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Sample records for repeat caesarean sections

  1. Maternal views and experiences regarding repeat Caesarean section

    African Journals Online (AJOL)

    2014-11-28

    Nov 28, 2014 ... Teaching Hospital, P.M.B 5355, Ado‑Ekiti, Ekiti State, Nigeria. E‑mail: tundeolofinbiyi@gmail.com. Introduction. All women with prior cesarean section may not be eligible .... vaginal delivery (14.7%), cost of surgery (5.9%), stress of .... Gredilla E, Pérez Ferrer A, Martínez B, Alonso E, Díez J, Gilsanz F.

  2. Successful Pregnancy Following Repair of Vesicouterine Fistula Following Repeat Caesarean Section: A Case Report

    Directory of Open Access Journals (Sweden)

    Dilruba Akter

    2012-06-01

    Full Text Available A lady, para 2, both delivered by caesarean section for prolonged labour, presented with the complaints of menouria and infertility for 3 years following her last caesarean section. She had history of haematuria during menstruation and her menstrual flow is scanty. Her first baby was female and alive, but her second baby was stillborn following prolonged and obstructed labour. This has been continuously blamed by family and others for happening that events. Her fistula was confirmed by ultrasound scan, histerography and cystoscopy. The vesicouterine fistula was treated by local repair with omental patch through transperitoneal approach. Pregnancy following one year of successful repair has turned her from miserable to happiness in life.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11030 BSMMU J 2012; 5(1:76-78 

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

    African Journals Online (AJOL)

    Most of the caesarean sections were carried out because of a previous CS; maternal request and HIV status also contributed to the high rate. Conclusion: The high CS rate in private practice is probably a window to the increased rates of Caesarean section being performed worldwide. This high rate is in keeping with trends ...

  4. Maternal mortality following caesarean sections.

    Science.gov (United States)

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

    1979-08-01

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

  5. [Caesarean section and anal incontinence].

    Science.gov (United States)

    Kalis, V; Stipán, J; Chaloupka, P; Karbanová, J; Rokyta, Z

    2008-04-01

    Summary of the impact of Caesarean section on anal incontinence. Review. Department of Gynaecology and Obstetrics, Charles University and University Hospital Plzen. Review of the current international literature. Currently, Caesarean section is not considered to reduce symptoms of anal incontinence. If there is any reduction of symptoms, that remains only for a short term (40% in 3 months after the delivery in the largest trial). In a long term, virtually in no trial has been observed any difference, and others, non-obstetrical factors (particularly aging) prevail. Current knowledge does not allow to assess sufficiently pros and cons of Caesarean compared to vaginal delivery. High risk groups, that would profit from elective Ceasarean, have not been clearly identified yet.

  6. Caesarean section and anaesthetic mortality

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group. LETTER TO THE EDITOR. Caesarean section and ... births there are 3.1 maternal deaths,2 13 neonatal deaths, 28 infantile deaths and 40 deaths under the age of 5 ...

  7. Caesarean section wound infiltration with ropivacaine versus ...

    African Journals Online (AJOL)

    Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up. ... South African Journal of Obstetrics and Gynaecology. Journal Home · ABOUT THIS JOURNAL · Advanced Search ...

  8. Post caesarean section anterior abdominal wall endometriosis ...

    African Journals Online (AJOL)

    Abdominal wall endometriosis is a likely sequelae of caesarean section as viable endometrial tissue are deposited in the peritoneal cavity or anterior abdominal wall. One such case to sensitize clinicians of this rare presentation of the disease is presented. The patient was a 48 year old woman who presented with a lesion ...

  9. Predicting spinal hypotension during Caesarean section

    African Journals Online (AJOL)

    There is a significant body of recent work which has looked at the haemodynamic changes which occur under spinal anaesthesia and the effects of various treatment regimens on these changes. It has long been held that the dominant mechanism of hypotension in the patient for Caesarean section is caval compression.9.

  10. Caesarean section in Eisenmenger's syndrome: anaesthetic ...

    African Journals Online (AJOL)

    pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger's syndrome.

  11. 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....

  12. Wound Infection following Caesarean Section in a University ...

    African Journals Online (AJOL)

    Background: Caesarean section is a common operation in obstetric practice, but there is a general aversion to caesarean section amongst Nigerian women due to a myriad of reasons amongst which are its associated morbidity and mortality. Surgical site infection following caesarean section is both a major cause of ...

  13. Outcome of caesarean section at the Edward Francis Small ...

    African Journals Online (AJOL)

    Data was extracted from patients' record. Descriptive ... Results: The Caesarean section rate in the hospital is 24.0%. ... Caesarean section, a surgical procedure to deliver a baby ... rate remain uncertain in the short and long term and the ... Educational level ... Table 4: Duration of hospitalization after caesarean section.

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

    African Journals Online (AJOL)

    McRoy

    2014-03-30

    Mar 30, 2014 ... maintain the rates of caesarean section to a ... perception and attitude toward caesarean delivery are encouraging. ..... This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 ...

  15. Achondroplasia: anaesthetic challenges for caesarean section.

    Science.gov (United States)

    Dubiel, L; Scott, G A; Agaram, R; McGrady, E; Duncan, A; Litchfield, K N

    2014-08-01

    Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Perimortem caesarean section following maternal gunshot wounds

    Directory of Open Access Journals (Sweden)

    Ozlem Gunevsel

    2011-01-01

    Full Text Available Perimortem caesarean section is an ethically difficult decision for emergency medicine resuscitation teams. A 34-years-old woman was attacked by her husband with a gunshot. At the time arrival to the emergency room, there was no pulse, no spontaneous breath and blood pressure was unobtainable. Although extensive advanced cardiopulmonary resuscita-tion was performed for 7 minutes, no cardiac activity was regained. During the cardiopulmonary resuscitation efforts, an abdominal ultrasonography was performed and revealed a fetal heart rate with bradycardia. Low segment caesarean section was performed by the obstetrician in the resuscitation room and a female newborn was delivered within less than one minute of the skin incision. Decision on terminating the CPR efforts should not be made in maternal cardiac arrests older than 28 weeks′ gestational age, unless the viability of the fetus had been evaluated.

  17. 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.

  18. VBAC Scoring: Successful vaginal delivery in previous one caesarean section in induced labour

    International Nuclear Information System (INIS)

    Raja, J.F.; Bangash, K.T.; Mahmud, G.

    2013-01-01

    Objective: To develop a scoring system for the prediction of successful vaginal birth after caesarean section, following induction of labour with intra-vaginal E2 gel (Glandin). Methods: The cross-sectional study was conducted from January 2010 to August 2011, at the Pakistan Institute of Medical Sciences in Islamabad. Trial of labour in previous one caesarean section, undergoing induction with intra-vaginal E2 gel, was attempted in 100 women. They were scored according to six variables; maternal age; gestation; indications of previous caesarean; history of vaginal birth either before or after the previous caesarean; Bishop score and body mass index. Multivariate and univariate logistic regression analysis was used to develop the scoring system. Results: Of the total, 67 (67%) women delivered vaginally, while 33 (33%) ended in repeat caesarean delivery. Among the subjects, 55 (55%) women had no history of vaginal delivery either before or after previous caesarean section; 15 (15%) had history of vaginal births both before and after the previous caesarean; while 30 (30%) had vaginal delivery only after the previous caesarean section. Rates of successful vaginal birth after caesarean increased from 38% in women having a score of 0-3 to 58% in patients scoring 4-6. Among those having a score of 7-9 and 10-12, the success rates were 71% and 86% respectively. Conclusion: Increasing scores correlated with the increasing probability of vaginal birth after caesarean undergoing induction of labour. The admission VBAC scoring system is useful in counselling women with previous caesarean for the option of induction of labour or repeat caesarean delivery. (author)

  19. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Kirti N Saxena

    2008-01-01

    A twenty year old parturient with short stature presented to the hospital in early labour. An elective lower segment caesarean section(LSCS was planned in view of cephalopelvic disproportion. She had papers which suggested that she had been diagnosed as a case of achondroplasia though details were not available. Combined spinal epidural(CSE anaesthesia was planned in the patient in view of the death of her first baby following caesarean section under general anaesthesia. Repeatedly dry taps were achieved on attempting dural puncture. Dural puncture was abandoned and an 18 G epidural catheter was threaded via the Tuohy needle. Sensory block till T 6 was achieved with 6ml of local anaesthetic solution. The patient was stable during the intraoperative and postoperative period.

  20. 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.

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

    African Journals Online (AJOL)

    Abstract Caesarean section incurs significant cost and poses a hindrance to healthcare. The aim of the study was to determine maternal, foetal outcomes and cost. This was a cross sectional study conducted at the two health facilities. The study covered an eight month period. The rate of caesarean section was 5.69% and ...

  2. Elective Caesarean Section for Breech Presentation in First Pregnancy and Subsequent Mode of Labour

    International Nuclear Information System (INIS)

    Khaskheli, M.; Baloch, S.; Sheeba, A.

    2014-01-01

    Objective: To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. Study Design: A cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. Methodology: All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned proforma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. Results: Out of the total, 131 (16.92%) women had previous elective caesarean section due to breech presentation while 643 (83.07%) women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 (70.22%) in women with previous breech presentation (n=131) in comparison with 475 (73.87%) women with previous cephalic presentation n=643 (RR=1.04, p=0.32). The vaginal birth rate after elective caesarean section due to breech presentation was 39 (29.77%) in comparison with 168 (26.12%) cases with previous cephalic presentation (RR=0.98, p=0.83). Conclusion: Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section. (author)

  3. Outcomes in women attempting vaginal birth after caesarean section ...

    African Journals Online (AJOL)

    A successful vaginal delivery was associated with lower NICU admissions and higher APGAR scores in the neonate than those delivered by caesarean section but there was no statistically significant difference between the groups for APGAR scores <7. There were 3 cases of uterine rupture discovered at caesarean section ...

  4. 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....

  5. Effective education to decrease elective caesarean section

    International Nuclear Information System (INIS)

    Sanavi, F. S.; Rakhshani, F.

    2014-01-01

    Objective: To examine the effect of education on deciding about natural delivery in women opting for elective caesarean section. Methods: The quasi-experimental study was carried out between January and March 2012 and comprised a sample of 200 women in their third trimester of pregnancy attending women's clinics of Imam Ali Hospital, Zahedan, Iran, with the intention of having elective caesarean section. The subjects were voluntarily classified into three groups: one group received an educational package; the other had educational package along with group discussion, and the last one without any intervention was considered the control group. Post-test was conducted a month after intervention. Data were analysed using Kruskal Wallis, and logistic regression tests. Results: Group A represented the controls and had 100 (50%) women; Group B with the educational package had 40 (20%), while there were 60 (30%) women in Group C who had exposure to the educational package as well as group discussion. There were significant changes in behaviour in Group B and C (p <0.01) but no change among the controls in Group A. In Group C, 25 (42%) women decided to go for natural delivery, while 1 (2.5%) woman had a change of opinion in Group B. Four (4%) women in the control Group A had ultimately natural delivery, but they were all emergency cases. Conclusion: The two educational methods increased model construct scores, including awareness, attitude, perceived behaviour control, subjective norms and behavioural intention. Nevertheless, educational package in conjunction with group discussion was more effective in influencing the choice towards natural delivery. (author)

  6. Caesarean section – desired rate versus actual need

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    2016-03-11

    Mar 11, 2016 ... If conducted when medically justified, a caesarean section can effectively prevent ... vested interests.4 This lifesaving procedure can be a cause of short and long term ... nervous system depression among infants delivered by ...

  7. 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...

  8. 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...

  9. Caesarean Delivery: Why The Aversion? | Ezechi | Tropical Journal ...

    African Journals Online (AJOL)

    While only 28.9% will accept caesarean section on doctor\\'s advice, 71.1% will not accept caesarean delivery for any reason. 26.8% of the patients that have had previous caesarean section prefer to die while attempting vaginal delivery than to have a repeat caesarean section. Reasons for refusing caesarean section were ...

  10. 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.

  11. [Caesarean section with vacuum extraction of the head].

    Science.gov (United States)

    Dimitrov, A; Pavlova, E; Krŭsteva, K; Nikolov, A

    2008-01-01

    The aim of the study is to investigate the benefits and the limits in using the soft cup vacuum extractor on the fetal scalp during the caesarean section. The prospective study includes 19 cases of caesarean sections (group A), with vacuum assisted delivery using the soft cup vacuum extractor on the fetal scalp (diameter 6 cm) and 25 cases (group B) of caesarean sections with usual, manual extraction of the head assisted by fundal compression. All of the patients had undergone a planned caesarean section on term in absence of uterine activity and preserved amniotic membranes. Our results doesn't show differences in the Apgar score on the first and 5-th minute in the newborns of the two groups. The duration of the scalp traction was significantly shorter (30 +/- 4 sec) in comparison to the classical manual extraction (53 +/- 21 sec). The mean duration for applying the vacuum cup was 10 sec and 25 sec for tractions. The total blood loose and total duration of the caesarean sections were shorter than in the control group. The applied traction with the vacuum cup was sufficient for head extraction and there was no need for additional fundal compression. In conclusion we consider that the extraction of the fetal head in high position in caesarean section with vacuum extractor is an easy, non traumatic and rapid method which can put away the need of rough and prolonged fundal compression and its consequences.

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

    African Journals Online (AJOL)

    EagleMarkRes

    Materials and Method: A three year retrospective study from January 2010 to December 2012 involving all women who had caesarean delivery at the Federal Medical ... knowledge of women and increase safety about the procedure; the CS rate .... centres in Nigeria, where resident doctors on training are allowed to perform ...

  13. Proportion of litters of purebred dogs born by caesarean section.

    Science.gov (United States)

    Evans, Katy M; Adams, Vicki J

    2010-02-01

    To describe the frequency of caesarean sections in a large sample of pedigree dogs in the UK. Data on the numbers of litters born in the previous 10 years were available from a cross-sectional study of dogs belonging to breed club members (2004 Kennel Club/BSAVA Scientific Committee Purebred Dog Health Survey). In this survey 151 breeds were represented with data for households that had reported on at least 10 litters (range 10-14,15): this represented 13,141 bitches which had whelped 22,005 litters. The frequency of caesarean sections was estimated as the percentage of litters that were reported to be born by caesarean section (caesarean rates) and are reported by breed. The dogs were categorised into brachycephalic, mesocephalic and dolicocephalic breeds. The 10 breeds with the highest caesarean rates were the Boston terrier, bulldog, French bulldog, mastiff, Scottish terrier, miniature bull terrier, German wirehaired pointer, Clumber spaniel, Pekingese and Dandie Dinmont terrier. In the Boston terrier, bulldog and French bulldog, the rate was > 80%. These data provide evidence for the need to monitor caesarean rates in certain breeds of dog.

  14. 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.

  15. At what price? A cost-effectiveness analysis comparing trial of labour after previous Caesarean versus elective repeat Caesarean delivery.

    LENUS (Irish Health Repository)

    Fawsitt, Christopher G

    2013-01-01

    Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.

  16. Trial of labour after caesarean section and the risk of neonatal and infant death: a nationwide cohort study.

    LENUS (Irish Health Repository)

    O'Neill, Sinéad M

    2017-02-27

    Caesarean section (CS) rates are increasing worldwide and as a result repeat CS is common. The optimal mode of delivery in women with one previous CS is widely debated and the risks to the infant are understudied. The aim of the current study was to evaluate if women with a trial of labour after caesarean (TOLAC) had an increased odds of neonatal and infant death compared to women with an elective repeat CS (ERCS).

  17. 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

  18. 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.

  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. MATERNAL AND FOETAL OUTCOME OF VAGINAL BIRTH AFTER CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Thulasi

    2016-04-01

    . Epidural analgesia can be used. 9. Ventouse or outlet forceps is kept ready to cut short second stage of labour. 10. Operation theatre is kept ready to deal any emergency caesarean section. 11. Anaesthetist and paediatrician to be available while giving a trial of scar. 12. Post-partum digital exploration of caesarean scar done only if persistent bleeding, hypotension and tachycardia are present. Senior obstetrician to be available all the time while giving trial of scar. RESULTS A total of 50 cases for the study was selected. Among that 46(92% patients were in the age group 20-30 years There were no patients below 145 cm. 39(78% patients were gravida 2. All of them were para-1, 34 patients (68% had emergency LSCS in previous pregnancy. whereas 16 patients (32% had elective LSCS. Post-operative period was uneventful among 94% patients. 3 patients (6% had post-operative morbidity after LSCS 34 patients (68% cervical dilatation less than 3 cm. Oxytocin augmentation were 3 cases. 46 patients (92% had spontaneous onset of labour, whereas 4 patients (8% were induced with Cerviprime. Among the induced cases, 3 had repeat LSCS. Among the spontaneous onset of labour cases, 7 had repeat LSCS among 46 patients (92%. Post-operative periods were uneventful. 3 patients (6% had fever. 40 patients (80% had successful VBAC. CONCLUSION Success of VBAC depends on the proper selection of the cases, provided senior obstetrician, anaesthetist, emergency OT, and fresh cross-matched blood as well as paediatrician also available.

  1. Angiographic treatment of the arteriovenous malformation occurred after caesarean section

    Directory of Open Access Journals (Sweden)

    Selim Büyükkurt

    2009-03-01

    Full Text Available INTRODUCTION: Uterine arteriovenous malformations are classified as acquired or congenital. Caesarean section which is performed more frequently on nowadays, uterine curettage and other uterine surgeries are the most common causes of the acquired arteriovenous malformations. CASE: Twenty-two years old woman delivered her second child by caesarean section, due to history of caesarean section, was admitted with complaint of profuse vaginal bleeding 15 days after the surgery. She demonstrated the clinical features of the hypovolemic shock. At first she treated with four units of red blood suspension, two units of fresh frozen plasma and rapid infusion of the fluids. On endometrial curettage only blood and coagulum were obtained. The bleeding could only be controlled by the internal pressure of the 18 F Foley catheter. Doppler analyze of the uterus revealed a vascular malformation signifying a turbulent flow pattern with low pressure and high flow rate. A unilateral uterine artery embolization was performed her and her menstruel cycles are resumed at the fifth month of the puerperium. DISCUSSION: The clinical presentation of the uterine arteriovenous malformations depends on the localization and the dimensions of the malformation. The uterine arteriovenous malformation should be kept in mind in cases of late occurrence vaginal bleeding unresponsive to the uterotonic medications, especially in a woman with previous history of uterine damage, such as curettage or caesarean section.

  2. Puerperal infection after caesarean section at Chris Hani ...

    African Journals Online (AJOL)

    Objectives. To determine the incidence of puerperal sepsis after caesarean section (CS) at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods. A longitudinal descriptive study was done on women undergoing CS, with follow-up for readmission or development of sepsis, including telephone ...

  3. Caesarean section delivery and breastfeeding initiation at the ...

    African Journals Online (AJOL)

    Background: Caesarean section (CS) presents a challenge for early breastfeeding of the newborn infant. It is expected that with the Baby Friendly Hospital Initiative (BFHI), mothers who deliver by CS can be helped to initiate breastfeeding early. Objectives: This study aims to determine the time of initiation of breastfeeding in ...

  4. Graded epidural anaesthesia for Caesarean section in a parturient ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the. Creative Commons License ... CASE REPORT. Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study. Anjum Naza*, Sugata Dasguptab, Bijoy Kumar Bandyopadhyayb and Hasibul Hasan Shirazeec. aDepartment of ...

  5. Is the attendance of paediatricians at all elective caesarean sections ...

    African Journals Online (AJOL)

    Objectives. To determine the need for resuscitation at the birth of babies delivered by elective caesarean section (CS) and to record the time spent by doctors attending such deliveries. Methods. Data were collected prospectively on all elective CSs performed at Groote Schuur Hospital over a 3-month period. Data collected ...

  6. Is routine caesarean section necessary for breech-breech and ...

    African Journals Online (AJOL)

    Subjects: Twin gestations with breech-breech and breech-transverse presentations. Main outcome measures: Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections.

  7. Higher Incision at Upper Part of Lower Segment Caesarean Section

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    Yong Shao

    2014-06-01

    Conclusions: An incision at the upper part of the lower segment reduces blood loss, enhances uterine retraction, predisposes to fewer complications, is easier to repair, precludes bladder adhesion to the suture line and reduces operation time. Keywords: caesarean section; higher incision technique; traditional uterine incision technique.

  8. 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...

  9. External cephalic version before elective caesarean section for breech presentation

    International Nuclear Information System (INIS)

    Zafar, F.; Sanusi, A.

    2008-01-01

    The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech Presentation should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. To ascertain the acceptability of external cephalic version before elective caesarean section for breech Presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. The clinical audit was registered with the audit department at Watford general hospital and written Consent for the access of medical records was obtained. A retrospective view of 86 accessible medical records out of Total 110 elective breech caesarean sections was done over a period of one year. This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who under went elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient's profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version. Among 37 patients who were offered external cephalic version only 15 patients accepted (22 declined) the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. External cephalic version was not successful in any of the patient. Causes for

  10. Audit of Caesarean Section Births in Small Private Maternity Homes: Analysis of 15-Year Data Applying the Modified Robson Criteria, Canada.

    Science.gov (United States)

    Atnurkar, Kishore B; Mahale, Arun R

    2016-10-01

    To audit the data of caesarean sections carried out in single-handed-run small private hospitals on the basis of the modified Robson criteria (Canada), to know the changing trends of caesarean sections over a considerable duration of time (15 years) in private sector, and to focus on a particular group out of the classification of caesarean section in the efforts to reduce the caesarean section rate. It is a retrospective observational study of 7342 caesarean section cases carried out in different small private maternity hospitals over a period of 15 years. The data analysed by applying the modified Robson criteria (Canada) and the changing trends were studied in the view of reducing caesarean section rate. Statistically significant increasing trend was observed in groups of both primary and repeat caesarean section cases done before the onset of labour in the last 5 years. Auditing the data of caesarean sections on the basis of the modified Robson criteria (Canada) is a better way of classification as compared to Ten Group Classification System (TGCS). The change in trends is seen only in the last 5 years, which suggests that there is shift in attitude of the obstetricians of small private hospitals in performing caesarean sections before onset of labour than performing it after the onset of labour. Our analysis suggests the obstetricians from small private hospitals to target groups 2B, 4B and 5C.

  11. 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...

  12. 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.

  13. 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.)

  14. Can classic metaphyseal lesions follow uncomplicated caesarean section?

    International Nuclear Information System (INIS)

    O'Connell, AnnaMarie; Donoghue, Veronica B.

    2007-01-01

    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. 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.

  16. 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.

  17. Caesarean section greatly increases risk of scar endometriosis.

    Science.gov (United States)

    Nominato, Nilo Sérgio; Prates, Luis Felipe Victor Spyer; Lauar, Isabela; Morais, Jaqueline; Maia, Laura; Geber, Selmo

    2010-09-01

    To estimate the incidence of scar endometriosis after different surgical procedures. A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Assessment of competence for caesarean section with global rating scale

    International Nuclear Information System (INIS)

    Qureshi, R.N.; Ali, S.K.

    2013-01-01

    Objective: To establish as reliable and valid the nine-point global rating scale for assessing residents' independent performance of Caesarean Section. Methods: The validation study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan University Hospital, from April to December 2008, and comprised 15 residents during 40 Caesarean Sections over 9 months. Independently two evaluators rated each procedure and the difficulty of each case. Results: The observations per faculty ranged from 1-8 (mean 4.07+- 2.56). The Year 4 residents were observed the most i.e. 32 (40%), followed by Year 3, 30 (37.5%); Year 2; 14 (17.5%); and Year 1, 4 (5%). Mean time required for observation of the surgery was 43.81+-14.28 (range: 20-90) with a mode of 45 min. Mean aggregate rating on all items showed gradual progression with the year of residency. The assessment tool had an internal consistency reliability (Cronbach's alpha) of 0.9097 with low inter-rater reliability. Conclusion: The evaluation tool was found to be reliable and valid for evaluating a resident's competence for performing Caesarean Section. Training of the assessors is required for a better inter-rater agreement. (author)

  19. At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery.

    Directory of Open Access Journals (Sweden)

    Christopher G Fawsitt

    Full Text Available BACKGROUND: Elective repeat caesarean delivery (ERCD rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland. METHODS: Using a decision analytic model, a cost-effectiveness analysis (CEA was performed where the measure of health gain was quality-adjusted life years (QALYs over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations. RESULTS: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€ 1,835.06 versus € 4,039.87 per women, respectively, and QALYs were modestly higher (0.84 versus 0.70. Our findings were supported by probabilistic sensitivity analysis. CONCLUSIONS: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single

  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. 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.

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

    LENUS (Irish Health Repository)

    Sinnott, Sarah-Jo

    2016-01-01

    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.

  3. Determinants of caesarean section in Lebanon: geographical differences.

    Science.gov (United States)

    Carayol, Marion; Zein, Ali; Ghosn, Nada; Du Mazaubrun, Christiane; Breart, Gérard

    2008-03-01

    This study, based on the Lebanese National Perinatal Survey which included 5231 women, examined the relations between the caesarean section (CS) rate and the characteristics of mothers, children, antenatal care and maternity units in two geographical zones of Lebanon (Beirut-Mount Lebanon and the rest of the country) and then looked at geographical variations. This analysis concerned 3846 women with singleton pregnancies and livebirths at low risk of CS, after exclusion of women with a previous CS, non-cephalic fetal presentations, or delivery before 37 weeks' gestation. The principal end point was caesarean delivery. The relations between the factors studied and CS were estimated by odds ratios (OR), both crude and adjusted, using logistic regression. The rate of CS was higher in the Beirut-Mount Lebanon zone than elsewhere (13.4% vs. 7.6%). After adjustment, several factors remained associated with caesarean delivery in each zone. Common factors were primiparity, gestational age > or = 41 weeks and antenatal hospitalisation. Factors identified only in the Beirut-Mount Lebanon zone were obstetric history and insurance coverage, whereas for the other zones we only found major risk factors for obstetric disease: maternal age > or = 35 years, number of antenatal consultations > or = 4 and birthweight Lebanon (OR = 1.80 [95% CI 1.09, 2.95]). In conclusion, the CS rates in Lebanon were high, with geographical differences that were associated with access to care and with obstetric practices.

  4. 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

  5. Techniques for assisting difficult delivery at caesarean section.

    Science.gov (United States)

    Waterfall, Heather; Grivell, Rosalie M; Dodd, Jodie M

    2016-01-31

    Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Methods to assist with delivery include vacuum or forceps extraction or manual delivery utilising fundal pressure. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section. Delivery of the impacted head after prolonged obstructed labour can be associated with significant maternal and neonatal complication; to facilitate delivery of the head the surgeon may utilise either reverse breech extraction or head pushing. To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo and to compare different extraction methods at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies. All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby. Use of instrument versus manual delivery to facilitate birth of the baby. Reverse breech extraction versus head pushing to facilitate delivery of the deeply impacted fetal head. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Seven randomised controlled trials, involving 582 women undergoing caesarean section were included in this review. The risk of bias of included trials was variable, with some trials not adequately describing allocation or

  6. 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. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. 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...... respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. CONCLUSION: Emergency caesarean section was not associated with childhood asthma. FUNDING: none. TRIAL REGISTRATION: not relevant.......: 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...

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

    Science.gov (United States)

    Daher, Silvia; Betrán, Ana Pilar; Widmer, Mariana; Montilla, Pilar; Souza, Joao Paulo; Merialdi, Mario

    2011-01-01

    Objective To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women’s magazines. Design Review of articles published during 1988-2008 in top selling women’s magazines. Setting Brazil, one of the countries with the highest caesarean section rates in the world. Data sources Women’s magazines with the largest distribution during the study period, identified through the official national media indexing organisations. Selection criteria Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section. Main outcome measures Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section. Results 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section. Conclusions Most of the articles published in Brazilian women’s magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to

  9. Portrayal of caesarean section in Brazilian women's magazines: 20 year review.

    Science.gov (United States)

    Torloni, Maria Regina; Daher, Silvia; Betrán, Ana Pilar; Widmer, Mariana; Montilla, Pilar; Souza, Joao Paulo; Merialdi, Mario

    2011-01-25

    To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women's magazines. Review of articles published during 1988-2008 in top selling women's magazines. Brazil, one of the countries with the highest caesarean section rates in the world. Women's magazines with the largest distribution during the study period, identified through the official national media indexing organisations. Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section. Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section. 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section. Most of the articles published in Brazilian women's magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to underestimate the maternal/perinatal risks associated with this route of delivery.

  10. Intrathecal isobaric versus hyperbaric bupivacaine for elective caesarean section

    International Nuclear Information System (INIS)

    Aftab, S.; Ali, H.; Zafar, S.; Sheikh, M.; Sultan, T.

    2007-01-01

    To compare the results of isobaric bupivacaine (0.5%) with hyperbaric bupivacaine (0.75%) in cases of elective Caesarean Section, in respect of time to sensory analgesia, highest level of sensory block, haemodynamic effects, and complications. Sixty pregnant patients scheduled for elective Caesarean Section. The patients were randomly assigned to receive either 0.5% isobaric bupivacaine (Group-1B) or 0.75% hyperbaric bupivacaine (Group-HB) via intrathecal route. The time of onset of block, highest level of sensory block, cardio-respiratory data, duration of analgesia and complications were recorded during surgery. The time taken to reach T4 sensory analgesia in Group-1B was 6+-6.43 minutes as compared to 6.93+-7.8 minutes in Group-HB, while the highest sensory level achieved in Group-1B was T1 and in Group-HB T2. The lowest systolic blood pressure recorded in Group-1B was 83.27+-12.69 mmHg and in Group-HB 114.33+-13.83 mm Hg, the difference being significant (p<0.05). There was a higher incidence of complications in Group-1B as compared to Group-HB like high spinal analgesia, vomiting and discomfort. Intrathecal block showed a greater reduction in the systolic blood pressure, and associated complications, with Isobaric Bupivacaine as compared to Hyperbaric Bupivacaine. (author)

  11. VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.

    Science.gov (United States)

    Seffah, J D; Adu-Bonsaffoh, K

    2014-01-01

    The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa where there are obvious systemic and management-related challenges associated with trial of scar. However, there is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated. The primary objective of the study was to determine the current trends and performance of VBAC in Ghana after decades of practice of trial of labour after caesarean section (TOLAC) in the mist of inherent challenges in deciding the optimal mode of childbirth for women with a previous caesarean birth. The secondary objective was to relate evidence based practice of TOLAC to obstetric practice in low resource settings like Ghana and provide recommendations for improving maternal and newborn health among women with prior caesarean birth. This was a retrospective study of the records of patients who had had a prior caesarean delivery and who then proceeded to deliver the next babies at the Korle Bu Teaching Hospital (KBTH) between Jan 2010 and Dec 2014. The data on demography, antenatal care, labour and delivery and outcomes were collected from the Labour and Recovery wards and the Biostatistics unit of the Maternity unit of the Hospital. Excluded were women with a previous CS who had multiple pregnancies and those with incomplete notes as well as those whose delivery plans were not predetermined antenatally.. The data were analyzed using SPSS version 20. There were 53,581 deliveries during the study period. Vaginal delivery was obtained in 31,870 (59.5%) pregnancies and 21,711(40.5%) had CS. Also, 6261 (11.7%) had had a prior CS and 2472 (39.5%) of these were selected for TOLAC while 2119 (33.8) were scheduled for planned repeat CS. There was

  12. Increasing the availability and quality of caesarean section in Tanzania.

    Science.gov (United States)

    Nyamtema, A; Mwakatundu, N; Dominico, S; Mohamed, H; Shayo, A; Rumanyika, R; Kairuki, C; Nzabuhakwa, C; Issa, O; Lyimo, C; Kasiga, I; van Roosmalen, J

    2016-09-01

    To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. Before-after intervention study design. Rural Tanzania. Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests. Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia. During the audit period (2012-2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P = 0.02) and from 37 to 20% in hospitals (P availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings. Increasing availability and quality of CS in rural Africa is feasible. © 2016 Royal College of Obstetricians and Gynaecologists.

  13. Outcome of trial of scar in patients with previous caesarean section

    International Nuclear Information System (INIS)

    Khan, B.; Bashir, R.; Khan, W.

    2016-01-01

    Medical evidence indicates that 60-80% of women can achieve vaginal delivery after a previous lower segment caesarean section. Proper selection of patients for trial of scar and vigilant monitoring during labour will achieve successful maternal and perinatal outcome. The objective of our study is to establish the fact that vaginal delivery after one caesarean section has a high success rate in patients with previous one caesarean section for non-recurrent cause. Methods: The study was conducted in Ayub Teaching Abbottabad, Gynae-B Unit. All labouring patients, during the study period of five years, with previous one caesarean section and between 37 weeks to 41 weeks of gestation for a non-recurrent cause were included in the study. Data was recorded on special proforma designed for the purpose. Patients who had previous classical caesarean section, more than one caesarean section, and previous caesarean section with severe wound infection, transverse lie and placenta previa in present pregnancy were excluded. Foetal macrosomia (wt>4 kg) and severe IUGR with compromised blood flow on Doppler in present pregnancy were also not considered suitable for the study. Patients who had any absolute contraindication for vaginal delivery were also excluded. Results: There were 12505 deliveries during the study period. Total vaginal deliveries were 8790 and total caesarean sections were 3715. Caesarean section rate was 29.7%. Out of these 8790 patients, 764 patients were given a trial of scar and 535 patients delivered successfully vaginally (70%). Women who presented with spontaneous onset of labour were more likely to deliver vaginally (74.8%) as compared to induction group (27.1%). Conclusion: Trial of vaginal birth after caesarean (VBAC) in selected cases has great importance in the present era of the rising rate of primary caesarean section. (author)

  14. 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.

  15. 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.

  16. Exploring full cervical dilatation caesarean sections-A retrospective cohort study.

    Science.gov (United States)

    Corry, Edward M A; Ramphul, Meenakshi; Rowan, Ann M; Segurado, Ricardo; Mahony, Rhona M; Keane, Declan P

    2018-05-01

    The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit's electronic database for 2015. The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80-5.33 kg) vs 3.48 kg (1.53-4.40 kg)). There was no difference in neonatal morbidity. Fetal head malposition is

  17. Video ethnography during and after caesarean sections: methodological challenges.

    Science.gov (United States)

    Stevens, Jeni; Schmied, Virginia; Burns, Elaine; Dahlen, Hannah G

    2017-07-01

    To describe the challenges of, and steps taken to successfully collect video ethnographic data during and after caesarean sections. Video ethnographic research uses real-time video footage to study a cultural group or phenomenon in the natural environment. It allows researchers to discover previously undocumented practices, which in-turn provides insight into strengths and weaknesses in practice. This knowledge can be used to translate evidence-based interventions into practice. Video ethnographic design. A video ethnographic approach was used to observe the contact between mothers and babies immediately after elective caesarean sections in a tertiary hospital in Sydney, Australia. Women, their support people and staff participated in the study. Data were collected via video footage and field notes in the operating theatre, recovery and the postnatal ward. Challenges faced whilst conducting video ethnographic research included attaining ethics approval, recruiting vast numbers of staff members and 'vulnerable' pregnant women, and endeavouring to be a 'fly on the wall' and a 'complete observer'. There were disadvantages being an 'insider' whilst conducting the research because occasionally staff members requested help with clinical tasks whilst collecting data; however, it was an advantage as it enabled ease of access to the environment and staff members that were to be recruited. Despite the challenges, video ethnographic research enabled the provision of unique data that could not be attained by any other means. Video ethnographic data are beneficial as it provides exceptionally rich data for in-depth analysis of interactions between the environment, equipment and people in the hospital environment. The analysis of this type of data can then be used to inform improvements for future care. © 2016 John Wiley & Sons Ltd.

  18. Should women be able to choose caesarean section?

    African Journals Online (AJOL)

    2006-04-26

    Apr 26, 2006 ... important, including fun, fashion, education and my rights (not ... my opinion was formed. Caesareans: how many ... from the two Leeds Teaching Hospitals show that the rate in these ... high caesarean rates: the USA has a higher rate than the UK at ... Brazil that 'wins' with a rate of over 40%.1-5 It is unclear.

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

    African Journals Online (AJOL)

    Despite the increasing safety of anesthesia and surgical technique, caesarean delivery accounts for more maternal morbidity and mortality compared to a normal ... Records of patients who had caesarean section (CIS) were retrieved from the operation record book in the theatre and the labour ward delivery record book.

  20. The Rate of Caesarean Section in Nnewi, Nigeria: A 10-year Review ...

    African Journals Online (AJOL)

    Background: There is widespread public and professional concern about the increasing proportion of births by caesarean section (c/s). Objectives: This study is to determine the c/s rate, the indications and the reasons for the high rate. Methods: The obstetric records of all caesarean deliveries that occurred at Nnamdi ...

  1. 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

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

    Directory of Open Access Journals (Sweden)

    Yibeltal T. Bayou

    2016-07-01

    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.

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

    African Journals Online (AJOL)

    2010-08-08

    Aug 8, 2010 ... INTRODUCTION. The overall rate of Caesarean birth is increasing worldwide with wide geographical variations from the developing countries and industrialised nations .... The distribution of the respondents by professional.

  4. [The Decision-Making Processes in Taiwanese Women With Repeat Caesarean Deliveries].

    Science.gov (United States)

    Chen, Shu-Wen

    2016-10-01

    Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy. To explore the decision-making processes regarding RCD in Taiwanese women. A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis. A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women's decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician's recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians' professional judgment, and a lack of progress during the course of labour. The well-being of mother and fetus is the major concern affecting mothers' decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth

  5. SONOGRAPHIC PREDICTION OF SCAR DEHISCENCE IN WOMEN WITH PREVIOUS CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Shubhada Suhas Jajoo

    2018-01-01

    Full Text Available BACKGROUND Caesarean section (Sectio Caesarea is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after caesarean section was significantly reduced from year to year and the rate of repeated caesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding “cut-off value” for the completion of the delivery method. To better assess the risk of uterine rupture, some authors have proposed sonographic measurement of lower uterine segment thickness near term assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS may increase safety during labour by selecting women with the lowest risk of uterine rupture. The aim of the study is to study the diagnostic accuracy of sonographic measurements of the Lower Uterine Segment (LUS thickness near term in predicting uterine scar defects in women with prior Caesarean Section (CS. We aim to ascertain the best cut-off values for predicting uterine rupture. MATERIALS AND METHODS 100 antenatal women with history of previous one LSCS who come to attend antenatal clinic will be assessed for scar thickness by transabdominal ultrasonography and its correlation with intraoperative findings. This prospective longitudinal study was conducted for 1 year after IEC approval with inclusion criteria previous one LSCS. Exclusion criteria- 1 Previous myomectomy scar; 2 Previous 2 LSCS; 3 Previous hysterotomy scar. RESULTS Our findings indicate that there is a strong association between degree of LUS thinning measured near term and the risk of uterine scar defect at birth. In our study, optimal cut-off value for predicting

  6. [Carbetocin versus Oxytocin during caesarean section for preventing postpartum haemorrhage].

    Science.gov (United States)

    Pizzagalli, F; Agasse, J; Marpeau, L

    2015-05-01

    The aim of the study was to compare the effectiveness of Carbetocin versus Oxyotcin during caesarean section for preventing postpartum haemorrhage. Prospective observational study (before/after design). Five hundred and forty patients who received an injection of Oxytocin were compared to 262 patients with single injection of 100 micrograms of Carbetocin. The primary outcome was to compare the differential hematocrit level between pre- and postoperative blood samples. The secondary outcome was to compare differential hemoglobin level and the use of complementary therapies for postpartum haemorrhage. We did not find any difference between the Oxytocin and Carbetocin groups on differential hematocrit level. There was no difference between the groups regarding the use of additionnal therapies (Sulproston injections, blood transfusions and surgery methods). The rate of postpartum haemorrhage was similar in the two groups (18.7% vs 21.6%; P=0.33). We found a lower percentage of patients with differential of hemoglobin level between 2 g/dL and 4 g/dL in the Carbetocin group (6.5% vs 15.6%, Poxytocin. Carbetocin seems to reduce the need for postoperative intravenous iron injection. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. The role of caesarean section in modern Obstetrics

    Directory of Open Access Journals (Sweden)

    Alessandra Meloni

    2012-10-01

    Full Text Available Caesarean section (CS is a safe obstetric surgical procedure that contributes to reducing maternal and perinatal mortality and morbidity. Nevertheless, its advantages do not justify its continuous increase. During the last few years an average of 35% of deliveries have occurred by CS in Italy whereas an average of 20-25% is very common in other western countries. Although these percentages are very different, an important issue of modern obstetric Medicine is to ascertain whether the threshold of 15% proposed by the WHO in 1985 is actually adequate. Different medical, cultural, social, economic and medico-legal issues are of concern in the different countries and in contemporary society compared with the past. If we wish to discuss whether a new threshold should be proposed to reach the best balance between risks and benefits of CS in modern Obstetrics, it is mandatory to evaluate the reasons why these high percentages of CS occur in western countries and, in particular, in Italy. To reach this goal an optimal management of the delivery room should be pursued by implementing an organizational program, considering the objective delivery trend (Robson’s ten group classification and organizing continuous audit processes. The potential concern for the medico-legal issue, women’s choice and the use of analgesia in childbirth must be taken into account.

  8. THE INCIDENCE OF CAESAREAN SECTIONS IN THE UNIVERSITY CLINICAL CENTER OF KOSOVO

    OpenAIRE

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

    2012-01-01

    Introduction: As in most countries of the world also at Kosovo the rate of Cesarean section from year to year is increasing. Aim: 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 Prishtin?. Material and methods: This study is retrospective, namely its made by collecting epidemiological data from patients? histories that completed birth by Caesarean section ...

  9. Caesarean section rates in Southwestern Ontario: changes over time after adjusting for important medical and social characteristics.

    Science.gov (United States)

    Brown, Hilary K; Hill, Jacquelyn; Natale, Renato

    2014-07-01

    To compare Caesarean section rates in a cohort of women in Southwestern Ontario over time, overall, and in patient subgroups defined by the Robson criteria, after adjusting for important medical and social characteristics. We obtained data from a perinatal database on deliveries at ≥ 22 weeks' gestation at a level II centre and a level III centre in London, Ontario between 1999 and 2010. Caesarean section rates were examined overall and in subgroups defined by parity, presentation, plurality, gestational age, and history of previous Caesarean section. Multivariable modified Poisson regression was used to compare Caesarean section rates in 2003-2006 and 2007-2010 versus 1999-2002. In the fully adjusted models, the overall Caesarean section rate was significantly higher in 2007-2010 than in 1999-2002 for the level II centre (adjusted relative risk [aRR] 1.12; 95% CI 1.05 to 1.21). An increase was also seen in the level III centre in both 2003 to 2006 (aRR 1.19; 95% CI 1.14 to 1.24) and 2007 to 2010 (aRR 1.17; 95% CI 1.12 to 1.22). Similar increases were seen over time among patient subgroups. Notably, repeat Caesarean sections without labour increased at the level II centre (2003 to 2006 aRR 1.21; 95% CI 1.01 to 1.45, and 2007 to 2010 aRR 1.44; 95% CI 1.21 to 1.71) and the level III centre (2003 to 2006 aRR 1.72; 95% CI 1.53 to 1.94, and 2007 to 2010 aRR 1.77; 95% CI 1.57 to 2.00). There has been a significant increase over time in the Caesarean section rate overall and in important subgroups. This increase remains even after controlling for other factors which may explain the trend.

  10. Caesarean section in a patient with varicella: Anaesthesia considerations and clinical relevance

    Directory of Open Access Journals (Sweden)

    Nandini M Dave

    2007-01-01

    Full Text Available A primigravida with chicken pox was posted for an emergency caesarean section. General anaesthesia was administered. Key issues in anaesthesia management and the clinical implications are discussed.

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

    African Journals Online (AJOL)

    2009-10-05

    Oct 5, 2009 ... Conclusion: Trial of vaginal birth after caesarean section in ... continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood ..... poverty level in our environment such that only.

  12. Spinal anaesthesia for Caesarean section: How can we make it safer?

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... where predominantly general anaesthesia for caesarean section is still performed, and ... data is being collected, so that information will be available on ... deaths during obstetric delivery in the United States, 1979-1990.

  13. 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.

  14. 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

    OBJECTIVE: To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. DESIGN: Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark. SETTING: Obstetric department...... 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...

  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. 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.

  17. 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

  18. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries.

    Science.gov (United States)

    Boatin, Adeline Adwoa; Schlotheuber, Anne; Betran, Ana Pilar; Moller, Ann-Beth; Barros, Aluisio J D; Boerma, Ties; Torloni, Maria Regina; Victora, Cesar G; Hosseinpoor, Ahmad Reza

    2018-01-24

    To provide an update on economic related inequalities in caesarean section rates within countries. Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Women aged 15-49 years with a live birth during the two or three years preceding the survey. Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Substantial within country economic inequalities in caesarean deliveries remain

  19. 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.

  20. An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

    Directory of Open Access Journals (Sweden)

    Yasmin Adam

    2018-05-01

    Full Text Available Abstract:Background:A systematic review concluded that a caesarean section that is performed for medical indications will save lives, but is associated with short and long term complications. The caesarean section rate at CHBAH was 39.78% in 2015. Objectives:To evaluate the indications for caesarean section.Methods:This was a cross-sectional study  in the week 23rd June to the 29th June 2015. Each file was  evaluated for the  correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessmen.Results:The mean age was 27.01 (6.35; range- 15-44. The median parity was 1(IQR=0-2; range=0-4. No co-morbdities was found in 20 (13.61%. Complications occurred in 25 (17.01% women. The median gestational age at delivery was 38.14 (IQR=36.39-40.14; range-28.0-42.4. The median Apgar (5 min was 10 (IQR=9-10; range- 0-10. The median birth weight was 3040 g (IQR=2530-3440; range- 825-4575 g. The most common indications were fetal distress (n=73; 49.66% and dystocia (n=42; 28.57%. There was absolute agreement between the 2 reviewers in the following; retained 2nd twin, APH of unknown origin, placenta previa, severe IUGR, multiple pregnancy, abnormal presentation, eclampsia, two caesarean sections. When the indication was fetal distress, dystocia, 2nd stage caesarean section, or with 1 previous caesarean the absolute agreement was between 73.85% and 90.24%.Conclusion:There were  few absolute disagreements with the indication. There needs to be an evaluation of methods to diagnose fetal distress and dystocia.  

  1. 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.

  2. Association between placental abruption and caesarean section among patients at Khyber teaching hospital Peshawar

    International Nuclear Information System (INIS)

    Gul, S.; Jamal, T.; Rana, G.E.; Majid, A.; Iqbal, M.; Abrar, S.

    2016-01-01

    Background: Ante partum haemorrhage remains to be a major cause of morbidity and mortality. 30 percentage of this haemorrhage is attributed to placental abruption. Along with other adverse maternal outcomes, it increases the risk of Caesarean sections in patients, which is a public health concern. This study was conducted to find out whether any significant association exists between placental abruption and C-section in our set up. Methods: A cross-sectional study was conducted from July 26th, 2011 to May 1st, 2013 (i.e., 21 months) in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital Peshawar on a sample of 334 patients who presented with antepartum haemorrhage after 28 weeks of gestation. All those patients with and without placental abruption were followed throughout pregnancy and labour to detect the risk of caesarean section. Results: Among study participants, parity had the highest dispersion while gestational age had the lowest. Caesarean section was performed on 26.3 percentage (95 percentage CI) of the study participants. Proportion of placental abruption among patients presenting with ante partum haemorrhage was 20.6 percentage, (95 percentage CI) out of which 7.5 percentage underwent C-section. Association between placental abruption and C-section was found significant at a=0.05 (ρ=0.03). Conclusion: Risk of caesarean section is increased in pregnancies complicated by placental abruption as compared to pregnancies complicated by other causes of ante partum haemorrhage. (author)

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

    OpenAIRE

    Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

    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...

  4. 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

    in English on elective caesarean section and respiratory morbidity in the newborn. We included studies that compared elective caesarean section to vaginal or intended vaginal delivery, with clear definition of outcome measures and information about gestational age. RESULTS: Nine eligible studies were......-analysis with a pooled risk estimate because of a variety of methodological differences between the studies. The overall risk for respiratory morbidity, however, seemed to increase about 2 to 3 times, though some studies presented much higher risk estimates. A decreasing risk with increasing gestational age was shown...

  5. Management of emergency caesarean section in a patient with decompensated critical aortic stenosis

    Directory of Open Access Journals (Sweden)

    Andrew C Leatherbarrow

    2018-01-01

    Full Text Available Increasing numbers of congenital heart disease patients are now surviving to child bearing age. This complex patient cohort present a great challenge to the obstetric anaesthetist and multidisciplinary teams. This report describes a rare case of a patient undergoing emergency caesarean section at 31 weeks gestation due to decompensated critical congenital aortic stenosis. The physiological effects of pregnancy in patients with aortic stenosis are discussed along with principles of managing anaesthesia for caesarean section in the presence of this cardiac lesion.

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

    Science.gov (United States)

    Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

    2015-01-01

    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.

  7. Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.

    Science.gov (United States)

    Foureur, Maralyn; Turkmani, Sabera; Clack, Danielle C; Davis, Deborah L; Mollart, Lyndall; Leiser, Bernadette; Homer, Caroline S E

    2017-02-01

    One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  8. 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.

  9. 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

    BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined. METHODS: Ninety patients scheduled for elective Caesarean...... found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed. CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed...

  10. STUDY CONCERNING THE COSTS OF BIRTH BY CAESAREAN SECTION COMPARED TO NATURAL BIRTH

    Directory of Open Access Journals (Sweden)

    Diana UIVAROȘAN

    2016-12-01

    Full Text Available The birth by caesarean section has become an expanding phenomenon in the recent years, natural births being more and more rare in Romania. The increasing incidence of these operations has been observed in the recent years, in the conditions of more effective fetal monitoring, modification of the malpractice law and increasing degree of information of the women. In Romania, depending on the hospital, the percentage of births by caesarean section ranges between 20-80%, even 90% (these latter percentage being valid especially in private clinics. The percentage of the operations is higher in big cities, and in Bucharest about 70% of the births are done by C-section. The World Health Organization recommends a maximum percentage surgical intervention of 10-15%. Fearing the labor pain, more and more women are choosing to bring their children into the world by Caesarean section. Also the number of doctors who claim that cesarean section is a better option is increasing. Both persons involved in the birth process have the responsibility of that decision - meaning both mother and doctor. The option of the mother is very important, but the recommendation of the doctor can make the difference. The decision is not only of the doctor, he just presents the information that the mother does not know, mother's wish being the most important. In this paper we conducted a study to determine the comparative costs of the vaginal births with those by Caesarean section. The retrospective study was conducted between 01.01.2015 - 31.12.2015, on 3607 births registered in the Obstetrics and Gynecology Clinics of Clinical Emergency County Hospital Oradea. Gemellary births were excluded from the study. We analyzed the comparative costs of a vaginal birth and of a birth by caesarean section in order to highlight the share of cesarean births compared to vaginal births.

  11. Differences in nulliparous caesarean section rates across models of care: a decomposition analysis.

    LENUS (Irish Health Repository)

    Brick, Aoife

    2016-01-01

    To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates.

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

    African Journals Online (AJOL)

    Vaginal Birth After Caesarean Section (VBAC), has for a long time been practised in low resource settings using nonconventional 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 had been informed by observational ...

  13. Quality of pain treatment after caesarean section : Results of a multicentre cohort study

    NARCIS (Netherlands)

    Marcus, H.; Gerbershagen, H. J.; Peelen, Linda M.; Aduckathil, S.; Kappen, T. H.; Kalkman, C. J.; Meissner, W.; Stamer, U. M.; Peelen, LM

    BackgroundA large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment. MethodsWe analysed pain scores, pain-related

  14. 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.

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

    African Journals Online (AJOL)

    In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under a combined spinal-epidural technique. A level of sensory block of T6 was achieved with 2.8 mL of 0.5% hyperbaric bupivacaine administered intrathecally. Towards the end of surgery, analgesia was supplemented through ...

  16. Comparison of intrathecal plain articaine and levobupivacaine with fentanyl for Caesarean section.

    Science.gov (United States)

    Demircioglu, Rüveyda I; Gozdemir, Muhammet; Usta, Burhanettin; Sert, Hüseyin; Karabayirli, Safinaz; Muslu, Bünyamin; Keskin, Esra A

    2016-12-01

    Articaine is used as a local anesthetic for outpatient surgery because it offers rapid onset of anesthesia and short duration motor block. Levobupivacaine is often preferred for Caesarean section. We evaluated the anesthetic characteristics of fentanyl-supplemented plain articaine and levobupivacaine for Caesarean section under combine spinal epidural anesthesia. Patients undergoing Caesarean section received in random order plain articaine 40 mg (Group A, n=50) or plain levobupivacaine 10 mg (Group L, n=50) mixed with fentanyl 20 µg intrathecally. The onset and duration of sensory and motor block, first analgesic request, and hemodynamic parameters were recorded. Onset times of maximum motor block were longer in Group L than Group A (P=0,001). Time to two-segment regression of sensory block were 70 min for Group A and 90 min group L (P=0.001). Times to complete regression of motor blockade were significantly longer in group L than group A (P =0,001). To have a faster onset and shorter duration of spinal anesthesia, we recommend the use of plain articaine for Caesarean section.

  17. Learning Curve Characteristics for Caesarean Section Among Associate Clinicians : A Prospective Study from Sierra Leone

    NARCIS (Netherlands)

    Waalewijn, B.P.; van Duinen, A.; Koroma, A. P.; Rijken, M. J.; Elhassein, M.; Bolkan, H. A.

    2017-01-01

    Background: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to

  18. 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.

  19. 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

  20. 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

    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...

  1. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

    Science.gov (United States)

    Souza, J P; Betran, A P; Dumont, A; de Mucio, B; Gibbs Pickens, C M; Deneux-Tharaux, C; Ortiz-Panozo, E; Sullivan, E; Ota, E; Togoobaatar, G; Carroli, G; Knight, H; Zhang, J; Cecatti, J G; Vogel, J P; Jayaratne, K; Leal, M C; Gissler, M; Morisaki, N; Lack, N; Oladapo, O T; Tunçalp, Ö; Lumbiganon, P; Mori, R; Quintana, S; Costa Passos, A D; Marcolin, A C; Zongo, A; Blondel, B; Hernández, B; Hogue, C J; Prunet, C; Landman, C; Ochir, C; Cuesta, C; Pileggi-Castro, C; Walker, D; Alves, D; Abalos, E; Moises, Ecd; Vieira, E M; Duarte, G; Perdona, G; Gurol-Urganci, I; Takahiko, K; Moscovici, L; Campodonico, L; Oliveira-Ciabati, L; Laopaiboon, M; Danansuriya, M; Nakamura-Pereira, M; Costa, M L; Torloni, M R; Kramer, M R; Borges, P; Olkhanud, P B; Pérez-Cuevas, R; Agampodi, S B; Mittal, S; Serruya, S; Bataglia, V; Li, Z; Temmerman, M; Gülmezoglu, A M

    2016-02-01

    To generate a global reference for caesarean section (CS) rates at health facilities. Cross-sectional study. Health facilities from 43 countries. Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. © 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  2. Caesarean Section Rates in South Africa: evidence of bias among different ‘population groups’

    Science.gov (United States)

    MATSHIDZE, K. PATRICK; RICHTER, LINDA M.; ELLISON, GEORGE T. H.; LEVIN, JONATHAN B.; McINTYRE, JAMES A.

    2007-01-01

    Objective The aim of this study was to assess the effect of ‘population group’ classification, as a specific instance of ‘racial’ categorization, on caesarean section rates in South Africa. Design Information on ‘population group’ classification (‘Black’, ‘Coloured’, ‘Indian’ or ‘White’, as defined under apartheid legislation) and place of delivery, together with basic obstetric, sociodemographic and perinatal data, were extracted from the birth notification forms of 5456 children who made up the birth cohort of the Birth to Ten longitudinal study. This cohort included all births that occurred to mothers resident in Soweto-Johannesburg during a 7-week period in 1990. Results After accounting for differences in maternal age, gravidity, birth weight and gestational age at delivery, the rate of caesarean sections at private facilities was more than twice that at public facilities. Although there were significant differences in the utilisation of private facilities by women from different ‘population groups’, there was an independent effect of ‘population group’ classification on caesarean section rates: caesarean section rates among women classified as ‘White’ and ‘Coloured’ were significantly higher (95% confidence intervals for odds ratios: 1.40-2.42 and 1.05-1.81, respectively) than among women classified as ‘Black’. Conclusion ‘Population group’ differences in caesarean section rates among South African women are not explained by differences in demographic risk factors for assisted delivery, nor by differences in access to private health care. Instead, the differences in section rates may reflect the effect of bias in clinical decision-making, and/or differences among women from different ‘population groups’ in their attitude towards assisted delivery, and their capacity to negotiate with clinicians. PMID:9673465

  3. Prediction of successful trial of labour in patients with a previous caesarean section

    International Nuclear Information System (INIS)

    Shaheen, N.; Khalil, S.; Iftikhar, P.

    2014-01-01

    Objective: To determine the prediction rate of success in trial of labour after one previous caesarean section. Methods: The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Cantonment General Hospital, Rawalpindi, from January 1, 2012 to January 31, 2013, and comprised women with one previous Caesarean section and with single alive foetus at 37-41 weeks of gestation. Women with more than one Caesarean section, unknown site of uterine scar, bony pelvic deformity, placenta previa, intra-uterine growth restriction, deep transverse arrest in previous labour and non-reassuring foetal status at the time of admission were excluded. Intrapartum risk assessment included Bishop score at admission, rate of cervical dilatation and scar tenderness. SPSS 21 was used for statistical analysis. Results: Out of a total of 95 women, the trial was successful in 68 (71.6%). Estimated foetal weight and number of prior vaginal deliveries had a high predictive value for successful trial of labour after Caesarean section. Estimated foetal weight had an odds ratio of 0.46 (p<0.001), while number of prior vaginal deliveries had an odds ratio of 0.85 with (p=0.010). Other factors found to be predictive of successful trial included Bishop score at the time of admission (p<0.037) and rate of cervical dilatation in the first stage of labour (p<0.021). Conclusion: History of prior vaginal deliveries, higher Bishop score at the time of admission, rapid rate of cervical dilatation and lower estimated foetal weight were predictive of a successful trial of labour after Caesarean section. (author)

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

    Directory of Open Access Journals (Sweden)

    Gayatri Desai

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

  5. CHANGING TRENDS IN CAESAREAN DELIVERY - A CLINICAL STUDY

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    Annappa Shetty

    2016-10-01

    Full Text Available BACKGROUND Today, there is a concern over the rising caesarean delivery both in the developed and developing countries across the world. It has been observed that both primary and repeat caesarean deliveries have been increasing at an alarming rate. Indications for caesarean deliveries also shows changing trends in the present scenario. The main aim of this study is to compare the caesarean delivery rates over the last one decade. The objective behind the study is to understand the contributing factors for the new trends. MATERIALS AND METHODS For this study, the data was collected in a retrospective manner from all the deliveries that occurred between July 1, 2005, to June 30, 2006, and July 2015 to June 30, 2016, in the Department of Obstetrics and Gynaecology, Karwar Institute of Medical Science, Karwar. A cohort of 2752 delivered women were studied. Among the caesarean births, the indications for both the primary and repeat caesarean sections were studied. After analysing the caesarean births from total live births, the rate for both primary and repeat caesarean were calculated. RESULTS The caesarean delivery rate is increased from 167 to 263 for 1000 live births with increase in primary caesarean delivery rate from 101 (10.1% to 187 (18.7% per 1000 live births in last one decade. Foetal distress, cephalopelvic disproportion, arrest of descent, multiple gestations, breech presentation contributed to this increase. CONCLUSION There is an increase in the total caesarean rate with significant rise in the primary caesarean rate in the last one decade.

  6. Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

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    Thobeka P. Jikijela

    2018-01-01

    Conclusion: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

  7. 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

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

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    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.

  9. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data.

    Science.gov (United States)

    Ye, J; Zhang, J; Mikolajczyk, R; Torloni, M R; Gülmezoglu, A M; Betran, A P

    2016-04-01

    Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. Ecological study using longitudinal data. Worldwide country-level data. A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio-economic development by means of human development index (HDI) using fractional polynomial regression models. Maternal mortality ratio and neonatal mortality rate. Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5-10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality. The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality. © 2015 The Authors

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

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    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.

  11. The effect of physicians' remuneration system on the Caesarean section rate: the Uruguayan case.

    Science.gov (United States)

    Triunfo, Patricia; Rossi, Máximo

    2009-12-01

    Using data about births from the perinatal information system (PIS) registered in Montevideo (Uruguay), we estimated the probability of having a Caesarian section delivery, controlled by risk factors and the endogeneity of the choice of hospital. In public hospitals in Montevideo there is a fixed payment system, but in private hospitals this procedure has to be paid for separately. In the former, there is no effect on the doctor's income if he performs a Caesarian, but in the latter there is a positive effect. Empirical evidence shows the probability of a Caesarean section increases with the age of the woman, the presence of eclampsy, pre-eclampsy, previous hypertension, previous Caesarean sections, multiple pregnancies and fetopelvic disproportion, and decreases for multiparous women and women in a public hospital. In fact, the probability of having a Caesarean section in a private institution is almost two times higher than in a public hospital (20% as against 39%). Focusing on women without risk factors, we found that the probability a Caesarian in a public hospital was 11%, but the probability in a private hospital was 25%. We conclude that the remuneration system explains an important part of this difference.

  12. [Thinking about the evolution of caesarean section rate at University Teaching Hospital of Dakar between 1992 and 2001].

    Science.gov (United States)

    Cissé, C-T; Ngom, P-M; Guissé, A; Faye, E-O; Moreau, J-C

    2004-03-01

    The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar? This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%. Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis. Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

  13. 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...

  14. 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.

  15. Anaesthetic Management of Caesarean Section in a Patient with Large Mediastinal Mass

    International Nuclear Information System (INIS)

    Kashif, S.; Saleem, J.

    2015-01-01

    Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with anterior and middle mediastinal masses are recognized to be at risk for cardiorespiratory compromise. Likewise, pregnancy has a widely known constellation of potential complications that confront the anaesthesiologist. The combination of both (pregnancy and mediastinal mass) in a single patient presents an unusual anaesthetic challenge. Caesarean sections are usually the mode of delivery, therefore, the cardio-respiratory stability is very important. The following is the report of a 31 weeks pregnant patient with a large, symptomatic anterior and middle mediastinal mass, who required anaesthesia for emergency caesarean section. The anaesthetic management entailed Combined Spinal and Epidural (CSE) technique with safe feto-maternal outcome. (author)

  16. Does amnioinfusion reduce caesarean section rate in meconium-stained amniotic fluid.

    Science.gov (United States)

    Choudhary, Deepti; Bano, Imam; Ali, S M

    2010-07-01

    The purpose of our study was to evaluate the safety and efficacy of transcervical amnioinfusion during labour complicated by meconium-stained amniotic fluid, in a setting with limited peripartum facilities, to lower the incidence of caesarean section. A prospective study was conducted in a teaching hospital in north India, which enrolled 292 patients admitted in labour. Patients were randomly divided into two groups after taking their consent. One group received transcervical amnioinfusion, whilst in the other group amnioinfusion was not done. Caesarean sections were performed in either group if there were foetal heart rate abnormalities (bradycardia or irregularity for 10-20 min) or slow progress of labour. The outcomes studied were the incidence of caesarean sections, duration of maternal hospital stay, maternal febrile morbidity (temperature of >38 degrees C, 24 h after delivery), low Apgar score (at 1 and 5 min), respiratory death, MAS and perinatal mortality. There was a statistically significant reduction in the incidence of caesarean sections in the study group compared to the control group (31 vs. 61%). Amnioinfusion was associated with improved neonatal outcome as evidenced by statistically improved Apgar score at 1 min in newborns in the study group compared to the control group (10 vs. 37.2%). Amnioinfusion during labour was not associated with any significant maternal and neonatal complications. The mean hospital stay of the mother was decreased significantly in the study group patients compared to the control group. Transcervical amnioinfusion in labour for meconium-stained amniotic fluid is a simple, safe and easy-to-perform procedure. It can be performed safely in a setup with limited peripartum facilities, especially in developing countries, to decrease intrapartum operative intervention and reduce foetomaternal morbidity and mortality.

  17. Bioethical considerations: Caesarean section at the request of the patient and autonomy

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    Rogelio González Pérez

    2012-04-01

    Full Text Available A doctor who has to perform an on demand Caesarean section instead of a vaginal birth, without any medical need, must analyze several ethical elements to accept this request. To review and reflect on the principles of medical ethic can guide the physician to prioritize a medical-based decision, ensuring the best result possible for the mother and for the unborn child.

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

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    Simran Kaur Bhatia

    2015-01-01

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

  19. 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.

  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. Assessment of block height for satisfactory spinal anaesthesia for caesarean section.

    Science.gov (United States)

    Ousley, R; Egan, C; Dowling, K; Cyna, A M

    2012-12-01

    We investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch, pinprick, first cold and icy were: T10 (T7-T12 [T3-L1]); T5 (T4-T6 [C7-L1]); T5 (T4-T6 [C7-L1]); and T3 (T2-T4 [C7-L1]), respectively. Modalities were significantly correlated for: touch and cold, p = 0.0001; touch and icy, p = 0.0007; touch and pinprick, p = 0.0018; cold and icy, p satisfactory anaesthesia despite 76 (81%) having a block to touch below T6. Single modality assessment of block height, particularly using touch, may erroneously indicate inadequate anaesthesia for caesarean section. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  2. 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....

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

    African Journals Online (AJOL)

    Results: The mean age of the respondents was 32±1.8 yearswith 118(79%) of the surgeries being emergency Cesarean sections. The consent for CS were mostly given by the patients (96, 64.0%) and husbands (43, 28.6%). Majority of the respondents 123(81.5%) had the consent obtained in the labour ward with profuse ...

  4. 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.

  5. Ropivacaine 7.5 mg/mL for Caesarean Section

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    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.

  6. Intravenous Magnesium Sulphate for Analgesia after Caesarean Section: A Systematic Review

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    Andrew McKeown

    2017-01-01

    Full Text Available Objective. To summarise the evidence for use of intravenous magnesium for analgesic effect in caesarean section patients. Background. Postcaesarean pain requires effective analgesia. Magnesium, an N-methyl-D-aspartate receptor antagonist and calcium-channel blocker, has previously been investigated for its analgesic properties. Methods. A systematic search was conducted of PubMed, Scopus, MEDLINE, Cochrane Library, and Google Scholar databases for randomised-control trials comparing intravenous magnesium to placebo with analgesic outcomes in caesarean patients. Results. Ten trials met inclusion criteria. Seven were qualitatively compared after exclusion of three for unclear bias risk. Four trials were conducted with general anaesthesia, while three utilised neuraxial anaesthesia. Five of seven trials resulted in decreased analgesic requirement postoperatively and four of seven resulted in lower serial visual analogue scale scores. Conclusions. Adjunct analgesic agents are utilised to improve analgesic outcomes and minimise opioid side effects. Preoperative intravenous magnesium may decrease total postcaesarean rescue analgesia consumption with few side effects; however, small sample size and heterogeneity of methodology in included trials restricts the ability to draw strong conclusions. Therefore, given the apparent safety and efficacy of magnesium, its role as an adjunct analgesic in caesarean section patients should be further investigated with the most current anaesthetic techniques.

  7. Ogilvie's syndrome (acute colonic pseudo-obstruction) after caesarean section

    International Nuclear Information System (INIS)

    Munzar, Z.; Munir, T. A.; Asad, M.

    2013-01-01

    Ogilvie's syndrome (OS), a massive dilation of the colon in the absence of mechanical obstruction, is a rare postsurgical complication. The high mortality rate (normally 15 - 31% and upto 45% after caecal perforation) explains the seriousness of this clinical situation. Early diagnosis is made by plain abdominal X-ray and CT abdomen. Conservative treatment is usually effective and surgery should be reserved for complicated cases or refractory to conservative treatment. We report a case of 25 years primigravida who developed OS, 24 hours after cesarean section, which was treated by conservative methods. (author)

  8. 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.

  9. 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

  10. The Efficacy of Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Pain After Caesarean Section

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    Melike Sakallı

    2010-01-01

    Full Text Available Background:: The effect of ilioinguinal and iliohypogastric (II-IH nerve block on postoperative pain is well documented when applied before Caesarean section but the efficacy remains unclear when applied after the surgical procedure. Therefore we investigated the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when applied after Caesarean Section. Methods: Sixty ASA I-II patients, scheduled for elective C/S were included in the study. After general anaesthesia was performed, the patients were allocated into 2 groups randomly. In Group I (n=30, bilateral II-IH block had been applied after the skin closure, with 10 ml of 0.5% ropivacaine on each side. In Group II (n=30 sham block had been applied. For postoperative analgesia all patients received tramadol via i.v patient controlled analgesia. VAS scores, tramadol consumption and side effects at 0th, 2nd, 4th, 6th, 8th, 12th, 16th, 20th, 24th hours were noted. Results: There was no difference between groups regarding demographical data. The mean VAS scores in Group I were significantly lower than in Group II at 6th (p=0.003, 8th (p=0.019, 12th (p=0.024, 24th hours (p=0.004 at rest and at 6th (p=0.022, 8th hours (p=0.047 with movement. Tramadol usage in Group I was significantly less than in Group II at all estimated time intervals (P=0.001. Total tramadol consumption was 331 ± 82 mg in Group I and 622±107 mg in group II (P=0.001. Conclusions: We observed that II-IH nerve block when applied after the surgery may reduce analgesic consumption after C/S. Key Words: Caesarean section, postoperative analgesia, Ilioinguinal and Iliohypogastric (II-IH nerve block.

  11. A comparison of morbidity associated with placenta previa with and without previous caesarean sections

    International Nuclear Information System (INIS)

    Baqai, S.; Siraj, A.; Noor, N.

    2018-01-01

    To compare the morbidity associated with placenta previa with and without previous caesarean sections. Study Design: Retrospective comparative study. Place and Duration of Study: From March 2014 till March 2016 in the department of Obstetrics and Gynaecology at PNS Shifa hospital Karachi. Material and Methods: After the approval from hospital ethical committee, antenatal patients with singleton pregnancy of gestational age >32 weeks, in the age group of 20-40 years diagnosed to have placenta previa included in the study. All patients with twin pregnancy less than 20 years and more than 40 years of age were excluded. The records of all patients fulfilling the inclusion criteria were reviewed. Data had been collected for demographic and maternal variables, placenta previa, history of previous lower segment caesarean section (LSCS), complications associated with placenta previa and techniques used to control blood loss were recorded. Results: During the study period, 6879 patients were delivered in PNS Shifa, out of these, 2060 (29.9%) had caesarean section out of these, 47.3% patients had previous history of LSCS. Thirty three (1.6%) patients were diagnosed to have placenta previa and frequency of placenta previa was significantly higher in patients with previous history of LSCS than previous normal delivery of LSCS i.e. 22 vs. 11 (p=0.023). It was observed that the frequency of morbidly adherent placenta (MAP) and Intensive care unit (ICU) stay were significantly higher in patients with previous history of LSCS than previous history of normal delivery. Conclusion: Frequency of placenta previa was significantly higher in patients with history of LSCS. Also placenta previa remains a major risk factor for various maternal complications. (author)

  12. Elective caesarean section versus vaginal delivery. Whither the end of traditional obstetrics?

    Science.gov (United States)

    Husslein, P

    2001-11-01

    No other topic has dominated the obstetrical discussion to the same extent as caesarean section. Nor has any other aspect of obstetrics been subject to a comparable degree of professional controversy,quite recently the topic has been discussed in this journal by Ludwig and Loeffler. For some caesarean section remains a major surgical procedure with a corresponding level of risk, which must only be employed in the presence of specific complications and in conjunction with a clearly defined set of indications; others consider caesarean section quite simply to be the most efficient and straightforward means to deliver as well as the one attended by the least amount of risk. Opinion among those most immediately affected is likewise divided: For many women the experience of vaginal birth is among the most fulfilling of their entire life - comparable only to sexuality-related moments of ecstasy - other women come to regard birth as the worst thing that ever happened to them an experience attended by pain, fear, loneliness, perhaps even long lasting negative consequences. There can be no doubt that, this question also affects the foundations of patriarchal thinking, still so firmly embedded in peoples' minds: Are doctors to determine what exactly takes place in the delivery room and in the operating theatre, or will the patient - in obstetrics, the parturient - be enabled to assert her right to self-determination also in the medical context; especially in light of the fact that said right can currently be exercised in an almost unlimited fashion throughout the rest of one's adult life? It is against the wider background of this ongoing controversy that the ensuing article will seek to defuse the emotional charge characterising some of the commonly employed arguments and instead revert to a more rational and factually based approach to this question.

  13. Anaesthesia for caesarean section in a patient with acute generalised pustular psoriasis.

    Science.gov (United States)

    Samieh-Tucker, A; Rupasinghe, M

    2007-10-01

    We describe a 30-year-old parturient with acute generalised pustular psoriasis who presented for urgent caesarean section. A multidisciplinary team was involved and general anaesthesia was used successfully. Management of this condition is discussed and the literature reviewed. While generalised pustular psoriasis or impetigo herpetiformis is well recognised in pregnancy, it has not hitherto been reported in obstetric anaesthesia literature. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.

  14. 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.

  15. Anaesthetic management for emergency caesarean section in a patient with an untreated recently diagnosed phaeochromocytoma

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    Anil Agarwal

    2011-01-01

    Full Text Available Phaeochromocytoma is a rare cause of hypertension during pregnancy with potentially fatal consequences. If not detected and treated early in pregnancy, it is catastrophic for both the mother and the baby. Management requires close co-ordination between the obstetrician, anaesthesiologist, paediatrician and the endocrinologist. Perioperative management for an emergency caesarean section in a parturient with untreated phaeochromocytoma is an anaesthetic challenge and no standard recommendations have been reported till date. In this case report, we present anaesthetic management in such a case with successful maternal and foetal outcome.

  16. Anaestetic management of caesarean section for conjoint-twins: A case report

    Directory of Open Access Journals (Sweden)

    Deogaonkar Shrikrishna G, Aditya Prakash

    2014-04-01

    Full Text Available At Pravara Rural Hospital a 29 year old patient was admitted for delivery. Patient had conjoint-twins diagnosed after sonography and was posted for elective caesarean section. Patient was managed under general anaesthesia after thorough preparation and under multi-disciplinary involvement. Both the twins females were living and were further managed by neonatologists. Though conjoint-twins are rare and patients coming for delivery with conjoint-twins are still rarer because of early diagnosis and termination, anaesthesiologists working in developing countries and working in remote areas may face such patients. There are very few publications for management of delivery in such patients, hence this case report.

  17. Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania.

    Science.gov (United States)

    Dekker, Luuk; Houtzager, Tessa; Kilume, Omary; Horogo, John; van Roosmalen, Jos; Nyamtema, Angelo Sadock

    2018-05-15

    Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.

  18. Risk of a venous thromboembolic episode due to caesarean section and BMI

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Ladelund, S; Rasmussen, S

    2014-01-01

    BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery.......BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery....

  19. 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

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

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    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.

  1. 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.

  2. 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.

  3. Use of electrocautery for coagulation and wound complications in Caesarean sections.

    Science.gov (United States)

    Moreira, Cristiane M; Amaral, Eliana

    2014-01-01

    To evaluate the safety of electrocautery for coagulation during Caesarean sections. 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. 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). 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. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section.

    Science.gov (United States)

    Hussin, O A; Mahmoud, M A; Abdel-Fattah, M M

    2013-02-01

    The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version (ECV) and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif, Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited. ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally (84.1%) and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section (62.7%). Successful ECV reduced the breech and caesarean section rate.

  5. 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,

  6. Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay.

    Science.gov (United States)

    Jikijela, Thobeka P; James, Sindiwe; Sonti, Balandeli S I

    2018-01-30

    The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis. Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different. Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

  7. Ergometrine given during caesarean section and incidence of delayed postpartum haemorrhage due to uterine atony.

    Science.gov (United States)

    Lourens, R; Paterson-Brown, S

    2007-11-01

    Delayed postpartum haemorrhage due to uterine atony after caesarean section was occurring in women in our recovery area despite many of them already having an oxytocin infusion running to prevent such a problem. We therefore decided to compare the incidence of such problems for a 2-month period before and after altering our uterotonic policy: in addition to the routine bolus dose of 5 units of oxytocin after delivery of the baby, we added 500 microg of intramuscular ergometrine during abdominal closure. We noticed a reduced number of massive postpartum haemorrhages due to an atonic uterus in the recovery room but an increased incidence of nausea and vomiting. No prophylactic anti-emetic was given during this pilot study. This small study suggests that 50 women would need to be given ergometrine at caesarean section to prevent one delayed massive haemorrhage from uterine atony and four extra women would suffer with vomiting. We feel this is reasonable and now use a prophylactic anti-emetic as well as delaying the ergometrine until closure of the rectus sheath which reduces the incidence of nausea and vomiting.

  8. Central neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.

    Science.gov (United States)

    Caranza, R; Jeyapalan, I; Buggy, D J

    1999-04-01

    In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). The incidence of nausea or vomiting was significantly higher in SM than ED (73% vs. 41%, P=0.01). In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.

  9. Red, orange and green Caesarean sections: a new communication tool for on-call obstetricians.

    Science.gov (United States)

    Dupuis, Olivier; Sayegh, Isabelle; Decullier, Evelyne; Dupont, Corinne; Clément, Henri-Jacques; Berland, Michel; Rudigoz, René-Charles

    2008-10-01

    To evaluate the effect of a novel communication tool, related to the degree of urgency for Caesarean sections (CSs), on the decision-to-delivery interval for emergency CS. Red CS are very urgent cases corresponding to life-threatening maternal or foetal situations, orange CS are urgent cases and green CS are non-urgent intrapartum CS. We carried out this cohort study in a French maternity hospital. The study included all emergency Caesarean sections during two 6-month periods, before and after introduction of the code. We compared the decision-to-delivery interval of the two study periods. Our study included 174 emergency CS. The mean decision-to-delivery interval after introduction of the code was 31.7 min, significantly shorter (p=0.02) than the 39.6 min interval before introduction of the colour code. Except for the preparation time, each time interval decreased. This included transporting the patient into the operating theatre, and the incision-to-delivery time interval. This study suggests that the use of the three-colour code could significantly shorten the decision-to-delivery interval in emergency CS. Further prospective studies are needed to confirm this result.

  10. [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.

  11. 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.

  12. Does a Caesarean section increase the time to a second live birth? A register-based cohort study.

    Science.gov (United States)

    O'Neill, Sinéad M; Khashan, Ali S; Henriksen, Tine B; Kenny, Louise C; Kearney, Patricia M; Mortensen, Preben B; Greene, Richard A; Agerbo, Esben

    2014-11-01

    Does a primary Caesarean section influence the rate of, and time to, subsequent live birth compared with vaginal delivery? Caesarean section was associated with a reduction in the rate of subsequent live birth, particularly among elective and maternal-requested Caesareans indicating maternal choice plays a role. Several studies have examined the relationship between Caesarean section and subsequent birth rate with conflicting results primarily due to poor epidemiological methods. This Danish population register-based cohort study covered the period from 1982 to 2010 (N = 832 996). All women with index live births were followed until their subsequent live birth or censored (maternal death, emigration or study end) using Cox regression models. In all 577 830 (69%) women had a subsequent live birth. Women with any type of Caesarean had a reduced rate of subsequent live birth (hazard ratio [HR] 0.86, 95% confidence intervals [CI] 0.85, 0.87) compared with spontaneous vaginal delivery. This effect was consistent when analyses were stratified by type of Caesarean: emergency (HR 0.87, 95% CI 0.86, 0.88), elective (HR 0.83, 95% CI 0.82, 0.84) and maternal-requested (HR 0.61, 95% CI 0.57, 0.66) and in the extensive sub-analyses performed. Lack of biological data to measure a woman's fertility is a major limitation of the current study. Unmeasured confounding and limited availability of data (maternal BMI, smoking, access to fertility services and maternal-requested Caesarean section) as well as changes in maternity care over time may also influence the findings. This is the largest study to date and shows that Caesarean section is most likely not causally related to a reduction in fertility. Maternal choice to delay or avoid childbirth is the most plausible explanation. Our findings are generalizable to other middle- to high-income countries; however, cross country variations in Caesarean section rates and social or cultural differences are acknowledged. Funding was

  13. Different classes of antibiotics given to women routinely for preventing infection at caesarean section.

    Science.gov (United States)

    Gyte, Gillian M I; Dou, Lixia; Vazquez, Juan C

    2014-11-17

    Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects. To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and reference lists of retrieved papers. We included randomised controlled trials comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane reviews. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We included 35 studies of which 31 provided data on 7697 women. For the main comparison between cephalosporins versus penicillins, there were 30 studies of which 27 provided data on 7299 women. There was a lack of good quality data and important outcomes often included only small numbers of women.For the comparison of a single cephalosporin versus a single penicillin (Comparison 1 subgroup 1), we found no significant difference between these classes of antibiotics for our chosen most important seven outcomes namely: maternal sepsis - there were no women with sepsis in the two studies involving 346 women; maternal endometritis (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.81 to 1.52, nine studies, 3130 women, random effects, moderate quality of the evidence); maternal wound infection (RR 0.83, 95% CI 0.38 to 1.81, nine studies, 1497 women, random effects, low quality of the evidence), maternal urinary tract infection (RR 1.48, 95% CI 0.89 to 2.48, seven studies, 1120

  14. Fractional CO2 laser treatment of caesarean section scars

    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...... AND METHODS: A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar...... Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction. RESULTS: Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0...

  15. Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

    Science.gov (United States)

    Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit; Zimmo, Kaled; Anti, Marit; Sørum Falk, Ragnhild; Vikanes, Åse

    2018-01-01

    Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics. PMID:29500211

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

    Science.gov (United States)

    Herishanu-Gilutz, Shirley; Shahar, Golan; Schattner, Emanuel; Kofman, Ora; Holcberg, Gershon

    2009-10-01

    This qualitative research focused on the significance of subjective experience of mothers who gave birth in an emergency Caesarean section. Ten first-time mothers experiencing emergency Caesarean section were interviewed, and their narrative accounts were analyzed using Giorgi's phenomenological method. Mothers described alienation from the infant on encountering her/him; primal difficulties in holding; a 'mechanistic' pattern of childcare at home; over-apprehension and fear of a cradle-death. A few of the women seemed to cope with these experiences by performing 'a symbolic adoption' of their infants. In the context of object-relations theory, the findings, will potentially inform psychological care in obstetrics and gynaecology.

  17. 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.

  18. Where does ergometrine stand in prevention of postpartum haemorrhage in caesarean section

    Energy Technology Data Exchange (ETDEWEB)

    Mahmud, G.; Javaid, K.; Tasnim, N.; Tabassum, A.; Bangash, K. T. [Pakistan Inst. of Medical Sciences (PIMS), Islamabad (Pakistan). Maternal and Child Health Centre Unit-I

    2014-08-15

    Objective: To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. Method: The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intra-operatively from November 1 to December 31, 2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P <0.05 was taken as statistically significant. Results: Of the total number of 701 subjects, 378 (54%) women were given 10 units syntocinon and 323 (46%) were given 0.25 mg ergometrine in addition to 10 units syntocinon. The mean age in the syntocinon group was 28+-3.5 yrs with gestational age of 37.5+-2 weeks, while that in syntocinon-ergometrine group was 29+-3.4 years and 38+-2 weeks respectively. Postpartum haemorrhage in the syntocinon group was found in 38 (10%) women versus 05 (1.5%) women) in the other group (p<0.001). Adverse effects like nausea, vomiting and raised blood pressure were slightly more with syntocinon-ergometrine than syntocinon alone (n=56; 15.3% vs n=35; 9.2%), but it was not statistically significant. Post partum haemorrhage was responsible for 40% of maternal mortality during the study period and that was in the syntocinon group. Conclusion: Prophylactic ergometrine in addition to syntocinon is superior to syntocinon alone in decreasing frequency of postpartum haemorrhage in caesarean section and associated maternal morbidity and mortality. Regarding safety profile, the two

  19. Where does ergometrine stand in prevention of postpartum haemorrhage in caesarean section

    International Nuclear Information System (INIS)

    Mahmud, G.; Javaid, K.; Tasnim, N.; Tabassum, A.; Bangash, K. T.

    2014-01-01

    Objective: To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. Method: The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intra-operatively from November 1 to December 31, 2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P <0.05 was taken as statistically significant. Results: Of the total number of 701 subjects, 378 (54%) women were given 10 units syntocinon and 323 (46%) were given 0.25 mg ergometrine in addition to 10 units syntocinon. The mean age in the syntocinon group was 28+-3.5 yrs with gestational age of 37.5+-2 weeks, while that in syntocinon-ergometrine group was 29+-3.4 years and 38+-2 weeks respectively. Postpartum haemorrhage in the syntocinon group was found in 38 (10%) women versus 05 (1.5%) women) in the other group (p<0.001). Adverse effects like nausea, vomiting and raised blood pressure were slightly more with syntocinon-ergometrine than syntocinon alone (n=56; 15.3% vs n=35; 9.2%), but it was not statistically significant. Post partum haemorrhage was responsible for 40% of maternal mortality during the study period and that was in the syntocinon group. Conclusion: Prophylactic ergometrine in addition to syntocinon is superior to syntocinon alone in decreasing frequency of postpartum haemorrhage in caesarean section and associated maternal morbidity and mortality. Regarding safety profile, the two

  20. Support from a prenatal instructor during childbirth is associated with reduced rates of caesarean section in a Mexican study.

    Science.gov (United States)

    Campero, Lourdes; Hernández, Bernardo; Osborne, Jomo; Morales, Sara; Ludlow, Teresa; Muñoz, Christian

    2004-12-01

    to assess the association between non-clinical factors and the incidence of caesarean section (CS); to estimate the effect of a prenatal instructor's presence during childbirth on birth outcome (vaginal or CS). cross-sectional study from a register of women who attended prenatal classes. Multivariate logistic regression was used to measure the effects of each variable on whether the birth was vaginal or CS. Mexico City, Mexico. 992 births to 847 women from the register of the Birth Education Centre (CEPAPAR) between 1987 and 2000. the incidence of CS was 33%. The most commonly reported (by the women) reason for performing a CS was dystocia (53%). Most women were middle or upper-middle class professionals, and 85% of the women gave birth in private institutions. Odds of having a CS were higher among women who gave birth in a large hospital, women who were over 25 years of age, primigravidae, and women who were not supported by a prenatal instructor during childbirth. non-clinical factors considerably affect the type of birth outcome (vaginal vs. CS). A system in which a prenatal instructor provided support to the woman during childbirth could contribute significantly to reducing initial and repeat CS.

  1. [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.

  2. 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).

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

    International Nuclear Information System (INIS)

    Skjoeldebrand, A.; Eklund, J.; Johansson, H.; Lunell, N.-O.; Nylund, L.; Sarby, B.; Thornstroem, S.

    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)

  4. Anaesthesia for an emergent caesarean section in a patient with acute transverse myelitis

    Directory of Open Access Journals (Sweden)

    Samuel A Hunter

    2018-01-01

    Full Text Available We present a 32-year-old G1P0 woman at 32 weeks and two days gestation with new onset paraplegia, hyperreflexia, and sensory disturbance that gradually progressed over the past month and acutely worsened over the last 24 hours. MRI revealed a demyelinating process of the thoracic spine and diffuse cervicothoracic cord oedema. After 7 days, her foetus developed recurrent heart rate decelerations and an emergent caesarean section was performed. On airway exam, she was Mallampati 3 with a short thyromental distance. She reported fasting overnight and into the morning. Our choice was between performing neuraxial anaesthesia in the setting of an acute demyelinating process of her spinal cord versus general anaesthesia on a patient at risk of aspiration with a potentially difficult airway. Given the potential complications of neuraxial anaesthesia, we utilized rocuronium to perform a rapid sequence induction of general anaesthesia with endotracheal intubation.

  5. Risk factors and between-hospital variation of caesarean section in Denmark

    DEFF Research Database (Denmark)

    Wehberg, Sonja; Guldberg, Rikke; Gradel, Kim Oren

    2018-01-01

    OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions. DESIGN: Historical registry-based cohort study. SETTINGS AND PARTICIPANTS: The study......, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation. RESULTS: The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed...... CSs and one unit fewer CSs than expected. CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk...

  6. 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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    Tahmina Begum

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

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

    Science.gov (United States)

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

    2017-01-01

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

  10. Vaginal birth after caesarean section prediction models: a UK comparative observational study.

    Science.gov (United States)

    Mone, Fionnuala; Harrity, Conor; Mackie, Adam; Segurado, Ricardo; Toner, Brenda; McCormick, Timothy R; Currie, Aoife; McAuliffe, Fionnuala M

    2015-10-01

    Primarily, to assess the performance of three statistical models in predicting successful vaginal birth in patients attempting a trial of labour after one previous lower segment caesarean section (TOLAC). The statistically most reliable models were subsequently subjected to validation testing in a local antenatal population. A retrospective observational study was performed with study data collected from the Northern Ireland Maternity Service Database (NIMATs). The study population included all women that underwent a TOLAC (n=385) from 2010 to 2012 in a regional UK obstetric unit. Data was collected from the Northern Ireland Maternity Service Database (NIMATs). Area under the curve (AUC) and correlation analysis was performed. Of the three prediction models evaluated, AUC calculations for the Smith et al., Grobman et al. and Troyer and Parisi Models were 0.74, 0.72 and 0.65, respectively. Using the Smith et al. model, 52% of women had a low risk of caesarean section (CS) (predicted VBAC >72%) and 20% had a high risk of CS (predicted VBAC <60%), of whom 20% and 63% had delivery by CS. The fit between observed and predicted outcome in this study cohort using the Smith et al. and Grobman et al. models were greatest (Chi-square test, p=0.228 and 0.904), validating both within the population. The Smith et al. and Grobman et al. models could potentially be utilized within the UK to provide women with an informed choice when deciding on mode of delivery after a previous CS. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study.

    Science.gov (United States)

    Amin, Pina; Zaher, Summia; Penketh, Richard; Cherian, Sobha; Collis, Rachel E; Sanders, Julia; Bhal, Kiron

    2018-02-19

    To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK. Cohort study of births from 2006 to 2015. A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom. Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA). Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more. During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen. Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

  12. Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section

    NARCIS (Netherlands)

    A. Herdan; R. Roth; D. Grass; M. Klimek (Markus); S. Will; B. Schauf; R. Rossaint; M. Heesen

    2011-01-01

    textabstractHypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of

  13. 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...

  14. Access to facility delivery and caesarean section in north-central Liberia: a cross-sectional community-based study

    Science.gov (United States)

    Gartland, Matthew G; Taryor, Victor D; Norman, Andy M; Vermund, Sten H

    2012-01-01

    Objective Rural north-central Liberia has one of the world's highest maternal mortality ratios. We studied health facility birthing service utilisation and the motives of women seeking or not seeking facility-based care in north-central Liberia. Design Cross-sectional community-based structured interviews and health facility medical record review. Setting A regional hospital and the surrounding communities in rural north-central Liberia. Participants A convenience sample of 307 women between 15 and 49 years participated in structured interviews. 1031 deliveries performed in the regional hospital were included in the record review. Primary outcomes Delivery within a health facility and caesarean delivery rates were used as indicators of direct utilisation of care and as markers of availability of maternal health services. Results Of 280 interview respondents with a prior childbirth, only 47 (16.8%) delivered their last child in a health facility. Women who did not use formal services cited cost, sudden labour and family tradition or religion as their principal reasons for home delivery. At the regional hospital, the caesarean delivery rate was 35.5%. Conclusions There is an enormous unmet need for maternal health services in north-central Liberia. Greater outreach and referral services as well as community-based education among women, family members and traditional midwives are vital to improve the timely utilisation of care. PMID:23117566

  15. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative.

    Directory of Open Access Journals (Sweden)

    Jayleen K L Gunn

    Full Text Available In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented.In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89. Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28.This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.

  16. Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review.

    Science.gov (United States)

    Boatin, A A; Cullinane, F; Torloni, M R; Betrán, A P

    2018-01-01

    In most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates. To identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates. Medline, Embase, CINAHL and LILACS were searched from 2001 to 2016. Studies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates. Data on study design, interventions used, CS rates, and perinatal outcomes were extracted. Of 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias. We identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates. Use of the Robson classification in clinical audit cycles to reduce caesarean rates. © 2017 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  17. Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Zhu, Y-P; Wang, W-J; Zhang, S-L; Dai, B; Ye, D-W

    2014-06-01

    Gum chewing has been reported to enhance bowel motility and reduce postoperative ileus (POI). However, the efficacy remains imprecise for women following caesarean section. To summarise and evaluate the current evidence for postoperative gum chewing on the recovery of bowel function following caesarean section. We searched studies from the following electronic databases: PubMed, EMBASE, SCOPUS and Cochrane Library from inception to 30 May 2013. We included randomised controlled trials (RCTs) of women after caesarean section; these RCTs should compared gum chewing with no gum chewing and reported on at least one of the outcomes: time to flatus, time to bowel sound, time to passing stool and length of hospital stay (LOS). Study outcomes were presented as mean differences (for continuous data) with 95% confidence interval (95% CI). The risk of bias in the study results was assessed using the assessment tool from the Cochrane Handbook. Six RCTs including 939 women were included in our meta-analysis. The pooled results demonstrated that gum chewing is superior to no gum chewing with a reduction of 6.42 hours (95% CI -7.55 to -5.29) for time to first flatus, 3.62 hours (95% CI -6.41 to -0.83) for time to first bowel sound, 6.58 hours (95% CI -10.10 to -3.07) for time to first stool and 5.94 hours (95% CI -9.39 to -2.49) for LOS. In addition, no evidence emerged for any side effects caused by gum chewing. The current evidence suggests that gum chewing is associated with early recovery of bowel motility and shorter LOS for women after caesarean section. This safe and inexpensive intervention should be included in routine postoperative care following a caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

  18. Ecological Panel Inference from Repeated Cross Sections

    NARCIS (Netherlands)

    Pelzer, Ben; Eisinga, Rob; Franses, Philip Hans

    2004-01-01

    This chapter presents a Markov chain model for the estimation of individual-level binary transitions from a time series of independent repeated cross-sectional (RCS) samples. Although RCS samples lack direct information on individual turnover, it is demonstrated here that it is possible with these

  19. Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study

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    Morris Jonathan M

    2011-01-01

    Full Text Available Abstract Background Caesarean section (CS rates around the world have been increasing and in Australia have reached 30% of all births. Robson's Ten-Group Classification System (10-group classification provides a clinically relevant classification of CS rates that provides a useful basis for international comparisons and trend analyses. This study aimed to investigate trends in CS rates in New South Wales (NSW, including trends in the components of the 10-group classification. Methods We undertook a cross-sectional study using data from the Midwives Data Collection, a state-wide surveillance system that monitors patterns of pregnancy care, services and pregnancy outcomes in New South Wales, Australia. The study population included all women giving birth between 1st January 1998 and 31st December 2008. Descriptive statistics are presented including age-standardised CS rates, annual percentage change as well as regression analyses. Results From 1998 to 2008 the CS rate in NSW increased from 19.1 to 29.5 per 100 births. There was a significant average annual increase in primary 4.3% (95%CI 3.0-5.7% and repeat 4.8% (95% CI 3.9-5.7% CS rates from 1998 to 2008. After adjusting for maternal and pregnancy factors, the increase in CS delivery over time was maintained. When examining CS rates classified according to the 10-group classification, the greatest contributors to the overall CS rate and the largest annual increases occurred among nulliparae at term having elective CS and multipara having elective repeat CS. Conclusions Given that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.

  20. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India and Nepal

    NARCIS (Netherlands)

    M. Neuman (Melissa); G. Alcock (Glyn); K. Azad (Kishwar); A. Kuddus (Abdul); D. Osrin (David); N. Shah More (Neena); N. Nair (Nirmala); P. Tripathy (Prasanta); C. Sikorski (Catherine); N. Saville (Naomi); A. Sen (Aman); T. Colbourn (Tim); A.J. Houweling (Tanja); N. Seward (Nadine); A. Manandhar; B. Shrestha (Bhim); A. Costello (Anthony); A. Prost (Audrey)

    2014-01-01

    textabstractObjectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design: Cross-sectional study. Setting: 81 community-based geographical clusters in four locations in Bangladesh, India

  1. Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

    International Nuclear Information System (INIS)

    Ghazi, A.; Karim, F.; Hussain, M.; Ali, T.; Jabbar, S.

    2012-01-01

    Background: In the past 30 years the rate of caesarean section (C/S) has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. Method: It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. Results: There were 50 patients in each group. In group A, 11 (22%) were booked and 33 (66%) were referred cases. In group B, 48 (96%) were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 (20%) patients in group A, and 39 (78%) patients in group B, placenta previa, chorioamionitis, obstructed labour (6, 12% each); pregnancy induced hypertension and eclampsia in 5 (10%) cases in group A only. Intra-operative complications in group A were 48 (96%) vs 15 (30%) in group B (p=0.000). Postoperative morbidity in group A was 50 (100%) and 26 (52%) in group B (p=0.000). Intra-operative complication was haemorrhage in 46 (92%) cases in group A and 11 (22%) in group B. Anaesthetic complications were 40 (80%); prolonged intubation 25 (50%), aspiration of gastric contents 8 (16%), and difficult intubation 7 (14%) in group A. Ten (20%) cases had anaesthetic complications in group B

  2. Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals.

    Science.gov (United States)

    Ismail, S; Siddiqui, S; Shafiq, F; Ishaq, M; Khan, S

    2014-08-01

    Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin. A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (Ptransfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study

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    Ilona C. Narayen

    2018-02-01

    Full Text Available BackgroundAlthough little data are available concerning safety for newborns, family-centered caesarean sections (FCS are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC, where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA ≥38 weeks and without increased risks for respiratory morbidity.MethodsThe incidence of respiratory pathology, unplanned admission, and hypothermia in infants born after FCS in LUMC were retrospectively reviewed and compared with a historical cohort of standard elective cesarean sections (CS.ResultsFrom June 2014 to November 2015, 92 FCS were performed and compared to 71 standard CS in 2013. Incidence of respiratory morbidity, hypothermia, temperatures at arrival at the department, GA, and birth weight were comparable (ns. Unplanned admission occurred more often after FCS when compared to standard CS (21 vs 7%; p = 0.03, probably due to peripheral oxygen saturation (SpO2 monitoring. There was no increase in respiratory pathology (8 vs 6%, ns. One-third of the babies were separated from their mother during or after FCS.ConclusionUnplanned neonatal admissions after elective CS increased after implementing FCS, without an increase in respiratory morbidity or hypothermia. SpO2 monitoring might have a contribution. Separation from the mother occurred often.

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

    Science.gov (United States)

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

    2016-04-01

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

  5. Impact on caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial.

    Science.gov (United States)

    Lee, Nigel; Mårtensson, Lena B; Homer, Caroline; Webster, Joan; Gibbons, Kristen; Stapleton, Helen; Dos Santos, Natalie; Beckmann, Michael; Gao, Yu; Kildea, Sue

    2013-05-03

    Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate. A double blind randomised placebo controlled trialSetting: Maternity hospitals in AustraliaParticipants: 1866 women in labour, ≥18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent. Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis' rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively. Proportion of women who have a caesarean section in labour.Randomisation: Permuted blocks stratified by research site.Blinding (masking):Double-blind trial in which participants, clinicians and research staff blinded to group assignment. Funded by the National Health and Medical Research CouncilTrial registration:Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954). Sterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to

  6. 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; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-01-01

    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

  7. 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

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

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    Billy M. Tsima

    2013-02-01

    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 ascontributory 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 forCS 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 evidencebased national guidelines could help alleviate the problem.

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

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    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.

  10. Role of prophylactic ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section

    International Nuclear Information System (INIS)

    Abbas, N.

    2016-01-01

    Objective: To determine the efficacy of prophylactic administration of intravenous Ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section. Study Design: Double blinded randomized controlled trial. Place and Duration of Study: It was conducted in Anesthesiology department, CMH Rawalakot; from 3 Mar to 4 Jun 2014. Material and Methods: One hundred patients were selected for this study, and randomly divided in two groups of 50 each, using random numbers table. Both groups were preloaded with Ringer's lactate at dose of 10ml/kg. Group A received 04 mg of IV ondansetron 5 min prior to spinal anaesthesia, whereas Group B received normal saline 05 minutes before administration of Spinal Anaesthesia. Results: Average age of Group A was 28.62 +- 4.64 years, whereas that of Group B was 27.88 +- 3.98 (p-value= 0.394). Average weight of Group A was 70.30 +- 6.25 kg, whereas that of Group B was 70.74 +- 6.17 kg (p-value= 0.724). Hypotension was noted in 21 patients in group A (42 percent), whereas it was observed in 34 Patients in Group B (68 percent) (p-value= 0.009). Bradycardia was noted in 9 patients in Group A (18 percent) and 19 patients in Group B (p=0.026). Conclusion: Intravenous administration of 04 mg of intravenous ondansetron, 05 minutes prior to subarachnoid block, is effective in decreasing frequency of hypotension. (author)

  11. Shoulder pain after caesarean section: comparison between general and spinal anaesthesia.

    Science.gov (United States)

    Zirak, N; Soltani, G; Hafizi, L; Mashayekhi, Z; Kashani, I

    2012-05-01

    This study investigated shoulder pain as a maternal complication after caesarean section (CS), evaluation of its prevalence and comparison between spinal anaesthesia (SA) and general anaesthesia (GA) groups. A total of 200 women as CS candidates were allocated into two equal groups; SA and GA. The total prevalence of shoulder pain was 39.45%. The two groups were matched according to demographic data. However, the incidence of shoulder pain in the GA group was more than that in the SA group (p =0.004). Shoulder pain in the right shoulder in the GA group was more prevalent than the left shoulder (p <0.001). Moderate severity of shoulder pain was significantly more in the GA group (p =0.000), while in the SA group, the mild severity was significant (p <0.001). Our study revealed that the incidence of shoulder pain after CS is significant. Moreover, shoulder pain was significantly more common in the GA group than the SA group.

  12. Caesarean Section at Full Dilatation and Risk of Major Obstetric Haemorrhage

    LENUS (Irish Health Repository)

    O’Dwyer, V

    2018-03-01

    The purpose of the study was to examine the risk factors for caesarean section (CS) at full dilatation and to assess the risk and management of haemorrhage. The study took place in a tertiary referral maternity hospital. Women who had a CS at full dilatation were included. Clinical and demographic details were recorded. There were 199 cases. The average age was 30.3 years and average BMI was 25.8kg\\/m2. There were 79.9 % (159) primigravidas and 20.1% (40) multigravidas. The average gestation at delivery was 39.4 weeks. Labour was induced in 46.9 % (92) and spontaneous in 53.8% (107). Oxytocin was used in 67.8 % (135). An instrumental delivery was attempted in 46.7 % (93). The rate of malposition was 46.5 % (92). The average birthweight was 3,629g and 9 babies weighed ≥4.5kg. The average estimated blood loss (EBL) was 665mls and 34 had EBL>1L. Most had an oxytocin infusion (141). Other uterotonic agents were used in 70 women. Seven women had blood transfusions. The highest rate of CS at full dilatation was in primigravidas due to malposition. There was a low rate of major obstetric haemorrhage.

  13. Learning from the Law. A review of 21 years of litigation for pain during caesarean section.

    Science.gov (United States)

    McCombe, K; Bogod, D G

    2018-02-01

    The large majority of caesarean sections in the UK are now carried out under neuraxial anaesthesia. Although this technique is widely accepted as being the safest option in most circumstances, the use of regional anaesthesia increases the risk of patients experiencing intra-operative discomfort or pain. Pain during operative obstetric delivery is the commonest successful negligence claim relating to regional anaesthesia against obstetric anaesthetists in the UK. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning pain during caesarean section and consider how anaesthetists might avoid litigation. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

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

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    Kurmanadh Kalepalli

    2016-10-01

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

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

    OpenAIRE

    D. Mannaerts; L. Van der Veeken; H. Coppejans; Y. Jacquemyn

    2018-01-01

    Purpose. To compare the incidence of nausea, vomiting, and arterial hypotension between carbetocin and oxytocin to prevent haemorrhage after caesarean section (CS). Methods. A randomized controlled trial in term pregnant women undergoing planned CS. Groups were randomized to carbetocin or oxytocin. Blood pressure (BP), heart rate, presence of nausea/vomitus, and need for vasopressors were evaluated throughout surgery. Preoperative and postoperative haemoglobin and haematocrit levels were comp...

  16. Life saving or money wasting? Perceptions of caesarean sections among users of services in rural Bangladesh.

    Science.gov (United States)

    Parkhurst, Justin Oliver; Rahman, Syed Azizur

    2007-03-01

    Bangladesh has a high level of maternal mortality, corresponding to one of the world's lowest rates of use of skilled birth attendance (12.1%), and a similarly low rate of caesarean births (2.4%). While increasing the proportion of women who deliver with professional medical care is essential to prevent maternal deaths, past work has identified distrust of caesarean procedures in Bangladesh. The reasons behind this distrust can manifest itself in health seeking behaviour around maternal care. This paper presents findings from a qualitative study of 30 women in a rural district of Bangladesh who recently delivered in a health facility. It finds that the distrust in doctor's recommendations for surgery stemmed from high costs incurred and a belief that it was used when not medically justified. This could lead to women avoiding or leaving medical facilities in extreme cases. Some women's experiences further illustrated disagreement among medical staff as to whether or not a caesarean procedure should be done, with conflicting financial incentives for doctors to perform caesarean deliveries, and for nurses and midwives to conduct normal deliveries. Policy makers must recognise that the fears women hold of caesarean deliveries may not simply be rooted in ignorance and may, in fact, reflect legitimate concerns with medical practice. Ultimately, it will be essential to address problems in the health systems environment, which may promote improper service provision.

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

    Directory of Open Access Journals (Sweden)

    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

  18. [Caesarean section in german hospitals: validity of hospital quality report data for monitoring C-section rates].

    Science.gov (United States)

    Junghänel, K; Renz-Polster, H; Jarczok, M N; Hornemann, A; Böhler, T; De Bock, F

    2015-04-01

    It is not known if "hospital quality reports" (HQR) document Caesarean (C-) section rates at the hospital level accurately enough for use as a reliable data source when it comes to explaining regional variations of C-sections in Germany by factors at the hospital level. We aimed to answer this question using HQR from hospitals in Baden-Württemberg as data source. Diagnostic and procedure codes from HQR for the year 2008 (HQRdata), were used to calculate numbers of births, numbers of C-sections, and rates of births by C-section (CSR) for 94 of 97 hospitals in Baden-Württemberg. These numbers were compared to internal hospital (IH) data delivered upon request by 80 of 97 hospitals and stemming from vital statistics, birth registry forms, or external quality assurance datasets. There was no difference in the number of births between HQR data and IH data, but the number of C-sections and the CSR differed significantly (pCSR calculated using HQR data was 4.9 ± 17.9% higher than CSR from IH data (absolute difference 1.5 ± 5.8%). The correlation between the 2 data sources was moderate (r=0.73). Only 55% of the variance in IH data-based CSR was explained by HQR data. The proportion between highest and lowest CSR in hospitals in Baden-Württemberg was 4.9 for HQR data and 3.6 for IH data. There are significant and relevant differences between C-section rates based on ei-ther HQR or IH data. This questions routine data from HQR for 2008 as a reliable data source for research work. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. [External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate].

    Science.gov (United States)

    Lojacono, A; Donarini, G; Valcamonico, A; Soregaroli, M; Frusca, T

    2003-12-01

    Although term breech presentation is a relatively rare condition (3-5% of all births), it continues to be an important indication for caesarean section and has contributed to its increased use. Risk of complications may be increased for both mother and foetus in such a situation. Vaginal delivery of a breech presenting foetus is complex and may involve many difficulties, so today there is a general consensus that planned caesarean section is better than planned vaginal birth for the foetus in breech presentation at term. External cephalic version is one of the most effective procedures in modern obstetrics. It involves the external manipulation of the foetus from the breech into the cephalic presentation. A successful manoeuvre can decrease costs by avoiding operative deliveries and decreasing maternal morbidity. The aim of the present study is to evaluate the effectiveness of this obstetric manoeuvre to increase the proportion of vertex presentation among foetuses that were formerly in the breech position near term, so as to reduce the caesarean section rate. The safety of the version is also showed. From 1999 to 2002, 89 women with foetal breech presentation underwent external cephalic version at the Department of Obstetrics and Gynaecology of the Brescia University. The gestational age was 36.8+/-0.8 weeks. The following variables have been taken into consideration: breech variety, placental location, foetal back position, parity, amount of amniotic fluid and gestational age. Every attempt was performed with a prior use of an intravenous drip of Ritodrine, and foetal heart rate was monitored continuously with cardiotocogram. The success rate of the procedure was 42.7% (n=38). No maternal or foetal complication or side effects occurred, both during and after the manoeuvre, except a transient foetal bradycardia that resolved spontaneously. Only one spontaneous reversion of the foetus occurred before delivery. Of all the women that underwent a successful version

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

    Science.gov (United States)

    Zwedberg, Sofia; Blomquist, Josefin; Sigerstad, Emelie

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

    To assess the mode of delivery and Caesarean Section (CS) rate after successful External Cephalic Version (ECV). A matched case-control study. Data were gathered from a tertiary care university hospital register from 1996-2015. All pregnant women who delivered after successful External Cephalic Version (ECV). Among 643 women who attempted ECV, we identified 198 with successful ECVs and compared them with the next two women who presented for labor management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index, and delivery history using univariate and stepwise logistic regression. The main outcome measure was the risk of caesarean. The caesarean section rate was higher after successful ECV (respectively 20.7% versus 7.07%, P<0.05). Caesarean section for abnormal fetal head position (forehead, bregma, face) 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 presentation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study.

    Science.gov (United States)

    Horsch, Antje; Vial, Yvan; Favrod, Céline; Harari, Mathilde Morisod; Blackwell, Simon E; Watson, Peter; Iyadurai, Lalitha; Bonsall, Michael B; Holmes, Emily A

    2017-07-01

    Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child. ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    Science.gov (United States)

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

    2017-08-01

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

  5. Transversus abdominis plane block vs. wound infiltration in Caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Telnes, A; Skogvoll, E; Lonnée, H

    2015-04-01

    Multiple studies suggest that transversus abdominis plane (TAP) block (without intrathecal morphine) after Caesarean section (CS) reduces post-operative morphine consumption. In our study, we wanted to compare the analgesic effect of TAP block with infiltration of the wound after CS. We included 60 pregnant women scheduled for elective CS under spinal anaesthesia in a randomised, single-centre, double-blind study. Thirty patients received ultrasound-guided TAP block using 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml bilaterally and 20 ml normal saline as wound infiltration (TAP group). The other 30 patients (the control group) received normal saline 20 ml bilaterally in the TAP, and 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml as wound infiltration. The main outcome was cumulative morphine consumption at 48 h after surgery. In addition, continuous morphine consumption, pain scores and side effects were registered. Fifty-seven patients completed the study. Cumulative morphine consumption at 48 h (mean±standard deviation) was 41±34 mg in the TAP group and 38±27 mg in the control group (P=0.7); a difference of 3 mg (95% confidence interval -13 to 19 mg). Morphine consumption at any time up to 48 h was virtually identical in both groups. Side effects were similar, except for a higher degree of sedation in the TAP group (P=0.04). Compared with wound infiltration with local anaesthetics, TAP block did not reduce cumulative morphine consumption following CS. The TAP block was associated with more pronounced sedation. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Torloni, M R; Campos Mansilla, B; Merialdi, M; Betrán, A P

    2014-04-01

    Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Systematic review. Women's magazines printed from 1989 to 2009 with the largest national distribution. Articles with any information on CS. Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Accuracy, comprehensiveness and sources of information. Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. © 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  7. Modest Rise in Caesarean Section from 2000-2010 : The Dutch Experience

    NARCIS (Netherlands)

    Yanjun Zhao; Jun Zhang; Chantal Hukkelhoven; Pien Offerhaus; Joost Zwart; Ank de Jonge; Caroline Geerts

    2016-01-01

    Background The caesarean delivery (CD) rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is

  8. Studies on Section XI ultrasonic repeatability

    International Nuclear Information System (INIS)

    Jamison, T.D.; McDearman, W.R.

    1981-05-01

    A block representative of a nuclear component has been welded containing intentional defects. Acoustic emission data taken during the welding correlate well with ultrasonic data. Repetitive ultrasonic examinations have been performed by skilled operators using a procedure based on that desribed in ASME Section XI. These examinations were performed by different examination teams using different ultrasonic equipment in such a manner that the effects on the repeatability of the ultrasonic test method caused by the operator and by the use of different equipment could be estimated. It was tentatively concluded that when considering a large number of inspections: (1) there is no significant difference in indication sizing between operators, and (2) there is a significant difference in amplitude and defect sizing when instruments having different, Code acceptable operating characteristics are used. It was determined that the Section XI sizing parameters follow a bivariate normal distribution. Data derived from ultrasonically and physically sizing indications in nuclear components during farication show that the Section XI technique tends to overestimate the size of the reflectors

  9. No. 155-Guidelines for Vaginal Birth After Previous Caesarean Birth.

    Science.gov (United States)

    Martel, Marie-Jocelyne; MacKinnon, Catherine Jane

    2018-03-01

    To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

  10. Intrathecal hyperbaric versus isobaric bupivacaine for adult non-caesarean-section surgery: systematic review protocol.

    Science.gov (United States)

    Uppal, Vishal; Shanthanna, Harsha; Prabhakar, Christopher; McKeen, Dolores M

    2016-05-18

    Bupivacaine is the most commonly used local anaesthetic for spinal anaesthesia (SA). There are two forms of commercially available bupivacaine; isobaric bupivacaine (IB): a formulation with a specific gravity or density equal to cerebrospinal fluid, and hyperbaric bupivacaine (HB): a formulation with density heavier than cerebrospinal fluid. The difference in densities of the two available preparations is believed to affect the diffusion pattern that determines the effectiveness, spread and side-effect profile of bupivacaine. This systematic review will summarise the best available evidence regarding the effectiveness and safety on the use of HB compared with IB, when used to provide SA for surgery. Primarily, we will analyse the need for conversion to general anaesthesia. As secondary outcomes, we will compare the incidence of hypotension, incidence of nausea/vomiting, the onset time and duration of anaesthesia. We will search key electronic databases using search strategy (1) injections, spinal OR intrathecal OR subarachnoid; (2) bupivacaine OR levobupivacaine; (3) hypobaric OR isobaric OR plain; (4) baricity. We will search MEDLINE, EMBASE and Cochrane databases, from their inception for randomised controlled trials, with no restrictions on language. Caesarean section surgery will be excluded. 2 reviewers will independently extract the data using a standardised form. Extracted items will include study characteristics, risk of bias domains, as per modified Cochrane risk of bias, participant disposition and study outcomes. We will conduct a meta-analysis for variables that can be compared across the studies. We will evaluate clinical heterogeneity by qualitatively appraising differences in study characteristics in participants, interventions and the outcomes assessed. We will report our findings as relative risks (dichotomous), and weighted mean differences (continuous) for individual outcomes, along with their 95% CIs. We plan to submit, and will publish, our

  11. 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.

  12. [Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].

    Science.gov (United States)

    Kuppens, S M I; Hasaart, T H M; van der Donk, M W P; Huibers, M; Franssen, M J; de Becker, B M J; Wijnen, H A A; Pop, V J M

    2008-06-07

    Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. Retrospective analysis. In 2003 a standardized protocol of ECV was developed in the outpatient clinic for obstetrics of the Catharina Hospital in Eindhoven, the Netherlands; it was tested in 'version office visits'. Obstetric characteristics of all pregnant women who underwent attempts of ECV in the clinic from January 2004 until June 2006 during these sessions, and the subsequent births, were analysed. 85% of all ECVs were performed by the same hospital midwife and gynaecologist, in accordance with the protocol. ECV was successful in 96 of 209 pregnant women (46%). In 1 pregnant woman an emergency caesarean section was performed after ECV because of partial abruptio placentae. Nulliparity, incomplete breech presentation and low birth weight of the baby were associated with a lower success rate of ECV in this study. In the group with a successful ECV the percentage of caesarean deliveries was substantially lower (9 versus 83%; odds ratio: 0.21; 95% CI: 0.09-0.51). A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    Bondada Suryakumari

    2017-09-01

    Full Text Available BACKGROUND Recently, caesarean section rates are increased in developing countries like India. Postpartum haemorrhage is more after caesarean section. Most of the maternal mortality is attributed to postpartum haemorrhage. This study was undertaken to find out the drug effective in reducing blood loss in lower segment caesarean section. The aim of the study is to compare the efficacy of ethamsylate versus tranexamic acid in reducing blood loss during and after caesarean section. MATERIALS AND METHODS All women undergoing LSCS were divided in 3 groups, viz. 2 study groups and control group. All were requested for preop and postop Hb%, PCV and TRBC. Tranexamic acid and ethamsylate, 1 g diluted in 10 mL NS were given intravenously for both the study groups and control group with NS, 20 minutes prior to skin incision and blood loss was measured from placental delivery up to 2 hours in all the groups was calculated by weighing pre-weighted pads soaked in blood. RESULTS Statistical analysis was done quantitatively by Student’s t-test. Postoperative blood loss was similar and lower in both the study groups compared to the control group. Hb% change in postop period is significant in control group. CONCLUSION Ethamsylate is safe and effective alternative to tranexamic acid in preventing postpartum haemorrhage after caesarean section.

  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. Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study.

    Science.gov (United States)

    Chen, Shu-Wen; Hutchinson, Alison M; Nagle, Cate; Bucknall, Tracey K

    2018-01-17

    Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women's decision-making processes and the influences on their mode of birth following a previous CS. A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks' gestation. Stage II involved interviews with pregnant women at 35-37 weeks' gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. Ensuring the safety of mother and baby was the focus of women's decisions. Women's decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians' recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians' professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women's interactions with obstetricians regarding birth choices

  17. 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.

  18. Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage.

    Science.gov (United States)

    De Bonis, Maria; Torricelli, Michela; Leoni, Licia; Berti, Paolo; Ciani, Valentina; Puzzutiello, Rosa; Severi, Filiberto Maria; Petraglia, Felice

    2012-06-01

    To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.

  19. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta

    International Nuclear Information System (INIS)

    Teixidor Viñas, M.; Chandraharan, E.; Moneta, M.V.; Belli, A.M.

    2014-01-01

    Aim: To report experience of prophylactic occlusion balloon catheters (POBCs) in both internal iliac arteries before caesarean section, with or without embolization, to preserve the uterus and reduce haemorrhage. Methods and materials: Twenty-seven women diagnosed with morbidly adherent placenta (MAP) and with suspected placenta percreta underwent POBC placement before caesarean section. The balloons were inflated immediately after delivery of the baby. The patients' case notes were reviewed retrospectively for histological grading of MAP, blood loss, transfusion, requirement of uterine artery embolization (UAE), or hysterectomy, radiation dose, and infant or maternal morbidity and mortality. Results: MAP was confirmed histologically as percreta in 17, accreta in eight, and increta in two women. Mean blood loss was 1.92 l (range 0.5–12 l). Postpartum haemorrhage (PPH) occurred in nine patients. Eight were referred for UAE, which was successful in six. Immediate peri-partum hysterectomy was performed in one patient. Three women in total required hysterectomy, two after recurrent haemorrhage after UAE. No foetal morbidity or mortality occurred. No maternal mortality occurred. There was one case of iliac artery thrombosis, which resolved with conservative therapy. Conclusion: POBC, with or without UAE, contributes to reduction of blood loss and preservation of the uterus in women with MAP. - Highlights: • Management of morbidly adherent placenta requires a multidisciplinary team approach. • Prophylactic occlusion balloon catheters reduce blood loss and help avoid hysterectomy. • Protocols ensure correct management of placenta percreta patients and minimise risk

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

    Science.gov (United States)

    Drake, M J P; Hill, J S

    2013-05-01

    Upper-arm non-invasive blood pressure measurement during caesarean section can be uncomfortable and unreliable because of movement artefact in the conscious parturient. We aimed to determine whether ankle blood pressure measurement could be used instead in this patient group by comparing concurrent arm and ankle blood pressure measured throughout elective caesarean section under regional anaesthesia in 64 term parturients. Bland-Altman analysis of mean difference (95% limits of agreement [range]) between the ankle and arm was 11.2 (-20.3 to +42.7 [-67 to +102]) mmHg for systolic arterial pressure, -0.5 (-21.0 to +19.9 [-44 to +91]) mmHg for mean arterial pressure and -3.8 (-25.3 to +17.8 [-41 to +94]) mmHg for diastolic arterial pressure. Although ankle blood pressure measurement is well tolerated and allows greater mobility of the arms than measurement from the arm, the degree of discrepancy between the two sites is unacceptable to allow routine use of ankle blood pressure measurement, especially for systolic arterial pressure. However, ankle blood pressure measurement may be a useful alternative in situations where arm blood pressure measurement is difficult or impossible. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  1. First birth Caesarean section and subsequent fertility: a population-based study in the USA, 2000-2008.

    Science.gov (United States)

    Kjerulff, K H; Zhu, J; Weisman, C S; Ananth, C V

    2013-12-01

    for the pregnancy and childbirth complications had little effect on the RR of not having a subsequent live birth (RR = 1.15, 95% CI: 1.11-1.19). We were unable to distinguish between women who did not have a subsequent live birth and those who moved out of the state, which may have introduced a selection bias if those who had Caesarean births were more likely to emigrate than those who delivered vaginally. In addition we were unable to measure pre-pregnancy body mass index, weight gain during pregnancy and prior infertility, which would have been helpful in our efforts to reduce selection bias. The results of this study provide further corroboration of previous studies that have reported reduced fertility subsequent to Caesarean section in comparison with vaginal delivery. This study was funded by the US National Institute of Child Health and Human Development (NICHD, R01-HD052990). No competing interests are declared.

  2. Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study.

    Science.gov (United States)

    Jadon, Ashok; Jain, Priyanka; Chakraborty, Swastika; Motaka, Mayur; Parida, Sudhansu Sekhar; Sinha, Neelam; Agrawal, Amit; Pati, Asit Kumar

    2018-05-14

    While opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial. One hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management. The median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained. The trial was registered with the Clinical Trial Registry of India ( CTRI/2017/03/008194 ) on 23/03/2017 (trial registered retrospectively).

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

    Directory of Open Access Journals (Sweden)

    Bernardo L Horta

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

  4. 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.

  5. [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.

  6. Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta

    International Nuclear Information System (INIS)

    Duan, X.-H.; Wang, Y.-L.; Han, X.-W.; Chen, Z.-M.; Chu, Q.-J.; Wang, L.; Hai, D.-D.

    2015-01-01

    Aim: To determine the efficacy and safety of caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation (UAE) for the treatment of patients with placenta accreta. Materials and methods: This retrospective study involved 42 patients with placenta accreta. All patients underwent caesarean section combined with temporary aortic balloon occlusion followed by UAE through the right femoral approach. Results: All patients were confirmed to have placenta praevia and accreta, including five patients with placenta percreta, at the time of delivery. The technical success rate of the combined treatment was 97.6% (41/42). Forty-one patients underwent successful caesarean section with conservation of the uterus. Hysterectomy was required in one (3.1%) patient. The amount of blood loss and blood transfusion, and the operation time were was 586 ± 355 ml, 422 ± 83 ml and 65.5 ± 10.6 minutes, respectively. The mean postoperative hospital stay, occlusion time and fetal radiation dose were 5.5 ± 2.6 days, 22.4 ± 7.2 minutes and 4.2 ± 2.9 mGy, respectively. There were no significant changes before and 7 days after the endovascular procedure in creatinine levels (56.8 ± 13.8 μmol/l versus 63.4 ± 16.7 μmol/l, p = 0.09) or urea nitrogen (6.3 ± 2.5 μmol/l versus 7.4 ± 3.8 μmol/l, p = 0.17). There were no access-site complications after the endovascular procedure and no complications related to the intervention during follow-up. Conclusion: Temporary aortic balloon occlusion followed by UAE can effectively control postpartum haemorrhage during placental dissection, and reduce transfusion requirements, hysterectomy rate, and operation time in patients with placenta accreta. -- Highlights: •Aortic balloon occlusion can overcome the collateral flow from other arteries. •UAE can effectively manage secondary postpartum haemorrhage. •The aortic balloon can rapidly and easily insert. •The mean

  7. The decision delivery interval in emergency caesarean section and its associated maternal and fetal outcomes at a referral hospital in northern Tanzania: a cross-sectional study.

    Science.gov (United States)

    Hirani, Birjna A; Mchome, Bariki L; Mazuguni, Nicholaus S; Mahande, Michael J

    2017-12-07

    Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania. This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant. A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40-120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5 th minute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63-1.64) and hospital stay (OR: 1.02; 95% 0.63-1.64). Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the

  8. Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section.

    Science.gov (United States)

    Abdel-Aleem, Hany; Aboelnasr, Mohamad Fathallah; Jayousi, Tameem M; Habib, Fawzia A

    2014-04-11

    Caesarean section (CS) is the most common obstetric surgical procedure, with more than one-third of pregnant women having lower-segment CS. Bladder evacuation is carried out as a preoperative procedure prior to CS. Emerging evidence suggests that omitting the use of urinary catheters during and after CS could reduce the associated increased risk of urinary tract infections (UTIs), catheter-associated pain/discomfort to the woman, and could lead to earlier ambulation and a shorter stay in hospital. To assess the effectiveness and safety of indwelling bladder catheterisation for intraoperative and postoperative care in women undergoing CS. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2013) and reference lists of retrieved studies. Randomised controlled trials (RCTs) comparing indwelling bladder catheter versus no catheter or bladder drainage in women undergoing CS (planned or emergency), regardless of the type of anaesthesia used. Quasi-randomised trials, cluster-randomised trials were not eligible for inclusion. Studies presented as abstracts were eligible for inclusion providing there was sufficient information to assess the study design and outcomes. Two review authors independently assessed studies for eligibility and trial quality, and extracted data. Data were checked for accuracy. The search retrieved 16 studies (from 17 reports). Ten studies were excluded and one study is awaiting assessment. We included five studies involving 1065 women (1090 recruited). The five included studies were at moderate risk of bias.Data relating to one of our primary outcomes (UTI) was reported in four studies but did not meet our definition of UTI (as prespecified in our protocol). The included studies did not report on our other primary outcome - intraoperative bladder injury (this outcome was not prespecified in our protocol). Two secondary outcomes were not reported in the included studies: need for postoperative analgesia and women

  9. Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment.

    Science.gov (United States)

    Oláh, K S

    2005-02-01

    During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.

  10. 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.

  11. A prospective cohort study evaluating the cost-effectiveness of carbetocin for prevention of postpartum haemorrhage in caesarean sections.

    Science.gov (United States)

    Luni, Yasmin; Borakati, Aditya; Matah, Arti; Skeats, Katie; Eedarapalli, Padma

    2017-07-01

    Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylaxis with oxytocic medication is recommended by the WHO to prevent its occurrence. Carbetocin is a newer oxytocic, with potential to lower PPH rates, reduce the total use of oxytocic drugs and lead to financial savings. Meta-analyses have confirmed a reduction in the use of additional oxytocic medication with the use of carbetocin compared to oxytocin. However, there are few studies evaluating the costs of carbetocin prophylaxis. We carried out a prospective cohort study evaluating the financial impact of carbetocin, following its introduction at our centre for caesarean section. We collected data for 400 patients in total, making this, to our knowledge, the largest study conducted on this topic. We found a significant reduction in PPH rates and the use of additional oxytocics with projected overall financial savings of £68.93 per patient with the use of carbetocin. Impact statement It is well established that carbetocin reduces the use of secondary oxytocics compared to oxytocin alone in the active management of the third stage of labour. Evidence for reduction of post-partum haemorrhage and its cost effectiveness are more equivocal. Our study demonstrates that carbetocin also reduces post-partum haemorrhage, use of blood and blood products and midwifery recovery time in the setting of caesarean section. We have also demonstrated that despite the increased index cost of carbetocin it delivers an overall substantial cost benefit. The implications of these findings are of reduced morbidity, faster recovery and cost savings in these times of austerity in the UK. It allows more efficient labour distribution of midwives, particularly in the setting of staff shortages across the NHS. A randomised control trial in this area needs to be conducted to determine the cost benefit of carbetocin and with this and post-partum haemorrhage rates as the primary outcome measures.

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

    Directory of Open Access Journals (Sweden)

    Udita Naithani

    2011-01-01

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

  13. 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.

  14. Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan.

    Science.gov (United States)

    Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

    2016-01-01

    The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03-0.25) in women's awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women's preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22-0.85); P>0.001). The results of this study showed that an increase in the density of midwives

  15. Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis.

    Science.gov (United States)

    van der Nelson, Helen A; Draycott, Tim; Siassakos, Dimitrios; Yau, Christopher W H; Hatswell, Anthony J

    2017-03-01

    To determine the economic impact of the introduction of carbetocin for the prevention of postpartum haemorrhage (PPH) at caesarean section, compared to oxytocin. The model is a decision tree conducted from a UK National Health Service perspective. 1500 caesarean sections (both elective and emergency) were modelled over a 12 month period. Efficacy data was taken from a published Cochrane meta-analysis, and costs from NHS Reference costs, the British National Formulary and the NHS electronic Medicines Information Tool. A combination of hospital audit data and expert input from an advisory board of clinicians was used to inform resource use estimates. The main outcome measures were the incidence of PPH and total cost over a one year time horizon, as a result of using carbetocin compared to oxytocin for prevention of PPH at caesarean section. The use of carbetocin compared to oxytocin for prevention of PPH at caesarean section was associated with a reduction of 30 (88 vs 58) PPH events (>500ml blood loss), and a cost saving of £27,518. In probabilistic sensitivity analysis, carbetocin had a 91.5% probability of producing better outcomes, and a 69.4% chance of being dominant (both cheaper and more effective) compared to oxytocin. At list price, the introduction of carbetocin appears to provide improved clinical outcomes along with cost savings, though this is subject to uncertainty regarding the underlying data in efficacy, resource use, and cost. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  16. 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...

  17. EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION IN MULTIGRAVIDA PARTURIENTS: A CASE CONTROLLED PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Gunavathi Kandappan

    2016-06-01

    Full Text Available OBJECTIVES To study the efficacy of Tranexamic acid in reducing blood loss during and after the lower segment caesarean section in Multigravida parturients. METHODOLOGY A case controlled prospective study was conducted in 50 multigravida parturient women undergoing elective lower segment caesarean section in our hospital after getting Institutional Ethical Committee approval, over a period of two months. 25 of them were given Tranexamic acid 15 mg/kg immediately before caesarean section. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and the second from the end LSCS to 2 hours postpartum. RESULTS Tranexamic acid significantly reduces the quantity of blood loss from the end of LSCS to 2 hours post-partum in multigravida parturients. No complications or side effects are noted in both the groups. CONCLUSION Tranexamic acid significantly reduces the amount of blood loss during and after the lower segment caesarean section in multigravida parturients and its use was not associated with any side effects or complications.

  18. Near-miss maternal morbidity from severe haemorrhage at caesarean section: A process and structure audit of system deficiencies in South Africa.

    Science.gov (United States)

    Maswime, T S; Buchmann, E

    2017-10-31

    A rising caesarean section rate and substandard peri-operative care are believed to be the main reasons for recent increases in maternal deaths from bleeding during and after caesarean section (BDACS) in South Africa (SA). The Donabedian model assumes that clinical outcomes are influenced by healthcare workers and the healthcare system. To evaluate near-miss cases from BDACS with regard to health system structure (resources and facilities) and process (patient care). A cross-sectional prospective study was conducted in greater Johannesburg, SA. Data of women who had near-miss-related BDACS were collected by means of ongoing surveillance at 13 public hospitals. The World Health Organization intervention criteria were used to identify near-miss cases. A comparison of structure and process between the healthcare facilities was conducted. Of 20 527 caesarean sections , there were 93 near misses and 7 maternal deaths from BDACS. Dominant risk factors for near misses were previous caesarean section (43.9%), anaemia (25.3%) and pregnancy-induced hypertension (28.6%). Eighteen women were transferred to higher levels of care, and 8 (44.4%) experienced transport delays of >1 hour. The caesarean section decision-to-incision interval (DII) was ≥60 minutes in 77 of 86 women, with an average interval of 4 hours. Structural deficiencies were frequently present in district hospitals, and there were serious delays in ambulance transfer and DIIs at all levels of care. The majority of the women had risk factors for BDACS. There were major ambulance delays and lack of facilities, mostly in district hospitals. All women required life-saving interventions, but could not access appropriate care timeously. Prevention and management of BDACS require a fully functional health system.

  19. Protocol for a randomised controlled trial of fetal scalp blood lactate measurement to reduce caesarean sections during labour: the Flamingo trial [ACTRN12611000172909].

    Science.gov (United States)

    East, Christine E; Kane, Stefan C; Davey, Mary-Ann; Kamlin, C Omar; Brennecke, Shaun P

    2015-11-03

    The rate of caesarean sections around the world is rising each year, reaching epidemic proportions. Although many caesarean sections are performed for concerns about fetal welfare on the basis of abnormal cardiotocography, the majority of babies are shown to be well at birth, meaning that the operation, with its inherent short and long term risks, could have been avoided without compromising the baby's health. Previously, fetal scalp blood sampling for pH estimation was performed in the context of an abnormal cardiotocograph, to improve the identification of babies in need of expedited delivery. This test has largely been replaced by lactate measurement, although its validity is yet to be established through a randomised controlled trial. This study aims to test the hypothesis that the performance of fetal scalp blood lactate measurement for women in labour with an abnormal cardiotocograph will reduce the rate of birth by caesarean section from 38 % to 25 % (a 35 % relative reduction). Prospective unblinded randomised controlled trial conducted at a single tertiary perinatal centre. Women labouring with a singleton fetus in cephalic presentation at 37 or more weeks' gestation with ruptured membranes and with an abnormal cardiotocograph will be eligible. Participants will be randomised to one of two groups: fetal monitoring by cardiotocography alone, or cardiotocography augmented by fetal scalp blood lactate analysis. Decisions regarding the timing and mode of delivery will be made by the treating team, in accordance with hospital protocols. The primary study endpoint is caesarean section with secondary outcomes collected from maternal, fetal and neonatal clinical course and morbidities. A cost effectiveness analysis will also be performed. A sample size of 600 will provide 90 % power to detect the hypothesised difference in the proportion of women who give birth by caesarean section. This world-first trial is adequately powered to determine the impact of fetal

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

    Directory of Open Access Journals (Sweden)

    Ali Sizlan

    2009-04-01

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

  1. Influences on decision making among primiparous women choosing elective caesarean section in the absence of medical indications: findings from a qualitative investigation.

    Science.gov (United States)

    Kornelsen, Jude; Hutton, Eileen; Munro, Sarah

    2010-10-01

    Patient-initiated elective Caesarean section (PIECS) is increasingly prevalent and is emerging as an urgent issue for individual maternity practitioners, hospitals, and policy makers, as well as for maternity patients. This qualitative study sought to explore women's experiences of the decision-making process leading to elective operative delivery without medical indication. We conducted 17 exploratory qualitative in-depth interviews with primiparous women who had undergone a patient-initiated elective Caesarean section in the absence of any medical indication. The study took place in five hospitals (three urban, two semi-rural) in British Columbia. The findings revealed three themes within the process of women deciding to have a Caesarean section: the reasons for their decision, the qualities of the decision-making process, and the social context in which the decision was made. The factors that influenced a patient-initiated request for delivery by Caesarean section in participants in this study were diverse, culturally dependent, and reflective of varying degrees of emotional and evidence-based influences. PIECS is a rare but socially significant phenomenon. The a priori decision making of some women choosing PIECS does not follow the usual diagnosis-intervention trajectory, and the care provider may have to work in reverse to ensure that the patient fully understands the risks and benefits of her decision subsequent to the decision having been made, while still ensuring patient autonomy. Results from this study provide a context for a woman's request for an elective Caesarean section without medical indication, which may contribute to a more efficacious informed consent process.

  2. Modest Rise in Caesarean Section from 2000-2010: The Dutch Experience.

    Directory of Open Access Journals (Sweden)

    Yanjun Zhao

    Full Text Available The caesarean delivery (CD rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is attributable to the relative stability of the Dutch CD rate.A total of 1,935,959 women from the nationwide Perinatal Registry of the Netherlands were included. Women were categorized into ten groups based on the modified CD classification scheme. Trends of CD rates in each group were described.The overall CD rate increased slightly from 14.0% in 2000-2001 to 16.7% in 2010. Fetal, early and late neonatal mortality rates decreased by 40-50% from 0.53%, 0.21%, 0.04% in 2000-2001 to 0.29%, 0.12%, 0.02% in 2010, respectively. During this period, the prevalence of non-vertex presentation decreased from 6.7% to 5.3%, even though the CD rate in this group was high. The nulliparous women with spontaneous onset of labor at term and a singleton child in vertex presentation had a CD rate of 9.9%, and 64.7% of multiparous women with at least one previous uterine scar and a singleton child in vertex presentation had a trial of labor and the success rate of vaginal delivery was 45.9%.The Dutch experience indicates that external cephalic version for breech presentation, keeping the CD rate low in nulliparous women and encouraging a trial of labor in multiparous women with a previous scar, could help to keep the overall CD rate steady.

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

    Directory of Open Access Journals (Sweden)

    Lokman Soyoral

    2017-03-01

    Full Text Available 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. Resumo: Miastenia grave (MG é uma doença autoimune caracterizada por fraqueza muscular que flutua, piorando com o esforço físico e melhorando com o repouso. O diagnóstico de MG é feito após exame clínico e físico e confirmado por imunoensaios séricos para medir os níveis de autoanticorpos. MG, especialmente quando associada à gravidez, é uma doença de alto risco e de curso imprevisível. Descrevemos o segundo relato sobre o uso de sugamadex após rocurônio para um parto cesário com miastenia grave, mas, ao contrário de nosso caso que foi previamente diagnosticado com miastenia grave, a paciente foi extubada com sucesso no pós-operatório sem qualquer problema respiratório. Keywords: Myasthenia gravis, Sugammadex, Pregnancy, Palavras-chave: Miastenia grave, Sugammadex, Gravidez

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

    Science.gov (United States)

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

    2014-01-01

    To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information. A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria. Obstetric health care in the Netherlands. A multidisciplinary steering group, an expert panel, and 25 future users of the PtDA, i.e. women with a previous caesarean section. The development consisted of a construction phase (definition of scope and purpose, and selection of content, framework, and format) and a pilot testing phase by interview. The process was supervised by a multidisciplinary steering group. Usability, clarity, and relevance. The construction phase resulted in a booklet including unbiased balanced information on mode of birth after caesarean section, a preference elicitation exercise, and tailored risk information, including a prediction model for successful VBAC. During pilot testing, visualisation of risks and clarity formed the main basis for revisions. Pilot testing showed the availability of tailored structured information to be the main factor involving women in decision-making. The PtDA meets 39 out of 50 IPDAS criteria (78%): 23 out of 23 criteria for content (100%) and 16 out of 20 criteria for the development process (80%). Criteria for effectiveness (n = 7) were not evaluated. An evidence-based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision-making on mode of birth after caesarean section. © 2013 Royal College of Obstetricians and Gynaecologists.

  5. Advantages and disadvantages : longitudinal vs. repeated cross-section surveys

    Science.gov (United States)

    1996-06-20

    The benefits of a longitudinal analysis over a repeated cross-sectional study include increased statistical power and the capability to estimate a greater range of conditional probabilities. With the Puget Sound Transportation Panel (PSTP), and any s...

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

    Directory of Open Access Journals (Sweden)

    Hazel Gonsalves

    2016-11-01

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

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

    Science.gov (United States)

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

    2017-06-02

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

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

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    D. Mannaerts

    2018-01-01

    Full Text Available Purpose. To compare the incidence of nausea, vomiting, and arterial hypotension between carbetocin and oxytocin to prevent haemorrhage after caesarean section (CS. Methods. A randomized controlled trial in term pregnant women undergoing planned CS. Groups were randomized to carbetocin or oxytocin. Blood pressure (BP, heart rate, presence of nausea/vomitus, and need for vasopressors were evaluated throughout surgery. Preoperative and postoperative haemoglobin and haematocrit levels were compared. Results. Fifty-eight women were randomized (carbetocin n=32; oxytocin n=26. Both medications had hypotensive effect, difference in BP for carbetocin versus oxytocin: systolic (14.4 ± 2.4 mmHg versus 8.5 ± 1.8 mmHg; diastolic (7.8 ± 1.6 mmHg versus 8.9 ± 3.0 mmHg without significant difference between the drugs (p=0.1 and p=0.7. Both groups had similar needs for vasopressors. The presence of nausea was not rare, but the difference was not statistically significant (p=0.4. Average blood loss was slightly lower in the carbetocin group but not statistically significant (p=0.8. Conclusion. In planned CS, a possible clinical significant lower incidence of nausea after carbetocin was noted but this was not statistically significant. There were no differences regarding BP, heart rate, the need for vasopressor, and blood loss. The study was registered in the International Journal of Clinical Trials (ISRCTN 95504420, 2/2017.

  10. A randomised controlled trial comparing oxytocin and oxytocin + ergometrine for prevention of postpartum haemorrhage at caesarean section.

    Science.gov (United States)

    Koen, Sandy; Snyman, Leon Cornelius; Pattinson, Robert C; Makin, Jennifer A

    2016-03-07

    Globally 166 000 women die annually as a result of obstetric haemorrhage. More than 50% of these deaths occur in sub-Saharan Africa. Uterine atony is the commonest cause of severe postpartum haemorrhage (PPH). Bleeding at or after caesarean section (CS) is responsible for >30% of maternal deaths due to obstetric haemorrhage in South Africa (SA). To compare oxytocin alone with oxytocin + ergometrine in terms of primary prophylaxis for PPH at the time of CS. This was a double-blind randomised controlled interventional study comparing oxytocin with oxytocin + ergometrine administered during CS. Patients were randomised to receive oxytocin alone intravenously as a bolus or oxytocin + ergometrine intramuscularly, with the placebo being an injection of sterile water. The study population consisted of women undergoing CS at Kalafong Provincial Tertiary Hospital in Atteridgeville, Gauteng, SA. Five hundred and forty women were randomised and data for 416 women, of whom 214 received oxytocin and 202 oxytocin + ergometrine, were available for analysis. In the oxytocin group 19 women (8.9%) required blood transfusion, compared with seven (3.5%) in the oxytocin + ergometrine group (p=0.01; relative risk = 2.78; 95% confidence interval 1.21 - 6.4). There were no statistically significant differences in the mean estimated visual and mean calculated blood loss. The overall need for blood transfusion was significantly reduced by about two-thirds in women receiving the oxytocin + ergometrine combination. Consideration should be given to using oxytocin + ergometrine for prophylaxis of PPH at CS.

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

    Science.gov (United States)

    Bolaji, Ibrahim; Alabi-Isama, Lillian

    2009-01-01

    We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB) external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from “excessive force-pain biofeedback loop” induced through motor nerve blockade. We can attribute 30% of cost savings amounting to £42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4). The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended. PMID:20069044

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

    Directory of Open Access Journals (Sweden)

    Ibrahim Bolaji

    2009-01-01

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

  13. 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.

  14. Re: What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour?

    DEFF Research Database (Denmark)

    Boie, Sidsel; Glavind, Julie; Uldbjerg, Niels

    2017-01-01

    The authors pose the question - What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour? and state in their paper that "There is no consensus on the optimal dose regimen of oxytocin for delay in the first stage of labour...... in nulliparous women at term (37-42 weeks’ gestation) to reduce unplanned caesarean section and increase vaginal birth with minimal adverse events". However, they describe only low and high dose oxytocin regimens and fail to acknowledge that no oxytocin at all is associated with a spontaneous delivery just...... as often as when oxytocin is given (1,2) or that discontinuation of oxytocin once the active phase of labour is reached can result in higher spontaneous delivery rates than continuing oxytocin (3,4). The paper in its list of trials (box 2) only describes those addressing high and low dose oxytocin, which...

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

    Science.gov (United States)

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

    2017-05-01

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

  16. 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.

  17. A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section.

    Science.gov (United States)

    Elfil, H; Crowley, L; Segurado, R; Spring, A

    2015-11-01

    A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min. Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Anjali R Bhure

    2011-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a complex cardiovascular disorder with autosomal dominant inheritance and an incidence of 0.1-0.5% in pregnant females. Anaesthetic management of a pregnant female with HOCM posted for elective caesarean section is a challenge, as even minor hemodynamic insults may lead to life-threatening complications. We report successful management of one such patient using epidural anaesthesia with 0.75% Ropivacaine.

  19. Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

    OpenAIRE

    Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

    2015-01-01

    Purpose 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. Methods 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 heig...

  20. Influence of lateral decubitus positioning after combined use of hyperbaric and hypobaric ropivacaine on hemodynamic characteristics in spinal anesthesia for caesarean section

    OpenAIRE

    Quan, Zhe-Feng; He, Hai-Li; Tian, Ming; Chi, Ping; Li, Xin

    2014-01-01

    Purpose: Positioning of the patient during and after surgery can have significant implications on recovery. Therefore, the purpose of the present study was to determine the influence of placing patients in a lateral decubitus position for 15 min after combined use of hyperbaric and hypobaric ropivacaine and assess hemodynamic characteristics during spinal anesthesia for caesarean section. Methods: One hundred-forty patients undergoing elective cesarean delivery with combined use of hyperbaric...

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    -section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p Within...... study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section. RESULTS: The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C...... the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design....

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

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... imminent threat and no imminent threat to fetal wellbe- ing. The primary ... proposed a grading system based on the clinical state of the mother and ... sarean sections each day using one operating theatre for both elective and ...

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

    Directory of Open Access Journals (Sweden)

    Md Nuruzzaman Khan

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

  4. 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

    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.

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

    Science.gov (United States)

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

    2011-01-01

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

  6. Rate of caesarean sections according to the Robson classification: Analysis in a French perinatal network - Interest and limitations of the French medico-administrative data (PMSI).

    Science.gov (United States)

    Lafitte, A-S; Dolley, P; Le Coutour, X; Benoist, G; Prime, L; Thibon, P; Dreyfus, M

    2018-02-01

    The objective of our study was to determine, in accordance with WHO recommendations, the rates of Caesarean sections in a French perinatal network according to the Robson classification and determine the benefit of the medico-administrative data (PMSI) to collect this indicator. This study aimed to identify the main groups contributing to local variations in the rates of Caesarean sections. A descriptive multicentric study was conducted in 13 maternity units of a French perinatal network. The rates of Caesarean sections and the contribution of each group of the Robson classification were calculated for all Caesarean sections performed in 2014. The agreement of the classification of Caesarean sections according to Robson using medico-administrative data and data collected in the patient records was measured by the Kappa index. We also analysed a 6 groups simplified Robson classification only using data from PMSI, which do not inform about parity and onset of labour. The rate of Caesarean sections was 19% (14.5-33.2) in 2014 (2924 out of 15413 deliveries). The most important contributors to the total rates were groups 1, 2 and 5, representing respectively 14.3%, 16.7% and 32.1% of the Caesarean sections. The rates were significantly different in level 1, 2b and 3 maternity units in groups 1 to 4, level 2a maternity units in group 5, and level 3 maternity units in groups 6 and 7. The agreement between the simplified Robson classification produced using the medical records and the medico-administrative data was excellent, with a Kappa index of 0.985 (0.980-0.990). To reduce the rates of Caesarean sections, audits should be conducted on groups 1, 2 and 5 and local protocols developed. Simply by collecting the parity data, the excellent metrological quality of the medico-administrative data would allow systematisation of the Robson classification for each hospital. Copyright © 2017. Published by Elsevier Masson SAS.

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

    Directory of Open Access Journals (Sweden)

    Montgomery Alan A

    2009-08-01

    Full Text Available Abstract Background Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4–10 minutes therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. Methods and design A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml. A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. Discussion It is both important and timely that we evaluate the optimal approach to the management

  8. 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

    Science.gov (United States)

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

    2009-01-01

    Background Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4–10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. Methods and design A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. Discussion It is both important and timely that we evaluate the optimal approach to the management of the third stage at

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

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-02-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

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

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2009-01-01

    BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

  11. Association of Maternal Vitamin D Status with Glucose Tolerance and Caesarean Section in a Multi-Ethnic Asian Cohort: The Growing Up in Singapore Towards Healthy Outcomes Study.

    Science.gov (United States)

    Loy, See Ling; Lek, Ngee; Yap, Fabian; Soh, Shu E; Padmapriya, Natarajan; Tan, Kok Hian; Biswas, Arijit; Yeo, George Seow Heong; Kwek, Kenneth; Gluckman, Peter D; Godfrey, Keith M; Saw, Seang Mei; Müller-Riemenschneider, Falk; Chong, Yap-Seng; Chong, Mary Foong-Fong; Chan, Jerry Kok Yen

    2015-01-01

    Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD) with gestational diabetes mellitus (GDM) and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Plasma 25OHD concentrations, fasting glucose (FG) and 2-hour postprandial glucose (2HPPG) concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26-28 weeks' gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section. In total, 388 (41.3%) women had 25OHD inadequacy. Of these, 131 (33.8%), 155 (39.9%) and 102 (26.3%) were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI) = 0.01, 0.14), but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR) = 1.39, 95% CI = 0.95, 2.05) was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33), while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43) and Indian women (OR = 2.41, 95% CI = 1.01, 5.73). 25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency

  12. Association of Maternal Vitamin D Status with Glucose Tolerance and Caesarean Section in a Multi-Ethnic Asian Cohort: The Growing Up in Singapore Towards Healthy Outcomes Study.

    Directory of Open Access Journals (Sweden)

    See Ling Loy

    Full Text Available Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD with gestational diabetes mellitus (GDM and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO study.Plasma 25OHD concentrations, fasting glucose (FG and 2-hour postprandial glucose (2HPPG concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26-28 weeks' gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section.In total, 388 (41.3% women had 25OHD inadequacy. Of these, 131 (33.8%, 155 (39.9% and 102 (26.3% were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI = 0.01, 0.14, but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR = 1.39, 95% CI = 0.95, 2.05 was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33, while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43 and Indian women (OR = 2.41, 95% CI = 1.01, 5.73.25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency

  13. Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

    Science.gov (United States)

    Morisaki, N; Ganchimeg, T; Ota, E; Vogel, J P; Souza, J P; Mori, R; Gülmezoglu, A M

    2014-03-01

    To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible. © 2014 RCOG The World Health Organization retains copyright and all other rights in

  14. blood loss during caesarean myomectomy: a retrospective analysis ...

    African Journals Online (AJOL)

    Administrator

    Myomectomy during Caesarean delivery is thought to be associated with increased risk of haemorrhage ... appropriate measures are taken to maintain the tonicity of the uterus during the procedure. Selected cases of Caesarean myomectomy could therefore reduce the incidence of repeat ... Avoidance of Caesarean.

  15. Nursing Care Model Based on Knowledge Management in Preventing Nosocomial Infection After Caesarean Section in Hospital

    Directory of Open Access Journals (Sweden)

    Ahsan Ahsan

    2016-09-01

    Full Text Available Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1 there was difference in knowledge management implementation before and after training; 2 there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3 there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4 there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1 nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2 knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3 implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care. Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea

  16. Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012.

    Science.gov (United States)

    Cresswell, Jenny A; Assarag, Bouchra; Meski, Fatima-Zahra; Filippi, Veronique; Ronsmans, Carine

    2015-05-01

    To examine trends in the utilisation of facility-based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care. Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events. Uptake of facility-based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR: 1.09; 95% CI: 1.07-1.11) than the richest quintile (annual increase RR: 1.01; 95% CI: 1.02-1.02). A similar pattern was observed for caesareans (annual increase among poorest RR: 1.13; 95% CI: 1.07-1.19 vs. annual increase among richest RR: 1.08; 95% CI: 1.06-1.10). We found no significant acceleration in trend coinciding with any of the events investigated. Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply-side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive. © 2015 John Wiley & Sons Ltd.

  17. Caesarean section and mortality

    African Journals Online (AJOL)

    Hawkins JL, Gibbs CP, Orleans M, et al. Obstetric anesthesia work force survey, versus 1992. Anesthesiology. 1981;1997(87):135–43. 2. Bert CJ, Atrash HK, Koonin KM, et al. Pregnacy related mortality in the. United States, 1987–1990. Obstet Gynecol. 1996;88:161–7. Received: 10-08-2015 Accepted: 14-08-2015.

  18. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study.

    Science.gov (United States)

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

    2017-02-01

    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 decreased in

  19. 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

  20. Obstetrical correlates of the first time cesarean section, compared with the repeated cesarean section

    International Nuclear Information System (INIS)

    Rukh, G.; Akhtar, S.

    2007-01-01

    To determine the clinical and epidemiological characteristics in patients having their first cesarean section (FCS) and compare it with findings in patients with repeated cesarean section (RCS). This study included all the women who gave birth by cesarean sections, 817 of the total 5992 deliveries, at this unit during the study period. Data on potential risk factors for the first cesarean section (FCS) and repeated cesarean section (RCS were extracted from medical records, which were reviewed and compared between these two groups of women. Data were statistically analyzed with student t-test for comparison between means and Chi-square test for comparison between percentages. Crude odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Significance was taken at p 0.05). The frequency of first cesarean section and repeat cesarean section is high in our setup. Adequate following of the programs to diminish the percentage of FCS by curtailing its predisposing factors is needed. (author)

  1. Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study.

    Science.gov (United States)

    Brown, S J; Gartland, D; Donath, S; MacArthur, C

    2011-07-01

    To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. Urinary incontinence 3 months postpartum in women continent before the index pregnancy. Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  2. Generation of a human induced pluripotent stem cell line (MUSIi001-A from caesarean section scar fibroblasts using Sendai viral vectors

    Directory of Open Access Journals (Sweden)

    Methichit Wattanapanitch

    2018-03-01

    Full Text Available We generated a human induced pluripotent stem cell (iPSC line from caesarean section scar fibroblasts of a 33-year-old healthy woman using transgene-free Sendai viral vectors under feeder-free condition. The established iPSC line, designated as MUSIi001-A, exhibited a normal karyotype, expressed pluripotent markers, differentiated into cells of three embryonic germ layers. Further analyses showed that the Sendai viral genome was absent at passage 25. The MUSIi001-A line can serve as a control for studying developmental biology and phenotypic comparison with disease-specific iPSCs.

  3. Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

    Directory of Open Access Journals (Sweden)

    Esther Arendt

    Full Text Available The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health.We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (<145.0cm, Short (145.0-149.9cm, Short-average (150.0-154.9cm, Average (155.0-159.9cm, Average-tall (160.0-169.9cm and Tall (≥170.0cm. Multivariate logistic regression was used to assess the contribution of maternal stature to the odds ratio of caesarean section delivery, adjusting for other exposures, such as age at index birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index

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

    Science.gov (United States)

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

    2012-11-16

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

  5. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial.

    Science.gov (United States)

    Attilakos, G; Psaroudakis, D; Ash, J; Buchanan, R; Winter, C; Donald, F; Hunt, L P; Draycott, T

    2010-07-01

    To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH). Double-blind randomised single centre study (1:1 ratio). Teaching hospital in Bristol, UK with 6000 deliveries per annum. Women at term undergoing elective or emergency caesarean section under regional anaesthesia, excluding women with placenta praevia, multiple gestation and placental abruption. Women were randomised to receive either carbetocin 100 microg or oxytocin 5 IU intravenously after the delivery of the baby. Perioperative care was otherwise normal and use of additional oxytocics was at the discretion of the operating obstetrician. Analysis was by intention to treat. The proportion of women in each arm of the trial that needed additional pharmacological oxytocic interventions. Significantly more women needed additional oxytocics in the oxytocin group (45.5% versus 33.5%, Relative risk 0.74, 95% CI 0.57-0.95). The majority of women had oxytocin infusions. There were no significant differences in the secondary outcomes, including major PPH, blood transfusions and fall in haemoglobin. Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.

  6. 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.

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

    Science.gov (United States)

    Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

    2015-01-01

    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 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.

  8. Comparison of colloid (polygeline) over crystalloid (lactated ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia

    International Nuclear Information System (INIS)

    Boota, M.; Haq, I.

    2012-01-01

    Objective: To assess efficacy of colloid (Polygeline) over crystalloid (Lactated Ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia. Study design: Randomized control trial. Settings: The study was conducted in department of Anesthesiology and Intensive care Combined Military Hospital Peshawar over a period of 6 months from 01 March 2007 to 31 August 2007. Material and Methods: One hundred patients fulfilling the inclusion criteria were selected for study and divided into two groups of 50 each. Group A was given 500 ml Polygeline as preloading solution while group B received 1 liter of Ringer's Lactate as preloading solution just before administration of spinal anaesthesia. Heart rate and systolic blood pressure were recorded at 01 min, 05 mins, 10 mins, 15 mins, 20 mins, 30 mins and 45 mins after the performance of spinal block. Dose of ephedrine given to treat hypotension after the block was also recorded. Results: There was significant difference in terms of heart rate and systolic arterial pressure 1 and 5 minutes after block between both the groups. There was also significant difference in terms of dose of ephedrine between both the groups. Conclusion: Polygeline is more effective than Ringer's Lactate as preloading fluid in preventing hypotension for caesarean section under spinal anaesthesia. (author)

  9. Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

    Science.gov (United States)

    Arendt, Esther; Singh, Neha S; Campbell, Oona M R

    2018-01-01

    The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health. We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index quintile, multiple birth, birth order and country of survey. There was a gradual increase in the rate of caesarean section with decreasing maternal height. Compared to women of Average height (155.0-159.9cm), taller women were protected. The adjusted odds ratio (aOR) for Tall women was 0.67 (95% CI:0.52-0.87) and for Average-tall women was 0

  10. Predictors of Severe Neonatal Compromise Following Caesarean ...

    African Journals Online (AJOL)

    BACKGROUND: The potential harm to a mother and baby from caesarean delivery for clinically diagnosed foetal distress may not always be justified by the degree of neonatal depression at birth. OBJECTIVE: To assess the accuracy of clinical diagnosis of foetal distress indicating caesarean section and identify antepartum ...

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

    Directory of Open Access Journals (Sweden)

    Nanik Handayani

    2015-11-01

    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Pain is the most common effects in patients after undergoing surgery of Caesarean section. Pain management using pharmacological and non pharmacological management, one of non-pharmacological management is using music therapy The purpose of this study was to analyze the effect of music therapy on pain level of postoperative patients' with Caesarean section. The type of study is analytic with True Experimental type with Pre Post Test Control Group Design done by Random Allocation. The study population is post-operative Caesarean section mothers who are hospitalized in Surabaya Islamic Hospital Surabaya Jl. A Yani since May 2011. The Sample are some populations above mentioned with amount of 24 respondents, 12 respondents as a control and 12 respondents were given music therapy. The Sampling technique uses Consecutive Sampling. Independent variable is music therapy and dependent variable is pain level. The instrument used to measure the independent variables is a check sheet lists while the dependent variable is Descriptive Pain Intensity Scale. To analyze the changes of pain level in the control group and the treatment used Paired T Test, the result showed that values of ρ is 0.166 or (ρ > 0.05, so there is no significant change of pain level on a pre test and post test control group, whereas in treatment group obtained value of ρ is 0.000 or (ρ < 0.05, so there is a significant change of pain level on a pre test and post test. To analyze differences of pain

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

    Directory of Open Access Journals (Sweden)

    Kolokotroni Ourania

    2012-11-01

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

  13. Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?

    Science.gov (United States)

    Higgins, L; Mechery, J; Tomlinson, A J

    2011-11-01

    Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. This study describes a clinical and financial evaluation undertaken at a United Kingdom District General Hospital surrounding the introduction of carbetocin for prophylaxis against postpartum haemorrhage at caesarean deliveries. A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.

  14. The impact of nonclinical factors on repeat cesarean section.

    Science.gov (United States)

    Stafford, R S

    1991-01-02

    Nonclinical factors, including the setting in which health care takes place, influence clinical decisions. This research measures the independent effects of organizational and socioeconomic factors on repeat cesarean section use in California. Of 45,425 births to women with previous cesarean sections in 1986, vaginal birth after cesarean section occurred in 10.9%. Sizable nonclinical variations were noted. By hospital ownership, rates ranged from 4.9% (for-profit hospitals) to 29.2% (University of California). Variations also existed by hospital teaching level (nonteaching hospitals, 7.0%, vs formalized teaching hospitals, 23.3%); payment source (private insurance, 8.1%, vs indigent services, 25.2%); and obstetric volume (low-volume hospitals, 5.4%, vs high-volume hospitals, 16.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and the effects of patient characteristics. The observed variations demonstrate the prominence of nonclinical factors in decision making and question the clinical appropriateness of current practice patterns.

  15. Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

    Directory of Open Access Journals (Sweden)

    Shahid Adeel

    2017-01-01

    Full Text Available Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819. In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000 at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265. Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different

  16. Efficacy of magnesium sulphate and/or fentanyl as adjuvants to intrathecal low-dose bupivacaine in parturients undergoing elective caesarean section

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    Shelly Rana

    2017-01-01

    Full Text Available Background and Aim: Recent developments in the field of intrathecal adjuvants have led to accelerated functional recovery with adequate postoperative analgesia following caesarean section. Encouraging results have been obtained with the use of intrathecal magnesium with or without fentanyl in parturients. This study was conceived to evaluate the effects of adding magnesium sulphate and/or fentanyl to low-dose intrathecal bupivacaine in parturients undergoing caesarean section under subarachnoid block (SAB. Materials and Methods: Ninety, American Society of Anesthesiologists I or II, parturients for the elective caesarean section were enrolled in this prospective randomized, double-blind study. The parturients were randomly assigned to three groups. In Group M, parturients received 8.5 mg (1.7 mL hyperbaric bupivacaine 0.5% with 50 mg (0.1 mL magnesium sulphate and 0.4 mL normal saline. Group F received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg (0.4 mL fentanyl and 0.1 mL of normal saline and Group MF parturients received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg fentanyl added to 50 mg magnesium sulphate. Results: Parturients in the group MF were pain free for longest period (273.70 ± 49.30 min as compared to group M (252.67 ± 40.76 min and group F (239.80 ± 38.45 mins [gp MF vs F and, gp M vs F (P = 0.00]. The total doses of rescue analgesics were least in group MF (2.43 ± 0.56 and maximum in group F (3.30 ± 0.63, with comparable neonatal outcomes in three groups. Conclusion: Our data supports synergistic action of intrathecal magnesium sulphate to fentanyl, and it is concluded that on addition of intrathecal magnesium sulphate and fentanyl to low-dose bupivacaine as adjuvant in subarachnoid block, results in prolonged duration of postoperative analgesia with lesser pain scores and lesser dose of rescue analgesia with better haemodynamic stability.

  17. 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.

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

    Science.gov (United States)

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

    2016-11-01

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

  19. 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.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    AIM: To test whether intramuscular injection of 30 microg adrenaline decreased the incidence of respiratory distress and hypoglycaemia in term infants delivered by elective caesarean section before active labour. METHOD: The study was randomised and double-blinded. A total of 270 neonates were...... assigned to intramuscular treatment with saline (0.30 ml) or 30 microg adrenaline (0.30 ml) immediately after birth. The primary endpoint was referral to the neonatal ward because of respiratory distress or a blood glucose level ... with pulse oximetry to disclose potential side effects. RESULTS: Pulse-oximetry recordings revealed a modest systemic effect by intramuscular adrenaline as the heart rate and the haemoglobin oxygen saturation were significantly higher in infants who received adrenaline. In contrast, the incidence...

  1. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles.

    Science.gov (United States)

    Shaikh, Jan Muhammad; Memon, Amna; Memon, Muhammad Ali; Khan, Majida

    2008-01-01

    To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used.

  2. Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron.

    Science.gov (United States)

    Tan, T; Ojo, R; Immani, S; Choroszczak, P; Carey, M

    2010-01-01

    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. 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). 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. 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. Copyright 2009 Elsevier Ltd. All rights reserved.

  3. 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.

  4. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G quince, 27G quince and 27G whitacre spinal needles

    International Nuclear Information System (INIS)

    Shaikh, J.M.; Memon, M.; Khan, M.

    2008-01-01

    To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used. (author)

  5. Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix : a secondary analysis of the HYPITAT and DIGITAT trials

    NARCIS (Netherlands)

    Bernardes, T. P.; Broekhuijsen, K.; Koopmans, C. M.; Boers, K. E.; van Wyk, L.; Tajik, P.; van Pampus, M. G.; Scherjon, S. A.; Mol, B. W.; Franssen, M. T.; Berg, van den P. P.; Groen, Henk

    Objective To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. Design Secondary analysis of data from two randomised clinical trials. Setting Data were collected in two nationwide Dutch

  6. Closed-loop double-vasopressor automated system vs manual bolus vasopressor to treat hypotension during spinal anaesthesia for caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Sng, B L; Tan, H S; Sia, A T H

    2014-01-01

    Hypotension necessitating vasopressor administration occurs commonly during caesarean section under spinal anaesthesia. We developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive arterial pressure monitoring. A phenylephrine bolus of 50 μg was given at 30-s intervals when systolic blood pressure fell manual boluses of either phenylephrine 100 μg or ephedrine 8 mg, administered at 1-min intervals based on the same thresholds for systolic pressure and heart rate. This randomised, controlled, double-blinded trial involved 213 healthy women who underwent elective caesarean delivery under spinal anaesthesia using 11 mg hyperbaric bupivacaine with 15 μg fentanyl and 100 μg morphine. The automated vasopressor group had better systolic pressure control, with 37/106 (34.9%) having any beat-to-beat systolic pressure reading 120% of baseline, with 8/106 (7.5%) in the automated vasopressor group vs 14/107 (13.1%) in the control group, or total dose of vasopressors. The automated vasopressor group had lower median absolute performance error of 8.5% vs control of 9.8% (p = 0.013), and reduced incidence of nausea (1/106 (0.9%) vs 11/107 (10.3%), p = 0.005). Neonatal umbilical cord pH, umbilical lactate and Apgar scores were similar. Hence, our system afforded better control of maternal blood pressure and reduced nausea with no increase in reactive hypertension when compared with manual boluses. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  7. Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia.

    Science.gov (United States)

    Belihu, Fetene B; Small, Rhonda; Davey, Mary-Ann

    2017-03-01

    Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. Victoria, Australia. 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (OR adj 1.94, 95% CI 1.57-2.47) but less likely to succeed (OR adj 0.54 95% CI 0.41-0.71) in having a VBAC. There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births.

    Science.gov (United States)

    Liang, Juan; Mu, Yi; Li, Xiaohong; Tang, Wen; Wang, Yanping; Liu, Zheng; Huang, Xiaona; Scherpbier, Robert W; Guo, Sufang; Li, Mingrong; Dai, Li; Deng, Kui; Deng, Changfei; Li, Qi; Kang, Leni; Zhu, Jun; Ronsmans, Carine

    2018-03-05

    To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. Observational study. China's National Maternal Near Miss Surveillance System (NMNMSS). 6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016. Obstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time. Caesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government's policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time. China is the only country that

  9. 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

  10. Influence of lateral decubitus positioning after combined use of hyperbaric and hypobaric ropivacaine on hemodynamic characteristics in spinal anesthesia for caesarean section.

    Science.gov (United States)

    Quan, Zhe-Feng; He, Hai-Li; Tian, Ming; Chi, Ping; Li, Xin

    2014-01-01

    Positioning of the patient during and after surgery can have significant implications on recovery. Therefore, the purpose of the present study was to determine the influence of placing patients in a lateral decubitus position for 15 min after combined use of hyperbaric and hypobaric ropivacaine and assess hemodynamic characteristics during spinal anesthesia for caesarean section. One hundred-forty patients undergoing elective cesarean delivery with combined use of hyperbaric and hypobaric ropivacaine were included in the present study. Patients meeting inclusion criteria (134) were randomly allocated into Group A: immediately turned to the supine position after induction of spinal anesthesia (n = 67) or Group B: maintained in a lateral decubitus position for 15 min before being turned to the supine position (n = 67). Primary endpoints of the study were to compare hemodynamic characteristics and sensory blockade levels in the two groups, while a secondary endpoint was to observe the incidence of complications. Both groups showed similar effects of the combined anesthetic treatment. Incidence of hypotension (43% vs 18%, P = 0.001), systolic AP hyperbaric and hypobaric ropivacaine had satisfactory anesthetic effects and a more stable hemodynamic characteristic than either drug used alone. Maintaining the patient in a lateral decubitus position for 15 min can significantly decrease the incidence of hypotension.

  11. 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.

  12. [Impact of DRG payment on the length of stay and the number of outpatient visits after discharge for caesarean section during 2004-2007].

    Science.gov (United States)

    Shon, Changwoo; Chung, Seolhee; Yi, Seonju; Kwon, Soonman

    2011-01-01

    The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the difference-in-differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

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

    Science.gov (United States)

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

    2017-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Nahid Manouchehrian

    2016-07-01

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

  15. 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.

  16. Blood transfusion requirement during caesarean delivery: Risk factors

    African Journals Online (AJOL)

    Background: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. Methods: This was a prospective ...

  17. Association of placenta praevia with repeat cesarean section in ...

    African Journals Online (AJOL)

    Background: Several risk factors for placenta praevia exist, including previous cesarean section(C/S). This association has been investigated long time ago, however in this hospital there is no documented evidence. This study was done to assess the risk of placenta praevia based on number of previous cesarean sections.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

    Fakherpour, Atousa; Ghaem, Haleh; Fattahi, Zeinabsadat; Zaree, Samaneh

    2018-01-01

    Although spinal anaesthesia (SA) is nowadays the preferred anaesthesia technique for caesarean section (CS), it is associated with considerable haemodynamic effects, such as maternal hypotension. This study aimed to evaluate a wide range of variables (related to parturient and anaesthesia techniques) associated with the incidence of different degrees of SA-induced hypotension during elective CS. This prospective study was conducted on 511 mother-infant pairs, in which the mother underwent elective CS under SA. The data were collected through preset proforma containing three parts related to the parturient, anaesthetic techniques and a table for recording maternal blood pressure. It was hypothesized that some maternal (such as age) and anaesthesia-related risk factors (such as block height) were associated with occurance of SA-induced hypotension during elective CS. The incidence of mild, moderate and severe hypotension was 20%, 35% and 40%, respectively. Eventually, ten risk factors were found to be associated with hypotension, including age >35 years, body mass index ≥25 kg/m 2 , 11-20 kg weight gain, gravidity ≥4, history of hypotension, baseline systolic blood pressure (SBP) 100 beats/min in maternal modelling, fluid preloading ≥1000 ml, adding sufentanil to bupivacaine and sensory block height >T 4 in anaesthesia-related modelling ( P < 0.05). Age, body mass index, weight gain, gravidity, history of hypotension, baseline SBP and heart rate, fluid preloading, adding sufentanil to bupivacaine and sensory block hieght were the main risk factors identified in the study for SA-induced hypotension during CS.

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

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

    Directory of Open Access Journals (Sweden)

    Boniface Nguhuni

    2017-05-01

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

  2. Caesarean section and its impact on fertility and time to a subsequent pregnancy in Germany: a database analysis in gynecological practices.

    Science.gov (United States)

    Jacob, Louis; Weber, Katherina; Sechet, Ingeborg; Macharey, Georg; Kostev, Karel; Ziller, Volker

    2016-11-01

    To analyze the impact of caesarean section (CS) on fertility and time to pregnancy in German gynecological practices. Women initially diagnosed for the first time with a vaginal delivery (VD) or CS between 2000 and 2013 were identified by 227 gynecologists in the IMS Disease Analyzer database. They were included if they were aged between 16 and 40 years, and were not previously diagnosed with female sterility. The two main outcomes were the first-time diagnosis of female sterility and the time between the first delivery and the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics. 6483 patients were included in the CS group and 6483 in the VD group. Mean age was 30.6 years and the proportion of individuals with private health insurance amounted to 9.0 %. Within 10 years of the index date, 19.5 % of women who delivered by CS and 18.3 % of women who delivered vaginally were diagnosed with sterility (p value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of sterility. Within 10 years of the index date, 57.9 % of women who underwent a CS and 64.0 % of women who delivered vaginally were pregnant for the second time (p value <0.001). CS, polycystic ovary syndrome, and the deterioration of menstrual cycle significantly decreased the chance of becoming pregnant a second time. CS is associated with an increased risk of sterility and a decreased number of subsequent pregnancies in Germany.

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

    Directory of Open Access Journals (Sweden)

    Atousa Fakherpour

    2018-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

  6. 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.

  7. Caesarean delivery: An experience from a tertiary institution in North ...

    African Journals Online (AJOL)

    increasing use of CS as a mode of delivery in Europe and the. USA is because of fear of malpractice litigation, increased ... Daniel and Singh: Caesarean delivery, Nigeria. 19. Nigerian Journal of Clinical Practice • Jan-Feb ..... Efetie RE, Umezulike AC, Agboghoroma CO. Caesarean section at the. National Hospital, Abuja ...

  8. Caesarean Risk Factors in Northern Region of Bangladesh: A ...

    African Journals Online (AJOL)

    Purpose: To explore the measurement of a scale of caesarean (C-section) risk factors and degree of risk contribution in different health facilities and to determine a suitable graphical representation (image) of caesarean cases. Methods: Based on seventeen indicators, a composite index was computed for each respondent ...

  9. Changing trends of indications and rate of cesarean section

    International Nuclear Information System (INIS)

    Ambreen, A.; Intsar, A.; Khurshid, S.

    2013-01-01

    Background: There is a trend of rising caesarean section rate over the past decade affecting the economy of the country. This continually rising caesarean section rate is of increasing concern to the health professionals and the public This study was designed to assess the indications and trends of caesarean sections done over a five year period from 2007 to 2011. Methods: This was a retrospective observational study done over a five year period in the department of Obstetrics and Gynaecology Fatima Memorial Hospital Lahore from 2007 to 2011. Results: Total no of deliveries from 2007 to 2011 were 30741 out of which caesarean sections performed were 13820.The caesarean birth rate increased from 41% to-48%. The indications varied a little in case of mal-presentation and eclampsia. APH and IUGR has risen a little from (from 2.56% to 2.6% and 1.83% to 2.34% respectively). But proportion of repeat caesarean section increased by 25.99% to 31.45% and that of presumed fetal distress increased from 8% to 15% respectively. Recently the indication of maternal choice is emerging with incidence of 0.8% in our study. The proportion has fallen in prolonged labour due to cervical dystocia from 17% to 14% and in obstructed labour from 4.6% to 3%. Conclusion: Individualization of every case, meticulous clinical examination, use of intrapartum fetomaternal survellience along with regular use of partograrm would limit the practice of undue caesarean sections. (author)

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

    Directory of Open Access Journals (Sweden)

    Anette Hein

    2017-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Anette Hein

    2017-11-01

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

  12. 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...

  13. Comparison of analgesic efficacy of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol for postoperative pain relief in caesarean section under spinal anaesthesia: A double-blind randomized trial

    Directory of Open Access Journals (Sweden)

    Roopa Sachidananda

    2017-01-01

    Full Text Available Background: Caesarean section is one of the most frequently performed surgeries in obstetrics. Optimal pain relief of the mother is possible with multimodal methods. Wound infiltration is one of the simplest and safe methods. The aim of the study was to compare the analgesic efficacy of wound infiltration of bupivacaine, with tramadol and bupivacaine mixture for postoperative pain. Materials and Methods: After obtaining Institutional Ethical Committee approval, 60 pregnant women of age group 18–35 years, undergoing elective caesarean section under spinal anaesthesia were included in the study. The patients were randomized into two groups of 30 each. Patients belonging to group B received bupivacaine 0.25% 0.7 mg/kg (diluted to 20 mL with normal saline, while those belonging to group T received tramadol 2 mg/kg mixed in bupivacaine 0.25% 0.7 mg/kg (diluted to 20 mL with normal saline. The time for first request of analgesia, numerical rating scale score, and cumulative consumption of diclofenac and tramadol in 24 h were compared. Results: The time for first request of analgesia in group T was 386.17 ± 233.84 min compared to group B which was 192.50 ± 134.77 (P < 0.0002. The total diclofenac consumption in the first 24 h was significantly reduced in group T when compared to group B (P < 0.0068. Conclusions: Subcutaneous wound infiltration with tramadol and bupivacaine prolongs the pain-free period and analgesic consumption after caesarean section, while it also enhances the patient satisfaction.

  14. Factors associated with women's intention to request caesarean ...

    African Journals Online (AJOL)

    audit meetings, engaging mothers in the decision-making process ..... of a relatively lower quality of service in these facilities compared with. MNH. .... emergency caesarean section: A quality assurance analysis by criterion-based audit at two ...

  15. Factors associated with women's intention to request caesarean ...

    African Journals Online (AJOL)

    audit meetings, engaging mothers in the decision-making process ..... The findings regarding the influence of advanced maternal age, .... emergency caesarean section: A quality assurance analysis by criterion-based audit at two Tanzanian.

  16. Intra-Generational Mobility and Repeated Cross-Sections: A Three Country Validation Exercise

    NARCIS (Netherlands)

    Cruces, G.; Lanjouw, P.F.; Lucchetti, L.; Perova, E.; Vakis, R.; Viollaz, M.

    2015-01-01

    This paper validates a recently proposed method to estimate intra-generational poverty transitions through repeated cross-sectional surveys. The technique allows the creation of a “synthetic panel” – done by predicting future or past household income or consumption using a set of simple modeling and

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

    DEFF Research Database (Denmark)

    Ørbaek, M; Thorsteinsson, K; Helleberg, M

    2017-01-01

    OBJECTIVES: We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS: All WLWH giving birth to live...... in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective...

  18. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry.

    Science.gov (United States)

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

    2015-08-01

    Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Repeat cesarean section in subsequent gestation of women from a birth cohort in Brazil.

    Science.gov (United States)

    Mascarello, Keila Cristina; Matijasevich, Alicia; Barros, Aluísio J D; Santos, Iná S; Zandonade, Eliana; Silveira, Mariângela Freitas

    2017-08-25

    The current literature indicates increasing concern regarding the number of safe cesarean sections which a woman can undergo, mainly in face of the high cesarean section rates, which are growing in Brazil and worldwide. Aimed to describe the prevalence and associated factors of repeat cesarean section in a cohort of Brazilian women who had a cesarean section in the first birth. This is a prospective cohort study using data from the 2004 Pelotas Birth Cohort. The sample included 480 women who had their first delivery in 2004, regardless of the form of delivery, and who had a second delivery identified in the cohort's follow-ups (in 2005, 2006, 2008, and 2010). Descriptive, bivariate and multivariate analyses using Poisson regression with robust error variance were carried out. Among the women who underwent a cesarean section in their first delivery (49.47%), 87.44% had a second surgical delivery. The risk factors for repeat cesarean section included ages 21-34 (PR 1.67, CI 95% 1.07-2.60), not being seen by SUS (Public Healthcare System) in 2004 (PR 2.27, CI 95% 1.44-3.60), and the number of prenatal medical visits, i.e., women with ten or more visits were at 2.33 times higher risk (CI 95% 1.10-4.96) compared to those who had five or fewer visits. The proportion of cesarean sections both in the first and in the subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who undergo consecutive cesarean sections with possible consequent complications and changes in care policies for pregnant women should be implemented.

  20. 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.

  1. Comparison of the hemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section using Hyperbaric Bupivacaine

    International Nuclear Information System (INIS)

    Ali, M.; Naqvi, S.E.H.

    2018-01-01

    To compare the frequency of hypotension of sitting versus lateral position during induction of spinal anesthesia for elective LSCS using Hyperbaric Bupivacaine. Study Design: Randomized control trial. Place and Duration of Study: The study was conducted at Military Hospital Rawalpindi, a tertiary care hospital, after seeking hospital ethics committee permission. Study was carried out for six months, from Nov 2014 to May 2015. Patient and Methods: A total of 130 participants achieving the inclusion criteria were picked up for this study. Patients were randomized into group-S and group-L (65 in each group). Group-S received spinal anesthesia using 0.75% hyperbaric Bupivacaine in sitting position and group-L in left lateral position. Maternal Blood pressure was measured before Induction (baseline) and every 3 min after subarachnoid injection for 15 min and final outcome measured at 15 minutes. Decrease in systolic blood pressure of >20% from baseline or a value <90 mmHg was considered as hypotension. Results: The age of the patients ranged between 25-35 years. Average age of participants were 29.18 +- 2.80 and 29.12 +- 2.52 in group S and L, respectively. In group-S hypotension developed in 34 patients (52.3%) and in group-L hypotension was observed in 20 patients (30.7%), (p=0.013). Mean weight in group-S was 71.77 +- 2.82 and in group-L was 70.91 +- 2.05. Stratification with regard to age and ASA status was carried out. Conclusion: Occurrence of Hypotension was significantly less frequent when spinal anesthesia was induced to patients in the left lateral position, for elective caesarean using 0.75% Hyperbaric Bupivacaine compared to the sitting position. (author)

  2. The scheduling of repeat cesarean section operations: prospective management protocol experience.

    Science.gov (United States)

    Read, J A

    1985-03-01

    There are benefits to patients and a busy obstetric service if repeat cesarean section operations are performed on a scheduled basis. Optimum management avoids prematurity and reduces the need for amniocentesis. Over a period of 20 months repeat cesarean sections were performed at Tripler Army Medical Center while a protocol with the following elements was used: (1) known last menstrual period; (2) landmarks: positive urine human chorionic gonadotropin test by 6 weeks, Doppler fetal heart tone by 12 weeks, date determination by examination before 10 weeks, fetoscope fetal heart tone by 20 weeks, and date determination by size before 30 weeks; (3) date determination by midtrimester sonogram(s); (4) normal third-trimester glucose screening; (5) biparietal diameter of 9.2 or 9.5 cm before scheduling. With two or more clinical landmarks and one date by sonogram or one landmark and date by two sonograms, elective repeat cesarean section was scheduled at 39 weeks if the biparietal diameter was greater than or equal to 9.2 cm (127). If dates by sonogram were less than dates by last menstrual period but greater than 1 week or if last menstrual period was unknown, dates by sonogram and landmarks corresponding to dates by sonogram were used to electively schedule, with biparietal diameters of 9.2 or 9.5 cm respectively required (28). If protocol criteria were not met or earlier delivery was indicated (e.g., vertical scar or diabetes), amniocentesis was performed (42), except when not possible, advisable, or refused when patients either elected labor (20) or were scheduled if three or more criteria for 40+ weeks were met (18). Of 225 patients (70.5%) scheduled by protocol (173), amniocentesis (34), or medical indication (18), 188 (58.9%) were delivered without labor. In the 147 patients (46.1%) delivered electively by protocol without labor or amniocentesis, there were no cases of respiratory distress syndrome and the mean birth weight was 3517 gm. With early care and better

  3. Repeat participation in annual cross-sectional surveys of drug users and its implications for analysis.

    Science.gov (United States)

    Agius, P A; Aitken, C K; Breen, C; Dietze, P M

    2018-06-04

    We sought to establish the extent of repeat participation in a large annual cross-sectional survey of people who inject drugs and assess its implications for analysis. We used "porn star names" (the name of each participant's first pet followed by the name of the first street in which they lived) to identify repeat participation in three Australian Illicit Drug Reporting System surveys. Over 2013-2015, 2468 porn star names (96.2%) appeared only once, 88 (3.4%) twice, and nine (0.4%) in all 3 years. We measured design effects, based on the between-cluster variability for selected estimates, of 1.01-1.07 for seven key variables. These values indicate that the complex sample is (e.g.) 7% less efficient in estimating prevalence of heroin use (ever) than a simple random sample, and 1% less efficient in estimating number of heroin overdoses (ever). Porn star names are a useful means of tracking research participants longitudinally while maintaining their anonymity. Repeat participation in the Australian Illicit Drug Reporting System is low (less than 5% per annum), meaning point-prevalence and effect estimation without correction for the lack of independence in observations is unlikely to seriously affect population inference.

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

    Science.gov (United States)

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

    2017-03-20

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

  5. Post-caesarean analgesia: What is new?

    Directory of Open Access Journals (Sweden)

    Sukhyanti Kerai

    2017-01-01

    Full Text Available Adequate post-operative analgesia after caesarean section (CS is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.

  6. Timing of elective repeated cesarean delivery in patients with previous two or more cesarean section.

    Science.gov (United States)

    Mohammed, Abdel-Baset F; Bayo, Arabo I; Abu-Jubara, Mahmoud F

    2013-01-01

    To assess the maternal and neonatal consequences of scheduling elective repeated cesarean section (ERCS) at 39 weeks rather than 38 weeks and to assess the impacts of delivering by emergency cesarean section (CS) before the planned date. Retrospective Cohort study. Patients with previous two or more CS planned for ERCS at term during the period from January to June 2011. Medical records were reviewed for demographic and clinical data, planned timing of CS, emergency cesarean and any adverse maternal or neonatal outcome. Adverse maternal or neonatal outcome. Four hundred and twenty women were included, 71.4% of cases were posted <39 weeks and 28.6% were posted at ≥39 weeks. Patients posted ≥ 39 weeks were more prone to deliver by emergency CS (16.6 vs. 10.6%) and the neonates were less prone to RDS and NICU admission (p < 0.05). Our data support the justification to book patients for ERCS at ≥39 weeks.

  7. 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.

  8. 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.

  9. Transportation assimilation revisited: New evidence from repeated cross-sectional survey data

    Science.gov (United States)

    2018-01-01

    Background Based on single cross-sectional data, prior research finds evidence of “transportation assimilation” among U.S. immigrants: the length of stay in the U.S. is negatively correlated with public transit use. This paper revisits this question by using repeated cross-sectional data, and examines the trend of transportation assimilation over time. Methods and results Using 1980, 1990, 2000 1% census and 2010 (1%) American Community Survey, I examine the relationship between the length of stay in the U.S. and public transit ridership among immigrants. I first run regressions separately in four data sets: I regress public transit ridership on the length of stay, controlling for other individual and geographic variables. I then compare the magnitudes of the relationship in four regressions. To study how the rate of transportation assimilation changes over time, I pool the data set and regress public transit ridership on the length of stay and its interactions with year dummies to compare the coefficients across surveys. Results confirm the conclusion of transportation assimilation: as the length of stay in the U.S. increases, an immigrant’s public transit use decreases. However, the repeated cross-section analysis suggests the assimilation rate has been decreasing in the past few decades. Conclusions This paper finds evidence of transportation assimilation: immigrants become less likely to ride public transit as the length of stay in the U.S. increases. The assimilation rate, however, has been decreasing over time. This paper finds that the rate of public transit ridership among new immigrants upon arrival, the geographic distribution of immigrants, and the changing demographics of the U.S. immigrants play roles in affecting the trend of transportation assimilation. PMID:29668676

  10. The method of purging applied to repeated cross-sectional data: Practical applications using logistic and linear regression analysis

    NARCIS (Netherlands)

    Grotenhuis, H.F. te; Eisinga, R.N.; Scheepers, P.L.H.

    2004-01-01

    In cross-sectional survey research, it is quite common to estimate the(standardized) effect of independent variable(s) on a dependent variable. However, if repeated cross-sectional data are available, much is to be gained if the consequences of these effects on longitudinal social change are

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

    African Journals Online (AJOL)

    Nicky

    2005-06-24

    Jun 24, 2005 ... The effect of restructuring of health care services on caesarean section rates. ARTICLE. Medical Research Council/ University of KwaZulu-Natal, Pregnancy Hypertension Research. Unit and Department of Obstetrics and Gynaecology, Nelson R Mandela School of Health. Sciences, University of ...

  12. Caesarean Risk Factors in Northern Region of Bangladesh: A ...

    African Journals Online (AJOL)

    private hospitals on the basis of higher estimated value of range (R = 0.134) but a higher ... of private hospitals may be contributory factors to the caesarean section rates in private health facilities. ... Expanded fetal indications, law and rules concerning medical liability and development ...... hospitals in Malaysia 2006.

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

    Directory of Open Access Journals (Sweden)

    Susmita Bhattacharyya

    2017-01-01

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

  14. blood transfusion requirement during caesarean delivery: risk factors

    African Journals Online (AJOL)

    Factors predisposing to increased risk for blood transfusion identified from previous ... This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. ... study which could fall into either of the following conditions: satisfactory post- operative clinical status up to 48 hours ...

  15. "In God we trust" and other factors influencing trial of labor versus Repeat cesarean section.

    Science.gov (United States)

    Pomeranz, Meir; Arbib, Nissim; Haddif, Limor; Reissner, Hana; Romem, Yitzhak; Biron, Tal

    2018-07-01

    To investigate factors influencing women's decisions to undergo trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery (ERCD) based on the Multidimensional Health Locus of Control (MHLC), religious observance and family planning. Cross-sectional study of candidates for TOLAC or ERCD at two hospitals in Israel. Eligible women completed a demographic questionnaire and Form C of the MHLC scale. The study included 197 women. Those who chose TOLAC (N = 101) were more religiously observant, wanted more children and had higher Internal and Chance health locus of control. Women who chose ERCD (N = 96) were more likely to be secular and had a higher health locus of control influenced by Powerful Others, notably physicians. Women not influenced by others were more likely to choose TOLAC. A woman's choice of TOLAC or ERCD is influenced by her sense of control over her health, degree of religious observance and number of children desired. Healthcare providers can use this information to better understand, counsel and educate women regarding appropriate delivery decisions. Women who feel in control of their health, educated about delivery options and are less influenced by provider preference, might choose TOLAC; thus, reducing the rate of unnecessary ERCD.

  16. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

    Science.gov (United States)

    Daniels, Michael N; Maynard, Sharon; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel

    2017-01-01

    Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative

  17. 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.

  18. Distributions, trends and inter-annual variability of nutrients along a repeat section through the Weddell Sea (1996-2011)

    NARCIS (Netherlands)

    Hoppema, Mario; Bakker, Karel; van Heuven, Steven M. A. C.; van Ooijen, Jan C.; de Baar, Henricus

    2015-01-01

    Nutrient data from five repeat sections spanning 1996 to 2011 crossing the Weddell Sea are presented. These measurements have been standardized against the same reference material, yielding an outstanding internal consistency. The generic structure of the Weddell Gyre and its hydrographic features

  19. Distributions, trends and inter-annual variability of nutrients along a repeat section through the Weddell Sea (1996–2011)

    NARCIS (Netherlands)

    Hoppema, M.; Bakker, K.; van Heuven, S.; van Ooijen, J.C.; de Baar, H.J.W.

    2015-01-01

    Nutrient data from five repeat sections spanning 1996 to 2011 crossing the Weddell Sea are presented. These measurements have been standardized against the same reference material, yielding an outstanding internal consistency. The generic structure of the Weddell Gyre and its hydrographic features

  20. Safer caesarean sections at Juba Teaching Hospital

    African Journals Online (AJOL)

    2012-05-02

    May 2, 2012 ... spinal anaesthesia, lack of drugs/equipment, Category ... safest option o The AMAs work unsupervised and many had not had any ... o Due to the lack of staff and monitoring equipment ... with further information, to take home.

  1. General Anaesthesia for Caesarean Section | Downing | South ...

    African Journals Online (AJOL)

    South African Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 47, No 8 (1973) >. Log in or Register to get access to full text downloads.

  2. THE'INDICATIONS FOR CAESAREAN SECTION*

    African Journals Online (AJOL)

    be much basking in the reflected happiness brought to the mother and her family circle. .... tend to show that should true labour last for longer than. 48 hours the risk to foetal life becomes excessive. It must be taken into consideration that ...

  3. Intervention for postpartum infections following caesarean section

    DEFF Research Database (Denmark)

    Hyldig, Nana; Bille, Camilla; Kruse, Marie

    2012-01-01

    seeks to elucidate the health economic cost and consequences of this type of infection and treatment. Background: Obesity is an increasing problem in the health care system. Today more than 12% of all pregnant women in Denmark are obese (BMI >30). There is a significant association between obesity...... with the department of plastic surgery at OUH, this study will be performed at two large obstetrical units at OUH and Hvidovre Hospital with more than 10000 deliveries and 2500 CS’s annually. Data will be collected prospectively from 1) self-administered questionnaires 2) registration forms registering used wound...

  4. Hematometra following caesarean section for placenta previa

    African Journals Online (AJOL)

    2017-12-08

    Dec 8, 2017 ... to surgical procedures such as cone biopsy. Hematometra following ... Subharti Medical College, Meerut, India, with abdominal pain for the previous 3 ... spinal anaesthesia, the vagina was visualised with the help of two.

  5. 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...

  6. Private-sector caesarean sections in perspective

    African Journals Online (AJOL)

    2005-02-28

    Feb 28, 2005 ... with HLA-DRB1'010l and abrogated by low CD4 T-cell counts. ... Benn PD, Mercey DE, Scott G, Williams IG. ... patient's right to choose a health intervention that may not be .... schemes environment is that of CS rates in the emerging .... Wax JR, Cartin A, Pinette MG, Blackstone J. Patient choice cesarean: ...

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

    African Journals Online (AJOL)

    ... hemoglobine post-opératoire, et poids de naissance ont été comparés p 0,05. L'indication la plus fréquente pour la chirurgie dans les deux groupes des patientes était la douleur foetale (NPG = 28%, ...

  8. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

    Directory of Open Access Journals (Sweden)

    Michael N Daniels

    Full Text Available Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents.This was a repeated cross-sectional survey of internal medicine residents before (Group 1 and 3 years after (Group 2 the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology.131 (80.9% of 162 residents completed the survey. 19 (14.8% residents indicated interest in a nephrology career, with 8 (6.3% indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2 and residents who were not (Group 1. The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed, practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed, and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed. More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04, whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02.The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several

  9. 轻比重与重比重布比卡因腰麻在剖宫产术中的作用比较%Comparison between intrathecal hypobaric bupivacaine and hyperbaric bupivacaine for caesarean section

    Institute of Scientific and Technical Information of China (English)

    曲元; 徐成娣

    2001-01-01

    目的对0.125%轻比重布比卡因与0.5%重比重布比卡因腰麻在剖宫产术腰麻-硬膜外联合麻醉(CSEA)应用中的麻醉效果及并发症进行比较。方法随机选择60例拟行剖宫产手术的产妇,平均分为两组,均采用CSEA麻醉方法。分别向蛛网膜下腔注射0.5%重比重布比卡因1ml(重组)与0.125%轻比重布比卡因4ml(轻组)。结果重组起效时间明显比轻组短,腰麻后15分钟麻醉平面高于轻组(P均<0.01)。轻组2%利多卡因用量显著多于重组(P<0.05)。低血压发生率:重组43.3%,轻组16%;恶心呕吐发生率:重组26.7%,轻组6.7%,具有显著性差异。轻组的腰麻平面消退较重组快(33.4分钟对61.7分钟)。结论轻比重药液与重比重药液相比更具有对下肢运动神经阻滞轻、对循环影响小的特点。%Objective Evaluating the effectiveness and complications by use of intrathecal injection of hypobaric and hyperbaric bupivacaine for caesarean section.Methods Sixty term parturients were randomly divided into one of two groups and intrathecally recieved either:hypobaric group with 1ml of 0.125% bupivacaine and hyperbaric group with 4ml of 0.5% bupivacaine.Results The onset time of hyperbaric group was shorter and level of spinal anesthesia was higher than hypobaric group (P<0.05 or P<0.01).The incidence of hypotension and nausea/vomitting was higher in hyperbaric groups (P<0.05).Conclusions The combined spinal-epidural technique,using hypobaric bupivacaine had advantages of less mobile nerves block and fewer complications than using hyperbaric bupivacaine.

  10. Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trial.

    Science.gov (United States)

    Impey, Lawrence; Pandit, Meghana

    2005-05-01

    External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Randomised, double-blinded, placebo-controlled trial. UK teaching hospital. One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23-8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14-0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64-53.62). Maternal and neonatal morbidity remain unchanged. The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.

  11. '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.

  12. The use of snake venom derived fibrin glue in hysterorrhaphy of ovine caesarean surgery

    OpenAIRE

    CHALHOUB, M.; PRESTES, N. C.; LOPES, M. D.; ROCHA, N. S.; THOMAZINI-SANTOS, I. A.; MENDES-GIANNINI, M.J.

    2000-01-01

    Fibrin glue has been used on its own or in conjunction with suturing materials to promote hemostasis, reduce adherence, strengthen the wound site, and improve healing. Snake venom derived fibrin glue was evaluated as an alternative to conventional uterine suturing after ovine caesarean surgery. Twenty-eight pregnant ewes of known mating date were used. The animals submitted to conventional caesarean sections showed a better wound healing process. As expected, all the operated animals had reta...

  13. Rising frequency of placenta previa and associated morbidity in women with previous casearean section

    International Nuclear Information System (INIS)

    Akhter, F.; Nawaz, Q.; Mushtaq, Q.U.A.

    2015-01-01

    To determine rising frequency of placenta previa and its associated morbidity in women with previous caesarean section. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted in the Department of Obstetrics and Gynecology at CMH Kohat from Jul 2010 to Jun 2011. Patients and Methods: This study included all pregnant women undergoing repeat caesarean sections. Of these, total 74 patients were admitted with placenta previa. The frequency and associated morbidity were determined. Results: In our study 74 patients with placenta previa were included. 71.62% were less than 35 yrs of age, while 28.38% were equal to or more than 35 years. The gestational age at presentation was 24-36 weeks in 74.3% and 37 + weeks in 5.7% at presentation, 89% patients were symptomatic and 11% were asympyomatic. The morbidities observed were placenta accrete 47%, urinary tract trauma in 63.51%, caesarean hysterectomy in 62.16%, post operative febrile morbidity in 77.03%, maternal mortality was nil, paralytic ileus in 28.38%, PPH in 82.43%, surgical site infection in 16.21%. Conclusion: Frequency of placenta previa and its associated morbidity was raised due to repeated caesarean section rate which must be reduced to decrease maternal morbidity and mortality. (author)

  14. Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

    Institute of Scientific and Technical Information of China (English)

    高佩佩; 汪平

    1999-01-01

    Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostot.Subjects and Methods A total of 213 pregnant women with amenorrhea of 34-69d after caesarian section who asked for medical abortion were recruited,including 63 cases undergoing their second medical abortion.A total amount of mi feprisstone of 150 mg given in separate doses(25 mg×4 and 50 mg at the first time)was administered orally within 3d, followed by misoprostot of 0.6 mg orally in the morning of d 3.Results The complete abortion rate was 92.5%,incomplete abortion was 4.7% and failure was 2.8%.Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section histo-ry.Its efficacy was similar to that for ordinary population.Its safety and effec-tiveness were satisfactory.

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

    International Nuclear Information System (INIS)

    Kim Ju Ree; Lee, Sang Hoon

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-06-15

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

  17. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.

    Science.gov (United States)

    Akinlusi, Fatimat M; Rabiu, Kabiru A; Durojaiye, Idayat A; Adewunmi, Adeniyi A; Ottun, Tawaqualit A; Oshodi, Yusuf A

    2018-01-10

    Caesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization. A prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion. Of the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25-4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22-476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06-211.02, p blood transfusion (aOR = 0.24, 95% CI = 0.09-0.61, p = 0.0024). The overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and

  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. 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

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

    Science.gov (United States)

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

    2015-05-01

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

  2. Joint effect of education and age at childbirth on the risk of caesarean delivery: findings from Germany 2008-2015.

    Science.gov (United States)

    Castiglioni, L; Schmiedeberg, C

    2018-02-01

    This article aims at assessing the joint effect of maternal age and education on the risk of having a caesarean delivery. As high maternal education is often associated with lower caesarean-birth rates, but high-educated women tend to postpone motherhood, these effects may offset each other in traditional analyses. Secondary analysis of the data from the German Family Panel pairfam. The interview-based data refer to 1020 births between 2008 and 2015. We analyse only reports from mothers and calculate logistic regression models. The caesarean delivery rate differs strongly between education levels, and low-educated women are at higher risk of having a caesarean delivery when controlling for parity and age. A positive age gradient is found, indicating a higher risk of caesarean section for older mothers. Without controlling for age, the association of education and caesarean section risk is weaker, i.e., effects of age and education partially level each other out. A model including an interaction term between age and education confirms this result. The risk of having a caesarean delivery does not differ between levels of education when maternal age is not taken into account. Lower maternal education and higher age are both positively associated with the risk of experiencing a caesarean section in Germany. However, as higher educated women tend to have their children later, effects of education and age weigh each other out. Preventive campaigns should target women with lower education and raise women's awareness on the risks associated with late motherhood. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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

    African Journals Online (AJOL)

    variables were nonsignificant. None of the women or their babies needed readmission to hospital or transfer to an intensive care unit. Table I: Demographic data of mother and neonate following Caesarean delivery in the first and second stages of labour. Demographics. Caesarean delivery 2nd stage (n = 53). Caesarean.

  4. Factors Associated with Preference for Repeat Cesarean in Neyshabur Pregnant Women

    Directory of Open Access Journals (Sweden)

    Ali Gholami

    2014-01-01

    Conclusions: As observed in this study, most pregnant women with previous caesarean delivery prefer repeated caesarean delivery rather than VD in their subsequent pregnancy and educational level of pregnant women and doctor′s advice were important factors that influenced this preference. This subject suggests the need to counsel pregnant women with an obstetrician before select delivery type.

  5. 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.

  6. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data.

    Science.gov (United States)

    Basu, Sanjay; Yoffe, Paula; Hills, Nancy; Lustig, Robert H

    2013-01-01

    While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations. Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.

  7. Public perception of drinking water safety in South Africa 2002–2009: a repeated cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background In low and middle income countries, public perceptions of drinking water safety are relevant to promotion of household water treatment and to household choices over drinking water sources. However, most studies of this topic have been cross-sectional and not considered temporal variation in drinking water safety perceptions. The objective of this study is to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. Methods This repeated cross-sectional study draws on General Household Surveys from 2002–2009, a series of annual nationally representative surveys of South African households, which include a question about perceived drinking water safety. Trends in responses to this question were examined from 2002–2009 in relation to reported cholera cases. The relationship between perceived drinking water safety and organoleptic qualities of drinking water, supply characteristics, and socio-economic and demographic household characteristics was explored in 2002 and 2008 using hierarchical stepwise logistic regression. Results The results suggest that perceived drinking water safety has remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000–02 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. Conclusion This suggests that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period. PMID:22834485

  8. Public perception of drinking water safety in South Africa 2002-2009: a repeated cross-sectional study.

    Science.gov (United States)

    Wright, Jim A; Yang, Hong; Rivett, Ulrike; Gundry, Stephen W

    2012-07-27

    In low and middle income countries, public perceptions of drinking water safety are relevant to promotion of household water treatment and to household choices over drinking water sources. However, most studies of this topic have been cross-sectional and not considered temporal variation in drinking water safety perceptions. The objective of this study is to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. This repeated cross-sectional study draws on General Household Surveys from 2002-2009, a series of annual nationally representative surveys of South African households, which include a question about perceived drinking water safety. Trends in responses to this question were examined from 2002-2009 in relation to reported cholera cases. The relationship between perceived drinking water safety and organoleptic qualities of drinking water, supply characteristics, and socio-economic and demographic household characteristics was explored in 2002 and 2008 using hierarchical stepwise logistic regression. The results suggest that perceived drinking water safety has remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000-02 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. This suggests that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.

  9. Public perception of drinking water safety in South Africa 2002–2009: a repeated cross-sectional study

    Directory of Open Access Journals (Sweden)

    Wright Jim A

    2012-07-01

    Full Text Available Abstract Background In low and middle income countries, public perceptions of drinking water safety are relevant to promotion of household water treatment and to household choices over drinking water sources. However, most studies of this topic have been cross-sectional and not considered temporal variation in drinking water safety perceptions. The objective of this study is to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. Methods This repeated cross-sectional study draws on General Household Surveys from 2002–2009, a series of annual nationally representative surveys of South African households, which include a question about perceived drinking water safety. Trends in responses to this question were examined from 2002–2009 in relation to reported cholera cases. The relationship between perceived drinking water safety and organoleptic qualities of drinking water, supply characteristics, and socio-economic and demographic household characteristics was explored in 2002 and 2008 using hierarchical stepwise logistic regression. Results The results suggest that perceived drinking water safety has remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000–02 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. Conclusion This suggests that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.

  10. Emergency inevitable caesarean myomectomy, challenge to ...

    African Journals Online (AJOL)

    Emergency inevitable caesarean myomectomy, challenge to obstetrician/ ... CASE REPORT Mrs BD is a 34-year-old unbooked G1 Para 0+0 at 38 weeks' gestation ... Obstetric ultrasound done on admission were in keeping with above clinical ...

  11. Repeat Colonoscopy within 6 Months after Initial Outpatient Colonoscopy in Ontario: A Population-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Lawrence Paszat

    2017-01-01

    Full Text Available Background. The goal of this study is to examine utilization of early repeat colonoscopy ≤ 6 months after an index procedure. Methods. We identified persons having repeat colonoscopy ≤ 6 months following outpatient colonoscopy without prior colonoscopy ≤ 5 years or prior diagnosis of colorectal cancer (CRC. We modeled repeat colonoscopy using a generalized estimating equation with an exchangeable correlation structure to account for clustering of patients by endoscopist. Results. The population included 334,663 persons, 7,892 (2.36% of whom had an early repeat colonoscopy within 6 months. Overall, endoscopist prior year colonoscopy volume was inversely related to repeat ≤ 6 months. Repeat colonoscopy ≤ 6 months varied by the clinical setting of the index colonoscopy (adjusted OR = 1.41 (95% CI 1.29–1.55 at nonhospital facilities compared to teaching or community hospitals. Among those who had polypectomy or biopsy, the adjusted OR for early repeat ≤ 6 months was elevated among those whose index colonoscopy was at a nonhospital facility (OR 1.44, 95% CI 1.30–1.60, compared to those at a teaching hospital or community hospital. Conclusions. Repeat colonoscopy ≤ 6 months after an index procedure is associated with the clinical setting of the index colonoscopy.

  12. 布比卡因混合芬太尼用于剖宫产术患者腰麻的半数有效剂量%Median effective dose of bupivacaine for spinal anesthesia when combined with fentanyl in patients undergoing caesarean section

    Institute of Scientific and Technical Information of China (English)

    权哲峰; 池萍; 张本厚; 曹英浩; 李昕

    2013-01-01

    Objective To explore the median effective dose( ED50 ) of bupivacaine for spinal anesthesia when combined with fentanyl in patients undergoing caesarean section. Methods Twenty-six ASA Ⅰ - Ⅱ patients, undergoing elective caesarean section under spi-nal-epidural anesthesia, were enrolled in this study. The spinal-epidural anesthesia was performed at L2-3 interspace. The mixture of bupivacaine and 10 μg fentanyl was injected into the subarachnoid space. The ED50 was determined by up-down sequential allocation. The initial dose of bupivacaine was 4.5 mg. The dose was increased/decreased by 0.75 mg in the next patient. The effective definition of spinal anesthesia was as follows;① the sensory block level of spinal anesthesia level reach to T8 after 10 min;②the modified Bro-mage score ≥ 1;③ the perioperative VAS score of patients ≤ 2; ④obstetricians are satisfied to the muscle relax. Results The ED50 of bupivacaine was 3. 04 mg (95 % confidence interval 2.93 -3. 15 mg). Conclusion When combined with fentanyl 10 μg, the ED,,, of bupivacaine for spinal anesthesia is 3.04 mg in patients undergoing caesarean section.%目的 研究剖宫产术患者布比卡因腰麻混合芬太尼时的半数有效剂量. 方法 择期行剖宫产26例,ASA Ⅰ-Ⅱ级,于L2-3间隙行脊椎-硬膜外联合穿刺.蛛网膜下隙注射布比卡因混合芬太尼10 μg,按照序贯法进行试验,第1例选择布比卡因剂量为4.5 mg,根据腰麻是否有效确定下一例患者的布比卡因剂量,相邻剂量为0.75 mg.腰麻有效的定义为:①腰麻10 min后感觉阻滞平面达到T8;②改良Bromage评分≥1分;③围术期产妇的VAS评分≤2分;④产科医生对肌松效果满意.结果 患者蛛网膜下隙注射比卡因的半数有效剂量为3.04 mg(95%可信区间为2.93-3.15 mg). 结论 布比卡因混合10 μg芬太尼用于剖宫产腰麻的ED50为3.04 mg.

  13. Trends in standardized mortality among individuals with schizophrenia, 1993–2012: a population-based, repeated cross-sectional study

    Science.gov (United States)

    Gatov, Evgenia; Rosella, Laura; Chiu, Maria; Kurdyak, Paul A.

    2017-01-01

    BACKGROUND: We examined mortality time trends and premature mortality among individuals with and without schizophrenia over a 20-year period. METHODS: In this population-based, repeated cross-sectional study, we identified all individual deaths that occurred in Ontario between 1993 and 2012 in persons aged 15 and over. We plotted overall and cause-specific age- and sex-standardized mortality rates (ASMRs), stratified all-cause ASMR trends by sociodemographic characteristics, and analyzed premature mortality using years of potential life lost. Additionally, we calculated mortality rate ratios (MRRs) using negative binomial regression with adjustment for age, sex, income, rurality and year of death. RESULTS: We identified 31 349 deaths among persons with schizophrenia, and 1 589 902 deaths among those without schizophrenia. Mortality rates among people with schizophrenia were 3 times higher than among those without schizophrenia (adjusted MRR 3.12, 95% confidence interval 3.06–3.17). All-cause ASMRs in both groups declined in parallel over the study period, by about 35%, and were higher for men, for those with low income and for rural dwellers. The absolute ASMR difference also declined throughout the study period (from 16.15 to 10.49 deaths per 1000 persons). Cause-specific ASMRs were greater among those with schizophrenia, with circulatory conditions accounting for most deaths between 1993 and 2012, whereas neoplasms became the leading cause of death for those without schizophrenia after 2005. Individuals with schizophrenia also died, on average, 8 years younger than those without schizophrenia, losing more potential years of life. INTERPRETATION: Although mortality rates among people with schizophrenia have declined over the past 2 decades, specialized approaches may be required to close the persistent 3-fold relative mortality gap with the general population. PMID:28923795

  14. Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study.

    Science.gov (United States)

    Gatov, Evgenia; Rosella, Laura; Chiu, Maria; Kurdyak, Paul A

    2017-09-18

    We examined mortality time trends and premature mortality among individuals with and without schizophrenia over a 20-year period. In this population-based, repeated cross-sectional study, we identified all individual deaths that occurred in Ontario between 1993 and 2012 in persons aged 15 and over. We plotted overall and cause-specific age- and sex-standardized mortality rates (ASMRs), stratified all-cause ASMR trends by sociodemographic characteristics, and analyzed premature mortality using years of potential life lost. Additionally, we calculated mortality rate ratios (MRRs) using negative binomial regression with adjustment for age, sex, income, rurality and year of death. We identified 31 349 deaths among persons with schizophrenia, and 1 589 902 deaths among those without schizophrenia. Mortality rates among people with schizophrenia were 3 times higher than among those without schizophrenia (adjusted MRR 3.12, 95% confidence interval 3.06-3.17). All-cause ASMRs in both groups declined in parallel over the study period, by about 35%, and were higher for men, for those with low income and for rural dwellers. The absolute ASMR difference also declined throughout the study period (from 16.15 to 10.49 deaths per 1000 persons). Cause-specific ASMRs were greater among those with schizophrenia, with circulatory conditions accounting for most deaths between 1993 and 2012, whereas neoplasms became the leading cause of death for those without schizophrenia after 2005. Individuals with schizophrenia also died, on average, 8 years younger than those without schizophrenia, losing more potential years of life. Although mortality rates among people with schizophrenia have declined over the past 2 decades, specialized approaches may be required to close the persistent 3-fold relative mortality gap with the general population. © 2017 Canadian Medical Association or its licensors.

  15. Adaptive geostatistical sampling enables efficient identification of malaria hotspots in repeated cross-sectional surveys in rural Malawi.

    Directory of Open Access Journals (Sweden)

    Alinune N Kabaghe

    Full Text Available In the context of malaria elimination, interventions will need to target high burden areas to further reduce transmission. Current tools to monitor and report disease burden lack the capacity to continuously detect fine-scale spatial and temporal variations of disease distribution exhibited by malaria. These tools use random sampling techniques that are inefficient for capturing underlying heterogeneity while health facility data in resource-limited settings are inaccurate. Continuous community surveys of malaria burden provide real-time results of local spatio-temporal variation. Adaptive geostatistical design (AGD improves prediction of outcome of interest compared to current random sampling techniques. We present findings of continuous malaria prevalence surveys using an adaptive sampling design.We conducted repeated cross sectional surveys guided by an adaptive sampling design to monitor the prevalence of malaria parasitaemia and anaemia in children below five years old in the communities living around Majete Wildlife Reserve in Chikwawa district, Southern Malawi. AGD sampling uses previously collected data to sample new locations of high prediction variance or, where prediction exceeds a set threshold. We fitted a geostatistical model to predict malaria prevalence in the area.We conducted five rounds of sampling, and tested 876 children aged 6-59 months from 1377 households over a 12-month period. Malaria prevalence prediction maps showed spatial heterogeneity and presence of hotspots-where predicted malaria prevalence was above 30%; predictors of malaria included age, socio-economic status and ownership of insecticide-treated mosquito nets.Continuous malaria prevalence surveys using adaptive sampling increased malaria prevalence prediction accuracy. Results from the surveys were readily available after data collection. The tool can assist local managers to target malaria control interventions in areas with the greatest health impact and is

  16. Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study.

    Science.gov (United States)

    Kristensen, Solvejg; Christensen, Karl Bang; Jaquet, Annette; Møller Beck, Carsten; Sabroe, Svend; Bartels, Paul; Mainz, Jan

    2016-05-13

    Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention. A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders. In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (pculture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. The business cycle and drug use in Australia: evidence from repeated cross-sections of individual level data.

    Science.gov (United States)

    Chalmers, Jenny; Ritter, Alison

    2011-09-01

    This paper examined the implications of the business cycle for cannabis and alcohol use. What little we know about cannabis use suggests that young Americans (teenagers and adults in their early 20s) seem more inclined to use illicit drugs and to use them more frequently with rises in the unemployment rate. In contrast, a more fulsome alcohol literature suggests that participation in drinking is unaffected by the business cycle. Heavy drinkers drink less during economic downturns and their reduced use counteracts the fact that light drinkers might drink a little more. Using individual level data from repeated cross-sections of Australia's National Drug Strategy Household Survey (NDSHS), spanning 1991-2007, this study examined the relationship between cannabis and alcohol use of Australians aged 14-49 years and the unemployment rate and real income per capita, two indicators of the business cycle. Australians in their late 20s, 30s and 40s drink less frequently during economic downturns. If unemployment rate rises are accompanied by falls in income per capita, younger Australians will also drink less frequently. Recent participation in cannabis use (within the last year) increases with falls in income per capita regardless of age, although the increase is less marked for young people (14-24 years). Whereas the participation rate of people aged 25-49 years also falls with rising unemployment rates, the participation of younger people increases. Cannabis users younger than 35 will use more frequently as the unemployment rate rises. In contrast, older Australians will use less frequently. Australia's recent economic slowdown has been characterised by rising unemployment rates without accompanying falls in income per capita. Based on our findings this slowdown should have encouraged young Australians aged 14-24 years to both drink and use cannabis more frequently. The slowdown would have had little impact on the frequency of drinking of older Australians. However it

  18. Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.

    Science.gov (United States)

    Koplin, Jennifer; Allen, Katie; Gurrin, Lyle; Osborne, Nicholas; Tang, Mimi L K; Dharmage, Shyamali

    2008-12-01

    Several studies have shown differences in the composition of the gastrointestinal flora of children who develop sensitization to food allergens compared with non-allergic children. It has been hypothesized that changes in the gut microbiota resulting from caesarean section delivery could increase a child's risk of developing food allergy; however, studies examining the relationship between mode of delivery and food allergy have produced conflicting results. The objective of this review was to determine whether there is sufficient evidence to support an association between delivery by caesarean section and the development of sensitization to food allergens and immunoglobulin E (IgE) mediated food allergy. Using predefined inclusion and exclusion criteria, MEDLINE and PubMed were searched for studies investigating the relationship between caesarean section delivery and food allergy. The information on the quality of the studies and results were extracted and analysed systematically. The search identified four relevant studies as per our protocol. Symptomatic food allergy was used as the outcome in two studies and was found to occur more frequently in children born by caesarean section in one study while the second study found no association between food allergy diagnoses and mode of delivery. The other two studies measured levels of food antigen-specific IgE, with both studies showing an increase in sensitization to food allergens among children born by caesarean section. Overall, there is evidence that the risk of developing IgE-mediated sensitization to food allergens is increased among children delivered by caesarean section, however further studies using objectively diagnosed food allergy as the outcome are needed to verify whether this equates to an increase in confirmed food allergy. Future birth cohort studies should control for the effects of mode of delivery when investigating environmental modifiers of food allergy.

  19. Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?

    Science.gov (United States)

    Halvorsen, Lotta; Nerum, Hilde; Sørlie, Tore; Oian, Pål

    2010-02-01

    the attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth ('coping attitude'), and the other emphasised that the ultimate choice of mode of birth was the womans' ('autonomy attitude'). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an 'autonomy attitude' to a 'coping attitude' increase the number of women who change their request for a caesarean and who give birth vaginally? the study population consisted of two samples of pregnant women with fear of birth and concurrent request for a caesarean, referred for crisis-oriented counselling at the antenatal clinic, University Hospital of North Norway between 2000-2002 (n=86) and 2004-2006 (n=107). Data were gathered from referral letters, counseling and antenatal, intra- and postpartum records. a coping attitude of the counsellor was positively associated with change in the request for a caesarean and with vaginal birth. A change from an autonomy attitude to a coping attitude was associated with a significant increase in the percentage of women who changed their desire for a caesarean from 77 to 93, and who had a vaginal birth from 42 to 81. a coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results. Copyright 2008 Elsevier Ltd. All rights reserved.

  20. Incidence and risk factors for caesarean wound infection in Lagos Nigeria

    Directory of Open Access Journals (Sweden)

    Gab-Okafor Chidinma V

    2009-09-01

    Full Text Available Abstract Background Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors. Findings Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0. Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3% of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3% than in the subjects without wound infection (33.9% p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02, prolonged operation time (p = 0.001, anaemia (p = 0.031 and multiple vaginal examinations during labour (0.021 among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45, prolonged operation time (OR = 2.87 and body max index > 25 (2.34 retained their association with post caesarean wound infection. Conclusion Effort should be geared towards the prevention of prolonged

  1. Clinical Efficacy Comparion of Ropivacaine and Levobupivacaine for Combined Spinal-Epidural Anesthesia(CSEA) on Caesarean Section%罗哌卡因与布比卡因用于腰硬联合麻醉剖宫产的临床效果对比

    Institute of Scientific and Technical Information of China (English)

    谢伟

    2011-01-01

    目的:探讨罗哌卡因与布比卡因用于腰硬联合麻醉剖宫产的临床效果.方法:采用随机双盲对照试验设计,将60 例择期行腰硬膜联合麻醉剖宫产产妇按照1:1 的比例随机分为罗哌卡因组和布比卡因组.罗哌卡因组:0.75% 罗哌卡因2ml,布比卡因组:0.75% 布比卡因2ml 用脑脊液稀释到3ml 注药2ml.结果:两组最高感觉阻滞平面、到达最高阻滞平面时间、感觉恢复时间、麻醉效果无显著性差异(P>0.05),罗哌卡因组感觉起效时间、运动阻滞起效时间明显晚于布比卡因组(P<0.05),运动恢复时间明显快于布比卡因组(P<0.05);罗哌卡因组低血压、心动过缓、恶心呕吐和头晕均少于布比卡因组,其中低血压有显著性差异(P<0.05).结论:与布比卡因比较,罗哌卡因麻醉效能相似,但运动恢复更快,利于早期下床活动,且不良反应少,更适用于腰硬联合麻醉剖宫产.%Objective: To investigation the of ropivacaine and levobupivacaine for combined spinal-epidural anesthesia(CSEA) on caesarean section.Methods: Use randomized double-blind controlled trial design,sixty primiparae schedualed for caesarean section were divided into ropivacaine group and bupivacaine group in 1:1 proportion.Ropivacaine group: 0.75% ropivacaine 2ml, bupivacaine group: 0.75% bupivacaine 2ml was diluted to 3ml with cerebrospinal fluid,injection 2ml.Results: There were no significant difference on the highest sensory block plane, reach the maximum block plane time, sensory recovery time, anesthesia effect in the two groups (P> 0.05), sensory onset time, motor block onset time of ropivacaine group was significantly later than that of bupivacaine group (P<0.05), motor recovery was significantly faster than the bupivacaine group (P<0.05); the cases of hypotension, bradycardia, nausea, vomiting and dizziness in ropivacaine group were less than the bupivacaine group, the hypotension cases has significantly differences (P<0

  2. Caesarean delivery in urban second tier missionary hospital in Nigeria

    African Journals Online (AJOL)

    Objective: To determine the current trend of Caesarean and highlight the role of a major operative obstetric practice in materno-foetal medicine. Design: Descriptive case study. Setting: St Philomena Catholic Hospital (SPCH), an urban second tier missionary hospital. Subjects: One thousand and fourteen (1014) Caesarean ...

  3. Sonographic evaluation of intra-abdominal adhesions during the third trimester of pregnancy: a novel technique in women undergoing repeated cesarean section.

    Science.gov (United States)

    Baron, Joel; Tirosh, Dan; Mastrolia, Salvatore Andrea; Ben-Haroush, Yigal; Schwartz, Shoshana; Kerner, Yoav; Hershkovitz, Reli

    2018-03-25

    Intra-abdominal adhesions may result in an increased risk of major complications in case of a repeated cesarean section, such as bladder and bowel injury, hemorrhage, infection, and hysterectomy. In an attempt to predict intra-abdominal adhesions before a repeated cesarean delivery, we suggest the use of a novel technique employing a simple and feasible ultrasound imaging technique. The study included pregnant women who underwent one or more cesarean deliveries in their obstetric history and were evaluated during the third trimester of the ongoing pregnancy. In order to diagnose intra-abdominal adhesions, we used a sonographic sliding sign of the uterus under the inner part of the fascia of the abdominal muscles, and considered women 1) at high risk for severe adhesions in the absence of sonographic uterine sliding; or 2) at a low risk for severe adhesions in the presence of an obvious or moderate uterine sliding. A comparison between sonographic findings and intra-abdominal adhesions as evaluated by the surgeons during surgery was performed. We examined 63 patients with one or more previous cesarean delivery. Out of these 63 patients, 59 had completed the study and underwent repeated cesarean section at our Institution. In 16 out of the19 cases assigned to the high risk for severe adhesions group, the suspicion was confirmed at surgery, with a sensitivity of 76.2%. In addition, the suspicion for low risk for adhesions was confirmed in 35 out of 40 patients, with a specificity of 92.1%. The inter and intra-observer correlation using Cohen's Kappa (k) coefficient were 0.52 and 0.77 respectively. Our data show that a simple sonographic sign might predict both high and low risk for intra-abdominal adhesions in patients who underwent previous cesarean delivery. This technique may aid clinical decisions regarding repeated cesarean section approach. This article is protected by copyright. All rights reserved.

  4. Timing of planned repeat cesarean delivery after two or more previous cesarean sections--risk for unplanned cesarean delivery and pregnancy outcome.

    Science.gov (United States)

    Melamed, Nir; Hadar, Eran; Keidar, Liron; Peled, Yoav; Wiznitzer, Arnon; Yogev, Yariv

    2014-03-01

    objective: To assess the effect of the scheduled gestational age for a repeat planned cesarean section (CS) on the risk for adverse pregnancy outcome in women with two or more previous CS. A retrospective cohort study of all women after ≥2 previous CS who were scheduled for a repeat planned CS. Women were divided into two groups at which the planned CS was scheduled: 38-week group or 39-week group. Overall, 377 were enrolled, 264 (70.0%) and 113 (30.0%) in the 38-week and the 39-week groups, respectively. The rate of an unplanned CS was significantly higher in the 39-week versus the 38-week group (23.0% versus 13.3%, p = 0.02). A repeat planned CS scheduled to week 39 was associated with an increased risk of maternal adverse outcome (31.9% versus 21.6%, p = 0.03). There was no significant difference in the rate of adverse neonatal outcome between the two groups (20.8% versus 23.0%, p = 0.5). The lowest rate of any adverse outcome (maternal and/or neonatal) was observed when CS was scheduled to 38 + 1 weeks of gestation. In women after two cesarean sections, scheduling a planned CS at around 39 weeks compared with at around 38 weeks is associated with an increased risk for maternal adverse outcome with no apparent advantage in terms of neonatal outcome.

  5. Study of patient satisfaction and self-expressed problems after emergency caesarean delivery under subarachnoid block

    Directory of Open Access Journals (Sweden)

    V R Hemanth Kumar

    2014-01-01

    Full Text Available Background and Aims: Subarachnoid block is one of the common modes of anaesthesia opted for emergency caesarean section, if the maternal and foetal conditions are favourable. Various factors influence the quality of care administered during the procedure. This questionnaire based study was undertaken to look for self-expressed problems in peri-operative period in patients undergoing emergency caesarean surgery under subarachnoid block. Methods: All the parturients who underwent emergency caesarean section under subarachnoid block during 6 months period were distributed a questionnaire in post-operative period. They were encouraged to fill and return the form within 15 days. Patient satisfaction and the self-expressed problems were analysed at the end of 6 months. Results: One hundred and seventy five out of 220 parturients responded. 58.3% of them said that they were explained about the anaesthesia prior to surgery and 85.3% overall remained anxious. With people around them, 93.1% of them felt comfortable and 91.4% expressed that they were made comfortable inside the theatre. The self-expressed problems were shivering (43.4%, breathlessness (21.7%, pain (20%, post-operative headache (15.4% and backache (19.4%. Parturients who heard their babies cry was 85.1%. After their babies were shown after delivery, 77.1% mothers slept well; 86.9% fed their babies within 4 h of delivery. Conclusion: Pre-operative communication in emergency caesarean section by health personnel did not reduce the anxiety level, which shows that communication was ineffective. Intra-operative psychological support like making the patient comfortable, showing baby to mother and early breast feeding improve bonding between child and mother and essentially contribute to patient satisfaction.

  6. Factors associated with women’s intention to request caesarean delivery in Dar es Salaam Tanzania

    Directory of Open Access Journals (Sweden)

    B Kamala

    2017-09-01

    Full Text Available Background. In the past decade, the rate of caesarean section (CS has increased dramatically in many parts of the world. At Muhimbili National Hospital (MNH there has been a dramatic rise in the caesarean section rate over the past decade.Objective. To determine the incidence of maternal request for CS and factors associated with intention to request caesarean section at the MNH antenatal clinic.Methods. We conducted a cross-sectional study from August to October 2014. A structured questionnaire gathered participants’ background and obstetric information, perceptions and opinions regarding a request for caesarean section, and the respective reasons for the request. Confidence intervals were calculated and a p-value <0.05 was considered significant.Results. The incidence of CS on maternal request was about 6%. The intention to request for CS in the index pregnancy was 8%. Higher-level education and formal-sector employment had higher odds for requesting CS (p=0.01 and p=0.05, respectively. Half of the participants agreed that maternal request for CS should be allowed; more private patients agreed that it could affect the doctor-patient relationship (p=0.02; more private patients agreed that request for CS was due to fear of losing a child (p=0.03. Previous history of CS was an independent predictor of maternal request for caesarean section (OR 1.7; 95% CI 1.7 - 15.4 and (OR 5.8; 95% CI 1.6 - 20.1, respectively.Conclusion. Maternal requests for CS exist at the national referral hospital in Tanzania. This was associated with factors other than women’s preferences, including perceived fear of child loss and events associated with previous CS.

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

    DEFF Research Database (Denmark)

    Studsgaard, Anne; Skorstengaard, Malene; Glavind, Julie

    2013-01-01

    OBJECTIVE: To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). DESIGN: Prospective cohort study. SETTING: Danish university hospital. POPULATION: Women with TOLAC (n = 1161) and women with ERCD-MR (n = 622) between 2003...... registration of the deliveries. MAIN OUTCOME MEASURES: Adverse neonatal outcomes, risk factors for emergency cesarean, and uterine rupture in case of TOLAC. RESULTS: TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.1-19.1] and neonatal...... vaginal delivery (adjusted OR 1.8, 95% CI 1.1-3.0), index emergency cesarean during labor (adjusted OR 3.0, 95% CI 2.3-4.1), maternal age ≥35 years (adjusted OR 1.9, 95% CI 1.3-2.8), pre-pregnancy body mass index ≥30 (adjusted OR 2.1, 95% CI 1.3-3.3), and birthweight 4000-4499 g (adjusted OR 1.5, 95% CI 1...

  8. International migration as a determinant of emergency caesarean.

    Science.gov (United States)

    Merry, Lisa; Semenic, Sonia; Gyorkos, Theresa W; Fraser, William; Small, Rhonda; Gagnon, Anita J

    2016-10-01

    High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  9. Improvement in Trainees' Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training: Cross-Sectional Simulation Study.

    Science.gov (United States)

    Kim, Jong Won; Lee, Jeong Hun; Lee, Kyeong Ryong; Hong, Dae Young; Baek, Kwang Je; Park, Sang O

    2016-08-01

    This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality. Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups. Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased. Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

  10. Effect of Planned Early Recommended Ambulation Technique on Selected Post caesarean Biophysiological Health Parameters

    Directory of Open Access Journals (Sweden)

    Jyoti V. Dube

    2014-01-01

    Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative

  11. Going public: do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?

    Science.gov (United States)

    Miller, Yvette D; Prosser, Samantha J; Thompson, Rachel

    2012-10-01

    women who birth in private facilities in Australia are more likely to have a caesarean birth than women who birth in public facilities and these differences remain after accounting for sector differences in the demographic and health risk profiles of women. However, the extent to which women's preferences and/or freedom to choose their mode of birth further account for differences in the likelihood of caesarean birth between the sectors remains untested. women who birthed in Queensland, Australia during a two-week period in 2009 were mailed a self-report survey approximately 3 months after birth. Seven hundred and fifty-seven women provided cross-sectional retrospective data on where they birthed (public or private facility), mode of birth (vaginal or caesarean) and risk factors, along with their preferences and freedom to choose their mode of birth. A hierarchical logistic regression was conducted to determine the extent to which maternal risk and freedom to choose one's mode of birth explain sector differences in the likelihood of having a caesarean birth. while there was no sector difference in women's preference for mode of birth, women who birthed in private facilities had higher odds of feeling able to choose either a vaginal or caesarean birth, and feeling able to choose only a caesarean birth. Women had higher odds of having caesarean birth if they birthed in private facilities, even after accounting for significant risk factors such as age, body mass index, previous caesarean and use of assisted reproductive technology. However, there was no association between place of birth and odds of having a caesarean birth after also accounting for freedom to choose one's mode of birth. these findings call into question suggestions that the higher caesarean birth rate in the private sector in Australia is attributable to increased levels of obstetric risk among women birthing in the private sector or maternal preferences alone. Instead, the determinants of sector

  12. Caesarean section wound infiltration with ropivacaine versus placebo

    African Journals Online (AJOL)

    To test the hypothesis that optimal management of postoperative pain may reduce the risk of developing chronic ... acute injury is persistent stimulation of C fibres in the peripheral nerves, .... Melzack R, Wall P. Pain mechanism: A new theory.

  13. combined with caesarean sectIon Low spinal anaesthesia local ...

    African Journals Online (AJOL)

    1983-01-01

    Jan 1, 1983 ... The disadvantages of this technique are that no retractor can be used in the lower end of the ... big light' or 'the baby crying'. It was graded as .... in analysing these data and to Dr M. V. Gumede, Secretary for. * Following ...

  14. Outcome of Subsequent Labour After Primary Caesarean Section ...

    African Journals Online (AJOL)

    Context: Teenage mothers are at risk of numerous problems among which is cephalopeelvic disproportion or obstructed labour because of small and immature pelvis. This leads to a tendency to allowing trial of scar in subsequent pregnancies because the teenage pelvis might not have reached full capacity as at the time of ...

  15. Female sterilization by tubal ligation at caesarean section in Makurdi ...

    African Journals Online (AJOL)

    Background: Female sterilization is an important tool in reducing unplanned pregnancy and maternal mortality in our environment. The aim of this study was to determine the incidence, sociodemographic characteristics, technique, effectiveness and complications associated with female sterilization by bilateral tubal ligation ...

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

    African Journals Online (AJOL)

    ... could be employed but are often not followed due to inadequate healthcare systems.1,2 ... TAP block requires administration of a bolus of local anaesthetic into the ... history of allergy to the drugs used in this study, obesity (body mass index ≥ 30 ... tion to the paracetamol, diclofenac 1 mg/kg intramuscularly. (IM) every 8 h ...

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

    African Journals Online (AJOL)

    Data recorded include breed and age of dogs, indication for CS and method of anaesthesia used. Other records obtained ... Indication for CS in the dogs included uterine inertia (13), uterine torsion (1) and vaginal prolapse (1). Mean time of ...

  18. 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

  19. Management of failed spinal anaesthesia for caesarean section

    African Journals Online (AJOL)

    based on an intent-to-treat analysis. Of these, 10 ... testing the level of a spinal block, nor is there an algorithm on how ... scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA).

  20. Supplemental oxygen for Caesarean section under spinal anaesthesia

    African Journals Online (AJOL)

    East African Medical Journal ... Setting: The Obafemi Awolowo University Teaching Hospital; a 580 bed hospital situated in Ile-Ife in South-western Nigeria. ... circuit and standard anaesthetic facemask at 4L/min causes relative desaturation.

  1. Managing spinal hypotension during caesarean section: An update

    African Journals Online (AJOL)

    on these variables (pulse rate >90 bpm, age >25 years, MAP <90 mmHg. – the PRAM score) ... present. This simple scoring system, although not validated in larger studies .... There is little information on the effects of spinal anaesthesia on the.

  2. Caesarean Section and Hospitalization for Respiratory Syncytial Virus Infection

    DEFF Research Database (Denmark)

    Kristensen, Kim; Fisker, Niels; Haerskjold, Ann

    2015-01-01

    regression with adjustment for prematurity, asphyxia, birth weight, multiple births, single parenthood, maternal smoking during pregnancy, older siblings, and asthma diagnoses up to 2 weeks before hospitalization for RSV infection, to compare the effects of acute or elective CS versus vaginal delivery...

  3. Emergency caesarean section in low risk nulliparous women

    DEFF Research Database (Denmark)

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

    2012-01-01

    and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate.......26-3.20) were associated with increased risk of ECS due to FTP....

  4. Cerebrospinal fluid loss at lumbar puncture for caesarean section ...

    African Journals Online (AJOL)

    Background Post dural puncture headache (PDPH) is an unpleasant complication of spinal anaesthesia. Several studies have attempted explanation of its pathophysiology. A widely held view is that it results from loss of cerebrospinal fluid volume resulting from leak following a hole left in the dura after the puncture.

  5. Caesarean section wound infiltration with local anaesthetic for ...

    African Journals Online (AJOL)

    We searched the Cochrane Pregnancy and Childbirth Group's Trials Register ... morphine consumption at 24 hours compared with placebo (morphine dose -1.70 mg; ... Non-steroidal anti-inflammatory drugs may provide additional pain relief.

  6. Girl in the Cellar: A Repeated Cross-Sectional Investigation of Belief in Conspiracy Theories about the Kidnapping of Natascha Kampusch

    Directory of Open Access Journals (Sweden)

    Stefan eStieger

    2013-05-01

    Full Text Available The present study utilized a repeated cross-sectional survey design to examine belief in conspiracy theories about the abduction of Natascha Kampusch. At two time points (October 2009 and October 2011, participants drawn from independent cross-sections of the Austrian population (Time Point 1, N = 281; Time Point 2, N = 277 completed a novel measure of belief in conspiracy theories concerning the abduction of Kampusch, as well as measures of general conspiracist ideation, self-esteem, paranormal and superstitious beliefs, cognitive ability, and media exposure to the Kampusch case. Results indicated that although belief in the Kampusch conspiracy theory declined between testing periods, the effect size of the difference was small. In addition, belief in the Kampusch conspiracy theory was significantly predicted by general conspiracist ideation at both time points. The need to conduct further longitudinal tests of conspiracist ideation is emphasized in conclusion.

  7. Girl in the cellar: a repeated cross-sectional investigation of belief in conspiracy theories about the kidnapping of Natascha Kampusch

    Science.gov (United States)

    Stieger, Stefan; Gumhalter, Nora; Tran, Ulrich S.; Voracek, Martin; Swami, Viren

    2013-01-01

    The present study utilized a repeated cross-sectional survey design to examine belief in conspiracy theories about the abduction of Natascha Kampusch. At two time points (October 2009 and October 2011), participants drawn from independent cross-sections of the Austrian population (Time Point 1, N = 281; Time Point 2, N = 277) completed a novel measure of belief in conspiracy theories concerning the abduction of Kampusch, as well as measures of general conspiracist ideation, self-esteem, paranormal and superstitious beliefs, cognitive ability, and media exposure to the Kampusch case. Results indicated that although belief in the Kampusch conspiracy theory declined between testing periods, the effect size of the difference was small. In addition, belief in the Kampusch conspiracy theory was significantly predicted by general conspiracist ideation at both time points. The need to conduct further longitudinal tests of conspiracist ideation is emphasized in conclusion. PMID:23745118

  8. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

    International Nuclear Information System (INIS)

    Wu, Qinghua; Liu, Zhuan; Zhao, Xianlan; Liu, Cai; Wang, Yanli; Chu, Qinjun; Wang, Xiaojuan; Chen, Zhimin

    2016-01-01

    PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P   0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.

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

    African Journals Online (AJOL)

    AJRH Managing Editor

    ultrasound guided approach with dilatation of uterine cervix and subsequent evacuation of uterine ... Keywords: caesarean scar pregnancy, transrectal ultrasound guided surgical approach. ... a viable embryo with a crown rump length (CRL).

  10. The free delivery and caesarean policy in Morocco: how much do households still pay?

    Science.gov (United States)

    Boukhalfa, C; Abouchadi, S; Cunden, N; Witter, S

    2016-02-01

    The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes. © 2015 John Wiley & Sons Ltd.

  11. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors. PMID:22551645

  12. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Directory of Open Access Journals (Sweden)

    Magnavita Nicola

    2012-05-01

    Full Text Available Abstract Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form for reporting violent incidents, the DCS (demand/control/support model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

  13. E. coli O157 on Scottish cattle farms: Evidence of local spread and persistence using repeat cross-sectional data

    Science.gov (United States)

    2014-01-01

    Background Escherichia coli (E. coli) O157 is a virulent zoonotic strain of enterohaemorrhagic E. coli. In Scotland (1998-2008) the annual reported rate of human infection is 4.4 per 100,000 population which is consistently higher than other regions of the UK and abroad. Cattle are the primary reservoir. Thus understanding infection dynamics in cattle is paramount to reducing human infections. A large database was created for farms sampled in two cross-sectional surveys carried out in Scotland (1998 - 2004). A statistical model was generated to identify risk factors for the presence of E. coli O157 on farms. Specific hypotheses were tested regarding the presence of E. coli O157 on local farms and the farms previous status. Pulsed-field gel electrophoresis (PFGE) profiles were further examined to ascertain whether local spread or persistence of strains could be inferred. Results The presence of an E. coli O157 positive local farm (average distance: 5.96km) in the Highlands, North East and South West, farm size and the number of cattle moved onto the farm 8 weeks prior to sampling were significant risk factors for the presence of E. coli O157 on farms. Previous status of a farm was not a significant predictor of current status (p = 0.398). Farms within the same sampling cluster were significantly more likely to be the same PFGE type (p Scottish E. coli O157 paves the way for future research into the mechanisms of transmission which should help with the design of control measures to reduce E. coli O157 from livestock-related sources. PMID:24766709

  14. Impact on smoking of England's 2012 partial tobacco point of sale display ban: a repeated cross-sectional national study.

    Science.gov (United States)

    Kuipers, Mirte A G; Beard, Emma; Hitchman, Sara C; Brown, Jamie; Stronks, Karien; Kunst, Anton E; McNeill, Ann; West, Robert

    2017-03-01

    A partial tobacco point of sale (PoS) display ban was introduced in large shops (>280 m 2 floor area) in England on 6 April 2012. The aim of this study was to assess the medium-term effects of the partial tobacco PoS display ban on smoking in England. Data were used from 129 957 respondents participating in monthly, cross-sectional household surveys of representative samples of the English adult population aged 18+ years from January 2009 to February 2015. Interrupted-time series regression models assessed step changes in the level of current smoking and cigarette consumption in smokers and changes in the trends postban compared with preban. Models were adjusted for sociodemographic variables and e-cigarette use, seasonality and autocorrelation. Potential confounding by cigarette price was accounted for by time, as price was almost perfectly correlated with time. Following the display ban, there was no immediate step level change in smoking (-3.69% change, 95% CI -7.94 to 0.75, p=0.102) or in cigarette consumption (β -0.183, 95% CI -0.602 to 0.236). There was a significantly steeper decline in smoking post display ban (-0.46% change, 95% CI -0.72 to -0.20, p=0.001). This effect was demonstrated by respondents in manual occupations (-0.62% change, 95% CI -0.72 to -0.20, p=0.001), but not for those in non-manual occupations (-0.42, 95% CI -0.90 to 0.06, p=0.084). Cigarette consumption declined preban period (β -0.486, 95% CI -0.633 to -0.339, p<0.001), but no significant change in cigarette consumption trend was observed (β 0.019, 95% CI -0.006 to 0.042, p=0.131). The partial tobacco PoS display ban introduced in England in April 2012 did not lead to an immediate decline in smoking, but was followed by a decline in the trend of smoking prevalence that could not be accounted for by seasonal factors, e-cigarette use or price changes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sinéad M O'Neill

    Full Text Available OBJECTIVE: To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery. DESIGN: Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th 2011, using a detailed search-strategy and cross-checking of reference lists. STUDY SELECTION: Cohort, case-control and cross-sectional studies examining the association between previous caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality. DATA SYNTHESIS: 11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually. CONCLUSIONS: Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE, providing women the right to request a caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment

  16. THE IMPACT OF LAVENDER AROMATHERAPY ON PAIN INTENSITY AND BETA-ENDORPHIN LEVELS IN POST-CAESAREAN MOTHERS

    Directory of Open Access Journals (Sweden)

    Yohana Putri Apryanti

    2017-10-01

    Full Text Available Background: Caesarean section is one of the most common interventions to overcome labor complications. However, pain cannot be avoided after the surgery. Lavender aromatherapy is considered as one of non-pharmacological therapy to reduce pain and increase beta-endorphin levels. Objective: To examine the effect of lavender aromatherapy on the intensity of pain and beta-endorphin levels in post-caesarean mothers. Methods: This was a quasy-experimental study with pretest and posttest with control group at Sembiring Delitua General Hospital on December 2016 to February 2017. There were 40 samples selected using purposive sampling, with 20 samples assigned in the experiment and control group. Numerical Rating Scale (NRS was used to measure pain and ELIZA methods to measure beta-endorphin levels. Independent t-test and paired t-test were used for data analysis Results: Results of this study showed that there was a significant difference in the mean value of pain intensity levels (p=0.000 and beta-endorphin levels (p=0.023 between experiment and control group. Conclusion: There was a significant effect of lavender aromatherapy on the decrease of pain intensity and the increase of beta-endorphin hormone in post-caesarean mothers. It is expected that lavender aromatherapy can be used as an alternative treatment to reduce pain and increase beta-endorphin levels in post-caesarean mothers.

  17. The impact of a new McDonald's restaurant on eating behaviours and perceptions of local residents: A natural experiment using repeated cross-sectional data.

    Science.gov (United States)

    Thornton, Lukar E; Ball, Kylie; Lamb, Karen E; McCann, Jennifer; Parker, Kate; Crawford, David A

    2016-05-01

    Neighbourhood food environments are posited as an important determinant of eating behaviours; however causality is difficult to establish based on existing studies. Using a natural experiment study design (incorporating repeated cross-sectional data), we tested whether the development of a new McDonald's restaurant increased the frequency of consumption of McDonald's products amongst local residents in the suburbs of Tecoma (site of a new McDonald's restaurant development) and Monbulk (control site) in Victoria, Australia. Across both sites, the reported frequency of McDonald's consumption did not change during the follow-up surveys. In the context explored, the development of a new McDonald's restaurant has not resulted in an increased consumption of McDonald's products. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean.

    Science.gov (United States)

    Horey, Dell; Kealy, Michelle; Davey, Mary-Ann; Small, Rhonda; Crowther, Caroline A

    2013-07-30

    Pregnant women who have previously had a caesarean birth and who have no contraindication for vaginal birth after caesarean (VBAC) may need to decide whether to choose between a repeat caesarean birth or to commence labour with the intention of achieving a VBAC. Women need information about their options and interventions designed to support decision-making may be helpful. Decision support interventions can be implemented independently, or shared with health professionals during clinical encounters or used in mediated social encounters with others, such as telephone decision coaching services. Decision support interventions can include decision aids, one-on-one counselling, group information or support sessions and decision protocols or algorithms. This review considers any decision support intervention for pregnant women making birth choices after a previous caesarean birth. To examine the effectiveness of interventions to support decision-making about vaginal birth after a caesarean birth.Secondary objectives are to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013), Current Controlled Trials (22 July 2013), the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (22 July 2013) and reference lists of retrieved articles. We also conducted citation searches of included studies to identify possible concurrent qualitative studies. All published, unpublished, and ongoing randomised controlled trials (RCTs) and quasi-randomised trials with reported data of any intervention designed to support pregnant women who have previously had a caesarean birth make decisions about their options for birth. Studies using a cluster-randomised design were eligible for inclusion but none were identified. Studies using a cross-over design were not eligible for inclusion. Studies published in abstract form

  19. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births

    Directory of Open Access Journals (Sweden)

    Khajehei M

    2009-01-01

    Full Text Available Background and Objective: We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births. Materials and Methods: This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum. Results: The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi group was 40 days and in the caesarean section (C/S group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%, sexual dissatisfaction (65%, and vaginal looseness (55%. In the C/S group, the most common problems were vaginal dryness (85%, sexual dissatisfaction (60%, and decreased libido (35%. There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant. Conclusion: Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women′s sexual life and try to improve their quality of life after delivery.

  20. National Rates of Uterine Rupture are not Associated with Rates of Previous Caesarean Delivery

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Langhoff-Roos, Jens; Jakobsson, Maija

    2017-01-01

    % of all Nordic deliveries. Information on the comparison population was retrieved from the national medical birth registers. Incidence rate ratios by previous caesarean delivery and intended mode of delivery after caesarean were modelled using Poisson regression. RESULTS: The incidence of uterine rupture......BACKGROUND: Previous caesarean delivery and intended mode of delivery after caesarean are well-known individual risk factors for uterine rupture. We examined if different national rates of uterine rupture are associated with differences in national rates of previous caesarean delivery and intended...... was 7.8/10 000 in Finland and 4.6/10 000 in Denmark. Rates of caesarean (21.3%) and previous caesarean deliveries (11.5%) were highest in Denmark, while the rate of intended vaginal delivery after caesarean was highest in Finland (72%). National rates of uterine rupture were not associated...

  1. Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey.

    Science.gov (United States)

    Poortinga, Wouter; Jones, Nikki; Lannon, Simon; Jenkins, Huw

    2017-12-02

    While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design. A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition. The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health. The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific

  2. Operationsteknikker ved 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 of evi...

  3. Are Changes in Neighbourhood Perceptions Associated with Changes in Self-Rated Mental Health in Adults? A 13-Year Repeat Cross-Sectional Study, UK

    Directory of Open Access Journals (Sweden)

    Jonathan R. Olsen

    2017-11-01

    Full Text Available The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480 living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS. A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI 0.01 to 0.07 and anxiety (0.04, 95% CI 0.00 to 0.08 scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.

  4. Short-Term Changes in Anemia and Malaria Parasite Prevalence in Children under 5 Years during One Year of Repeated Cross-Sectional Surveys in Rural Malawi

    Science.gov (United States)

    Kabaghe, Alinune N.; Chipeta, Michael G.; Terlouw, Dianne J.; McCann, Robert S.; van Vugt, Michèle; Grobusch, Martin P.; Takken, Willem; Phiri, Kamija S.

    2017-01-01

    Abstract. In stable transmission areas, malaria is the leading cause of anemia in children. Anemia in children is proposed as an added sensitive indicator for community changes in malaria prevalence. We report short-term temporal variations of malaria and anemia prevalence in rural Malawian children. Data from five repeated cross-sectional surveys conducted over 1 year in rural communities in Chikwawa District, Malawi, were analyzed. Different households were sampled per survey; all children, 6–59 months, in sampled household were tested for malaria parasitemia and hemoglobin levels using malaria rapid diagnostic tests (mRDT) and Hemocue 301, respectively. Malaria symptoms, recent treatment (2 weeks) for malaria, anthropometric measurements, and sociodemographic details were recorded. In total, 894 children were included from 1,377 households. The prevalences of mRDT positive and anemia (Hb anemia and parasite prevalence varied differently. Overall, unadjusted and adjusted relative risks of anemia in mRDT-positive children were 1.31 (95% CI: 1.09–1.57) and 1.36 (1.13–1.63), respectively. Changes in anemia prevalence differed with short-term changes in malaria prevalence, although malaria is an important factor in anemia. PMID:28820717

  5. Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007

    Science.gov (United States)

    Jones-Smith, Jessica C.; Gordon-Larsen, Penny; Siddiqi, Arjumand; Popkin, Barry M.

    2011-01-01

    Chronic diseases are now among the leading causes of morbidity and mortality in lower income countries. Although traditionally related to higher individual socioeconomic status (SES) in these contexts, the associations between SES and chronic disease may be actively changing. Furthermore, country-level contextual factors, such as economic development and income inequality, may influence the distribution of chronic disease by SES as well as how this distribution has changed over time. Using overweight status as a health indicator, the authors studied repeated cross-sectional data from women aged 18–49 years in 37 developing countries to assess within-country trends in overweight inequalities by SES between 1989 and 2007 (n = 405,550). Meta-regression was used to examine the associations between gross domestic product and disproportionate increases in overweight prevalence by SES, with additional testing for modification by country-level income inequality. In 27 of 37 countries, higher SES (vs. lower) was associated with higher gains in overweight prevalence; in the remaining 10 countries, lower SES (vs. higher) was associated with higher gains in overweight prevalence. Gross domestic product was positively related to faster increase in overweight prevalence among the lower wealth groups. Among countries with a higher gross domestic product, lower income inequality was associated with faster overweight growth among the poor. PMID:21300855

  6. Cross-national comparisons of time trends in overweight inequality by socioeconomic status among women using repeated cross-sectional surveys from 37 developing countries, 1989-2007.

    Science.gov (United States)

    Jones-Smith, Jessica C; Gordon-Larsen, Penny; Siddiqi, Arjumand; Popkin, Barry M

    2011-03-15

    Chronic diseases are now among the leading causes of morbidity and mortality in lower income countries. Although traditionally related to higher individual socioeconomic status (SES) in these contexts, the associations between SES and chronic disease may be actively changing. Furthermore, country-level contextual factors, such as economic development and income inequality, may influence the distribution of chronic disease by SES as well as how this distribution has changed over time. Using overweight status as a health indicator, the authors studied repeated cross-sectional data from women aged 18-49 years in 37 developing countries to assess within-country trends in overweight inequalities by SES between 1989 and 2007 (n=405,550). Meta-regression was used to examine the associations between gross domestic product and disproportionate increases in overweight prevalence by SES, with additional testing for modification by country-level income inequality. In 27 of 37 countries, higher SES (vs. lower) was associated with higher gains in overweight prevalence; in the remaining 10 countries, lower SES (vs. higher) was associated with higher gains in overweight prevalence. Gross domestic product was positively related to faster increase in overweight prevalence among the lower wealth groups. Among countries with a higher gross domestic product, lower income inequality was associated with faster overweight growth among the poor. © The Author 2011. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.

  7. [Repeated cross-sectional studies on urinary iodine and iodine content of salt among school-aged children from 2012 to 2014 in Yuhuan County, Zhejiang Province].

    Science.gov (United States)

    Su, Meifang; Wang, Congyun; Li, Songtao; Ying, Xuhua; Zhao, Qi; Fu, Chaowei; Jiang, Qingwu

    2016-01-01

    To investigate the iodine status and its change among school-aged children in their morning urine and eating salt from 2012 to 2014 in Yuhuan County, Zhejiang Province, China. Three repeated cross-sectional studies were carried out at a same primary school in 2012, 2013 and 2014, respectively. Three classes were randomly selected from each of 3 to 5 grade by the cluster-stratified sampling every year. Totally, 1343 out of 1350 eligible children aged 8 to 10 years old were involved into this study. Their morning urine and salt eating at home were collected and tested. The overall median of urine iodine was 116.0 μg/L, and no significant change was found over year. The overall proportions of subjects with urine iodine iodine from 1343 salt samples was 0.0 mg/kg and no year difference was statistically observed. The proportions of subjects consumed iodized salt significantly decreased from 25.1% in 2012 to 21.8% in 2013 and to 14.2% in 2014. There was a significant difference in urine iodine between subjects taken iodized salt or not and also a weak positive correlation between salt iodine and urine iodine. The nutritional status of iodine is overall stable, proper and safety in recent 3 years among school children in Yuhuan County. The coverage rate of iodized salt is very low.

  8. The HysNiche trial: hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial

    NARCIS (Netherlands)

    Vervoort, A. J. M. W.; van der Voet, L. F.; Witmer, M.; Thurkow, A. L.; Radder, C. M.; van Kesteren, P. J. M.; Quartero, H. W. P.; Kuchenbecker, W. K. H.; Bongers, M. Y.; Geomini, P. M. A. J.; de Vleeschouwer, L. H. M.; van Hooff, M. H. A.; van Vliet, H. A. A. M.; Veersema, S.; Renes, W. B.; van Meurs, H. S.; Bosmans, J.; Oude Rengerink, K.; Brölmann, H. A. M.; Mol, B. W. J.; Huirne, J. A. F.

    2015-01-01

    A caesarean section (CS) can cause a defect or disruption of the myometrium at the site of the uterine scar, called a niche. In recent years, an association between a niche and postmenstrual spotting after a CS has been demonstrated. Hysteroscopic resection of these niches is thought to reduce

  9. ROLE OF 400 MCG INTRAOPERATIVE SUBLINGUAL MISOPROSTOL FOR REDUCTION OF CAESAREAN BLOOD LOSS

    Directory of Open Access Journals (Sweden)

    Lalmohan Nayak

    2017-02-01

    Full Text Available BACKGROUND Lower segment caesarean section is a common surgical procedure. Postpartum haemorrhage incidence after LSCS is 4%. Misoprostol is a prostaglandin E1 analogue with good uterotonic properties, easy availability, low cost, thermostability, long shelf life, easy administration and few adverse effects at therapeutic dose. It is readily absorbed by oral, sublingual, buccal, vaginal or rectal route. Sublingual route attains quickest concentration. Dose of 400 mcg was chosen in this study to minimise adverse effects with optimal therapeutic benefit. The aim of the study is to determine the efficacy of sublingual misoprostol in reducing caesarean blood loss. MATERIALS AND METHODS It is a prospective experimental study done in VSSIMSAR, Burla. Women undergoing LSCS were randomly assigned to study and control groups of equal strength of 100 each. In all cases, preoperative Hb%, haematocrit, pulse, BP was noted. Study group were given 400 mcg misoprostol at the time of cord clamping. In control group, nothing was given. In all patients, active management of third stage of labour was done by using oxytocin 10 IU (IV along with uterine massage. Blood loss soaked by tetra was calculated using formula, blood loss = wet weight-dry weight/1.05 (1.05 is constant. Amount of blood loss, postoperative Hb%, haematocrit, pulse rate, BP was noted in both groups and compared. BP and pulse were noted after 1 hour and Hb%, haematocrit were noted after 24 hours. RESULTS Study group showed significant decrease in total blood loss (around 117.9 mL as compared to control group. There was significant decrease in the postoperative fall in Hb in the study group as compared to control, the mean difference being 0.631 gm%. Study group also showed decrease in postoperative fall in haematocrit as compared to control, the mean difference being 0.055. CONCLUSION Misoprostol significantly reduced caesarean blood loss and doesn’t affect foetal outcome without significant

  10. Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

    Science.gov (United States)

    Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

    2016-10-01

    Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

  11. The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice.

    Science.gov (United States)

    Oladapo, O T; Sotunsa, J O; Sule-Odu, A O

    2004-06-01

    A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.

  12. Medida da espessura do segmento uterino inferior em gestantes com cesárea prévia: análise da reprodutibilidade intra- e interobservador por ultra-sonografia bi- e tridimensional Lower uterine segment thickness measurement in pregnant women with previous caesarean section: intra- and interobserver reliability analysis using bi- and tridimensional ultrasonography

    Directory of Open Access Journals (Sweden)

    Daniela de Abreu Barra

    2008-03-01

    interferir na conduta do obstetra ou antecipar o parto, foi feito por medidas bidimensionais abdominais da espessura total.PURPOSE: to compare the intra and interobserver reproducibility of the total thickness measurement of the inferior uterine segment (IUS, through the abdominal route, and of the muscle layer measurement, through the vaginal route, using bi and tridimensional ultrasonography. METHODS: the IUS thickness measurement of 30 women, between the 36th and 39th weeks of gestation with previous caesarean section, done by two observers, was studied. Abdominal ultrasonography with the patient in both supine and lithotomy position was performed. In the sagittal section, the IUS was identified and four bidimensional images and two tridimensional blocks of the total thickness were collected through the abdominal route, and the same for the muscle layer, through the vaginal route. Tridimensional acquisitions were manipulated in the multiplanar mode. The time was measured with a chronometer. Reproducibility was evaluated by the computation of the absolute difference between measurements, the ratio of differences smaller than 1 mm, the intraclass coefficient (ICC, and the Bland and Altman's concordance limits. RESULTS: the average bidimensional measurement of IUS thickness was 7.4 mm through the abdominal and 2.7 mm through the vaginal route, and the tridimensional measurement was 6.9 mm through the abdominal and 5.1 mm through the vaginal route. Intra- and interobserver reproducibility of vaginal versus abdominal route: smaller absolute difference (0.2-0.4 mm versus 0.8-1.5 mm, greater ratio of differences (85.8-97.8% versus 48.7-72,8%, with p0.05[A1] and similar lower concordance limits (-38 to 3.4 versus -3.6 to 4 mm for tridimensional ultrasonography and ICC (0.6-0.9 versus 0.7-0.9. CONCLUSIONS: from the above, we came to the conclusion that the measurement of the IUS muscle layer, through the vaginal route using tridimensional ultrasonography is more reproducible

  13. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia.

    Science.gov (United States)

    Tan, Terry T; Teoh, Wendy H L; Woo, David C M; Ocampo, Cecilia E; Shah, Mukesh K; Sia, Alex T H

    2012-02-01

    Previous studies examining the efficacy of transversus abdominis plane block after caesarean section have mostly been in parturients under spinal anaesthesia. We postulated that the advantage of performing transversus abdominis plane block after caesarean section might be even more obvious after general anaesthesia, resulting in reduced 24-h consumption of morphine. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: In this single centre, randomised double-blind controlled trial, 40 women who underwent caesarean delivery under general anaesthesia were allocated randomly to receive a transversus abdominis plane block or no block. In those who received the block, 20 ml of levobupivacaine 2.5 mg ml was deposited bilaterally into the transversus abdominis plane under ultrasound guidance using a Sonosite Titan (SonoSite, Bothell, Washington, USA) 7-13 MHz linear transducer at the end of surgery when the patient was still anaesthetised. We recorded patient-controlled intravenous morphine use for 24 h, pain scores at rest and activity, sedation, nausea and vomiting, use of antiemetic medication and overall maternal satisfaction. The primary outcome was 24-h morphine consumption. Patients who received the transversus abdominis plane block used significantly less morphine in 24 h than those in the control group [12.3 (2.6) vs. 31.4 mg (3.1), Pplane block reduced morphine consumption following caesarean section under general anaesthesia, with increased maternal satisfaction.

  14. Changes over time in population level transport satisfaction and mode of travel: A 13 year repeat cross-sectional study, UK.

    Science.gov (United States)

    Olsen, Jonathan R; Macdonald, Laura; Ellaway, Anne

    2017-09-01

    The aim of the study was to examine changes over time in satisfaction with usual transport mode, explore individual and area level characteristics as mediators in the likelihood of transport satisfaction, and whether any changes in transport satisfaction varied by these factors over time. Adults from West Central Scotland, United Kingdom, who participated at both waves of the repeat cross-sectional 'Transport, Health and Well-being Study' conducted in 1997 (n=2735) and 2010 (n=2024) were assessed. Individuals completed a detailed postal questionnaire at both time points including self-rated satisfaction with usual transport mode (using a seven point scale subsequently dichotomised to a binary outcome of satisfied (1-2) and other (3-7)). Participants reported usual transport mode for travel to various destinations. A multilevel logistic regression model was used and individuals were nested within areas (c. 4000 population). At the 2010 sweep, two thirds (n=1345) of individuals were satisfied with their transport choice. Those with fair/poor health were less satisfied with their usual transport compared to those in better health (Odds Ratio (OR) 0.49, ptravelled by public transport (OR 2.39, p=0.005) and using multiple modes (OR 2.19, ptravelled by car. The proportion of those who travelled using public transport, active modes or by multiple mode increased journey satisfaction over time at a greater rate than those who travelled by car, highlighting that continued efforts should be made to promote these more active transport modes which have potential to impact on health.

  15. Trends in non-help-seeking for mental disorders in Germany between 1997-1999 and 2009-2012: a repeated cross-sectional study.

    Science.gov (United States)

    Brandstetter, Susanne; Dodoo-Schittko, Frank; Speerforck, Sven; Apfelbacher, Christian; Grabe, Hans-Jörgen; Jacobi, Frank; Hapke, Ulfert; Schomerus, Georg; Baumeister, Sebastian E

    2017-08-01

    This study sought to examine trends in non-help-seeking for mental disorders among persons with a prevalent mental disorder (12-month prevalence) in Germany between 1997-1999 and 2009-2012. We examined data from 1909 persons aged 18-65 years who participated in two independent, repeated cross-sectional surveys (German National Interview and Examination Study 1997-1999, German Health Interview and Examination Survey for Adults 2009-2012) conducted 12 years apart. Prevalent mental disorders (12-month prevalence) were determined using the Composite International Diagnostic Interview, which included information on lifetime help-seeking for mental health problems. Correlates of self-reported help-seeking were analyzed according to Andersen's Behavioral Model. Multivariable Poisson regression models were used to assess time trends in the directly standardized and model-adjusted prevalence of non-help-seeking across strata of socio-economic and clinical variables. The proportion of people with a prevalent mental disorder who have never sought help in their lifetime decreased significantly from 62% (95% CI 58.7-64.7) to 57% (95% CI 52.2-60.9) between 1997-1999 and 2009-2012 in adults aged 18-65 years in Germany. Downward trends in non-help-seeking occurred in all investigated strata and reached statistical significance in women, in people who were living alone, people with medium educational level, people living in middle-sized communities, people with non-statutory health insurance, smokers, and people with co-existing somatic conditions. Despite a downward trend over the course of 12 years, a large proportion of people suffering from mental disorders are still not seeking treatment in Germany. Further efforts to increase uptake of help-seeking for mental disorders in hard-to-reach groups are warranted to continue this trend.

  16. Impact of the 2008 global financial crisis on the health of Canadians: repeated cross-sectional analysis of the Canadian Community Health Survey, 2007-2013.

    Science.gov (United States)

    Nour, Sabrina; Labonté, Ronald; Bancej, Christina

    2017-04-01

    Despite a clear impact on the Canadian economy, little is known about the subsequent health impacts of the 2008 global financial crisis (GFC) in this country. This study fills this gap in knowledge by conducting a repeated cross-sectional analysis of the Canadian Community Health Survey (CCHS). Data from 7 cycles (2007-2013) of the CCHS were combined to form a large data set representative of the Canadian working-age population (15-64 years) residing in 1 of 10 provinces. A logistic regression model was used to determine whether exposure to various periods of the GFC resulted in increased odds of reporting poor mental health. Exposure was categorised into 4 periods based on political and economic indicators, as follows: precrisis period (baseline), initial crisis period, stimulus period and austerity period. Other outcomes investigated included: anxiety disorders (AD), mood disorders (MD), poor physical health and health-related behaviours (heavy alcohol drinking (HAD) and decreased fruit/vegetable consumption (FVC)). A significant increased odds of reporting poor mental health was observed during the austerity period compared with the precrisis period (OR=1.26 (1.16 to 1.32)); findings remain significant when adjusted for sex, marital status and education. Exposure to the austerity period was also significantly associated with increased odds of reporting AD, MD, HAD and decreased odds of FVC. No significant associations were observed for the poor self-perceived physical health variable. Statistically significant associations were observed between several negative health outcomes and the austerity period when compared with the precrisis period. Austerity has been linked to worsening health in other studies and represents an example of how the policy response can have greater detrimental impact on health than the financial crisis itself. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  17. Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey.

    Science.gov (United States)

    Johansen, Ingrid Hjulstad; Baste, Valborg; Rosta, Judith; Aasland, Olaf G; Morken, Tone

    2017-08-11

    The aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades. Repeated cross-sectional survey. All healthcare levels and medical specialties in Norway. Representative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158). Relative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty. There were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95). A substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors' education and within work settings. © 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.

  18. Association between secondhand smoke exposure at home and cigarette gifting and sharing in Zhejiang, China: a repeat cross-sectional study.

    Science.gov (United States)

    Xu, Yue; Xu, ShuiYang; Wu, QingQing; Guo, YuJie

    2016-03-03

    The aims of the current study were to assess the prevalence of household cigarette gifting and sharing, and to evaluate the relationship between secondhand smoke (SHS) exposure, and cigarette gifting and sharing, in Zhejiang, China. A repeat cross-sectional design. 10 sites in 5 cities in Zhejiang, China. Two surveys were conducted with adults in Zhejiang, China, in 2010 (N=2112) and 2012 (N=2279), respectively. At both waves, the same questionnaire was used; respondents were asked questions on residence, number of family smokers, indoor smoking rules, household income and cigarette gifting and sharing. The findings revealed that more than half of respondents' families (54.50% in 2010, 52.79% in 2012) reported exposure to SHS. Many families (54.73% in 2010, 47.04% in 2012) shared cigarettes with others, and a minority (14.91% in 2010, 14.17% in 2012) reported their family giving cigarettes as a gift. There was a significant decrease in cigarette sharing from 2010 to 2012, irrespective of household with SHS exposure status; and the cigarette gifting was significantly decreased in household without SHS exposure. Compared to households without SHS exposure, the prevalence of cigarette gifting and sharing in households with SHS exposure was more obvious. Encouraging and promoting a smoke-free household environment is necessary to change public smoking customs in Zhejiang, China. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Qinghua, E-mail: qh-wu77@163.com [The First Affiliated Hospital of Zhengzhou University, Departments of Prenatal Diagnosis, and Obstetrics, Obstetric Critical Treatment Center of Henan Province (China); Liu, Zhuan, E-mail: liuchuan2015ck@163.com; Zhao, Xianlan, E-mail: zxl121292014@163.com; Liu, Cai, E-mail: liucai2015ck@163.com [The First Affiliated Hospital of Zhengzhou University, Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics (China); Wang, Yanli, E-mail: wangyanli2015yfy@163.com; Chu, Qinjun, E-mail: chuqinjun2015@163.com [The First Affiliated Hospital of Zhengzhou University, Department of Anesthesiology (China); Wang, Xiaojuan, E-mail: wangxiaojun2015ck@163.com; Chen, Zhimin, E-mail: chenzhimin2015ck@163.com [The First Affiliated Hospital of Zhengzhou University, Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics (China)

    2016-11-15

    PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.

  20. Employment status and mental health care use in times of economic contraction: a repeated cross-sectional study in Europe, using a three-level model.

    Science.gov (United States)

    Buffel, Veerle; van de Straat, Vera; Bracke, Piet

    2015-03-11

    Framed within the recent economic crisis, in this study we investigate the medical mental health care use of the unemployed compared with that of the employed in Europe, and whether the relationship between employment status and mental health care use varies across macro-economic conditions. We examine whether the macro-economic context and changes therein are related to mental health care use, via their impact on mental health, or more directly, irrespective of mental health. We use data from three waves of the Eurobarometer (2002, 2005/2006, and 2010), which has a repeated cross-sectional and cross-national design. Linear and logistic multilevel regression analyses are performed with mental health, contacting a general practitioner, and contacting a psychiatrist for mental health problems as dependent variables. The multilevel design has three levels (the individual, the period-country, and the country), which allows us to estimate both longitudinal and cross-sectional macro-effects. The macro-economic context and changes therein are assessed using national unemployment rates and growth rates in Gross Domestic Product (GDP). The mean unemployment rate is negatively related to mental health, although for women, this effect only applies to the employed. Among women, no relationship is found between changes in the macro-economic context and mental health. The unemployment rate, and changes in both the unemployment rate and the real GDP growth rate, are associated with men's care use, regardless of their mental health, whereas this does not hold for women. In countries with an increase in the unemployment rate, both unemployed and employed men tend to medicalize their problems more by contacting a general practitioner, irrespective of their mental health, while the likelihood of contacting a psychiatrist is lower among employed men. Our findings stress the importance of taking the macro-economic context and changes therein into account when studying the mental health

  1. Deployment Repeatability

    Science.gov (United States)

    2016-04-01

    evaluating the deployment repeatability builds upon the testing or analysis of deployment kinematics (Chapter 6) and adds repetition. Introduction...material yield or failure during a test. For the purposes of this chapter, zero shift will refer to permanent changes in the structure, while reversible ...the content of other chapters in this book: Gravity Compensation (Chapter 4) and Deployment Kinematics and Dynamics (Chapter 6). Repeating the

  2. Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study.

    Science.gov (United States)

    Sengupta, Kaushik; Christensen, Lisa Bøge; Mortensen, Laust Hvas; Skovgaard, Lene Theil; Andersen, Ingelise

    2017-10-01

    Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail. To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013. Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates. Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate showed statistically significant graded

  3. Socio-economic differences in self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Talala Kirsi M

    2012-08-01

    Full Text Available Abstract Background Over the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland. Methods The data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK, from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%. Outcome measures were single questions of self-reported insomnia and stress. Results The overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002. Conclusions Self-reported insomnia and stress were more common during later study periods. The

  4. Frequency of the C9orf72 hexanucleotide repeat expansion in patients with amyotrophic lateral sclerosis and frontotemporal dementia: A cross-sectional study

    NARCIS (Netherlands)

    E. Majounie (Elisa); A. Renton (Alan); K. Mok (Kin); E.G.P. Dopper (Elise); A. Waite (Adrian); S. Rollinson (Sara); A. Chiò (Adriano); G. Restagno (Gabriella); N. Nicolaou (Nayia); J. Simón-Sánchez (Javier); J.C. van Swieten (John); Y. Abramzon (Yevgeniya); J. Johnson (Janel); M. Sendtner (Michael); R. Pamphlett (Roger); R. Orrell (Richard); S. Mead (Simon); K.C. Sidle (Katie); H. Houlden (Henry); J.D. Rohrer (Jonathan Daniel); K.E. Morrison (Karen); H. Pall (Hardev); D. Talbot; O. Ansorge (Olaf); D.G. Hernandez (Dena); S. Arepalli (Sampath); M. Sabatelli (Mario); G. Mora (Gabriele); J.C. Corbo (Joseph); F. Giannini (Fabio); A. Calvo (Andrea); E. Englund (Elisabet); G. Borghero (Giuseppe); O.A.M. Floris; A. Remes (Anne); H. Laaksovirta (Hannu); L. McCluskey (Leo); J.Q. Trojanowski (John); V.M. Deerlin (Vivianna); G.D. Schellenberg (Gerard); M.A. Nalls (Michael); V.E. Drory (Vivian E); C.S. Lu (Chin-Song); T.-H. Yeh (Tu-Hsueh); H. Ishiura (Hiroyuki); Y. Takahashi (Yukari); S. Tsuji (Shoji); I. Le Ber (Isabelle); A. Brice; C. Drepper (Carsten); N. Williams (Nigel); J. Kirby (Janine); P.J. Shaw (Pamela); J. Hardy (John); P.J. Tienari (Pentti); P. Heutink (Peter); H. Morris (Huw); S. Pickering-Brown (Stuart); B.J. Traynor (Bryan)

    2012-01-01

    textabstractBackground: We aimed to accurately estimate the frequency of a hexanucleotide repeat expansion in C9orf72 that has been associated with a large proportion of cases of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Methods: We screened 4448 patients diagnosed with

  5. Frequency of the C9orf72 hexanucleotide repeat expansion in patients with amyotrophic lateral sclerosis and frontotemporal dementia: a cross-sectional study

    NARCIS (Netherlands)

    Majounie, E.; Renton, A.E.; Mok, K.; Dopper, E.G.P.; Waite, A.; Rollinson, S.; Chio, A.; Restagno, G.; Nicolaou, N.; Simon-Sanchez, J.; van Swieten, J.C.; Abramzon, Y.; Johnson, J.O.; Sendtner, M.; Pamphlett, R.; Orrell, R.W.; Mead, S.; Sidle, K.C.; Houlden, H.; Rohrer, J.D.; Morrison, K.E.; Pall, H.; Talbot, K.; Ansorge, O.; Hernandez, D.G.; Arepalli, S.; Sabatelli, M.; Mora, G.; Corbo, M.; Giannini, F.; Calvo, A.; Englund, E.; Borghero, G.; Foris, G.L.; Remes, A.M.; Laaksovirta, H.; McCluskey, L.; Trojanowski, J.Q.; Van Deerlin, V.M.; Schellenberg, G.D.; Nalls, M.A.; Drory, V.E.; Lu, C.S.; Yeh, T.H.; Ishiura, H.; Takahashi, Y.; Tsuji, S.; Le Ber, I.; Brice, A.; Drepper, C.; Williams, N.; Kirby, J.; Shaw, P.; Hardy, J.; Tienari, P.J.; Heutink, P.; Morris, H.R.; Pickering-Brown, S.; Traynor, B.J.

    2012-01-01

    Background: We aimed to accurately estimate the frequency of a hexanucleotide repeat expansion in C9orf72 that has been associated with a large proportion of cases of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Methods: We screened 4448 patients diagnosed with ALS (El