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Sample records for high caesarean section

  1. Caesarean section: an historical riddle.

    Science.gov (United States)

    Majumdar, S K

    2001-01-01

    Etymologically, the word 'Caesar' originates from the Latin word 'Caedaere' meaning - 'to cut'. So cutting remains the core point, but little is known about the real origin of the history of Caesarean Section. There is evidence that, the ancient Hindus excelled in surgery and many operations were performed, including caesarean section. This operation was mentioned several times in the Mishnah of Rabbi Judah, the first large commentary on the Hebrew Bible. There are also several mythological anecdotes in Hindu, Buddhist and Greek mythologies. The myth of caesarean section did not even escape the keen eyes of William Skakespeare. The landmarks, treatises and the advancement in this operative procedure are presented in this article.

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

    African Journals Online (AJOL)

    Background: Caesarean section (CS) rates are increasing worldwide; rates in the private ... data were pooled and used to analyse the clinical information. .... labour – very sparingly and judiciously in the presence of poor progress ... Laboratory data .... Broomberg conducted a retrospective analysis of CS rates among white.

  3. Neonatology and the caesarean section.

    Science.gov (United States)

    Zanini, R; Minghetti, D

    2012-10-01

    The origins of the use of the Caesarean section date far back in human history. Traces of this procedure can be found in Greek mythology and in the history of Ancient Rome. Many documents about the history of religion make reference to a delivery from the abdomen.

  4. Changing trends in incidence and indications of caesarean section.

    Science.gov (United States)

    Khan, A; Ghani, T; Rahim, A; Rahman, M M

    2014-01-01

    Caesarean section is most frequently performed major operation in obstetrics. The rate of caesarean section has been increasing both in developed and developing countries in the past decade. This study was done to find out the change of sociodemographic condition of respondents, identify the different types & rate of caesarean section indications, the outcome of different indications, estimate the rate of caesarean section proportion of the elective & emergency indications and evaluate the complications of caesarean sections. This is a cross-sectional study of randomly selected 130 cases of lower caesarean section done at Sir Salimullah Medical College & Mitford Hospital, Dhaka from March 2006 to August 2006. In this study 80(61.5%) cases underwent emergency caesarean section and in 50(38.5%) cases elective caesarean section had done. Among indications of caesarean section repeat section scores the top of the list. No maternal mortality case recorded in this study. This study shows high incidence of caesarean section which does not reflect the picture of total population of Bangladesh.

  5. Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study.

    Science.gov (United States)

    Murray, S F

    2000-12-16

    To explore the circumstances and factors that explain the association between private health insurance cover and a high rate of caesarean sections in Chile. Qualitative analysis of audiotaped in-depth interviews with obstetricians and pregnant women; quantitative analysis of data from face to face semistructured interview survey conducted postnatally (with women who had given birth in the previous 24-72 hours), and of a review of medical notes at a public hospital, a university hospital, and a private clinic. Santiago, Chile. Qualitative arm: 22 obstetricians, 21 pregnant women; quantitative arm: 540 postnatal women. Rates of caesarean section in different types of institutions; consultants' views on private practice; work patterns in private practice; women's reasons for choosing private care; women's preferences on method of delivery. Private health insurance cover requires the primary maternity care provider to be an obstetrician. In the postnatal survey, women with private obstetricians showed consistently higher rates of caesarean section (range 57-83%) than those cared for by midwives or doctors on duty in public or university hospitals (range 27-28%). Only a minority of women receiving private care reported that they had wanted this method of delivery (range 6-32%). With the diversification in the healthcare market, most obstetricians now have demanding peripatetic work schedules. Private maternity patients are a lucrative source of income. The obstetrician is committed to attend these private births in person, and the "programming" (or scheduling) of births is a common time management strategy. The rate of elective caesarean sections was 30-68% in women with private obstetricians and 12-14% in women not attended by private obstetricians. Policies on healthcare financing can influence maternity care management and outcomes in unforeseen ways. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral

  6. Rising caesarean section rates in public hospitals in Malaysia 2006.

    Science.gov (United States)

    Ravindran, J

    2008-12-01

    The caesarean section rate in Malaysian public hospitals has increased to 15.7% from 10.5% in the year 2000. There are inter-state variations in the rate ranging from a high of 25.4% in Melaka to 10.9% in Sabah. The West Coast states generally had a higher caesarean section rate than the East Coast states as well as East Malaysia. It would be prudent for Malaysia to implement stringent caesarean audits to ensure that rising caesarean section rates are kept in check.

  7. Induced vaginal birth after previous caesarean section

    OpenAIRE

    Akylbek Tussupkaliyev; Andrey Gayday; Bibigul Karimsakova; Saule Bermagambetova; Lunara Uteniyazova; Guldana Iztleuova; Gulkhanym Kusherbayeva; Meruyert Konakbayeva; Assylzada Merekeyeva; Zamira Imangaliyeva

    2016-01-01

    Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC) remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administra...

  8. Caesarean sections in Mexico: are there too many?

    Science.gov (United States)

    Gonzalez-Perez, G J; Vega-Lopez, M G; Cabrera-Pivaral, C; Muñoz, A; Valle, A

    2001-03-01

    This paper seeks to quantify the magnitude of caesarean sections in Mexican public health-care institutions in recent years, to characterize the evolution of caesarean section rates (CSR) during the last decade, and to estimate the possible economic cost caused by the excess of caesareans performed in these institutions. The study is based on data obtained from the health sector, both for Mexico in the 5-year period 1993-97 and for the Mexican State of Jalisco between 1983 and 1998. Linear regression analysis was used to evaluate time series, and "excess of caesareans" was considered the number of caesarean deliveries performed above the admissible 15% CSR. The results reflect that on the national level, more than one-quarter of the deliveries handled by public institutions ended in caesarean section for each analyzed year, and if the deliveries performed in private institutions are included, the national rate is around 30%. A marked increase in CSR can be observed in Jalisco between 1983 and 1998 (almost 50%); and the cost for the nation of this CSR excess in financial terms is highly significant: several millions of dollars--obtained from public funds--are spent annually and unnecessarily by health services. The findings suggest that the increase in CSR is a public health problem that has not been satisfactorily faced by the health sector authorities. Many unnecessary caesareans would undoubtedly be avoided if the policies of these public health-care institutions were to consider, as a priority, both the known higher risk implicit in a caesarean for the health of the mother and child, and the economic impact on the country and its health institutions of the excessive number of caesareans performed yearly.

  9. Prolonged labour as indication for emergency caesarean section

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Sorensen, B L; Onesmo, R

    2012-01-01

    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.......To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour....

  10. Predicting spinal hypotension during Caesarean section

    African Journals Online (AJOL)

    surrounding the prediction of spinal hypotension in the patient for Caesarean ... topics of great interest to the majority of obstetric anaesthetists.4,5. It would seem ... high maternal mortality rate in South Africa6 and the potential contribution of ...

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

    LENUS (Irish Health Repository)

    Robson, Michael

    2013-04-01

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

  12. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Faúndes Anibal

    2009-10-01

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

  14. Effect of high-volume systematic local infiltration analgesia in Caesarean section

    DEFF Research Database (Denmark)

    Larsen, Klaus Richter; Kristensen, B B; Rasmussen, M A

    2015-01-01

    section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary...

  15. Speechless after general anaesthesia for caesarean section.

    Science.gov (United States)

    Narayanan, Aravind; Tawfic, Qutaiba Amir; Kausalya, Rajini; Mohammed, Ahmed K

    2012-06-01

    'Speechless' patient after general anesthesia may be a real horror for the anaesthetist as well as the patient and his relatives. Whatever the cause "functional or organic" the anaesthetist will be under pressure as his patient is not able to talk. Here we report a 40 years old patient who has no history of medical problems and developed aphemia after general anaesthesia for emergency caesarean section with an uneventful intra-operative course. Clinical examinations and investigations failed to reveal any clear cause and the patient returned her ability to talk and discharged home with normal voice.

  16. Thromboprophylaxis for women undergoing caesarean section.

    LENUS (Irish Health Repository)

    Kennedy, C

    2012-02-01

    Thromboprophylaxis for women undergoing caesarean section (CS) was introduced in the hospital in 1995. This study audited the use of tinzaparin prophylaxis in a nested cohort of women who screened negative for diabetes mellitus at 28 weeks gestation. All the women had their weight measured and BMI calculated at the first antenatal visit. Of the 284 women, 68 (24%) had a CS and all received tinzaparin. Of the 68, however, 94% received a dose lower than recommended. Compliance with prophylaxis was complete but compliance with the recommended dosage was suboptimal, which may result in venous thromboembolism after CS despite thromboprophylaxis.

  17. Labour and Childbirth After Previous Caesarean Section

    Science.gov (United States)

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

    2016-01-01

    The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patientʼs wishes into account. In view of good success rates (60–85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician. PMID:28017971

  18. Opinions and attitudes of obstetricians and midwives in Turkey towards caesarean section and vaginal birth following a previous caesarean section.

    Science.gov (United States)

    Kisa, Sezer; Kisa, Adnan; Younis, Mustafa Z

    2017-01-01

    Aim To determine the opinions and attitudes of Turkish obstetricians and midwives to caesarean section (C-section) and vaginal birth following a C-section. Methods The study involved obstetricians and midwives who were working in a state women's hospital and two private hospitals in Gaziantep, Turkey. Participants were asked to complete questionnaires on sociodemographic data and provide opinions about C-section. Results A total of 88 midwives and 22 obstetricians participated in the study. Approximately one-third of midwives believed caesarean rates were high at their institution and more than 50% thought that the rate should be reduced. In contrast, although approximately 80% of obstetricians thought that caesarean rates in their institutions ranged between 25-50%, only 18% believed the rate was high and 68% believed that the rate of should be reduced. Midwives and obstetricians tended to agree on most suggested reasons for high C-section rates. When asked about interventions that may reduce the C-section rates, midwives and obstetricians had opposing views. However, most participants agreed that prenatal childbirth preparation courses would be beneficial. Conclusions This study showed that most midwives and obstetricians believe the rate of C-section at their institution is high and should be reduced.

  19. OUTCOME OF PREGNANCY IN WOMEN WITH PREVIOUS CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Bellad Girija

    2016-06-01

    Full Text Available BACKGROUND Carefully selected cases of Vaginal Birth after Caesarean Section (VBAC is safe and successful. Even though options of elective caesarean section or a trial of labour are given to women with prior caesarean section, the risk is always present. In successful VBACs, morbidity is less compared to repeat caesarean section. That is why this study is conducted to determine the outcome of pregnancy in women with previous CS. OBJECTIVES 1. To evaluate the clinical course of labour in cases with previous caesarean section. 2. To study the perinatal outcome in cases with previous caesarean section either by vaginal delivery or repeat Caesarean section. 3. To study maternal morbidity in these cases. METHOD A retrospective analysis of medical records of 250 women with a previous caesarean section, who delivered in BIMS Hospital between May 2015 and July 2015 was carried out. Women with recurrent indications for caesarean section and those having nonrecurrent indications with any complicating factors in present pregnancy and women with previous two caesarean sections were not given trial for vaginal delivery. Those women with previous section for the non-recurrent indications were given trial for vaginal delivery. STATISTICAL ANALYSIS Was done by Chi-square test. RESULT In 250 cases, 132 cases were given trial for vaginal delivery. In these, vaginal delivery was 61.3% and repeat section was 38%. There is an association between maternal morbidity and type of delivery. Birth weight was associated with the type of delivery. There is no association between neonatal outcome and type of delivery. CONCLUSION In carefully selected patients, appropriate timing and close supervision, trial of vaginal delivery in previous one caesarean section is safe and successful. Individual approach seems to be the best.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  1. 剖宫产术后高危妊娠药物流产临床分析%Clinical analysis of high risk medical abortion after caesarean section

    Institute of Scientific and Technical Information of China (English)

    胡乔飞; 方瑞娟; 陈素文; 李长东; 孟凡; 李军; 陈雁鸣

    2014-01-01

    Objective To analyze the high risk induced abortion inpatients after caesarean section in Beijing Ob-stetrics and Gynecology Hospital, and understand the status in order to put forward the countermeasures and effective con-traception measures. Methods One hundred and fifty cases of re-pregnant women who were treated by induced abortion associated with curettages (uterine aspiration) guided by B mode ultrasound were analyzed retrospectively from Jan-uary, 2012 to December, 2013. Results The success rate of abortion using Mifepristone and Carboprost methylate was 98.0%, the average vaginal bleeding was (36.5±10.3)ml, the average days in hospital were (4.3±1.2)d without evident com-plications. No significant differences were observed among the number of caesarean sections and educational levels and contraception conditions (P>0.05), but there was significant differences between the number of caesarean sections and the interval from the last caesarean section (P0.05), but there was significant differences between the number of caesarean sections and hemorrhage volume during abortion (P0.05);但不同剖宫产次数患者本次妊娠距离末次剖宫产时间的差异有统计学意义(P0.05);但不同剖宫产次数患者再次妊娠流产中出血量的差异有统计学意义(P<0.05),≥2次剖宫产术后再次妊娠患者流产中出血量明显增加。结论米非司酮配合卡前列甲酯结合B超下清宫术是终止剖宫产术后高危妊娠的有效方法;呼吁医疗机构大力宣传剖宫产术后避孕知识,落实科学有效的避孕方法。

  2. Elective caesarean section at 38 weeks versus 39 weeks

    DEFF Research Database (Denmark)

    Glavind, Julie; Kindberg, S F; Uldbjerg, N;

    2013-01-01

    To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.......To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes....

  3. Myth: babies would choose prelabour caesarean section.

    Science.gov (United States)

    Sinha, Anjita; Bewley, Susan; McIntosh, Thea

    2011-10-01

    Interest in rising caesarean section (CS) rates focuses on the putative relative effects on maternal health and perinatal mortality, especially in 'non-medical', 'request' or 'repeat' planned prelabour CS (PLCS). Shortening pregnancy and avoiding labour affect fetal maturity. Babies who do not experience labour have significantly increased respiratory and other morbidities that may have profound effects on development, determining immediate and potentially life-long disease. It is thus surprising that obstetricians do not advocate awaiting or inducing labour even in women considering CS. Mothers must be fully informed of all the evidence before they can give valid consent and make decisions on their baby's behalf. New evidence about immunological and metabolic differences induced by obstetric interventions continues to emerge, but large knowledge gaps exist. Although all modes of delivery carry potential risk of neonatal morbidity or mortality, we conclude that normal babies would indeed 'choose' labour. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  4. Intervention for Postpartum Infections following Caesarean Section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    Purpose: To examine the effect on wound healing, using Negative Pressure Wound Therapy (NPWT) compared with standard wound dressings in women, who experience spontaneous dehiscence or reoperation due to infection or hematoma after caesarean section. In addition, an analysis of the health economic...... subsequently from the inside. By comparison a review of medical records from 2008 to mid-2010 found that out of 19 women 58% were re-sutured, 21% experience re-rupture and 30% healed from the inside. An economic calculation has shown that it requires four changes of wound dressing with conventional wound...... is the frequency of re-rupture in each group. The secondary endpoints are a cosmetic outcome score and a Quality of Life score. Preliminary results: Fifteen women have so far been included, of whom 93% were re-sutured as scheduled on the fourth day postoperatively, 0% experience re-rupture and 7% healed...

  5. 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.

  6. Third caesarean section in patient with myasthenia gravis

    Institute of Scientific and Technical Information of China (English)

    A Pizzo; R De Dominici; I Borrielli; FV Ardita; I Lo Monaco; E Sturlese

    2012-01-01

    Myasthenia gravis(MG) is an autoimmune neuromuscular disease, characterised by muscle weakness and fatigability of the voluntary muscles, it affects young women in the second and third decade of life.We report a case of30 years old multigravida woman with myasthenia gravis submitted to third iterative caesarean section with no adverse neonatal and maternal outcome. The course myathenia is highly variable and unpredictable during gestation and can change in subsequent pregnancies.Delivery specially, through caesarean section is very stressful and may cause severe myasthenic crisis.Although pregnancy and delivery represent particular events, that require more attention in these patients, they are not associated, in most cases, with higher risks of complications compared to normal pregnancy, delivery and postpartum period.According our experiences, in the management of myasthenic pregnant woman is necessary cooperation in a multidisciplinary team between obstetricians, neurologist, anaesthetist, and neonatologist for ensure an optimum outcome.

  7. Caesarean section for non-medical reasons at term.

    Science.gov (United States)

    Lavender, Tina; Hofmeyr, G Justus; Neilson, James P; Kingdon, Carol; Gyte, Gillian M L

    2012-03-14

    Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and a greater risk of stillbirth and neonatal morbidity. The differences in neonatal physiology following vaginal and caesarean births are thought to have implications for the infant, with caesarean section potentially increasing the risk of compromised health in both the short and the long term. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics. To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012) and reference lists of relevant studies. All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section. We identified no studies that met the inclusion criteria. There were no included trials. There is no evidence from randomised

  8. [Caesarean sections in Mexico: tendencies, levels and associated factors].

    Science.gov (United States)

    Puentes-Rosas, Esteban; Gómez-Dantés, Octavio; Garrido-Latorre, Francisco

    2004-01-01

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

  9. STUDY OF OBSTETRIC AND FETAL OUTCOME OF PREGNANCY IN PREVIOUS CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Gurpreet Kaur

    2015-09-01

    Full Text Available Previous caesarean section sparks an area of controversy in Obstetrics. The management of women with previous caesarean section regarding the mode of delivery whether to opt for repeat caesarean section or vaginal delivery, is an area of debate. Very often the decision on management is not made on Principle of sound reasoning and many who choose the elective repeat caesarean section do so to circumvent the anxious moment that arise during conduct ion of labour. AIMS AND OBJECTIVE: To determine the maternal and fetal outcome in relation to type of delivery . MATERIALS AND METHOD S: A 18 month prospective observational study was conducted where in 150 patients who had a term pregnancy with a history of prior LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients in the present pregnancy were analyzed by Z test. RESULTS: Out of the 150 subjects 78 ( 52% were in age group of 26 - 30 years, 106 ( 70.67% patients belonged to the urban population, 116 ( 77.33% were booked patie nts, 107 ( 71.33% were housewives, 122 ( 81.33% belonged to middle class and 22 ( 14.67% were from high socio economic status. 67 ( 44.67% were second gravid, 112 ( 74.67% were para 1. Out of total 134 patients 29 ( 21.64% had elective caesarean section and 5 ( 3 .73% patients came as emergency admission and underwent caesarean section. Out of 134 patients, with one previous caesarean section. 32 had spontaneous onset of labour. Out of which 20 ( 68.97% had vaginal delivery and 9 ( 31.03% had repeat caesarean section. 13 patients had augmentation, 11 ( 84.62% had vaginal delivery and 2 ( 15.38% had caesarean section. In 58 patients labour was induced 29 ( 50% had section. 14 patients out of 50 who had previous 2 caesarean section only 1 ( 7.69% patient had spontane ous onset of labour and had caesarean section. 3 ( 92.86% patients had elective caesarean section. There were only 2 patients with previous 3 caesarean

  10. Caesarean section and risk of autism across gestational age

    DEFF Research Database (Denmark)

    Yip, Benjamin Hon Kei; Leonard, Helen; Stock, Sarah

    2017-01-01

    BACKGROUND: The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did...

  11. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    DEFF Research Database (Denmark)

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

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

    African Journals Online (AJOL)

    If labour starts before the scheduled date the decision for mode of delivery is reached ... caesarean section, vertex presentation and spontaneous onset of labour. ... Oxytocic drugs (syntocinon or prostaglandins) are not used for argumentation.

  13. Techniques and materials for skin closure in caesarean section

    DEFF Research Database (Denmark)

    Mackeen, A Dhanya; Berghella, Vincenzo; Larsen, Mie-Louise

    2012-01-01

    Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples....... A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women....

  14. Caesarean section in a case of systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Varsha Vyas

    2014-01-01

    Full Text Available Systemic lupus erythematosus (SLE is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear antibody (ANA positive parturient with bad obstetric history who underwent elective caesarean section under spinal anaesthesia.

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

    Directory of Open Access Journals (Sweden)

    G. Fang

    2011-01-01

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

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

    Science.gov (United States)

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

    2012-12-01

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

  17. Caesarean section – desired rate versus actual need

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    2016-03-11

    Mar 11, 2016 ... global level particularly in high- and middle-income countries.1,2. Ideally a caesarean ... neonatal mortality.5 However, increasing the rate above this value has little ... emergency with both classes categorized by different ...

  18. Caesarean section in Ancient Greek mythology.

    Science.gov (United States)

    Lurie, Samuel

    2015-01-01

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

  19. Refusal of emergency caesarean section in Ireland: a relational approach.

    Science.gov (United States)

    Wade, Katherine

    2014-01-01

    This article examines the issue of emergency caesarean section refusal. This raises complex legal and ethical issues surrounding autonomy, capacity, and the right to refuse treatment. In Ireland, the situation is complicated further by the constitutional right to life of the unborn. While cases involving caesarean section refusal have occurred in other jurisdictions, a case of this nature has yet to be reported in Ireland. This article examines possible ways in which the interaction of a woman's right to refuse treatment and the right to life of the unborn could be approached in Ireland in the context of caesarean section refusal. The central argument of the article is that the liberal individualistic approach to autonomy evident in the caesarean section cases in England and Wales is difficult to apply in the Irish context, due to the conflicting constitutional rights of the woman and foetus. Thus, alternative visions of autonomy which take the interests and rights of others into account in medical decision-making are examined. In particular, this article focuses on the concept of relational consent, as developed by Alasdair Maclean and examines how such an approach could be applied in the context of caesarean section refusal in Ireland. The article explains why this approach is particularly appropriate and identifies mechanisms through which such a theory of consent could be applied. It is argued that this approach enhances a woman's right to autonomy, while at the same time allows the right to life of the unborn to be defended.

  20. Rates and Predictors of Caesarean Section for First and Second Births: A Prospective Cohort of Australian Women.

    Science.gov (United States)

    Hure, Alexis; Powers, Jennifer; Chojenta, Catherine; Loxton, Deborah

    2017-05-01

    Objective To determine rates of vaginal delivery, emergency caesarean section, and elective caesarean section for first and second births in Australia, and to identify maternal predictors of caesarean section. Methods Data were from the Australian Longitudinal Study on Women's Health. A total of 5275 women aged 18-38 years, who had given birth to their first child between 1996 and 2012 were included; 75.0% (n = 3956) had delivered a second child. Mode of delivery for first and second singleton birth(s) was obtained from longitudinal survey data. Socio-demographic, lifestyle, anthropometric and medical history variables were tested as predictors of mode of delivery for first and second births using multinomial logistic regression. Results Caesarean sections accounted for 29.1% (n = 1535) of first births, consisting of 18.2% emergency and 10.9% elective caesareans. Mode of delivery for first and second births was consistent for 85.5% of women (n = 3383) who delivered both children either vaginally or via caesarean section. Higher maternal age and body mass index, short-stature, anxiety and having private health insurance were predictive of caesarean section for first births. Vaginal birth after caesarean section was more common in women who were older, short-statured, or had been overweight or obese for both children, compared to women who had two vaginal deliveries. Conclusions for Practice Rates of caesarean section in Australia are high. Renewed efforts are needed to reduce the number of unnecessary caesarean births, with particular caution applied to first births. Interventions could focus on elective caesareans for women with private health insurance or a history of anxiety.

  1. Anaesthesia for lower-segment caesarean section: Changing perspectives

    Directory of Open Access Journals (Sweden)

    Sean Brian Yeoh

    2010-01-01

    Full Text Available The number of caesarean sections has increased over the last two decades, especially in the developed countries. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anaesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Unique problems that patients with obesity and pre-eclampsia present will be discussed in the present article. New medications and devices now used in obstetric anaesthesia will change the practice and perspectives of our clinical practice.

  2. Do Urgent Caesarean Sections Have a Circadian Rhythm?

    Science.gov (United States)

    Doğru, Serkan; Doğru, Hatice Yılmaz; Karaman, Tuğba; Şahin, Aynur; Tapar, Hakan; Karaman, Serkan; Arıcı, Semih; Özsoy, Asker Zeki; Çakmak, Bülent; İşgüder, Çiğdem Kunt; Delibaş, İlhan Bahri; Karakış, Alkan

    2016-01-01

    Objective The primary goal of the present study was to demonstrate the existence of a possible circadian variation in urgent operative deliveries. Methods All urgent caesarean sections between 1 January 2014 and 1 January 2015 with known exact onset times of operation were included in this retrospective study. Cases that were previously scheduled for elective caesarean section were excluded. Information regarding age, delivery date, onset time of operation and type of anaesthesia was collected from the database. Analyses were completed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0 software. The statistical significance for all analyses was set at p<0.05. Results A total of 285 urgent caesarean section deliveries were included in the study. There were 126 (44.2%) deliveries during the day shift and 159 (55.8%) during the night shift. 80 patients (28.1%) received general anaesthesia and 65 (22.8%) received spinal anaesthesia in the morning shift, whereas 54 patients (18.9%) received general anaesthesia and 86 (30.2%) received spinal anaesthesia during the night shift. Conclusion The present study suggested that urgent caesarean sections revealed a circadian rhythm during the day. PMID:27366574

  3. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    DEFF Research Database (Denmark)

    Kristensen, Kim; Fisker, Niels; Haerskjold, Ann

    2015-01-01

    BACKGROUND AND OBJECTIVE:: Hospitalization for respiratory syncytial virus (RSV) infection and asthma share common determinants, and meta-analyses indicate that children delivered by caesarean section (CS) are at increased risk of asthma. We aimed to investigate whether birth by CS is associated ...

  4. Caesarean section wound infiltration with ropivacaine versus placebo

    African Journals Online (AJOL)

    as a result of adhesion formation, adenomyosis, and injury to nerves and blood ... which gradually build up electrical responses in the central nervous system – i.e. it is a .... chronic pain after caesarean section under spinal anesthesia. Anaesth ...

  5. Post Repeat Lower Segment Caesarean Section Cervicovesical Fistula

    Directory of Open Access Journals (Sweden)

    Vidya A.Thobbi

    2008-12-01

    Full Text Available A 35 year old female patient G2P1L1 with previous LSCS with 9 months amenorrhea with labor pains was admitted and caesarean section was done for cephalo – pelvic disproportion with foetal distress. Patient developed cervico-vesical fistula which was successfully repaired by total abdominal hysterectomy and fistula was repaired using peritoneal flap .

  6. Evidence-based surgical techniques for caesarean section

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Secher, Niels Jørgen; Krebs, Lone

    2014-01-01

    Caesarean section (CS) is a common surgical procedure, and in Denmark 21% of deliveries is by CS. There is an increasing amount of scientific evidence to support the different surgical techniques used at CS. This article reviews the literature regarding CS techniques. There is still a lack...

  7. A population-based cohort study of the effect of Caesarean section on subsequent fertility.

    Science.gov (United States)

    Gurol-Urganci, I; Cromwell, D A; Mahmood, T A; van der Meulen, J H; Templeton, A

    2014-06-01

    Is there an association between Caesarean section and subsequent fertility? There is no or only a slight effect of Caesarean section on future fertility. Previous studies have reported that delivery by a Caesarean section is associated with fewer subsequent pregnancies and longer inter-pregnancy intervals. The interpretation of these findings is difficult because of significant weaknesses in study designs and analytical methods, notably the potential effect of the indication for Caesarean section on subsequent delivery. Retrospective cohort study of 1 047 644 first births to low-risk women using routinely collected, national administrative data of deliveries in English maternity units between 1 April 2000 and 31 March 2012. Primiparous women aged 15-40 years who had a singleton, term, live birth in the English National Health Service were included. Women with high-risk pregnancies involving placenta praevia, pre-eclampsia, eclampsia (gestational or pre-existing), hypertension or diabetes were excluded from the main analysis. Kaplan-Meier analyses and Cox proportional hazard models were used to assess the effect of mode of delivery on time to subsequent birth, adjusted for age, ethnicity, socio-economic deprivation and year of index delivery. Among low-risk primiparous women, 224 024 (21.4%) were delivered by Caesarean section. The Kaplan-Meier estimate of the subsequent birth rate at 10 years for the cohort was 74.7%. Compared with vaginal delivery, subsequent birth rates were marginally lower after elective Caesarean for breech (adjusted hazard ratio, HR 0.96, 95% CI 0.94-0.98). Larger effects were observed after elective Caesarean for other indications (adjusted HR 0.81, 95% CI 0.78-0.83), and emergency Caesarean (adjusted HR 0.91, 95% CI 0.90-0.93). The effect was smallest for elective Caesarean for breech, and this was not statistically significant in women younger than 30 years of age (adjusted HR 0.98, 95% CI 0.96-1.01). We used birth cohorts from maternity

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery...... it is encouraged that all these issues are taken into account and balanced to the benefits of having a caesarean section....

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

    Science.gov (United States)

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

    2017-03-01

    high" where midwives to a greater extent agreed with the statement (p = 0.033). There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Caesarean Section Refusal in the Irish Courts: Health Service Executive v B.

    Science.gov (United States)

    Wade, Katherine

    2017-08-01

    In the Irish High Court case of Health Service Executive v B, it was held that a competent woman could not be forced to have a caesarean section against her will notwithstanding the fact that her refusal increased the risk of injury and death to both her and her unborn child.1 This case is of particular interest since it is the first reported case on caesarean section refusal in Ireland. This commentary provides a critical analysis of the judgment, focusing on aspects of the law on informed consent and the way in which the judge reached the conclusion that an order for an enforced caesarean section should not be made. It is argued that, while the outcome can be justified, the reasoning appears at times to be unpersuasive. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    LENUS (Irish Health Repository)

    Khalifeh, A

    2012-02-01

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

  12. Oral microflora in infants delivered vaginally and by caesarean section

    DEFF Research Database (Denmark)

    Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron

    2011-01-01

    International Journal of Paediatric Dentistry 2011 Background. Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. Aim....... To investigate and compare the oral microbial profile between infants delivered vaginally and by C-section. Design. This is a cross-sectional case-control study. Eighty-four infants delivered either vaginally (n = 42) or by C-section (n = 42) were randomly selected from the 2009 birth cohort at the County...

  13. Does induction really reduce the likelihood of caesarean section?

    Science.gov (United States)

    Wickham, Sara

    2014-09-01

    Two recent systematic reviews have arrived at the same, rather surprising and somewhat counter-intuitive result. That is, contrary to the belief and experience of many people who work on labour wards every day, induction of labour doesn't increase the chance of caesarean section at all. In fact, the reviewers argue, their results demonstrate that induction of labour reduces the likelihood of caesarean section. It might be that our instincts are wrong, and that we need to reconsider what we think we know. But before we rush to recommend induction as the latest tool to promote normal birth, we might want to look a bit more closely at the evidence, as I am not at all certain that this apparently straightforward conclusion is quite as cut-and-dried as it sounds.

  14. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-05-15

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

  15. Caesarean section in a parturient with a spinal cord stimulator.

    LENUS (Irish Health Repository)

    Sommerfield, D

    2010-01-01

    A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.

  16. Epidural anaesthesia for caesarean section in pituitary dwarfism.

    Science.gov (United States)

    Li, Hongbo; Li, Ruihua; Lang, Bao

    2017-04-01

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

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

    Science.gov (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon

    2010-11-01

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

  18. Missing Broken Needle During Caesarean Section

    Directory of Open Access Journals (Sweden)

    Chandana Das

    2009-09-01

    Full Text Available Breakage of the needle and missing while repairing the uterine wound during cesarean section is an uncommon event. Subsequently it was removed under fluoroscopic guidance on the 7th postoperative day

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

    Directory of Open Access Journals (Sweden)

    Yibeltal T. Bayou

    2016-03-01

    Full Text Available Setting: The study was conducted in Addis Ababa, the capital city of Ethiopia. Specifically, it was conducted in all healthcare facilities offering maternity and obstetric services.Objective: The objective of the study was to explore the patterns of caesarean-section (CS delivery in Addis Ababa.Methods: A cross-sectional survey was carried out between December 2013 and January 2014. The population for the study were women aged between 15 and 19 years of age who had given birth in the last 1–3 years before the date of data collection. The Census and Survey Processing System software was used for data capturing and analysing both descriptive and inferential statistics using Statistical Package for Social Sciences version 20.0.Results: Amongst the 835 women who delivered at health facilities, 19.2% had given birth by CS. The prevalence of CS based on medical indication was 91.3%. However, 6.9% of CS performed had no medical indication. Private health facilities performed more CSs than public health facilities, 41.1% and 11.7% respectfully. CS was high amongst women of higher socioeconomic standing.Conclusion: Overall, CS deliveries rate in Ethiopia is above the rate recommended by the World Health Organisation. Because socio-economic factors influence CS delivery, governments should play a key role in regulating performance of CSs in private institutions.

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

    Science.gov (United States)

    Petrou, Stavros; Khan, Kamran

    2013-12-01

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

  1. Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    Liang-kun Ma; Na Han; Jian-qiu Yang; Xu-ming Bian; Jun-tao Liu

    2012-01-01

    Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section.Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period.Results There was no difference in the mean age (28.9±3.6 vs.28.1±4.5 years) and the average gravidity (2.35 ± 1.48 vs.2.21 ± 1.53) between RCS group and FCS group (all P>0.05).The RCS group had more preterm births (24.1% vs.13.2%),complete placenta previa (55.2% vs.4.9%),placenta accreta (34.5% vs.2.5%),more blood loss during caesarean section (1412±602 vs.648 ±265 mL),blood transfusion (51.7% vs.4.9%),disseminated intravascular coagulation (13.8% vs.2.1%),and obstetric hysterectomy ( 13.8 % vs.0.8 %) than the F C S group (all P< 0.05).The preterm infant rate ( 30.0% vs.13.0%),neonatal asphyxia rate (10.0% vs.4.9%),and perinatal mortality rate (6.7% vs.0.4%) of the RCS group were higher than those of the FCS group (all P<0.05).Conclusions More patients had complete placenta previa and placenta accreta,postpartum hemorrhage,transfusion,uterine packing,obstetric hysterectomy,and perinatal morbidity in the placenta previa patients with previous caesarean section.The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

  2. Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria

    Directory of Open Access Journals (Sweden)

    Emmanuel Ugwa

    2015-01-01

    Full Text Available Objectives: This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1 st January 2010 to 31st December, 2012. Materials and Methods: This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1 st January 2010 to 31 st December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA. Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson′s Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant. Result: This study reported a caesarean section rate of 17.69 % and a perinatal mortality rate of 165.6 per 1000. Majority of the babies (78.2% were within normal weight. The mean age of the women was 25.9 ± 6.2 years and mean parity was 4 ± 3. Majority of them were uneducated and unemployed. Obstructed labour was the commonest indication for emergency caesarean section accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1% and bad obstetrics history the least indication (1.4%. There is a weak positive correlation (r = 0.35 between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12. Conclusion: Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is

  3. Rectus Abdominis Endometrioma after Caesarean Section

    Directory of Open Access Journals (Sweden)

    Igor Mishin

    2016-01-01

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

  4. [Caesarean section at full dilatation: What are the risks to fear for the mother and child?

    Science.gov (United States)

    Bruey, N; Beucher, G; Pestour, D; Creveuil, C; Dreyfus, M

    2017-03-01

    Caesarean section is associated with increased maternal morbidity compared to a vaginal delivery, especially if it occurs during labour. Little data on caesarean section performed at full dilatation is available. This was a retrospective study done in University Hospital of type 3 over a period of ten years, including future primiparous patients who had a caesarean section performed at full dilatation, compared to a control group of patients whose caesarean section was conducted in first part of the labour. We collected different maternal data per- and postoperative and neonatal. In total, 824 patients were enrolled including 412 in each group. For caesarean section at full dilatation, foetal extraction required more manoeuvres (RR=3.05; 95% CI: 2.1; 4.39; Psection at full dilatation. A caesarean section at full dilatation has an excess intraoperative risk and requires great caution. Nevertheless, no significant increase of postoperative and neonatal complications can be proved. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea.

    Science.gov (United States)

    Mark, Terence B; Radcliffe, Jim; Laman, Moses

    2014-07-01

    We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea.

  6. Oral microflora in infants delivered vaginally and by caesarean section.

    Science.gov (United States)

    Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron; Blomqvist, Susanne; Dahlén, Gunnar; Twetman, Svante

    2011-11-01

    BACKGROUND.  Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. AIM.  To investigate and compare the oral microbial profile between infants delivered vaginally and by C-section. DESIGN.  This is a cross-sectional case-control study. Eighty-four infants delivered either vaginally (n = 42) or by C-section (n = 42) were randomly selected from the 2009 birth cohort at the County Hospital in Halmstad, Sweden. Medically compromised and premature children (oral health need to be further investigated.

  7. Emergency caesarean section in low risk nulliparous women

    DEFF Research Database (Denmark)

    Haerskjold, Ann; Hegaard, H K; Kjaergaard, H

    2012-01-01

    the association between risk factors and indications for ECS. Smoking during pregnancy (OR 2.33; CI 1.18-4.61) and BMI ≥ 30 (OR 2.87, CI 1.34-6.16) were associated with increased risk of ECS due to SFD. Birth weight (BW) ≥ 4,000 (OR 2.95; CI 1.92-4.53) and smoking cessation during pregnancy (OR 2.02; CI 1......The rising incidence of caesarean section (CS), including emergency caesarean section (ECS) in nulliparas is of concern. Previous CS may have implications for future pregnancies and deliveries. This article describes the prevalence and indications for ECS in a cohort of low risk nulliparas...... and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate...

  8. A rare case of thyroid storm following caesarean section

    Directory of Open Access Journals (Sweden)

    Sanjay Singh

    2016-03-01

    Full Text Available Thyroid storm in pregnancy is a rare life threatening emergency, with very high maternal and perinatal mortality and morbidity. Here we present an unusual case of a 30 year-old G2P1L1 woman, a known case of post caesarean pregnancy with hyperthyroidism who presented with severe preeclampsia and on second post op day developed thyroid storm. Early recognition and timely institution of appropriate management resulted in good outcome in this case. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 933-936

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Is neonatal head circumference related to caesarean section for failure to progress?

    Science.gov (United States)

    de Vries, Bradley; Bryce, Bianca; Zandanova, Tatiana; Ting, Jason; Kelly, Patrick; Phipps, Hala; Hyett, Jon A

    2016-12-01

    There is global concern about rising caesarean section rates. Identification of risk factors could lead to preventative measures. To describe the association between neonatal head circumference and (i) caesarean section for failure to progress, (ii) intrapartum caesarean section overall. This was a retrospective cohort study of 11 687 singleton live births with cephalic presentation, attempted vaginal birth and at least 37 completed weeks gestation from January 2005 to June 2009. Neonatal head circumference was grouped into quartiles and multiple logistic regressions performed. The rates of caesarean section for failure to progress were 4.1, 6.4, 8.8 and 14.3% in successive head circumference quartiles. Rates of intrapartum caesarean section overall were 8.7, 12.1, 15.8 and 21.5%. The odds ratios for caesarean section for failure to progress were: 1.00, 1.33 (95% CI 1.02- 1.73), 1.54 (1.18-2.02) and 1.93 (1.44-2.57) for successive head circumference quartiles after adjusting for multiple demographic and clinical factors. The adjusted odds ratios for intrapartum caesarean section for any indication were: 1.00, 1.52 (95% CI 1.24-1.87), 1.99 (1.62-2.46) and 2.38 (1.89-3.00), respectively. There is a strong positive relationship between head circumference quartile and both caesarean section for failure to progress and caesarean for any indication. If this finding is confirmed using ultrasound measurements, there is potential for head circumference to be incorporated into predictive models for intrapartum caesarean section with a view to offering interventions to reduce the risk of caesarean section. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  11. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2011-05-01

    Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

    Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. Emergency caesarean section was not associated with childhood asthma. none. not relevant.

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  16. PREVENTION OF SURGICAL WOUND INFECTION IN OBESE WOMEN UNDERGOING CAESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL

    DEFF Research Database (Denmark)

    Hyldig, Nana; Vinter, Christina Anne; Kruse, Marie;

    2016-01-01

    Aim: Obese women undergoing caesarean section are at increased risk of surgical wound infection, which may lead to reduced quality of life, and increased health care cost. The aim is to evaluate the effect of incisional Negative Pressure Wound Therapy applied prophylactically in obese women......: The study is on-going. We expect to find a 50% reduction of wound infection when using iNPWT compared to standard dressings in this high-risk subpopulation....

  17. The effect of malpractice claims on the use of caesarean section.

    Science.gov (United States)

    Schifrin, Barry S; Cohen, Wayne R

    2013-04-01

    Malpractice fears are believed to influence various aspects of obstetrical practice. They seem to have contributed in small part to the rising primary caesarean section rate, but have also played a considerable role in the downtrend in vaginal birth after caesarean statistics. The rising vaginal birth after caesarean section rate between 1981 and 1995 was interrupted by a spate of lawsuits associated with broadened indications for vaginal birth after caesarean section in conjunction with requirements for immediate clinician availability. These factors dramatically reduced the availability of hospitals and clinicians willing to offer vaginal birth after caesarean section. This reversal, however, has not diminished the demand for vaginal birth after caesarean section from various stakeholders in the name of patient autonomy, clinician beneficence and optimal care. Nevertheless, as long as stringent requirements remain for clinician attendance during vaginal birth after caesarean section, and as long as the spectre of preventable error and the lingering dread of lawsuits retain their hold on obstetrical practice, caesarean section trends are unlikely to change.

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

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola;

    2017-01-01

    INTRODUCTION: Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. METHODS......: The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. RESULTS......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

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

    Directory of Open Access Journals (Sweden)

    Thulasi

    2016-04-01

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

  20. An Orwellian scenario: court ordered caesarean section and women's autonomy.

    Science.gov (United States)

    Cahill, H

    1999-11-01

    Between 1992 and 1996, a small number of women in the UK were forced by the courts to undergo caesarean section against their expressed refusal. Analysis of the reported cases reveals the blanket assumption of maternal incompetence and the widespread use of thinly veiled coercion. Such attitudes and practices are themselves frequently compounded by inadequate communication. Medical discretion in such problematic cases seems to err on the side of safety and so appears to favour the life of the fetus over maternal autonomy. Despite current policy's placement of the pregnant woman at the centre of maternity care, obstetricians' concerns appear to lie more with the unborn fetus. In other words, there seems to be a point at which the value of fetal life begins to outweigh, not so much the life of the woman, but her right to self-determination, her plans and her choices. While it is important to acknowledge that these court ordered caesareans represent an unusual extreme within contemporary maternity care in this country, that they have happened brings into sharp relief some of the stereotypical assumptions about women. These are assumptions that underlie much of current medical practice and may compromise or disempower women in other ways during their experience of pregnancy and labour. Using the first and last of the six reported cases as contextual illustrations, this article focuses on the complex interplay of processes that have brought the medical profession to a position in which their own self-conviction and determination to do what they believe is best for their patients has resulted in gross denial of women's autonomy and the use of the law to override pregnant women's refusal of consent.

  1. Antepartum uterine rupture in previous caesarean sections presenting as advanced extrauterine pregnancies: lessons learnt.

    Science.gov (United States)

    Ramphal, Surandhra R; Moodley, Jagidesa

    2009-03-01

    In present day obstetric practice, rupture of a previously scarred uterus should be uncommon. It occurs in uterine pregnancy is made. We present a series of 7 cases, all of whom had one or more previous caesarean sections, were haemodynamically stable and were being managed expectantly, to illustrate the fact that ruptured uterus should be strongly considered in the differential diagnosis, even when the clinical signs and sonography are suggestive of an advanced extra-uterine pregnancy. The lessons in these cases fall into the following categories: 1. Ruptured uteri can occur in non-labouring women with previous lower segment caesarean sections. 2. Absence of signs of peritonism is possibly due to the fact that the pregnancy is extruded through the uterine rupture with the amniotic sac being intact and there is little or no bleeding into the abdominal cavity or vaginally. 3. Imaging techniques should focus on the size of the uterus, as an enlarged uterus in the background of an advanced extra-uterine pregnancy in a previously scarred uterus is highly suggestive of uterine rupture. Clinicians must strongly consider ruptured uteri in non labouring women with previous caesarean sections even when imaging modalities suggest an advanced extrauterine pregnancy. This will lead to earlier surgical treatment and appropriate information being provided to patients.

  2. RETROSPECTIVE STUDY OF PRIMARY CAESAREAN SECTION AT A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    S. Prasanna Lakshmi

    2016-12-01

    Full Text Available BACKGROUND The caesarean section epidemic is a reason for immediate concern and deserves serious National and International attention. Rates of caesarean section are of concern to both developed and developing countries. The indications for caesarean section have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economical and medicolegal factors play a role in the rising trend of caesarean section. The aim of the study was undertaken to determine the rate, indications, intraoperative and postoperative complications of primary caesarean section in primi and multipara and maternal and foetal morbidities in these patients. MATERIALS AND METHODS This is a retrospective study carried out on primary caesarean section in the Department of O and G at Mahatma Gandhi Memorial Government Hospital attached to K.A.P.Viswanatham Government Medical College, Trichy, during 1 year period from January 2015-December 2015. Inclusion Criteria- Patients (booked/unbooked attending the labour room undergoing primary caesarean section in the department. Their intraoperative and postoperative complications were noted and also maternal and foetal morbidities and complications. Exclusion Criteria- Gestational age <28 wks., previous LSCS, previous uterine surgery or hysterotomy, multiple gestation. RESULTS There has been a steady increase in total deliveries (increase by 5.2% in the last 2 yrs. at Mahathma Gandhi Memorial Government Hospital attached to K.A.P. Viswanatham Government Medical College, Trichy, and total caesarean section rate (increased by 19.3% and primary caesarean section rate (increased by 12.3% in the past 2 years with concomitant reduction in neonatal mortality rate by 28%. However, this doesn’t justify the increase in primary caesarean section rate. CONCLUSION Potentially modifiable factors such as patient preferences, practice variations among hospitals, systems and

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

    Directory of Open Access Journals (Sweden)

    Madhu Gupta

    2013-01-01

    Full Text Available A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

  4. An observational study on extraperitoneal caesarean section in present era

    Directory of Open Access Journals (Sweden)

    Sudhanshu Sekhara Nanda

    2014-06-01

    Full Text Available Background: This study was designed to find out the maternal and perinatal outcome in cases of extraperitoneal caesarean section. Total 100 women undergoing extraperitoneal cesarean section were included in the study. Methods: A detailed history taking, examination done and intra and post-operative parameters as per protocols were noted. Results: Success rate of extra peritoneal CS was 79.63%, Time taken from incision to delivery was and #8804;5 minutes in 60% cases, time taken from incision to closure was between 31-45 min in 67% cases, blood loss and #8804;500 ml in 58% cases, return of bowel function between 5-8 hours in 52%, mobilization within 24 hours in 52%, neonatal one minute APGAR score and #8805;7 in 90.91%. Conclusions: Extraperitoneal cesarean section can be applied as a surgical form of infection prophylaxis. Since it possesses a rational basis for the avoidance of serious post-operative pelvic infectious complications, this operation deserves reconsideration in the modern era. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 724-727

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

    Science.gov (United States)

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

    2015-08-19

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

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

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola

    2017-01-01

    : The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. RESULTS......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

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

    Directory of Open Access Journals (Sweden)

    Vilma Tapia

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

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

    African Journals Online (AJOL)

    2009-10-05

    Oct 5, 2009 ... reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of ..... the caesarean section rates. ... Source of Support: Nil, Conflict of Interest: None declared.

  9. Maternal morbidity with caesarean section for non-progress of labour: an analytical study.

    Science.gov (United States)

    Chhabra, S

    2007-12-01

    To estimate the maternal morbidity and mortality in caesarean section for non-progress of labour, a study was conducted over a period of 16 years at Mahatma Gandhi Institute of Medical Sciences, Sevagram among 533 cases of non-progress of labour for which caesarean section was performed. A total of 34975 women delivered including 7309 cases by caesarean section. Sixteen years records divided into 4 blocks, one each of 4 years were analysed. There was no maternal mortality but 8.25% women had intra-operative complication and 42.21% had postoperative morbidity. Timely intervention can save complication of prolonged labour as well as complications for which caesarean section was done for non-progress of labour.

  10. [Unilateral temporary meralgia paresthetica after caesarean section: report of a case].

    Science.gov (United States)

    Yanaru, Tomoaki; Katori, Kiyoshi; Higa, Kazuo; Miyako, Yuka; Nitahara, Keiichi

    2012-10-01

    We report a patient who developed unilateral temporary meralgia paresthetica after caesarean section. A 28-year-old morbidly obese woman underwent caesarean section under combined spinal and epidural anesthesia. Intraoperative position was 5-degree head down lithotomy position. She noted pain and hypesthesia along the anterolateral aspect of the right thigh on the second postoperative day, when postoperative continuous epidural analgesia was stopped. The pain and sensory impairment resolved 8 days after surgery without medications.

  11. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial)

    OpenAIRE

    Stutchfield, Peter Roy; Whitaker, Rhiannon; Gliddon, Angela E; Hobson, Lucie; Kotecha, Sailesh; Doull, Iolo J M

    2013-01-01

    Objectives To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. Design A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). Setting Four UK study centres from the original trial. Participants 862 participants from the four largest recruiti...

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

    Science.gov (United States)

    Robson, Stephen J; de Costa, Caroline M

    2017-03-06

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

  13. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section.

    LENUS (Irish Health Repository)

    Higgins, Mary F

    2013-11-01

    Placenta accreta, morbid adherence to the uterus to the myometrium, is commonest in association with placenta previa in women previously delivered by caesarean section (CS). It has become proportionally a greater cause of major maternal morbidity and mortality as the frequency of other serious obstetric complications has declined. The aim of this study was to examine the incidence of placenta accreta in the context of a rising caesarean delivery rate.

  14. Caesarean sections and private insurance: systematic review and meta-analysis.

    Science.gov (United States)

    Hoxha, Ilir; Syrogiannouli, Lamprini; Braha, Medina; Goodman, David C; da Costa, Bruno R; Jüni, Peter

    2017-08-21

    Financial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section. Systematic review and meta-analysis. MEDLINE, Embase and The Cochrane Library from the first year of records through August 2016. We included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women. The prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. Eighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ(2)=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ(2)=0.011). Caesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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    Hagen Terje P

    2011-10-01

    Full Text Available Abstract Background There has been a marked increase in the number of Caesarean sections in many countries during the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased by about 260% (adjusted for inflation. Methods The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included. Results The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p Conclusion The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.

  16. Secular trends in caesarean section rates over 20 years in a regional obstetric unit in Hong Kong.

    Science.gov (United States)

    Chung, W H; Kong, C W; To, W Wk

    2017-08-01

    Although caesarean section rates have been increasing over the years in both public and private sectors in Hong Kong, there has been a paucity of formal surveys on local trends in such rates. This study aimed to examine the trends in caesarean section rates over a 20-year period at a public regional obstetric unit in Hong Kong using the Robson's Ten-group Classification System. All deliveries in a single obstetric unit during a 20-year period (1995-2014) were classified into 10 subgroups according to the Robson's classification. The annual caesarean section rate for each subgroup was calculated and then stratified into 5-year intervals to analyse any significant trends. The caesarean section rates in a total of 86 262 births with complete data were analysed. The overall caesarean section rate increased modestly from 15.4% to 24.6% during the study period. There was an obvious increasing trend for caesarean section in those with previous caesarean section (Robson's category 5), breech presentation at delivery (category 6 and 7), multiple pregnancy (category 8), and preterm labour (category 10). A gradual fall in caesarean section rate from 14.4% to 10.8% was seen in primiparous women with term spontaneous labour (category 1). Statistically significant differences (Psection rate may be associated with clinical management policies that allow women with relative risk factors (such as breech, previous caesarean section, or multiple pregnancy) to opt for caesarean section. This rise was counterbalanced by a decrease in primary caesarean section rate in primiparous women with spontaneous labour. The trend for caesarean section was more in line with patient expectations rather than evidence-based practice.

  17. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

    OpenAIRE

    Bamigboye, Anthony A; Hofmeyr, G Justus

    2014-01-01

    Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the ...

  18. A prospective study of awareness and recall associated with general anaesthesia for caesarean section.

    Science.gov (United States)

    Paech, M J; Scott, K L; Clavisi, O; Chua, S; McDonnell, N

    2008-10-01

    The obstetric population is considered at high risk of awareness and recall when undergoing general anaesthesia for caesarean section. In recent years the incidence may have been altered by developments in obstetric anaesthesia. A prospective observational study of general anaesthesia for caesarean section was conducted during 2005 and 2006 in 13 maternity hospitals dealing with approximately 49,500 deliveries per annum in Australia and New Zealand. As a component of this study the frequency of recall of intraoperative events was examined using a structured postoperative interview on two occasions. There were 1095 general anaesthetics surveyed with 47% being performed for urgent fetal delivery. Thiopental was the most common induction agent (83%) with sevoflurane being used for maintenance in 63%. In 32% of cases a depth-of-anaesthesia monitor was used. In 763 cases (70%) there was least one postoperative interview enquiring into dreaming and awareness. There were two cases deemed to be consistent with awareness (incidence 0.26%, CI 0.03-0.9%, or 1 in 382) and three cases of possible awareness. Awareness with recall of intraoperative events remains a significant complication of obstetric general anaesthesia but was potentially avoidable in all cases detected in this study.

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

    Directory of Open Access Journals (Sweden)

    T Gurumurthy

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dewi Y Bisri

    2017-01-01

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

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

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    Matthias David

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

  2. [Trend of caesarean section rate and puerpera characteristics: based on Robson classification].

    Science.gov (United States)

    Wang, J X; Sun, H Q; Huang, K; Zheng, X F; Tao, F B

    2017-07-10

    Objective: To analyze the trend in caesarean section rate and puerpera characteristics in hospital, and provide valuable information for maternal and child health policy making and clinical practice. Methods: A total of 12 041 women who delivered in the affiliated Chaohu Hospital of Anhui Medical University from October 1, 2010 to September 30, 2016 were selected. Based on Robson classification system, changes in the rate of caesarean delivery as well as its relationship with two-child policy and infant sex ratio were analyzed. Results: The overall caesarean section rate gradually decreased from 66.9% to 44.2% during the past six years. Respectively, the caesarean section rate in primiparae with singleton term babies decreased to 32.1% and the rate in multiparas without uterine scar decreased to 14.2%, and the rate in premature delivery decreased to 22.9%, the differences were significant (Psection rate. The caesarean section rate and proportion were unstable in multiparas with uterine scar, breech deliveries and twin deliveries. The application of Robson classification system can improve the comparability of the surveillance data.

  3. Prostaglandins before caesarean section for preventing neonatal respiratory distress.

    Science.gov (United States)

    Motaze, Nkengafac V; Mbuagbaw, Lawrence; Young, Taryn

    2013-11-11

    Respiratory distress (RD) can occur in both preterm and term neonates born through normal vaginal delivery or caesarean section (CS). It accounts for about 30% of neonatal deaths and can occur at any time following birth. Respiratory distress syndrome (RDS), transient tachypnoea (rapid breathing) of the newborn and persistent pulmonary hypertension (increased blood pressure of pulmonary vessels) of the newborn are the most frequent clinical presentations of neonatal RD. Prostaglandins are used in routine obstetric practice to ripen the uterine cervix and to trigger labour, with those of the E series being preferred over others due to the fact that they are more uteroselective. Administration of prostaglandins to an expectant mother before delivery causes reabsorption of lung fluid from the fetal lung and promotes surfactant secretion by inducing a catecholamine surge. As a result, significant reduction in neonatal respiratory morbidity following a CS could be obtained, leading to reduced long-term complications such as bronchopulmonary dysplasia (chronic lung disease with lung tissue modification) and asthma. The objective of this review was to determine if administration of prostaglandins before CS can improve respiratory outcomes of newborns. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). We also searched three clinical trial registries; ClinicalTrials.gov, the Australian New Zealand Clinical Trials Registry and the WHO Clinical Trials Registry Platform (ICTRP), for ongoing studies (24 June 2013). We included all published and unpublished randomised controlled trials comparing the use of prostaglandins with other treatments (including placebo) to reduce neonatal respiratory morbidity. Participants were pregnant women with an indication for a CS, and we compared administration of prostaglandins prior to CS with no treatment, placebo or another treatment. Two review authors independently assessed studies for inclusion

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

    Science.gov (United States)

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

    2017-06-09

    augmentation (RR 1.65, 95% CI 1.17 to 2.32). There were no clear differences in the other reported secondary outcomes. The following GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. 80 mL versus 30 mL Foley catheter (one trial, 154 women): no clear difference between groups for the primary outcomes: vaginal delivery not achieved within 24 hours (RR 1.05, 95% CI 0.91 to 1.20, evidence graded moderate) and caesarean section (RR 1.05, 95% CI 0.89 to 1.24, evidence graded moderate). However, more women induced using a 30 mL Foley catheter required oxytocin augmentation (RR 0.81, 95% CI 0.66 to 0.98). There were no clear differences between groups for other secondary outcomes reported. Several GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Vaginal PGE2 pessary versus vaginal PGE2 tablet (one trial, 200 women): no difference between groups for caesarean section (RR 1.09, 95% CI 0.74 to 1.60, evidence graded very low), or any of the reported secondary outcomes. Several GRADE outcomes were not reported: vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. RCT evidence on methods of induction of labour for women with a prior caesarean section is inadequate, and studies are underpowered to detect clinically relevant differences for many outcomes. Several studies reported few of our prespecified outcomes and reporting of infant outcomes was especially scarce. The GRADE level for quality of evidence was moderate to very low, due to imprecision and study design limitations.High-quality, adequately-powered RCTs would be the best approach to determine the optimal method for induction of labour in

  5. Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

    Science.gov (United States)

    Wanyonyi, Sikolia; Muriithi, Francis G

    2015-10-01

    Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

  6. The respiratory consequences of early-term birth and delivery by caesarean sections.

    Science.gov (United States)

    Kotecha, Sarah J; Gallacher, David J; Kotecha, Sailesh

    2016-06-01

    In England and Wales, 19% of live births in 2012 were at 37-38 weeks' gestation, equating to nearly 140 000 early-term births each year. Since caesarean sections (CS) are often performed at early-term gestations, this accounts for some of the increased proportion of the early-term births. Infants born early-term are at an increased risk of neonatal respiratory morbidity particularly if they are delivered by caesarean section. The long term lung function data are limited but available data suggest that early-term delivery is associated with respiratory morbidity in childhood. CS also appears to be associated with increased neonatal morbidity and future development of respiratory symptoms. However, future studies need to confirm the independent effects of caesarean sections and early-term deliveries particularly for long term outcomes as both are likely to affect the respiratory system differently.

  7. Injury to a transplanted kidney during caesarean section: a case report.

    Science.gov (United States)

    Shrestha, Badri Man; Throssell, David; McKane, William; Raftery, Andrew Thomas

    2007-06-01

    As fertility is restored after renal transplant, more female recipients of a renal transplant successfully complete pregnancies that are safe for the mother, the fetus, and the renal allograft. Although the transplanted kidney lies in one of the iliac fossae, normal vaginal delivery is not impeded by this positioning. Caesarean section is indicated in many scenarios, primarily for obstetric reasons, particularly when the transplanted kidney lies in a position where it could be injured. Here, we report our experiences managing a rare instance of injury to a transplanted kidney during caesarean section and discuss the relevant aspects of its management. To our knowledge, this is the first report in the English literature of an injury to a transplanted kidney during caesarean section.

  8. Ogilvie's syndrome with caecal perforation after Caesarean section: a case report

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    Saha Arin K

    2009-06-01

    Full Text Available Abstract Introduction Ogilvie's syndrome describes the phenomenon of an acute colonic pseudo-obstruction without a mechanical cause. It is rare but has been reported to occur after Caesarean section. It can lead to bowel perforation or ischaemia. Case presentation A healthy, 28-year-old Caucasian woman presented 2 weeks past her expected date of delivery for her first pregnancy. She underwent an uncomplicated elective Caesarean section but developed abdominal pain and bloating postoperatively and was subsequently diagnosed with acute colonic pseudo-obstruction, also known as Ogilvie's syndrome. Conclusion This case report highlights the rare, but potentially dangerous, diagnosis of Ogilvie's syndrome after Caesarean section. It is of particular interest to obstetricians, midwifery staff and general surgeons and shows the importance of accurate diagnosis, regular abdominal reassessment and early senior input to ensure appropriate and rapid treatment.

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

    Science.gov (United States)

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

    2012-09-01

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

  10. Clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review.

    Science.gov (United States)

    Catling-Paull, Christine; Johnston, Rebecca; Ryan, Clare; Foureur, Maralyn J; Homer, Caroline S E

    2011-08-01

    The aim of this study was to review clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Repeat caesarean section is the main reason for the increase in surgical births. The risk of uterine rupture in women who have prior caesarean sections prevents many clinicians from recommending vaginal birth after caesarean. Despite this, support for vaginal birth after caesarean continues. A search of five databases and a number of relevant professional websites was undertaken up to December 2008. A systematic review of quantitative studies that involved a comparison group and examined a clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. An assessment of quality was made using the Critical Skills Appraisal Programme. Induction of labour using artificial rupture of membranes, prostaglandins, oxytocin infusion or a combination, was associated with lower vaginal birth rates. Cervical ripening agents such as prostaglandins and transcervical catheters may result in lower vaginal birth rates compared with spontaneous labour. The impact of epidural anaesthesia in labour on vaginal birth after caesarean success is inconclusive. X-ray pelvimetry is associated with reduced uptake of vaginal birth after caesarean and higher caesarean section rates. Scoring systems to predict likelihood of vaginal birth are largely unhelpful. There is insufficient data in relation to vaginal birth after caesarean section between different closure methods for the primary caesarean section. Clinical factors can affect vaginal birth after caesarean uptake and success. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

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

    OpenAIRE

    2011-01-01

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

  12. [Life threatening postpartal haemorrhage after rupture of the vagina, uterine cervix, caesarean section or hysterectomy].

    Science.gov (United States)

    Kozovski, I; Radoinova, D

    2010-01-01

    The authors discuss 10 cases--seven after vaginal and cervical rupture, 2 after Caesarean section and 1 after hysterectomy. Six of them died--5 after rupture of the vagina and cervix and one after Caesarean section. The lethal issue was avoidable in all cases because it was a result of untimely done or not done at all hysterectomy and other interventions, e.g., ligation of the hypogastric arteries, as well as of faulty surgical performance. Basic principles of surgical behavior in such cases are postulated.

  13. Post-operative complications after caesarean section in HIV-infected women.

    Science.gov (United States)

    Ferrero, Simone; Bentivoglio, Giorgio

    2003-10-01

    This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient ( n=45) a control group of ten seronegative women ( n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500x10(6) CD4(+) lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500x10(6) CD4(+) lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.

  14. Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries.

    Science.gov (United States)

    Kaboré, C; Chaillet, N; Kouanda, S; Bujold, E; Traoré, M; Dumont, A

    2016-12-01

    To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. A prospective 4-year observational study. Senegal and Mali. A cohort of 9712 women with one previous caesarean delivery. Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women. © 2015 Royal College of Obstetricians and Gynaecologists.

  15. An examination of women experiencing obstetric complications requiring emergency care: perceptions and sociocultural consequences of caesarean sections in Bangladesh.

    Science.gov (United States)

    Khan, Rasheda; Blum, Lauren S; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-06-01

    Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008-August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health systems

  16. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia

    OpenAIRE

    Seyedeh Masoumeh Hosseini Valami; Seyed Abbas Hosseini Jahromi; Niolofar Masoodi

    2015-01-01

    Background and Aims: Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Methods: Fifty partur...

  17. Trends in and socio-demographic factors associated with caesarean section at a large Tanzanian hospital, 2000 to 2013

    OpenAIRE

    2014-01-01

    Introduction: Caesarean section (CS) can prevent maternal or fetal complications. Sub-Saharan Africa has the lowest CS levels in the world but large variations are seen between and within countries. The tertiary hospital, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania has had a high level of CS over years. Objectives: To examine trends in the socio-demographic background of babies born at KCMC from year 2000 to 2013, and trends in the CS percentage, and to identify socio-demographic ...

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

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

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

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

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola

    2017-01-01

    ) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal...

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

    NARCIS (Netherlands)

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

    OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity

  1. Sequential combined spinal epidural anaesthesia for caesarean section in peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Kumari Indira

    2007-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery.We report a case of PPCM (LVEF< 25% requiring caesarean section who was successfully managed with sequential combined spinal epidural anaesthesia.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    OBJECTIVE: The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C...

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

    NARCIS (Netherlands)

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

    2016-01-01

    OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

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    I. J. J. Dons-Sinke

    2014-01-01

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

  6. Compromised immune response in infants at risk for type 1 diabetes born by Caesarean Section.

    Science.gov (United States)

    Puff, R; D'Orlando, O; Heninger, A-K; Kühn, D; Krause, S; Winkler, C; Beyerlein, A; Bonifacio, E; Ziegler, A-G

    2015-10-01

    Children born by Caesarean Section have a higher risk for type 1 diabetes. We aimed to investigate whether Caesarean Section leads to alterations of the immune response in children with familial risk for type 1 diabetes. We examined measures of innate and adaptive immune responses in 94 prospectively followed children, including 40 born by Caesarean Section. Proinflammatory serum cytokine concentrations were determined at age 6 months. As a measure of vaccine response, IgG1, IgG2, and IgG4 tetanus antibody titers and CD4(+) T cell proliferation against tetanus toxoid were quantified. Compared to infants born by vaginal delivery, infants born by Caesarean Section had lower concentrations of the cytokines IFN-ɣ (p=0.014) and IL-8 (p=0.005), and weaker CD4(+) T cell responses to tetanus measured in the first (p=0.007) and second year (p=0.047) of life. Overall, our findings provide evidence that the mode of delivery influences the immune status and responsiveness during childhood.

  7. Caesarean section delivery in Kerala, India : evidence from a national family health survey

    NARCIS (Netherlands)

    Padmadas, SS; Kumar, S; Nair, SB; Kumari, A

    2000-01-01

    Ensuring safe pregnancy and motherhood occupies a pivotal role and has been considered as one of the key issues in the framework of reproductive and child health programmes, Evidence from research studies indicate that there is a growing tendency for caesarean section deliveries especially during co

  8. Caesarean Section--A Density-Equalizing Mapping Study to Depict Its Global Research Architecture.

    Science.gov (United States)

    Brüggmann, Dörthe; Löhlein, Lena-Katharina; Louwen, Frank; Quarcoo, David; Jaque, Jenny; Klingelhöfer, Doris; Groneberg, David A

    2015-11-17

    Caesarean section (CS) is a common surgical procedure. Although it has been performed in a modern context for about 100 years, there is no concise analysis of the international architecture of caesarean section research output available so far. Therefore, the present study characterizes the global pattern of the related publications by using the NewQIS (New Quality and Quantity Indices in Science) platform, which combines scientometric methods with density equalizing mapping algorithms. The Web of Science was used as a database. 12,608 publications were identified that originated from 131 countries. The leading nations concerning research activity, overall citations and country-specific h-Index were the USA and the United Kingdom. Relation of the research activity to epidemiologic data indicated that Scandinavian countries including Sweden and Finland were leading the field, whereas, in relation to economic data, countries such as Israel and Ireland led. Semi-qualitative indices such as country-specific citation rates ranked Sweden, Norway and Finland in the top positions. International caesarean section research output continues to grow annually in an era where caesarean section rates increased dramatically over the past decades. With regard to increasing employment of scientometric indicators in performance assessment, these findings should provide useful information for those tasked with the improvement of scientific achievements.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

    OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    H. Virgin, MD

    2016-01-01

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

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

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    Zaman Shakila

    2010-01-01

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

  14. Impact of Bifidobacterium lactis supplementation on fecal microbiota in infants delivered vaginally compared to Caesarean section

    Directory of Open Access Journals (Sweden)

    Tetty Yuniaty

    2013-03-01

    Full Text Available AbstractBackground It has been reported that infants born by Caesarean section have altered gut microbiota, with lower numbers of bifidobacteria and Bacteroides, compared to that of infants who were delivered vaginally. Probiotic supplementation has been reported to have beneficial effects on the immune response, generally in relation to allergies.Objective To assess the effect of Bifidobacterium lactis (B. lactis supplementation on the presence of B. lactis and bifidobacteria counts in stool of infants during the first 2 months of life.Methods We conducted an observational study of 122 healthy, breast-fed infants delivered vaginally or by Caesarean section. Infants assigned to the test group received breast milk and formula supplemented with the B. lactis probiotics. Infants in the control group received breast milk and formula without probiotics. The presence of B. lactis and stool bifidobacteria counts were determined at 1 month and 2 months of age. Growth, morbidity, serum immune markers, and stool immunoglobulin (Ig A were also assessed.Results B. lactis was more frequently detected in the stool of infants who received breast milk and probiotic-supplemented formula than in stool of infants who received breast milk and non-supplemented formula, both at 1 month and 2 months of age (OR 1,263; 95%CI 11 to 151,030; P=0.003. Of infants who received probiotic-supplemented formula, B. lactis was detected in 80% of those delivered by Caesarean section and in 38% of those delivered vaginally, at the 1-month mark. In infants delivered by Caesarean section, the mean stool bifidobacteria level at 1 month was significantly higher in the probiotic-supplemented group compared to that of the non-supplemented group (P=0.021.Conclusion Eearly bifidobacteria supplementation of infants, particularly those delivered by Caesarean section, is associated with higher levels of stool bifidobacteria. Anthropometric data suggests beneficial effects of bifidobacteria

  15. Impact of Bifidobacterium lactis supplementation on fecal microbiota in infants delivered vaginally compared to Caesarean section

    Directory of Open Access Journals (Sweden)

    Tetty Yuniaty

    2013-03-01

    Full Text Available Background It has been reported that infants born by Caesarean section have altered gut microbiota, with lower numbers of bifidobacteria and Bacteroides, compared to that of infants who were delivered vaginally. Probiotic supplementation has been reported to have beneficial effects on the immune response, generally in relation to allergies. Objective To assess the effect of Bifidobacterium lactis (B. lactis supplementation on the presence of B. lactis and bifidobacteria counts in stool of infants during the first 2 months of life. Methods We conducted an observational study of 122 healthy, breast-fed infants delivered vaginally or by Caesarean section. Infants assigned to the test group received breast milk and formula supplemented with the B. lactis probiotics. Infants in the control group received breast milk and formula without probiotics. The presence of B. lactis and stool bifidobacteria counts were determined at 1 month and 2 months of age. Growth, morbidity, serum immune markers, and stool immunoglobulin (Ig A were also assessed. Results B. lactis was more frequently detected in the stool of infants who received breast milk and probiotic-supplemented formula than in stool of infants who received breast milk and non-supplemented formula, both at 1 month and 2 months of age (OR 1,263; 95%CI 11 to 151,030; P=0.003. Of infants who received probiotic-supplemented formula, B. lactis was detected in 80% of those delivered by Caesarean section and in 38% of those delivered vaginally, at the 1-month mark. In infants delivered by Caesarean section, the mean stool bifidobacteria level at 1 month was significantly higher in the probiotic-supplemented group compared to that of the non-supplemented group (P=0.021. Conclusion Eearly bifidobacteria supplementation of infants, particularly those delivered by Caesarean section, is associated with higher levels of stool bifidobacteria. Anthropometric data suggests beneficial effects of bifidobacteria

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

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    Hansa Dhar

    2014-05-01

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

  17. Review of vaginal birth after primary caesarean section without prostaglandin induction and or syntocinon augmentation in labour.

    Science.gov (United States)

    Ogbonmwan, S E O; Miller, V; Ogbonmwan, D E; Akinsola, A A

    2010-04-01

    To show the results of vaginal birth after primary caesarean (VBAC) without using prostaglandin for induction and/or syntocinon augmentation are comparable when induction is done with these agents but without the added risks of uterine rupture. A review of the obstetric records of 16,498 parturient from 1 January 2001 to 31 December 2006 was carried out. The 229 cases of women who wanted VBAC were subjected to further analysis to determine the number of successful vaginal delivery after spontaneous onset of labour or membrane sweep. The instrumental vaginal delivery rate, analgesia commonly used and the complication rate were analysed. The result showed that 34.49% had spontaneous onset of labour, 27.07% laboured after membrane sweep and 38.42% had repeat urgent caesarean section as they failed to go into spontaneous labour. Of those who went into labour spontaneously or after membrane sweep, 67% had vaginal delivery, a further 13.97% had instrumental vaginal delivery and 16% had emergency caesarean section. There was no case of uterine rupture. VBAC can end successfully in a high proportion of cases without the use of prostaglandin or syntocinon for induction of labour and or syntocinon for augmentation in these women because of their associated increased relative risk of uterine rupture.

  18. Role of cerebral oxygenation for prediction of hypotension after spinal anesthesia for caesarean section.

    Science.gov (United States)

    Sun, Shen; Liu, Nai-He; Huang, Shao-Qiang

    2016-08-01

    To investigate the role of cerebral oxygen saturation (ScO2) for prediction of hypotension after spinal anesthesia for caesarean section. Forty-five parturients undergoing elective caesarean section under spinal anesthesia were selected. Blood pressure, heart rate and pulse oxygen saturation before and after anesthesia were recorded, and the association between changes in ScO2 before and after anesthesia with hypotension after spinal anesthesia was explored. Hypotension occurred in 32 parturients after spinal anesthesia. The decrease in ScO2 after spinal anesthesia in parturients with hypotension was larger than in parturients without hypotension (P spinal anesthesia is associated with hypotension after spinal anesthesia for cesarean section, and may be a clinically useful predictor.

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

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

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

  20. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

    Science.gov (United States)

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    El-Khoury Marianne

    2012-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Rodrigo M. Carrillo-Larco

    2015-06-01

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

  3. ANESTHETIC MANAGEMENT OF AN ANEMIC PARTURIENT WITH SEVERE KYPHOSCOLIOSIS AND BILATERAL POLIOMYELITIS FOR EMERGENCY CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Sujay

    2014-05-01

    Full Text Available Anesthesia for emergency caesarean section for a pregnant patient with severe dorsolumbar kyphoscoliosis and severe anemia is associated with potential risks for both mother and the fetus due to alterations in maternal physiology and the pathological changes associated with kyphoscoliosis. In an emergency situation, the anesthesiologist has to quickly choose the anesthetic technique depending on the cardiopulmonary status of the patient and feasibility. We present a case of a 20 year old parturient in labour with severe kyphoscoliosis and severe anemia who was posted for emergency caesarean section. In view of severe anemia, anticipated technical difficulties with central neuraxial blocks and emergency situation, she was administered general anesthesia (GA with uneventful recovery.

  4. Fear of childbirth and emergency caesarean section in low-risk nulliparous women

    DEFF Research Database (Denmark)

    Jespersen, Cecilie; Hegaard, Hanne Kristine; Schroll, Anne-Mette

    2014-01-01

    OBJECTIVE: To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN: A prospective cohort study of low-risk nulliparous women at term. SETTING: Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION: A total of 2598 nulliparous women...... in spontaneous labor with a single fetus in cephalic presentation at term. METHODS: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery...... was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Risk of emergency caesarean section in women who feared childbirth. RESULTS: FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated...

  5. Vaginal prostaglandin gel to induce labour in women with one previous caesarean section.

    LENUS (Irish Health Repository)

    Agnew, G

    2012-02-01

    This retrospective study reviewed the mode of delivery when vaginal prostaglandins were used to induce labour in women with a single previous lower segment caesarean section. Over a 4-year period, PGE 2 gel was used cautiously in low doses in 54 women. Induction with PGE 2 gel was associated with an overall vaginal birth after caesarean section (VBAC) rate of 74%, which compared favourably with the 74% VBAC rate in women who went into spontaneous labour (n = 1969). There were no adverse outcomes recorded after the prostaglandin inductions but the number reported are too small to draw any conclusions about the risks, such as uterine rupture. We report our results because they may be helpful in assessing the chances of a successful VBAC in the uncommon clinical circumstances where prostaglandin induction is being considered.

  6. Epidural top-up solutions for emergency caesarean section: a comparison of preparation times.

    Science.gov (United States)

    Lucas, D N; Borra, P J; Yentis, S M

    2000-04-01

    We compared the preparation times of three solutions commonly used for epidural top-up for emergency Caesarean section. Twenty-two anaesthetists were asked to prepare fresh solutions in random order as quickly as possible: 0.5% bupivacaine 20 ml (B); 2% lidocaine 20 ml with 1:200,000 epinephrine (LE); and 0.5% bupivacaine 10 ml and 2% lidocaine 10 ml with 1:200,000 epinephrine and 8.4% sodium bicarbonate 2 ml (BLEB). Preparation times for B were approximately half of those for LE, which in turn were approximately half of those for BLEB (P = 0.0001). If local anaesthetic solutions with additives such as epinephrine or bicarbonate are prepared just before emergency Caesarean section, any possible reduction in onset time that they might afford may be offset by the additional preparation time required.

  7. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.

  8. [Caesarean section in conflict with the patient's right to self-determination?].

    Science.gov (United States)

    Blondeau, Marie-José C E; Koorengevel, Kathelijne M; Schneider, A J Tom; van der Knijff-van Dortmont, A L M J Anouk; Dondorp, Wybo J

    2015-01-01

    Competent patients have the right to refuse treatment and healthcare workers should acknowledge their wishes. In the Netherlands there are conflicting (constitutional) rights of the foetus and of mentally ill patients. This paper describes the legal and ethical problems in the case of a mentally ill patient at 37 weeks of pregnancy who refused an obstetric examination. The patient refused to cooperate and have her physical condition and mental status examined. Her refusal endangered the life of the foetus. The obstetrician decided to perform a caesarean section, even if this would be in conflict with the patient's right to self-determination. In these cases no legal framework exists for providing the best medical care. New legislation should be drawn up to prevent similar cases occurring in the future. If a caesarean section is in conflict with a patient's right to self-determination, it should always be performed as a last resort.

  9. Emergency and elective caesarean sections: comparison of maternal and fetal outcomes in a suburban tertiary care hospital in Puducherry

    Directory of Open Access Journals (Sweden)

    Valsa Diana

    2016-09-01

    Conclusions: It was inferred that both elective and emergency caesarean imposes certain complications to the mother and the fetes. However, maternal and fetal complications were felt very high in emergency caesarean than elective. Proper planning can help obstetric practitioners to avoid complications. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3060-3065

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

    Directory of Open Access Journals (Sweden)

    Simran Kaur Bhatia

    2015-01-01

    Full Text Available Introduction: Association between caesarean section and intra operative and post operative bleeding is known. Post-partum hemorrhage is still a leading cause for maternal morbidity and mortality. This study will evaluate the efficacy and safety of tranexamic acid in reducing the blood loss after placental delivery following lower segment caesarean section (LSCS and note any adverse effects. Materials and Methods: A total of 100 women, who underwent elective or emergency primary caesarean section at term between 37 and 41 weeks have been studied prospectively. They were divided into two groups. In the study group of 50, tranexamic acid 1 gm IV was given 20 minutes before making incision for caesarean section and the control group of 50 did not receive tranexamic acid. Statistical Analysis: For quantitative outcomes, the t-test was used to test for difference in the two groups. For categorical outcomes, chi square and odds ratio with 95% confidence interval were used as applicable. Results: The patient characteristics, namely age, height, weight, gestational age and gravidity in two groups were similar which was statistically insignificant. Hemoglobin decreased slightly after birth in both groups but no statistical difference between two groups was noticed. There was no episode of thrombosis in the study. Tranexamic acid significantly reduced the quantity of the blood loss from time of placental delivery to 2 hours postpartum (P < 0.001 and from end of LSCS to 2 hours postpartum (P < 0.001. However, there was no statistical difference in quantity of blood loss from time of placental delivery to end of LSCS in both groups (P < 0.001. Conclusion: A safe dose of tranexamic acid has an effective role in reducing blood loss during LSCS without causing adverse reaction. Thus, drug can be used effectively in reducing maternal morbidity and mortality during LSCS.

  11. Anaesthetic management of peripartum cardiomyopathy for emergency caesarean section: A case report

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2014-06-01

    Full Text Available Peripartum cardiomyopathy is a rare but life threatening condition. Anaesthetic management of a patient with peripartum cardiomyopathy for caesarean section is a major challenge for anaesthesiologist. Timely diagnosis of the condition, institution of appropriate medication regimen, a carefully chosen anaesthetic technique and vigilant perioperative monitoring are essential for optimizing outcome in these patients. The goals of anaesthetic management include maintenance of optimal ventricular preload and afterload while avoiding any anaesthesia induced myocardial depression.

  12. Caesarean section in a parturient with Carpenter syndrome and corrected Tetralogy of Fallot.

    Science.gov (United States)

    Bhardwaj, M; Grange, C

    2013-07-01

    Carpenter syndrome is an extremely rare congenital disorder characterized by craniofacial malformations, syndactyly, cardiac defects and obesity. Even after surgical correction of cardiac abnormalities, intrapartum care of a parturient with this condition can be challenging because of progression of residual cardiac defects compounded by the haemodynamic changes of pregnancy. We describe the anaesthetic management for caesarean section of a parturient with Carpenter syndrome and corrected Tetralogy of Fallot. Additional complicating issues included worsening cardiac function, asthma, needle-phobia and osteoarthritis.

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

    Science.gov (United States)

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

    2009-09-01

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

  14. CORONIS - International study of caesarean section surgical techniques: the follow-up study

    OpenAIRE

    Abalos, E; Oyarzun, E; Addo, V.; Sharma, JB; Matthews, J; Oyieke, J; Masood, SN; El Sheikh, MA; Brocklehurst, P.; Farrell, B; Gray, S; Hardy, P.; Jamieson, N; Juszczak, E.; Spark, P

    2013-01-01

    BACKGROUND: The CORONIS Trial was a 2×2×2×2×2 non-regular, fractional, factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes, the primary outcome being a composite of maternal death or infectious morbidity. The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies. Such outcomes include those related to subsequent pregnancy: mode of delivery; abnormal placentation (e....

  15. The half-life and exposure of cefuroxime varied in newborn infants after a Caesarean section

    DEFF Research Database (Denmark)

    Zachariassen, G.; Hyldig, N.; Joergensen, J.S.

    2016-01-01

    in normal adults and seemed to clear within 24 hours. The median area under the concentration–time curve was 65.0 hour μg/mL (range 31.7–162.4). Conclusion: We found that the cefuroxime half-life after a Caesarean section varied among infants and was longer than in normal adults but cleared within 24 hours....... Exposure to cefuroxime in newborn infants may influence the gut microbiota and should be investigated further....

  16. Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey

    OpenAIRE

    2012-01-01

    Abstract Background Two years after implementing the free-CS policy, we assessed the non-financial factors associated with caesarean section (CS) in women managed by referral hospitals in Senegal and Mali. Methods We conducted a cross-sectional survey nested in a cluster trial (QUARITE trial) in 41 referral hospitals in Senegal and Mali (10/01/2007–10/01/2008). Data were collected regarding women’s characteristics and on available institutional resources. Individual and institutional factors ...

  17. Elective induction of labour increases caesarean section rate in low risk multiparous women.

    Science.gov (United States)

    Jacquemyn, Y; Michiels, I; Martens, G

    2012-04-01

    The aim of this study was to compare the risk of secondary caesarean section in induced versus spontaneous labour in the second delivery of low risk women who had a vaginal delivery in their first pregnancy. The data were retrospective cohort from an existing regional database, comparing term (between 37 and 42 gestational weeks) second deliveries in cephalic position in women who had previously given vaginal birth. Diabetes, hypertension and multiple pregnancy were excluded as were those with a birth weight less than 2500 g or more than 4500 g. The difference was not significant when induction was performed after 41 weeks. The results showed a total number of 29693 deliveries were included, 21243 in spontaneous labour and 8450 after induction of labour. In the spontaneous group 312 (1.5%) underwent secondary caesarean section, as compared to 237 (2.8%) in the induced group, p elective induction of labour in low risk women who have previously given vaginal birth is associated with an almost doubled rate of secondary caesarean section if performed before 41 weeks.

  18. Effect of phenylephrine vs. ephedrine on frontal lobe oxygenation during caesarean section with spinal anesthesia

    DEFF Research Database (Denmark)

    Foss, Visti T; Christensen, Robin; Rokamp, Kim Z

    2014-01-01

    BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether that is th......BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether...... that is the case for patients exposed to spinal anesthesia is not known. OBJECTIVES: To evaluate the impact of phenylephrine vs. ephedrine on ScO2during caesarean section with spinal anesthesia in a single center, open-label parallel-group study with balanced randomization of 24 women (1:1). Secondary aims were...... anesthesia, ephedrine maintains frontal lobe oxygenation and maternal heart rate with a similar increase in fetal heart rate as elicited by phenylephrine. TRIAL REGISTRATION: Clinical trials NCT 01509521 and EudraCT 2001 006103 35....

  19. Alterations in head shape of newborn infants after caesarean section or vaginal delivery.

    Science.gov (United States)

    Souza, S W; Ross, J; Milner, R D

    1976-08-01

    Alterations of head shape in preterm, small-for-dates, and term normal infants were studied by measuring occipitofrontal circumference (OFC), biparietal diameter (BPD), and occipitofrontal diameter (OFD) at intervals after birth. In 9 preterm infants born by elective caesarean section ther was a 5-2% reduction in BPD and 2-0% reduction in OFC at the age of 7 days. In 18 term infants born by elective caesarean section these changes were 2-4% and 0% respectively in BPD and OFC. In 25 preterm infants born by vertex vaginal delivery there was a significant fall in OFC of 0-7% at the age of 7 days and of 2-4% in BPD, but no significant change in OFD. In 19 small-for-dates infants born vaginally OFC increased 1-0% and OFD 2-7% at 7 days, but BPD decreased 2-5%. After the first week all three measurements increased in both groups of vaginal deliveries. The results show that shrinkage and biparietal flattening of the skull occur during the first week of life in preterm and term infants born by caesarean section and in preterm infants born vaginally. This fact should be borne in mind when comparing the measurements of an infant's head size with published norms.

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

    Science.gov (United States)

    Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

    2011-12-01

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

  1. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background.

    Science.gov (United States)

    Daly, B; Young, S; Marla, R; Riddell, L; Junkin, R; Weidenhammer, N; Dolan, J; Kinsella, J; Zhang, R

    2017-02-01

    Pain, both from the surgical site, and from other sources such as musculoskeletal backache, can persist after caesarean section. In this study of a predominantly socially deprived population we have sought to prospectively examine the association between antenatal maternal anxiety and socioeconomic background and the development of persistent pain of all sources after caesarean section. Demographic details and an anxiety questionnaire were completed by 205 women before elective caesarean section. On the first postoperative day, pain scores were recorded, and at four months patients were asked to complete a Brief Pain Inventory and an Edinburgh Postnatal Depression Score. Of 205 parturients recruited, 186 records were complete at the hospital admission phase and 98 (52.7%) were complete at the four-month follow-up phase. At recruitment, 15.1% reported pain. At four months 41.8% (95% CI 32.1 to 51.6%) reported pain, of whom pain was a new finding in 35.7% (95% CI 26.2 to 45.2%). Antenatal anxiety was not a significant predictor of severity of new pain at four months (P=0.44 for state anxiety, P=0.52 for trait anxiety). However, four-month pain severity did correlate with social deprivation (P=0.011), postnatal depression (Panxiety scoring to predict persistent pain in this setting, but suggest that persistent pain is influenced by acute pain, postnatal depression and socioeconomic deprivation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Study of drug control over postoperative hemorrhage after selective caesarean section

    Institute of Scientific and Technical Information of China (English)

    Teng Li-rong; Bian Xu-ming; Zhai Gui-rong; Wang Xin; Chen Qian; Zhang Xiao-wei

    2006-01-01

    Objective: To compare the efficacy and safety of carbetocin and oxytocin in the prevention of postpartum hemorrhage after selective caesarean section. Methods: Two hundred and sixteen pregnant women who were going to deliver by caesarean section were randomly divided into two paralleled and controlled groups, of which the oxytocin group(group A) contained 105 women and the carbetocin group(group B) 111 women. 20 IU of oxytocin was administrated during operation for both groups, 10 IU directly into uterus and 10 IU intravenously. When the operation was over, 20 IU of oxytocin was dripped for group A lasting for 8 hours, while for group B 100μg of carbetocin was immediately injected intravenously for 1 minute. Blood loss as well as hemoglobin alteration was measured for the comparison of the effect of the two drugs. Blood biochemical indicators were introduced for the evaluation of the safety of carbetocin including the function of liver and kidney and the fasting glucose.Results: No significant difference was revealed between the two groups concerning the postpartum hemorrhage within 24 hours, the postpartum hemorrhage incidence and the changes of hemoglobin. There was no significant difference in the change of liver and kidney function, fasting glucose and electrolyte changes as well.Conclusions: Carbetocin has a similar effect and safety of oxytocin in controlling the blood loss of selective caesarean section.

  3. Indications for Caesarean Section at a Nigerian District Hospital

    African Journals Online (AJOL)

    Alasia Datonye

    caeserean sections performed with obstructed labour being the highest indication. ... maternity ward register while other clinical records were retrieved from the ... December 2006 was recorded for analysis. The patients ... The routine laboratory ... rate of CS various Nigerian studies are 10.4% in Awka , 9.1%. 9. 10 in Ilorin ...

  4. Ropivacaine 7.5 mg/mL for Caesarean Section

    Directory of Open Access Journals (Sweden)

    N. K. Nguyen

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    2007-10-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  7. National Variation in Caesarean Section Rates: A Cross Sectional Study in Ireland

    Science.gov (United States)

    Sinnott, Sarah-Jo; Brick, Aoife; Layte, Richard; Cunningham, Nathan; Turner, Michael J.

    2016-01-01

    Objective Internationally, caesarean section (CS) rates are rising. However, mean rates of CS across providers obscure extremes of CS provision. We aimed to quantify variation between all maternity units in Ireland. Methods Two national databases, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women delivering singleton births weighing ≥500g. We used multilevel models to examine variation between hospitals in Ireland for elective and emergency CS, adjusted for individual level sociodemographic, clinical and organisational variables. Analyses were subsequently stratified for nullipara and multipara with and without prior CS. Results The national CS rate was 25.6% (range 18.2% ─ 35.1%). This was highest in multipara with prior CS at 86.1% (range 6.9% ─ 100%). The proportion of variation in CS that was attributable to the hospital of birth was 11.1% (95% CI, 6.0 ─ 19.4) for elective CS and 2.9% (95% CI, 1.4 ─ 5.6) for emergency CS, after adjustment. Stratifying across parity group, variation between hospitals was greatest for multipara with prior CS. Both types of CS were predicted by increasing age, prior history of miscarriage or stillbirth, prior CS, antenatal complications and private model of care. Conclusion The proportion of variation attributable to the hospital was higher for elective CS than emergency CS suggesting that variation is more likely influenced by antenatal decision making than intrapartum decision making. Multipara with prior CS were particularly subject to variability, highlighting a need for consensus on appropriate care in this group. PMID:27280848

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

    Directory of Open Access Journals (Sweden)

    Huang Kun

    2012-04-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    and neonatal department of a university hospital in Denmark. PARTICIPANTS: All liveborn babies without malformations, with gestational ages between 37 and 41 weeks, and delivered between 1 January 1998 and 31 December 2006 (34 458 babies). MAIN OUTCOME MEASURES: Respiratory morbidity (transitory tachypnoea...... section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks' gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks' gestation (3.0, 2.1 to 4.3), and 39 weeks...

  10. Impact single versus double layer uterine closure in caesarean section to uterine rupture

    OpenAIRE

    Budi Iman Santoso; Raymond Surya; Rima Irwinda

    2016-01-01

    Caesarean section (CS) is one of the most frequent delivery methods in the world whereas the rates of CS were varied according to developing (from 3.5 to 29.2%) and developed countries (21.1%). The study aims to known the impact of single versus double layer uterine closure to uterine rupture in the history of cesarean section (CS). In this case report, the clinical question is single versus double-layer uterine closure on the previous CS, gives better outcome to reduce the risk of uterine ru...

  11. A rare case of peripartum cardiomyopathy posted for caesarean section

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2007-01-01

    Full Text Available Post Partum Cardiomyopathy (PPCM is a relatively rare form of heart failure associated with pregnancy. It was recognized first in the 19th century by Ritchie and is defined as the onset of acute heart failure in the last trimester or early post partum period in the absence of infections, metabolic, toxic, ischaemic or valvular causes of myocardial dysfunction. Prognosis depends on the degree of cardiomegaly at presentation and in the following 6 months. Initial high risk period carries a mortality of 25 to 50%. Keeping in mind the reduced contractility and ejection fraction with ventricular dilatation proceeding to cardiac failure, the anesthesiologist managing a case of PPCM faces the challenge of avoiding myocardial depression, hypovolemia and increased SVR, all of which may be hazardous

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

    Directory of Open Access Journals (Sweden)

    Volkov O.O.

    2014-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Gao Xiao-ling

    2010-12-01

    Full Text Available Abstract Background Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. A critical examination of this issue in relation to maternal outcomes is important. At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women. To fill the gap left by trials, this indication-matched cohort study was carried out to examine prospectively the outcomes of caesarean section on women with no absolute obstetric indication compared with similar women who had vaginal delivery. Methods An indication-matched cohort study was undertaken to compare maternal outcomes following caesarean section with those undergoing vaginal delivery, in which the two groups were matched for non-absolute indications. 301 nulliparous women with caesarean section were matched successfully with 301 women who delivered vaginally in the Maternal and Children's Hospitals (MCHs in Shanghai, China. Logistic regression model or binomial regression model was used to estimate the relative risk (RR directly. Adjusted RRs were calculated adjusting for propensity score and medical indications. Results The incidence of total complications was 2.2 times higher in the caesarean section group during hospitalization post-partum, compared with the vaginal delivery group (RR = 2.2; 95% CI: 1.1-4.4. The risk of haemorrhage from the start of labour until 2 hours post-partum was significantly higher in the caesarean group (RR = 5.6; 95% CI: 1.2-26.9. The risk of chronic abdominal pain was significantly higher for the caesarean section group (RR = 3.6; 95% CI: 1.2-10.9 than for the vaginal delivery group within 12 months post-partum. The two groups had similar incidences of anaemia and complicating infections such as wound complications

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

    Directory of Open Access Journals (Sweden)

    Kurmanadh Kalepalli

    2016-10-01

    Full Text Available BACKGROUND Recent trends in obstetric anaesthesia show increased popularity of regional anaesthesia among obstetric anaesthetists. General anaesthesia in caesarean section is associated with high morbidity and mortality rate when compared with regional anaesthesia. Regional anaesthesia has its own demerits which are primarily related to excessively high spinal blocks and toxicity of local anaesthetics. Reduction in doses and improvement in technique to avoid high level blocks and increased awareness of toxicity of local anaesthetics have contributed to reduction in complications related to regional anaesthesia. The challenges presented by a parturient requiring anaesthesia or analgesia, or both, make the role of obstetric anaesthesiologist both challenging and rewarding. Spinal anesthesia is a popular technique for caesarean delivery. Hyperbaric Bupivacaine in 8% glucose is often used. Plain or glucose-free, Bupivacaine has been frequently referred to as “Isobaric” in the literature, even after Blomqvist and Nilsson demonstrated its hypobaricity. More recently, several studies have confirmed that plain Bupivacaine is indeed hypobaric in comparison with human CSF. Although hyperbaric local anesthetic solutions have a remarkable record of safety, their use is not totally without risk. To prevent unilateral or saddle blocks, patients should move from the lateral or sitting position rapidly to supine position. Hyperbaric solutions may cause sudden cardiac arrest after spinal anesthesia because of the extension of the sympathetic block. The use of truly isobaric solutions may prove less sensitive to position issues. Hyperbaric solutions may cause hypotension or bradycardia after mobilization. Isobaric solutions are favored with respect to their less sensitivity to postural changes. MATERIALS AND METHODS 60 full term parturients of ASA Grade 1 and 2 posted for elective caesarean section under spinal anaesthesia were divided in to two groups. GROUP

  15. Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms.

    Science.gov (United States)

    Fergus, Paul; Hussain, Abir; Al-Jumeily, Dhiya; Huang, De-Shuang; Bouguila, Nizar

    2017-07-06

    Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤ 7.20-acidosis, n = 18; pH > 7.20 and pH machine-learning algorithms are trained, and validated, using binary classifier performance measures. The findings show that deep learning classification achieves sensitivity = 94%, specificity = 91%, Area under the curve = 99%, F-score = 100%, and mean square error = 1%. The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies.

  16. GOAL ORIENTED ANAESTHETIC MANAGEMENT FOR CAESAREAN SECTION IN A PARTURIENT WITH PITUITARY TUMOUR

    Directory of Open Access Journals (Sweden)

    Sushma

    2015-03-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anesthesia for Pregnancy with pituitary tumours is a challenge to an Anesthesiologist , requires careful preoperative assessment and meticulous perioperative management to achieve optimal safety of mother and fetus. There are very limited studies in literature to guide the anaesthetic management of such patients. Here we report the successful Anaesthetic management of a parturient with pituitary tumour with epilepsy posted for emergency caesarean section. PRESENTATION, DIAGNOSIS, MANAGEMENT: A 25 year young woman, G2P1L1, a known epileptic, diagnosed with pituitary macroadenoma presented at 40 weeks of gestation with severe Oligohydramnios (AFI - 4cm was posted for an emergency caesarean section. Following consultation with the obstetrician, neonato logist and the neurosurgeon the decision was made to proceed with caesarean section under general anesthesia. Rapid sequence induction and intubation was performed with inj Thiopentone sodium and inj Rocuronium and was maintained with Isoflurane, titrated to maintain the stability of mean arterial pressure until extraction. A live 4. 25kgs male child was born with Apgar scores of 8 and 9 at 1 and 5 mins respectively. Following extraction 10U run as infusion in Ringers lactate. Intraoperative analgesia was a dministered after extraction. Dexmedetomedine infusion was used. Postoperative period was uneventful. DISCUSSION & CONCLUSION: Management of obstetric patients with pituitary tumour is complex, requiring knowledge of the physiological effects of pregnancy on tumour size and labour on intracranial pressure. General anesthesia combined with multimodal balanced analgesia is associated with a favorable outcome. General anaesthesia using Thiopentone, Fentanyl, Dexmedetomedine and titrated dose of Isoflurane was used in our case were found to be safe with adequate hemodynamic stability and postoperative pain control. A team approach involving the Anaesthethesiologist

  17. SURGICAL SITE INFECTION FOLLOWING LOWER SEGMENT CAESAREAN SECTION IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Nishi Roshini

    2016-03-01

    Full Text Available AIM OF THE STUDY To identify infection rates and risk factors associated with Surgical Site Infection (SSI following Caesarean Section. DESIGN OF THE STUDY Case control study. PLACE OF STUDY Academic Tertiary Care Obstetrics and Gynaecology Centre with 60 Beds. PATIENTS All women who delivered by caesarean section in Govt. Medical College, Thrissur, during 1st June 2010 to 30th September 2011. METHODS Wound infections were identified during hospital stay using the criteria of the Centres for Disease Control and Prevention, National Nosocomial Infections Surveillance System. A case control study of 50 patients with wound infection after Lower Segment Caesarean Section (LSCS was undertaken between 1st June 2010 and 30th September 2011. The control group comprised of 50 patients selected randomly from among those who had LSCS during the study period with no wound infection. The CDC definition describes three levels of SSI (Superficial incisional, Deep incisional and Organ or Space infection. Comparisons for categorical variables were performed using the X2 or Fisher exact test. Continuous variables were compared using the 2-tailed Student ‘t’ test and p 0.05 was considered significant. RESULTS The overall wound infection rate in the study was 3.5%, (50 among 1410 Lower Transverse CS. Obesity, Hypertension and Poorly Controlled Diabetes are associated with significant risk for development of SSI. The commonest presentation of SSI in LSCS was fever 40 (80% followed by local pain and induration 25 (50%. SSI was detected on 6±3 days. Average duration of hospital stay among SSI was 22.78±10.2 days. Staphylococcus aureus was the commonest pathogen for SSI in our series. The increase in the presence of (Methicillin Resistant Staphylococcus Aureus MRSA (20.83% might alter the pattern of prophylactic antibiotic given preoperatively in the near future. CONCLUSIONS Increased incidence of drug resistant organisms needs proper attention and strategies for

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

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    Prerana N Shah

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  20. Local anaesthetic wound infiltration used for caesarean section pain relief: a meta-analysis

    Science.gov (United States)

    Li, Xiangnan; Zhou, Miao; Shi, Xuan; Yang, Haiqin; Li, Yonghua; Li, Jian; Yang, Mei; Yuan, Hongbin

    2015-01-01

    Purpose: Local anaesthetic wound infiltration techniques were reported to reduce opiate requirements and pain scores in women undergoing caesarean section (CS). However, the results were conflicting. The primary aim of this meta-analysis was to assess whether local analgesia could reduce pain intensity when injected via wound catheters. Methods: A search of randomized clinical trials (RCTs) evaluating local analgesia in caesarean surgery in PubMed, EMBASE and the Cochrane database was performed. Cumulative morphine consumption and pain scores at rest at different time point after surgery were extracted and synthesized using random or fixed model for meta-analysis. Subgroup analysis was performed according to incision type and administration regimen. Results: Nine RCTs with a total of 512 patients were included. Cumulative morphine consumption was lower in LA group compared with placebo group in the first 12 h (SMD = -0.736, 95% CI (-1.105, -0.368)), 24 h (SMD = -0.378, 95% CI (-0.624, -0.132)) and 48 h after surgery (SMD = -0.913, 95% CI (-1.683 to -0.143)). Lower morphine consumption was observed in the first 6 h after surgery but the reduction failed to meet the common level of significance. Pain scores was significantly reducedat 12 h but not 6 h after surgery in the LA group compared with placebo group. At 24 h and 48 h after surgery, the pain sore was lower but the difference did not meet the common level of significance. Lower rate of post-operative nausea was observed in the LA group. Conclusions: Local anaesthetic wound infiltration can reduce morphine requirements and the rate of patients suffer nausea but not pain scores after caesarean section. Further procedure-specific RCTs were encouraged to confirm the efficacy of local anaesthetic wound infiltration techniques. PMID:26309720

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

    Directory of Open Access Journals (Sweden)

    Atossa Mahdavi

    2016-12-01

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

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

    Science.gov (United States)

    Mahdavi, Atossa; Telkabadi, Zeinab; Aleyasin, Ashraf; Agha Hosseini, Marzieh; Safdarian, Leili; Momenzadeh, Ali

    2016-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Cristiane M. Moreira

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jafar S. Tabrizi

    2014-12-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  8. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

    OpenAIRE

    Liu, E H C; Sia, A T H

    2004-01-01

    Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women.

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

    Science.gov (United States)

    Tamrakar, S R; Chawla, C D

    2010-06-01

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

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

    Science.gov (United States)

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

    2015-05-01

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

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

    Science.gov (United States)

    Kehila, Mehdi; Derouich, Sadok; Touhami, Omar; Belghith, Sirine; Abouda, Hassine Saber; Cheour, Mariem; Chanoufi, Mohamed Badis

    2016-01-01

    The delivery of a macrosomic infant is associated with a higher risk for maternofoetal complications. Shoulder dystocia is the most feared fetal complication, leading sometimes to a disproportionate use of caesarean section. This study aims to evaluate the interest of preventive caesarean section. We conducted a retrospective study of 400 macrosomic births between February 2010 and December 2012. We also identified cases of infants with shoulder dystocia occurred in 2012 as well as their respective birthweight. Macrosomic infants weighed between 4000g and 4500g in 86.25% of cases and between 4500 and 5000 in 12.25% of cases. Vaginal delivery was performed in 68% of cases. Out of 400 macrosomic births, 9 cases with shoulder dystocia were recorded (2.25%). All of these cases occurred during vaginal delivery. The risk for shoulder dystocia invaginal delivery has increased significantly with the increase in birth weight (p dystocia affectd macrosoic infants in 58% of cases. Shoulder dystocia is not a complication exclusively associated with macrosomia. Screening for risky deliveries and increasing training of obstetricians on maneuvers in shoulder dystocia seem to be the best way to avoid complications.

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

    Directory of Open Access Journals (Sweden)

    Lokman Soyoral

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

  13. Management of Neuraxial Anaesthesia for Emergent Caesarean Section for Placenta Previa.

    Science.gov (United States)

    Günaydın, Berrin; Kurdoğlu, Mertihan; Güler, İsmail; Bashiri, Mehrnoosh; Büyüktaşkın, Fırat; Keleşoğlu, Mine Dağgez; İnan, Gözde

    2016-02-01

    Abnormal placental attachments, such as placenta accreta, increta or percrata, can result in increased morbidity and mortality because of the risk of severe postpartum haemorrhage. We aimed to present the management of spinal anaesthesia and surgical approach for emergent caesarean section because of vaginal bleeding in a multiparous pregnant woman with placenta previa at 36 weeks' gestation. Hyperbaric bupivacaine 12 mg, fentanyl 10 μg and morphine 150 μg were intrathecally administered for spinal anaesthesia. Oxytocin, methyl ergonovin and tranexamic acid were administered after umbilical cord clamping. Breech delivery of the baby was provided by a vertical incision to the uterus for avoiding placental harm. Subtotal hysterectomy was performed leaving the placenta in situ. Two units of red blood cells were transfused during the operation, lasting approximately 40 min. The patient was uneventfully discharged on the postoperative fourth day. In conclusion, a single-shot spinal anaesthesia was successfully maintained without conversion to general anaesthesia until the end of the hysterectomy in the patient in whom placenta increta was observed during caesarean delivery.

  14. Evaluation of “J”-shaped Uterine Incision during Caesarean Section in Patients with Placenta Previa:A Retrospective Study

    Institute of Scientific and Technical Information of China (English)

    邹丽; 钟少平; 赵茵; 朱剑文; 陈莉娟

    2010-01-01

    This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine...

  15. Predicting successful intended vaginal delivery after previous caesarean section : external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate

    NARCIS (Netherlands)

    Schoorel, E. N. C.; Melman, S.; van Kuijk, S. M. J.; Grobman, W. A.; Kwee, A.; Mol, B. W. J.; Nijhuis, J. G.; Smits, L. J. M.; Aardenburg, R.; de Boer, K.; Delemarre, F. M. C.; van Dooren, I. M.; Franssen, M. T. M.; Kleiverda, G.; Kaplan, M.; Kuppens, S. M. I.; Lim, F. T. H.; Sikkema, J. M.; Smid-Koopman, E.; Visser, H.; Vrouenraets, F. P. J. M.; Woiski, M.; Hermens, R. P. M. G.; Scheepers, H. C. J.

    2014-01-01

    ObjectiveTo externally validate two models from the USA (entry-to-care [ETC] and close-to-delivery [CTD]) that predict successful intended vaginal birth after caesarean (VBAC) for the Dutch population. DesignA nationwide registration-based cohort study. SettingSeventeen hospitals in the Netherlands.

  16. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2012-02-01

    BACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)Caesarean section. The addition of TAP block with bupivacaine 2 mg kg(-1) to spinal morphine did not further improve analgesia.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

    Zeitlin, J.; Lallo, D. Di; Blondel, B.; Weber, T.; Schmidt, S.; Kunzel, W.; Kollee, L.A.A.; Papiernik, E.

    2010-01-01

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

  19. A brief study on status and reason of caesarean section and its effect%浅谈剖宫产率增高的原因及对策

    Institute of Scientific and Technical Information of China (English)

    吴少平; 陈婉; 黄芳

    2010-01-01

    Objective To study the status and reason of caesarean section and its effect to obstetrics and gynecology department. Methods Caesarean section was the effective method to solve dystocia and some high risk pregnancy before 1980s. With the improving of anesthesia,caesarean section and newborn rescue technology, the cesarean rate was increased year after year. Results There were many reasons, the main one was the social factors, secondly, the diagnostic technique was improved and the reducing application of the vagina deliver technique, etc. ,There were man y complications after caesarean section, and the maternal mortality was higher than that of vaginal spontaneous labour. Conclusion Doctors are expected to correctly master the operative indication for caesare an section, increase vagina deliver technique, reduce cesarean section rate and improve obstetric quality.%20世纪80年代之前剖宫产是解决难产及解决某些高危妊娠的有效方法.随着麻醉,削宫产及新生儿抢救技术的提高,剖宫产率逐年增高.原因很多,主要原因有社会因素,其次是诊疗技术的提高以及阴道助产技术的减少等,削官产术后的并发症较多,产妇死亡率较阴道分娩高,希望临床产科医生正确掌握削宫产的手术指征,提高阴道助产技术,降低剖宫产率,提高产科质量.

  20. [Skin-to-skin caesarean section: a hype or better patient care?

    Science.gov (United States)

    Korteweg, F J; de Boer, H D; van der Ploeg, J M; Buiter, H D; van der Ham, D P

    2017-01-01

    A caesarean section (CS) is one of the most common surgical procedures performed in the world, for which there are minimal variations in the surgical approach. During the last few years the "skin-to-skin" CS, also coined "natural" or "gentle" CS, is on the rise; parental participation, slow delivery and direct skin-to-skin contact are important aspects. Most Dutch hospitals offer some form of "skin-to-skin" CS but there are local differences in availability and performance of the procedure. Since 2011, the standard procedure in the Martini Hospital in Groningen is the "skin-to-skin" CS (for both elective and emergency CS, 24/7). We describe our method and share our retrospective data, and demonstrate that this procedure does not result in more complications for mother or baby.

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

    Energy Technology Data Exchange (ETDEWEB)

    Skjoeldebrand, A.; Eklund, J.; Johansson, H.; Lunell, N.-O.; Nylund, L.; Sarby, B.; Thornstroem, S. (Departments of Anaesthesiology, Obstetrics and Gynaecology and Medical Physics, Karolinska Institute at Huddinge University Hospital, Stockholm (Sweden))

    1990-01-01

    The uteroplacental blood flow was measured before and during epidural anaesthesia for caesarean section in 11 woman. The blood flow was measured with dynamic placental scintigraphy. After an i.v. injection of indium-113m chloride, the gamma radiation over the placenta was recorded with a computer-linked scintillation camera. The uteroplacental blood flow could be calculated from the isotope accumulation curve. The anaesthesia was performed with bupivacaine plain 0.5%, 18-22 ml and a preload of a balanced electrolyte solution 10 ml/kg b.w. was given. The placental blood flow decreased in eight patients and increased in three with a median change of -21%, not being statistically significant. No correlation between maternal blood pressure and placental blood flow was found. (author).

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

    Directory of Open Access Journals (Sweden)

    C. C. Ceronio

    1995-05-01

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

  3. Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

    LENUS (Irish Health Repository)

    Tadrous, R

    2012-02-01

    Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.

  4. Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

    LENUS (Irish Health Repository)

    Tadrous, R

    2011-07-01

    Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.

  5. Can Caesarean section improve child and maternal health? The case of breech babies.

    Science.gov (United States)

    Jensen, Vibeke Myrup; Wüst, Miriam

    2015-01-01

    This paper examines the health effects of Caesarean section (CS) for children and their mothers. We use exogenous variation in the probability of CS in a fuzzy regression discontinuity design. Using administrative Danish data, we exploit an information shock for obstetricians that sharply altered CS rates for breech babies. We find that CS decreases the child's probability of having a low APGAR score and the number of family doctor visits in the first year of life. We find no significant effects for severe neonatal morbidity or hospitalizations. While mothers are hospitalized longer after birth, we find no effects of CS for maternal post-birth complications or infections. Although the change in mode of delivery for the marginal breech babies increases direct costs, the health benefits show that CS is the safest option for these children.

  6. Ileo-uterine fistula in a degenerated posterior wall fibroid after Caesarean section.

    Science.gov (United States)

    Shehata, Ayman; Hussein, Naglaa; El Halwagy, Ahmed; El Gergawy, Adel; Khairallah, Mohamed

    2016-03-01

    Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.

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

    DEFF Research Database (Denmark)

    Fuhrmann, Lone; Pedersen, T H; Atke, A

    2015-01-01

    to evaluate the effect of a simulation-based team training programme on the proportion of ECSs achieved within a 30-min time frame. METHOD: We performed an interventional before-and-after study. We evaluated a total of one hundred 30-min ECSs before and after the intervention. The primary outcome of interest......BACKGROUND: Emergency Caesarean section is performed when the life of the pregnant woman and/or the foetus is considered at risk. A 30-min standard for the decision-to-delivery interval (DDI) is a common practice and is supported by national organisations including The Danish Society of Obstetrics...... and Gynaecology. Danish obstetric departments report the DDI to a national database. A national arbitrarily set standard recommends that 95% of ECSs should be achieved within the 30-min DDI standard. In 2011, 34.4% of ECSs, performed at our hospital, were achieved within the 30-min time frame. This study aims...

  8. 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.

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

    Science.gov (United States)

    Ramya, V; Ghose, Seetesh; Pallavee, P

    2015-08-01

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

  10. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany

    Science.gov (United States)

    Lerchl, Alexander

    2008-02-01

    A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states’ professional midwives’ organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.

  11. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial).

    Science.gov (United States)

    Stutchfield, Peter Roy; Whitaker, Rhiannon; Gliddon, Angela E; Hobson, Lucie; Kotecha, Sailesh; Doull, Iolo J M

    2013-05-01

    To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). Four UK study centres from the original trial. 862 participants from the four largest recruiting centres, 92% of the original study. 824 (96%) were traced and 799 (93%) were successfully contacted. Fifty-one percent (407/799) completed and returned the questionnaire. The children were aged 8-15 years (median 12.2 years, 52% girls). 386 gave consent to contact schools with 352 (91%) reports received. Questionnaires including a strengths and difficulties questionnaire, International Study of Asthma and Allergies in Childhood, general health and school performance. There were no significant differences between children whose mothers received betamethasone and controls for the mean total strengths and difficulties questionnaire scores and subscores for hyperactivity, emotional symptoms, prosocial behaviour, conduct or peer problems. 25 (12%) children whose mothers received betamethasone had reported learning difficulties compared with 27 (14%) control children. The proportion of children who achieved standard assessment tests KS2 exams level 4 or above for mathematics, English or science was similar as were the rates of ever reported wheeze (30% vs 30%), asthma (24% vs 21%), eczema (34% vs 37%) and hay fever (25% vs 27%). Antenatal betamethasone did not result in any adverse outcomes or reduction in asthma or atopy. It should be considered for elective CS at 37-38 weeks of gestation. : Original trial was preregistration, the trial publication is BMJ. 2005 Sep 24;331(7518):662.

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

    Directory of Open Access Journals (Sweden)

    Alma Soxhuku-Isufi

    2015-12-01

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

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

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2009-01-01

    elective caesarean section. Safe operative delivery is now a priority and a reality for many pregnant women. Obstetricians, obstetric anaesthetists, midwives and pregnant women need high quality evidence on which to base management approaches. The overall aim is to reduce maternal haemorrhagic morbidity and its attendant risks at elective caesarean section. TRIAL REGISTRATION: number: ISRCTN17813715.

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

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-02-01

    elective caesarean section. Safe operative delivery is now a priority and a reality for many pregnant women. Obstetricians, obstetric anaesthetists, midwives and pregnant women need high quality evidence on which to base management approaches. The overall aim is to reduce maternal haemorrhagic morbidity and its attendant risks at elective caesarean section. TRIAL REGISTRATION: number: ISRCTN17813715.

  15. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis

    Science.gov (United States)

    Syrogiannouli, Lamprini; Luta, Xhyljeta; Tal, Kali; Goodman, David C; da Costa, Bruno R; Jüni, Peter

    2017-01-01

    Objective Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. Design Systematic review and meta-analysis. Data sources MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. Eligibility criteria To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. Outcomes The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals. Results 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ2≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ2≥0.179). Conclusions CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS. PMID:28213600

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

    Directory of Open Access Journals (Sweden)

    Milanez Helaine M

    2010-06-01

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

  17. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review

    Directory of Open Access Journals (Sweden)

    Yang Jin

    2008-08-01

    Full Text Available Abstract Background Caesarean section before labor or before ruptured membranes ("elective caesarean section", or ECS has been introduced as an intervention for preventing mother-to-child transmission (MTCT of hepatitis B virus (HBV. Currently, no evidence that ECS versus vaginal delivery reduces the rate of MTCT of HBV has been generally provided. The aim of this review is to assess, from randomized control trails (RCTs, the efficacy and safety of ECS versus vaginal delivery in preventing mother-to-child HBV transmission. Results We searched Cochrane Pregnancy and Childbirth Group's Trials Register (January, 2008, the Cochrane Central Register of Controlled Trials (the Cochrane Library 2008, issue 1, PubMed (1950 to 2008, EMBASE (1974 to 2008, Chinese Biomedical Literature Database (CBM (1975 to 2008, China National Knowledge Infrastructure (CNKI (1979 to 2008, VIP database (1989 to 2008, as well as reference lists of relevant studies. Finally, four randomized trails involving 789 people were included. Based on meta-analysis, There was strong evidence that ECS versus vaginal delivery could effectively reduce the rate of MTCT of HBV (ECS: 10.5%; vaginal delivery: 28.0%. The difference between the two groups (ECS versus vaginal delivery had statistical significance (RR 0.41, 95% CI 0.28 to 0.60, P Conclusion ECS appears to be effective in preventing MTCT of HBV and no postpartum morbidity (PPM was reported. However, the conclusions of this review must be considered with great caution due to high risk of bias in each included study (graded C.

  18. Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus ® for the perioperative management of a caesarean section in a patient with severe cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Nicolas Brogly

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus® for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT: We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus® monitor. The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION: This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

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

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

  1. Analysis of Caesarean-Section rates according to Robson's ten group classification system and evaluating the indications within the groups

    Directory of Open Access Journals (Sweden)

    Amita Ray

    2017-01-01

    Full Text Available Background: With Caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates. Methods: This was a cross sectional study for a period of 24 months at a tertiary care hospital in a tribal area of Kerala South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group. Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 38% of the total Caesareans. Followed by Group 8 and 10. All four added contributed to 63% of the section rate The least contribution was by Group 3. Groups 6, 7 and 9 by themselves did not contribute much but within their groups had a 100% C-Section rate. Conclusions: The contribution of the various Robson's Group to the absolute C-Section rates needs to be looked into. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for dystocia and non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute C-Section rates.

  2. Impact single versus double layer uterine closure in caesarean section to uterine rupture

    Directory of Open Access Journals (Sweden)

    Budi Iman Santoso

    2016-07-01

    Full Text Available Caesarean section (CS is one of the most frequent delivery methods in the world whereas the rates of CS were varied according to developing (from 3.5 to 29.2% and developed countries (21.1%. The study aims to known the impact of single versus double layer uterine closure to uterine rupture in the history of cesarean section (CS. In this case report, the clinical question is single versus double-layer uterine closure on the previous CS, gives better outcome to reduce the risk of uterine rupture. To answer this question, we search the evidence from Pub Med and Cochrane database with the keywords: and ldquo;cesarean section" and "uterine rupture" and and ldquo;uterine closure and rdquo;. The inclusion criteria are written in English and focused comparing single and double layer uterine closure to uterine rupture in the previous CS. From the searching literature, we found 3 systematic reviews and 23 articles which were relevant to the topic. After screening the abstract and language, we got 2 systematic reviews and 4 articles. At the end, only 4 articles consisting of 1 systematic review and 3 articles were included to be appraised. Based on evidences, single layer uterine closure did not increase the risk of uterine rupture. Apart from that, shorter operative times and lower estimated blood loss became the superiority of single-layer uterine closure. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2074-2078

  3. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Hong-Yan; Jiang, Qing; Shi, Hao; Xu, Yun-Qing; Shi, Ai-Chao; Sun, Yuan-Li; Li, Jian; Ning, Qin; Shen, Guan-Xin

    2016-07-08

    Several studies have reported a positive association between caesarean section for expeditious pregnancy termination and perinatal outcomes in acute fatty liver of pregnancy (AFLP); however, the risks remain unclear and independent studies have reported conflicting findings. In this meta-analysis, we aimed to confirm the relationship between caesarean section and perinatal outcomes in AFLP. The PubMed, Embase, and China National Knowledge Infrastructure databases were searched (until July 17, 2015) for observational clinical studies focusing on the association between caesarean section and perinatal outcomes in AFLP. Data were extracted and processed independently by 2 authors. We also compared caesarean section with vaginal delivery to further investigate this relationship. We observed that 2 of the 3 primary outcomes in caesarean section exhibited positive effects-the maternal mortality rate was 44% lower (relative risk [RR], 0.56 [0.41-0.76]) and perinatal mortality rate was also reduced (RR, 0.52 [0.38-0.71]), compared to those for vaginal delivery. We did not find any associations between caesarean section and perinatal outcomes in AFLP in terms of neonatal mortality type and maternal multiple organ complications. These findings emphasise the significant prognostic value and clinical implications of caesarean section in AFLP, and suggest that the adverse outcomes should be reduced.

  4. Caesarean Section on The Risk of Celiac Disease in the Offspring: The Teddy Study.

    Science.gov (United States)

    Koletzko, Sibylle; Lee, Hye-Seung; Beyerlein, Andreas; Aronsson, Carin A; Hummel, Michael; Liu, Edwin; Simell, Ville; Kurppa, Kalle; Lernmark, Åke; Hagopian, William; Rewers, Marian; She, Jin-Xiong; Simell, Olli; Toppari, Jorma; Ziegler, Anette-G; Krischer, Jeffrey; Agardh, Daniel

    2017-07-27

    Caesarean section (C-section) is associated with various immune-mediated diseases in the offspring. We investigated the relationship between mode of delivery and celiac disease (CD) and CD autoimmunity (CDA) in a multinational birth cohort. From 2004 to 2010 infants from the general population who tested positive for HLA DR3-DQ2 or DR4-DQ8 were enrolled in The Environmental Determinants for Diabetes in the Young (TEDDY) study. Children were annually screened for transglutaminase autoantibodies, if positive re-tested after 3-6 months and those persistently positive defined as CDA. Associations of C-section with maternal (age, education level, parity, pre-pregnancy weight, diabetes, smoking, weight gain during pregnancy) and child characteristics (gestational age, birth weight) were examined by Fisher's exact test or Wilcoxon rank-sum test. Hazard ratios (HRs) for CDA or CD were calculated by Cox proportional hazard regression models. Of 6,087 analyzed singletons 1600 (26%) were born by C-section (Germany 38%, US 37%, Finland 18%, Sweden 16%), the remaining vaginally without instrumental support; 979 (16%) had developed CDA and 343 (6%) CD. C-section was associated with lower risk for CDA (HR = 0.85, [95% CI 0.73, 0.99], p = 0.032) and CD (HR = 0.75, [95% CI 0.58, 0.98], p = 0.034). After adjusting for country, sex, HLA-genotype, CD in family, maternal education and breastfeeding duration, significance was lost for CDA (HR = 0.91, [95% CI 0.78, 1.06], p = 0.20) and CD (HR = 0.85, [95% CI 0.65, 1.11], p = 0.24). Pre-surgical ruptured membranes had no influence on CDA or CD development. C-section is not associated with increased risk for CDA or CD in the offspring.

  5. Sources of funding for caesarean section in two hospitals in Jakarta

    Directory of Open Access Journals (Sweden)

    Anggita Bunga Anggraini

    2014-02-01

    Full Text Available AbstrakLatar belakang: Prevalensi seksio sesarea meningkat setiap tahunnya. Penelitian ini bertujuan untuk mengetahui sumber pembiayaan seksio sesarea di beberapa rumah sakit di Jakarta. Metode: Penelitian dilakukan dengan desain potong lintang yang dilakukan di satu rumah sakit pemerintah daerah DKI Jakarta dan satu rumah sakit bersalin di Jakarta. Pengumpulan data dilakukan dengan mengekstrak data rekam medis pasien yang melahirkan dan dirawat pada periode 1 Januari sampai 31 Desember 2011. Analisis dilakukan dengan menggunakan regresi Cox dengan waktu konstant. Hasil: Proporsi seksio sesaria di rumah sakit (RS pemerintah Jakarta (922/1351 = 68,2% relatif lebih tinggi dari rumah sakit swasta (1036/1645 = 63,0%. Insiden tertinggi seksio sesaria pada kelompok umur 21-35 tahun (76,9%. Subjek paling banyak berpendidikan menengah (74,5%. Kebanyakan sumber pendanaan merupakan biaya pribadi (51,2%, sedangkan sumber pendanaan terendah dari perusahaan (0,3%. Dibandingkan dengan yang harus membayar sendiri, subjek yang memiliki Jamkesda, Jamsostek, dan Jampersal lebih memilih seksio scesaria. Subjek yang memiliki Jampersal 35% lebih banyak melakukan seksio sesarea [risiko relatif suaian (RRa = 1,35; P = 0,000]. Kesimpulan: Seksio sesarea paling banyak atas biaya pribadi, dan di samping itu banyak yang memanfaatkan Jamsostek dan Jampersal sebagai sumber pembiayaannya. (Health Science Indones 2013;2:93-7Kata kunci: seksio sesarea, sumber pembiayaanAbstractBackground: The prevalence of Caesarean section (c-section has increased each year. This study aimed to identify the major source of funding related to c-section in government and private hospitals in Jakarta. Methods: The cross sectional study was conducted in a provincial general hospital in Jakarta and a private maternity hospital in Jakarta. The data were collected from all medical records of patients giving birth in those hospitals in the period of January 1st through December 31st, 2011. Analysis

  6. Incidence and risk factors of caesarean section in preterm breech births: A population-based cohort study.

    Science.gov (United States)

    Lorthe, Elsa; Quere, Mathilde; Sentilhes, Loïc; Delorme, Pierre; Kayem, Gilles

    2017-05-01

    To describe the incidence of breech presentation at 22-34 weeks' gestation, estimate the incidence of cesarean section delivery by cause of prematurity, and assess the factors associated with caesarean delivery in preterm breech births with preterm labor or preterm premature rupture of membranes. EPIPAGE 2 is a French national prospective population-based cohort study of preterm births that occurred in 546 maternity units in 2011. We estimated the overall incidence of breech presentation and the incidence of cesarean delivery by cause of prematurity. Among the 579 singletons with breech presentation born at 22-34 weeks in a context of spontaneous preterm labor or membrane rupture, multivariable logistic regression was used to assess the association between individual and institutional characteristics and caesarean delivery. Among the 3660 singletons born at 22-34 weeks' gestation in the EPIPAGE 2 study, 20.1% (n=911) were breech presentation. Among these births, the rate of cesarean section was 99.6% with vascular pathologies, intrauterine growth retardation or placental abruption as compared with 60.1% with spontaneous preterm labor or membrane rupture. The main indication for caesarean delivery was gestational age associated with breech presentation (61.0%). Delivery mode varied by region of birth. Other characteristics associated with caesarean delivery were hospital status (public teaching, public non-teaching or private), clinical chorioamniotitis, hospital admission after labor onset, and gestational age. Breech presentation is common in preterm infants and is associated with widespread use of cesarean delivery with significant regional disparities that could reflect the lack of consensus and recommendations on the preferential mode of delivery. Other factors associated with caesarean delivery are the status of the maternity unit, clinical chorioamniotitis, admission after labor onset and gestational age. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. The risk of caesarean section in obese women analysed by parity.

    LENUS (Irish Health Repository)

    O'Dwyer, Vicky

    2012-02-01

    OBJECTIVE: This study looked at the association between caesarean section (CS) and Body Mass Index (BMI) in primigravidas compared with multigravidas. STUDY DESIGN: We enrolled women at their convenience, in the first trimester after an ultrasound examination confirmed an ongoing pregnancy. Weight and height were measured digitally and BMI calculated. After delivery, clinical details were again collected from the Hospital\\'s computerised database. RESULTS: Of the 2000 women enrolled, there were 50.4% (n=1008) primigravidas and 49.6% (n=992) multigravidas. Of the 2000 8.5% were delivered by elective CS and 13.4% were delivered by emergency CS giving an overall rate of 21.9%. The overall CS rate was 30.1% in obese women compared with 19.2% in the normal BMI category (p<0.001). In primigravidas the increase in CS rate in obese women was due to an increase in emergency CS (p<0.005) and in multigravidas the increase was due to an increase in elective CS (p<0.01). In obese primigravidas 20.6% had an emergency section for fetal distress. In obese multigravidas 17.2% had a repeat elective CS. CONCLUSION: The influence of maternal obesity on the increase in CS rates is different in primigravidas compared with multigravidas.

  8. [Rates of caesarean sections tn two types of private hospitals: restriced-access and open-access].

    Science.gov (United States)

    Paleari, Leonardo; Gibbons, Luz; Chacón, Sandra; Ramil, Verónica; Belizán, José M

    2012-04-01

    In recent years, rising rates of caesarean section are of concern in the medical community in many countries, especially in Latin America. Determine if there is a difference in the rate of Caesarean sections in a restricted-access hospital (HC) and an open-access hospital (HA) using the Robson classification to explain potential differences. A prospective cohort study was conducted. This in volved all patients that attended the obstetrics sector in the two hospitals in Buenos Aires where they gave birth between 1 June 2009 and 25h January 2010. The open-access hospital is open to doctors with varying professional training and differing clinical practice. The restricted-access hospital, on the other hand, can only be attended by specified doctors with certain professional training; their medical) conduct is based on service standards and clinical practice. Over the study period 762 patients who fulfilled the study criteria were included from the open-access hospital and 768 from the restricted-access hospital. The global rate of caesarean sections in the HAwas 53.5%, and 48.7% in the HC, RR 1.09 (CI 0.99-1.21) a difference that was not statistically significant (p = 0.058). The onset of spontaneous labour in the HAwas significantly more than in the HC (74.9% vs. 41.8%) RR 2.66 (CU.98-3.57). The induced labour was significantly lower in HA (9,7% vs. 28,3%); RR 0.34 (CI 0.27-0.44). Elective caesarean sections were significantly lower in the HA (15.3% vs. 29.9%) RR 0.51 (CI 0.42-0.62). This study reveals a similar rate of caesarean sections in two private hospitals with different systems of care. However, it observed that the HA has a greater tendency to operate on patients at the onset of spontaneous labour and the HC has a greater number of induced labour and elective caesarean section.

  9. Analysis of Situation of the Caesarean Section Rate in Sichuan%四川省剖宫产现状分析

    Institute of Scientific and Technical Information of China (English)

    吴方银; 肖兵; 熊庆; 曹静; 潘惊萍

    2012-01-01

    目的 分析四川省剖宫产现状,为制定相关政策提供依据.方法 对四川省2009年剖宫产资料进行回顾分析.结果 全省剖宫产率为38.17%;乡镇级、县级、市级医疗保健机构剖宫产率分别为42.81%、50.20%、62.93%;非医学指征剖宫产占剖宫产总数的30.96%.结论 剖宫产率与经济发展水平、医疗保健机构级别成正相关,非医学指征剖宫产升高是剖宫产率上升的重要原因.%OBJECTIVE To analyze the present status of caesarean section in Sichuan Province, and supply evidences for government to make policy. METHODS A retrospective review of the data of caesarean section in 2009 was carried out. RESULTS The caesarean birth rate in Sichuan Province was 38.17%. The caesarean section rate to the Medical Health Establishment at village, county and municipal level was 42.81%, 50.20% and 62.93%, respectively. The caesarean section without medical signs constituted about 30.96% of the total caesarean section. CONCLUSION The level of economic development and the composition of Medical Health Establishment was positive correlation with the caesarean section rate. The rising caesarean section without medical signs was an important cause of the raising rate of Caesarean Section.

  10. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.

    LENUS (Irish Health Repository)

    Sheehan, Sharon R

    2012-02-01

    OBJECTIVE: Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. STUDY DESIGN: We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. RESULTS: The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85-95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest-55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4h, but only 122 clinicians (40%) used this. CONCLUSIONS

  11. Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.

    LENUS (Irish Health Repository)

    Lundgren, Ingela

    2015-02-05

    BackgroundThe number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.MethodsThe bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, `Effective Public Health Practice Project¿. The primary outcome measure was VBAC rates.Results238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.ConclusionsThis systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that

  12. Elective caesarean section and neonatal respiratory diseases%择期剖宫分娩与新生儿呼吸系统疾病

    Institute of Scientific and Technical Information of China (English)

    岳少杰

    2011-01-01

    As an effective solution to high-risk pregnancy, dystocia and other obstetric critical diseases, the caesarean section plays an important role in reducing the perinatal morbidity and mortality. In spite of the effect of the eaesarean section on reducing the incidence of neonatal asphyxia, trauma and meeonium aspiration syndrome,however, recent studies found that it cannot reduce the neonatal mortality. Meanwhile, the elective caesarean can increase the probability of the occurrence of neonatal respiratory distress and of the admission to neonatal intensive care unit significantly. Based on the main types of respiratory diseases in term newborn infants caused by elective caesarean section, this paper briefly discusses the potential mechanisms and the principles of management for the respiratory diseases. The aims of this paper are lo increase the knowledge of adverse effects on the respiratory system caused by elective caesarean, and to reduce the occurrence of neonatal respiratory disease due to elective caesarean section, and to improve the prognosis.%剖宫分娩作为解决高危妊娠、难产等产科危重症的有效途径,在降低围产期母婴发病率和病死率中起着非常重要的作用.但近期研究发现剖宫分娩并未降低新生儿的死亡率,同时发现虽然剖宫分娩使新生儿窒息、创伤和胎粪吸入发生率降低,但择期剖宫分娩的新生儿发生呼吸窘迫和入住新生儿重症监护病房的概率明显增高.文章在简要介绍择期剖宫分娩足月儿出现呼吸系统疾病主要类型的基础上进一步讨论择期剖宫分娩的新生儿出现严重呼吸系统疾病的可能机制以及处理原则,以提高对择期剖宫分娩新生儿呼吸系统疾病的认识,减少择期剖宫分娩所致新生儿呼吸系统疾病的发生及改善预后.

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

    Science.gov (United States)

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

    1995-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Gowri Vaidyanathan

    2016-02-01

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

  15. Clonidine versus tramadol for post spinal shivering during caesarean section: A randomized double blind clinical study

    Directory of Open Access Journals (Sweden)

    Velayudha S Reddy

    2011-01-01

    Full Text Available Background : Control of post spinal shivering is essential for optimal perioperative care, which can be achieved either by oral or parental medications. The present study is designed to evaluate the efficacy and safety of intravenous low-dose clonidine and tramadol in the treatment of post spinal shivering. Materials and Methods : In this prospective, a double blind, randomized study, 90 ASA grade I or II, parturients aged 18 - 35 years, undergoing caesarean section under spinal anaesthesia, who subsequently developed shivering grade 3 or 4, were randomized into two groups, to receive either clonidine or tramadol. The efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting, hypotension, bradycardia, dry mouth, sedation, skin rash and headache, if present, were recorded. All data were analyzed by using the Chi square test and the Z-test. Results : There were significant differences in the response rate between the drugs (P < 0.05. Time taken from the starting of treatment to cessation of shivering was significantly less with the tramadol group (P < 0.05, however, the frequency of nausea, vomiting, sedation and headache were also significantly more in the tramadol group Conclusion : In our study we concluded that both clonidine and tramadol control shivering. However, the response rate was higher and time taken to control shivering was lesser with tramadol, but the response rate and the side effects were lesser with clonidine.

  16. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons.

    Science.gov (United States)

    Ferraro, Federica; Piselli, Pierluca; Pittalis, Silvia; Ruscitti, Luca E; Cimaglia, Claudia; Ippolito, Giuseppe; Puro, Vincenzo

    2016-04-01

    Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive.

  17. A review of Caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital.

    Science.gov (United States)

    Lau, Chang Qi Hester; Wong, Tuck Chin Tiffany; Tan, Eng Loy; Kanagalingam, Devendra

    2017-06-01

    Although Caesarean sections (CSs) are among the most commonly undertaken procedures in the world, there are wide variations in the surgical techniques used. This study aimed to: (a) review the surgical techniques used for CS by obstetricians working in a tertiary hospital in Singapore; (b) compare the techniques with those recommended in evidence-based guidelines; and (c) examine the relationship between the technique used and the level of seniority of the surgeons. Data on 490 CSs performed in Singapore General Hospital (SGH) between 1 August 2013 and 30 June 2014 was collected from the Delivery Suite database and reviewed. The surgical techniques studied were closure of the pelvic and parietal peritoneum, closure of the uterine layer, use of surgical drains and use of postoperative thromboprophylaxis. A total of 486 CSs were analysed after four cases were excluded due to missing data. Most fetal head deliveries were manual. The majority of surgeons did not close the peritoneum; most of those who did were senior surgeons. Double-layer uterine closures were done for all cases and drain usage was rare. 2.0% of the patients received grossly inadequate thromboprophylaxis. The surgical techniques currently practised in SGH are closely aligned with those of the evidence-based guidelines. Peritoneal closure appears to be associated with the surgeon's early training, with a greater number of senior surgeons being less willing to abandon this step. Greater vigilance in implementing appropriate thromboprophylaxis is recommended.

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

    Directory of Open Access Journals (Sweden)

    Billy M. Tsima

    2013-01-01

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

  19. TRAMADOL AS A PRE-INDUCTION AGENT FOR CAESAREAN SECTION UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Rakesh

    2016-05-01

    Full Text Available AIM To evaluate the efficacy and safety of Tramadol for the mother and the foetus when used as part of balanced anaesthesia without the possibility of using potent anaesthetics. METHODS Forty parturients undergoing caesarean section irrespective of their American Society of Anaesthesiologists physical status classification or associated medical conditions were included in randomised single blind study. The patients were randomly allocated to receive Tramadol 1 mg/kg (n=20 and Tramadol 2 mg/kg (n=20 intravenously 15 minutes before induction with Thiopentone. Anaesthesia was maintained only on nitrous-oxide and oxygen mixture with controlled ventilation. RESULTS A total of 70% of patients in group I and 90% in group II showed acceptable haemodynamic changes. There was no significant difference in the uterine tone between the two groups. The Apgar scores at one and five minutes were not significantly different between the two groups. CONCLUSION It was found that the Tramadol at 2 mg/kg intravenous dose could avoid use of inhalation agents in 90% of patients and the dose was safe for even compromised babies.

  20. User cost of Caesarean section: case study of Bunia, Democratic Republic of Congo.

    Science.gov (United States)

    Deboutte, Danielle; O'Dempsey, Tim; Mann, Gillian; Faragher, Brian

    2015-01-01

    The study estimated the user cost of Caesarean section (CS), a major component of emergency obstetric care (EmOC), in a post conflict situation in Bunia, DR Congo, 2008. A case control study used a structured questionnaire to compare women who had a CS (cases) with women who had a vaginal delivery (controls). Service information was recorded in 20 facilities providing obstetric care. Maternal and perinatal deaths, including those outside health facilities, were recorded and verified. The user cost of CS was estimated at four hospitals, one of them managed by an international non-governmental organization offering EmOC free of charge, compared to the user cost of women who had a vaginal delivery. Among paying users, the mean healthcare cost was $US68.0 for CS and $US12.1 for vaginal delivery; mean transport cost to and from the hospital was $US11.7 for cases and $US3.2 for controls. The mean monthly family income was $US75.5. The user cost of CS placed an important financial burden on patients and their families. During transition from humanitarian to developmental assistance, donors and the State should shore up the EmOC budget to avoid an increase in maternal and perinatal mortality.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Background: Cefuroxime is a broad-spectrum cephalosporin antibiotic. It is standard caesarean section (CS) procedure at many hospitals to administer the mother a single prophylactic dose (1500mg) before skin incision and hence before the umbilical cord is cut, indirectly exposing the foetus...... born by CS. Methods: 42 pregnant women (BMImothers were randomly assigned to either receiving cefuroxime before skin incision or immediately after the umbilical cord were cut. Faecal samples were collected from...

  2. Post Caesarean section infective morbidity in HIV-positive women at a tertiary training hospital in Zimbabwe.

    Science.gov (United States)

    Zvandasara, P; Saungweme, G; Mlambo, J T; Moyo, J

    2007-01-01

    To investigate the infective morbidity in HIV-positive and HIV-negative women whose babies were delivered by Caesarean section. A hospital based, prospective study: part of a larger operational research project. Harare Maternity Hospital, a tertiary referral teaching hospital in Harare, Zimbabwe. 164 HIV-positive and 382 HIV-negative women who were delivered of their babies by Caesarean sections. Minor and major infective complications. The results compare HIV-positive and HIV-negative women, 18/164 (10.9%) HIV-positive women developed anaemia requiring blood transfusion compared with 15/382 (3.9%) HIV-negative women. The difference was statistically significant (RR 3.05). HIV-positive women had a statistically significant increase in the incidence of post operative fever (RR 1.3) and wound sepsis/sinus (p = 0.002). Our study indicates that HIV-positive women who were given prophylactic pre-operative antibiotics were at an increased risk of minor infective complications and blood transfusion post Caesarean section. The risk of blood transfusion was higher in women who had a pre-operative haemoglobin of 10.5 grams/dl. Post operative fever, wound sepsis and wound sinus was commoner in HIV-positive when compared to HIV-negative women.

  3. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia

    Directory of Open Access Journals (Sweden)

    Seyedeh Masoumeh Hosseini Valami

    2015-01-01

    Full Text Available Background and Aims: Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Methods: Fifty parturients were randomly divided into two equal groups. Patients in the first group received alfentanil 10 μg/kg and in the second group received placebo intravenously 1 min before induction of anaesthesia for elective caesarean section. Haemodynamic parameters and bispectral index system (BIS in mothers, peripheral capillary oxygen saturation (SpO 2 and Apgar score in the newborn were assessed. Results: Changes in systolic blood pressure were significant at 1, 5 and 10 min after intubation between two groups. Changes in diastolic blood pressure were significantly less in alfentanil group, 1 min after induction of anaesthesia and 1 min after endotracheal intubation. Mean heart rate at 1 min after induction and at 1 and 5 min after intubation also reduced significantly in this group. Conclusion: Alfentanil use was associated with decreases or minimal increases in maternal systolic and diastolic blood pressures and heart rate after endotracheal intubation.

  4. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia.

    Science.gov (United States)

    Hosseini Valami, Seyedeh Masoumeh; Hosseini Jahromi, Seyed Abbas; Masoodi, Niolofar

    2015-11-01

    Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Fifty parturients were randomly divided into two equal groups. Patients in the first group received alfentanil 10 μg/kg and in the second group received placebo intravenously 1 min before induction of anaesthesia for elective caesarean section. Haemodynamic parameters and bispectral index system (BIS) in mothers, peripheral capillary oxygen saturation (SpO2) and Apgar score in the newborn were assessed. Changes in systolic blood pressure were significant at 1, 5 and 10 min after intubation between two groups. Changes in diastolic blood pressure were significantly less in alfentanil group, 1 min after induction of anaesthesia and 1 min after endotracheal intubation. Mean heart rate at 1 min after induction and at 1 and 5 min after intubation also reduced significantly in this group. Alfentanil use was associated with decreases or minimal increases in maternal systolic and diastolic blood pressures and heart rate after endotracheal intubation.

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

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    Oshodi Yussuf A

    2010-09-01

    Full Text Available Abstract Background Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies. Methods Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s of blood transfused and duration of hospital stay was extracted and the data analysed. Results There were 1056 deliveries out of which 327 (31% were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6% were transfused to 41 patients. Amongst those transfused, twenty-six (54% were booked and 31 (75.6% had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood and cephalo-pelvic disproportion (8 patients with 13 units. Conclusion Even though a large number of units of blood was reserved and made available in the theatre at

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

    Science.gov (United States)

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

    2017-02-01

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

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

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    Kaukab Tashfeen

    2017-03-01

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

  8. Neonatal clinical evaluation, blood gas and radiographic assessment after normal birth, vaginal dystocia or caesarean section in dogs.

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    Silva, L C G; Lúcio, C F; Veiga, G A L; Rodrigues, J A; Vannucchi, C I

    2009-07-01

    This study aimed to standardize signs and diagnostic criteria of respiratory function in newborn puppies delivered normally or after dystocia and caesarean operation. A total of 48 neonates were allocated into groups: eutocia (n = 20), dystocia (n = 8), caesarean (c)-section (n = 20). Neonatal health was assessed using the Apgar score and body temperature was determined at 0, 5 and 60 min after delivery. Venous blood gases (pO(2) and SO(2)) was measured immediately and 60 min after delivery, and a thoracic radiograph was made between 0 and 5 min of life. The c-section group had significantly lower Apgar scores at birth and 5 min. Hypothermia was present at 5 min in the eutocia and c-section groups, and at 60 min in all groups. The eutocia group had an irregular respiratory pattern in 78% of puppies at birth, 27.7% at 5 min and 21% at 60 min compared with 87.5%, 62.5% and 12.5% of the pups in the dystocia group where there was irregular respiratory rhythm, moderate to intense respiratory sounds with agonic episodes. The c-section group had respiratory alterations in 70%, 45% and 16% of puppies at 0, 5 and 60 min, respectively. Radiographic abnormalities were present in 17% of the pups in the eutocia group, 25% of the pups in the dystocia group and 30% of the pups in the c-section group, respectively. The c-section group had significantly lower SO(2) values at 60 min than at birth. All puppies had hypoxaemia, but a significant decrease was observed in the c-section group. Newborn puppies had tissue hypoxia and irregular respiratory pattern at birth. Caesarean-section puppies had lower vitality; however, all developed satisfactory Apgar scores at 5 min of life, regardless of the obstetric condition.

  9. Indications of caesarean section in overweight and obese versus normal-weight pregnant women: a retrospective cohort study.

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    Fernández Alba, Juan Jesús; Paublete Herrera, Carmen; Vilar Sanchez, Angel; Gonzalez-Macias, Carmen; Castillo Lara, Maria; Torrejón, Rafael; Moreno Corral, Luis Javier

    2017-02-14

    The aim of this study was to test the hypothesis that indications of c-section in overweight or obese pregnant women are different from those with normal-weight. Retrospective cohort study at University Hospital of Puerto Real (Cádiz-Spain). We compared frequency distribution of c-section indications in overweight and obese versus normal-weight. The risk of c-section by different indications was calculated as relative risk. A total of 4685 births were included in the study. There are significant differences in the frequency distribution of caesarean indications among normal weight and overweight or obese women. In overweight, we found an increased risk of c-section due to previous c-section (RR: 1.73; confidence interval [CI] 95% 1.24-2.42), obstructed/non-progressive labour (RR: 1.34; CI 95% 1.03-1.75), failed induction of labour (RR: 2.38; CI 95% 1.30-4.34) and foetal distress (RR: 1.73; CI 95% 1.21-2.49). This risk was even higher in obese women: previous c-section (RR: 3.25; CI 95% 2.24-4.71), obstructed/non-progressive labour (RR: 2; CI 95% 1.45-2.77), failed induction (RR: 2.52; CI 95% 1.15-5.51) and foetal distress (RR: 2.35; CI 95% 1.51-3.65). The risk of caesarean section due to previous caesarean section, obstructed/non-progressive labour, failed induction of labour or foetal distress is greater in overweight and obese than in normal-weight. This increase in risk also increases progressively as maternal BMI increases.

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

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

    2015-01-01

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

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

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

    2017-08-01

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

  12. Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study

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    Clare Newton Dunn

    2016-01-01

    Full Text Available Background and Aims: A decision-to-delivery interval (DDI of 30 min for category-one caesarean section (CS deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (′crash′ CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation DDI was 9.4 (3.2 min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9% of women had general anaesthesia (GA for category-one CS. Of those who had an epidural catheter already in situ (34.4%, 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA. Conclusions: Our ′crash′ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9% of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA.

  13. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol

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    Greene, Richard A; Corcoran, Paul; O'Neill, Sinéad M

    2017-01-01

    Introduction Caesarean section (CS) rates have increased globally during the past three decades. Surgical site infection (SSI) following CS is a common cause of morbidity with reported rates of 3–15%. SSI represents a substantial burden to the health system including increased length of hospitalisation and costs of postdischarge care. The definition of SSI varies with the postoperative follow-up period among different health systems, resulting in differences in the reporting of SSI incidence. We propose to conduct the first systematic review and meta-analysis to determine the pooled estimate for the overall incidence of SSI following CS. Methods and analysis We will perform a comprehensive search to identify all potentially relevant published studies on the incidence of SSI following CS reported from 1992 in the English language. Electronic databases including PubMed, CINAHL, EMBASE and Scopus will be searched using a detailed search strategy. Following study selection, full-text paper retrieval, data extraction and synthesis, we will appraise study quality and risk of bias and assess heterogeneity. Incidence data will be combined where feasible in a meta-analysis using Stata software and fixed-effects or random-effects models as appropriate. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethics and dissemination Ethical approval is not required as this review will use published data. The review will evaluate the overall incidence of SSI following CS and will provide the first quantitative estimate of the magnitude of SSI. It will serve as a benchmark for future studies, identify research gaps and remaining challenges, and emphasise the need for appropriate prevention and control measures for SSI post-CS. A manuscript reporting the results of the systematic review and meta-analysis will be submitted to a peer-reviewed journal and presented at scientific conferences

  14. Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study

    Science.gov (United States)

    Dunn, Clare Newton; Zhang, Qianpian; Sia, Josh Tjunrong; Assam, Pryseley Nkouibert; Tagore, Shephali; Sng, Ban Leong

    2016-01-01

    Background and Aims: A decision-to-delivery interval (DDI) of 30 min for category-one caesarean section (CS) deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (‘crash’) CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation) DDI was 9.4 (3.2) min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9%) of women had general anaesthesia (GA) for category-one CS. Of those who had an epidural catheter already in situ (34.4%), 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA). Conclusions: Our ‘crash’ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9%) of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA. PMID:27601736

  15. 改良横切口子宫下段剖宫产术在产科剖宫产中应用的效果分析%Analysis of the Application Effect of Modified Lower Uterine Segment Cae-sarean Section via Transverse Incision in Obstetric Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    戚瑞虹

    2014-01-01

    Objective To study the use value of modified lower uterine segment caesarean section via transverse incision in obstet-ric caesarean section. Methods 68 puerperants underwent cesarean section in department of obstetrics of our hospital in the recent 1 year were selected. And the 68 cases were equally divided into the control group and the experimental group with 34 cases in each. The control group was treated by traditional lower uterine segment caesarean section via abdominal transverse incision, and the experimental group was treated by modified lower uterine segment caesarean section via transverse incision. And the curative effects of the two groups were observed. Results Compared with the control group, the amount of intraoperative bleeding, duration of operation, incidence of complications of the experimental group were less, the anal exhaust time was earlier, the neonatal Apgar score was higher with statistically significant difference (P<0.05). Conclusion Modified lower uterine segment caesarean section via transverse incision applied to the obstetric cesarean section has high use value and definite curative effect, so it is worthy of clini-cal promotion.%目的:研究改良式横切口子宫下段剖宫产术用于产科剖宫产的使用价值。方法选取68例在该院产科于近1年来接受剖宫产手术的产妇,将这68例产妇平均分为对照组34例和实验组34例,将传统腹部横切口子宫下段剖宫产手术应用于对照组,将改良横切口子宫下段剖宫产术用于实验组,观察两组疗效。结果实验组在术中出血量、手术持续时间、肛门排气时间、并发症发生率较对照组要低,且新生儿Apgar评分较对照组要高,差异有统计学意义(P<0.05),具有统计意义。结论改良横切口子宫下段剖宫产术在产科剖宫产手术中的使用价值较高,疗效肯定,值得于临床推广。

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

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    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.

  17. Anaesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath spinal catheter.

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    Dresner, M; Pinder, A

    2009-04-01

    Cardiac disease in pregnancy is now the leading medical cause of maternal mortality in the UK. Whilst anaesthesia has not been the precipitant of this morbidity, its safety cannot be taken for granted. Spinal catheter anaesthesia, a relatively uncommon choice in obstetric practice, offers the potential of maintaining haemodynamic stability through accurate and gradual titration of neuraxial blockade. Thirty-four women with cardiac disease requiring caesarean section were selected for spinal catheter anaesthesia. All received invasive arterial pressure measurement but in only two were central venous catheters sited. After inserting a 24-gauge Braun Spinocath, spinal anaesthesia was induced using diamorphine 300 microg and 0.5% hyperbaric bupivacaine in 0.25-mL increments. Technical problems, block quality and haemodynamic stability were recorded. Successful anaesthesia was achieved in 33 women. Spinal catheterisation proved impossible in one case, but the catheter was successfully used to provide epidural anaesthesia. There were no conversions to general anaesthesia. Eight women (24%) received supplementation with intravenous alfentanil, but all reported high satisfaction. Mild, transient hypotension occurred in six women (18%), and there was one case of vasovagal syncope induced by rapid exteriorisation of the uterus. Three patients (8.8%) experienced post dural puncture headache requiring a blood patch; two had received repeat dural puncture during catheter insertion. Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice.

  18. Trends in caesarean section and instrumental deliveries in relation to Body Mass Index: a clinical survey during 1978 - 2001

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    Josefsson Ann

    2010-07-01

    Full Text Available Abstract Background During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women. Method The design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001. Results No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI ≥ 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (χ2 test for trend; p Conclusion Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications.

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

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    Khan, Md Nuruzzaman; Islam, M Mofizul; Shariff, Asma Ahmad; Alam, Md Mahmudul; Rahman, Md Mostafizur

    2017-01-01

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

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

    Science.gov (United States)

    Khan, Md. Nuruzzaman; Islam, M. Mofizul; Shariff, Asma Ahmad; Alam, Md. Mahmudul; Rahman, Md. Mostafizur

    2017-01-01

    Background Globally the rates of caesarean section (CS) have steadily increased in recent decades. This rise is not fully accounted for by increases in clinical factors which indicate the need for CS. We investigated the socio-demographic predictors of CS and the average annual rates of CS in Bangladesh between 2004 and 2014. Methods Data were derived from four waves of nationally representative Bangladesh Demographic and Health Survey (BDHS) conducted between 2004 and 2014. Rate of change analysis was used to calculate the average annual rate of increase in CS from 2004 to 2014, by socio-demographic categories. Multi-level logistic regression was used to identify the socio-demographic predictors of CS in a cross-sectional analysis of the 2014 BDHS data. Result CS rates increased from 3.5% in 2004 to 23% in 2014. The average annual rate of increase in CS was higher among women of advanced maternal age (≥35 years), urban areas, and relatively high socio-economic status; with higher education, and who regularly accessed antenatal services. The multi-level logistic regression model indicated that lower (≤19) and advanced maternal age (≥35), urban location, relatively high socio-economic status, higher education, birth of few children (≤2), antenatal healthcare visits, overweight or obese were the key factors associated with increased utilization of CS. Underweight was a protective factor for CS. Conclusion The use of CS has increased considerably in Bangladesh over the survey years. This rising trend and the risk of having CS vary significantly across regions and socio-economic status. Very high use of CS among women of relatively high socio-economic status and substantial urban-rural difference call for public awareness and practice guideline enforcement aimed at optimizing the use of CS. PMID:28493956

  1. Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey

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    Briand Valérie

    2012-10-01

    Full Text Available Abstract Background Two years after implementing the free-CS policy, we assessed the non-financial factors associated with caesarean section (CS in women managed by referral hospitals in Senegal and Mali. Methods We conducted a cross-sectional survey nested in a cluster trial (QUARITE trial in 41 referral hospitals in Senegal and Mali (10/01/2007–10/01/2008. Data were collected regarding women’s characteristics and on available institutional resources. Individual and institutional factors independently associated with emergency (before labour, intrapartum and elective CS were determined using a hierarchical logistic mixed model. Results Among 86 505 women, 14% delivered by intrapartum CS, 3% by emergency CS and 2% by elective CS. For intrapartum, emergency and elective CS, the main maternal risk factors were, respectively: previous CS, referral from another facility and suspected cephalopelvic-disproportion (adjusted Odds Ratios from 2.8 to 8.9; vaginal bleeding near full term, hypertensive disorders, previous CS and premature rupture of membranes (adjusted ORs from 3.9 to 10.2; previous CS (adjusted OR=19.2 [17.2-21.6]. Access to adult and neonatal intensive care, a 24-h/day anaesthetist and number of annual deliveries per hospital were independent factors that affected CS rates according to degree of urgency. The presence of obstetricians and/or medical-anaesthetists was associated with an increased risk of elective CS (adjusted ORs [95%CI] = 4.8 [2.6-8.8] to 9.4 [5.1-17.1]. Conclusions We confirm the significant effect of well-known maternal risk factors affecting the mode of delivery. Available resources at the institutional level and the degree of urgency of CS should be taken into account in analysing CS rates in this context.

  2. Placenta previa with early opening of the uterine isthmus is associated with high risk of bleeding during pregnancy, and massive haemorrhage during caesarean delivery.

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    Goto, M; Hasegawa, J; Arakaki, T; Takita, H; Oba, T; Nakamura, M; Sekizawa, A

    2016-06-01

    To demonstrate the relationship between the timing of opening of the uterine isthmus and bleeding during pregnancy and caesarean section in patients with placenta previa. A prospective observational study was conducted at a single perinatal centre. All patients with placenta previa, diagnosed between 20 and 22 weeks of gestation, who were followed up at the study hospital and underwent caesarean section were enrolled. The condition of the uterine isthmus was examined every 2 weeks. The timing (in gestational weeks) of complete opening of the uterine isthmus was determined. Patients were divided into two groups: patients in whom the uterine isthmus opened before 25 weeks of gestation (EO-previa), and patients in whom the uterine isthmus opened after 25 weeks of gestation (LO-previa). The frequency of bleeding during pregnancy and the amount of intra-operative bleeding were compared between the two groups. Forty-four cases of EO-previa and 55 cases of LO-previa were analysed. Complete placenta previa at delivery was observed more frequently in the EO-previa group than in the LO-previa group (88.6% vs 47.3%, pprevia group (48%) than in the LO-previa group (25%) (p=0.021). The frequency of massive haemorrage (>2500ml) during caesarean section was higher in the EO-previa group than in the LO-previa group (25% vs 9%, p=0.033). Placenta previa was associated with a high risk of bleeding leading to emergency caesarean section during pregnancy, and massive haemorrhage during caesarean section in patients in whom the uterine isthmus opened before 25 weeks of gestation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2017-04-13

    Pregnancy induced anatomical and physiological changes in the airway makes airway management difficult in obstetric patients, thus the preoperative evaluation of the airway is important for obstetric patients. The first aim was determine the effectiveness of the modified mallampati test, the interincisor, sternomental, thyromental distances, the upper limb bite tests and the second aim was to access the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Cross-sectional study. Two hundred and fifty pregnant women scheluded for caesarean section were analyzed. Age, height and weight of the patients were all collected. Preoperative airway evaluation was done by using modified mallampati test. The interincisor, sternomental and thyromental distances and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by Results:No statistically significant difference was found between age, height and weight (p>0.05). The modified mallampati test, interincisor, sternomental, and thyromental distances revealed a lower number than the number of easy intubations determined by the Cormack-Lehane classification and a higher number than the case number of difficult intubations (pthyromental distance tests were found as 73.08, 57.69, 84.62, 80.77, 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05. When the combinations were examined, the sensitivity and the specificity of the combination of the upper limb bite test with the modified mallampati test were found as 57.69 and 100. When the upper limb bite test was combined with the the interincisor distance, the sensitivity and the specificity were detected as 46.15 and 100. We found 93.75 and 95.30 values as the sensitivity and specificity of the combination of the upper limb bite test with the thyromental distance test. The sensitivity and the specificity of the combination of upper limb bite test with the modified mallampati test and interincisor distance test

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

    Science.gov (United States)

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

    2002-04-20

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

  5. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing

    Science.gov (United States)

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

    2017-01-01

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

  6. Are caesarean sections, induced labor and oxytocin regulation linked to Autism Spectrum Disorders?

    Science.gov (United States)

    Gialloreti, Leonardo Emberti; Benvenuto, Arianna; Benassi, Francesca; Curatolo, Paolo

    2014-06-01

    The etiology of Autism Spectrum Disorders (ASDs) continues to be elusive. While ASDs have been shown to be heritable, several environmental co-factors, such as, e.g. pre- or perinatal adverse events, could play a role in the pathogenesis of the disorder as well. Prevalence of ASDs appears to have increased in the last three decades, but the causes of this surge are not fully understood. As perinatal adverse events have increased as well, they have been regarded as logical contributors to the risen prevalence of ASDs. Over the last three decades there has been also a considerable increase in the rates of induced labor and caesarean sections (CS). However, even if a causal association between CS and ASDs increase has been suggested, it has not yet been proven. Nevertheless, we hypothesize here that such an association is actual and that it might help to explain a part of the increase in ASD diagnoses. Our assumption is based on the wider epidemiological picture of ASDs and CS, as well as on the possible biological plausibility of this correlation, by postulating potential epigenetic and neurobiological mechanisms underpinning this relationship. Today, several observations point toward the existence of epigenetic dysregulation in ASDs and this raises the issue of the role of environmental factors in bringing about epigenetic modifications. Epigenetic dysregulations in some brain neuropeptide systems could play a role in the behavioral dysfunctions of ASDs. Particularly, some evidence suggests a dysregulation of the oxytocinergic system in autistic brains. Perinatal alterations of oxytocin (OT) can also have life-long lasting effects on the development of social behaviors. Within the perinatal period, various processes, like pitocin infusion or CS, can alter the OT balance in the newborn; OT dysregulation could then interact with genetic factors, leading ultimately to the development of ASDs. Large long-term prospective studies are needed to identify causal pathways

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

    Science.gov (United States)

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

    2017-09-22

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

  8. Anesthetic management of caesarean section in a patient with double outlet right ventricle

    OpenAIRE

    Rohith Krishna; Umesh Goneppanavar

    2012-01-01

    Double outlet right ventricle (DORV) is a rare congenital heart defect involving the great arteries. In DORV, both aorta and pulmonary artery arise from the right ventricle resulting in admixture of blood. We report a 22-year-old parturient with DORV and severe pulmonary stenosis who underwent caesarean delivery at 36 weeks gestation with low dose combined spinal-epidural anesthesia. This lady was assessed by echocardiogram to have situs inversus, dextrocardia, severe pulmonary artery stenosi...

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

    Directory of Open Access Journals (Sweden)

    Manoj K Sanwal

    2012-01-01

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

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

    Science.gov (United States)

    Valente, A.; Frassanito, L.; Natale, L.; Draisci, G.

    2012-01-01

    Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications. PMID:22844625

  11. Successful use of a Bakri Tamponade Balloon in the treatment of puerperal uterine inversion during caesarean section.

    Science.gov (United States)

    Vivanti, A J; Furet, E; Nizard, J

    2016-04-23

    Acute puerperal inversion of the uterus is a rare life-threatening obstetric emergency, especially during caesarean section. We present the case of a 30-year-old patient with acute puerperal inversion of the uterus that occurred during placental removal. After a quick reversion of the uterus, an immediate postpartum haemorrhage (PPH) due to massive uterine atony was observed. This atony impacted the whole uterus, with a very thin uterine myometrium. The use of a Bakri Tamponade Balloon use allowed treating extreme uterine atony, immediately stop haemorrhage, and prevent a possible risk of immediate recurrence.

  12. Anesthesia Management of an Emergent Caesarean Section Case with the History of Central Core Myopathy: Case Report

    Directory of Open Access Journals (Sweden)

    Cagla Bali

    2013-08-01

    Full Text Available Central core myopatyhy is a rarely seen hereditary neuromuscular disorder that is involved in congenitally myopathies group. The disease is characterized by muscular weakness, skeleton system deformities, increased malign hyperthermia sensitivity and anesthesia management is critically important. In these patients, prolonged muscular weakness and malign hyperthermia that can complicate the perioperative management are the most critical risks. In this case report, anesthesia management of an electively planned caesarean section patient, taken into emergency surgery that is also previously known to have central core myopathy diagnosis will be shared. [Cukurova Med J 2013; 38(4.000: 770-773

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

    Directory of Open Access Journals (Sweden)

    A. Valente

    2012-01-01

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

  14. A quality improvement tool - driver diagram: a model of driver diagram to reduce primary caesarean section rates

    Directory of Open Access Journals (Sweden)

    Naima Fathima

    2016-05-01

    Results: Various quality improvement tools can be used in the clinical context. Among them, driver diagram is most widely used at the start of an improvement initiative. The driver diagram in this article shows its applicability in one of the clinical aspects of obstetrics, to reduce primary caesarean section rates. Conclusions: Driver diagram is an easy and a simple tool widely used in quality improvement activities. It is essential to use at the beginning of improvement initiatives. [Int J Res Med Sci 2016; 4(5.000: 1339-1342

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

    Science.gov (United States)

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

    2012-04-01

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

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

    Science.gov (United States)

    Chaboyer, Wendy; Anderson, Vinah; Webster, Joan; Sneddon, Anne; Thalib, Lukman; Gillespie, Brigid M

    2014-09-30

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

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

    Directory of Open Access Journals (Sweden)

    Wendy Chaboyer

    2014-09-01

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

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Bernardo L Horta

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

  20. 关于择期剖宫产与急诊剖宫产的临床特征的对比研究%Comparison of Clinical Features between Elective Caesarean Section and E-mergency Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    危秀蓉; 杨成芬; 张久娣

    2015-01-01

    目的:回顾性分析择期剖宫产与急诊剖宫产的临床资料,解析急诊剖宫产的危险性。方法收集2010年1月-2014年1月在该院剖宫产的产妇资料共2135例,按开始手术与分娩发动和破膜的关系分为择期剖宫产与急诊剖宫产两组,其中择期剖宫产642例为A组,急诊剖宫产1493例为B组,进行回顾性分析。结果A组、B组手术时间分别为(45.2±15.1)min、(60.7±13.5)min;A组、B组手术中出血量分别为(305.1±107.4)mL、(425.4±218.2)mL;A组、B组术后肛门排气时间分别为(23.5±10.2)h、(29.0±13.6)h;以上数据两组相比差异有统计学意义(P<0.05)。 A组、B组取头困难率分别为6.72%、10.41%;A组、B组子宫切口撕裂率分别为1.68%、5.15%;A组、B组新生儿窒息率分别为2.45%、6.73%;A组、B组术后早期切口感染率分别为3.90%、7.61%;A组、B组术后发热率分别为30.17%、41.31%,以上数据两组相比差异有统计学意义(P<0.01)。结论急诊剖宫产比择期剖宫产具有更高的安全隐患和手术风险,在降低手术风险的同时也应尽量减少急诊剖宫产。%Objective To retrospectively analyze the the clinical data of elective caesarean section and emergency caesarean sec-tion, and the danger of emergency caesarean section. Methods 2135 cases in our hospital From January 2010 to January 2014 , according to the relation between the start operation and the onset of labor and rupture of membranes, were divided into elective caesarean section group (Group A,n=642) and emergency caesarean section (Group B, n=1493). The data of all the patients were retrospectively analyzed. Results Group A, group B, operation time were (45.2±15.1)min, (60.7±13.5)min;A group, B group, amount of bleeding during operation were (305.1±107.4)mL, (425.4±218.2)mL; Anal exhaust time of A group, B group after op-eration were (23.5±10.2)h, (29.0±13.6)h;there was statistical

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  2. 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

  3. A COMPARATIVE STUDY OF ANALGESIC EFFICACY OF INTRATHECAL CLONIDINE WITH BUPIVACAINE & BUPIVACAINE ALONE IN ELECTIVE CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Chethanananda

    2014-03-01

    Full Text Available : Spinal anaesthesia in caesarean section has many advantages in that it is simpler to perform, provides a more certain endpoint& has a higher degree of success than epidural anaesthesia as it provides more profound block than epidural anaesthesia. As the dose of local anaesthetics used with spinal anaesthesia is small, there is little chance of maternal toxicity & placental transfer of drugs. Bupivacaine 0.5% is the most popular drug used for spinal anaesthesia in caesarean section. Many adjuvant drugs are added intrathecally along with Bupivacaine to increase the duration and intensity of analgesia. Intrathecal Clonidine (an α2 agonist is being extensively evaluated as an alternative to neuraxial opioid along with local anaesthetic agents. We evaluated the efficacy of clonidine added to 0.5% bupivacaine in prolonging the analgesia produced by intrathecal bupivacaine in parturients undergoing elective lower segment caesarean section (LSCS. 60 parturients between 20-30 years of age weighing 50-70 Kgs belonging to ASA (American Society of Anaesthesiologists grading I & II were prospectively randomised to two groups. 30 parturients of Group B (control group received 2.0 ml of 0.5% hyperbaric bupivacaine intrathecally alone and 30 parturients of Group BC received 1.75 ml of 0.5% hyperbaric bupivacaine +0.25 ml (37.5mcg of preservative free clonidine. The time taken for onset of sensory and motor blockade duration of postoperative analgesia and the duration of motor blockade were noted. The mean time of onset of sensory blockade in Group B was 57.16±9.9 seconds and Group BC was 62.8±6.80 seconds (p < 0.05. The meantime taken for onset motor block was 66.00±5.15 seconds in Group B and 81.33±8.89 seconds in Group BC (p = 0.000 with the grade of motor blockade was similar in both groups. The mean duration of analgesia was 152.77±11.79 minutes in B group and 288.16±16.73 in BC group (p = 0.000. The mean duration of motor blockade was 93.33±8

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

    Science.gov (United States)

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

    2014-05-01

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

  5. EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION: A RANDOMIZED CASE CONTROL PROSPECTIVE STUDY

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    Tullika

    2014-03-01

    Full Text Available : INTRODUCTION: To reduce maternal mortality and morbidity caused by bleeding, it is important to reduce the amount of bleeding during and after lower segment caesarean section (LSCS. Tranexamic acid helps to reduce bleeding during and after LSCS. OBJECTIVES: To study the efficacy and safety of Tranexamic acid in reducing blood loss during and after Lower segment Caesarean Section (LSCS. METHODS: A randomized case controlled prospective study was conducted on 200 women undergoing lower segment cesarean section. Hundreds of them that were given tranexamic acid immediately before LSCS were compared to hundred others to whom tranexamic acid was not given. Blood loss was collected and measured during the two periods, from plancental delivery to end of LSCS and second from end of LSCS to two hours postpartum. RESULTS: Tranexamic acid significantly reduced the quantity of blood loss from placental delivery to end of LSCS, 202.25ml in the study group vs392.20 ml in the control group (p<0.001; from the end of LSCS, to 2 hours postpartum 3.80ml in the study group versus 112.25ml in the control group (p<0.001; In totality, it significantly reduced the quantity of blood loss from placental delivery to two hours postpartum i.e. 27.05ml in the study group versus 510.45ml in the control group (p < 0.001. No complications or side effects were noted. CONCLUSION: Tranexamic acid significantly reduced the amount of blood loss during and after LSCS. Tranexamic acid can be used prophylactically; moreover it is safer and effective in women undergoing LSCS.

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

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

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

    Science.gov (United States)

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

    2017-07-21

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

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

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    Oneko Olola

    2011-07-01

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

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

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    Udita Naithani

    2011-01-01

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

  11. A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section

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    Sabyasachi Das

    2011-01-01

    Full Text Available Introduction: This randomized double blind study was started with an objective of management of spinal anaesthesia-induced hypotension in elective caesarean section by combining two commonly used vasopressors - ephedrine and phenylephrine in half of their usual doses with an expectation of reducing their foetomaternal side effects. Methods: One hundred and thirty two patients were randomized into three groups to receive either 100 mg/ml phenylephrine (group-P, n=31 or 3 mg/ml ephedrine (group-E, n=33 or 50 mg phenylephrine plus 1.5 mg ephedrine/ml (group-PE, n=29. Immediately after spinal injection the study solution was started prophylactically in every patient at the rate of 40 ml/h. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP. Results: Mean fall of SBP was significantly more in group-E than group-P (P=0.009 and group-PE (P=0.013. This was not significantly different when compared between group-P and group-PE (P=0.9. Episodes of hypotension and tachycardia were more in group-E than the other two groups. Statistically significant tachycardia was seen in Group-E than that in other two groups. Incidence of bradycardia and hypertension did not differ significantly among the groups. Maternal nausea and Apgar score were also comparable in three groups. Conclusion: Current study claims that prophylactic phenylephrine 100 mg/ml is a better choice than ephedrine (3 mg/ml or 50 mcg phenylephrine plus 1.5 mg ephedrine/ml in prevention of spinal anaesthesia-induced hypotension in elective caesarean section. Combination of two drugs in half the usual dose has no added advantage over phenylephrine, but this is better than ephedrine alone.

  12. Transcutaneous carbon dioxide levels and oxygen saturation following caesarean section performed under spinal anaesthesia with intrathecal opioids.

    Science.gov (United States)

    Dalchow, S; Lubeigt, O; Peters, G; Harvey, A; Duggan, T; Binning, A

    2013-07-01

    Intrathecal opioids can be associated with respiratory depression which may have serious consequences. We describe the use of a non-invasive monitor (TOSCA) to measure transcutaneous carbon dioxide levels and percentage of haemoglobin oxygen saturation in post-caesarean section patients in two hospitals which used different intrathecal opioids. Eighty-nine women undergoing caesarean section were monitored postoperatively until 08.00h on the first postoperative day. In addition to hyperbaric bupivacaine, patients from Hospital 1 received intrathecal diamorphine 300μg: those from Hospital 2 received intrathecal fentanyl 15μg and postoperative intramuscular morphine 10mg and were given morphine patient-controlled analgesia. Data from TOSCA were analysed the following day. Respiratory depression was defined as oxygen saturations carbon dioxide levels >7kPa for >2min or the need for medical intervention for clinical respiratory depression. Sustained hypercapnia was recorded in 8/45 (17.8%) patients from Hospital 1 and 3/44 (6.8%) from Hospital 2. Sustained oxygen saturations <90% were recorded in one patient from Hospital 2 and none from Hospital 1. The overall incidence of respiratory depression was 17.8% in Hospital 1 and 9.1% in Hospital 2. The median duration of hypercapnia was 9min [IQR 5.8-12.4] in Hospital 1 and 11.5min [IQR 7-32.8] in Hospital 2. No patient required medical intervention. The incidence of opioid-induced respiratory depression detected by TOSCA is higher than previously reported by other monitoring methods. TOSCA may have a role in detecting subclinical respiratory depression in the obstetric population. Further studies with a control population are needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

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    Ashem Jack Meitei

    2016-12-01

    Conclusions: Addition of dexmedetomidine to spinal bupivacaine block in caesarean section increase the duration of analgesia and motor block with minimal side effect and no adverse effects on the babies. [Int J Basic Clin Pharmacol 2016; 5(6.000: 2675-2682

  14. Carbetocin in comparison with oxytocin in several dosing regimens for the prevention of uterine atony after elective caesarean section in the Netherlands

    NARCIS (Netherlands)

    Holleboom, C. A. G.; van Eyck, J.; Koenen, S. V.; Kreuwel, I. A. M.; Bergwerff, F.; Creutzberg, E. C.; Bruinse, H. W.

    2013-01-01

    Purpose The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication. Methods Eac

  15. Carbetocin in comparison with oxytocin in several dosing regimens for the prevention of uterine atony after elective caesarean section in the Netherlands

    NARCIS (Netherlands)

    Holleboom, C. A. G.; van Eyck, J.; Koenen, S. V.; Kreuwel, I. A. M.; Bergwerff, F.; Creutzberg, E. C.; Bruinse, H. W.

    2013-01-01

    Purpose The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication. Methods Eac

  16. Pentazocine Alone Versus Pentazocine Plus Diclofenac for Pain Relief in the First 24 Hours after Caesarean Section: A Randomized Controlled Study.

    Science.gov (United States)

    Egede, John Okafor; Ajah, Leonard Ogbonna; Umeora, Odidika Ugochukwu; Ozumba, Benjamin Chukwuma; Onoh, Robinson Chukwudi; Obuna, Johnson Akuma; Ekem, Napoleon

    2017-04-01

    Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05). The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.

  17. Anesthetic management of caesarean section in a patient with double outlet right ventricle

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    Rohith Krishna

    2012-01-01

    Full Text Available Double outlet right ventricle (DORV is a rare congenital heart defect involving the great arteries. In DORV, both aorta and pulmonary artery arise from the right ventricle resulting in admixture of blood. We report a 22-year-old parturient with DORV and severe pulmonary stenosis who underwent caesarean delivery at 36 weeks gestation with low dose combined spinal-epidural anesthesia. This lady was assessed by echocardiogram to have situs inversus, dextrocardia, severe pulmonary artery stenosis (gradient = 146 mm Hg, DORV with subarterial VSD (1 cm. She had 95% room air saturation and her blood investigations were within normal limits. We established a peripheral venous access and radial arterial line for continuous blood pressure monitoring. Combined spinal epidural anesthesia was considered a better option. Epidural catheter was secured at L 2 -L 3 space and fixed after giving test dose 3 mL 2% lignocaine. Subarachnoid block administered at L 3 -L 4 level using 1.2 mL of 0.5% heavy bupivacaine. A sensory block of T 10 was obtained which was supplemented with 4 mL 0.75% ropivacaine to obtain a level of T 6 . Patient tolerated the procedure well. She was shifted to post-operative ICU. Post-operative pain was managed with epidural 0.2% ropivacaine at 4 mL/h. Patient remained hemodynamically stable throughout the procedure and in the postoperative period while she was being followed up for subsequent 48 h.

  18. Spinal anaesthesia for caesarean section in pregnant women with fetal distress: time for reappraisal.

    Science.gov (United States)

    Afolayan, J M; Olajumoke, T O; Esangbedo, S E; Edomwonyi, N P

    2014-06-01

    Residents' competency-based training and multidisciplinary cooperation are needed for rapid sequence spinal anaesthesia for fetal distress. Multiple standard but 'crash' spinal anaesthesia for non-obstetric procedures is imperative for acquisition of experienced hands. The purpose of this review is to share our modest experiences in the use of rapid spinal anaesthesia for emergency Caesarean delivery in pregnant women complicated with fetal distress. Fetal distress diagnosis is made promtly, intravenous line put in place in labour ward. Pre-loading or not, one-touch, non-touch spinal technique prevents unnecessary delay and further fetal hypoxic injury. Spinal pack is on stand by in the operating room at all time. Preloading is possible during the waiting period for other care providers otherwise coloading is used. A single wipe of the back with chlorhexidine lotion is frequently used for scrubbing. Lidocaine infiltration or spay is essential and does not waste time but opioid as adjuvant to bupivacaine wastes a lot of time to constitute and measure. So, opioid should be avoided. Average of 2.5 ml of 0.5% hyperbaric bupivacaine is frequently used in our centres. Surgery starts almost immediately after cleaning and drapping of the patient by the obstetrician. Ephedrine is made handy and constituted in case there is hypotension which fluid alone cannot treat.

  19. The Effect of Musical Therapy on Postoperative Pain after Caesarean Section

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    Ali Sizlan

    2009-04-01

    Full Text Available AIM: We reasoned that addition of musicotherapy -a simple and convenient method with no adverse effects- in the preoperative period would have favorable effects pertaining to postoperative pain. METHODS: One hundred patients, between the ages of 20-40 years, who were undergoing elective caesarean delivery under general anaesthesia, were enrolled. The patients were randomly allocated into two groups (with 50 patients in each and in group 1, patients listened to music through a headphone for one hour immediately before surgery whereas in group 2, patients did not listen to any music during the same period. The anaesthetic technique was standardized. All neonates were also assessed and Apgar scores were recorded. In the postanaesthesia care unit, patients were connected to i.v.-PCA device when they were able to respond to commands. The patient’s level of satisfaction with perioperative care was assessed by a 10-cm visual analogue scale and the severity of postoperative pain was assessed with VAS. RESULTS: Postoperative tramadol consumption, total amount of tramadol consumption, additional analgesic use and all VAS values were lower in group 1 (p<0.05. Apgar scores were significantly greater in group 1. CONCLUSION: We imply that music therapy given before surgery decreases postoperative pain and analgesic requirement. [TAF Prev Med Bull 2009; 8(2.000: 107-112

  20. Outcome in women with previous caesarean section in a secondary care hospital in rural South India

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    Anuradha Dhanasekaran

    2016-10-01

    Conclusions: The VBAC rate in the study is 30.5% in carefully selected patients for trial of scar with the existing litigation pressure. TOLAC can be judiciously implemented in carefully chosen patients even in rural health setting equipped with required facilities. Patient's participation in the decision making has brought down the VBAC rate which is reflected by the increased repeat elective cesarean section done at patients' request (54.9%. Factors such as prior vaginal delivery, favorability of the cervix, indication of previous cesarean section, onset of labour and birth weight are highly significant in deciding the success of VBAC and can be used to improve VBAC rates in practice. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3532-3536

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

    Science.gov (United States)

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

    2017-01-01

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

  2. Changes in qualitative and quantitative ultrasound assessment of the gastric antrum before and after elective caesarean section in term pregnant women: a prospective cohort study.

    Science.gov (United States)

    Rouget, C; Chassard, D; Bonnard, C; Pop, M; Desgranges, F P; Bouvet, L

    2016-11-01

    Ultrasound measurement of the antral cross-sectional area allows a quantitative estimate of gastric contents in non-pregnant adults, but this relationship may be affected by compression of the stomach exerted by the gravid uterus during pregnancy. This study aimed to assess differences in quantitative (Perlas score) and qualitative (antral cross-sectional area) ultrasound assessments of the gastric antrum performed immediately before and after caesarean section. Forty-three women having elective caesarean section performed under spinal anaesthesia were studied in the semirecumbent and semirecumbent-right lateral positions. Thirty-nine women showed no change in stomach contents using the Perlas score between the two measurement periods; four women showed a change, but by one grade only. The median (IQR [range]) antral cross-sectional area was 323 (243-495 [103-908]) mm(2) before, and 237 (165-377 [112-762]) mm(2) after, caesarean section in the semirecumbent position (p = 0.001); the comparable values in the semirecumbent-right lateral position were 418 (310-640 [161-1238]) mm(2) and 362 (280-491 [137-1231]) mm(2) (p = 0.09). The distance between the skin and the antrum, and the aorta and the antrum, decreased significantly in both positions after surgery. We suggest that our results indicate that stomach contents remain largely unchanged in women having elective caesarean section, but antral cross-sectional area decreases, especially in the semirecumbent position, related to a change in the position of the stomach within the abdomen. This implies that the relationship of antral cross-sectional area to volume of stomach contents, which has been determined for non-pregnant subjects, may not apply in term pregnant women. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

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

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    Hazel Gonsalves

    2016-11-01

    Full Text Available Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results: Most women were 25–35 years old (76.5% and 20 women had had one previous vaginal delivery (29.4%. The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%. Most women delivered after 40 gestational weeks (48.5% and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%, although a few had vaginal bleeding (5.9%, intrapartum fever (4.4%, rupture of the membranes (2.9% and cord prolapse shortly after insertion of the Foley catheter (1.5%. However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%. Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.

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

    Science.gov (United States)

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

    2017-08-04

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

  5. Does caesarean section negatively influence the post-partum prognosis of low back pain and pelvic pain during pregnancy?

    Science.gov (United States)

    Mogren, Ingrid M

    2007-01-01

    Low back and pelvic pain (LBPP) is prevalent during pregnancy and also post-partum. The aetiology is poorly understood. The aim of this study was to investigate possible associations between epidural or spinal anaesthesia and caesarean section (CS) with persistent LBPP half a year after pregnancy. In a previous questionnaire study (n=891) altogether 639 (72%) women had reported LBPP during pregnancy. We sent these respondents a second questionnaire at approximately 6 months post-delivery. The response rate was 72.6% (n=464). The respondents were divided into three groups reporting 'no pain', 'recurrent pain' and 'continuous pain' in relation to LBPP 6 months after delivery. Pearson's chi-square test was used to test the difference between groups and logistic regression analysis was performed. Forty percent of the respondents had received epidural anaesthesia (EDA) or spinal anaesthesia during delivery and 18.5% of women had been delivered by CS. Epidural or spinal anaesthesia was not associated with persistent LBPP. There was no significant difference in CS rates between different sub-groups. The risk of persistent LBPP was increased three- to fourfold in women delivered by elective CS compared with women delivered by emergency CS. Epidural or spinal anaesthesia was not associated with risk of persistent LBPP. Elective CS was associated with an increased risk of persistent LBPP. However, the results must be interpreted with caution because of a relatively small study sample.

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

    Science.gov (United States)

    Tanaka, Keisuke

    2017-01-01

    Caesarean section (CS) rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates. 2625 women who birthed over a 12-month period were analysed using this classification. Women with previous CS (group 5) comprised 10.9% of the overall 23.5% CS rate. Women with one previous CS who did not attempt VBAC contributed 5.3% of the overall 23.5% CS rate. Second largest contributor was singleton nulliparous women with cephalic presentation at term (5.1% of the total 23.5%). Induction of labour was associated with higher CS rate (groups 1 and 3) (24.5% versus 11.9% and 6.2% versus 2.6%, resp.). For postdates IOL we recommend a gatekeeper booking system to minimise these being performed <41 weeks. We suggest setting up dedicated VBAC clinic to support for women with one previous CS. Furthermore review of definition of failure to progress in labour not only may lower CS rates in groups 1 and 2a but also would reduce the size of group 5 in the future. PMID:28167965

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

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    Keisuke Tanaka

    2017-01-01

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

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

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    Siti Zubaidah Ab Wahab

    2015-01-01

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

  9. Anaesthesia management of caesarean section in a patient with severe factor XI deficiency

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    Debesh Bhoi

    2013-01-01

    Full Text Available Factor XI deficiency is a rare coagulation disorder associated with bleeding tendency and prolonged APTT. Parturients can have increased bleeding during vaginal delivery or cesarean section. Patients with severe factor XI deficiency should receive prophylactic fresh frozen plasma or factor XI transfusion in the peripartum period to maintain a near normal APTT. Limited evidence based on case reports and series is inconclusive as to the choice of anesthesia technique for cesarean section. We describe the anesthesia management of a parturient with severe factor XI deficiency for cesarean section and discuss the relevant literature.

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

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    Somashekharappa Basavanneppa Kadur

    2016-12-01

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

  11. 护理干预对基层医院剖宫产率的影响%Influence of nursing intervention on caesarean section rate in grassroots hospitals

    Institute of Scientific and Technical Information of China (English)

    张小绸; 钟小洁; 陈娇娇; 黄晓秋; 张小央

    2009-01-01

    Objective To observe the effect of nursing intervention on caesarean section rate in grass-roots hospitals. Methods 240 parturient women who were to infanticipate were divided into the experimental group and the control group with 120 patients in each group according to hospitalization sequence. Parturient women in the experimental group received nursing intervention with new nursing model during the delivery, while women in the control group just finished parturition using routine procedures. The caesarean section rate of the two groups were compared with χ2 test. Results The caesarean section rate of parturient women in the experimental group was significantly lower than that in the control group. Conclusions Nursing inter-vention has certain effect on decreasing the caesarean section rate in grassroots hospitals.%目的 观察护理干预对基层医院剖宫产率的影响.方法 选择240例待分娩产妇,按住院顺序随机分成实验组和对照组各120例.实验组产妇在整个分娩过程中,采用护理新模式给予护理干预.对照组产妇只按常规程序分娩.比较2组产妇的剖官产率,进行χ2检验.结果 实验组产妇剖官产率明显低于对照组.结论 护理干预对降低基层医院剖宫产率有一定的影响.

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

    NARCIS (Netherlands)

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

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

  13. Court-ordered caesareans.

    Science.gov (United States)

    Prochaska, Elizabeth; Lomri, Sara

    2014-11-01

    Court-ordered caesarean sections are in the news after a number of recent legal decisions authorising surgery for women who lack mental capacity to consent. The decisions have not always been based on good evidence and they raise serious concerns about the protection of the rights of mentally ill women. The authors explain the legal process and question the wisdom of recent judgements.

  14. Analysis of the current status and related factors of caesarean section in Zhangjiagang%张家港市剖宫产现状与相关因素分析

    Institute of Scientific and Technical Information of China (English)

    查建梅; 褚光萍

    2014-01-01

    Objective To analyze the current status and influencing factors of caesarean section in Zhangjiagang and to provide evidence for controlling caesarean section .Methods Retrospective study was conducted to understand the situation of caesarean section and the changes of caesarean section indications in Zhangjiagang from 2008 to 2012 with the monitoring data of delivery in maternal and child health annual report and questionnaires allocated randomly to pregnant women and medical staff .Results The rate of caesarean section in Zhangjiagang was always high, however, the high rate of caesarean section did not reduce prenatal mortality rate (r=0.500, P>0.05).The first 6 indications for cesarean section were social factors , scar uterus , intrauterine fetal distress , cephalopelvic disproportion , premature rupture of fetal membranes and umbilical cord around neck .Of all these factors , social factors came first .Survey among pregnant women showed significant differences between women with different delivery modes in the aspect of cognition on benefit of vaginal delivery (χ2 =15.225, P<0.01), support of family members on vaginal delivery (χ2 =73.569, P<0.01), mastering of nutrition knowledge during pregnancy (χ2 =11.367,P<0.05) and participating in natural delivery course (χ2 =13.300,P<0.01).Survey among medical staff showed that little understanding of long-term harm of caesarean section and social factors resulted in high rate of caesarean section .Conclusion The rate of caesarean section in Zhangjiagang has been at a relative high level .We should put more emphasis on health education among pregnant women, improving professional quality of medical staff and seeking for governmental support and social participation to reduce the rate of caesarean section so as to protect maternal and infant health .%目的:分析张家港市剖宫产现状及其影响因素,提出相关控制措施。方法采用张家港市2008至2012年的妇幼卫生年报分娩情况监测

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

    Science.gov (United States)

    Vandervaart, Sondra; Berger, Howard; Tam, Carolyn; Goh, Y Ingrid; Gijsen, Violette M G J; de Wildt, Saskia N; Taddio, Anna; Koren, Gideon

    2011-02-26

    Approximately 25% of all babies in North America are delivered via Caesarean section (C-section). Though a common surgical procedure, C-section recovery can be painful. Opioids, specifically codeine, are commonly used to ease pain; however, its active metabolite, morphine, passes into breast milk, and may produce unwanted side effects in neonates; therefore, alternatives to opioids are being sought. Reiki is an ancient Japanese form of healing where practitioners transfer healing energy through light touch and positive healing intention. Although 1.2 million Americans use reiki to reduce pain or depression, there is a lack of strong evidence supporting its effectiveness. A recent systematic review showed existing studies to be of poor methodological quality, with the common limitation of lack of blinding. To overcome this issue, the authors used distant reiki to assess its effectiveness in reducing pain following an elective C-section. In this randomised, double-blinded study, women who underwent an elective C-section were allocated to either usual care (control, n=40) or three distant reiki sessions in addition to usual care (n=40). Pain was assessed using a visual analogue scale (VAS). The primary endpoint was the Area Under the VAS-Time Curve (AUC) for days 1-3. Secondary measures included: the proportion of women who required opioid medications and dose consumed, rate of healing and vital signs. AUC for pain was not significantly different in the distant reiki and control groups (mean ± SD; 212.1 ± 104.7 vs 223.1 ± 117.8; p=0.96). There were no significant differences in opioid consumption or rate of healing; however, the distant reiki group had a significantly lower heart rate (74.3 ± 8.1 bpm vs 79.8 ± 7.9 bpm, p=0.003) and blood pressure (106.4 ± 9.7 mmHg vs 111.9 ± 11.0 mmHg, p=0.02) post surgery. Distant reiki had no significant effect on pain following an elective C-section. Clinical Trial Registration Number ISRCTN79265996.

  16. A Case of Type 2 Youssef's Syndrome following Caesarean Section for Placenta Previa Totalis

    Science.gov (United States)

    Obuz, Funda

    2016-01-01

    Vesicouterine fistula is a rare type of urogenital fistulas. It is most commonly observed after cesarean section (C/S) due to iatrogenic reasons. In this article, a case of a vesicouterine fistula which developed after C/S operation is presented. This was the patient's second C/S and this time placenta previa totalis was the primary pathology. Since it is a rare complication, we found it interesting, and, in this article, this clinical problem was discussed with details about diagnosis and treatment in light of the literature. PMID:27803827

  17. A Case of Pneumococcal Peritonitis after Caesarean Section in a Healthy Woman

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    Georgios Kourounis

    2015-01-01

    Full Text Available Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults.

  18. Understanding the factors associated with differences in caesarean section rates at hospital level: the case of Latin America.

    Science.gov (United States)

    Taljaard, Monica; Donner, Allan; Villar, José; Wojdyla, Daniel; Faundes, Anibal; Zavaleta, Nelly; Acosta, Arnaldo

    2009-11-01

    As in many other regions of the world, caesarean section (CS) rates in Latin America are increasing. Studies elsewhere have shown that providing feedback to caregivers regarding their own performance relative to their peers can significantly reduce the rates. Our objectives are to calculate risk-adjusted CS rates for hospitals in Latin America and to identify factors associated with differences among risk-adjusted rates. We included 120 randomly selected institutions in eight countries of Latin America, representing 97 095 pregnancies. We used random-effects models to calculate a risk-adjusted rate for each hospital and to identify hospitals significantly higher or lower than a benchmark rate. We conducted a regression analysis to identify characteristics of hospitals associated with differences among risk-adjusted rates. The overall CS rate was 35%, ranging from 0% to 85%. Risk-adjusted CS rates ranged from 11% to 78%. Three-quarters of hospitals had risk-adjusted rates significantly above the previously identified benchmark of 20%. Characteristics of institutions explained 48% of the variability among risk-adjusted rates, including being a private as opposed to a public institution, having some economic incentive for CS as opposed to no incentive, and having > or = 50 maternity beds. Strategies to halt further increases in CS rates and reduce rates to levels that reflect the best quality of care, are urgently needed worldwide. The involvement of local quality control departments is an essential component in achieving success. Our results can be used to identify institutions that can be targets for further interventions to reduce CS rates.

  19. Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study

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    Prachee Sachan

    2014-01-01

    Full Text Available Background and Aims: Mixing adjuvants with hyperbaric bupivacaine in a single syringe before injecting the drugs intrathecally is an age old practice. In doing so, the density of the hyperbaric solution and also of the adjuvant drugs may be altered, thus affecting the spread of drugs. Administering local anaesthetic and the adjuvants separately may minimise the effect of the changes in densities. We aimed to compare block characteristics, intraoperative haemodynamics and post-operative pain relief in parturients undergoing caesarean section (CS after administering hyperbaric bupivacaine and clonidine intrathecally as a mixture and sequentially. Methods: In this single-blind prospective randomised controlled study at a tertiary care centre from 2010 to 12, 60 full-term parturients scheduled for elective CSs were divided into two groups on the basis of technique of intrathecal drug administration. Group M received mixture of clonidine (75 mcg and hyperbaric bupivacaine 0.5% (10 mg intrathecally, whereas Group B received clonidine (75 mcg followed by hyperbaric bupivacaine 0.5% (10 mg through separate syringes. Observational descriptive statistics, analysis of variance test, Wilcoxon test and Chi-square test were used as applicable. Results: Duration of analgesia was significantly longer in Group B (474.33 ± 20.79 min in which the drug was given sequentially than in Group M (337 ± 18.22 min. Furthermore, the time to achieve highest sensory block and complete motor block was significantly less in Group B without any major haemodynamic instability and neonatal outcome. Conclusions: When clonidine and hyperbaric bupivacaine were administered in a sequential manner, block characteristics improved significantly compared to the administration of the mixture of the two drugs.

  20. COMPARATIVE EVALUATION OF INTRATHECAL BUPIVACAINE-FENTANYL AND BUPIVACAINE-SUFENTANIL FOR CAESAREAN SECTION

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    Pooja

    2014-06-01

    Full Text Available BACKGROUND: Addition of lipophilic opioids like Fentanyl and Sufentanil to local anaesthetic for spinal anaesthesia has shown to prolong the duration of analgesia. This study was carried out to study (a Comparison of effect of Fentanyl and Sufentanil added to Bupivacaine on onset and duration of anaesthesia in Cesarean Section. (b To compare the quality and duration of analgesia between the two opioids and (c To compare the effect on neonatal outcome. METHODS: 50 parturients of ASA grade 1 and 2 undergoing Cesarean Section were randomized into two groups of 25 each. Group F received 2.5 ml 0.5% Bupivacaine heavy + inj. Fentanyl 0.25 ml (12.5 mcg and Group S received 2.5 ml 0.5% Bupivacaine heavy + inj. Sufentanil 0.1 ml (5 mcg intrathecally. Onset of sensory and motor blockade was noted in all the patients. Haemodynamic parameters were recorded every 5 minutes for first 30 minutes and then every 15 minutes till the completion of surgery. Duration of sensory and motor sensory blockade was observed post operatively. RESULT: Both the groups were stable haemodynamically. Both the groups were comparable regarding the duration of sensory and motor block, but the total duration of effective analgesia was significantly longer in Sufentanil group. Pruritus was significant side effect in Sufentanil group. Neither the mother nor the neonate had respiratory depression. CONCLUSION: Addition of Sufentanyl to intrathecal bupivacaine provides longer duration of analgesia as compared to intrathecal fentanyl-bupivacaine. However, the incidence of pruritus was greater in Sufentanyl group.

  1. COMPARATIVE EVALUATION OF INTRATHECAL BUPIVACAINE-FENTANYL AND BUPIVACAINE - CLONIDINE FOR CAESAREAN SECTION IN PREGNANCY INDUCED HYPERTENSION

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    Tripti

    2014-09-01

    Full Text Available BACKGROUND: Pain free postoperative period and early ambulation are the need of the day for mothers and their neonates for early initiation of breast feeding. It is moral responsibility of Anaesthesiologist to provide a safe and pain free postoperative period with use of various techniques and drug combinations. Spinal anaesthesia has been widely used for caesarean section in normalas well as preeclamptic parturients and has been found to be efficaciousand safe. The present study aimed to compare the analgesic efficacy and side effect profile of intrathecal Bupivacaine with Fentanyl and Bupivacaine with Clonidine in cesarean section of parturients with pregnancy induced hypertension (PIH. METHODS: 50 full term parturients with pregnancy induced hypertension scheduled for cesarean section were randomized into 2 groups of 25 each. GROUP BF (Bupivacaine with Fentanyl received 7.5mg of 0.5% hyperbaric Bupivacaine and 20µg Fentanyl intrathecally. GROUP BC (Bupivacaine with Clonidine received 7.5mg of 0.5% hyperbaric Bupivacaine and 60µg clonidine intrathecally. RESULTS: Patients in group BC showed long lasting analgesia compared to group BF (p value<0.05. Both the groups had satisfactory analgesia with hemodynamic stability, however the incidence of hypotension and vasopressor requirement was more in group BC compared to BF. Incidence of pruritus was exceptionally seen in group BF, however more patients were sedated and complained of dry mouth in group BC. Both the groups had comparable APGAR scores with no adverse neonatal effects. CONCLUSION: We conclude use of intrathecal clonidine 60µg and Fentanyl 20µg both provide excellent sensory and motor blockage with lower dose of bupivacaine. Both drugs improved intraoperative analgesia and prolonged the duration of effective analgesia without any adverse effect on neonate neurobehaviour. Fairly good analgesia with less sedation and better haemodynamic stability is observed with 20μg fentanyl

  2. A study of risk factors of postpartum hemorrhage and indications for caesarean section

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    Bhavana G

    2016-06-01

    Conclusions: The prevalence of anemia among women at term was found to be 43%. The different medical high risk factors were human immunodeficiency virus positive (asymptomatic diagnosed during pregnancy, Hepatitis B antigen positive, cardiovascular risk, hypothyroidism, epilepsy observed in the groups. Other high risk factors included asthma, Crohns disease, and systemic sclerosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2017-2021

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

    Science.gov (United States)

    Senel, Ahmet Can; Mergan, Fatih

    2014-01-01

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

  4. Clinical investigation of the causes of poor wound healing after caesarean section%剖宫产术后腹部切口愈合不良临床调查与分析

    Institute of Scientific and Technical Information of China (English)

    唐艳琴; 邢镝; 陈润芳

    2011-01-01

    OBJECTIVE To explore the risk factors of poor wound healing after caesarean section, and to reduce nosocomial infection rate. METHODS Prospective study was conducted among 1273 patients who underwent caesarean section from Jan 2007 to Dec 2009. RESULTS Totally 23 patients had malunited wound, the morbidity was 1. 81%, the common causes weres infection of incisional wound and fat liquation, the risk factors included obesity, underlying diseases, surgical wound dehiscence, intraamniotic infection, hemorrhage, operation time and surgical technique. CONCLUSION Strict prevention measure should be take for high risk patients to reduce the morbidity of poor wound healing after caesarean section.%目的 分析剖宫产术后腹部切口愈合不良的危险因素,减少医院感染的发生.方法 对2007年1月-2009年1 2月1273例剖宫产术后患者进行前瞻性调查与分析.结果 发生切口愈合不良23例,发生率为1.81%,常见于切口感染、裂开或脂肪液化;危险因素调查主要与肥胖、基础疾病、术中出血量、羊膜腔感染、手术技巧及手术时间长等有关.结论对高危人群应采取严格预防措施,以减少剖宫产术切口愈合不良的发生率.

  5. PGE1 nebulisation during caesarean section for Eisenmenger's syndrome: a case report

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    Siddiqui Shahla

    2008-05-01

    Full Text Available Abstract Introduction Eisenmenger's syndrome in pregnancy can lead to death in 50% to 65% of parturients. Expensive invasive monitoring and medication have improved management and outcomes. Cheaper alternatives for the management of high-risk patients who present with no prenatal care are still not available. Case presentation We describe the obstetric anaesthesia management of a 34-year-old, 34-weeks pregnant woman who presented with a recent diagnosis of severe Eisenmenger's syndrome. A combined spinal epidural anaesthesia was used together with invasive cardiac monitoring as well as PGE1 nebulisation after delivery of the baby. This helped achieve a reduction of shunt, improvement of hypoxia and reduction of pulmonary pressures. Conclusion We found this to be a cheaper and safe alternative in the management of such patients who present with no adequate prior management.

  6. Effect of Intrauterine packing with gauze in treating and preventing hemorrhage in caesarean section%宫腔纱条填塞治疗及预防剖宫产术中出血的效果观察

    Institute of Scientific and Technical Information of China (English)

    何学素; 肖琳; 陈丽融

    2012-01-01

    目的 观察宫腔纱条填塞在治疗及预防剖宫产术中出血的效果.方法 42例剖宫产术中大出血者经常规方法处理无效者,采用宫腔纱条填塞的方法进行治疗.对26例具有出血倾向的高危孕妇采用预防性宫腔纱条填塞以防止产后出血.结果 42例用宫腔纱条填塞治疗产后出血的患者中40例有效,有效率95.2%.26例预防性宫腔纱条填塞者无一例发生产后出血,有效率100%.结论 宫腔纱条填塞是治疗和预防剖宫产术中大出血的较好方法,止血迅速,简单易行.%Objective To observe the effect of intrauterine packing with gauze in treating and preventing hemorrhage in Caesarean Section. Methods Treating 42 cases of massive hemorrhage during Caesarean Section with intrauterine gauze packing, with whom conventional methods have proven ineffective. In the case of 26 high-risk pregnancy, we have also applied intrauterine gauze packing to prevent postpartum hemorrhage. Results Among the 42 cases who suffers from massive hemorrhage during Caesarean Section, 40 are successfully treated with this method, which brings the success rate to 95. 2%. Among the 26 cases high-risk pregnancy, none suffers from postpartum hemorrhage, which brings the success rate to 100%. The total success rate of intrauterine is 97%. Conclusion Intrauterine packing with gauze is an effective method in treating and preventing hemorrhage in Caesarean Section. It staunch hemorrhage quickly and is eas-y to implement.

  7. B超诊断剖宫产宫壁瘢痕缺损及相关临床分析%Clinical analysis on diagnosis of post-caesarean section scar defect by B ultrasonography

    Institute of Scientific and Technical Information of China (English)

    胡志恒

    2014-01-01

    目的:探讨剖宫产宫壁瘢痕缺损的B超诊断。方法回顾性分析B超诊断剖宫产宫壁瘢痕缺损的结果及参数特点。结果本组共检出剖宫产宫壁瘢痕缺损57例,检出率为63.33%;剖宫产宫壁瘢痕缺损组经产妇瘢痕至宫颈内口距离及前位子宫率均明显低于剖宫产宫壁瘢痕完整组,差异具有统计学意义(P<0.05或P<0.01);两组经产妇子宫内膜厚度、优势卵泡的直径、子宫长径、子宫前后径和子宫横径比较,差异无统计学意义(P>0.05);不同剖宫产次数及子宫前后位置宫壁瘢痕缺损参数相互比较,差异无统计学意义(P>0.05)。结论剖宫产宫壁瘢痕缺损临床检出率较高,位置多接近于宫颈内口,子宫后位者发生剖宫产宫壁瘢痕缺损风险更高。%Objective To discuss diagnosis of post-caesarean section scar defect(PCSD)by B ultrasonography. Methods A retrospective analysis was conducted on the results and parameter characteristics of PCSD diagnosis by B ultrasonography. Results 57 cases of PCSD were detected with detection rate of 63.33%. The group with PCSD had significantly shorter distance between the scar and the internal cervix and significantly lower incidence of anteposition of uterus than the group with post-caesarean section intact scar, with statistical significance (P 0.05). There was no statistical difference regarding the number of caesarean sections and the parameters of post-caesarean section scar defect at anterior and posterior uterus (P>0.05). Conclusion PCSD has high detection rate in clinical practice and PCSD is often adjacent to the internal cervix. Patients with retroposition of uterus have higher risk of PCSD.

  8. Retrospective analysis of elective caesarean section and respiratory distress syndrome in the term neonates%选择性剖宫产与足月儿呼吸窘迫综合征回顾性分析

    Institute of Scientific and Technical Information of China (English)

    吴秀静; 张宣东; 施丽萍; 吴明远; 杜立中

    2009-01-01

    Objective Severe respiratory distress syndrome (RDS) caused by pulmonary surfactant (PS) deficiency is described not only in preterm infants but also in term babies delivered via caesarean section, especially before the onset of labour (elective caesarean section). Once RDS of term neonates happened, mechanical ventilation is needed, and the infants were at high risk of developing further complications such as persistent pulmonary hypertension of neonates (PPHN), pulmonary air leak and cardiovascular instability, even fatal outcome cannot be avoided. The present study aimed to analyze the association between the elective caesarean section and respiratory distress syndrome (RDS) in term neonates, and to determine the related factors and outcomes of RDS cases in neonatal intensive care unit (NICU) and neonatology ward. Methods A retrospective study was conducted at the NICU and the Neonatology Ward of A center (Children's Hospital of Zhejiang University) and the NICU of center B (Obstetrics and Gynecology Hospital of Zhejiang University) on 90 term infants who were diagnosed as RDS between June 2006 and June 2008. The general clinical data, mode of delivery, severity of the radiological sign, pulmonary surfactant (PS) application, the onset time and duration of mechanical ventilation, the ratio of PaO_2 to FIO_2 before mechanical ventilation, oxygenation index (OI), duration of oxygen supplementation, the length of hospital stay and complications including pulmonary air leaks (pneumothorax, pulmonary interstitial emphysema), PPHN, systemic hypotension and ventilator-associated pneumonia (VAP) were collected. The gestational age distribution was studied in RDS cases delivered by elective caesarean section, and the comparative analysis and non-conditional logistic regression analysis were performed for clinical characteristics and risk factors between the RDS cases with or without complications. P 25(t=4.737,P=0.03)、用氧时间(χ~2=10.475,P=0.001)

  9. Clinical analysis of caesarean section scar pregnancy 42 cases%42例剖宫产子宫切口疤痕妊娠的临床分析

    Institute of Scientific and Technical Information of China (English)

    张娜

    2014-01-01

    OBJECTIVE: The clinical features of caesarean section scar pregnancy and treatment were analyzed and discussed. Methods: 42 patients in our hospital caesarean section scar pregnancy patients, for example, clinical characteristics of al patients were analyzed, the implementation of targeted therapy. Results: The patients had a history of menopause, more performance for vaginal bleeding. Under section B surreal anterior muscular presence blob, ultrasonography showed the presence of clumps of color flow signals around. Al patients were discharged after treatment. Conclusion: For patients with previous caesarean section scar pregnancy, need to be implemented in the clinical condition of the patient for targeted therapy, diagnostics and strengthen efforts to reduce the rate of misdiagnosis.%目的:对剖宫产子宫切口疤痕妊娠的临床特点以及治疗进行分析和探讨。方法:选取我院收治的42例剖宫产子宫切口疤痕妊娠患者为例,对所有患者的临床特点进行分析,实施针对性治疗。结果:患者均存在停经史,多表现为阴道出血。B超现实前壁下段肌层存在团状物,彩超显示团块周围存在彩色血流信号。患者经治疗均全部出院。结论:对于剖宫产子宫切口疤痕妊娠患者,在临床上需要针对患者的病情实施针对性治疗,并加强诊断力度,减少误诊率。

  10. A randomised controlled trial of opioid only versus combined opioid and non-steroidal anti inflammatory analgesics for pain relief in the first 48 hours after Caesarean section

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    Natalia Adamou

    2014-01-01

    Full Text Available Background: Post-Caesarean section pain is complex in nature, requiring a combination of pharmacological and non-pharmacological methods. Effective management of postoperative pain will reduce postoperative morbidity, hospital stay and cost. The objective of this study was to compare the clinical effectiveness and adverse effects of a combination of non-selective cyclooxygenase (COX inhibitor (Diclofenac sodium 50 mg and opioid (Pentazocine 60 mg to opiod only (Pentazocine 60 mg for pain management after Caesarean section (CS at Aminu Kano Teaching Hospital (AKTH. Materials and Methods: This was a randomised double-blind controlled study conducted at AKTH, Kano, Nigeria. A total of 166 patients scheduled to undergo either emergency or elective Caesarean section were studied. Group I received a combination of COX inhibitor and opiod while Group II received opiod only for pain management after CS. Results: The average age of the patients was 28.35 years (SD ± 6.426 in the group I and 26.9(SD ± 6.133 in group II. The mean parity was 3.27(SD ± 2.67 and 2.75(SD ± 2.14 while the mean gestational age at admission was 37.68(SD ± 2.69 and 38.18(SD ± 2.63 weeks in the first and second groups, respectively. Comparison of the level of pain experienced and patients satisfaction during the first 48 hours postoperatively revealed that the level of pain was statistically significantly less and patient′s satisfaction significantly better in group I compared to group II (P-value 0.00001. Conclusion: The use of combined compared to single agent analgesia is safe, significantly reduced pain and improved patient satisfaction after a caesarian section (CS.

  11. A mixed-method study of factors associated with differences in caesarean section rates at community level: the case of rural China.

    Science.gov (United States)

    Huang, Kun; Tao, Fangbiao; Faragher, Brian; Raven, Joanna; Tolhurst, Rachel; Tang, Shenglan; van den Broek, Nynke

    2013-08-01

    to assess population-based caesarean section (CS) rates in rural China and explore determinants and reasons for choosing a CS. cross-sectional study, quantitative and qualitative methods, statistical modelling. two rural counties in Anhui province, China. (a) household survey participants: 2326 women who gave birth in the two counties from January 2005 to December 2006; (b) qualitative study participants: health providers at township and village level and maternal health-care providers (N=58). the household survey were conducted among 2326 women, collecting data on socio-economic and health status and utilisation of maternal health services. Eleven Focus Group Discussions with health-care providers and users to explore perceptions surrounding CS. the CS rate in the two areas were 46.0% and 64.7%. There were complex and different interactions among social-economic and clinical determinants associated with differences in CS rates. The main determinants that emerged were maternal age, maternal education, yearly income, primiparity, uptake of antenatal care and recorded obstetric complications with complex and differing interactions for each county. Maternal fear of pain, worry about mothers' and infants' safety, not satisfied with doctors' competences and physicians' low confidence in vaginal delivery, and absence of a strong midwifery cadre together contributed to final determination of CS. the CS rates were extremely high in the two counties in rural China. Maternal socio-economic, clinic characteristics and health providers' preference contributed together to the high rates of CS. evidence-based knowledge and methods to reduce unnecessary CS should be communicated to medical professionals and women. Greater comprehensive attention needs to be paid to a complex pattern of medical, socio-cultural, political and economic contexts of maternity care. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Scott, R

    2000-01-01

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

  13. A RANDOMIZED CLINICAL STUDY TO EVALUATE THE EFFECT OF INTRAVENOUS MAGNESIUM SULPHATE FOR POSTOPERATIVE PAIN RELIEF IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION

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    Jitendra

    2015-09-01

    Full Text Available BACKGROUND : In this randomized, double - blind, prospective study, we have evaluated the effect of i.v. infusion of magnesium sulphate during spinal anaesthesia, for postoperative pain relief in patients undergoing lower segment caesarean section. AIM : A comparative evaluation of intravenous magnesium sulphate for prevention of postoperative pain relief in lower segment caesarean section under spinal anaesthesia” . METHODS AND MATERIAL S : 60 female patients of ASA grade I and II of the age group 20 - 40 yrs., posted for lower segment caesarean section under spinal anaesthesia were selected after pre anaesthetic fitness. Randomly patient were divided into two groups (n=30 patients each group NS, and group MS to receive 100ml of 0.9% Normal saline and Magnesium sulphate 50mg kg - 1 in 100ml of 0.9% Normal saline respectively to be given over 15 min, 60min after performing spinal anaesthesia. After surgery, rescue analgesia in form of inj. tramadol 100 mg i.v was provided for the patients. The Postoperative pain scores, Rescue analgesic consumption, and incidences of sedation, shivering, dysrhythmia, bradycardia, and hypotension evaluated immediately after surgery, and at 30 min, 1, 2, 3, hrs. After surgery. STATISTICAL ANALYSIS: Results were expressed as mean and standard deviation. P value of <0.05 was considered statistically significant. RESULTS: IV Magnesium sulphate 50 mg kg - 1 bolus significantly prolonged duration of analgesia, superior quality of analgesia ( L ower VAS and significant reduction in postoperative analgesic requirement than normal saline under spinal anaesthesia. No significant hemodynamic and respiratory instability occurred with Magnesium Sulphate use. CONCLUSION: I.V. magnesium sulphate administration during spinal anaesthesia improves postoperative analge sia without any notable complications.

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

    Science.gov (United States)

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

    1977-04-01

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

  15. Effect of phenylephrine vs. ephedrine on frontal lobe oxygenation during caesarean section with spinal anesthesia: an open label randomized controlled trial

    Science.gov (United States)

    Foss, Visti T.; Christensen, Robin; Rokamp, Kim Z.; Nissen, Peter; Secher, Niels H.; Nielsen, Henning B.

    2014-01-01

    Background: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether that is the case for patients exposed to spinal anesthesia is not known. Objectives: To evaluate the impact of phenylephrine vs. ephedrine on ScO2during caesarean section with spinal anesthesia in a single center, open-label parallel-group study with balanced randomization of 24 women (1:1). Secondary aims were to compare the effect of the two drugs on maternal hemodynamics and fetal heart rate. Intervention: Ephedrine (0.8–3.3 mg/min) vs. phenylephrine infusion (0.02–0.07 mg/min). Results: For the duration of surgery, administration of ephedrine maintained ScO2 (compared to baseline +2.1 ± 2.8%; mean ± SE, while phenylephrine reduced ScO2 (−8.6 ± 2.8%; p = 0.005) with a 10.7% difference in ScO2between groups (p = 0.0106). Also maternal heart rate was maintained with ephedrine (+3 ± 3 bpm) but decreased with phenylephrine (−11 ± 3 bpm); difference 14 bpm (p = 0.0053), but no significant difference in mean arterial pressure (p = 0.1904) or CO (p = 0.0683) was observed between groups. The two drugs also elicited an equal increase in fetal heart rate (by 19 ± 3 vs. 18 ± 3 bpm; p = 0.744). Conclusion: In the choice between phenylephrine and ephedrine for maintenance of blood pressure during caesarean section with spinal anesthesia, ephedrine maintains frontal lobe oxygenation and maternal heart rate with a similar increase in fetal heart rate as elicited by phenylephrine. Trial registration: Clinical trials NCT 01509521 and EudraCT 2001 006103 35. PMID:24624090

  16. A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004)

    Science.gov (United States)

    Collin, Simon M; Anwar, Iqbal; Ronsmans, Carine

    2007-01-01

    Background Bangladesh is committed to the fifth Millennium Development Goal (MDG-5) target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC). Methods We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics. Results Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18%) compared with the richest urban women with secondary or higher education (99%). Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas), and caesarean sections trebled (from 2% to 6%), but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services. Conclusion Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a major impediment to

  17. The Effect of the Combined Use of Methylergonovine and Oxytocin during Caesarean Section in the Prevention of Post-partum Haemorrhage.

    Science.gov (United States)

    Şentürk, Şenol; Kağıtçı, Mehmet; Balık, Gülşah; Arslan, Halit; Kır Şahin, Figen

    2016-05-01

    We aimed to show to patients the benefit of post-partum haemorrhage prophylaxis treatment and the effectiveness as a uterotonic agent of the combined use of methylergonovine and oxytocin infusion in the prevention of haemorrhage during and after Caesarean section, by comparison with a control group which received oxytocin infusion only. Two groups of patients undergoing Caesarean section at the same clinic were included in the study. A combination of methylergonovine and oxytocin was administered to the first group during the intra-operative and post-operative periods. The second group did not receive methylergonovine and was administered only with oxytocin infusion in the intra-operative and post-operative periods. Pre-operative and post-operative haemogram readings were taken for all patients in each of the groups for comparison. No difference was found between the two groups with regard to mean ages and pre-operative haemogram values. The decrease in post-operative haemoglobin values for the group administered with methylergonovine maleate and oxytocin was found to be significantly greater than for the group administered with oxytocin only. Results indicated that prophylactic methylergonovine treatment was clearly successful for the patients and no adverse side effects were found. The routine use of methylergonovine and oxytocin infusion in combination during the intra-operative period of Caesarean section reduced the level of post-partum haemorrhage considerably. We believe that this procedure will also reduce the risk of uterine atony, but clearly, prospective studies will be necessary in future to confirm this assumption.

  18. A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004

    Directory of Open Access Journals (Sweden)

    Ronsmans Carine

    2007-08-01

    Full Text Available Abstract Background Bangladesh is committed to the fifth Millennium Development Goal (MDG-5 target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC. Methods We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics. Results Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18% compared with the richest urban women with secondary or higher education (99%. Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas, and caesarean sections trebled (from 2% to 6%, but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services. Conclusion Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a

  19. 前置胎盘剖宫产产后出血的影响原因%Influence reasons of postpartum hemorrhage after placenta previa caesarean section

    Institute of Scientific and Technical Information of China (English)

    阙贵珍; 杨佩娴; 谭秀红

    2015-01-01

    目的:探讨前置胎盘剖宫产产后出血的影响原因。方法前置胎盘剖宫产产后出血的40例患者作为研究对象,分析导致产后出血的原因。结果中央型前置胎盘患者的出血量明显多于其他两种类型,有胎盘植入或粘连、有剖宫产史的患者出血量明显多于无胎盘植入或粘连和剖宫产史产妇,相比差异具有统计学意义(P<0.05);出血量与孕产妇年龄、胎盘附着部位、产妇流产频率无关。结论针对中央型前置胎盘,在产妇实施剖宫产手术时,需借助彩超对胎盘定位,确认子宫切口,从而确保手术的安全和新生儿的顺畅出生。%Objective To investigate the influence reasons of postpartum hemorrhage after placenta previa caesarean section. Methods There were 40 patients with postpartum hemorrhage after placenta previa caesarean section as the study subjects. Their causes of postpartum hemorrhage were analyzed. Results Patients with central placenta previa had larger bleeding volume than the other two types, and patients with history of placenta implantation, adhesion, and caesarean section had larger bleeding volume than patients without these history. The difference had statistical significance (P<0.05). Bleeding volume had no relationship with age, placenta adherent parts, and abortion frequency of pregnant women. Conclusion For central placenta previa in caesarean section, color Doppler ultrasound should be applied to positioning placenta and confirming uterine incision, so as to guarantee surgical and fetal safety.

  20. 前置胎盘合并剖宫产史临床分析%Clinical analysis of placenta previa complicated with previous caesarean section

    Institute of Scientific and Technical Information of China (English)

    马良坤; 韩娜; 杨剑秋; 边旭明; 刘俊涛

    2012-01-01

    目的 探讨前置胎盘合并剖宫产史患者的临床特点及处理.方法 回顾性分析2003年1月至2011年10月北京协和医院前置胎盘合并剖宫产史(再次剖宫产组,RCS组)患者母婴结局,并与同期前置胎盘行初次剖宫产(初次剖宫产组,FCS组)进行比较.结果 RCS组及FCS组分别有29例及243例患者.两组的平均年龄、孕周差异无统计学意义(P>0.05).RCS组患者手术时间长,产后出血量多,早产、产后出血、胎盘植入、输血、弥漫性血管内凝血和产科子宫切除的发生率均高于FCS组,差异有统计学意义(P<0.05),RCS组早产儿、新生儿窒息发生率及围产儿死亡率均高于FCS组(P<0.05).结论 前置胎盘合并剖宫产史更易发生胎盘植入,产后出血、产科子宫切除及围产儿病率高,需要高度重视.%Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods Twenty - nine cases of placenta previa complicated with previous caesarean section (RCS group) treated in Peking Union Medical College Hospital from 2003 to 2011 were retrospectively reviewed and compared with 243 cases of placenta previa complicated without previous caesarean section (FCS group) at the same time. Results The mean age and the average gravidity of RCS group and FCS group had no difference. The RCS group had longer operation time, more preterm birth, postpartum hemorrhage volume, blood transfusion, placenta accreta, disseminated intravascular coagulation and obstetric hysterectomy than FCS group (Pcaesarean section has more placenta accreta, postpartum hemorrhage, obstetric hysterectomy and perinatal morbidity rate. We need to pay more attention to these cases.

  1. 剖宫产术后再次妊娠172例临床分析%Analysis of 172 cases of re-pregnancy after caesarean section

    Institute of Scientific and Technical Information of China (English)

    徐艳红; 吕玉人

    2010-01-01

    Objective To analyze the delivery ways of the re-pregnant women after caesarean section. Methods The mode of delivery and birth outcome of 172 cases re-pregnancy after caesarean section from Jan. 2005 to Dec. 2008 were retrospectively analyzed. 48 cases of vaginal delivery after cesarean section were compared with 48 cases of non-vaginal birth after cesarean section during the same period. 124 cases of re-cesarean section were compared with 124 random case of cesarean section for the first time during the same period. Results Among 172 cases , 54 cases had vaginal labor in whom 48 cases succeeded. The success rate was 88. 89%. There was no significant difference in postpartum hemorrhage scar uterus and no-scar uterus. There were 124 cases of re-caesarean section. There was a significant difference in postpartum hemorrhage re-caesarean section and cesarean section for the first time [ (265 ±14)ml vs (201 ±12)ml, P<0.05]. Conclusions Scar uterus can be applied to vaginal delivery. Caesarea section history is not the definite indication of caesarean birth.%目的 探讨剖宫产术后再次妊娠分娩方式的选择,以期减少分娩并发症.方法 选择民航总医院妇产科2005年1月至2008年12月住院的剖宫产术后再次妊娠孕妇172例,对其分娩方式、分娩结局进行回顾性分析.将其中剖宫产术后阴道分娩48例与同期非剖宫产术后子宫阴道分娩48例进行对照分析,再次剖宫产124例与随机抽取同期首次剖宫产124例进行对照分析.结果 172例剖宫产术后再次妊娠孕妇中,有54例阴道试产,48例试产成功,成功率88.89%,瘢痕子宫与正常子宫阴道分娩产后出血差异无统计学意义;再次剖宫产124例,手术产率72.09%,再次剖宫产与首次剖宫产产后出血量差异有统计学意义[(265±14)ml比(201±12)ml,P<0.05].结论 剖宫产术后再次妊娠的孕妇在一定条件下可阴道分娩,应给予试产机会,瘢痕子宫并非再次剖宫产的绝对指征.

  2. Comparison of administration of single dose ceftriaxone for elective caesarean section before skin incision and after cord clamping in preventing post-operative infectious morbidity.

    Science.gov (United States)

    Kalaranjini, S; Veena, P; Rani, Reddi

    2013-12-01

    To compare the efficacy of ceftriaxone before skin incision and after cord clamping in preventing post-operative infectious morbidity and neonatal outcome in elective caesarean section and to determine the effect of antibiotic prophylaxis before skin incision on neonatal outcome. Our study was a randomised controlled trial conducted among 874 women undergoing elective caesarean section from October 2010 to July 2012. These women were randomly categorised into two groups with 437 women in each group. Group 1 received single dose of ceftriaxone 1 g intravenously 15-45 min before skin incision. Group 2 received the antibiotic after cord clamping. Primary outcome measures were maternal post-operative infectious morbidities like surgical site wound infection, febrile morbidity, endometritis, urinary tract infections and neonatal sepsis. Results were analysed using Chi-square test and unpaired t test. Surgical site wound infection occurred in 3 women in group 1 (0.7%) and 6 women in group 2 (1.4%). Fever occurred in 9 women in group 1 (2.1%) and 5 in group 2 (1.1%) with the p value of 0.419, not statistically significant. Urinary tract infection occurred in 9 women in group 1 (2.1%) and 7 women in group 2 (1.6%) with the p value of 0.801. None of the women in either group developed endometritis. About 20 neonates [10 neonates (2.3%) in group 1 and 10 neonates (2.3%) in group 2] required NICU admission after caesarean delivery. The reasons for admission were respiratory distress, prematurity and congenital anomaly. About 0.9% of neonates in group 1 and 1.8% in group 2 developed neonatal sepsis with positive blood culture (p = 0.388). Timing of administration of prophylactic antibiotics for elective caesarean section either before skin incision or after cord clamping did not have significant difference in the occurrence of post-operative infectious morbidity. No adverse neonatal outcome was observed in women who received the antibiotic before skin incision.

  3. 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.

  4. A STUDY OF VAGINAL BIRTH AFTER CAESAREAN

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    Ratana

    2015-06-01

    Full Text Available OBJECTIVE : To evaluate the efficacy and safety of attempted VBAC with a view to decrease the incidence of caesarean section . METHOD S : A prospective study is carried out on women with one previous LSCS for a non - recurrent cause attending ANC & labour room of RIMS for 2 years from 1 st Aug 2007 to 31 st July 2009. RESULTS : 100 eligible PCS women agreed to undergo trial of labour. Of these 50 delivered vaginally and the remaining 50 had to undergo emergency repeat caesarean section due to fetal distress, scar tenderness o r non - progress of labour resulting in a VBAC rate of 50%. CONCLUSION : A trial of labour in cases of previous caesarean section is the way to reduce the overall caesarean section rate. Physicians need to discuss the risks and benefits of VBAC following tria l of labour or elective repeat caesarean section with patients and patients’ choices must be considered.

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

    Directory of Open Access Journals (Sweden)

    ZheFeng Quan

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

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

    Science.gov (United States)

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

    2017-01-31

    The objective of this study was to assess effectiveness and safety of the reverse breech extraction approach in Caesarean section for obstructed labour, and compare it with the standard approach of pushing the fetal head up through the vagina. This randomised controlled trial included 192 women. In 96, the baby was delivered by the 'reverse breech extraction approach', and in the remaining 96, by the 'standard approach'. Extension of uterine incision occurred in 18 participants (18.8%) in the reverse breech extraction approach group, and 46 (47.9%) in the standard approach group (p = .0003). Two women (2.1%) in the reverse breech extraction approach group needed blood transfusion and 11 (11.5%) in the standard approach group (p = .012). Pyrexia developed in 3 participants (3.1%) in the reverse breech extraction approach group, and 19 (19.8%) in the standard approach group (p = .0006). Wound infection occurred in 2 women (2.1%) in the reverse breech extraction approach group, and 12 (12.5%) in the standard approach group (p = .007). Apgar score extraction approach group, and 21 (21.9%) in the standard approach group (p = .015). In conclusion, reverse breech extraction in Caesarean section for obstructed labour is an effective and safe alternative to the standard approach of pushing the fetal head up through the vagina.

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

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    Nanik Handayani

    2015-11-01

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

  8. 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....

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

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    Kolokotroni Ourania

    2012-11-01

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

  10. Intravenous 1 gram tranexamic acid for prevention of blood loss and blood transfusion during caesarean section: a randomized case control study

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    Babita Ramani

    2014-04-01

    Full Text Available Background: Aim of current study was to determine the effect of tranexamic acid in reducing blood loss during and after C-section. Methods: All women undergoing LSCS were divided in two groups viz study and control group. All were requested for pre-op and post-op Hb%, PCV and TRBC. Intravenous tranexamic acid one gm was given to study group (not to control group 10 min prior to skin incision and blood loss in both groups was calculated by weighing prewieghed pads soaked in blood. Results: Post-op blood loss was significantly lower in study group (P = 0.020. Hb% changes in post-op period is significant in control group (P = 0.037. Conclusions: Tranexamic acid is safe and effective in preventing post-partum hemorrhage after caesarean section. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 366-369

  11. 148例剖腹产产妇术后护理体会%The Nursing Experience of Postoperative Care in Caesarean Section 148 Patients

    Institute of Scientific and Technical Information of China (English)

    郑红梅

    2016-01-01

    目的:探讨剖腹产手术患者术后护理干预的方法与效果。方法选取我院收治的148例剖腹产产妇,随机分为两组,对照组给予常规术后护理,观察组给予整体护理干预,观察并比较两组产妇的护理效果。结果观察组下床时间(28.3±2.1)h,住院时间(5.2±1.7)d,对照组下床时间(39.1±2.4)h,住院时间(7.8±1.5)d,两组比较,差异有统计学意义(P<0.05);观察组并发症发生率为2.7%,低于对照组的12.2%(χ2=4.81,P=0.03)。结论对剖腹产手术患者提供术后整体护理干预,能够有效缩短下床时间与住院时间,降低术后并发症发生率。%Objective Discussion the methods and results of postoperative care in caesarean section patients.Methods 148 cases of caesarean section,which randomly divided into two groups, control group received routine postoperative care, and study group was overall nursing intervention. The effects of care were compared in two groups.Results Bed time in study group was (28.3±2.1) hours, shorter than control group (5.2±1.7) hours,P<0.05), hospital stay in study group was (39.1±2.4) days, shorter than control group (7.8±1.5)days,P<0.05, and incidence of postoperative complications in study group was 2.7%, lower than control group 12.2%(χ2=4.81,P=0.03).ConclusionFor caesarean section patients with postoperative whole nursing can effectively shorten bed time and hospital stays, reduced the incidence of postoperative complications.

  12. Analysis of 178 postpartum hemorrhage cases in caesarean section%178例剖宫产产后出血病例分析

    Institute of Scientific and Technical Information of China (English)

    董渭盈; 陈敏

    2015-01-01

    目的:探讨剖宫产产后大出血的原因,分析相关高危因素,以减少剖宫产大出血的发生率。方法回顾分析178例剖宫产产后大出血患者的临床资料。结果109例发生子宫收缩乏力性出血,62例发生胎盘植入大出血,7例系宫缩乏力合并胎盘植入;54例经一线治疗成功止血,87例经各种二线治疗成功止血,37例切除子宫,无死亡产妇。结论宫缩乏力、前置胎盘、胎盘植入仍是产后出血的主要原因,积极的一、二线治疗可降低子宫切除率,提高产妇的远期生活质量。%Objective To investigate causes of postpartum massive hemorrhage of caesarean section, and to analyze related factors, in order to reduce incidence of massive hemorrhage of caesarean section. Methods Clinical data of 178 patients with postpartum massive hemorrhage of caesarean section were retrospectively analyzed. Results There were 109 cases with uterine inertia hemorrhage, 62 cases with placenta implantation massive hemorrhage, and 7 cases with uterine inertia complicated with placenta implantation. There were 54 cases received first-line treatment for successful hemostasis, 87 cases received second-line treatment, and 37 cases received hysterectomy, and no death cases. Conclusion The main causes of postpartum hemorrhage include uterine inertia, placenta previa, and placenta implantation. Implement of active first-line and second-line treatment can reduce hysterectomy rate and improve long-term life quality of puerperal.

  13. Factors associated with success of vaginal birth after one caesarean section (VBAC at three teaching hospitals in Addis Ababa, Ethiopia: a case control study

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    Birara Malede

    2013-02-01

    Full Text Available Abstract Background Vaginal delivery after previous one cesarean section for a non recurring indication has been described by several authors as safe and having a success rate of 60–80%. Hence many centers are offering VBAC for candidates leaving the century old dictum of once cesarean always cesarean. But predicting success of VBAC after trial of labor (TOL is still a difficult task due to the lack of a validated prediction tool. Studies on predictors of success are few and most of them conducted in developed countries and difficult to generalize. Therefore assessing factors associated with successful VBAC is very important to for counseling mothers while offering VBAC. The aim of this study was to assess factors associated with successful VBAC in three teaching Hospitals in Addis Ababa Ethiopia. Methods A case control study was conducted to compare the factors associated with successful VBAC in teaching hospitals in Addis Ababa in one year period. The cases were those successfully delivered vaginally and the controls were those with failed VBAC and delivered by caesarean section. The sample size of the cases was 101vaginal deliveries and the controls were 103 failed VBAC patients which made the case to control ratio of 1:1. Result In this study independent factors determining successful VBAC were, history of successful VBAC in the past, rupture of membrane at admission, and cervical dilatation of more than 3cm at admission. Presence of meconium, malposition and history of stillbirth were associated with failed VBAC. Factors like maternal age, past caesarean indications, inter delivery interval, and birth weight were not found to be significant determinants of success. The most common reason for repeat cesarean section for after trial of labor was labour dysfunction because of absence of a policy for augmentation on a scarred uterus in these hospitals. Conclusion It is possible to prepare a decision tool on the success of VBAC by taking

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

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    Esteban Puentes-Rosas

    2004-02-01

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

  15. Dilatation of the cervix at non-labour caesarean section: Does it improve the patients' perception of pain post-operatively?

    Science.gov (United States)

    Sakinci, M; Kuru, O; Olgan, S; Gunduz, S; Bakir, V L; Kaya, O; Bakirci, I T

    2015-01-01

    Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.

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

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    Yasmine El-Masry

    2015-01-01

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

  17. Delivery times for caesarean section at Queen Elizabeth Central Hospital, Blantyre, Malawi: is a 30-minute 'informed to start of operative delivery time' achievable?

    Science.gov (United States)

    O'Regan, M

    2003-08-01

    A timesheet questionnaire was used to assess the time it took from informing the anaesthetist about a case to the start of operative delivery in 78 consecutive patients undergoing caesarean section. Median (IQR [range]) times for grade-1 cases (immediate threat to the life of the mother or fetus) and grade-2 cases (fetal or maternal compromise without immediate threat to life) were 20 (17-35 [6-75]) min and 41 (27-60 [17-136]) min, respectively. Delays occurred in all the component time intervals examined. The primary avoidable delay was the patient's late arrival in theatre. Many significant delays were apparently not perceived by the anaesthetist. In nine (69%) grade-1 cases, the 30-min target decreed by the Association of Anaesthetists of Great Britain & Ireland and the Obstetric Anaesthetists' Association was achieved.

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

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

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

  19. THE EFFECTS OF ANTIBIOTIC PROPHYLAXIS ON INFECTIOUS COMPLICATIONS AFTER CAESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL IN A TERTIARY HOSPITAL OF EASTERN INDIA

    Directory of Open Access Journals (Sweden)

    Shelley

    2013-04-01

    Full Text Available ABSTRACT: CONTEXT: Infectious complications after caesarean deliveries are an important and substantial cause of maternal morbidity and inc rease in the hospital stay and cost of treatment. Routine prophylaxis with antibiotics may reduce this risk. AIMS: To determine whether prophylactic antibiotic administration using ceftriaxone at the time of caesarean section significantly reduces maternal and neonatal infectious complications . SETTINGS AND DESIGN: The study was conducted in a tertiary teaching hospi tal of eastern India during March 2011 to October 2011. It was a prospective, double-b lind randomised placebo-controlled trial. METHODS AND MATERIAL: After exclusion due to different reasons, 288 patien ts were enrolled in study group and received prophylactic inje ction ceftriaxone. 293 patients were enrolled in control group who received placebo. Patie nts were randomly selected according to computerized randomization protocol. Postpartum infect ious complications were recorded, as were the duration of hospital stay and neonatal compl ications. STATISTICAL ANALYSIS USED: Analysis of statistical data was done by using stat istical software Open Epi, 8version 2.3.1. RESULTS: Wound indurations, discharge, erythema were 2.43% a nd 5.80% in study and control group respectively and it was statistically significa nt with p value 0.043 (RR=0.419, 95% confidence interval [CI] 0.405. Endomyometritis was more in control group (1.04% vs. 3.75% with p value 0.036 and RR=0.279 and CMLE OR= 0.272. No significant relationship with neonatal morbidities was found. Maternal stay in ho spital was significantly more with p=0.01 in control group. CONCLUSIONS: Antibiotic prophylaxis prior to skin incision of caes arean sections resulted in better maternal outcome when i nfectious morbidity and postoperative hospital stay were concerned, without influencing th e neonatal outcome.

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

    NARCIS (Netherlands)

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

    2015-01-01

    OBJECTIVE: to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. DESIGN: nationwide descriptive study. SETTING: The Netherlands Perinatal Registry. PARTICIPANTS: 807,437 births of nine year coh

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

    NARCIS (Netherlands)

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

    2015-01-01

    Objective: to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. Design: nationwide descriptive study. Setting: The Netherlands Perinatal Registry. Participants: 807,437 births of nine year coh

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

    NARCIS (Netherlands)

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

    2014-01-01

    OBJECTIVE: to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. DESIGN: nationwide descriptive study. SETTING: the Netherlands Perinatal Registry. PARTICIPANTS: 789,795 births of nine year coh

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

    NARCIS (Netherlands)

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

    2014-01-01

    Objective to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. Design nationwide descriptive study. Setting the Netherlands Perinatal Registry. Participants 789,795 births of nine year cohorts

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

    NARCIS (Netherlands)

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

    2014-01-01

    OBJECTIVE: to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. DESIGN: nationwide descriptive study. SETTING: the Netherlands Perinatal Registry. PARTICIPANTS: 789,795 births of nine year coh

  5. Omission of the bladder flap at caesarean section reduces delivery time without increased morbidity: a meta-analysis of randomised controlled trials.

    Science.gov (United States)

    O'Neill, Heidi A; Egan, Grace; Walsh, Colin A; Cotter, Amanda M; Walsh, Stewart R

    2014-03-01

    Caesarean section (CS) is the most common major surgical procedure performed worldwide. Traditionally, creation of a bladder flap (BF) has been a routine surgical step at CS although recent randomised controlled trials (RCTs) have begun to question its value. We performed a meta-analysis of RCTs examining the benefits of BF formation at CS. Pubmed, Medline, Embase, CINAHL Plus(®), Web of Science Reference and Cochrane Databases online were searched in March 2012 using combinations of the terms "c(a)esarean", "bladder", "flap" and "technique". Citations identified in the primary search were screened for eligibility. Online clinical registries (www.clinicaltrials.gov, www.controlled-trials.com and www.ukcrc.org.) were also searched. The primary outcome was bladder injury. Secondary outcomes were skin incision-delivery interval, total operating time, blood loss and duration of hospitalisation. Pooled outcome measures (odds ratio [OR] and weighted mean difference [WMD]) were calculated using a random effects model. Three published RCTs and one unpublished trial identified from an online trial registry were included (n=581 women). All four trials excluded very preterm and emergency CS. Omission of the BF step at CS reduced the skin incision-delivery interval (WMD 1.27min; p=0.0001). No differences were found for bladder injury (pooled OR 0.96), total operating time (WMD 3.5min), blood loss (WMD 42ml) or duration of hospitalisation (WMD 0.07 days). Omission of the BF at elective CS does not appear to increase the rate of peri-operative complications and improves the skin incision-delivery interval. The role of BF formation in very preterm procedures and emergency intrapartum CS needs further study. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Hospitalization Expenses Influencing Factors Analysis of Non-emergency Caesarean Section Patients%非急诊剖宫产住院费用影响因素的分析

    Institute of Scientific and Technical Information of China (English)

    李凌; 黄利娟; 谭小燕; 欧辉

    2016-01-01

    Objectives To study the hospitalization expenses and influencing factors of non-emergency caesarean section patients, and provide new theoretical evidence for improving the current clinical pathways. Methods To select the hospitalized medical records of non-emergency caesarean section patients of a hospital in Abstract Objectives To study the hospitalization expenses and influencing factors of non-emergency caesarean section patients, and provide new theoretical evidence for improving the current clinical pathways. Methods To select the hospitalized medical records of non-emergency caesarean section patients of a hospital in 2015, establish database, compare the total expenses of different groups with the application of variance analysis, and make multiple linear regression analysis on the influencing factors of total expenses. Results The average total hospitalization expenses was 6807.00 ± 1952.12 yuan in 2015,the median was 6522.11 yuan.The total hospitalization expenses were high in patients with more operation, the expenses of medical insurance payment patients were lower than other payment mode. The influencing factors included principal diagnosis, hospitalization days, waiting time before operation,delay time after operation, operation numbers and payment modes. Conclusions The control of average length of stay was still an effective method to control total hospitalization expenses, we should treat differently according to the pregnant women of different state of diseases, and also make reasonable programming of clinical pathways to decrease the economic burden of the patients.%目的:研究非急诊剖宫产住院费用及影响因素为改进现有临床路径提供新的理论依据。方法抽取某院2015年的非急诊的,以剖宫产手术为分娩方式的住院病案,建立数据库,采用方差分析比较不同分组的住院总费用,并使用多元线性回归分析住院总费用到影响因素。结果2015年某院

  7. Clinical research of section choice in caesarean section for placenta praevia%前置胎盘剖宫产子宫切口选择的临床研究

    Institute of Scientific and Technical Information of China (English)

    石光; 杨鹏; 等

    2001-01-01

    Objective To investigate the influence of transverse and longitudinal lower segment caesarean section on the outcome of newborn, postpartum haemorrhage and ratio of complications in placenta previa. Methods Placenta previa with lower segment transverse caesarean section( 117 cases) were taken as control group, meanwhile, the lower segment with longitudinal section (142 cases ) as experimental group. Their operational complications, amount of bleeding during and after operation and outcome of the perinatal period were analysed. Results No significant difference in age, parities, gestational weeks, the types of the placenta praevia and the locus of placenta between the two groups were found( P>0.05), while there were significant difference in the amount of bleeding during and after operation, the need of using gauze ribbon to stop bleeding, section splitting and rate of hysterectomy after caesarean section(P<0.01). Conelusion Lower segment longitudinal caesarean section in placenta praevia not only shows less bleeding during operation and lower rate of postpartum haemorrhage, but also avoids using gauzes to stop bleeding and causes lower rate of hysterectomy after caesarean section, so it can be the first choice when determining the style of section in placenta praevia.%目的比较前置胎盘剖宫产子宫下段横切口和子宫下段纵切口对产时并发症、产后出血量及围产期结局的影响。方法以行子宫下段横切口剖宫产者为对照组(117例),以子宫下段纵切口剖宫产术为研究组(142例),分别记录两组研究对象剖宫产术时并发症、产时和产后24小时累计出血量、产后出血发生率及围产期结局。结果年龄、孕产次、孕周及前置胎盘类型和胎盘附着位置等有关因素比较无显著性(P>0.05)。两组间的术时出血量、产后出血发生率、子宫切口撕裂发生率、宫腔填纱条和子宫切除率、围产期结局的比较差异十分显著(P<0.01)。

  8. 重复剖宫产对妊娠结局的影响%Effects of repeated caesarean section on maternal and neonatal outcomes

    Institute of Scientific and Technical Information of China (English)

    刘娜; 边旭明; 马良坤; 滕莉荣; 戚红; 龚晓明; 刘俊涛; 杨剑秋

    2008-01-01

    目的 探讨重复剖宫产对孕产妇及围产儿结局的影响.方法 回顾性分析1998年1月1日至2007年12月31日,在北京协和医院妊娠超过28周行再(多)次剖宫产手术分娩的产妇共412例,根据剖官产次数分为再次剖宫产组(repeated caesarean section group,RCS组,394例)和多次剖宫产组(multiple caesarean section group,MCS组,18例),随机选取同期行初次剖宫产手术分娩的480例为初次剖宫产组(first caesarean section group,FCS组)作为对照,分析三组孕妇的一般临床资料、产时产后并发症及围产儿结局.结果 近十年我院再次剖官产率为4.1%,呈逐年上升趋势.(1)一般临床资料比较:RCS组及MCS组平均年龄分别为(33.7±4.3)岁,(34.5±5.1)岁,大于FCS组(31.5±4.3)岁(P<0.05).RCS组及MCS组平均孕次分别为(3.5±1.4)次,(4.7±1.5)次,多于FCS组(2.1±1.2)次(P<0.05).(2)盆腔粘连发生率:RCS组及MCS组分别为13.5%和50.0%,高于FCS组(0.4%)(P<0.05).(3)子宫破裂发生率:RCS组(1%)高于FCS组(0%)(P<0.05).(4)RCS组及MCS组平均分娩孕周分别为(38.1±1.8)周,(37.3±2.5)周,与FCS组[(38.9±2.1)周]比较差异有统计学意义(P<0.05).结论 再 (多)次剖宫产发生率逐年上升,其显著增加盆腔粘连及子官破裂的发生率,但并不增加围产儿并发症的发生率.%Objective To investigate the effects of repeated caesarean section (RCS) on maternal and neonatal outcomes. Methods From January 1998 to December 2007, 412 cases underwent RCS at Peking Union Medical College Hospital were reviewed and divided into two groups based on the number of CSs: RCS group (n= 394) and multiple caesarean section (CS) group (MCS group, n= 18). General conditions, maternal complications and neonatal outcomes were compared among RCS group, MCS group and first CS groups (FCS group) which consisted of 480 women underwent the first CS during the same period. Results The incidence of RCS was 4. 0% with an increasing trend during the past ten

  9. 临床路径在计划性剖宫产中的应用%Application of Clinical Pathway in Scheduled Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    李丹; 朱义保; 赵菲; 万凌玲; 郑九生; 刘淮

    2011-01-01

    Objective:To evaluate the effect of clinical pathway tried out by the Ministry of Public Health in the scheduled caesarean section. Methods: 185 cases with scheduled caesarean section were selected clinical pathway (Pathway group). 96 cases were selected non clinical pathway as control group. The time of hospitalization, various medical care costs, coefficient of variation and constituent ratio of different parameters, and patient's satisfaction degree as well as their complications after operation were analyzed and compared between the two groups. Results:The time of hospitalization in pathway group was shorter than that in control group. There was statistical difference between them( P=0. 00). There was no statistical difference between them about medical care costs( P=0. 19). In pathway group, the constituent ratio of medical care cost was changed. The drug costs were decreased, but the treatment costs were increased. There was statistical difference among two groups about drug and treatment costs(P<0. 05). Compared to control group, the coefficient of variation in pathway group was smaller than control group, and the patient' s satisfactory degree was increased, but there was no obvious changes about complications after operation. Conclusions; Clinical pathway applied in our hospital standardizes medical treatment in the scheduled caesarean section.%目的:探讨卫生部试行的临床路径管理在我院计划性剖宫产中的应用效果.方法:选取185例已实施临床路径管理的计划性剖宫产孕妇(路径组)和96例未实施临床路径管理的计划性剖宫产孕妇(对照组),对两组孕妇的住院天数、各种住院费用、各项指标的变异系数和构成比,以及患者的满意度和术后并发症等指标进行综合比较分析.结果:路径组住院天数比对照组缩短,差异有高度统计学意义(P=0.00),但住院总费用两组比较,差异无统计学意义(P=0.19);对于住院总费用的构成变化,路径组

  10. [Anesthesia for caesarean section in a gravida with peripartum cardiomyopathy combined with acute heart failure: a case report].

    Science.gov (United States)

    Zeng, Hong; Li, Xiao-xi; Zhao, Wen-qiu; Feng, Xin-heng; Guo, Xiang-yang

    2012-10-18

    Peripartum cardiomyopathy(PPCM) is a rare but serious form of cardiac failure affecting women in the last month of pregnancy or early puerperium within six months. Clinical presentation of PPCM is similar to that of idiopathic dilated cardiomyopathy, and maternal mortality is high. An 18 year-old primigravida was admitted to our hospital at the end of forty-one weeks of gestation. She was diagnosed with PPCM complicated with heart failure. Preoperative optimization was done with a view to managing left ventricular failure. Continuous epidural anesthesia in the sitting position with lidocaine was used for cesarean section. The baby was delivered successfully. Intravenous furosemide 20 mg, morphine 10 mg, cedilanid 0.4 mg were given. Nitroglycerin and milinone infusions continued throughout the surgery titrated to the hemodynamics. The patient received inotropic agents, dieresis, vasodilators and anticoagulants post-operatively. Both the mother and the baby were discharged safely 9 days after operation.

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

    Science.gov (United States)

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

    2015-06-01

    to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. nationwide descriptive study. The Netherlands Perinatal Registry. 807,437 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008. primary outcome is the caesarean section rate. Vaginal instrumental childbirth, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics were associated with the caesarean section rate. the caesarean section rate increased from 6.2 to 8.3 per cent for nulliparous and from 0.8 to 1.1 per cent for multiparous women. After controlling for maternal characteristics the year by year increase in the caesarean section rate was still significant for nulliparous women (adj OR 1.03; 95% CI 1.02–1.03). The vaginal instrumental birth declined from 18.2 to 17.4 per cent for nulliparous women (multiparous women: 1.7–1.5 per cent). Augmentation of labour and/or pharmacological pain relief increased from 23.1 to 38.1 per cent for nulliparous women and from 5.4 to 9.6 per cent for multiparous women. the rise in augmentation of labour, pharmacological pain relief and electronic fetal monitoring in the period 2000–2008 among women in primary midwife-led care was accompanied by an increase in caesarean section rate for nulliparous women. The vaginal instrumental deliveries declined for both nulliparous and multiparous women. primary care midwives should evaluate whether they can strengthen the opportunities for nulliparous women to achieve a physiological birth, without augmentation or pharmacological pain relief. If such interventions are considered necessary to achieve a spontaneous vaginal birth, the current disadvantage of

  12. Comparison of the analgesic effects of intravenous magnesium sulfate infusion versus intrathecal fentanyl in patients with severe pre-eclampsia undergoing caesarean section

    Directory of Open Access Journals (Sweden)

    Ahmed Said Elgebaly

    2011-01-01

    Full Text Available Background : A double-blinded, prospective, randomized, controlled study was designed to determine the analgesic efficacy and tolerability of intravenous magnesium sulfate versus intrathecal fentanyl, in patients with severe pre-eclampsia, scheduled for caesarean section, under spinal anaesthesia. Materials and Methods : One hundred and five patients were randomly allocated to one of the three groups; the control group B received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine, the test group FB received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine plus 25 ΅g of preservative-free fentanyl and the test group MB received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine along with intravenous magnesium sulfate (6 gm iv as a loading dose over 20-30 minutes, followed by infusion of magnesium sulfate 2 gm per hour for 24 hours. Results : The time required for the first postoperative analgesic requirement was significantly more in groups FB and MB, as compared to the control group. (Group FB: 6.85 + 1.7 hours, group MB: 7.05 + 1.95 hours and Group B: 3.75 + 0.75 hours. This difference, however, was not significant between group FB and group MB. The frequency of postoperative analgesic requirement was significantly less in the FB and MB groups, as compared to the control group. (Control group: 3.9 + 0.5, group FB 2.3 + 0.25 and group MB: 2.5 + 0.4. Perioperative sedation was significantly higher in group FB as compared to group B and group MB. Nine patients in group FB had postoperative nausea and vomiting, whereas, none of the patients in the control group or group MB experienced this. This difference too was statistically significant. Conclusion : Intravenous magnesium sulfate and intrathecal fentanyl in the doses mentioned, increased the duration of postoperative analgesia in severely pre-eclamptic patients undergoing caesarean section under spinal anaesthesia; however, patients who received intravenous magnesium sulfate

  13. Clinical analysis of 39 cases of ectopic pregnancy in caesarean section scar%剖宫产疤痕部位妊娠39例诊治分析

    Institute of Scientific and Technical Information of China (English)

    赵松兰; 刘晓健; 李飞; 于红凤

    2011-01-01

    Objective To study the clinical characteristics, early diagnosis and effective treatment of pregnancy in caesarean section scar. Methods 39 cases of pregnancy in caesarean section scar treated in Jiangsu University Attached People's Hospital were retrospectively analyzed. Results All of the patients had undergone caesarean section at least once before pregnancy in caesarean scar, and they suffered vaginal bleeding of different severity after menolipsis. Pregnancy in caesarean section scar was suspicious by B-ultrasonography. There were 5 cases of hysterectomy, 15 cases of methotrexate chemotherapy, 6 cases of intervention and methotrexate chemotherapy, 6 cases of intervention, wedge resection of scar lesions in lower uterine segment and uterus neoplasty, and 7 cases of intervention, methotrexate chemotherapy, wedge resection of scar lesions in lower uterine segment and uterus neoplasty. Conclusion Once pregnancy in caesarean section scar is diagnosed, it should be interrupted in time so as to reduce the harmfulness of adverse pregnancy. Personalized treatment should be provided for different patients.%目的 探讨剖宫产疤痕部位妊娠的临床特点、早期诊断及适当的治疗方法.方法 分析就诊于江苏大学附属人民医院的39例剖宫产疤痕部位妊娠患者的临床资料及治疗结果.结果 39例患者均有剖宫产史,并都有不同程度停经后阴道流血史;患者经彩超检查显示有剖宫产疤痕部位妊娠可能.39例中有5例行子宫全切除术,15例行甲氨蝶呤化疗,6例行介入+甲氨蝶呤化疗,6例行介入+子宫下段疤痕病灶楔形切除术+子宫修补术,7例行介入+甲氨蝶呤化疗+子宫下段疤痕病灶楔形切除术+子宫修补术.结论 剖宫产疤痕部位妊娠的诊断一旦确认,应及时中止妊娠,从而降低不良妊娠带来的危害;并且要根据患者的具体情况给予个性化治疗.

  14. Survey on the conditions of caesarean section in three tertiary hospitals of Hohhot in 2001 and 2011%呼和浩特市三所三甲医院剖宫产情况十年前后对比研究

    Institute of Scientific and Technical Information of China (English)

    董瑞丽; 吉亚南; 刘文忠

    2015-01-01

    change of the delivery mode, change of indications for caesarean section in three tertiary hospitals of Hohhot in 2001 and 2011, also to analyze the related factors for caesarean section without medical indications to provide theoretical foundation for the administrative department of health policy. Methods To make retrospective analysis of the medical records of three tertiary hospitals in Hohhot which conformed to the study of the maternity hospital records in 2001 and 2011, to sum up the overall delivery modes between these two years, and according to the hospital obstetric birth registration, to select randomly 10% of medical records to record and analyze the general situation of maternal and child birth. Results (1) In three tertiary hospitals of Hohhot, the whole caesarean delivery rate was 30.4% in 2001, which rose to 46.2% in 2011, but the rate of vaginal midwifery (forceps and suction) and hip traction had a downward trend, which dropped respectively from 6.6% and 1.8% in 2001 to 0.4% and 0.5% in 2011. (2) In 2001, the top five of caesarean section indications were presented: fetal distress, pregnant women require caesarean delivery, breech presentation, cephalopelvic disproportion and others. In 2011, the top five of caesarean section indications: pregnant women require caesarean delivery, scared uterus, macrosomia, others, fetal distress. Compared the caesarean section indications of 10 years before and after: pregnant women asking for caesarean delivery, scared uterus and macrosomia with a trend of increase, fetal distress, abnormal labor, pelvic deformity, cephalopelvic disproportion with a downward trend, composition ratio difference was statistically significant; twins, gestational hypertension disease, pregnancy complications, placenta factor, breech presentation and other, there were no statistically significant difference. (3) In natural birth group as the control group, the regression analysis, age, with a certain economic income, primipara, highly

  15. Delivery mode of 167 cases of re pregnancy after caesarean section%剖宫产术后再次妊娠167例分娩方式分析

    Institute of Scientific and Technical Information of China (English)

    丁华

    2012-01-01

    目的 探讨剖宫产术后再次妊娠的分娩方式.方法 2006年12月-2011年12月对该院产科167例剖宫产术后再次妊娠孕妇的分娩情况进行回顾分析,并与同期首次剖宫产92例比较.结果 167例中108例进行阴道试产,成功75例(成功率69.4%),再次剖宫产33例,先兆宫破2例.再次剖宫产组比首次剖宫产组住院天数长,产后出血及盆腔黏连发生率较首次剖宫产组高,差异有显著性(P<0.05).结论 剖宫产术后再次妊娠并非剖宫产绝对指征,符合试产条件者可在严密监护下给予阴道试产.%Objective To analyze the delivery mode of the re-pregnant women after caesarean section. Methods We Retrospectively analyzed the delivery mode of 167 cases of the re-pregnant women after caesarean section( RCS ) between Dec. 2006 and Dec. 2011. At the same time, we compared those cases with the 92 cases of the first caesarean section( PCS ) in the same period. Results In 167 cases, 108 cases adopted trial of vaginal labor, with 75 successful cases( the success rate was 69.4% ),33 cases of re-caesarean section,2 cases of threatened rupture of uterus. The average days of hospitalization of the RCS were more than that of the PCS. The quantity of the post-partum hemorrhage and the rate of pelvic adhesion were more than those of the PCS, with statistical significance( P <0. 05 ). Conclusion Caesarean birth history is not the absolute indication of a caesarean birth. If the pregnant fits for the indications of vaginal trial production, vaginal delivery is possible under the intensive monitoring.

  16. Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score.

    Science.gov (United States)

    Arpino, Bruno; Cannas, Massimo

    2016-05-30

    This article focuses on the implementation of propensity score matching for clustered data. Different approaches to reduce bias due to cluster-level confounders are considered and compared using Monte Carlo simulations. We investigated methods that exploit the clustered structure of the data in two ways: in the estimation of the propensity score model (through the inclusion of fixed or random effects) or in the implementation of the matching algorithm. In addition to a pure within-cluster matching, we also assessed the performance of a new approach, 'preferential' within-cluster matching. This approach first searches for control units to be matched to treated units within the same cluster. If matching is not possible within-cluster, then the algorithm searches in other clusters. All considered approaches successfully reduced the bias due to the omission of a cluster-level confounder. The preferential within-cluster matching approach, combining the advantages of within-cluster and between-cluster matching, showed a relatively good performance both in the presence of big and small clusters, and it was often the best method. An important advantage of this approach is that it reduces the number of unmatched units as compared with a pure within-cluster matching. We applied these methods to the estimation of the effect of caesarean section on the Apgar score using birth register data. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Cost-effectiveness of caesarean sections in a post-conflict environment: a case study of Bunia, Democratic Republic of the Congo.

    Science.gov (United States)

    Deboutte, Danielle; O'Dempsey, Tim; Mann, Gillian; Faragher, Brian

    2013-07-01

    This paper demonstrates the feasibility of health services research in an unstable environment during the transition from crisis to development and its importance for future planning. Effectiveness and the cost of caesarean sections (CSs) were investigated in Bunia, a town affected by conflict and insecurity, in the Democratic Republic of the Congo (DRC) in 2008. The CS rate was 9.7 per cent of expected deliveries. All CSs in the study sample were emergency procedures. A humanitarian non-governmental organisation (NGO) hospital, offering free services, performed 75 per cent of all CSs. The estimated provider cost for CS in 2008 at this hospital was USD 103,514 (that is, USD 144 per CS). With a cost of between USD 3.8 and 9.2 per year of health adjusted life expectancy (HALE) gained, CSs at the NGO hospital were very cost-effective. The estimates give an indication of funding requirements to maintain adequate access to CS after the departure of the humanitarian organisation.

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

    Science.gov (United States)

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

    2009-09-01

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

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

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-02-01

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

  20. Influence of different delivery methods on re-pregnancy after caesarean section%疤痕子宫再次妊娠的分娩方式对母婴结局的影响

    Institute of Scientific and Technical Information of China (English)

    王莉; 刘柯玲; 徐丽丹

    2015-01-01

    Objective To discuss the influence of different delivery methods on re-pregnancy after Caesarean section.Methods Took retrospective analysis on the clinical data of 204 re-pregnant women after Caesarean section.Took an analysis on the delivery outcome, delivery related indexes and the outcome of newborn and ratings of Apgar of different delivery methods.Results The occurrence rates of puerperal infection and postpartum hemorrhage of the Caesarean section group are evidently higher than those of the vaginal delivery group ( P<0.05);the amount of bleeding during delivery and 2h after delivery, and the hospital stays of the Caesarean section group were higher than those of the vaginal delivery group ( P<0.05); the birth process time of the Caesarean section group was lower than that of the vaginal group ( P<0.05 ); the occurrence rate of newborn jaundice of the Caesarean section group was higher than that of the vaginal delivery group ( P <0.05 ). Conclusions Taking vaginal delivery can effectively reduce the occurrence rates of puerperal infection, postpartum hemorrhage, hospital stays and newborn jaundice for re-pregnancy after Caesarean section.Therefore, the vaginal delivery trial of labor should be considered clinically as much as possible in order to safeguard both mothers and babies.%目的:探讨不同分娩方式对剖宫产术后再次妊娠的影响。方法回顾性分析204例剖宫产术后再次妊娠分娩产妇的临床资料。分析不同分娩方式的分娩结局、分娩相关指标及新生儿结局、Apgar评分情况。结果剖宫产组产褥感染、产后大出血的发生率显著高于阴道分娩组( P<0.05);剖宫产组产时出血量、产后2h出血量及住院时间高于阴道分娩组(P<0.05);剖宫产组产程时间低于阴道分娩组(P<0.05);剖宫产组新生儿黄疸的发生率高于阴道分娩组(P<0.05)。结论行阴道分娩可以有效降低剖宫产术后再次妊娠产褥感

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

    Directory of Open Access Journals (Sweden)

    Ana Pilar Betrán

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

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

    Directory of Open Access Journals (Sweden)

    Jacob, Louis

    2016-06-01

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

  3. 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。

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

    Science.gov (United States)

    Affolter, Michael; Garcia-Rodenas, Clara L; Vinyes-Pares, Gerard; Jenni, Rosemarie; Roggero, Iris; Avanti-Nigro, Ornella; de Castro, Carlos Antonio; Zhao, Ai; Zhang, Yumei; Wang, Peiyu; Thakkar, Sagar K; Favre, Laurent

    2016-08-17

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

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

    Directory of Open Access Journals (Sweden)

    Michael Affolter

    2016-08-01

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

  6. Vaginal birth after a caesarean section : the development of a Western European population-based prediction model for deliveries at term

    NARCIS (Netherlands)

    Schoorel, E. N. C.; van Kuijk, S. M. J.; Melman, S.; Nijhuis, J. G.; Smits, L. J. M.; Aardenburg, R.; de Boer, K.; Delemarre, F. M. C.; van Dooren, I. M.; Franssen, M. T. M.; Kaplan, M.; Kleiverda, G.; Kuppens, S. M. I.; Kwee, A.; Lim, F. T. H.; Mol, B. W. J.; Roumen, F. J. M. E.; Sikkema, J. M.; Smid-Koopman, E.; Visser, H.; Woiski, M.; Hermens, R. P. M. G.; Scheepers, H. C. J.

    2014-01-01

    ObjectiveTo develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term. DesignRegistration-based retrospective cohort study. SettingFive uni

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

    Directory of Open Access Journals (Sweden)

    Manisha Gupta

    2016-12-01

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

  8. Effect on mother and child of eculizumab given before caesarean section in a patient with severe antiphospholipid syndrome

    Science.gov (United States)

    Gustavsen, Alice; Skattum, Lillemor; Bergseth, Grethe; Lorentzen, Bjorg; Floisand, Yngvar; Bosnes, Vidar; Mollnes, Tom Eirik; Barratt-Due, Andreas

    2017-01-01

    Abstract Rationale: Antiphospholipid syndrome (APS) in pregnancy may trigger the life-threatening catastrophic antiphospholipid syndrome (CAPS). Complement activation is implicated in the pathogenesis, and inhibition of complement factor C5 is suggested as an additional treatment option. Patient concerns, diagnosis and interventions: We present a pregnant patient treated with the C5-inhibitor eculizumab due to high risk of developing devastating APS-related complications. The complement inhibitory effects of the treatment were examined both in the patient and the premature infant. Outcomes: Complement activity in the mother recovered considerably faster than anticipated; however, no new thrombosis or CAPS developed during the last week of pregnancy or postpartum. Blood sampling from the umbilical vein and artery, and from the infant after delivery showed low complement activity; however, only 0.3% of the eculizumab concentration detected in the mother, consistent with low placental passage of eculizumab. Lessons: The data underscore the importance of close monitoring of complement inhibition and individualizing dosage regimens in pregnant patients receiving eculizumab. We document how traditional functional complement activity tests cannot assess the effect of eculizumab in premature infants due to the very low levels of complement factors detected in this infant born in gestational week 33. Only trace amounts of eculizumab passed the placenta. In conclusion, complement C5 inhibition might be a safe candidate treatment option for APS during pregnancy and delivery, and additionally, enables prolongation of pregnancy with important weeks. PMID:28296762

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

    Directory of Open Access Journals (Sweden)

    Kaundinya Kiran Bharatam

    2015-01-01

    Conclusion: Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy.

  10. Comparation on the Modiifed Abdominal Transerse Incision and Longitudinal Incision for Caesarean Section%改良腹式横切口与纵切口子宫下段剖宫产效果对比

    Institute of Scientific and Technical Information of China (English)

    王明仙

    2016-01-01

    目的探究改良腹式横切口与纵切口子宫下段剖宫产效果的对比。方法选取我院2012年3月~2015年9月收治的160例剖宫产产妇,根据剖宫手术切口不同可分为横切口组和纵切口组,分别采用改良腹式横切口和传统腹式纵切口进行剖宫产,比较两组临床效果。结果不同腹式切口下,横切口组平均开腹出血量、手术时间、术中出血量及术后排气时间均低于纵切口组,差异具有统计学意义(P<0.05)。结论相比较传统腹式纵切口,采用改良腹式横切口进行子宫下段剖宫产的手术效果更好。%Objective To compare the clinical effects of the modified abdominal transerse incision and longitudinal incision for caesarean section.Methods 160 parturient women were divided into two groups and given modified abdominal transverse incision and longitudinal incision of caesarean section respectively, who were treated in our hospital from March 2012 and September 2015, the clinical effects in the two groups were compared.Results Under different abdominal incision, the abdominal bleeding, operative time, blood loss and postoperative time in transverse incision group were signiifcantly reduced compared with the longitudinal incision group (P<0.05).Conclusion Compared with longitudinal incision, modified abdominal transverse incision of caesarean section is more effective.

  11. 术中应用保温措施防止剖宫产产妇寒颤%Intraoperative body-temperature maintenance to prevent shivering during Caesarean section

    Institute of Scientific and Technical Information of China (English)

    陈少娟; 郭雅梅; 赖梅; 黄素娟; 张莹

    2010-01-01

    目的 探讨术中应用积极的保温措施对防止剖宫产产妇低体温寒颤的影响.方法 选取拟行剖宫产产妇100例,随机分为保温组和对照组,每组50例.对照组术中按传统护理常规进行护理,保温组采用多种积极的综合保温措施.结果 低体温寒颤发生率对照组为60%,保温组16%,两组比较差异有显著性(P<0.05).结论 术中采取积极有效的保温措施有助于预防剖宫产产妇低体温寒颤的发生.%Objective To explore the effect of aggressive intraoperative body-temperature maintenance on prevention of hypothermia-induced shivering in puerperas during Caesarean section.Methods 100 puerperas undergoing Caesarean section were randomly assigned to receive routine intraoperaive nursing (50 puerperas, control group)or various aggressive approachs for body-temperature maintenance (50 puerperas, study group). Results The rate of hypothermia-induced shivering differed significantly between the control group and the study group (60% vs. 16%, P< 0.05). Conclusions Aggressive intraoperative body-temperature maintenance is helpful for preventing the occurrence of hypothermia-induced shivering in puerperas undergoing Caesarean section.

  12. Causes of poor wound healing after caesarean section and prevention countermeasures%剖宫产手术后切口愈合不良的原因分析及防治对策

    Institute of Scientific and Technical Information of China (English)

    冷应蓉; 黄冰; 查筑红; 刘伟; 游灿青; 潘浩; 李凌竹; 罗光英; 王平; 王敏; 程永素

    2012-01-01

    OBJECTIVE To explore the susceptible factors for the poor wound healing after the caesarean section so as to provide theoretical basis for formulating the prevention and treatment measures. METHODS The clinical data of the patients with poor wound healing who underwent the caesarean section from May 2011 to Apr 2012 were retrospectively analyzed . RESULTS Of totally 920 patients undergoing the caesarean section . the poor wound healing occurred in 18 cases with the incidence rate of 1. 96%. The shortest time of incision healing was five days, 30 days of the longest , and 18 days of the mean time. The age, diabetes,obesity ,and amount of intraoperative blood loss were the risk factors for the poor wound healing after the surgery. CONCLUSION The medical staff should rigidly implement the aseptic operations, try to avoid the susceptible factors for poor wound healing, and use antibiotics reasonably so as to effectively reduce the incidence of the poor wound healing after the caesarean section.%目的 探讨剖宫产术后切口愈合不良的易感因素,为制定防治措施提供理论依据.方法 回顾性分析医院2011年5月-2012年4月剖宫产术后愈合不良的病例资料.结果 920例剖宫产患者术后发生切口愈合不良18例,愈合不良率1.96%;切口愈合时间最短5 d,最长30 d,平均18 d;术后切口愈合不良与易感因素为患者年龄、糖尿病、肥胖、术中失血量.结论 医务人员严格执行无菌操作,尽量去除切口愈合不良的易感因素,合理使用抗菌药物,可有效降低剖宫产手术切口愈合不良的发病率.

  13. 不同麻醉方式对剖宫产术后腰背痛发生率的影响%Influence of different anesthetic methods on incidence rate of lumbago and backache after caesarean section

    Institute of Scientific and Technical Information of China (English)

    张国栋

    2014-01-01

    Objective To explore the influence of different anesthetic methods on incidence rate of lumbago and back-ache after caesarean section. Methods One hundred and twenty patients undergone caesarean section in our hospital were selected and divided into combined spinal epidural anesthesia group,lumbar anesthesia group and general anes-thesia group.The combined spinal epidural anesthesia,subarachnoid anaesthesia and general anesthesia was applied in combined spinal epidural anesthesia group,lumbar anesthesia group and general anesthesia group before caesarean sec-tion respectively.The operation time in three groups was recorded and occurrence of lumbago and backache among three groups was observed. Results There was no statistical difference in operation time among 3 groups (P>0.05).The incidence rate of lumbago and backache at the 2nd and 7th day after surgery in combined spinal epidural anesthesia group was higher than that in lumbar anesthesia group and general anesthesia group during the same period respective-ly,with statistical difference (P0.05). Conclusion The influence of subarachnoid anaesthesia and general anesthesia on lumbago and backache in patients after caesarean section are milder and are worthy of reference in clinic.%目的:探讨不同麻醉方式对剖宫产术后腰背痛发生率的影响。方法选择本院120例剖宫产术者分为腰硬联合组、腰麻组和全麻组,分别实施腰硬联合麻醉、蛛网膜下腔麻醉和全身麻醉后行剖宫产术,记录3组患者的手术时间,观察3组患者腰背痛的发生情况。结果3组患者的手术时间比较,差异无统计学意义(P>0.05)。腰硬联合组术后第2天和术后第7天的腰背痛发生率分别高于同期腰麻组和全麻组,差异有统计学意义(P0.05)。结论蛛网膜下腔麻醉和全身麻醉对剖宫产术后患者的腰背痛影响较小,值得临床借鉴。

  14. Caesarean delivery and risk of developing asthma in the offspring

    DEFF Research Database (Denmark)

    Werner, Anette; Ramlau-Hansen, Cecilia Høst; Jeppesen, Simone K

    2007-01-01

    AIM: To evaluate the association between caesarean section and risk of developing asthma. METHOD: We evaluated this association in a Danish cohort, comprising of 11,147 mothers and their babies of which 7119 mother-child pairs were included in the analyses. The mothers' reported asthma data...... on their children were linked to hospitalization records on mode of delivery. RESULTS: The adjusted odds ratio for developing asthma was 1.11 (95% CI, 0.88-1.39) for caesarean sections versus vaginal births. CONCLUSION: We found no evidence that children being delivered by caesarean section have an increased risk...

  15. Prevention and treatment of fat liquefaction of abdominal incision after caesarean section%剖宫产术后腹部切口脂肪液化的防治分析

    Institute of Scientific and Technical Information of China (English)

    梁秀红

    2011-01-01

    Objective To investigate the cause and preventive measures of fat liquefaction of abdominal incision after caesarean section. Methods Sixty-two cases of abdominal incision after caesarean section fat liquefaction between January 2008 and December 2010 were retrospectively analyzed. Results Obesity in 48 cases, 32 cases of gestational edema, prolonged labor in 24 cases, 8 cases of diabetes, anemia in 8 cases and 6 cases of cough. Conclusions The cesarean section incision fat liquefaction is related to obesity, pregnancy, edema, prolonged labor, diabetes, anemia, cough, and the length of incision time.%目的 探讨剖宫产术后腹部切口脂肪液化的原因及预防措施.方法 对我科2008年1月至2010年12月62例剖宫产术后发生腹部切口脂肪液化患者的临床资料进行回顾性分析.结果 62例患者中肥胖48例,妊娠水肿32例,滞产24例,糖尿病8例,贫血8例,咳嗽6例.结论 剖宫产术后切口脂肪液化与肥胖、妊娠水肿、滞产、糖尿病、贫血、咳嗽以及切口暴露时间长短有关.

  16. To analysis the therapeutic effect of myomectomy during the process of caesarean section%宫剖产术中行子宫肌瘤剔除术疗效分析

    Institute of Scientific and Technical Information of China (English)

    张瑜; 陈圣莲; 周兰云; 王敏; 沃玲

    2010-01-01

    目的 探讨在剖宫产术中行子宫肌瘤剔除的可行性.方法 回顾性分析208例妊娠合并子宫肌瘤患者,其中108例为行剖宫产及子宫肌瘤剔除术组(CM=caesarean section and myomectomy),100例为单纯行剖宫产术组即非剔除术组(NCM=caesarean section with no myomectomy),按单个瘤体最大直径分三个层次(φ0.05);②5.0 cm≤φ<8 cm时UM组与NUM组比较OT、OBL增加,LW、LT减少,差异显著(P<0.05);③φ≥8 cm UMR组与NUMR组比较OT、OBL增加, LW、LT减少,差异显著(P<0.05).结论 剖宫产术中行子宫肌瘤剔除虽有增加手术时间及出血量的可能,但可以促进产后子宫恢复并避免了二次手术痛苦,在患者病情许可下是安全可行的.

  17. 硬膜外麻醉和腰硬联合麻醉用于剖官产手术效果的比较%Comparison of Effect Between Spinal-epidural Anesthesia and Epidural Anesthesia in Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    韩雪初

    2015-01-01

    Objective To compare the effects between spinal-epidural anesthesia and epidural anesthesia in caesarean section so as to provide reference for clinical procedures. Methods 160 pregnant woman who underwent caesarean section in our hospital during July 2012 and November 2014 were divided into group A (n=80) in which epidural anesthesia was performed, and group B (n=80) in which spinal-epidural anesthesia was conducted. The anesthetic effects of were compared between the two groups. Re-sults The excellent and good rate was higher, 100%vs 85.0%, in the group A than in the group B with statistically significant dif-ference, P0.05. Onset time of anesthesia was shorter in the group B than in the group A,P0.05,乙组患者麻醉起效时间明显短于甲组,P<0.05。结论在剖宫产手术中采用腰硬联合麻醉操作方便,成功率高,具有使用价值。

  18. Study on Choice of Delivery Method of Scarred Uterus Re-pregnancy after Caesarean Section%探讨剖宫产术后瘢痕子宫再次妊娠分娩方式的选择

    Institute of Scientific and Technical Information of China (English)

    肖艳霞

    2016-01-01

    目的:探讨剖宫产术后瘢痕子宫再次妊娠分娩方式的选择。方法随机抽取2015年3月—2016年2月到该院住院并分娩的剖宫产术后瘢痕子宫再次妊娠的孕妇120例,对其临床分娩方式的选择、临床表现以及分娩结果等展开回顾性的分析。结果120例剖宫产术后瘢痕子宫再次妊娠的孕妇均于分娩前接受健康妊娠方式的知识宣教,之后共有66例孕妇主动选择阴道试产,占比55.0%(66/120),其余的54例孕妇仍选择剖宫产术进行再次分娩,占比45.0%(54/120)。结论经临床实践证明,剖宫产术后瘢痕子宫再次妊娠的孕妇在全面了解并符合阴道试产的适应证后,选择阴道试产的分娩方式比再行剖宫产术分娩的安全性和可行性要高得多,能更好地保障母儿的安全健康。%Objective To study the choice of delivery method of scarred uterus re-pregnancy after caesarean section. Methods 120 cases of pregnant women with scarred uterus after caesarean section hospitalized and giving birth in our hos-pital from March 2015 to February 2016 were randomly extracted and the choice of clinical delivery methods, clinical man-ifestations and delivery results were retrospectively analyzed. Results The 120 cases of patients received knowledge instruc-tion about healthy pregnant method before delivery, and then 66 cases of pregnant women actively chose trial of labor, ac-counting for 55.0% (66/120), and the other 54 cases still chose caesarean section for the second delivery, accounting for 45.0% (54/120). Conclusion The clinical practice proves that the safety and feasibility of the choice of the delivery method of trial of labor are much higher than those of the caesarean section delivery after the comprehensive understanding of trial of labor and conforming to the indications of trial of labor by patients with scarred uterus re-pregnancy after caesarean sec-tion, which can better ensure the maternal and child

  19. 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.

  20. The Experience of Using Holistic Nursing in Operation Room Nursing in Caesarean Section%整体护理模式在手术室剖宫产护理中的运用体会

    Institute of Scientific and Technical Information of China (English)

    李风芹

    2014-01-01

    Objective To explore the application effect of the whole nursing in operation room nursing in caesarean section. Methods 268 patients undergoing elective caesarean section were divided randomly into observation group and control group, 134 cases in each group, the control group received routine nursing mode, the observation group received holistic nursing mode, operation were compared between the two groups before and after the operation of heart rate and blood pressure of SAS score, anxiety index. Results In the observation group, preoperative and postoperative SAS score was significantly lower than that of the control group (P<0.01), heart rate and blood pressure were significantly lower than those of control group (P<0.01). Conclusion The implementation of holistic nursing care in operation room nursing in caesarean section, helps relieve maternal anxiety, maintain the heart rate and blood pressure stability, the women with the best physiological state of mind to accept and cooperate with operation.%目的:探讨整体护理模式在手术室剖宫产护理中的应用效果。方法将268例择期剖宫产产妇随机分成观察组及对照组,每组134例,对照组实施常规护理模式,观察组实施整体护理模式,比较两组产妇术前及术后焦虑指数SAS评分、术中心率及血压情况。结果观察组术前及术后SAS评分显著低于对照组(P<0.01),术中心率及血压显著低于对照组(P<0.01)。结论在手术室剖宫产护理中实施整体护理模式,有助于缓解产妇焦虑情绪,维持心率及血压稳定,使产妇以最佳生理心理状态接受和配合手术。

  1. Evaluation of application effect of clinical pathway in parturients with elective caesarean section%临床路径在择期剖宫产产妇中应用的效果评价

    Institute of Scientific and Technical Information of China (English)

    陈火明

    2012-01-01

    Objective To study the application effect of clinical pathway in patients with elective caesarean section. Methods 64 patients with elective caesarean section were divided into the control group and the research group with 32 patients in each group.The control group was nursed by routine way,while the research group was nursed by clinical pathway.The satisfaction degree with nursing,puerperal infection rate,postpartum hemorrhage rate and rate of breast feeding were compared between the two groups. Results The satisfaction degree with nursing in the research group was much higher than the control group.The rate of postpartum hemorrhage in the research group was much less than the control group.The rate of breast feeding in the research group was much higher than the control group.The rate of postpartum infection in the research group was much less than the control group. Conclusions Application of clinical pathway for patients with elective caesarean section is a scientific and reasonable health education method.%目的 研究临床路径在择期剖宫产术产妇中的应用效果.方法 将64例择期剖宫产术产妇随机分为对照组和研究组各32例,对照组采用传统方法进行健康教育,研究组采用临床路径进行健康教育.比较2组对护理工作的满意度、产后感染率、产后出血率及母乳喂养率.结果 研究组对护士工作满意度明显高于对照组,产后出血率明显低于对照组,母乳喂养率明显高于对照组,产后感染率明显低于对照组.结论 对择期剖宫产术产妇应用临床路径是一种科学合理的健康教育方法.

  2. Pregnancy outcomes in advanced maternal age pregnancies after taking measures to reduc-ing caesarean section rate%控制剖宫产率对高龄初产母婴结局影响的研究

    Institute of Scientific and Technical Information of China (English)

    曹冬如; 张小燕; 包狄

    2015-01-01

    Objective To compare pregnancy outcomes in advanced maternal age pregnancies after taking measures to reducing caesarean section rate. Method A total of 1062 pregnant women aged 35 years or older who gave birth in beijing haidian district maternal and children healthcare hospital from 2013 to 2014 were retrospectively studied. 490 Pregnant women aged 35 years and over delivered in 2014 were included in study group and those 572 patients delivered in 2013 were included in the control group. Pregnant complications,delivery mode,postpartum hemorrhage rate,neonatal asphyxia rate were compared in both groups. Result ①No statistically significant difference was ob-served in the frequency of premature rupture of membrane,gestational diabetes mellitus, placenta previa,uterine my-oma,hypertensive disorders, preterm birth, or macrosomia in both groups;②The caesarean section rate in study group was statistically significantly lower than that in the control group(51. 63%vs 68. 88%,P0. 05). Conclusion With the measures of strengthening prenatal and intrapartum care, it is possible to reducing the caesarean section rate in advanced maternal aged pregnancies.%目的:探讨采取控制剖宫产率相关措施对高龄初产妇母婴结局的影响。方法回顾性分析1062例高龄初产孕产妇临床资料,2014年分娩的490例高龄初产妇作为研究组,2013年分娩的高龄初产妇572例作为对照组,比较两组妊娠并发症、分娩方式、产后出血率、新生儿窒息率。结果①两组胎膜早破、妊娠期糖尿病、前置胎盘、子宫肌瘤、妊娠期高血压疾病、早产、巨大儿发生率差异无显著性(P>0.05);②研究组和对照组剖宫产率分别为51.63%、68.88%,两者比较差异有显著性(P0.05)。结论综合孕期和产时管理,将高龄初产孕妇剖宫产率控制在较合理的水平是可能的。

  3. A case-control study on post-caesarean endometritis-myometritis in Mozambique.

    Science.gov (United States)

    Libombo, A; Folgosa, E; Bergström, S

    1995-01-01

    Post-caesarean endometritis-myometritis (PCEM) was diagnosed in 49 Mozambican women. They were compared with 47 control women without signs of PCEM after caesarean section. The patients and controls were matched for age, parity and days post partum. Features of the socio-economic background and of past and current obstetric history were registered. Endocervical, intracavitary and blood cultures were carried out. Screening for syphilis seropositivity and HIV-1 and HIV-2 antibodies was performed. Socio-economic and obstetric background factors were similarly distributed in cases and referents, though previous caesarean section was less frequent among cases than among referents (OR 0.12). Moderate high-risk factors in existing antenatal card tended to be more frequent among cases than among referents (OR 3.29). Microbiological findings indicated more anaerobes in the vagina, in the endocervix and in the uterine cavity, though the differences only approached significance. It is concluded that women with PCEM in the setting studied expose few characteristic background features discriminating them from women with uneventful post-caesarean outcome. Further research efforts should be directed towards case-control studies with focus upon surgical factors and on a more comprehensive microbiology and serology approach.

  4. Discussion of interrupted circular suture dming caesarean section with placenta previa%前置胎盘剖宫产时环形间断缝合止血方法的探讨

    Institute of Scientific and Technical Information of China (English)

    张渺; 金燕志; 周子杰

    2001-01-01

    目的探讨环形间断缝合在前置胎盘剖宫产术时出血的止血效果。方法对54例前置胎盘剖宫产术病例进行总结。结果用环形间断缝合方法止血的9例病人手术时间少于子宫切除组(P<0.05),出血及输血少于子宫切除组,但无统计学差异(P>0.05),成功止血,保留子宫,且未发生术后合并症。结论环形间断缝合术是前置胎盘胎盘剥离面引起出血的有效止血方法之一。%Objective To discuss the value of interrupted circular suture in hemostasis of placenta previa during cesarean section. Methods We summarized 54 caesarean section patients with placenta previa. Results The hemostasis was succeeded in all of the 9 patients and uterus was retained without postpartum complications. The duration of operation was obviously shorter than that of hysterectomy( P<0.05). Bleeding and blood transfusion were less than that of hysterectomy, but without statistical difference (P>0.05). Conclusion Interrupted circular suture is one of the efficient methods in controlling postpartum bleeding during caesarean section with placenta previa.

  5. The Choice of Delivery Time and Delivery Mode of Pregnancy Again After Caesarean Section%剖腹产术后再次妊娠分娩时机及分娩方式的选择

    Institute of Scientific and Technical Information of China (English)

    林辉丽

    2015-01-01

    目的:探索剖宫产术后再次妊娠产妇分娩时间和分娩方式的选择。方法选择2012年1月~2015年1月于我院就诊的220例行剖宫产后再次妊娠的产妇作为研究对象,根据分娩方式不同而分为阴道分娩组(76例)和剖宫产组(144例),剖宫产组根据手术时机不同分为进入产程组(65例)和未进入产程组(79例),对其临床资料进行分析。结果阴道分娩组产妇产后出血和平均住院时间较剖宫产组减少, P<0.05,差异具有统计学意义;产妇产后感染率、新生儿感染率、新生儿窒息率较剖宫产组降低,P<0.05,差异具有统计学意义;进入产程组手术时间、产后出血量较未进入产程组减少,P<0.05,差异具有统计学意义;产妇产后感染率降低,P<0.05,差异具有统计学意义;2组新生儿感染率、新生儿窒息率比较,P>0.05,差异不具有统计学意义。结论再次妊娠产妇可根据自身情况在严密监测下选择经阴道试产,以改善妊娠结局,对于再次剖宫产者应掌握手术时机,提高分娩质量。%Objective To explore the choice of delivery time and delivery mode of the pregnant women after cesarean section. Methods Selected 220 cases with underwent cesarean section pregnancy maternal from January 2012 to January 2015 in our hospital as clinical research, according to the different modes divided into vaginal delivery group (76 cases) and caesarean section group (144 cases). The caesarean section group divided into stages of labor group (65 cases) and no stages of labor group (79 cases) as the different operation opportunity. Analyzed the clinical data. Results The vaginal delivery group of postpartum hemorrhage and the average hospitalization time is caesarean birth group was decreased, postpartum infection rate, neonatal morbidity and neonatal asphyxia rate was caesarean birth group decreased, P0.05, had no difference statistically

  6. Impact of Elective caesarean section and vaginal delivery on the term neonate respiratory distress syndrome%选择性剖宫产与阴道分娩对足月儿呼吸窘迫综合征发生的影响

    Institute of Scientific and Technical Information of China (English)

    刘萍

    2013-01-01

      目的:探讨选择性剖宫产与阴道分娩对足月儿呼吸窘迫综合征发生的影响。方法:选取我院妇产科2010年1月-2012年12月足月儿患者1236例,分析其剖宫产、选择性剖宫产发生率、阴道分娩与选择性剖宫产并发呼吸窘迫综合症发生率、不同孕周选择性剖宫产并发呼吸窘迫综合征发生率。结果:2012年剖宫产率(48.37%)、选择性剖宫产率(23.17%)明显高于2010年;选择性剖宫产并发 N RDS风险率(2.79%)明显高于阴道分娩组;37-38孕周选择性剖宫产并发 N RDS 风险率明显高于39-41孕周。结论:选择性剖宫产足月儿呼吸窘迫综合征发生风险明显增高,且随着胎龄增加逐渐降低。%Objective :To Discussion Impact of Elective caesarean section and vaginal delivery on the term neonate respiratory distress syndrome . Methods :Selected 1236 cases term neonates ,cesarean section rate ,elective caesarean section rate ,vaginal delivery and selective caesarean section and incidence of respiratory distress syndrome ,different gestational age selective cesarean section complicated with respiratory distress syndrome incidence were compared .Results :2012cesarean section rate (48 .37% ) ,elective caesarean section rate ,(23 .17% ) were significantly higher than in 2010 ;elec-tive caesarean section with NRDS risk rate (2 .79% ) were significantly higher than vaginal delivery group ;37 -38 gestational elective caesarean sec-tion with NRDS risk rate were significantly higher than 39 -41 gestational age .Conclusion:Elective caesarean section neonate respiratory distress syn-drome occurred significantly increased ,along with the gestational age increase gradually reduced .

  7. The definition, aetiology, presentation, diagnosis and management of previous caesarean scar defects.

    Science.gov (United States)

    Allornuvor, G F N; Xue, M; Zhu, X; Xu, D

    2013-11-01

    Caesarean sections are the most commonly performed surgical procedures involving the uterus in fertile women. Typically, this surgery involves a transverse incision in the anterior lower uterine segment. The incidence of caesarean sections is on the increase worldwide, and consequently, the complications associated with them are becoming more common. One such complication that is gaining more attention is previous lower uterine segment caesarean scar defect (PCSD). In this review, we sought to explore the definition, aetiology, presentation, diagnosis and management of PCSD.

  8. The Effect of Early Nursing Intervention on Postoperative abdominal Distension in Puerperas with Caesarean Section%剖腹产术后腹胀因素分析及护理

    Institute of Scientific and Technical Information of China (English)

    杨红

    2012-01-01

    Objective:To investigate the effect of early nursing intervention on postoperative abdominal distension in puerperas with caesarean section.Methods:214 cases of caesarean mothers from Jun. 2010 to Jun. 2011were selected and randomly divided into observation group(n=107) and control group (n=107). The control group was received usual care , analgesia and normal eating after anal discharge. The observation group was given earl nursing intervention, including diet guidance, abdominal massage to help patients turn over in bed and early mobilization guidance,etc..The anal exhaust time, incidences of abdominal distension and postoperative complications were observed and compared.Results:The anal exhaust time of the observation group was significantly shorter than that of the control group(P<0.05) and the incidences of abdominal distension and postoperative complications were significantly lower than those of the control group(P<0.05).Conclusion:Scientific nursing intervention after caesarean section can reduce abdominal distension and the incidence of postoperative complications in puerperas%目的:探讨及早护理干预对剖腹产术后产妇腹胀的影响.方法:选择2010年6月~2011年6月在我院住院剖腹产术后腹胀产妇214例,随机分为观察组(n=107)和对照组(n=107),对照组剖腹产术后进行常规护理、止痛,肛门排气后正常进食,观察组在常规护理基础上给予术前、术后早期护理干预,包括饮食、止痛、腹部按摩、早期活动指导等,对比观察两组产妇的肛门排气时间、腹胀发生率及术后并发症.结果:观察组的肛门排气时间明显少于对照组,腹胀、术后并发症发生率明显低于对照组,差异均有统计学意义(P<0.05).结论:剖腹产术后科学的护理干预能有效减少腹胀及术后并发症.

  9. 剖宫产至凶险型前置胎盘的临床治疗分析%Analysis of Clinical Treatment of Pernicious Placenta Previa Caused by Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    裴英桂

    2016-01-01

    Objective To discuss the treatment effect of pregnant women with pernicious placenta previa caused by caesare-an section by sorting out the clinical treatment data of them. Methods 48 cases of pregnant women with pernicious placenta previa caused by caesarean section admitted and treated in our hospital from January 2014 to January 2015 were selected as the research group, 48 cases of pregnant women with common placenta previa were selected as the control group, and the postpartum hemorrhage volumes and hysterectomy rates were compared between the two groups. Results The difference in the morbidity of adherent placenta between the research group and the control group was obvious with statistical signifi-cance, (60.41%vs 33.33%), P<0.05. Conclusion The morbidity of pernicious placenta previa caused by caesarean section is lower, and the postoperative hemorrhage volume of it is obviously higher than that of common placenta previa, and we had better treat the pregnant women with pernicious placenta previa caused by caesarean section by total hysterectomy in order to ensure the life safety of them.%目的:整理该院剖宫产至凶险型前置胎盘孕产妇的临床治疗资料,探讨剖宫产至凶险型前置胎盘孕产妇的治疗效果。方法整群选取该院2014年1月—2015年1月收治的48例剖宫产至凶险型前置胎盘孕产妇,将其作为研究组,另选48例普通前置胎盘孕产妇作为对照组,比较两组孕产妇的产后出血量以及子宫切除率。结果研究组孕产妇出现胎盘粘连率为60.41%,对比组孕产妇出现胎盘粘连率为33.33%,两组患者的胎盘粘连发病率差异有统计学意义(P<0.05)。结论剖宫产至凶险型前置胎盘的发病率较低,在术后出血量上明显的高于普通前置胎盘,对出现凶险型前置胎盘的孕产妇宜进行子宫全切治疗,以保证孕产妇的生命安全。

  10. 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.

  11. Performance of a closed-loop feedback computer-controlled infusion system for maintaining blood pressure during spinal anaesthesia for caesarean section: a randomized controlled comparison of norepinephrine versus phenylephrine.

    Science.gov (United States)

    Ngan Kee, Warwick D; Khaw, Kim S; Tam, Yuk-Ho; Ng, Floria F; Lee, Shara W

    2017-06-01

    Closed-loop feedback computer-controlled vasopressor infusion has been previously described for maintaining blood pressure during spinal anaesthesia for caesarean section but there are limited data available comparing the relative performance of different vasopressors. The aim of this study was to compare the performance of norepinephrine versus phenylephrine in this system. Data from a randomized, two-arm parallel group, double-blinded controlled trial were reanalyzed. 104 patients scheduled for elective caesarean section under spinal anaesthesia were randomized to receive computer-controlled closed-loop infusion of either norepinephrine 5 µg ml(-1) or phenylephrine 100 µg ml(-1). This was started immediately after induction of spinal anaesthesia and used an algorithm designed to maintain systolic blood pressure near baseline until fetal delivery. Performance error calculations were used to compare the performance of the two vasopressors. The primary outcome was defined as the median absolute performance error. Median performance error, wobble and divergence were also compared. Median absolute performance error was smaller in the norepinephrine group (median 3.79 [interquartile range 2.82-5.17] %) versus the phenylephrine group (4.70 [3.23-6.57] %, P = 0.028). In addition, median performance error was smaller (0.75 [-1.56-2.52] %) versus 2.61 [0.83-4.57] %, P = 0.002) and wobble was smaller (2.85 [2.07-5.17] %) versus 3.39 [2.62-4.90] %, P = 0.028) in the norepinephrine group versus the phenylephrine group. Divergence was similar between groups. The precision of the control of blood pressure was greater with norepinephrine compared with phenylephrine at the drug concentrations used.

  12. 50例剖腹产术中出血的临床分析与预防措施%50 Cases Clinical Analysis of Blood Loss During Caesarean Section and Preventive Measures

    Institute of Scientific and Technical Information of China (English)

    刘青建; 刘彩萍

    2013-01-01

    目的:探讨分析剖腹产术中出血的原因,并根据这些原因制定有针对性地预防措施,从而降低孕妇剖产术中出血的发生率。方法:回顾性分析2012年1月-2013年4月本院收治的50例剖腹产患者的临床资料,所有患者在剖腹产手术过程中发生出血,根据患者的具体情况,手术中采取药物治疗、缝扎止血、子宫切除、结扎子宫动脉上行支等治疗止血措施,分析患者发生术中出血的原因,并根据这些原因总结有针对性的预防措施。结果:50例剖腹产术中的出血患者,11例患者因胎盘因素发生术中出血,占22.0%;9例患者因凝血障碍发生术中出血,占18.0%;17例患者因宫缩乏力发生术中出血,占34.0%;6例患者因子宫肌瘤发生术中出血,占12.0%,7例患者因切口撕裂发生术中出血,占14.0%。对所有剖腹产术中出血患者给予对症处理之后患者生命体征稳定,无死亡病例。结论:胎盘因素、凝血障碍、宫缩乏力、子宫肌瘤、切口撕裂剖是剖腹产术中出血的主要原因,在临床治疗中,应该根据患者的病情、分析出血原因,同时结合医疗条件,制定科学的剖腹产术中出血的止血方案,保证母婴的安全。%Objective:To investigate the cause of bleeding caesarean section,and in accordance with these reasons to develop targeted prevention measures in order to reduce maternal bleeding incidence production profile.Method:A retrospective analysis of 50 patients with clinical data caesarean section from January 2012 to April 2013 in our hospital,all patients bleeding occurred during caesarean section,according to the specific circumstances of the patient,all patients were taken drug treatment,hemostasis,hysterectomy,ascending uterine artery ligation treatment measures of hemostasis in operation,the cause of hemorrhage occurred in patients were analyzed,and according to these reasons of targeted

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

    Directory of Open Access Journals (Sweden)

    Kidanto Hussein L

    2009-07-01

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

  14. Effect of Betamethasone on Neonatal Outcomes in Twin Pregnancies Delivered by Elective Caesarean Section%倍他米松对双胎择期剖宫产新生儿结局作用探讨

    Institute of Scientific and Technical Information of China (English)

    高岩; 杜晓红; 董江华; 周羽

    2013-01-01

    Objective:To explore the impact of antenatal betamethasone on neonatal morbidity and mortality in twin pregnancies delivered by elective prelabor caesarean section.Methods:The clinical data of 72 cases of twin pregnancies (study group) delivered by elective prelabor caesarean section from January 2011 to February 2012 in Sichuan Provincial Hospital for Women and Children were retrospectively analyzed.156 cases of singleton pregnancies delivered by elective prelabor caesarean section at same period were included as control group.Both singletons and twins caesarean delivery were undertaken electively only after prophylactic antenatal betamethasone administration.The neonatal outcomes were compared between the two groups.Results:There was no difference between the distribution of gestational age and the mean gestational age(P >0.05).The birth weight in study group was lower than that in control group,the difference was statistically significant(P < 0.05).There was no difference between the groups in Apgar scores,neonatal deaths,and morbidity of neonatal diseases such as NRDS(2.78% & 2.56%),PPHN(0.69% & 1.28%),IVH(2.78% & 3.21%),NEC(2.08% & 1.28%).The proportion of NICU and hospital stays in NICU in research group was significantly higher than that in control group (P < 0.05).Conclusions:Antenatal betamethasone for the prevention neonatal morbidity and mortality in twins after elective prelabor caesarean section is as effective as singletons.%目的:探讨倍他米松对双胎妊娠择期剖宫产新生儿结局的影响.方法:对2011年1月至2012年2月在四川省妇幼保健院临产前行择期剖宫产的72例双胎妊娠(研究组)临床资料进行回顾性分析,选择同期156例单胎妊娠作为对照组,两组患者剖宫产前均常规预防性使用倍他米松,比较两组新生儿结局.结果:两组在分娩孕周分布、平均孕周比较,差异无统计学意义(P>0.05);但研究组新生儿体重低于对照

  15. 妊娠急性脂肪肝剖宫产术患者临床护理体会%Nursing care for caesarean section in patients with acute fatty liver of pregnancy

    Institute of Scientific and Technical Information of China (English)

    王丽文; 熊号峰; 张红宇; 张丽; 刘景院

    2014-01-01

    Objective To discuss the nursing care methods for emergency caesarean section in patients with acute fatty liver of pregnancy. Methods Retrospective analysis of clinical characteristics and nursing care of patients with AFLP was receiving cesarean section in our hospital from January 1996 to January 2012. Results Nineteen cases were involved in this research who aged (27.9 ± 3.5) years old. Primipara accounted for 73.7%. Symptoms include malaise, nausea, vomiting and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia and acute renal injury. After admission, we gave fetal monitoring closely, mental intervention, watching closely postoperative especially for postpartum hemorrhage and infection prophylaxis, there were two maternal deaths (10.5%), but no fetal deaths. conclusions AFLP is a rare but life-threatening complication in late pregnancy. General nursing care methods would be helpful for the management of emergency caesarean section in patients with acute fatty liver of pregnancy.%目的:探讨妊娠急性脂肪肝剖宫产术患者围手术期护理特点。方法选择1996年1月至2012年1月本院行剖宫产手术的AFLP患者剖宫产手术围手术期护理经验进行总结。结果共计19例患者纳入研究,平均年龄(27.9±3.5)岁,其中初产妇14例(73.7%)前驱症状为乏力、纳差、恶心、呕吐、黄疸。实验室检查示肝功能异常、凝血功能障碍、白细胞升高、肾功能损伤等。入院后密切进行胎儿监测、对围手术期孕产妇进行心理干预,在术后密切注意产后出血的观察和护理,同时加强产后护理,预防感染等护理措施干预后,产妇死亡2例(10.5%),无围产儿死亡。结论对妊娠急性脂肪肝围手术期患者采取综合护理措施,对于改善预后起到积极的帮助。

  16. 剖宫产产妇术后早期乳房按摩护理对乳汁分泌的影响%Influence of postoperative early breasts massage nursing on lactation of parturient underwent caesarean section

    Institute of Scientific and Technical Information of China (English)

    钱春华

    2013-01-01

    Objective To explore the influence of postoperative early breasts massage nursing on lactation of parturient underwent caesarean section. Methods 114 parturients underwent caesarean section selected in our hospital from January to March 2013 were randomly divided into the control group in 57 cases and the observation group in 57 cases.The observation group were given early breasts massage nursing on the basis of conventional care. Results The initial time of lactation in the observation group was significantly earlier than that in the control group,and the incidence of postpartum galactostasis in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05). Conclusion Early breast massage after cesarean section is simple,easy to learn, and can effectively promote early lactation,and it is worth popularizing in obstetrics.%目的:探讨剖宫产产妇术后早期乳房按摩护理对乳汁分泌的影响。方法选择我院2013年1~3月行剖宫产的产妇114例,随机分为对照组和观察组,每组各57例,在常规护理基础上,对观察组产妇早期进行乳房按摩护理。结果观察组产妇的泌乳始动时间明显早于对照组,观察组产妇产后乳汁淤积发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论剖宫产术后早期乳房按摩手法简便、便于掌握,可有效促进早期泌乳,值得在产科进行推广。

  17. Effects of epidural fentanyl for caesarean section on pulse oxygen saturation of neonates%芬太尼硬膜外注射对剖宫产新生儿脉搏氧饱和度的影响

    Institute of Scientific and Technical Information of China (English)

    曾令全; 李频; 朱长江; 魏安宁

    2008-01-01

    目的 研究芬太尼、利多卡因联合应用于剖宫产术麻醉对新生儿脉搏氧饱和度的影响.方法 将40例产妇随机分为两组,芬太尼组(n=20)采用芬太尼、利多卡因联合硬膜外腔麻醉,常规组(n=20)采用单纯利多卡因硬膜外麻醉,记录手术开始及胎儿娩出的时间,术前及术毕麻醉平面、麻醉效果、新生儿娩出后1、5 min时Apgar评分,新生儿的脉搏血氧饱和度及心率.结果 芬太尼组麻醉效果较完善(P<0.01),两组手术过程及麻醉平面,新生儿娩出后1、5 min时Apgar评分、脉搏血氧饱和度及心率差异均无统计学意义(P>0.05).结论 芬太尼、利多卡因联合硬膜外阻滞能够提高镇痛时效,对新生儿脉搏氧饱和度无影响.%Objective To evaluate the effects of epidural fentanyl combined with lidocaine for caesarean section on pulse oxygen saturation of neonates. Methods Forty pregnancy parturients were randomly divided into two groups :fentanyl group (n = 20 ) and routine group (n = 20 ). The parturients received lidocaine. In group fentanyl,fentanyl 1 ml(50 μg) was injected. In group routine,normal saline 1 ml was injected. The neonatal Apgar score, duration of labor, analgetic effects, anaesthesia plane, pulse oxygen saturation and heat rates of neonates were observed. Results The analgetic effects in group fentanyl were more perfect than in group routine ( P < 0.01 ), however, the others items had no difference in two groups. Conclusion The addition of fentanyl (50 μg epidurally) can significantly improve the anesthetic quality during caesarean section at the same time no effect on pulse oxygen saturation of neonates.

  18. 连续助产护理模式对初产妇剖宫产率的影响%The clinical influence of continuous midwifery nursing on caesarean section rate of unipara

    Institute of Scientific and Technical Information of China (English)

    罗玉媚; 利伟江

    2015-01-01

    Objective:To explore the clinical influence of continuous midwifery nursing on caesarean section rate of unipara. Methods:220 cases of unipara with relative contraindication indications of vaginal delivery were randomly divided into observation group and control group. Control group was given routine midwifery nursing,and observation group was given continuous midwifery nursing. Results:Caesarean section rate,time of first stage labor,blooding amount during the delivery in experimental group were significantly lower than that in control group,nursing satisfaction was significantly higher than that in control group (P < 0. 05). Conclusion:Continuous midwifery nursing used for unipara that trying to vaginal delivery,can let unipara enjoy more continuous and proper physical and mental support,and maintain more steadier physical and mental support,so it deserves considering in clinical work.%目的::探讨连续助产护理模式对初产妇剖宫产率的影响。方法:将具有顺产相对禁忌指征的220例初产妇随机等分为观察组和对照组,所有患者均行阴道试产,对照组给予常规护理,观察组实施连续助产护理。比较两组患者的剖宫产情况、第一产程时间、产时出血量及护理满意度。结果:观察组剖宫产率、第一产程时间和产时出血量均显著低于对照组,护理满意度显著高于对照组(P <0.05)。两组产妇在分娩期间均未出现严重并发症,新生儿均顺利存活。结论:对于试行顺产的初产妇实施连续助产护理,能够让产妇得到更为连续的、合适的身心支持,从而维持相对更为稳定的身心状态,并降低剖宫产率,值得临床推广应用。

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

    Directory of Open Access Journals (Sweden)

    Tuhin Mistry

    2015-01-01

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

  20. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend.

    LENUS (Irish Health Repository)

    Unterscheider, J

    2011-08-01

    To audit caesarean sections performed at full cervical dilatation over a three year period in a tertiary referral centre in Ireland. To evaluate (i) the rate of caesarean deliveries in the second stage of labour, (ii) the indication for delivery and (iii) the associated fetal and maternal morbidity in this cohort of women.

  1. Ultrasound observation of uterine lower segment in metaphase and later period pregnancy again after a caesarean section%剖宫产后再次妊娠中晚孕期子宫下段的超声观察

    Institute of Scientific and Technical Information of China (English)

    郭锐

    2014-01-01

    目的:探究剖宫产后再次妊娠中晚孕期子宫下段的超声表现。方法产检妊娠中晚期孕妇1230例,按妊娠情况分为三组, A组为剖宫产后再次妊娠孕妇430例, B组为初产妇400例, C组为顺产后再次妊娠孕妇400例,对所有孕妇进行子宫下段超声监测与检查,对检查结果进行分析。结果三组子宫下段肌层测量值:A组[(3.5±1.2)mm,20~24周],[(1.8±0.6)mm,>36周];B组[(4.4±1.5)mm,20~24周],[(2.0±0.5)mm,>36周];C组[(6.0±1.2)mm,20~24周],[(2.8±0.9)mm,>36周];A组术前提示肌层消失5例, A组子宫下段肌层测量值低于B组、C组,差异具有统计学意义(P36 weeks]; group B [(4.4±1.5) mm, 20~24 weeks] [(2.0±0.5) mm, >36 weeks]; group C [(6.0±1.2) mm, 20~24 weeks] [(2.8±0.9) mm, >36 weeks]. There were 5 cases of muscular disappear before surgery in group A. Uterine segment measurement values of group A were significantly lower than group B and group C, and the difference was statistically significant (P<0.05). Transabdominal ultrasonography showed scar location was echogenic, muscle ill-defined, hypoechoic myometrium significant local thinning. All cases in group A were performed caesarean delivery, and there were 5 cases of uterine surgery threatened rupture and 50 cases of local thin.Conclusion Ultrasound examination of uterine lower segment metaphase and later period pregnancy again after a caesarean section can timely detect risk factors, and has important clinical significance.

  2. 三种麻醉方式在剖宫产术中的效果比较及对胎儿的影响%Effect comparison of three anesthesia methods in caesarean section and its influence on infants

    Institute of Scientific and Technical Information of China (English)

    刘碧华; 蒲江北

    2012-01-01

    Objective To compare the effect of epidural anesthesia, combined spinal-epidural anesthesia and general anesthesia in caesarean section and its influence on infants. Methods 210 pregnant women were divided into group E (epidural anesthesia), group C (combined spinal-epidural anesthesia) and group I (general anesthesia) with 70 patients in each group. The onset time of anaesthesia, Apgar and NBNA scores of newborn and adverse reaction were compared between three groups. Results The onset time of anaesthesia in group E was much slower than that in group C and group I (P 0.05); Apgar and NBNA scores of newborn and adverse reaction were no statistical difference among three groups (P > 0.05). Conclusion Combined spinal-epidural anesthesia is an ideal anesthesia method in caesarean with short onset time and a good effect. Three methods all have no influence for newborn.%目的 比较单纯硬膜外麻醉、腰麻-硬膜外联合麻醉和全身麻醉在剖宫产术的麻醉效果及对胎儿的影响.方法 将本院行剖宫产的210例孕妇分为E组(单纯硬膜外麻醉)、C组(腰麻-硬膜外联合麻醉)和I组(静脉麻醉),比较三组麻醉起效时间、麻醉阻滞效果、新生儿Apgar评分和NBNA评分以及不良反应.结果 三组麻醉起效时间从慢到快依次为E组、C组和I组,差异有统计学意义(P 0.05);三组新生儿Apgar评分、NBNA评分和不良反应发生率比较,差异无统计学意义(P > 0.05).结论 腰麻-硬膜外联合麻醉起效时间短,麻醉效果佳,是剖宫产的理想麻醉方法,三组麻醉方法对新生儿均无不良影响.

  3. Caesarean delivery scar pregnancy [CDSP]: A case report

    Directory of Open Access Journals (Sweden)

    Purnima Deb

    2011-10-01

    Full Text Available Caesarean scar pregnancy is a rare form of ectopic pregnancy. It is a dangerous condition that can potentially lead to uterine rupture and severe haemorrhage or even a secondary abdominal pregnancy. If it progress further in pregnancy it is likely to present as placenta accrete/increta with a high morbidity and mortality. Its early diagnosis can be challenging, and the optimal treatment has not been determined. We report a case of an ectopic pregnancy in a caesarean section scar, which was initially misdiagnosed despite using ultrasound. Although the use of ultrasound in combination with serum levels of human chorionic gonadotrophin [hCG] in the diagnosis of ectopic pregnancy is well established, the diagnosis of a rare kind remains diffi cult. However, early diagnosis allows appropriate management planning to preserve uterine integrity and future fertility. The surgical treatment includes curettage, laparoscopy, laparotomy with hysterotomy and excision of the gestational mass. A medical approach with systemic and /or intralesional methotrexate application, oral mifepristone and possibly local injection of potassium chloride or tricosanthin has been proposed by itself, or combined with surgical procedures.

  4. 咪达唑仑对剖宫产术初产妇情绪和记忆的影响%Emotion and memory effects of midazolam on primipara undergoing caesarean section

    Institute of Scientific and Technical Information of China (English)

    谭菁瑜; 董庆龙; 欧阳葆怡

    2007-01-01

    目的 探讨咪达唑仑对剖宫产手术产妇情绪和记忆的影响.方法 72例择期剖宫产术产妇随机分成4组,Ⅰ、Ⅱ和Ⅲ组麻醉前30 min分别肌注咪达唑仑0.05、0.06和0.07 mg/kg,Ⅳ组肌注生理盐水1.5 ml,同时肌肉注射阿托品0.01 mg/kg.于注药前和注药后30 min进行焦虑视觉类比试验(AVAT)、状态焦虑问卷(SAI)测试及Ramsay镇静水平评估.将麻醉准备到手术结束过程分为5阶段,每项告知产妇,记录剖宫产术后4 h产妇能准确回忆的项目.结果 注药后30 min时,Ⅰ~Ⅲ组AVAT分别下降36.4%、43.2%和43.1%;SAI分别下降20.9%、24.8%和26.9%,均获得Ramsay 2~4级镇静水平.Ⅰ~Ⅲ组和Ⅳ组比较记忆保留组间差异均有统计学意义(P均<0.01).Ⅰ~Ⅲ组以遗忘静脉穿刺过程的居多,4组产妇对椎管内麻醉穿刺和新生儿娩出后性别识别两过程全部记忆完觋整.结论 剖宫产手术前给予咪达唑仑0.05~0.07 mg/kg,对产妇有良好的镇静和抗焦虑作用,对外显记忆有一定程度的影响,其中对信息量小和关注程度低的信息能产生顺行性遗忘作用,能保留信息量大和关注程度高的信息的完整记忆.%Objective To investigate the emotion and memory effects of midazolam as a premedication on primipara undergoing caesarean section. Methods Seventy-two primiparous women scheduled for elective caesarean section were randomly divided into four groups. In group Ⅰ,Ⅱand Ⅲ,intramuscular midazolam 0.05 mg/kg,0.06 mg/kg and 0.07 mg/kg were given respectively. The primiparae in group Ⅳ were given intramuscular normal saline 1.5 ml. Anxiety vision analogy test(AVAT) , state anxiety index testing(SAIT) and Ramsay score were evaluated before and 30 min after injection of above drugs. The primiparae were informed when several stages of anesthesia and surgery began. Four hours after the caesarean section they would recall those stages. Accurate remembrance was recorded. Results Thirty minutes

  5. Anesthesia management of caesarean section for pregnant women complicated with Takayasu’s arteritis%合并大动脉炎产妇行剖宫产术的围术期管理

    Institute of Scientific and Technical Information of China (English)

    孙杰; 曾鸿; 王永清; 赵扬玉

    2016-01-01

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

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

    Science.gov (United States)

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

    2012-03-01

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

  7. Caesarean section and adiposity at 6, 18 and 30 years of age: results from three Pelotas (Brazil) birth cohorts.

    Science.gov (United States)

    Barros, Aluisio J D; Santos, Leonardo Pozza; Wehrmeister, Fernando; Motta, Janaina Vieira Dos Santos; Matijasevich, Alicia; Santos, Ina S; Menezes, Ana M B; Gonçalves, Helen; Assunção, Maria Cecília Formoso; Horta, Bernardo L; Barros, Fernando C

    2017-03-14

    Association between caesarian section (C-section) and obesity is controversial and mostly based on body mass index (BMI), which has inherent limitations. Using direct estimates of body fat mass, we aimed to assess the association between C-section and adiposity using fat mass index and BMI z-score in three birth cohort studies from Pelotas, Brazil. We measured weight, height and fat mass (using dual X-ray absorptiometry (DXA)) at ages 6, 18 and 30 years among participants in the 2004, 1993 and 1982 population-based Pelotas Birth Cohort Studies, respectively. We used multiple linear regression analysis to examine the crude and adjusted association between C-section and the body composition indicators. We also modelled height as an outcome to explore the presence of residual confounding. We observed that fat mass index and BMI z-score were strongly and positively associated with C-section in the crude analysis. However, when we adjusted for socioeconomic characteristics, maternal BMI, parity, age and smoking during pregnancy, effect estimates were attenuated towards the null, except for 30-year-old women. In those women from the 1982 cohort, C-section remained associated with fat mass index (β = 0.82; CI95% 0.32;1.32) and BMI z-score (β = 0.15; CI95% 0.03;0.28), even after adjusting for all potential confounders, suggesting an increase in fat mass index and BMI at 30 years among those born by C-section. We found no consistent association of C-section with fat mass index measured by DXA and BMI z-score in individuals aged 6, 18 and 30 years, except for women in the latter group, which might be explained by residual confounding. Confounding by socioeconomic and maternal characteristics accounted for all the other associations.

  8. Progress in diagnosis and treatment of caesarean scars pregnancy%剖宫产术后子宫瘢痕妊娠的诊治进展

    Institute of Scientific and Technical Information of China (English)

    李静玲(综述); 胡晓霞(审校)

    2014-01-01

    Caesarean scar pregnancy(CSP)is one of the rare ectopic pregnancy.With the increasing of cae-sarean section rates ,the incidence of caesarean scar pregnancy tends to rise .The pathogenesis of caesarean scar preg-nancy is unknown ,diagnosis has no unified standard ,and the misdiagnosis rate is high .Clinical treatment also remains controversial .This review focused on the research progress in diagnosis and treatment of caesarean scar pregnancy .%剖宫产术后子宫瘢痕妊娠是一种罕见的异位妊娠,近年来随着剖宫产率的增加,发病率也呈逐年增长的趋势,该病发病机制迄今尚未阐明,诊断方面尚无统一标准,误诊率高,临床治疗也尚存争议。现就其诊断与治疗的研究进展作一综述。

  9. Influence of caesarean section on vertical transmission of infectious pathogens%感染性疾病垂直传播的预防

    Institute of Scientific and Technical Information of China (English)

    郝祥云

    2011-01-01

    综述了几种可以通过产道感染的病原体,通过剖宫产术可降低新生儿感染率.%It reviewed several pathogens which can be infected through the birth canal, and introduced the cesarean section can reduce neonatal infection rates.

  10. Post operatory analgesia in caesarean surgery.

    Directory of Open Access Journals (Sweden)

    Bárbara Lucía Cabezas Poblet

    2003-12-01

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  11. 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.

  12. 不同麻醉方法用于剖宫产术的成本分析%Cost of continuous epidural anesthesia and general anesthesia for caesarean section

    Institute of Scientific and Technical Information of China (English)

    许敏; 魏昕; 柴小青; 潘建辉

    2014-01-01

    目的:比较分析剖宫产中应用椎管内麻醉或全身麻醉的成本消耗,为医疗成本运作和医疗政策制定提供临床参考数据。方法回顾我院择期行子宫下段剖宫产术的患者(212例),按其接受的麻醉方法分为椎管内麻醉组(连续硬膜外麻醉,SA组,106例)及全身麻醉组(喉罩下全麻,GA组,106例),对麻醉的直接成本进行了评估。从麻醉数据库中统计麻醉中使用的药品及耗材,根据麻醉相关时间及麻醉人员薪酬计算人员成本,并计算相关比例。结果剖宫产中应用全身麻醉直接麻醉成本及非人员麻醉成本均高于连续硬膜外麻醉(P<0.05),人员成本则是连续硬膜外麻醉高于全身麻醉(P<0.05),全身麻醉的药品及耗材成本明显高于连续硬膜外麻醉(P<0.05),连续硬膜外麻醉的诱导时间及持续时间较长(P<0.05),两组患者术后住院天数差异无统计学意义(P>0.05)。结论椎管内麻醉的直接成本较低,但是人员成本相对较高。麻醉方法的选择并不影响患者术后住院天数。%Objective To analyze the costs of continuous epidural anesthesia and general anesthesia for caesarean section and pro-vide clinical reference data for health behaviors and health policy makers.Methods The clinical data of 212 patients (aged 22~35 years) who received elective cesarean section surgery from to July to December in 2012 in our hospital were retrospectively analysed.The patients were divided into the spinal anesthesia group(continuous epidural anesthesia,SA group,n=106)and the general anesthesia group(LMA un-der general anesthesia,GA group,n=106 )according to their method of anesthesia.Direct costs were measured on detailed data of the re-sources used during anaesthetic procedures from the anesthesia record.Costs related to anaesthetic staff work were calculated based on per ca-pita remuneration and duration of

  13. Section on High Resolution Optical Imaging (HROI)

    Data.gov (United States)

    Federal Laboratory Consortium — The Section on High Resolution Optical Imaging (HROI) develops novel technologies for studying biological processes at unprecedented speed and resolution. Research...

  14. Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

    Directory of Open Access Journals (Sweden)

    Tapobrata Mitra

    2014-01-01

    Full Text Available Background: Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer′s lactate (RL or tetrastarch hydroxyethyl starch (HES or succinylated gelatin (SG in the patients undergoing cesarean section under spinal anesthesia. Materials and Methods: It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP, oxygen saturation was measured. Results: The fall in systolic blood pressure (SBP (<100 mm Hg noted among 5 (15.63%, 12 (37.5% and 14 (43.75% parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. Conclusion: RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor.

  15. A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

    Directory of Open Access Journals (Sweden)

    Madhuri Alwani

    2014-06-01

    Methods: In a double-blind randomized controlled trial, 200 pregnant women who had cesarean sections were assigned into two groups: to receive either oxytocin intramuscularly or misoprostol rectally after spinal anesthesia. Results: There was no significant difference between the two groups about change in postpartum hemoglobin, need for blood transfusion and incidence of PPH. We also did not observe any significant difference in any side effects. Conclusions: Misoprostol may be considered as an alternative for oxytocin in low resource clinical settings. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 512-515

  16. Randomized Controlled Trial on the Effect of Channa striatus Extract on Measurement of the Uterus, Pulsatility Index, Resistive Index of Uterine Artery and Superficial Skin Wound Artery in Post Lower Segment Caesarean Section Women.

    Directory of Open Access Journals (Sweden)

    Mohd Rizal Abu Bakar

    Full Text Available To compare the mean of anteroposterior (AP measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI and resistive index (RI of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo.Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain.This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS. Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI and resistive index (RI of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3 and at two weeks, four weeks and six weeks post-operatively.Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI and the resistive index (RI of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively.Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS.www.isrctn.com 11960786.

  17. Randomized Controlled Trial on the Effect of Channa striatus Extract on Measurement of the Uterus, Pulsatility Index, Resistive Index of Uterine Artery and Superficial Skin Wound Artery in Post Lower Segment Caesarean Section Women

    Science.gov (United States)

    Abdul Karim, Ahmad Helmy; Nik Hussain, Nik Hazlina; Mohd Noor, Norhayati; Omar, Julia; Bin Bai @ Bae, Saringat; Wan Mahmood, Wan Haslindawani; Abdul Razak, Asrenee; Yunus, Rohaizan

    2015-01-01

    Aim To compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo. Background Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain. Methodology This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively. Results Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively). Conclusion Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS. Trial Registration www.isrctn.com 11960786

  18. Caesarean delivery: An experience from a tertiary institution in North ...

    African Journals Online (AJOL)

    Materials and Methods:A cross-sectional study carried out over a period of two years. All patients who had caesarean ... Address for correspondence: Dr. CN Daniel, .... 15 and 50 years and the modal age was within the 25–29 age brackets.

  19. Caesarean of Lion (Panthera leo at Dulahajra Safari Park, Bangladesh

    Directory of Open Access Journals (Sweden)

    Z.M.M. Rahman

    2011-01-01

    Full Text Available A six years eight months pregnant lioness at the Dulahajara Safari Park, Chakoria, Cox’s Bazar, Bangladesh, was presented with dystocia. This paper described the pre-, intra- and postoperative procedures including anesthetic protocol carried out and performing a caesarean section to remove dead fetuses and the successful recovery of the lioness without complications.

  20. Evidence based nursing care of eating in patients after caesarean section%剖宫产术后进食的循证护理

    Institute of Scientific and Technical Information of China (English)

    王佳; 蒋晓莲

    2006-01-01

    [目的]循证护理1例硬膜外麻醉下剖宫产产妇术后早期进食的可行性.[方法]据该病人情况,用主题词"cesarean section;eating;feeding and diet and so on"检索Cochrane图书馆(2005年第4期)、Pubmed(2006年1月20日前)、CBMdisc(1978-2002)、CNKI(1979-2006)、VIP(1989-2006)获得相关证据.[结果]从Cochrane图书馆检索到系统评价1篇,随机对照试验6篇;从Pubmed检索到RCT5篇;CBMdisc检索到RCT21篇;CNKI检索到RCT 5篇;VIP检索到RCT 15篇.[结论]早期进食对该妇女是可行的,也不会引起相关并发症.

  1. A study of addition of Inj.Butorphanol to hyperbaric Inj.Bupivacaine given intrathecally to patients undergoing lower segment caesarean section: A randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Vangipuram Raghavachari Ranga Chari

    2013-01-01

    Full Text Available Background: Intrathecal 0.5% hyperbaric injection bupivacaine has become increasingly popular as it provides good sensory and motor block for longer duration without any significant neurological side effects. Spinal opiates have been of much interest in recent times as they potentiate the effect of local anesthetic agent and provide longer lasting post-operative analgesia. We compared injection butorphanol and normal saline as an adjuvant to local anesthetic agent in subarachnoid block in lateral position with respect to onset, duration of sensory and motor block and duration of analgesia. Aim: To evaluate the effect of addition of 25 mg of injection butorphanol to hyperbaric injection bupivacaine 0.5% on onset, quality, duration of sensory and motor block, hemodynamic changes, side effects, and post-operative analgesic effect when administrated intrathecally in patients undergoing elective lower segment cesarean section (LSCS. Methodology: Sixty ASA (American Society of Anaesthesiologist grade-I and II patients scheduled for elective LSCS aged 18-40 years were divided into two equal and comparable groups. The control group represented patients receiving injection bupivacaine 0.5% (10 mg, 2 ml + 0.5 ml normal saline (total volume 2.5 ml intrathecally. The study group were the patients receiving injection bupivacaine 0.5% (10 mg, 2 ml + injection butorphanol 25 mg in 0.5 ml of normal saline (1 mg/ml preservative-free injection butorphanol diluted up to 20 ml by normal saline and 0.5 ml of this solution was taken making total volume 2.5 ml by intrathecal route. The principle outcome measures were systolic and diastolic blood pressure changes and the anesthetic and analgesic effects. These were summarized and compared between the two groups. Parametric statistics were used to test the null hypothesis of no difference in the two groups. Results: In the early phase of surgery there was more decrease in systolic and diastolic blood pressures in the

  2. Factors associated with selection of Caesarean section in Baodi district of Tianjin City%天津市宝坻区剖宫产因素初步探讨

    Institute of Scientific and Technical Information of China (English)

    张欣; 兰淑海; 王葛菲

    2014-01-01

    目的:了解天津市宝坻区常住人口剖宫产的相关影响因素。方法收集天津市宝坻区产妇病历资料394例,分析医源性因素剖宫产和社会因素剖宫产的影响因素。结果医源性因素剖宫产占81.7%,主要医源性因素为剖宫产史(24.8%)、羊水过少(24.8%)、胎头跨耻征阳性(15.8%)等;社会因素剖宫产占18.3%,包括孕妇怕疼(6.9%)、孕妇精神紧张(5.6%)、孕妇家人担心(3.0%)等。年龄、产次和职业是医源性因素与社会因素剖宫产选择的影响因素。结论天津市宝坻区常住产妇剖宫产主要医源性因素为剖宫产史、羊水过少、胎头跨耻征阳性,主要社会因素为孕妇怕疼、孕妇精神紧张、孕妇家人担心;年龄、产次和职业对选择剖宫产有影响。%Objective To identify factors associated with selection of Caesarean section among pregnant woman Baodi District,a rural area of Tianjin City. Methods Data were obtained from the medical records of 394 women who delivered in 2012, and risk factors for Cesarean section with and without medical indications were examined. Results The ratio of cesarean section with a medical indication in Baodi district was 81.7%,including a history of previous Cesarean section (24.8%),oligohydramnios (24.8%),fetal head across the pubic symphysis positive (15.8%).Non-medical reasons accounted for 18.3% of all Cesarean section,including fear of pain (6.9%), nervousness about vaginal delivery (5.6%),over concerns from family members (3.0%). Conclusion The major medical indication for a Cesarean section in Baodi was a history of previous cesarean section,oligohydramnios,fetal head across the pubic symphysis positive.Major non-medical reasons included fear of pain,nervousness about vaginal delivery, over concerns from family members.

  3. Maternal obesity and Caesarean delivery in sub-Saharan Africa.

    Science.gov (United States)

    Cresswell, Jenny A; Campbell, Oona M R; De Silva, Mary J; Slaymaker, Emma; Filippi, Veronique

    2016-07-01

    To quantify maternal obesity as a risk factor for Caesarean delivery in sub-Saharan Africa. Multivariable logistic regression analysis using 31 nationally representative cross-sectional data sets from the Demographic and Health Surveys (DHS). Maternal obesity was a risk factor for Caesarean delivery in sub-Saharan Africa; a clear dose-response relationship (where the magnitude of the association increased with increasing BMI) was observable. Compared to women of optimal weight, overweight women (BMI 25-29 kg/m(2) ) were significantly more likely to deliver by Caesarean (OR: 1.54; 95% CI: 1.33, 1.78), as were obese women (30-34.9 kg/m(2) (OR: 2.39; 95%CI: 1.96-2.90); 35-39.9 kg/m(2) (OR: 2.47 95%CI: 1.78-3.43)) and morbidly obese women (BMI ≥40 kg/m(2) OR: 3.85; 95% CI: 2.46-6.00). BMI is projected to rise substantially in sub-Saharan Africa over the next few decades and demand for Caesarean sections already exceeds available capacity. Overweight women should be advised to lose weight prior to pregnancy. Furthermore, culturally appropriate prevention strategies to discourage further population-level rises in BMI need to be designed and implemented. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  4. Intervention for Postpartum Infections following Caesarean Section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    treatment for one change with NPWT to be cost effective. Concussion: The preliminary results indicate that NPWT reduce the risk of re-rupture significantly. The benefit of the treatment is expected to be twofold: a) A reduction in health care costs (inpatient bed days and readmissions) b) An increase...

  5. Intervention for postpartum infections following caesarean section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    2012-01-01

    treatment of post-CS infection requires hospital re-admission and re-operation for opening and debridement of the infected wounds under regional- or general anesthesia. The wound is normally re-sutured on the fourth day. NPWT is an alternative method of conservative wound management, which uses negative...

  6. Private-sector caesarean sections in perspective

    African Journals Online (AJOL)

    2005-02-28

    Feb 28, 2005 ... zidovudine to prevent mother-to-child transmission of HIV-1 in Thailand. N Engl J Med ... Cape Town. Heather McLeod, BBusSc, CFA, FIA, FASSA .... future, the required service level agreements will most likely specifically ...

  7. The Nursing Care of 66 Cases of Patients with Uterine Tamponade Bleeding Treated by the Sliver Treatment Caesarean Section%66例宫腔填塞纱条治疗剖腹产术中大出血的护理

    Institute of Scientific and Technical Information of China (English)

    秦琳

    2013-01-01

    Objective:To explore effancy of the nursing care of 66 cases of patients with uterine tamponade bleeding treated by the sliver treatment caesarean section.Methods:66 cases of patients with uterine tamponade bleeding were chosed to give the treatment of the sliver treatment caesarean section,and the treatment effect was observed.Results:Through the active treatment and intensive care,the patient’s temperature returned to normal,the shock symptoms disappeared,none postoperative flatulence have been found,the anus exhaust were normal,none re-bleeding and infection was happened. All patients were discharged.Conclusion:The nursing care of patients with uterine tamponade bleeding treated by the sliver treatment caesarean section was effectively.%  目的:探讨宫腔填塞纱条治疗剖腹产术中大出血的护理疗效。方法:选取笔者所在医院妇产科66例因剖腹产手术后大出血紧急给予宫腔填塞纱条治疗的患者作为研究对象,观察治疗效果。结果:经积极治疗和精心护理,患者体温均恢复正常,休克症状消失,术后无胀气,子宫正常,肛门排气正常,无再次出血和感染发生,患者痊愈出院。结论:宫腔填塞纱条治疗剖腹产术中大出血,配合严密的护理具有较好的疗效。

  8. Effect of ropivacaine administered intrathecally on pulmonary function after caesarean section%蛛网膜下腔注射罗哌卡因对剖宫产术后患者肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    李文会; 耿桂启; 孙星峰; 黄绍强

    2012-01-01

    目的 评价蛛网膜下腔注射罗哌卡因对剖宫产术后患者肺功能的影响.方法 选择拟行剖宫产术患者36例,ASA分级Ⅰ或Ⅱ级,年龄22 ~ 34岁,体重指数≤35 kg/m2,采用随机数字表法,将患者随机分为2组(n=18):布比卡因组(B组)和罗哌卡因组(R组).于L3,4蛛网膜下腔穿刺成功后,B组和R组分别注射0.5%布比卡因1.8 ml、1.0%罗哌卡因1.4ml,均用脑脊液稀释至3ml,注药时间10 s.于术前1 d(T0)及蛛网膜下腔给药后1 h(T1)、1.5 h(T2)、2 h(T3)时分别测定用力肺活量(FVC)、第1秒用力呼气量(FEV1)以及最大呼气峰流速(PEF),以FVC实测值低于预测值80%且FEV1实测值低于预测值70%为肺功能异常的标准.T1~3时记录运动阻滞评分.结果 与T0时比较,两组T1时FVC、FEV1下降,R组T1时PEF下降(P<0.05);与T1时比较,两组T2、T3时FVC、FEV1差异无统计学意义(P>0.05),R组T2,3时PEF升高(P<0.05).与B组比较,R组T1时PEF下降,T3时运动阻滞评分降低(P<0.05).两组术后均未见肺功能异常发生.结论 对无呼吸合并症的剖宫产术患者而言,蛛网膜下腔注射常规剂量罗哌卡因与布比卡因虽然对肺功能指标有一定的抑制作用,但患者肺功能仍维持在正常范围.%Objective To investigate the effect of ropivacaine administered intrathecally on the pulmonary function after caesarean section.Methods Thirty-six ASA Ⅰ or Ⅱ parturients,aged 22-34 yr,with body mass index ≤35 kg/m2,undergoing elective cesarean section,were randomly divided into 2 groups (n=18 each):bupivacaine group (group B) and ropivacaine group (group R).Spinal anesthesia was performed at L3,4 interspace and 0.5% bupivacaine 1.8 ml (in cerebrospinal fluid 3 ml) and 1.0% ropivacaine 1.4 ml (in cerebrospinal fluid 3 ml) were injected into the subarachnoid space over 10 s in groups B and R respectively.Forced vital capacity (FVC),forced expiratory volume first second (FEV1) and peak expiratory flow (PEF

  9. 静脉自控镇痛对术后产妇身心的影响%Mental and Physical Influence of Patient-controlled Intravenous Analgesia on Parturient Women Undergoing Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    宋爱军; 杨宝芬; 李美; 苑学; 于军; 何静; 张艳红; 李向民; 薛桂娟

    2011-01-01

    [Objective]To observe the mental and physical influence of patient-controlled intravenous analgesia (PCIA) on parturi-ent women after cesarean section. [Methods]278 parturient women undergoing caesarean section were divided into the observation group (139 cases) and the control group (139 cases) with the method of random number table. The observation group was given PCIA, and the control group was given conventional analgesia therapy. The postoperative pain, time of first exhaust, time of first uri-nation , postpartum haemorrhage and the initial time of lactation between two groups were compared. [ Results] The postoperative pain of patients in the observation group was obviously relieved, and there was no severe pain. 10 patients of the control group had severe pain. There was significant difference between two groups (P 0.05). [ Conclusion] PCIA has an obvious analgesia effect on parturient women after cesarean section, and is beneficial to re-covery of parturient women.%目的 观察剖宫产术后应用静脉自控镇痛(PCIA)对产妇身心的影响.方法 选择剖宫产产妇278例,按数字随机法分为观察组和对照组,每组各139例.观察组应用PCIA,对照组应用传统镇痛,比较两组产妇术后疼痛情况、第1次排气时间、第1次排尿时间、产后阴道出血、泌乳始动时间.结果 观察组产妇术后疼痛明显减轻,无例剧烈疼痛,对照组有10例剧烈疼痛,两组差异有统计学意义(P<0.01).第1次排气时间:观察组为(18.79±7.96)h,对照组为(23.65±8.01)h;第1次排尿时间:观察组为(4.08 ±1.78)h,对照组为(6.51±1.59)h,两组差异均有统计学意义(P<0.01).产后阴道出血、泌乳始动时间,两组差异无统计学意义(P>0.05).结论剖宫产术后应用PCIA,镇痛效果确切,有利于产妇身心恢复.

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

    Science.gov (United States)

    Kabakian-Khasholian, Tamar

    2013-11-01

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

  11. Effect of oxytocin on Tp-e and QTc interval during caesarean section%剖宫产时缩宫素对产妇Tp-e和QTc间期的影响

    Institute of Scientific and Technical Information of China (English)

    文继新; 张兆平; 顾美蓉; 高宏; 孙国华

    2011-01-01

    目的 观察和评价脊麻剖宫产时缩宫素对健康产妇Tp-e和QTc间期的影响.方法 ASA分级Ⅰ级择期剖宫产产妇40例,按随机数字表法分为缩宫素静脉推注组(静推组)和缩宫素静脉微泵组(微泵组),每组20例.在胎儿娩出后静推组55~60s静脉单次推注5%葡萄糖5ml+5 U缩宫素,微泵组10 min内静脉匀速泵注完5%葡萄糖20 ml+5 U缩宫素.记录并比较术前与脊麻后1、3、5 min,应用缩宫素后1、3、5、10min的QTc间期、Tp-e间期、平均动脉压(MAP)和心率.结果 静推组在应用缩宫素后1 min较术前心率明显增快[(89±13)次/min比(73±12)次/min],MAP显著降低[(69±12)mm Hg(1 mm Hg=0.133 kPa)比(82±13)mm Hg]和QTc间期明显延长[(426±21)ms比(405±18)ms](P<0.01);而在应用缩宫素后1、3、5min时Tp-e间期均较术前延长(P<0.01或<0.05).结论 单次较大剂量(5 U)缩宫素静脉快速推注可延长健康产妇的QTc和Tp-e间期;而Tp-e间期的延长可能更准确预测室性心律失常的发生.在处理QT间期延长综合征产妇脊麻剖宫产时,缩宫素的使用方式应慎重考虑.%Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre

  12. Pregnant women’s preference for vaginal or caesarean childbirth

    Directory of Open Access Journals (Sweden)

    Lígia Ebner Melchiori

    2009-10-01

    Full Text Available The study investigated the preference for delivery in 40 pregnant women using a semi-structured interview. Most women (75% reported a preference for vaginal delivery, mainly because they believe it will result in a speedy recovery and be better for them and/or their babies. Of the women interviewed, 15% preferred a caesarean section because they considered it be less painful. These preferences, in general, were influenced by friends. Most women said they had fear of parturition due to: feelings of pain/suffering, concern of something happening to them or their babies and because the situation is unknown or assessed in a negative fashion. The presence of trusted people, like one’s husband, mother or doctor, could minimize this fear. These results reinforce the contributions of health professionals, such as psychologists, in answering the psychosocial needs of pregnant women in situations of delivery and birth.   Keywords: vaginal birth; caesarean section; pregnancy; health psychology.

  13. Changes in Caesarean Section Scar Dimensions during Pregnancy%剖宫产再孕的妇女孕期B超监测下剖宫产瘢痕形态学改变*

    Institute of Scientific and Technical Information of China (English)

    冯颖; 李坚; 段华; 陈雁鸣; Sooranna Dev; Ruilian Chen

    2013-01-01

    Objective:To describe the changes in caesarean section scars(CSS)dimensions during pregnancy and obstetric variables to subsequent changes in scar features and the final pregnancy outcome. Method:In this prospective observational study,the CSS of 320 consecutive pregnant women were examined by transvaginal sonography(TVS)at 11-13,19-21 and 32-34 weeks gestation. Visible scars consisited of hypoechoic shadow and residual myometrial thickness(RMT)segments. Analyses were carried out using SPSS 17. Result:The scar was visible in 284/320 cases (88.7%). For both scar segments,the larger the initial scar size,the more the scar decreased in size during pregnancy. Two cases of uterine scar rupture were confirmed,these had a mean RMT of 0.5 mm and average decrease in RMT of 2.6 mm over the course of pregnancy. Conclusion:The study establishes reference data and confirms that CSS changes in dimension throughout pregnancy. Scar rupture is associated with a amller RMT and greater decrease in RMT during pregnancy. The absolute value and changes seen in CSS have the potential to be tested as predictors of uterine scar rupture.%  目的:通过B超监测评价剖宫产再孕的孕妇在整个妊娠过程中剖宫产瘢痕处的形态改变,并评价最后的分娩结局。方法:应用阴道超声观察320例有剖宫产史并再次妊娠的妇女怀孕11~13周、19~21周以及32~34周时剖宫产瘢痕的变化,主要测量剖宫产瘢痕处子宫肌层的厚度变化。结果:在320例孕妇中,284例发现剖宫产瘢痕的宽度、长度及厚度均发生改变,比例达到88.7%,瘢痕的长度和宽度明显增大,瘢痕的厚度明显变薄。2例孕妇因剖宫产瘢痕处子宫肌层发生破裂而终止妊娠,这2例病例,B超监测瘢痕处子宫肌层厚度为0.5 mm,整个孕期减少了2.7 mm、2.5 mm。结论:通过观察,建立了相关的B超参考数据,并证明了剖宫产瘢痕在下一次妊娠中会发生形态学上的改变

  14. 产科剖宫产术后下肢深静脉血栓管理中的危险因素与应对措施分析%Analysis of Risk Factors and Countermeasures of Deep Venous Thrombosis Management after the Obstetrical Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    张小勤; 文飞

    2016-01-01

    Objective To research and discuss the risk factors and countermeasures of deep venous thrombosis manage-ment after the obstetrical caesarean section and provide basis for enhancing postoperative management and predicting, diag-nosing and treating the deep venous thrombosis after the caesarean section. Methods 40 cases of patients with deep venous thrombosis after caesarean section diagnosed and treated in the department of gynaecology and obstetrics of our hospital were selected as the observation group and 40 cases of patients without deep venous thrombosis were selected as the control group, and the observation group implemented risk management model, the control group implemented the general manage-ment measures, and the relevant risk factors of the two groups were observed, compared and analyzed and the corresponding countermeasures were made. Results The body mass index, mental labour profession, complications and plasma D-Dimer level were the independent risk factors of deep venous thrombosis after the caesarean section. Conclusion Active weight control, strengthening exercise, treating complications and other risk factors are vital to enhancing postoperative manage-ment, diagnosing and treating the deep venous thrombosis after the caesarean section, which is worth further promotion and application in clinic.%目的:研究探讨产科剖宫产术后管理中的危险因素与应对措施,为加强术后管理,预防诊治剖宫产术后下肢深静脉血栓等并发症提供依据。方法分别选取于该院妇产科同期住院诊治的40例剖宫产术后合并下肢深静脉血栓患者为观察组及40例剖宫产术后无下肢深静脉血栓患者为对照组,观察与比较分析两组患者管理中出现的相关危险因素并制定应对措施。结果体质量指数、脑力劳动性职业、合并症及血浆D-二聚体水平是导致剖宫产术后出现下肢深静脉血栓的独立危险因素。结论积极控制体重、加强运

  15. Women's perceptions of caesarean birth: a Roy international study.

    Science.gov (United States)

    Fawcett, Jacqueline; Aber, Cynthia; Haussler, Susan; Weiss, Marianne; Myers, Sheila Taylor; Hall, Jaye L; Waters, V Lynn; King, Charlette; Tarkka, Marja-Terttu; Rantanen, Anja; Astedt-Kurki, Paivi; Newton, Jennifer; Silva, Virginia

    2011-10-01

    The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

  16. Difference observation of catheterization before and after combined spinal-epidural anesthesia in patients of Caesarean Section%腰硬联合麻醉前后留置导尿对剖宫产患者的影响观察

    Institute of Scientific and Technical Information of China (English)

    印夏微

    2011-01-01

    Objective To explore the difference of catheterization before and after anaesthesia in patients of Caesarean Section.Methods One hundred Caesarean Section patients undergoing Combined Spinal- epidural Anesthesia M were divided into two groups randomly.Fifty patients of observation group were accepted detaining urethral catheterization after anaesthesia.Fifty patients of control group were accepted detaining urethral catheterization before anaesthesia.The heart rate,blood pressure, pain rating and success rates of first catheterization were observed.Results The heart rate, blood pressure, and pain rating of observation group were lower than the control group.Success rates of first catheterization in observation group was 98%, the control group was 82%.Conclusions It is better to take catheterization after anaesthesia in patients of Caesarean Section.%目的 探讨对剖宫产患者在麻醉前后留置导尿的影响.方法 选择100例在腰硬联合麻醉前后的剖宫产患者,随机分为观察组和对照组各50例.对照组患者在麻醉前行导尿术,观察组患者在麻醉后行导尿术,比较两组患者留置导尿前后心率、血压变化,疼痛分级以及一次性置管的成功率.结果 与基础值比较,对照组患者在留置导尿后心率、血压均明显增加,而观察组增加不明显;对照组疼痛感受明显高于观察组;一次置管成功率对照组为82%,观察组为98%.结论 剖宫产患者宜麻醉后留置导尿.

  17. Minimum effective dose of intrathecal bupivacaine in combination with sulfentanil for caesarean section%布比卡因复合舒芬太尼用于剖宫产术腰麻布比卡因的最低有效剂量研究

    Institute of Scientific and Technical Information of China (English)

    肖云瑞; 钟江红; 郭检文; 杨为一; 陈柏成; 黄秀兰

    2011-01-01

    Objective To determine the minimum dose of intrathecal bupivacaine in combination with sulfentanil for caesarean section with sequential experimental method.Methods Thirty cases with a singleton full-term pregnancy for caesarean section and under combined spinal-epidural anesthesia (CSEA) were enrolled in this study.Spinal puncture was performed at the L3-4 interspace.Patients were injected intrathecally with sulfentanil 5.0 μ g and bupivacaine.The minimum local analgesic dose was determined by up-and-down sequential experiment.The initial dose of the spinal bupivacaine was decided to be 7.5 mg.If succeeded,the next case would receive bupivacaine of a lower dose if failed,the dose of bupivacaine would be increased in the next case.The dose of spinal bupivacaine increased / decreased by 0.5 mg each time.The clinical efficacy was assessed by the motor block of the lower limb,the block height,and the duration of block.If Bromage scale were Ⅲ since anesthesia was induced after 10 min and the maximum plane of sensory block was maintained at T6 since anesthesia was induced after 60 min were defined as a success.Result The minimum local analgesic dose of intrathecal bupivacaine in combination with sulfentanil 5.0 μ g for caesarean section was 5.12 mg (95% confidence interval 7.8~9.9 mg).Conclusion Determining by sequential experiment method,the minimum local analgesic dose of intrathecal bupivacaine in combination with sulfentanil 5.0 μ g for caesarean section is 5.12 mg.%目的 采用序贯法测定布比卡因复合舒芬太尼腰麻用于剖宫产术布比卡因的最低有效剂量.方法 30例单胎和妊娠足月行剖宫产术患者,于L3~4蛛网膜下腔穿刺成功后,给予舒芬太尼5.0 ug复合布比卡因腰麻,第一个病人给予布比卡因7.5 mg,每次剂量调整0.5 mg.成功:麻醉诱导10 min内改良Bromage运动阻滞评分为3级,阻滞60 min内麻醉平面维持在T6水平,下一个病人的布比卡因用量减少0.5 mg;反之为失

  18. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  19. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  20. Relationship of Pre-Pregnant Body Mass Index,Weight Gain During Pregnancy,Birth Weight of Neonate and Non-Selected Caesarean Section%孕妇孕前体重指数、孕期体重增加与新生儿出生体重及非选择性剖宫产的关系

    Institute of Scientific and Technical Information of China (English)

    崔宝奎; 樊萍; 马晓东; 郭粉妮; 赵尹霄

    2011-01-01

    Objective To study the effect of maternal pre-pregnant body mass index (BMI) and gestational weight gain during pregnancy on birth weight of neonate and incidence of non-selected caesarean section. Methods From January 2000 to May 2010, 3231 cases of pregnancy women giving birth to a single baby for the first time were recruited into the study. Pre-pregnant BMI and weight gain during pregnancy were measured and the pregnancy outcomes were followed up. According to BMI, they were divided into low BMI group(n = 671) , normal BMI group(n= 1845)and high BMI group(n= 715). They were further divided into 5^9 kg group(n = 331) , (9-18) kg group(n= 1755)and ^>18 kg group (n= 1145) according to weight gain during pregnancy. There had no significant differences between age, relevant family history of genetic diseases, pregnancy complications and parity between two groups (P18 kg group than (9-18)kg group and 5^9 kg group (P0.05)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书).结果 三组孕前BMI不同孕妇新生儿出生体重比较,差异有统计学意义(P<0.05).孕前低BMI组的低出生体重儿发生率高,孕前高BMI组巨大儿发生率高,非选择性剖宫产率随孕妇孕前BMI降低而降低.三组孕妇孕期体重增加不同,新生儿出生体重比较,差异有统计学意义(P<0.05).孕妇孕期体重增加过多,则巨大儿发生率增加;孕妇孕期体重增加越少,非选择性剖宫产率则越低.结论 孕妇孕前BMI过高和孕期体重增加过多,可导致新生儿出生体重增加,非选择性剖宫产率增高.

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

    Science.gov (United States)

    Jonsson, Maria

    2015-06-16

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

  2. Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database.

    Directory of Open Access Journals (Sweden)

    Sarah J Stock

    Full Text Available BACKGROUND: There is evidence that induction of labour (IOL around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery. However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management. METHODS AND FINDINGS: We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176. Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401 of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]. There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]. In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75] and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00]. CONCLUSIONS: A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.

  3. 子宫背带缝合术联合卡前列素氨丁三醇注射液在剖宫产术后出血的应用%Application of uterine strap suture technique combined with carboprost trometamol injection in the hemorrhage after caesarean section

    Institute of Scientific and Technical Information of China (English)

    黄慧敏

    2015-01-01

    Objective To observe the clinical efficacy of uterine strap suture technique combined with carboprost trometa‐mol injection in the hemorrhage after caesarean section . Methods Seventy puerpera with hemorrhage after caesarean section were divided into observation group and control group according to different therapies .The observation group adopted uterine strap suture technique combined with carboprost trometamol injection ,and the control group adopted carboprost trometamol in‐jection .The amount and complications of hemorrhage after caesarean section of two groups were observed . Results After 2 hours of surgery ,the amount of hemorrhage in control group and observation group was (245.69 ± 58.95) mL and (107.06 ± 65.35) mL ;after 24 hours of surgery ,the amount of hemorrhage in control group and observation group was (330.15 ± 61.87) mL and (186.54 ± 60.34) mL respectively .The incidence rate of hemorrhagic shock ,DIC and hysterectomy was 2.86% ,0% , 0% in the observation group ,and 8.57% ,2.86% ,2.86% in the control group respectively .The differences were not statisti‐cally significant (P>0.05) .Conclusion For puerpera with hemorrhage after caesarean section ,the uterine strap suture tech‐nique combined with carboprost trometamol injection can effectively reduce the amount and complications of hemorrhage after caesarean section .However ,it can′t be considered that the uterine strap suture technique combined with carboprost trometamol injection has a better effect in the postoperative haemorrhage than only carboprost trometamol injection .%目的:观察子宫背带缝合术联合卡前列素氨丁三醇注射液在剖宫产术后出血的临床疗效。方法临床纳入剖宫产术后出血产妇70例,根据治疗方案的不同分为观察组与对照组。观察组进行子宫背带缝合术联合卡前列素氨丁三醇注射,对照组仅给予卡前列素氨丁三醇注射。观察两组患者术后出血量及出

  4. Analysis of the relationship between caesarean section with chronic postpartum low back pain in 592 cases of pregnant women%592例妊娠期腰痛孕妇分娩方式与产后腰痛关系分析

    Institute of Scientific and Technical Information of China (English)

    王岚; 张媛; 张华; 陶兰; 蒋秋静; 张高东

    2011-01-01

    Objective To investigate the relationship between the mode of delivemy with postpartum low back pain in pregnant women. Methods It was a follow up study about 592 women who reported LBP during pregnancy. They were sent questionnaires at 36 weeks of gestation and approximately 6 months after delivery, respectively. And they were divided into three groups including group A submitted to elective caesarean section and group B submitted to emergency caesarean section while, and group C submitted to vaginal birth. The survey recorded the health history, LBP, function disability and other related factors about these women. Resuits There was no significant difference of breastfeding,the proportion of depression and postpartum rest time in the three groups of pregnant women. 6 months after delivery,the score of backpain and morement disorder in the three groups were decreased compared with that at 36 weeks of gestation. There was significant difference of backpain in the group B and C, while there was no differnce in group A. But there was no difference in group A. But there was no significant difference of movement disorder in the three groups. The score of backpain and morement discorder in group A was significantly higher than that in group B and C, but the difference between group B and C was no statistically significant. Conclusion The incidence of postpum low back pain no relation ship with emergenay casearean section and vaginal birth, but it had in the group of elective caesarean section.%目的 探讨妊娠期腰痛足月孕妇分娩方式与产后腰痛的关系.方法 对孕36周有腰痛的592例孕妇分别在孕36周时和产后6个月时进行问卷调查,调查内容包括腰痛、活动障碍及对腰痛可能产生影响的相关因素等,根据分娩方式分为社会因素剖宫产组(A组),有手术指针剖宫产组(B组),顺产组(C组).结果 三组产妇产后6个月母乳喂养、抑郁的比例及产后休息时间长短

  5. Comparison on the influence of different doses Bupivacaine combined with pinal-epidural anesthesia for hemorheology of parturient underwent caesarean section%不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学影响比较

    Institute of Scientific and Technical Information of China (English)

    李静

    2012-01-01

    Objective To compare the influence of different doses bupivacaine combined with spinal -epidural anesthesia for hemorheology of parturient underwent caesarean section. Methods 84 parturient underwent caesarean section with spinal-epidural anesthesia in our hospital from October 2009 to October 2011 were selected as research object, and they were divided into group A and group B with 42 cases in each group, the group A were given 7.0 mg 0.75% Bupivacaine, the group B were given 9.0 mg 0.75% Bupivacaine, then the incidence of adverse reactions and hemorheology indexes before and after the anesthesia at 5, 15, 30 min of two groups were detected and compared. Results The after the anesthesia at 5, 15, 30 min of group B were all lower than those of group A (all P 0.05). Conclusion The influence of 9.0 mg 0.75% Bupivacaine for hemorheology of parturient underwent caesarean section is more obvious, and it can sig nificantly improve blood circulation status of parturient and the security is higher, so it is more suitable for cesarean section.%目的 比较不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学的影响.方法 选取2009年10月~2011年10月于本院进行采用腰硬联合麻醉进行剖宫产的84例产妇为研究对象,将其分为A组与B组,每组各42例.A组采用7.0 mg的0.75%布比卡因进行麻醉,B组采用9.0 mg的0.75%布比卡因进行麻醉,后将两组产妇不良反应发生率及麻醉前及麻醉后5、15、30 min的血液流变学指标进行检测及比较.结果 B组麻醉后5、15、30 min的各项血液流变学指标低于A组(均P < 0.05),而两组患者不良反应发生率比较差异无统计学意义(P > 0.05).结论 9.0 mg的0.75%布比卡因对剖宫产产妇的血液流变学影响更为明显,可显著改善产妇的血液循环状态,且安全性也较高,故更适用于剖宫产术.

  6. Effect of touch combined with music therapy on anxiety and postoperative recovery of parturient with caesarean section%触摸联合音乐疗法对剖宫产手术产妇焦虑及术后恢复情况的影响

    Institute of Scientific and Technical Information of China (English)

    韩彩红

    2015-01-01

    目的:探讨触摸联合音乐疗法对剖宫产手术产妇焦虑及术后恢复情况的影响。方法选择在我院拟行剖宫产术的孕妇60例为研究对象。随机分为研究组和对照组各30例。研究组在常规护理基础上给予触摸和音乐疗法护理,对照组仅给予常规围手术期护理。比较两组产妇术后焦虑情况以及术后恢复情况。结果两组干预后焦虑评分均较干预前有所下降(P<0.05或<0.01);研究组干预后焦虑评分显著低于对照组(P<0.01)。两组干预后所有患者均存在不同程度的焦虑,但是研究组主要是轻度焦虑及中度焦虑,对照组重度焦虑的比例最高,差异存在显著统计学意义(P<0.01)。研究组首次下床活动时间、首次排气时间、首次母乳喂养时间均显著早于对照组(P<0.05);研究组人工喂养次数少于对照组(P<0.01)。两组母乳喂养例数比较差异无统计意义(P>0.05)。结论触摸疗法联合音乐疗法能够显著缓解剖宫产产妇的焦虑程度,促进术后恢复。%Objective To explore effect of touch combined with music therapy on anxiety and postoperative recovery of parturient with caesarean section.Methods60 pregnant women who were going to receive cesarean section in our hospital were selected as research subjects and they were randomly allocated to the study group and the control group, with 30 in each. The study group was received touch combined with music therapy based on routine nursing while the control group was only received routine perioperative nursing. Anxiety and postoperative recovery of parturient with caesarean section in two groups were compared.Results SAS scores after intervention of two group were lower than before (P0.05).ConclusionTouch combined with music therapy can significantly ease anxiety and improve postoperative recovery of parturient with caesarean section.

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

    Science.gov (United States)

    2013-01-01

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

  8. 小剂量舒芬太尼在剖宫产术麻醉中预防寒战和牵拉痛的临床观察%Clinical study on small dose sufentanil in anesthesia in caesarean section for prevention of chill and dragging pain

    Institute of Scientific and Technical Information of China (English)

    孙青山

    2014-01-01

    Objective To observe effect of small dose sufentanil in anesthesia in caesarean section for prevention of shivering and dragging pain. Methods From January 2012 to January 2013, 52 women who underwent cesarean section were arranged in two groups, sufentanil group and general anesthesia group. Patients in sufentanil group used 0.75%bupivacaine, sufentanil 5 μg and 10% glucose. Patients in general anesthesia group used 0.75% bupivacaine and 10%glucose. Heart rate before and after operation, newborn's Apgar score, chills, dragging pain were compared. Results Comparative difference of heart rate before and after operation, newborn's Apgar score between the two groups showed no statistical significance. Comparative difference of chills and dragging pain situations indicated statistical signifi-cance. Conclusion Small dose sufentanil can reduce the incidence of chill and dragging pain in anesthesia in caesare-an section, and it is safe.%目的:观察小剂量舒芬太尼在剖宫产术麻醉中预防寒战和牵拉痛的临床效用。方法选择2012年1月~2013年1月在我院行剖宫产术的产妇52例作为研究对象。随机分为两组:舒芬太尼组和常规麻醉组,每组26例。舒芬太尼组用药情况为:0.75%布比卡因1 mL、舒芬太尼5μg、10%葡萄糖0.5 mL;常规麻醉组用药为0.75%布比卡因1 mL、10%葡萄糖0.5 mL。观察两组产妇术前术后的心率、新生儿Apgar评分、寒战和牵拉痛情况。结果两组产妇术前、术后心率、新生儿Apgar评分比较无统计学意义;寒战和牵拉痛发生率比较有统计学意义。结论小剂量舒芬太尼在剖宫产术麻醉中可降低寒战和牵拉痛的发生率,并且是安全的。

  9. Beyond the short term effects of caesarean delivery and gynaecological surgery

    NARCIS (Netherlands)

    Kok, N.

    2015-01-01

    The work presented in this thesis focuses on the risk of maternal and neonatal complications in pregnancies after previous caesarean section and strategies for the prevention of post-surgical adhesion formation after abdominal and gynaecological surgery. In Part One: "Pregnancy and delivery after ca