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients

  4. Cesárea prévia como fator de risco para o descolamento prematuro da placenta Previous cesarean section as a risk factor for abruptio placentae

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    Fábio Roberto Cabar

    2004-10-01

    relationship between previous cesarean section and abruptio placentae. METHODS: a retrospective study reviewed 6495 deliveries between April 2001 and January 2004. The adopted inclusion criteria were: clinical diagnosis of abruptio placentae confirmed by placental examination after delivery, single pregnancy, birth weight >500 g, gestational age >22 weeks and no history of abdominal trauma. Five controls were selected for each abruptio placentae case and were matched for the following parameters: parity, gestational age ( 30 weeks, maternal arterial hypertension during pregnancy, presence of nonobstetrical uterine scar, premature rupture of membranes and polyhydramnios. Statistical analysis of continuous variables was perfomed by Student's t test. Statistical significance of the comparisons of categorical variables was evaluated by the chi2 test or by the Fisher exact test. p values <0.05 were considered to be significant. RESULTS: thirty-four cases of abruptio placentae were included (incidence 0.52%. The control group included 170 cases that fulfilled the matching criteria. The incidence of previous cesarean section in the abruptio placentae group was 26.5% (9 cases and in the control group it was 21.2% (36 cases. No significant difference was found between the groups (p=0.65, OR=1.34, CI 95%=0.53-3.34. CONCLUSION: the present study was not able to demonstrate association between abruptio placentae and previous cesarean section.

  5. 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

  6. 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。

  7. Uterine Closure in Cesarean Delivery: A New Technique

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    K M Babu

    2012-01-01

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

  8. 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。

  9. Scar endometriosis after caesarean section: a case series and review of literature

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    Sandeep S. Nanaware

    2016-04-01

    Full Text Available Endometriosis is defined as extra-uterine localization of ectopic functional endometrial gland and stroma. Cystic or solid tumoral masses caused by endometriosis are named as endometrioma. Although these pathologic conditions mostly encountered in ligaments of uterus, ovaries, pouch of douglos and pelvic peritoneum; endometriosis has also been reported in nose, breast, lung, spleen, gastrointestinal tract, kidney, abdominal wall, but scar endometriomais extremely rare. Scar endometriosis is rare and difficult to diagnose. This condition can be confused with other surgical conditions, however imaging techniques and FNAC are indicated towards better diagnostic approach. Medical treatment is helpful in selected cases but wide excision is the treatment of choice. By presenting this paper, and conducting a review of the literature, we intend to increase the awareness of this rather, rare condition. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 948-952

  10. Effect of low B-Lynch suture on menstrual cycle recovery and sex hormone levels in patients after cesarean section for placenta previa

    Institute of Scientific and Technical Information of China (English)

    Su-Lan Zhang; Wan-Cheng Feng; Yan Mi

    2016-01-01

    Objective:To explore the effect of low B-Lynch suture on the menstrual cycle recovery and sex hormone levels in patients after cesarean section for placenta previa.Methods:A total of 40 patients who were admitted in our hospital from August, 2013 to August, 2015 for cesarean section due to placenta previa were included in the study and randomized into the observation group and the control group. The patients in the observation group were given low B-lynch suture, while in the control group, yarns were plugged in the uterus. The bleeding during operation and 24 h after operation, the postpartum lochia duration, and menstrual cycle recovery in the two groups were observed. The postpartum FSH, E2, and LH levels in the two groups were determined.Results:The amount of bleeding during operation and 24 h after operation in the observation group was significantly less than that in the control group (P0.05). The comparison of FSH, E2, and LH levels between the two groups was not statistically significant (P>0.05).Conclusions:Low B-Lynch suture can effectively reduce the amount of bleeding after cesarean section for placenta previa, and has no effect on the menstrual recovery and ovarian function with a simple operation and less postoperative complications; therefore, it deserves to be widely recommended in the clinic.

  11. Application of improved packing in uterine cavity in cesarean section%改良宫腔填塞在剖宫产术中的应用

    Institute of Scientific and Technical Information of China (English)

    郭灵丽

    2014-01-01

    Objective:To observe the effect of application of the improved packing in uterine cavity in cesarean section with postpartum hemorrhage because of uterine atony.Methods:216 patients with cesarean section were selected,their clinical data were retrospectively analyzed.Results:Using improved packing in uterine cavity in cesarean section with postpartum hemorrhage because of uterine atony,can significantly reduce the amount of bleeding in these patients.Conclusion:Improved packing in uterine cavity is a feasible and effective rescue measures,it can play an obvious hemostasia effect.%目的:改良宫腔填塞在剖宫产术中因子宫收缩乏力引起的产后出血应用中的效果观察。方法:收治行剖宫产术患者216例,采用回顾性资料分析方法。结果:采用宫腔填塞法止血,控制剖宫产术中因子宫收缩乏力引起的产后出血,明显减少了此类患者术中出血量。结论:改良宫腔填塞是一种有效可行的抢救措施,能起到明显的止血作用。

  12. Determining the Effect of Early Feeding after Cesarean section Compared with Regular Diet on the Gastrointestinal Function of Women Referred to Tajrish Hospital, Iran

    Directory of Open Access Journals (Sweden)

    M Amiri-Siavoshani

    2016-10-01

    Full Text Available Background & aim: Early feeding after cesarean section can have beneficial effects, however, no sufficient study has been conducted in this area. The aim of this study was to determine the effects of early feeding on the gastrointestinal complications in women after cesarean section and comparing it with a regular diet.   Methods: The present randomized-clinical-trial study was conducted on 160 women who admitted to Shohada hospital and underwent cesarean section in 2011-2012. The inclusion criteria included women with gestational age more than 37 weeks, singleton pregnancy, having at least 8 hours of fasting, and regional anesthesia (spinal cord, respectively. After registration of demographic characteristics and pregnancy, women were randomly divided into two groups: Early feeding (2 hours after completion of the operation, 250 ml filtered juice, tea and biscuits style regime in the next 2 hours and 2 hours after the usual diet and the usual power (8 hours of operation clear liquid diet the day after the usual diet groups. Presence of gastrointestinal symptoms in 2, 4, 8 and 12 hours after surgery, time to the bowel sounds auscultation, passage of flatus and stool were recorded. Data were analyzed by SPSS software version13.The significance level of p-value was considered 0.05.   Conclusion: Early feeding caused the acceleration of gastrointestinal symptoms, earlier bowel sounds auscultation and earlier utilization of gas. It is recommended to investigate the different diets and examined the level of compliance and satisfaction.  

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

    OpenAIRE

    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 ar...

  14. 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.

  15. 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.

  16. 天花粉蛋白治疗子宫切口瘢痕妊娠的临床疗效及不良反应%Clinical application of trichosanthin in cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    戴良图; 张华; 曾敏华; 吴蕾; 李扬

    2014-01-01

    Objective To investigate the clinical value of trichosanthin in the treatment of cesarean scar pregnancy and in-curred adverse reactions.Methods Twenty-one cases of cesarean scar pregnancy were chosen for our study.With the knowledge and consent of the patients and in accordance with different sites of injection, the patients were divided into the muscular injection group (10 cases) and the intracervical injection group (11 cases) .Following negative skin test, the patients respectively received muscular and intracervical trichosanthin injection at a dosage of 1.8-3.6 mg.Seven days after treatment, close observation was made on the decrease of human chorionic gonadotropin (β-HCG) and adverse reactions induced by the drug.Results The patients in the 2 groups all respon-ded quite well to the treatment.After 7 days of treatment, a sharp reduction ofβ-HCG by over 70%was noted in 8 cases of the muscu-lar injection group, and a reduction ofβ-HCG by less than 50%was seen in 2 cases.Of the 2 cases, one had a secondary muscular in-jection and one was supplemented with methotrexate.The patients in the muscular injection group had such adverse reactions as fever, pain in the limbs, swelling and pain in the injection sites and skin rash.One case displayed chest distress and dyspnea, but symptoms were soon relieved following antianaphylactic treatment and oxygen breathing.Seven days after treatment with trichosanthin, the level ofβ-HCG in the patients of the intracervical injection group all dropped by over 70%.Four patients had such symptoms as fever, pain in the limbs, however, symptoms were lighter than those of the muscular injection group.Conclusion Trichosanthin injection seemed to produce good effect on cesarean scar pregnancy, however, adverse reactions might occur in the course of treatment, with muscular injec-tion having severer reactions, and trichosanthin injection having lighter reactions.For this reason, close observation should be made on the adverse

  17. Analysis on 48 cases with cesarean scar pregnancy treated by the combination of trichosanthin and mefepristone%天花粉、米非司酮联合治疗剖宫产瘢痕妊娠48例分析

    Institute of Scientific and Technical Information of China (English)

    赵富鲜; 周萍; 杨泽星

    2013-01-01

    目的:探讨天花粉、米非司酮联合治疗剖宫产瘢痕妊娠的疗效。方法回顾性分析2006年11月~2012年12月48例剖宫产瘢痕妊娠经天花粉、米非司酮联合治疗的临床资料,观察其疗效。结果48例患者,39例成功,成功率81.25%,3例破裂,6例疗程结束后血β-HCG未降至正常而行手术治疗。结论天花粉、米非司酮联合治疗剖宫产瘢痕妊娠是有效的,安全的,而且费用低,风险小,可供同行参考。%Objective: To discuss the curative effect of trichosanthin and mifepristone combined therapy for cesarean scar pregnancy. Methods: The clinical data of 48 cases with cesarean scar pregnancy treated by the combination of trichosanthin and mifepristone from November 2006 to December 2012 were retrospectivly analysed to observe their curative effect. Results:in 48 patients, 39 cases were successful, the success rate was 81.25%. 3 cases ruptured, 6 cases whose blood β-HCG did not decreased to normal level after the end of treatment were treated by operation. Conclusions : The treatment of Cesarean scar pregnancy by the combination of trichosanthin and mifepristone is effective and safe, and with low cost, low risk, which can be used for reference by peers.

  18. 疤痕子宫对再次妊娠分娩结局危险性的分析%Analysis on the Risk of Uterine Scar Pregnancy and Delivery Outcome

    Institute of Scientific and Technical Information of China (English)

    窦伯梅; 范明秀

    2014-01-01

    目的:探讨疤痕子宫孕妇的分娩结局,了解疤痕子宫孕妇再次分娩的风险及并发症。方法将2004~2013年入住我院的有剖宫产史的孕妇,妊娠结局、分娩方式的选择以及其风险性明显增高。结果疤痕子宫妊娠的分娩方式仍以剖宫产为主,社会因素仍是主要原因。结论疤痕子宫再次妊娠后分娩风险明显较非疤痕子宫高,临床应该严格控制无临床医学指征性剖宫产。%Objective To investigate the scar uterus of pregnant women give birth outcomes, to understand the risks and complications of uterine scar pregnancy to childbirth. Methods From 2004 to 2013 in our hospital with a history of cesarean section pregnant women, pregnancy, delivery mode and its risk significantly increased. Results Cesarean uterine scar pregnancy is stil in cesarean section, the main reason is the social factors. Conclusion Uterine scar pregnancy after delivery risk compared with non scar uterus, clinical should strictly control without clinical medical indications of cesarean section.

  19. A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting

    Directory of Open Access Journals (Sweden)

    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.

  20. Contraceptive willingness of women after cesarean section in Beijing%北京市剖宫产育龄妇女产后避孕意愿分析

    Institute of Scientific and Technical Information of China (English)

    沈洁; 高丽丽; 潘迎

    2014-01-01

    为了了解北京市剖宫产术后妇女的避孕意愿及其影响因素,在北京市城、近、郊区采用分层整群抽样方法随机抽取2011年7月-2011年12月期间接受剖宫产手术的产妇364名,进行问卷调查。采用卡方检验和多因素Logistic回归方法对问卷调查结果进行分析。结果显示,被调查妇女平均年龄为(31±4.53)岁,剖宫产术后计划恢复性生活时间中位数为7周。96.43%的妇女对于产后可以采用的避孕方法并不清楚。仅有27.74%的妇女表示产后会尽早或立即采取避孕措施,避孕套是妇女首选的产后避孕方法,占75.27%。72.25%的妇女没有避孕计划或要等到产后3个月才开始避孕。62.64%的妇女在剖宫产术后接受了避孕指导,医生推荐的产后避孕方法中避孕套占首位。医生强调剖宫产术后避孕的重要性、妇女具备正确产后避孕知识是妇女剖宫产术后尽早开始避孕的保护因素。剖宫产妇女对产后避孕服务有较高需求,希望在产前保健或产后访视时能得到专业人员的产后避孕咨询指导。剖宫产术后再次妊娠存在健康风险,剖宫产妇女产后尽早落实避孕措施应引起高度关注。建议尽快针对剖宫产妇女开展产后避孕服务,摸索适合北京的服务模式,以满足需求,减少产后非意愿妊娠的发生,降低剖宫产术后人工流产的风险。%To learn the contraceptive willingness and it’s affecting factors among women af-ter cesarean section in Beijing. Stratified cluster sampling and randomized data collection by questionnaires of women after cesarean section from July 2011 to December 2011 in various ar-eas in Beijing and data analyzed by Chi-squared test and Logistic Regression. The results show that the average age of the target women was (31±4.53) years old. The median of the women’s planning intercourse after cesarean section was 7 weeks. 96.43%of the women were unaware of

  1. Cesarean Section: The Operation

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  20. 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.

  1. Placenta accreta on the postoperative scar after previous caesarean section in late pregnancy:an analysis of 9 cases%妊娠晚期剖宫产切口瘢痕胎盘植入9例分析

    Institute of Scientific and Technical Information of China (English)

    申震; 周元元; 赵卫东; 陈玲

    2011-01-01

    目的:探讨妊娠晚期剖宫产切口瘢痕胎盘植入的诊治.方法:对2000年1月至2010年7月收治的9例妊娠晚期剖宫产切口瘢痕胎盘植入的临床诊治资料进行回顾性分析.结果:5例经保守治疗后于孕32~35周手术终止妊娠,4例在充分术前准备下行剖宫产术;9例均出现产后出血,1例粘连型胎盘植入者行子宫动脉结扎术,6例植入型和2例穿透型胎盘植入者均行子宫切除术;无孕产妇病死;早产5例,足月产2例,围生儿病死2例.结论:积极准确的诊断和有效的治疗是治疗晚期妊娠剖宫产切口瘢痕胎盘植入患者的关键.%Objective: To evaluate the diagnosis and treatment of the placenta accreta on the postoperative scar after previous caesarean section in late pregnancy. Methods: A retrospective study was conducted in 9 cases with placenta accreta on the postoperative scar after previous caesarean section in late pregnancy from Jan. 2000 to Jul. 2010. Results: Five cases were performed termination of pregnancy after conservative treatment during 32 - 35 weeks pregnancy and 4 cases were performed cesarean section after adequate preoperative preparation. All the 9 cases suffered from postpartum hemorrhage. One case with placental adherence underwent uterine artery ligation,and the other 6 cases with placenta accreta and 2 cases with placenta percreta received hysterectomy. No death occurred in the pregnant or lying-in women. Premature birth was observed in 5 infants and full term birth in 2 infants; perinatal deaths occurred in 2 infants. Conclusions: Accurate diagnosis and effective therapeutic procedure are essential for treatment of placenta accreta on the postoperative scar after previous caesarean section in late pregnancy.

  2. 腹腔镜结合甲氨蝶呤术前治疗Ⅱ型剖宫产瘢痕妊娠的疗效分析%Analysis of Therapeutic Effect of Methotrexate before Laparoscopic Operation on Type ⅡCesarean Scar Pregnancy Patients

    Institute of Scientific and Technical Information of China (English)

    姚颖杰; 曹映华

    2014-01-01

    目的:探讨剖宫产瘢痕妊娠(Cesarean scar pregnancy,CSP)行腹腔镜保守性手术联合术前使用甲氨蝶呤MTX的可行性及安全性。方法:将笔者所在医院2008年10月-至今收治Ⅱ型剖宫产瘢痕妊娠患者37例分为两组。A组18例术前给予甲氨蝶呤50~75 mg静脉注射,B组19例术前不使用甲氨蝶呤,仅进行腹腔镜下瘢痕处妊娠物清除术。随后对手术前后激素指标、术中出血量、手术时长等参数进行分析。结果:两组患者均保留生育功能治愈出院。A组手术过程中出血量明显低于B组,A组手术时间明显高于B组,两组比较差异均有统计学意义(P<0.05)。结论:腹腔镜保守性手术联合甲氨蝶呤治疗Ⅱ型剖宫产瘢痕妊娠具有创伤小、康复快的优点。在腹腔镜下可以对病情进行确诊,在瘢痕处妊娠物清除术的同时,也清除了与宫腔相连的腔隙与窦道,减少了再次发生CSP、胎盘植入的风险,值得推广。%Objective:To evaluate the feasibility and safety of Methotrexate before laparoscopic operation on type Ⅱcesarean scar pregnancy patients. Method:37 type Ⅱcesarean scar pregnancy patients from our hospital were randomly divided into two groups.Group A was intravenous injected 50-75 mg Methotrexate before operation,while group B was solely treated with laparoscopic operation.The parameters of operation result were analyzed with independent samples t-test.Result:Two groups of patients were reserved reproductive function and hospital cured.Compared with group B,bleeding volume during operation of group A were significantly reduced and operation duration of group A were significantly rised(P<0.05).Conclusion:It is effective and micro-traumatic to use of Methotrexate before laparoscopic operation on typeⅡcesarean scar pregnancy patients.The diagnosis conclusion can be confirmed with laparoscope observation, meanwhile the scar pregnancy and sinus tract connected to uterine

  3. Investigation of the health education on 86 maternal with cesarean section%剖宫产产妇86例健康教育的探讨

    Institute of Scientific and Technical Information of China (English)

    姜秀

    2015-01-01

    目的:探讨健康教育在剖宫产围术期中的应用效果。方法:收治子宫下段剖宫产产妇86例,对其进行健康教育。结果:86例产妇无静脉血栓、腹胀、乳腺炎等,只有1例尿管拔出后小便未能自解,需重新导尿。结论:在剖宫产围术期对产妇进行健康教育,使产妇积极参与新生儿护理和自我护理,有利于促进产妇身心康复,增进母子感情。%Objective:To explore the application effect of health education in perioperative period of cesarean section.Methods:86 patients with lower uterine segment cesarean section were selected,and then we carried on the health education for them.Results:All of those 86 maternal had no venous thrombosis,abdominal distension,mastitis or other symptoms,and only 1 case could not self urination after pulling out the catheter,and needed to recatheterization.Conclusion:Taking health education on maternal in the perioperative period of cesarean section can help the maternal actively participate in the self nursing and the newborn care,so it is helpful to promotion of maternal physical and mental rehabilitation,and enhance the bonding.

  4. 护理干预对剖宫产术后母乳喂养的影响%Impact on Nursing Intervention on Breastfeeding after Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    王文兰

    2014-01-01

    Objective: To explore the nursing intervention to improve the ef ects of cesarean section of breastfeeding. Method: select 2011 January to 2013 June in our hospital ful -term cesarean section maternal 400 cases, were randomly divided into observation group and control group with 200 cases in each group, the observation group was treated with nursing intervention; the control group was given routine nursing care. Results: the group of early sucking, frequent sucking, control group on-demand feeding significantly bet er, improve breastfeeding. Conclusion: the nursing intervention after cesarean section, improve the success rate of breastfeeding, conducive to maternal and child health.%目的:探讨护理干预对提高剖宫产术母乳喂养的影响。方法选择2011年1月~2013年6月在我院足月剖宫产分娩的产妇400例,随机分为观察组和对照组各200例,观察组采用护理干预;对照组给予常规护理。结果观察组早吸吮,勤吸吮,按需喂养情况明显优于对照组,提高母乳喂养。结论剖宫产术后采用护理干预措施,提高母乳喂养的成功率,利于母婴的健康。

  5. 循证护理在剖宫产护理中的应用效果%Application Effect of Evidence-based Nursing in Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    李晓梅

    2015-01-01

    Objective To explore the application effect of evidence-based nursing in cesarean section.Methods A total of 150 cases of maternal in our hospital as the research object,the implementation of cesarean section,were randomly divided into observation group and control group,the observation group were given evidence-based nursing, the control group were given routine nursing.The nursing effects were compared between the two groups.Results The observation group VAS score and nursing satisfaction scores were better than the control group, and adverse reaction rate is lower than the control group,the differences were statisticaly significant(P<0.05).Conclusion The application effect of evidence-based nursing in cesarean section obviously.%目的:探讨循证护理在剖宫产护理中的应用效果。方法选取150例产妇为研究对象,均实施剖宫术,将其按随机数字表法分为观察组与对照组,观察组产妇给予循证护理,对照组产妇给予常规护理。比较两组产妇的护理效果。结果观察组产妇VAS评分及护理满意度评分均优于对照组,且不良反应发生率低于对照组,差异均有统计学意义(均P<0.05)。结论在剖宫产护理中循证护理的应用效果明显。

  6. 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。

  7. Effect of different labor cesarean section on maternal and neonatal outcomes%不同产程剖宫产术对母婴结局的影响

    Institute of Scientific and Technical Information of China (English)

    李海英

    2012-01-01

    Objective To study the effect of different labor cesarean section on maternal and neonatal outcomes. Methods The clinical data of 80 patients of cesarean section in the first stage of labour in our hospital from June 2009 to June 2011 (the study group) were retrospectively analyzed, as well as that of 85 patients of cesarean section in the second stage of labour (the control group). All the patients were followed up for 3-6 months. The intra-operative status of patients, incidence of postoperative complications, and neonatal clinical outcomes were compared between the two groups. Results The intraoperative status, incidence of postoperative complications, and neonatal clinical outcomes after treatment were all significantly better in the study group than the control group (P<0.05). Conclusion Cesarean section in the first stage of labor can significantly reduce the risk of surgery, lower the incidence of maternal complications, and enhance the life quality of newboms.%目的 探讨不同产程剖宫产术对母婴结局的影响.方法 选择本院2009年6月至2011年6月收治的第一产程剖宫产80例产妇病例资料(实验组)进行回顾性分析,另选择同期85例第二产程剖宫产的产妇作为对照组.随访3~6个月,比较两组产妇的术中情况、并发症发生率和新生儿临床结局.结果 两组比较,治疗后实验组产妇的术中情况、术后并发症发生率和新生儿临床结局均优于对照组,差异有统计学意义(P<0.05).结论 第一产程剖宫产术可明显降低术中风险,减少产妇术后并发症发生率,增强新生儿生命质量.

  8. Effect of cesarean section on the second gynecologic surgery%剖宫产术对再次妇科手术的影响

    Institute of Scientific and Technical Information of China (English)

    张霞

    2016-01-01

    Objective:To explore the effect of cesarean section on the second gynecologic surgery.Methods:50 patients with gynecologic surgery after cesarean section were selected as the observation group,at the same time,50 patients with complete hysterectomy without history of gynecology and obstetrics surgery were selected as the control group.We compared the therapeutic effects of the two groups.Results:There were significant differences in the open time,the amount of bleeding at open the abdominal cavity,the amount of bleeding during operation and the time of operation between groups(P<0.05).In the observation group,the incidence of adhesion of 20.0% was significantly higher than 8% in the control group(P<0.05).Conclusion:Cesarean section had negative impact on the second gynecologic surgery.Reducing the rate of cesarean section was the best way to solve this problem.%目的:探讨剖宫产术对再次妇科手术的影响。方法:收治剖宫产术后再次妇科手术患者50例作为观察组,同时收治无妇产科手术史行全子宫切除术患者50例作为对照组,比较两组治疗效果。结果:两组的开腹时间、开腹出血量、术中出血量、手术时间差异有统计学意义(P<0.05)。观察组粘连发生率20.0%,明显高于对照组的8.0%(P<0.05)。结论:剖宫产术对再次妇科手术有一定负面影响,降低剖宫产率是解决这问题的最好途径。

  9. The Effects of Intrathecal Bupivacaine-Fentanyl and Bupivacaine-Morphine on Ephedrine Requirements and Health Status of Fetus in Elective Cesarean Section.

    OpenAIRE

    But, A.Kadir; Öztürk, Erdoğan; Gülhaş, Nurçin; Durmuş, Mahmut; Doğan, Zafer; Ersoy, M. Özcan

    2005-01-01

    Objectives: In this study, we aimed to compare the effects of intrathecal bupivacaine-fentanyl and bupivacainemorphine on ephedrine requirements and on health status of fetus. Methods: We enrolled 54 cases undergoing elective cesarean section in this study. Ringer's lactate was infused to all patients at a rate of 10-12 mL kg-1 preoperatively and 8-10 mL kg hr-1 during operation. Spinal anesthesia was achieved with 2 mL of bupivacaine %0.5 in Group I (n=18), with 1.5 mL of bupivacaine...

  10. Effect of aromatherapy massage on pain easing after cesarean section%香薰按摩对减轻剖宫产术后疼痛的效果

    Institute of Scientific and Technical Information of China (English)

    黄丽燕; 周嘉燕; 陈毓婵; 贺辉; 刘伟平; 罗震; 廖拾零; 余凤仙; 陈霞萍; 蔡丽萍

    2010-01-01

    目的 探讨香薰按摩对减轻剖宫产产妇术后疼痛的效果.方法 随机选择无慢性躯体疾病、无精神障碍、新生儿出生时健康、术后不使用麻醉镇痛泵的住院行剖宫产的初产妇456例,随机分成对照组和干预组各228例.对照组实施产后常规护理,干预组在常规护理的同时实施全身植物精华香薰按摩,比较两组剖宫产术后产妇切口疼痛、子宫收缩疼痛及产后相关的其他躯体疼痛不适和镇痛药物的使用情况.结果 干预组产妇术后不同时间的疼痛程度明显优于对照组(P<0.05),干预组产妇术后24 h后不再需要使用镇痛药物.结论 香薰按摩能有效减轻剖宫产产妇术后的疼痛程度,减少镇痛药物的使用次数.%Objective To discuss the effect of aromatherapy massage on pain easing after cesarean section.Methods 456 primiparas without chronic body disease,mental disorder,postoperative analgesia or unhealthy neonates were selected and randomly divided into control group(228 cases)and experimental group(228 cases).The control group received routine care,and the experimental group received plant essence aromatherapy massage besides routine care. Postpartum incision pain,uterine contraction pain and other body discomfort,as well as analgesic drug use after cesarean section were compared between the two groups. Results The degree of the pain at different stages in the experimental group was significantly lower than the control group(P <0. 05). Analgesic drug was not needed 24 hours after cesarean section in the experimental group. Conclusions Aromatherapy massage effectively eases pain after cesarean section and reduces analgesic drug use.

  11. Clinical analysis of transvaginal operation treatment of cesarean scar pregnancy%经阴道手术治疗剖宫产瘢痕妊娠的临床分析

    Institute of Scientific and Technical Information of China (English)

    聂东娥

    2015-01-01

    目的:探讨经阴道手术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果。方法回顾性分析我院于2011年12月~2014年1月收治的70例剖宫产瘢痕妊娠患者的临床资料,根据治疗方式不同将其分为对照组与观察组,各35例。对照组给予甲氨蝶呤化疗加清宫术治疗,观察组则实施经阴道手术切除瘢痕妊娠病灶组织进行治疗,观察对比两组治疗效果。结果观察组患者在手术时间、血β-hCG恢复正常时间、月经复潮时间以及住院时间均明显短于对照组,术中出血量则明显少于对照组,组间比较差异有统计学意义(P<0.05)。结论经阴道手术治疗剖宫产瘢痕妊娠效果显著,且具备微创、高效、经济等优点,值得在临床上推广应用。%Objective To study the clinical effect of transvaginal operation in the treatment of cesarean scar pregnancy(CSP). Methods 70 clinical patients with CSP,who were treated in our hospital from December 2011 to January 2014,were retrospectively analyzed,and were divided into control group and observation group according to different treatment modality,with 35 cases in each group.To comparable observe the clinical effect between the control group who were treated with methotrexate chemotherapy combined uterine curettage and observation group who were treated with transvaginal operation to excise the focal tissues of scar pregnancy. Results The operation time,the recovery time of serum β-hCG,the time of menstruation resume,and the hospitalization time of patients in observation group were significantly shorter than which in control group,the intraoperative blood loss of patients in observation group were significantly less than which in control group,the differences was statically significant between the two groups(P<0.05). Conclusion Transvaginal operation in the treatment of CSP has significant effect,has the advantages of minimally invasive,high efficiency

  12. 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

  13. Clinical analysis of cesarean section rate increased%剖腹产率增高的临床分析∗

    Institute of Scientific and Technical Information of China (English)

    霍军伟; 高雄杰; 王欣

    2015-01-01

    Objective:To study the changes of three years of caesarean section rate and indications of the hospital,providing the basis for the development of feasible measure control.Methods:Medical records of 1309 ca-ses of caesarean section in 8683 cases that delivery in the hospital between 2012 and 2014 were retrospectively ana-lyzed.Results:The rate of hospital caesarean section gradually increased from 2012 to 2014,the difference was sta-tistically significant(P <0.05).The change of caesarean section indications,fetal factor and social factor proportion gradually declined year by year(respectively χ2 =9.041,P =0.01 1;χ2 =7.232,P =0.027),maternal factor and ute-rus scar proportion gradually rised year by year(respectively χ2 =6.634,P =0.036;χ2 =7.071,P =0.029).Conclu-sion:Over the past three years,the overall caesarean section rate is rising.The hospital should continue to strength-en prenatal education and counseling and doctors should strictly grasp caesarean section indications,in order to effec-tively control of caesarean section rate in the scientific and reasonable range.%目的::探讨榆林市第一医院妇产科3年间剖腹产率及剖腹产指征的变化,为制定可行的控制措施提供依据。方法:对2012~2014年期间住院分娩的8683例产妇中1309例施行剖腹产的病例资料进行回顾性分析比较。结果:2012~2014年剖腹产出现逐年上升的趋势,各年份间差异有统计学意义(P <0.05)。在剖腹产指征变化中,胎儿和社会因素比例逐年下降(P 均<0.05),母体因素及瘢痕子宫比例逐年上升。结论:近3年本院剖腹产率总体上呈上升趋势,应继续加强产前宣教和心理咨询,严格掌握剖腹产指征,有效的把剖腹产率控制在科学、合理的范围内。

  14. Contrast Analysis:Cesarean Scar Pregnancy Signs of MRI and Transvaginal Ultrasound%宫内瘢痕处早孕的影像诊断:MRI与经阴道超声对照

    Institute of Scientific and Technical Information of China (English)

    张向群; 许乙凯; 郑泽宇; 郭学军

    2014-01-01

    目的:探讨剖宫产后宫腔内瘢痕处早期妊娠的MRI及经阴道超声表现,通过对比评估两种诊断方法对宫内瘢痕处早孕的诊断价值。方法回顾性分析2010年3月-2014年4月经手术证实为宫内瘢痕处早孕的35例患者的MRI及经阴道超声的影像资料,其中早早孕17例;早孕中期8例,早孕后期10例,对比分析两种方法显示孕囊着床位置、孕囊大小、是否有宫腔及孕囊内出血、胚芽及卵黄囊,胎心搏动等情况。结果 MRI及经阴道超声显示囊性孕囊29例,包块型孕囊6例,29例囊性孕囊中MRI显示位于瘢痕处孕囊12例,位于瘢痕处向宫腔方向延伸17例,而经阴道超声诊断位于瘢痕处孕囊8例,位于瘢痕处向宫腔内延伸21例;MRI诊断孕囊内合并出血8例,经阴道超声诊断囊内出血3例;经阴道超声发现卵黄囊16例,胚芽结构11例,其中见胎心搏动12例,MRI发现胚芽5例,无法区分卵黄囊结构及胚芽结构,无法判断胎心搏动;6例包块型孕囊中MRI诊断包块对子宫肌层浸润6例,经阴道超声无法判断孕囊对子宫肌层的浸润;MRI诊断包块内出血6例,经阴道超声诊断3例;MRI诊断宫腔内积血20例,经阴道超声诊断7例;结论 MRI与经阴道超声在宫内瘢痕处早孕中的诊断中各有优势,联合应用有利于提高对该病的全面认识,便于指导临床。%Objective To explore the value of MRI and transvaginal ultrasound in the diagnosis of cesarean scar pregnancy (CSP). Methods 35 cases time from March 2010 to April 2014 were retrospectivly studied, All cases were proved by operation. Among these cases, 17 cases were early-early pregnancy、8 cases were early-middle pregnancy, 10 cases were early-later pregnancy. Compare gestation sac location, size, nature, the myometrium invasion, whether combined with pouch of uterine cavity hemorrhage, and the yolk sac display and survival status, and so on the

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

    Directory of Open Access Journals (Sweden)

    Onoh RC

    2015-05-01

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

  16. Study on Application Value of Color Doppler Ultrasound in Diagnosis and Treatment of Cesarean Scar Pregnancy%探讨彩色多普勒超声在子宫瘢痕妊娠诊断及治疗中的应用价值

    Institute of Scientific and Technical Information of China (English)

    刘中芳

    2016-01-01

    Objective To study and observe the clinical application value of color Doppler ultrasound in clinical diagnosis and treatment of cesarean scar pregnancy. Methods 152 cases of patients with cesarean scar pregnancy diagnosed and treat-ed in our hospital from June 2014 to January 2016 were selected as the research object and all patients were examined by transvaginal and transabdominal color Doppler ultrasonic diagnosis, the clinical information and data were retrospectively analyzed, and the clinical application value of color Doppler ultrasound in diagnosis and treatment of cesarean scar preg-nancy was observed and discussed. Results The accuracy rates of transvaginal and transabdominal color Doppler ultrasonic diagnosis examinations were respectively up to 120 cases (78.95%) and 140 cases (92.11%), at the same time, the analysis of ultrasonic images of patients discovered that in terms of cesarean scar pregnancy types, 20 cases were in mixed type, (13.16%), 60 cases were in heterogeneous mass type(39.47%) and 72 cases were in embryo type(47.37%). Conclusion Color Doppler ultrasound in clinical diagnosis and treatment of cesarean scar pregnancy has a higher diagnostic accuracy rate, and it is of important value to the effective treatment of patients.%目的:探究在子宫瘢痕妊娠的临床诊断及治疗中,采用彩色多普勒超声进行诊断及指导其治疗,观察其临床应用价值。方法整群选取2014年6月—2016年1月来该院接受诊治的152例子宫瘢痕妊娠病人的临床信息资料作为研究的案例,全部152例病人均实施经阴道和经腹部的彩色多普勒超声诊断检查,回顾分析其临床信息资料,探究在子宫瘢痕妊娠的临床诊断及治疗中,采用彩色多普勒超声进行诊断及指导其治疗,观察其临床应用价值。结果经腹部的彩色多普勒超声诊断检查,其诊断正确率高达120例(78.95%),经阴道的彩色多普勒超声诊断检

  17. ASSESSMENT OF PREVIOUS LOWER SEGMENT CAESAREAN SECTION SCAR BY ULTRA SONOGRAPY: IT'S INFLUENCE ON MODE OF DELIVERY AND FOETOMATERNAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Geeta Vandana

    2015-04-01

    Full Text Available BACKGROUND & PURPOSE OF STUDY: The present study is a prospective study to evaluate the usefulness of ultrasonographic measurement of the thickness of the lower uterine segment of post caesarean pregnancy at term for predicting the risk of intrapartum dehiscence. METHODS: T his study was conducted in the D epartment of OBGYN, King George Hospital, Andhra Medical College, Visakhapatnam, from March 2011 to August 2012. All the pregnant women with previous one cesarean section attending Ante Natal Clinic for confinement were included in the s tudy after giving consent. RESULTS: The out of 100 cases of post caesarean pregnancy, 42 elective LSCS were done in 14 cases, and VBAC in 17 cases. Out of 58 emergency LSCS repeat elective LSCS were done in 26 cases and 5 cases underwent VBAC. There was no case of perinatal mortality or rupture in the present study. CONCLUSION: There was significant thinning of lower uterine segment in emergency caesarean group. The 3.5mm mean of LUS thickness was taken as cut off value. There is 46% chance of uterine dehis cence when thickness is 3.5mm. If the thickness of lower uterine segment is >3.5mm the possibility of dehiscence during subsequent trials of labor is very small. Hence t ransvaginal deliv ery can be undertaken with more confidence.

  18. 剖宫产子宫瘢痕部位妊娠42例临床研究%Clinical studies 42 cases of caesarean section scar pregnancy site

    Institute of Scientific and Technical Information of China (English)

    郑红艳

    2014-01-01

    目的:探讨剖宫产子宫瘢痕部位妊娠的临床分析,并探讨合适的治疗方法。方法选取我院2012年至2013年收治的42例剖宫产子宫瘢痕妊娠资料进行回顾性分析。结果42例孕妇中,均有剖宫产术史,停经后出现不规则引导出血,所有患者均经过超声检测,明确诊断,其中29例发现瘢痕处妊娠囊与子宫浆膜层厚度≥4mm,13例<4mm;所有患者先给予保守治疗,治疗5-6d 后给予宫腹腔镜监测下的刮宫术,经过治疗后,42例患者中,39例手术成功,占91.86%,3例未一次性成功,经药物治疗后痊愈。所有患者无穿孔、大出血等并发症出现。结论阴道超声检查为诊断剖宫产子宫瘢痕处妊娠的有效方法,剖宫产子宫瘢痕处妊娠可进行保守治疗+宫腹腔镜治疗,值得在临床上推广应用。%Objective to investigate the clinical analysis of caesarean section scar parts of pregnancy, and to explore appropriate treatment. Methods our hospital in 2012 and 2013 were treated 42 cases of caesarean section scar pregnancy were retrospectively analyzed. Results 42 cases of pregnant women have cesarean surgery history, guided postmenopausal irregular bleeding, all patients have to undergo ultrasonic testing, diagnosis, of which 29 cases found at the gestational sac and the uterine scar serous layer thickness ≥4mm, 13 cases <4mm; given conservative treatment in all patients before treatment given after 5-6d laparoscopy curettage under surveillance, after treatment, 42 cases of patients, 39 cases of surgical success, accounting for 91.86%, three cases are not disposable successful recovery after drug treatment. all patients without perforation, bleeding and other complications. Conclusion transvaginal ultrasound is an effective way to caesarean section scar pregnancy diagnosis, caesarean section scar pregnancies can be treated conservatively + laparoscopy treatment, worthy of clinical application.

  19. Clinical value of color Doppler ultrasound on monitoring the debridement surgery of hysteroscopic previous caesarean section scar pregnancy%彩色多普勒超声监测宫腔镜下剖宫产子宫瘢痕妊娠病灶清除术的临床价值

    Institute of Scientific and Technical Information of China (English)

    林炳钦; 张泽玫; 钟红珠; 杨楚香; 李婵粧

    2014-01-01

    目的:探讨彩色多普勒超声监测宫腔镜下剖宫产子宫瘢痕妊娠病灶清除术的临床价值。方法回顾性分析1999年1月至2012年12月汕头市第二人民医院在彩色多普勒超声监测宫腔镜下剖宫产子宫瘢痕妊娠病灶清除术的8例患者的临床资料。结果术前8例剖宫产子宫瘢痕妊娠患者彩色多普勒超声均表现为子宫下段前壁剖宫产瘢痕处混合性包块,在彩色多普勒超声监测宫腔镜下病灶清除术保守治疗成功,术中出血少。结论彩色多普勒超声是诊断剖宫产子宫瘢痕妊娠的主要方法。彩色多普勒超声监测宫腔镜下剖宫产子宫瘢痕妊娠病灶清除术,能够明显缩短手术时间,减少盲目性,保证了宫腔镜手术安全,具有很重要的临床实用价值。%Objective To investigate the clinical value of color Doppler ultrasound on monitoring the hysteroscopic previous caesarean section scar pregnancy debridement. Methods From January 1999 to December 2012,the clinical data of 8 patients with previous caesarean section scar pregnancy debride-ment under color Doppler ultrasound monitoring in the second people’s hospital of Shantou were retro-spectively analyzed. Results Preoperative color Doppler ultrasound of the 8 patients with previous caesar-ean section scar pregnancy showed mixed mass at the cesarean section scar in lower uterine segment anterior wall. Hysteroscopic conservative treatment for debridement was successful by color Doppler ultrasound mo-nitoring,and the blood loss was less. Conclusions Color Doppler ultrasound is the main method for diag-nosis of previous caesarean section scar pregnancy. Color Doppler ultrasound in monitoring the hysteroscop-ic debridement of previous caesarean section scar pregnancy,can obviously shorten the operation time,re-duce blindness,ensure the safety of hysteroscopic surgery,and has very important clinical value.

  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. Effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclamptic undergoing elective cesarean section under spinal anesthesia

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    Nashwa S. Elzayyat

    2014-07-01

    Full Text Available This study was designed to investigate and compare the effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclampsia undergoing elective cesarean section. A total of fifty parturients having moderate preeclampsia scheduled for elective cesarean section were included. They were randomly allocated into two equal groups 25 each, magnesium group (GMg received preoperative magnesium sulfate infusion and control group (GC then both received spinal anesthesia, serum troponin measured preoperative then at 6, 12 and 24 h postoperative. Mean arterial pressure and heart rate were also recorded. Baseline serum cardiac troponin was higher above normal and was comparable at the rest of times in both groups. Mean arterial pressure readings were significantly lower in GMg compared to GC at induction of spinal, skin incision and skin closure (P < 0.05 and were comparable at the rest of times. Serum cardiac troponin (cTn levels were comparable in parturients received magnesium sulfate infusion preoperatively with those did not receive magnesium sulfate.

  2. 超声在剖宫产子宫瘢痕妊娠诊治中的应用价值分析%Caesarean Section Scar Pregnancy, Ultrasound in the Diagnosis and Treatment Value Analysis

    Institute of Scientific and Technical Information of China (English)

    郭妮娜

    2013-01-01

    Objective This paper mainly discusses the ultrasound in the diagnosis of uterine cesarean section scar pregnancy patients clinical diagnostic value. Methods random selection from January 2010 to July 2012 to our this period were forty cases of cesarean section and postoperative uterine scar pregnancy patients as the research object, to al patients in B super mediated with percutaneous uterine artery embolization, quickly control vaginal bleeding, blocking the embryonic major blood supply and inhibition of embryonic growth, reduce the bleeding in the qing dynasty palace operation, to avoid the hysterectomy, summarize these patients after the ultrasonic image characteristics and the use of ultrasonography in uterine artery embolization in the treatment of curative ef ect was evaluated. Results the results showed that, forty cases of uterine scar pregnancy has simple gestational sac type 17 cases; Partly in uterine cavity type 9 cases;Mixed echo bag piece type 14 cases. Ultrasonic image display lower uterine segment scar place see pregnancy capsule or mixed echo bag piece, CDFI showed pregnancy capsule or bag piece perimeter visible rich blood flow through the low resistance, patients with conservative treatment after January, ultrasonic display gestational sac or bag piece of peripheral blood flow significantly reduced or even disappear, resistance index was also significantly increased before treatment, P<0.05. Conclusion the results showed that doppler ultrasound can clearly show the location of the uterine scar pregnancy, scope, uterine muscle wal thickness and blood supply, therefore, clinical use doppler ultrasonography can very accurate, timely to scar pregnancy for early diagnosis, ultrasonic technology can also dynamic observation scar pregnancy before and after treatment of the focus of the change, so ultrasonic inspection technology in scar pregnancy diagnosis, treatment in a very important meaning, it is worth clinical application.%目的本文主要探

  3. 剖宫产术后切口愈合不良危险因素调查%CESAREAN SECTION RISK FACTORS FOR POOR WOUND HEALING RESEARCH

    Institute of Scientific and Technical Information of China (English)

    张洪星; 郭文玲; 李宁

    2012-01-01

    [目的]分析剖宫产术后切口愈合不良的危险因素,总结护理措施,以提高剖宫产患者切口愈合的质量.[方法]采用病例对照的研究方法,对某院110例行剖宫产术后伤口愈合不良患者的临床资料进行回顾性分析,与同时期剖宫产术后愈合良好组在有关不良危险因素方面进行比较分析,提出合理的护理措施.[结果]110例剖宫产患者伤口轻度愈合不良者72例(65.45%),中度25例(22.73%),重度13例(11.82%);与对照组比较发现,影响切口愈合的危险因素为:BMI高、基础疾病、术前未预防应用抗生素、无菌操作不严格、手术时间长.[结论]多种危险因素影响切口的愈合.提高认识,正确指导孕期保健,做好产前检查、围术期给予药物进行预防、控制病房内细菌的数量,积极采取应对护理措施,以提高切口愈合质量.%[Objective] To analyze the risk factors of poor wound healing during cesarean section, and summary care measures to improve the quality of wound healing in patients with cesarean section. [Methods] A case-control study of 110 hospital routine cesarean section wound healing in patients with clinical data were retrospectively analyzed, and compared the risk factors with the same period a good set of healing after cesarean section to propose effective preventive measures. [Results] Among 110 cases of cesarean section, 72 patients had mild wound healing (65.45%) , 25 cases had moderate wound healing (22,73%), 13 cases had severe wound healing (11.82% ). Compared with the control group, we found that the impact of risk factors for wound healing, inclding higher BMI, underlying disease, preoperative antibiotic prophylaxis, non-strict aseptic and long time surgery. [Conclusion] Multiple risk factors affect wound healing, awareness, proper guidance to prenatal care, good prenatal care, preoperative administration of drugs for the prevention, control the number of bacteria within ward, take

  4. Abdominal distension after cesarean section analysis of the causes and nursing%剖宫产术后腹胀原因分析及护理

    Institute of Scientific and Technical Information of China (English)

    梁丽花

    2016-01-01

    目的:探讨剖宫产术后发生腹胀的原因,并总结其针对性护理措施。方法选取2015年1月~2016年1月于我院接受剖宫产术的产妇150例作为研究对象,根据产妇剖宫产术后是否发生腹胀,将其分为正常组118例与腹胀组32例。分析比较联合组剖宫产术后腹胀的原因,并总结其针对性护理措施。结果腹胀组产妇围手术期饮食不当、生产过程中大喊大叫、胃肠道准备不充分、长期卧床、伤口疼痛例数明显高于正常组,差异均有统计学意义(P<0.05)。结论饮食不当、生产过程中大喊大叫、胃肠道准备不充分、长期卧床、伤口疼痛导致腹肌力量减弱,可作为导致剖宫产术后腹胀发生的主要影响因素,围手术期护理应基于以上原因,对患者进行心理、生理、疼痛等综合护理措施,降低术后腹胀发生率。%ObjectiveTo study the cause of abdominal distension, cesarean section and summed up the pertinent nursing measures.MethodsBetween January 2015 and January 2015 in our hospital to accept cesarean section of 150 cases of maternal, as the research object. According to the puerpera whether abdominal distention after cesarean section will be divided into normal group (n=118) and abdominal distension group (n=32), by comparing with the normal group analysis the cause of abdominal distension after cesarean section, and summarize the corresponding nursing measures.ResultsMaternal abdominal distension group, perioperative improper diet, Shouting in the process of production and prepare adequately for the gastrointestinal tract, long-term lie in bed, wound pain were significantly higher than that of normal group,P<0.05, with statistical significance. ConclusionImproper diet, Shouting in the process of production, prepare adequately for the gastrointestinal tract, long-term lie in bed, wound pain, abdominal distension after cesarean section, as a result of weakened muscles can

  5. 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.

  6. 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

  7. 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

  8. Ultrasonic Detection of Cesarean Section Incision Healing Value%超声检测剖宫产切口愈合情况的价值

    Institute of Scientific and Technical Information of China (English)

    赵建婷

    2014-01-01

    目的:探讨应用超声观察剖宫产切口愈合情况的价值。方法经腹超声检测389例剖宫产术后切口愈合情况,观察其声像图特点。结果子宫切口愈合良好365例,子宫切口愈合不良24例,子宫切口憩室2例。结论超声能够无创、实时的观察子宫切口愈合情况。%Objective To investigate the application of ultrasonic on cesarean incision healing value. Methods Transabdominal ultrasound in 389 cases after cesarean section incision healing, observe the ultrasonographic features. Results 365 cases got good healing of uterus incision poor healing of uterus incision, 24 cases, 2 cases of uterine incision diverticulum. Conclusion Ultrasound can noninvasive, real-time observation of the healing of uterine incision.

  9. 改良宫腔镜手术治疗瘢痕妊娠疗效评估%An improved hysteroscopic approach for cesarean scar pregnancy management:a retrospective cohort study

    Institute of Scientific and Technical Information of China (English)

    李经纬; 赵福杰

    2016-01-01

    目的:回顾性分析宫腔镜改良手术治疗瘢痕妊娠的疗效。方法收集中国医科大学附属盛京医院60例瘢痕妊娠患者,其中30例经宫腔镜改良手术治疗为研究组,30例经双侧子宫动脉栓塞加宫腔镜电切术治疗为对照组。比较两组间术中及术后情况,评估改良宫腔镜手术治疗瘢痕妊娠的疗效。结果两组患者手术时间及术后血β-hCG值转阴时间比较,差异无统计学意义(P>0.05)。与对照组比较,研究组患者术中平均出血量较少(P<0.01),且术后宫腔引流量也显著少于对照组(P<0.01),术后子宫前壁包块更小且吸收更快(P<0.01),住院时间更短(P<0.01)。结论改良宫腔镜手术治疗瘢痕妊娠具有出血少、恢复快、更快捷经济等优点,是治疗瘢痕妊娠的有效方法。%Objective To evaluate the safety and efficacy of our improved hysteroscopic approach for CSP management. Methods Totally 60 women with cesarean scar pregnancy,30 received improved hysteroscopic removal( electrocoagulation and blunt separation) of CSP,and 30 hysteroscopic resection of CSP combined with uterine artery embolization. Compared the differents of operation time,in-traoperative blood loss,postoperative drainage of the uterine cavity,hospital stays,resolution time of β-human chorionic gonadotropin (β-hCG),size of the mass,absorption time of the mass between the two groups. Results For the improved hysteroscopic approach group,the intraoperative blood loss,postoperative drainage of the uterine cavity,hospital stays,size of the mass and absorption time of the mass were significantly lower than in the patients who had undergone hysteroscopic resection. We found no statistically significant difference in the operation time and resolution time of β-hCG between the two groups. Conclusion The improved hysteroscopic ap-proach has the advantage of less blood loss,shorter hospital stays and rapid return to normal morphology of the uterus. This

  10. 护理干预对剖宫产术后母乳喂养的影响%Influence of nursing intervention on breastfeeding after cesarean section

    Institute of Scientific and Technical Information of China (English)

    李敏

    2015-01-01

    Objective:To explore the influence of nursing intervention on breastfeeding after cesarean section.Method:100 cases of maternal with cesarean section were randomly divided into the observation group and the control group,with 50 cases in each group.The control group were given conventional nursing care,and the observation group were given a series of nursing intervention on the basis of conventional nursing care.The two sets of data were compared.Results:The breastfeeding rate of the observation group was obviously higher than that of the control group.The first lactation time,postpartum lactation ratios and so on of the observation group were better than those of the control group.Conclusion:Targeted nursing intervention could meet the emotional needs of maternal better and increase the lactation secretion after cesarean section and improve the quality of breastfeeding.%目的:探讨护理干预对剖宫产术后母乳喂养影响。方法:收治剖宫产产妇100例,随机分为观察组和对照组各50例。对照组给予常规护理,观察组在常规护理的基础上给予一系列的护理干预。对两组数据进行对比。结果:观察组的母乳喂养率明显高于对照组。观察组的初次泌乳时间、产后泌乳充足率等情况均优于对照组。结论:针对性的护理干预能够较好地满足产妇的情感需要,增加剖宫产术后乳汁的分泌,提高母乳喂养质量。

  11. 剖宫产术后切口妊娠18例临床分析%Clinical analysis of 18 cases of cesarean section incision pregnancy

    Institute of Scientific and Technical Information of China (English)

    雷红丹

    2014-01-01

    Objective:To summarize and analyze the diagnosis and treatment of cesarean section incision pregnancy.Methods:18 cases of cesarean section incision pregnancy were selected.The diagnosis and treatment were retrospectively studied.Results:1 case was diagnosed missed abortion,and the patient occured hemorrhoea in the uterine curettage and given uterine arterial embolization.7 cases were treated with taking mifepristone,a single dose methotrexate and air pressure oppression uterine cavity conservative treatment.2 cases were misdiagnosed as normal intrauterine pregnancy,and the patient occured hemorrhoea in the artificial abortion operation and was given a single dose methotrexate combined with air pressure oppression uterine cavity hemostasis,uterine curettage was performed after HCG drop.8 cases were given taking mifepristone combined with a single dose methotrexate drug therapy.Conclusion:Using air pressure oppression uterine cavity combined with drug killing embryo in the treatment of cesarean section incision pregnancy can effectively killing fetus and reduce bleeding,and reduce HCG value and preserve the uterus,in order to preserve fertility of patients.%目的:对剖宫产术后切口妊娠诊断、治疗方法进行总结分析。方法:收集剖宫产术后切口妊娠病例18例,对其诊断及治疗方法进行回顾性研究。结果:1例诊断为稽留流产,清宫术中大出血即行子宫动脉栓塞术;7例采用顿服米非司酮、单剂量甲氨蝶呤、气囊压迫宫腔保守治疗;2例误诊为宫内正常妊娠,人工流产术中大出血,给予甲氨蝶呤单剂量联合气囊压迫宫腔止血,待HCG下降后行清宫术;8例使用米非司酮顿服联合甲氨蝶呤单剂量行药物治疗。结论:剖宫产术后切口妊娠采用气囊压迫宫腔联合药物杀胚治疗可以有效杀胚并减少出血,降低HCG值与保全子宫,以保存患者生育能力。

  12. Explore the application of different anesthesia methods in cesarean section%探讨剖宫产手术中不同麻醉方法的应用

    Institute of Scientific and Technical Information of China (English)

    侯素珍

    2016-01-01

    Objective:To investigate the effect of different anesthesia methods in cesarean section.Methods:124 cases of puerpera with cesarean section were selected,they were randomly divided into the observation group and the control group with 62 cases in each,the control group was given single epidural anesthesia,the observation group was given the combined spinal epidural anesthesia,we compared the effect.Results:In the observation group,the induction time and the onset time were significantly better than the control group,the satisfaction of anesthesia of 98.7% was significantly higher than 84.5% of the control group(P<0.05). Conclusion:In cesarean section,the influence of application of combined spinal epidural anesthesia for respiration and circulation of puerpera was small,analgesia was complete,it can enhance the safety of mother and child.%目的:探讨不同麻醉方法在剖宫产手术中的应用疗效。方法:收治剖宫产产妇124例,随机分为观察组与对照组各62例,对照组行单次硬膜外麻醉,观察组行腰麻-硬膜外联合麻醉,比较效果。结果:在观察组,诱导时间及起效时间明显优于对照组,麻醉满意度98.7%,明显高于对照组的84.5%(P<0.05)。结论:在剖宫产手术中,采用腰麻-硬膜外联合麻醉方法,对产妇呼吸循环影响较小,镇痛完全,提升母婴安全性。

  13. Experience of intraoperative uterus bleeding cesarean section among 15 cases%剖宫产术中子宫出血15例防治体会

    Institute of Scientific and Technical Information of China (English)

    丁云青

    2012-01-01

    OBJECTIVE To discuss the experience of intraoperative uterus bleeding cesarean section for 15 cases. METHODS 50 patients with uterine bleeding during childbirth and cesarean section were selected from January 2008 to December 2010 in obstetrics and gynecology. 50 cases were at the age of 20-35 years old; 16 cases were puerpera, and 34 cases were included. During recent 10 years, 50 cases entered intraoperative hemorrhage uterine cesarean section, eight suture of the uterus bleeding wound and oppression of the uterus were taken. RESULTS The uterus were preserved by effectively stopping bleeding. CONCLUSION Each case with massive bleeding may happen maternal, and need to alert instance lactation. Each instance surgery should take the strict preoperative discussion and risk assessment, prepare blood, especially for severe anemia, thrombocy-topenia or blood coagulation disorders.%目的 就剖宫产术中子宫出血15例防治体会进行探讨.方法 选取2008年1月~2010年12月某院妇产科进行剖宫产分娩且子宫出血的患者50例,50例中年龄为20~35岁;经产妇为16例,初产妇为34例.该院近10年来剖宫产术中遇到子宫大出血50例,采取了8字缝合子宫出血创面及压迫缝合子宫法.结果 有效制止出血成功保留子宫.结论 每一例产妇均有发生大出血可能,需要警觉每一例产妇.每一例手术需要有严格的术前讨论和风险评估,做好配血和备血,对重度贫血、血小板减少或凝血功能障碍术前要纠正.

  14. 甲氨蝶呤妊娠囊内注射联合清宫术治疗子宫瘢痕处妊娠的效果%Influence of Methotrexate Gestation Injection Combined with Curettage Treating Cesarean Scar Pregnancy on Clinical Efficacy,β-hCG and Adverse Reactions

    Institute of Scientific and Technical Information of China (English)

    颜红丽; 田燕妮; 刘嗣超; 王彩英

    2016-01-01

    Objective:To research the influence of methotrexate gestation injection combined with curet-tage treating cesarean scar pregnancy on clinical efficacy,β-hCG and adverse reactions. Methods:The clini-cal data of 150 patients with cesarean scar pregnancy treated in our hospital from April 2015 to April 2016 were analyzed retrospectively. The control group was treated with methotrexate gestation injection, based on which, the observation group was treated with curettage. The efficacy of two groups was compared. Results:The fertile function, efficacy indicators andβ-hCG of the observation group was better than that of the control group , and the total incidence rate of adverse reactions of the observation group was lower than that of the con-trol group( P<0.05) . Conclusion:Methotrexate gestation injection combined with curettage in treating cesare-an scar pregnancy has evident effect.%目的::研究子宫瘢痕处妊娠患者行甲氨蝶呤妊娠囊内注射和清宫术联合治疗对临床疗效、β-hCG及不良反应的影响。方法:资料取本院2015年4月至2016年4月收治子宫瘢痕处妊娠150例患者予回顾分析,对照组行甲氨蝶呤妊娠囊内注射治疗,观察组联合清宫术,对比两组疗效。结果:观察组生育功能及相关疗效指标、β-hCG比对照组优,且总不良反应率比对照组低,差异具有统计学意义( P<0.05)。结论:子宫瘢痕处妊娠行甲氨蝶呤妊娠囊内注射和清宫术联合治疗效果显著。

  15. 甲氨蝶呤联合米非司酮在内生型早期剖宫产瘢痕妊娠治疗中的价值分析%Value Analysis of Methotrexate in Combination With Mifepristone in Treatment of Early Endogenous Type Cesarean Scar Pregnancy

    Institute of Scientific and Technical Information of China (English)

    邴佳

    2016-01-01

    Objective To analyze the value of methotrexate combined mifepristone in treatment of early cesarean scar pregnancy. Methods Our hospital from September 2013 to September 2015 admitted during the period of 60 patients with endogenous type cesarean scar pregnancy early as the research object, and randomly divided into treatment group and control group,control group treated with methotrexate,joint mifepristone treatment,treatment group on the basis of the analysis of therapeutic effect. Results The total effective rate in treatment group was significantly higher than the control group, compared with significant difference was statistical y significant(P<0.05). Conclusion For patients with endogenous type cesarean scar pregnancy early,taking methotrexate combined mifepristone treatment effect significantly,higher clinical value.%目的:分析甲氨蝶呤联合米非司酮在内生型早期剖宫产瘢痕妊娠治疗中的价值。方法选取我院在2013年9月~2015年9月收治的60例内生型早期剖宫产瘢痕妊娠患者为研究对象,随机分成治疗组和对照组,对照组采取甲氨蝶呤治疗,治疗组在此基础上联合米非司酮治疗,分析治疗效果。结果治疗组总有效率高于对照组,差异具有统计学意义(P<0.05)。结论对于内生型早期剖宫产瘢痕妊娠患者而言,采取甲氨蝶呤联合米非司酮进行治疗效果显著,临床价值较高。

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    Neerja Bhardwaj

    2013-01-01

    Results: The umbilical pH was comparable in all the three groups (P > 0.05. The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in group M (P < 0.05 than in group E and group P. Total drug consumption to meet target blood pressure till delivery was 39.3 ± 14.6 mg in group E, 1.7 ± 0.9 mg in group M, and 283.6 ± 99.8 mcg in group P. The incidence of nausea and vomiting was comparable in the three groups. Conclusion: All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anesthesia for cesarean section without any detrimental effects on fetal and maternal outcome.

  18. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial

    Science.gov (United States)

    Shahraki, Azar Danesh; Feizi, Awat; Jabalameli, Mitra; Nouri, Shadi

    2013-01-01

    Objective: Any operation leads to body stress and tissue injury that causes pain and its complications. Glucocorticoids such as Dexamethasone are strong anti-inflammatory agents, which can be used for a short time post-operative pain control in various surgeries. Main purpose of this study is to evaluate the effect of administration of intravenous (IV) Dexamethasone on reducing the pain after cesarean. Methods: A double-blind prospective randomized clinical trial was performed on 60 patients candidate for elective caesarean section. Patients were randomly assigned into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were recorded in different time points during first 24 h after operation. Statistical methods using repeated measure analysis of variances and t-test, Mann-Whitney and Chi-square tests were used for analyzing data. Findings: The results indicated that within-group comparisons including severity of pain, MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study period. Between group comparisons indicated significant differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in case group were lower than the control group. Conclusion: IV Dexamethasone could efficiently reduce post-operative pain severity and the need for analgesic consumption and improve vital signs after cesarean section. PMID:24991614

  19. Nursing Care of 46 Cases of Severe Preeclampsia After Cesarean Section%46例子痫前期重度剖宫产术后的护理

    Institute of Scientific and Technical Information of China (English)

    谢晓艳

    2015-01-01

    目的:探讨46例子痫前期重度剖宫产术后的护理。方法选取我院接受治疗的46例子痫前期重度患者作为研究对象,并将其随机分为观察组与对照组,每组23例。对照组进行常规护理,观察组患者在此基础上进行优质护理。结果观察组患者的术后子痫发生率及并发症发生率均低于对照组患者,两组数据差异显著,结果具有统计意义。结论重视子痫前期重度剖宫术后患者的心理护理,可改善患者预后,促进患者的康复。%Objective To explore the nursing care of 46 cases of severe preeclampsia after cesarean section. Methods 46 severe preeclampsia patients in our hospital were taken as the research object and randomly divided into observation group and control group,23 cases in each group. The control group received routine care. The patients in the observation group received high quality nursing. Results The observation group of patients with postoperative incidence of eclampsia and complication rates were significantly lower than control group,there was significant difference between two sets of data. Conclusion The psychological nursing for patients with severe preeclampsia after cesarean section can improve the prognosis of patients,promote the rehabilitation.

  20. El secuestro de Lucina (o cómo detener la epidemia de cesáreas Lucina's kidnap (or how to stop the cesarean section epidemic

    Directory of Open Access Journals (Sweden)

    Octavio Gómez-Dantés

    2004-02-01

    Full Text Available Las cesáreas han tenido un incremento explosivo en la mayoría de los países de ingresos altos y medios en años recientes. En América Latina los porcentajes de partos quirúrgicos alcanzan cifras de 30% en Brasil, 40% en Chile y 36% en México. En este ensayo se describe la relación de las cesáreas con diversas figuras mitológicas, se presenta una breve historia de esta operación y se discute el posible origen de su crecimiento reciente. Dentro de los factores relacionados con esta epidemia destacan los intereses económicos, la oferta de servicios especializados y la poca información que las mujeres embarazadas reciben respecto de las alternativas para el nacimiento de sus hijos. El trabajo concluye con un llamado al control de este tipo de intervenciones atendiendo a experiencias exitosas documentadas.Cesarean sections rates have increased considerably in high- and middle-income countries in recent years. In Latin America the rates of surgical births reached 30% in Brazil, 40% in Chile, and 36% in Mexico. This essay describes the relationship of cesarean section with several mythological characters, presents a brief history of surgical births, and discusses the possible origin of its explosive increase. Among the factors associated to this epidemic we can mention economic incentives, a mounting supply of specialists, and the lack of comprehensive information on birth alternatives for pregnant women.The essay concludes with a call for a generalized control of this procedure based on evidence gathered through different kinds of interventions.

  1. 水囊压迫法在子宫疤痕妊娠7例止血观察及护理配合%Efficacy and nursing cooperation of uterine cavity placed bladders oppression in the treatment of 7 cases of cesarean scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    苏月英

    2014-01-01

    Objective To analyze efficacy and nursing cooperation of uterine cavity placed bladders oppression in the treatment of 7 cases of cesarean scar pregnancy.Method 7 cases of cesarean scar pregnancy underwent curettage jointly uterine cavity placed bladders oppression treatment.Results The average hospitalization of 7 cases of uterine scar pregnancy was (5.6 ± 2.0) days,the average blood loss was (268.9 ± 71.6) ml,the average amount of bleeding after placing bladders was (65.4 ± 11.9) ml,the average time of serum β-HCG level down to normal level was (11.9 ± 3.8) days,without postoperative infection.Conclusions Uterine cavity placed bladders oppression in the treatment of uterine scar pregnancy is reliable and safe.Advantages of bladders are simple make,wide usage and low cost,especially suitable for treatment of uterine bleeding of gynecologic surgery in the primary hospital.%目的 分析宫腔放置水囊压迫法在子宫疤痕妊娠的止血效果及护理配合.方法 将7例确诊为子宫疤痕妊娠妇女作为研究对象,均进行刮宫术联合宫腔放置水囊压迫法止血治疗.结果 7例患者平均住院时间(5.6±2.0)d,术中出血量平均为(268.9±71.6) ml,放置水囊压迫法后平均出血量为(65.4±11.9) ml,血清β-HCG下水平降至正常水平时间(11.9±3.8)d,术后无一例患者出现感染.结论 宫腔放置水囊压迫法止血效果可靠、安全,且水囊制作简单、应用广泛、费用低廉,尤其适合基层医院妇产科手术宫腔大出血的止血处